The Specialist GP
Produced by Louise Kuegler
Recent Episode Log Feed
Perfectionism in medicine w Dr Sandra Splig
Perfectionism is common in medicine, where high standards, conscientiousness and a strong commitment to patients are valued. But when striving for excellence becomes an unrelenting need to get everything right, it can affect wellbeing, clinical practice and the ability to switch off.Dr Louise Kuegler is joined by Dr Sandra Spilg, Specialist GP, coach, mentor and professional supervisor, to explore why perfectionism is so common in medicine, how to recognise when it becomes unhelpful, and the impact it can have on clinicians and patients.Using the case of Sarah, a highly regarded GP who struggles with checking, uncertainty and feeling that she is never quite good enough, they discuss perfectionism, burnout, anxiety, imposter syndrome and the challenge of accepting uncertainty in clinical practice.Listeners will also hear practical strategies for maintaining high professional standards without sacrificing wellbeing, and the role of colleagues, supervision and workplace culture in supporting change.Practical Clinical pearls:Perfectionism is not the same as excellence. Excellence aims for high-quality care while recognising that uncertainty and human fallibility are part of medicine.Self-critical perfectionism is associated with burnout, anxiety and emotional exhaustion.Excessive checking, over-documentation and difficulty tolerating uncertainty may reduce efficiency without improving patient safety.High-quality care requires good judgement, not flawless performance.Self-compassion is not lowering standards, it is a skill that helps clinicians remain effective, resilient and safe throughout their careers.The goal is not to become a less conscientious doctor, today we have learnt thatcoaching and peer support can help calibrate and maintain a sustainable career.Bio:Dr Sandra Spilg is a Specialist GP, coach, mentor and professional supervisor with over 30 years' experience in general practice in Scotland and Aotearoa New Zealand. She co-founded Script for Change, supporting doctors to navigate burnout, perfectionism, career transitions and the challenges of medical practice through coaching, mentoring and professional supervision.Website: https://www.scriptforchange.co.nzResources:Shirai N, Koven S, Schwartz AW. “Oh I suppose I should”: a poem on the pressures of perfectionism in medicine. J Gen Intern Med. 2024;39:3091-3092. doi:10.1007/s11606-024-08863-y.Rallis KS, Wang YA, Barton J. Defining success in medicine: why perfectionism is not the answer. Postgrad Med J. 2022;98(Suppl 3):e181-e182.Martin SR, Fortier MA, Heyming TW, Ahn K, Nichols W, Golden C, et al. Perfectionism as a predictor of physician burnout. J Clin Psychol Med Settings. 2020;27(4):730-741. doi:10.1007/s10880-019-09675-6.Listen here:
Diagnostic overshadowing w Dr Cheryl Buhay
People living with mental illness or substance use challenges experience significant inequities in physical health outcomes, with physical illness often diagnosed later or overlooked altogether. Diagnostic overshadowing where symptoms are attributed to an existing mental health, substance use, disability or a chronic health condition rather than investigated fully remains a major issue in healthcare. In Aotearoa New Zealand, this inequity is even more pronounced for Māori, where the impacts of stigma, racism, mistrust, and fragmented care intersect. In this episode, we explore why this happens, how it affects patients, and what clinicians can do differently.Practical clinical pearls:Individually: build a habit of asking “What else could this be?”. Make it a habit to perform a focused physical examination and consider basic investigations even when symptoms seem to fit with the known psychiatric diagnosis. This simple cognitive forcing strategy can interrupt premature closure and implicit bias.System‑level: implement integrated care models where physical and mental healthcare are delivered together with shared records and coordinated plans. Integrated care models have been shown to improve physical health outcomes for people with serious mental illness, reduce fragmentation, and ensure that physical symptoms receive appropriate attention regardless of psychiatric comorbidityFor Māori, this means developing and funding culturally safe, Māori‑led services that integrate physical and mental healthcare, address the social determinants of health, and build trust through culturally aligned care delivery. This requires genuine partnership with Māori communities, addressing institutional racism, and ensuring adequate resourcing for Māori health services.Resources:Buhay C. Overlooked. The Horizon. Published September 16, 2025. Accessed May 18, 2026.Lazris A, Roth A. Diagnostic overshadowing: when cognitive biases can harm patients. American Family Physician. 2023;108(3):292-294.Iezzoni LI. Dangers of diagnostic overshadowing. New England Journal of Medicine. 2019;380(22):2092-2093. doi:10.1056/NEJMp1903078.Shefer G, Henderson C, Howard LM, Murray J, Thornicroft G. Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms: a qualitative study. PLoS ONE. 2014;9(11):e111682. doi:10.1371/journal.pone.0111682.Additional References:Hallyburton A, Allison-Jones L. Mental health bias in physical care: An integrative review of the literature. Journal of Psychiatric and Mental Health Nursing. 2023.Tosh G, Clifton AV, Xia J, White MM. Physical Health Care Monitoring for People With Serious Mental Illness. The Cochrane Database of Systematic Reviews. 2014.Hall WJ, Chapman MV, Lee KM, et al. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health. 2015.Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A Decade of Studying Implicit Racial/Ethnic Bias in Healthcare Providers Using the Implicit Association Test. Social Science & Medicine. 2018.Friedemann Smith C, Lunn H, Wong G, Nicholson BD. Optimising GPs' Communication of Advice to Facilitate Patients' Self-Care and Prompt Follow-Up When the Diagnosis Is Uncertain: A Realist Review of 'Safety-Netting' in Primary Care. BMJ Quality & Safety. 2022.Goetz CJ, Mushquash CJ, Maranzan KA. An Integrative Review of Barriers and Facilitators Associated With Mental Health Help Seeking Among Indigenous Populations. Psychiatric Services. 2023.Russell J, Boswell L, Ip A, et al. How Is Diagnostic Uncertainty Communicated and Managed in Real World Primary Care Settings?. BMC Primary Care. 2024.About Dr Cheryl Buhay:Cheryl is an adult psychiatrist with Takanga A Fohe Pacific Mental Health and Addictions Service within Health New Zealand Te Whatu Ora Waitematā. Prior to this she was a Clinical Director within the non-government organisation sector providing mental health and addiction support to communities across the country, and several years a Primary Care Liaison psychiatrist for Health New Zealand working closely with General Practitioners and their teams. She is the Chair for the NRPTP Vocational Training Committee for Psychiatry and an Honorary Senior Lecturer with the University of Auckland.Listen here:https://open.spotify.com/episode/0qrYj2lLuxrTEszZW3Hzro?si=f789f964a93f43fe
Kindness, supervision + leadership w Dr Nicki Macklin
Kindness at work is not the same as being nice.In this special one-year anniversary episode of The Specialist GP, we welcome back the podcast’s very first guest, Dr Nicki Macklin, to explore kindness in healthcare, leadership and the supervisor–supervisee relationship.We explore what kindness really looks like when we are busy, under pressure and responsible for supporting other people’s learning and development.We discuss the difference between kindness and niceness, why trust needs to come before difficult conversations, and how we can use coaching, feedback and early intervention to support people while maintaining standards.We also challenge the idea that kindness is simply an individual quality, and consider how we can build kindness into the way our workplaces and organisations are designed.A practical conversation about supervision, leadership, feedback and creating workplaces where people can learn, speak up and do their best work.Practical clinical pearls.First, kindness is not the same as niceness. Sometimes the kindest thing we can do is have the difficult conversation, set a boundary or give honest feedback.Second, kindness is something we build into our systems. Protected supervision time, clear expectations and regular check-ins create the structure for people to do well.Third, trust is built before it is needed. The small, everyday interactions are what make difficult conversations safer when they eventually need to happen.Fourth, silence is not neutral. Avoiding a difficult conversation may feel easier in the moment, but it can leave people anxious, prevent learning and allow problems to continue.Fifth, different situations need different conversations. Coaching, feedback and intervention are not the same thing, and knowing which one is needed is an important part of good supervision.Sixth, directness can be kinder than vague reassurance. Be specific about what happened, the impact it had and what needs to happen next.Lastly, Good supervision is a shared system responsibility. Power matters in supervision. The person with less power should not be expected to carry the burden of fixing a poor supervisory relationship. Supervisors and organisations have a responsibility to create safe, supportive and accountable supervision.If the relationship is not working, seek support outside the immediate supervisory relationship. A professional mentor, another supervisor or a trusted peer can help you work out what is happening, consider your options and decide how best to move forward.Resources:· Macklin N, Lee TH, Edmondson AC. Why kindness isn’t a nice to have. Harvard Business Review. 2025 Jul 29.· Macklin N, Rapana N, Wilkinson-Meyers L, Dowell A. He Aroha Whakatō, He Aroha Puta Mai. Embedding kindness in organisational practice: lessons from a kaupapa Māori primary care team. Kōtuitui. 2026;21(3). doi:10.1002/kot2.70056.· Macklin N, Wilkinson-Meyers L, Dowell A. Defining kindness in healthcare: perspectives from international experts. SSM Health Syst. 2026;7:100270. doi:10.1016/j.ssmhs.2026.100270.· Goode S, Hodge G, Cross D. A guide in undertaking core clinical supervision: supervisors’ experiences in implementing core clinical supervision in general practice. Practice Nursing. 2025;36(1):19-25. doi:10.12968/pnur.2025.36.1.19.· Ingham G, Johnson C. GP supervisors in Australia: a cornerstone in need of repair. Med J Aust. 2022;216(4):178-181. doi:10.5694/mja2.51411.· Wearne S, Dornan T, Teunissen PW, Skinner T. General practitioners as supervisors in postgraduate clinical education: an integrative review. Med Educ. 2012;46(12):1161-1173. doi:10.1111/j.1365-2923.2012.04348.x.· O’Sullivan B, Hickson H, Kippen R, Wallace G. Exploring attributes of high-quality clinical supervision in general practice through interviews with peer-recognised GP supervisors. BMC Med Educ. 2021;21:441. doi:10.1186/s12909-021-02882-7.· ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176-1177. doi:10.1111/j.1365-2929.2005.02341.x.· Dwyer M, Griffin P, Rouhi M, Waddingham S, O’Brien L, Prior S. Junior doctors’ experiences of workplace bullying, harassment and discrimination in Australia and Aotearoa New Zealand: a scoping review. ANZ J Surg. 2026;96(1-2):37-47. doi:10.1111/ans.70323.About Dr Nicki Macklin: Nicki is a researcher, consultant, and speaker who explores how organisations can design systems and structures that sustain kindness and human connection at work.Her PhD, through the University of Auckland's Faculty of Medicine and Health Sciences, was among the world's first doctoral studies on organisational kindness in healthcare. She is a former occupational therapist, with a background in quality improvement management and innovative service design in primary care, and has spent many years as a patient and whānau advocate both in Aotearoa and overseas. Nicki is currently an Associate Editor at BMJ Leader, where she leads its Kindness and Human Connection stream, and a visiting scholar and guest lecturer at the University of Toronto's Rotman School of Management. Her work has been published in peer-reviewed journals including the British Medical Journal Leader and Social Sciences and Medicine, and in outlets such as the Harvard Business Review, where her article with Amy Edmondson and Tom Lee was named one of HBR's top ten management insights of 2025.Through her consulting practice, KindFrame, Nicki works with leaders, teams, and governance groups across healthcare, legal and business sectors, including extensive work with the health and legal professions in New Zealand and Australia. She speaks regularly on kindness as designable infrastructure rather than personality, and on what it takes to build the conditions for people to do their best work.Listen here:https://podcasts.apple.com/nz/podcast/kindness-supervision-leadership-w-dr-nicki-macklin/id1845748299?i=1000791893728https://open.spotify.com/episode/5jO3CN4zlQSwytaVUAg0rS?si=d0235c0804a7438d
ADHD Maori Lens w Dr Diana Kopua
In one of my most challenging conversations of the year, Dr Diana Kopua asks us to slow down and look differently at ADHD.Equity CME poinst can be claimed.We meet Wiremu, a 22-year-old Māori man who comes to primary care with his auntie after his boss suggests he might have ADHD. He is struggling to stay focused at work and complete his apprenticeship theory, and it would be easy to move quickly towards a diagnosis.But Diana challenges us to pause.What happens when we start with the relationship rather than the diagnosis? What does context really mean when we are assessing ADHD? And what might we miss if we focus on symptoms without understanding whakapapa, whānau, culture, identity and the lived experience of the person sitting in front of us?This is not a conversation about finding a different checklist for diagnosing ADHD. It is a conversation about questioning whether the way we currently approach assessment is always serving our patients well.Diana shares how Māori models of health, including Mahi a Atua and Mauri, can change the way we think about distress and wellbeing. We talk about the role of whānau, culturally safe assessment, diagnostic labels and the uncomfortable possibility that our own clinical practice can sometimes contribute to inequity.We also ask a difficult question: when is an ADHD diagnosis actually helpful, and when might we be too quick to assume that a diagnostic label is the answer?There are no easy answers here. Instead, Diana asks us to be curious, to sit with some discomfort and to think more deeply about what we are doing, why we are doing it, and who our approach is working for.For GPs and other primary care clinicians, this episode offers practical ways to rethink ADHD consultations, while challenging us to look honestly at the assumptions we bring into the room.Sometimes better care starts with being willing to stop, listen and see the patient differently.Practical clinical pearls:Start with the relationship, not the diagnosis. Name the purpose of the consultation, establish what matters to the patient, and check how they want to approach the conversation.Bring whānau into the conversation early. Where appropriate, invite whānau participation from the beginning rather than treating it as an add-on to the consultation.Use a culturally appropriate framework. Frameworks such as Mauri can help explore wellbeing and the wider context of the patient’s experience alongside diagnostic assessment.Ask what the diagnosis will change. Before pursuing a diagnostic label, ask how it will benefit this patient, at this time. Consider whether the focus should be on potential, strengths and support as well as symptoms.Check how the consultation felt to the patient. Before finishing, ask whether they felt respected, heard and understood. Be willing to sit with discomfort, reflect on how your own practice may contribute to inequity, and stay curious about where you can do better.Feeling out of your depth? Upskill- see resources below.Resources:Te Kurahuna – Mahi a Atua – Official website for Mahi a Atua, including information about the approach, training, publications, and resources.Kopua, D., & Skirrow, P. (2023). Racism, Mātauranga Māori and ADHD: An Interview With Dr Diana Kopua. Journal of the New Zealand College of Clinical Psychologists, 33(1), 72–78. https://doi.org/10.5281/zenodo.8187808 (Mahi a Atua)Kopua, D. M., Kopua, M. A., & Bracken, P. J. (2020). Mahi a Atua: A Māori approach to mental health. Transcultural Psychiatry, 57(2), 375–383. https://doi.org/10.1177/1363461519851606 (Sage Journals)Te Kurahuna Publications & Resources – Collection of Dr Diana Kopua's publications, reports, and additional resources on Mahi a Atua, Indigenous mental health, racism, and systems transformation.About Dr Diana Kopua: (Ngāti Porou) is a consultant psychiatrist, co-founder of Te Kurahuna, and the developer of Mahi a Atua, an Indigenous approach to mental health grounded in Māori pūrākau, whakapapa and mātauranga Māori. Originally trained as a nurse before studying medicine at the University of Otago, she completed specialist training in psychiatry in 2014 and has led the development of innovative kaupapa Māori mental health services, including Te Kūwatawata and Te Hiringa Matua. Through her clinical work, teaching and research, Dr Kopua has become a leading voice on Indigenous mental health, racism in healthcare, and culturally grounded approaches to ADHD and wellbeing.Listen here:https://podcasts.apple.com/nz/podcast/adhd-maori-lens-w-dr-diana-kopua/id1845748299?i=1000789362552https://open.spotify.com/episode/7AHwjYFtJqcRYl4cY5syoi?si=85d7210fdc074d69
Varicose veins w Dr Sam Dunn
Varicose veins are common presentation in primary care, but knowing who to reassure, who to investigate and who to refer isn't always straightforward. Today we are doing something different- we are going work through five real-world quick-fire cases to highlight practical assessment and management of VV’s. I am joined by Dr Sam Dunn.Practical clinical pearls:1. Pregnancy- Treat the symptoms, not the veins.Compression, movement, avoiding prolonged standing and leg elevation are usually all that’s needed. Reassess 3–6 months postpartum.2. Examine varicose veins standing up.They can disappear when the patient lies down. Look for oedema, pigmentation, eczema, lipodermatosclerosis and ulcers—and check the pulses before compression.3. Compression isn’t automatically benign.Check arterial circulation first. If pulses are reduced or arterial disease is possible, assess further before prescribing higher-grade compression.4. Know who needs referral.Symptoms, oedema, skin changes, ulcers, thrombophlebitis or bleeding mean this is more than a cosmetic problem and warrants referral.5. A bleeding varicose vein is an emergency waiting to happen.Lie down, elevate the leg and apply firm pressure. If it doesn’t stop—or starts again—seek urgent medical care. Even when it stops, arrange urgent referral.Bio:Dr Sam Dunn. Sam is Medical Director at Palm Clinic and an experienced cosmetic medicine and vein physician. After beginning his career in emergency medicine, Sam has spent almost two decades practising phlebology and cosmetic medicine. He holds Diplomas in Procedural Phlebology, Skin Cancer Medicine and Community Emergency Medicine, and is a Fellow of the New Zealand Society of Cosmetic Medicine.Resources:https://www.palmclinic.co.nz/vein-care/what-to-expecthttps://www.anzsvs.org.au/patient-information/varicose-veins/https://medlineplus.gov/varicoseveins.htmlListen here:https://podcasts.apple.com/nz/podcast/varicose-veins-w-dr-sam-dunn/id1845748299?i=1000786889860https://open.spotify.com/episode/4gP40UOpbqu4p48SmCD4rm?si=721f49e4bd68454c
Frailty w Dr Helen Kenealy
Frailty is a common but often under-recognised clinical syndrome that has significant implications for health outcomes in older adults. In this episode, we explore how frailty develops, who is most at risk, and why early identification matters. We discuss practical approaches to assessment in primary care, the consequences of frailty, and evidence-based strategies to help patients maintain function, independence, and quality of life with specific discussions around Te Ao Māori perspective.Practical clinical pearls:Watch for the frailty pattern: unintentional weight loss, reduced activity, fatigue, slowed gait, and falls.Use the corridor as part of the consult: gait speed, chair rise, grip strength, and how they move tell you a lot.Ask family/whānau for collateral history, because gradual decline is often noticed there first.Think multifactorially: frailty is linked to sarcopenia, multimorbidity, polypharmacy, social isolation, nutrition, and environmental barriers.Prioritize resistance training and adequate protein intake; those are among the most effective preventive strategies.Review medications carefully, especially sedatives, anticholinergics, and overly tight diabetes or blood pressure treatment.Use frailty to change decision-making: shift from disease-only management to goals-of-care and whole-person planning.Keep care strengths-based and culturally grounded, especially for Māori patients: focus on what matters, what supports them, and what gives them mana.Don’t wait until someone is clearly frail; midlife is the right time to start prevention.Frailty is not just a label — it’s a signal to act.Resources:Health Quality & Safety Commission New Zealand. Frailty | Te Wairuhi: Frailty care guides 2023 [Internet]. Wellington: Health Quality & Safety Commission New Zealand; 2023 [cited 2026 Jun 17]. Available from: Frailty | Te Wairuhi: Frailty care guides 2023Healthify. Clinical Frailty Scale [Internet]. Auckland: Healthify He Puna Waiora; [cited 2026 Jun 17]. Available from: Clinical Frailty ScaleGee S, Bullmore I, Cheung G, et al. It's about who they are and what they can do: Māori perspectives on frailty in later life. N Z Med J. 2021;134(1535):17-24. Available from: ResearchGate articleBiography: Dr Helen Kenealy is a dual-trained General Physician and Geriatrician with extensive experience in the care of older adults. She is currently Chief Clinical and Risk Officer at Metlifecare, where she oversees clinical quality, governance, risk management, health and safety, and digital health innovation across retirement living and aged care services.Helen is passionate about delivering high-quality care for older adults and supporting people to maintain independence, function, and quality of life as they age. She brings extensive expertise in frailty, healthy ageing, comprehensive geriatric assessment, and the healthcare systems that support older New Zealanders.Listen here:https://podcasts.apple.com/nz/podcast/frailty-w-dr-helen-kenealy/id1845748299?i=1000783687000https://open.spotify.com/episode/5jbMGUOgMGMDTzBONMuOsS?si=6ef1d31419394317#frailty #CME
Neck lumps w Dr's Nick Lilic and John Chaplin
We follow Temu a 62y old Maori kaumatua’s journey from his first presentation in primary care through to referral to a head and neck specialist. I'm delighted to be joined by two expert Head and Neck Surgeons from Southern Cross Head and Neck Services. Along the way, we'll discuss the risk factors and changing epidemiology of head and neck cancer, the importance of recognising red flags, appropriate investigation and referral, the value of a neck lump clinic, and the role primary care can play in improving outcomes, for Māori and Pacific peoples. This podcast is eligible for equity CME points.Practical clinical pearls:1. A persistent neck lump is cancer until proven otherwiseAny neck lump in an adult that persists for more than three weeks, particularly if it is firm, enlarging, or non-tender, should be considered malignant until proven otherwise. Avoid repeated courses of antibiotics without a clear indication.2. Head and neck cancer is changingHPV-related oropharyngeal cancer is increasingly common and often presents as a painless neck lump in younger adults, many without a history of smoking or heavy alcohol use. Do not rely on traditional risk factors to determine who needs investigation.3. Refer first, investigate in parallelIf you suspect head and neck cancer, make an urgent HSOC/Faster Cancer Treatment referral immediately. If you arrange ultrasound or fine-needle aspiration, do so alongside the referral—never let investigations delay specialist assessment. Avoid open biopsy of a neck lump in primary care.4. Equity requires proactive follow-upMāori experience poorer outcomes from head and neck cancer because of later diagnosis and barriers to care. A low threshold for referral, active follow-up of missed appointments, and early involvement of Māori Cancer Navigators can make a meaningful difference.5. Every HPV vaccination is cancer preventionThe HPV vaccine prevents multiple cancers, including cervical and HPV-related throat cancers. Use every opportunity to recommend vaccination to eligible young people and their whānau. Increasing HPV vaccine coverage is one of the most effective strategies we have to reduce the future burden of head and neck cancer. With Aotearoa aiming for 90% HPV vaccination coverage by 2030, every recommendation from primary care counts.Resources:Te Aho o Te Kahu (Cancer Control Agency). Optimal Cancer Care Pathways / Faster Cancer Treatment Indicators.Weaver, A., Twine, S., Bather, M., Dowley, A., & Slough, C. M. (2024). Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer. JAMA Network Open, 7(6), e2413004.Lucas-Roxburgh, R. A. (2018). Human papillomavirus (HPV) associated oropharyngeal cancer: Case prevalence, diagnosis, and the potential for screening in New Zealand. Massey University.New Zealand Guidelines / HealthPathways. Head and Neck Cancer & High Suspicion of Cancer Criteria.Koh, S. P., et al. (2026). Economic burden of human papillomavirus-related cancers in New Zealand. BMJ Public Health, 4(2), e003800. https://bmjpublichealth.bmj.com/content/4/2/e003800Bio:Dr Nick Lilic is a New Zealand-trained Otolaryngologist, Head and Neck Surgeon. Following fellowship training in Edinburgh and a Master of Science from the University of London, he completed advanced fellowship training in Auckland, developing expertise in head and neck oncology, thyroid surgery and complex reconstruction. Nick is a consultant surgeon at Auckland City Hospital, a lecturer at the University of Auckland, and Clinical Director of Southern Cross Head and Neck Services.Dr John Chaplin is a New Zealand-trained Head and Neck Surgeon with more than 20 years' experience managing thyroid and parathyroid disease, neck lumps and head and neck cancer. Following specialist training, he completed prestigious fellowships in New York and Sydney, gaining expertise in complex head and neck oncology and reconstructive surgery. John is a consultant surgeon at Auckland City Hospital, a founding member of the Australian and New Zealand Head and Neck Society, and a surgeon at Southern Cross Head and Neck Services, where he continues to play a major role in surgical...
Underfuelling- Early Intervention w Dr's Megan Ogilvie and Roger Mysliwec
Collaborative care is crucial in in under fuelling to prevent further deterioration and can prevent progression to an eating disorder.Our case:Marnie is a 22-year-old woman with a two-year history of amenorrhoea. She exercises at high intensity every day, is underweight, and describes that she is lacking her usual zest for life.She has undergone a thorough medical assessment, and the diagnosis of low energy availability (LEA) has been made with other secondary causes of amenorrhoea excluded. Marnie has already seen a dietitian, engaged a trainer and understood the need to increase her energy intake, reduce her training load, and incorporate regular rest days. Despite understanding the advice, she is struggling to make these changes.Practical clinical pearls:1. Engaging in food restriction and high exercise can be a trigger of onset of an ED in vulnerable individuals2. There can be a gradual transition and progression from under-fuelling and over-exercising for reasons associated with sport goals to an ED which at times can be difficult to differentiate3. People with REDs display symptoms and traits reminiscent of those seen in people with an ED (cognitive and behavioural rigidity, habit and rule based behaviour, difficulty not engaging in exercise4. Once an ED has become activated treatment of the ED will need to become priority, i.e., treatment will need to go beyond addressing the physical sequelae of REDs5. Early intervention is crucial.Expert bio:Dr Megan Ogilvie is the Business Director at ERH Associates Subspeciality expertise in menopause, PCOS, athlete hormone health. PMS/PMDD, VSCs and gender-affirming medicine. Megan completed her endocrinology training in Auckland and then undertook a fellowship in London at St Bartholomew's and University College of London Hospitals. Since returning to New Zealand, Megan has worked in both general and reproductive endocrinology at Fertility Associates and at Auckland District Health Board, and now at ERH Associates. Megan has particular reproductive endocrine interests in menopause, polycystic ovarian syndrome, gender-affirming care, as well as athlete hormone health and energy deficiency. Megan was a founding member of WHISPA (a medical advisory board to High Performance Sport New Zealand, now disestablished) and has run training workshops for High Performance Sport NZ in the area of female athlete hormone health. Megan is the New Zealand representative on the board of the Australasian menopause society.Dr Roger Mysliwiec is an Auckland-based medical specialist with extensive expertise in psychosomatic medicine and eating disorders. Trained in Germany, he has over 35 years of clinical experience across hospital, public sector, and private practice settings. He previously served as Clinical Director of Auckland’s Regional Eating Disorders Service (1999–2014) and has played a key role in developing and strengthening eating disorder services in New Zealand.His clinical work focuses on assessment and treatment of anorexia nervosa, bulimia nervosa, binge eating disorder, and ARFID, particularly in adults and older adolescents. He integrates evidence-based psychological therapies including CBT, MANTRA, SSCM, and adolescent-focused approaches, alongside neuroscience-informed psychotherapy.Dr Mysliwiec also provides specialist consultations, medication reviews where appropriate, and multidisciplinary treatment planning. In addition, he is an experienced supervisor and educator, mentoring clinicians and contributing to professional development in eating disorders and mental health across New Zealand and Australia.Resources:Australian Institute of Sport. Female Performance & Health Initiative: Education modules [Internet]. Canberra (AU): Australian Sports Commission; [cited 2026 Jun 17]. Available from: https://www.ausport.gov.au/ais/fphi/education. (Australian Sports Commission)De Souza, M.J., Williams, N.I., Misra, M. et al. 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 1: State of the Science and Introduction of a New Adolescent Model. Sports Med 56, 327–373 (2026). Available from: https://doi.org/10.1007/s40279-025-02333-zEverett S. Optimizing Performance Nutrition for Adolescent Athletes: A Review of Dietary Needs, Risks, and Practical Strategies. Nutrients. 2025;17(17):2792. doi: https://doi.org/10.3390/nu17172792.Gallant TL, Ong LF, Wong L, Sparks M, Wilson E, Puglisi JL, Gerriets VA. Low energy availability and relative energy deficiency in sport: a systematic review and meta-analysis. Sports Med. 2025;55(2):325–339. Available from: https://doi.org/10.1007/s40279-024-02130-0Gould RJ, Ridout AJ, Newton J. Relative energy deficiency in sport (RED-S) in adolescents – a practical review. Int J Sports Med. 2023;44:236–246. Available from: https://doi.org/10.1055/a-1947-3174Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073–1098. doi: https://doi.org/10.1136/bjsports-2023-106994Listen here:https://open.spotify.com/episode/5QdH4aQrAnt5weLop0pTqR?si=3155a7cc6fef4381https://podcasts.apple.com/nz/podcast/underfueling-early-intervention-w-drs-megan-ogilvie/id1845748299?i=1000777449686
The Weight of the Future w Prof Wayne Cutfield
The Weight of the Future: Are We Getting Adolescent Obesity Treatment Right?Samuel is a 15-year-old European boy who has always been overweight. Over the past year, he’s gained a further eight kilos, and his BMI is now in the obese range. He’s otherwise well and active playing rugby.His mum comes in with him today. She’s tried reducing food portion size and limiting junk food at home, but with little success. They’re asking what else they can do, and specifically whether a medication like a GLP-1 RA might be an option. They feel they could afford it for about a year to help get him back on track. As the GP, you’re unsure how best to approach this case. What do you think?Practical clinical pearls:Obesity is common in childhood and adolescence in New Zealand, with Pacific peoples disproportionately affected, followed by Māori. Management should always be approached with an equity and culturally safe lens.Adolescent obesity should be managed as a chronic, lifelong condition rather than a short-term weight-loss problem. Successful treatment usually requires sustained lifestyle change supported by whānau, schools, and healthcare teams.A holistic management plan is essential. Alongside nutritional advice and physical activity, consider psychology input, family-based interventions, group programmes, and addressing sleep, mental health, stigma, and socioeconomic barriers to care.GLP-1 receptor agonists are emerging as an effective option for some adolescents with obesity, but gastrointestinal side effects are common and discontinuation rates remain high. Starting with very low doses and titrating slowly can improve tolerability.Families should understand that stopping GLP-1 receptor agonists commonly leads to significant weight regain, often within a year and sometimes exceeding the original weight lost. Research is ongoing into combining GLP-1 therapy with gut microbiome interventions alongside intensive lifestyle modification, with the hope of improving long-term weight maintenance. Watch this space.Bio:Wayne Cutfield is Professor of Paediatric Endocrinology and co-director of the highly successful Gut Bugs Research Programme. He was previously Director of the Liggins Institute and previously Director of a Better Start National Science Challenge. He single handedly established paediatric endocrinology in Auckland which has grown in to a national referral service. His research achievements and leadership in paediatric endocrinology have been widely recognised with the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes Norman Wetenhall Medal for research innovation, the University of Auckland’s Gluckman Medal for outstanding research contribution, the Royal Australasian College of Physicians Child Health Division Howard William’s Medal for clinical leadership and the RACP pinnacle award the College Medal for outstanding impact and leadership in medicine and research. He has published >350 articles in journals that include the New Journal of Medicine, Lancet, BMJ and Nature and has an H Index of 85.References:Hashemi, Ladan et al. “Associations between Specific and Cumulative Adverse Childhood Experiences, Childhood Obesity, and Obesogenic Behaviours.” European journal of psychotraumatology 16.1 (2025): 2451480. Web.Rahimi, Mehdi, Allen Bartley, and Ladan Hashemi. “Childhood Overweight/Obesity amidst Migration, Socioeconomic Factors, and Obesogenic Behaviors: Insights from the Growing Up in New Zealand Study.” Ed. by António Raposo. Advances in Public Health 2023 (2023): 1–10. Web.Hashemi, Ladan et al. “Associations between Specific and Cumulative Adverse Childhood Experiences, Childhood Obesity, and Obesogenic Behaviours.” European journal of psychotraumatology 16.1 (2025): 2451480. Web.Listen here:https://podcasts.apple.com/nz/podcast/the-weight-of-the-future-w-prof-wayne-cutfield/id1845748299?i=1000775543755https://open.spotify.com/episode/51OZdA07VjFoAAgEIsXhoX?si=158e5ed969174f69#glp1 #obesitymedicine #universityofauckland
Clinician burnout w Dr Jo Prendergast
This episode explores burnout in healthcare, its definitions, warning signs, systemic causes, and strategies for prevention. Dr. Louise Kuegler interviews Dr. Jo Prendergast, a psychiatrist and expert on mental health in medicine, to shed light on how clinicians can recognise and address burnout effectively.Practical pearls:Burnout is a system problem, not a personal failure.Burnout affects both emotions and the nervous system—both need support.Physical symptoms and withdrawal are early warning signs.Small recovery moments, like slow breathing, quickly reduce stress.Stress spreads through teams; calm and vulnerability do too.Leaders set the tone by modelling boundaries and honesty.Peer support turns isolation into connection and resilience.Bio:Dr Jo Prendergast is a psychiatrist, keynote speaker, author, comedian, and breast cancer survivor. She combines clinical expertise, humour, and lived experience to make mental health conversations engaging and relatable. A graduate of the University of Otago Medical School and a Fellow of the Royal Australian and New Zealand College of Psychiatrists, Jo has worked in mental health services across New Zealand and Australia for more than 30 years.Jo is the author of When Life Sucks, commissioned by HarperCollins, and an award-winning comedian. She has three solo comedy shows and has toured to international festivals across Australia and the UK. A sought-after keynote speaker and media commentator, Jo regularly appears on television, radio, and podcasts, and is known for making complex topics such as mental health, resilience, and wellbeing both accessible and entertaining. Jo is available for keynote presentations, conferences, corporate events, media interviews, and live performances.Resources:Prendergast J. Dr Jo Prendergast [Internet]. Available from: https://drjoprendergast.com/HarperCollins Australia. When Life Sucks: The Practical and Effective How-To Guide to Parenting Your Teen Through Tough Times [Internet]. Available from: https://harpercollins.com.au/products/9781775541998_when-life-sucks-the-practical-and-effective-how-to-guide-to-parenting-your-teen-through-tough-times-from-an-expert-psychiatrist-and-comedian-for-fans-of-maggie-dent-celia-lashlie-and-nigel-lattaKrebs L, Jung L, Arrich J. Prevention of burnout syndrome in physicians: a systematic review and meta-analysis. Wien Klin Wochenschr. 2026;138(5-6):167-178. doi:10.1007/s00508-025-02601-y.Tsatiris D. Physician Burnout: How to Rise Above a Broken Healthcare System as a Practicing Clinician. 1st ed. London: Routledge; 2025. doi:10.4324/9781003473923.Listen here:https://podcasts.apple.com/nz/podcast/clinician-burnout-w-dr-jo-prendergast/id1845748299?i=1000773646680https://open.spotify.com/episode/5hlyWpPXYAWbjNSdczRmtz?si=ae8f51c9e81741ee
Antibiotics in Early Life: What Are We Changing for the Future? w Prof Wayne Cutfield
We’re joined by Wayne Cutfield, a paediatric endocrinologist at Starship Children’s Hospital and Professor at the Liggins Institute. Co leader of gut bugs research team. We explore antibiotic use in children, the impact of antibiotics on the developing microbiome, and practical strategies for clinicians to prescribe appropriately while supporting long-term child health.Antibiotics are one of medicine’s most important discoveries, dramatically reducing deaths from infectious diseases. However, widespread and sometimes unnecessary use, particularly in children has raised concerns. Emerging evidence suggests antibiotic exposure may be contributing to shifts in the epidemiology of chronic and autoimmune diseases that cannot be explained by population changes alone. Practical clinical pearls:Antibiotics continue to be overused in infants and young children in New Zealand, although prescribing trends are improving. When antibiotics are needed, choose the narrowest-spectrum antibiotic for the shortest effective duration.Early antibiotic exposure alters the gut microbiome. Observational studies have linked this with higher rates of childhood obesity, allergic disease including asthma and eczema, type 1 diabetes, and even later mental health conditions such as depression and anorexia nervosa.Breastfeeding remains the gold standard for healthy microbiome development. Encourage exclusive breastfeeding for around six months where possible, as this supports immune development and microbial diversity.When infants require formula feeding, consider formulas containing human milk oligosaccharides (HMOs), which may help support a healthier gut microbiome more similar to that seen in breastfed infants.Diet matters once solids are introduced. Encouraging a “rainbow” of fruits and vegetables, alongside lean meats and high-fibre foods, helps promote microbiome diversity. For families in Auckland whose child requires antibiotics, consider referral to Professor Wayne Cutfield’s ongoing clinical trial investigating HMOs versus placebo following antibiotic exposure in early life. See the study link in the podcast bio.Bio:Wayne Cutfield is Professor of Paediatric Endocrinology and co-director of the highly successful Gut Bugs Research Programme. He was previously Director of the Liggins Institute and previously Director of a Better Start National Science Challenge. He single handedly established paediatric endocrinology in Auckland which has grown in to a national referral service. His research achievements and leadership in paediatric endocrinology have been widely recognised with the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes Norman Wetenhall Medal for research innovation, the University of Auckland’s Gluckman Medal for outstanding research contribution, the Royal Australasian College of Physicians Child Health Division Howard William’s Medal for clinical leadership and the RACP pinnacle award the College Medal for outstanding impact and leadership in medicine and research. He has published >350 articles in journals that include the New Journal of Medicine, Lancet, BMJ and Nature and has an H Index of 85.Resources:Hindson J. Post-antibiotics microbiome restoration driven by diet. Nat Rev Gastroenterol Hepatol. 2025;22:462. doi:10.1038/s41575-025-01090-8.Lizumi T, Battaglia T, Ruiz V, Perez-Perez GI. Gut microbiome and antibiotics. Arch Med Res. 2017;48(8):727–734. doi:10.1016/j.arcmed.2017.11.004. Professor Cutfeilds antibiotic study. https://www.auckland.ac.nz/en/liggins/in-the-community/clinical-studies/clinical-studies-babies-children/oak-study.htmlListen here:
Sun, Stores, and Supplementation: Vitamin D in Pregnancy and Early Life w Prof Ben Wheeler
Who should receive vitamin D in pregnancy and infancy? We focus on risk identification, prevention strategies, and the clinical recognition of deficiency, including nutritional rickets. Vitamin D deficiency remains an important and preventable issue, particularly in at-risk populations. To explore this topic, we are joined by Professor Ben Wheeler, a Paediatric Endocrinologist and Paediatrician.Practical clinical pearls: · Universal infant supplementation works bestProvide vitamin D supplementation to all infants up to 12 months, regardless of feeding method, ethnicity, or perceived sun exposure, as risk-based approaches miss vulnerable babies.· Maternal vitamin D status shapes infant healthMaternal deficiency during pregnancy directly affects neonatal vitamin D stores and future bone health, making antenatal supplementation an important prevention strategy.· Sun exposure is not a reliable strategy in infancyIn New Zealand’s high-latitude environment, sun exposure alone is inconsistent and carries skin cancer risks, so daily supplementation is preferred for infants.· Test selectively, supplement proactivelyRoutine vitamin D testing is usually unnecessary in asymptomatic women and infants; focus instead on guideline-based supplementation and prevention in at-risk populations.· Recognise rickets early and act urgentlyConsider vitamin D deficiency and nutritional rickets in infants with poor growth, delayed milestones, hypotonia, bone pain, or irritability. Hypocalcaemia and raised ALP are important clues, and suspected rickets requires urgent same-day paediatric discussion and possible hospital admission.Bio:Professor Ben Wheeler is a Paediatric Endocrinologist and Paediatrician working for the University of Otago and the Southern District Health Board.His research focuses on access to and use of new technologies for children and young people affected by diabetes, as well as factors that impact on glycaemic control in diabetes. He also has a research interest in vitamin D and bone health during pregnancy, lactation, and infancy. He has a number of collaborations ongoing in these areas, and usually multiple clinical trials or studies running in these areas at any one time.Resources:https://static.info.content.health.nz/docs/health-pros/topics/maternity/national/companion-statement-vitamin-d-sun-exposure-pregnancy-infancy-nz.pdfhttps://www.starship.org.nz/guidelines/vitamin-d-deficiency-investigation-and-management/https://bpac.org.nz/2025/vitamind.aspxWheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” Frontiers in endocrinology (Lausanne) 10 (2019): 795. Web.Simm, Peter J et al. “Editorial: Childhood Rickets—New Developments in Epidemiology, Prevention, and Treatment.” Frontiers in endocrinology (Lausanne) 11 (2020): 621734. Web.Listen Here:https://podcasts.apple.com/nz/podcast/sun-stores-and-supplementation-vitamin-d-in-pregnancy/id1845748299?i=1000769448088https://open.spotify.com/episode/6UiuK9TgKYFg8A3xXNIwN3?si=8f5ae56c48f9434a
Eyelid lesions w Dr Sid Ogra.
Dr Louise Kuegler and Dr Sid Ogra explore the assessment and management of eyelid lesions in primary care. They discuss a clinical case of a 67y female with a non healing lesion on the eyelid. Unpacking how to distinguish benign from malignant lesions, highlight key red flags such as non-healing or changing lesions, and emphasise the importance of early recognition and timely referral. The conversation covers common conditions including actinic keratosis, basal cell carcinoma and melanoma, along with practical strategies such as thorough history-taking, clinical intuition, and the use of photography for monitoring. Preventive approaches, including sun protection and awareness of risk factors, are also discussed to support better patient outcomes.Practical clinical pearls:Most eyelid lesions are benign (however as they are in a functional place, if large may still need to be removed)Malignant lesions are usually treatable if caught earlyRed flags to watch for: Loss of eyelashes (Number one by far). Non-healing areas of skin or styes that after 3/12 have not resolved as expected- this could be sebaceous cell carcinoma. Bleeding and ulceration.If uncertain of diagnosis→ refer earlySpeaker Bio:Dr Sid Ogra, MBChB, FRANZCOSpecialist in Oculoplastics (eyelid and tear duct disorders) – adults and childrenSpecialist in cataract surgery, including premium lenses and refractive correctionDr Sid Ogra is a well-established ophthalmologist with subspecialty expertise in oculoplastics and a busy cataract surgery practice. He provides care across Auckland and Queenstown, seeing both adult and paediatric patients.Sid graduated with distinction from the University of Auckland and completed his ophthalmology training across Auckland, Rotorua and Wellington. He then undertook an Oculoplastic Fellowship in Hereford, UK (2019), further refining his surgical skills in eyelid and tear duct disorders.He has also completed observerships at the Byers Eye Institute at Stanford (USA) and Samsung Medical Centre in Seoul (South Korea), gaining additional international experience in advanced ophthalmic care.Sid is committed to a collaborative approach, working closely with patients to ensure they are well informed about their condition and treatment options, and supporting shared decision-making to achieve the best possible outcomes.Resources: Bernardini, Francesco P. Management of malignant and benign eyelid lesions. Current Opinion in Ophthalmology 17(5):p 480-484, October 2006. | DOI: 10.1097/01.icu.0000243022.20499.90Sun, M. T., Huang, S., Huilgol, S. C., & Selva, D. (2019). Eyelid lesions in general practice. Australian Journal of General Practice, 48(8), 509–514. https://search.informit.org/doi/10.3316/informit.554448397575586Listen Here:
GLP- 1 RA and Eye Health w A Prof Racheal Niederer.
Are GLP-1 receptor agonists putting your patients’ eye health at risk? Here’s what you need to know.GLP-1 receptor agonists are revolutionising diabetes management, offering significant weight loss and cardiovascular benefits. However, there is a potential link to eye disease, particularly in those with pre-existing conditions.Recent studies suggest that while these medications improve overall health, they may cause a temporary worsening of diabetic retinopathy due to rapid improvements in blood glucose levels. This is important for primary care, as patients need appropriate assessment and counselling before starting treatment.Before prescribing, ensure a recent retinal screening has been completed, especially for higher-risk patients. Close monitoring in the first few months is essential to detect any early complications.Practical clinical pearls:Rapid weight loss can worsen diabetic retinopathy.Start low, go slow, and monitor the retina in diabetic patients.Ensure retinal screening has been completed within the last 12 months before starting treatment.If retinopathy is present, initiate cautiously and arrange closer ophthalmology follow-up.Advise all patients to seek urgent review if they develop any visual symptoms.Ocular complications are rare in non diabetics, but important to recognise early.Report any suspected adverse events to Medsafe to support ongoing safety monitoring.Guest bio:Assoc Prof Rachael Niederer PhD, MBChB, FRANZCOOphthalmologist | Uveitis and Medical Retina SpecialistRachael attended Auckland University Medical School from 1997–2002 and won the highly prized Sir William McKenzie Award for Early Excellence in Eye Research.She completed her PhD on corneal nerves and keratoconus in 2008 and was awarded the Vice Chancellor’s Best Doctoral Thesis award.Rachael completed her ophthalmology vocational training in both Auckland and Hamilton and, in the RANZCO final examination, achieved a gold Howsam Medal for the highest marks in Australia and New Zealand.She completed her fellowship at Moorfields Eye Hospital in London, specialising in uveitis and medical retina. In 2016, she was appointed Senior Medical Ophthalmologist at Greenlane Hospital and, in the same year, was the RANZCO college representative for Auckland ophthalmology trainees.In 2019, Rachael was appointed Senior Lecturer at the University of Auckland, Department of Ophthalmology.In late 2025, she was promoted to Associate Professor at the University of Auckland, recognising her ongoing contributions to ophthalmology, education, and research.Rachael’s research interests are extensive and include more than 140 publications in international journals and over 60 presentations at New Zealand and international conferences. She is an investigator in the Zoster Eye Disease Study and has a particular interest in uveitis and the epidemiology of eye disease.She is also committed to reducing inequalities in access to eye care within the community.Resources:MedSafe NZ Pharmacovigilance - https://medsafe.govt.nz/American Diabetes Association Screening Guidelines - https://diabetes.org/diabetes/medication-management/retinal-screeningGreen Lane Eye Clinic - https://aucklandeye.co.nz/Rachael Niederer - Auckland Eye - https://www.aucklandeye.co.nz/specialist/assoc-prof-rachael-niederer/GLP-1 Receptor Agonists Overview - NICE - https://www.nice.org.uk/guidance/ta543Listen Here:#GLP1 #EyeHealth #DiabetesCare
Mastitis spectrum in the lactating indivdual w Dr Yvonne Le Fort.
What if that red, painful breast isn’t an infection — and antibiotics aren’t needed?Mastitis is now seen as a spectrum, often inflammatory rather than infective. Treating it as routine infection risks overprescribing and missing early, effective care.Talking to Lactation medicine physician Dr Yvonne Le Fort we unpack the case of Kim, a well 26-year-old female, three months postpartum with a tender, erythematous breast, we cover:When mastitis is inflammatory vs infectiveWhat early management should prioritiseWhen antibiotics are actually neededRed flags and when to escalatePractical clinical pearls:Mastitis is a spectrum — it may be inflammatory and is not always due to infection.Initial management of lactational mastitis- includes pain relief, reducing breast oedema, and addressing hyperlactation.Milk culture – consider if symptoms persist despite antibiotics, or if mastitis is recurrent or prolonged.Antibiotics – not all cases need them. Use only for systemic symptoms or if no improvement after 24–48 hours. First-line: Flucloxacillin. If penicillin allergy: ClindamycinBreast abscess or mass – refer urgently for imaging ± surgical drainage.Non-lactational mastitis – usually infective; requires antibiotics and close follow-up. Refer early if cancer suspected.Inflammatory breast cancer can mimic mastitis — maintain a high index of suspicion.Guest bio:Dr Yvonne LeFort, a family medicine doctor trained in Canada, has practised breastfeeding medicine for over 20 years and runs a private breastfeeding clinic on Auckland’s North Shore.She is a dual Fellow of RNZCGP and CCFP (Canada), an IBCLC, and a Fellow of the Academy of Breastfeeding Medicine (ABM). She serves on the board of the New Zealand Breastfeeding Alliance (NZBAA), supporting evidence-based breastfeeding education for all medical and health care colleagues.Currently, she is a professional advisor to La Leche League New Zealand, a member of NZLCA, and the founder of a Breastfeeding Medicine RNZCGP Peer Review Group.Yvonne has recently completed a Post Graduate Diploma in Digital Health from Otago University.She has provided both formal and informal education for IBCLCs and medical colleagues, helping to upskill healthcare workers with the knowledge needed to provide best-practice care when consulting with breastfeeding dyads. She has presented nationally and internationally on a wide variety of topics.Yvonne is the first author of the ABM’s Position Statement on Ankyloglossia and Breastfeeding Dyads (2021), a contributor to New Zealand Aotearoa National Guidance for the Assessment, Diagnosis and Surgical Treatment of Tongue-Tie in Breastfeeding Neonates, and a co-author of Complications and Misdiagnoses Associated with Infant Frenotomy: Results of a Healthcare Professional Survey (International Breastfeeding Journal, 2022), along with several other clinical protocols.Resources:https://www.redwhale.co.uk/content/the-mastitis-spectrumhttps://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdfhttps://www.tewhatuora.govt.nz/for-the-health-sector/specific-life-stage-health-information/maternal-health/breastfeeding/breastfeeding-problems/mastitis-and-breast-abscesses/https://tewhatakura.nz/guidelinesListen here: https://podcasts.apple.com/nz/podcast/mastitis-spectrum-in-the-lactating-indivdual-w-dr/id1845748299?i=1000760964999https://open.spotify.com/episode/3hf6RuGQvdDZtpBbTaq1xt?si=919166e299a94d8c
Hyperbaric Oxygen Therapy: Panacea or Properly Indicated? w Prof Simon Mitchell.
Hyperbaric oxygen therapy (HBOT) which is used across a wide range of acute and chronic conditions, but for most clinicians, it remains something of a mystery outside of diving-related emergencies.In this episode, we explore what HBOT is, how it works, and when it’s indicated. Using a clinical case as a starting point, we discuss the approved uses, contraindications, practicalities, and emerging areas of interest — including concussion and long COVID-19 infection.Practical clinical pearls:HBOT has well-defined, evidence-based indications, and referrals should be made only to accredited facilities.For decompression illness and arterial gas embolism, air or gas embolism, carbon monoxide poisoning, sudden acute hearing loss consider referring urgently for hyperbaric assessment.Confirm the facility’s accreditation and safety protocols before referring.Discuss suitability with a hyperbaric service early if in doubt.Be cautious about non-accredited “wellness” HBOT clinics promoting unproven benefits. Do no harm.Guest bio:Simon Mitchell is an anaesthesiologist at Auckland City Hospital, a diving physician at North Shore Hospital, and Professor of Anaesthesiology at the University of Auckland.He is widely published, with two books and over 170 scientific papers or chapters, including co-authorship of the 5th edition of Diving and Subaquatic Medicine and the Hyperbaric and Diving Medicine chapters in the last four editions of Harrison’s Principles of Internal Medicine.Simon has twice served as Vice President of the Undersea and Hyperbaric Medicine Society (USA) and received the Behnke Award for scientific contributions to diving medicine in 2010. Since 2019, he has been Editor-in-Chief of the Diving and Hyperbaric Medicine Journal.Outside of medicine, Simon has had a long career in sport, scientific, commercial, and military diving. He has participated in exploratory wreck and cave diving expeditions worldwide and in 2002 performed what was then the deepest dive to a shipwreck. In 2023, he was part of the Wet Mules expedition to the Pearse Resurgence in New Zealand, where a 230 m hydrogen dive was conducted — the first of its kind in over 30 years. He is a Fellow of the Explorers’ Club of New York and was named Rolex Diver of the Year in 2015.Resources:·Undersea and Hyperbaric Medical Society. HBO Indications [Internet]. Available from: https://www.uhms.org/resources/featured-resources/hbo-indications.html·National Center for Biotechnology Information (NCBI). Hyperbaric Oxygen Therapy: Patient Selection [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499820/·UpToDate. Hyperbaric Oxygen Therapy [Internet]. Available from: https://www.uptodate.com/contents/hyperbaric-oxygen-therapy#H19·U.S. Food and Drug Administration (FDA). Hyperbaric Oxygen Therapy: Get the Facts [Internet]. Available from: https://www.fda.gov/consumers/consumer-updates/hyperbaric-oxygen-therapy-get-facts·National Center for Biotechnology Information (NCBI). Hyperbaric Medicine Overview for Wound Healing [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459172/·Mitchell SJ. Decompression illness: a comprehensive overview. Diving Hyperb Med. 2024 Mar 31;54(1 Suppl):1–53. doi: 10.28920/dhm54.1.suppl.1-53. PMID: 38537300; PMCID: PMC11168797.Please see local healthpathway for regional advice.Email me:thespecialistgp@outlook.co.nzListen here: Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg
Field treatments in sun damaged skin w Dr Chin-Yun Lin.
What if the rough, scaly patch you freeze in clinic today is just the visible part of widespread sun damage? Treating only what you can see may mean missing the bigger risk.We explore how recognising and treating the entire sun-damaged area reducing progression to squamous cell carcinoma and improve long-term outcomes.I’m joined by dermatologist and Mohs surgeon Dr Chin-Yun Lin, who shares practical, primary care–focused guidance on choosing and using field therapies for actinic keratoses.Using the case of Simon, a 55-year-old builder with significant sun exposure and multiple lesions on his face and hands, we discuss:What “field treatment” really means in everyday general practiceWhen to move beyond spot cryotherapy and treat the whole area of sun damageHow to choose between topical 5-fluorouracil, imiquimod, and photodynamic therapyPreparing patients for treatment reactions and improving adherenceWhen to refer and when you can confidently manage in primary careThis episode is full of practical tips to help you manage sun-damaged skin more effectively and reduce your patients’ long-term skin cancer risk.Practical clinical pearls :Patient Education is Key: Reinforce sun protection, ongoing self-examination, and adherence.Explain that AKs are precancerous, not benign warts—early treatment reduces risk of SCC.Preparation of the Skin Improves Efficacy: Gentle debridement, keratolytic creams (urea or salicylic acid), or low-potency retinoids before topical therapy can enhance penetration and response.Field Treatment is Often Preferable for Multiple Lesions: When you see multiple AKs or “field cancerization,” topical therapies (like 5-fluorouracil, imiquimod, or diclofenac) can treat visible and subclinical lesions simultaneously.Pick therapy based on patient tolerance, adherence, and skin location.Treatment Selection Depends on Lesion and Patient Factors:5-FU: aggressive but effective, may cause intense inflammation—good for thicker or widespread AKs. Imiquimod: immune-stimulating, good for thinner AKs or for patients who prefer intermittent dosing. Photodynamic therapy (PDT): alternative if topical therapy fails or not tolerated.Monitor for Flare or Incomplete Response: Mild irritation is expected, but severe inflammation, erosion, or ulceration may require pausing treatment. Non-responding lesions should be reevaluated for biopsy, as persistent AK may hide squamous cell carcinoma (SCC).Refer to a dermatologist: if the diagnosis is unclear, or if the lesion requires expert excision or specialized management.Resources:https://www.rnzcgp.org.nz/events/ongoing-events/gp-dermatology-course/https://dermnetnz.org/topics/actinic-keratosishttps://dermnetnz.org/cme/lesions/topical-treatment-of-photodamagehttps://dermnetnz.org/topics/5-fluorouracil-creamhttps://dermnetnz.org/topics/imiquimodGuest bio:Dr Chin-Yun Lin is a Dermatologist and accredited Mohs micrographic surgeon. His specialty interests include the treatment of skin cancer, melanoma, dermatitis, psoriasis, acne, pigmentary disorders, and cosmetic dermatology.After graduating as Dux of Macleans College in Auckland, he went on to complete his undergraduate medical degree with first-class honours at the University of New South Wales in Australia.He undertook Dermatology advanced training at tertiary teaching hospitals in Auckland, Hamilton, and Christchurch. Further Dermatology training and a Mohs surgical fellowship were undertaken at St Vincent's Hospital and the Skin Hospital in Sydney. He is also a Fellow of the American College of Mohs surgery.Dr Lin has won various Dermatology awards such as the Trans-Tasman Scholarship for best registrar presentation at the New Zealand Dermatological Society Annual Conference, and the best poster presentation at the Australasian College of Dermatologists Annual Scientific Meeting.Dr Lin also takes interest in clinical teaching and research. He is a registered education provider for the RNZCGP. He has published several papers in peer-reviewed journals, and presented at international conferences such as the World Congress of Dermoscopy. He has written a practical course for GP’s on dermatology- link in resources.Dr Lin has also served on the reviewers’ panel for the Australasian Journal of Dermatology.Email me:thespecialistgp@outlook.co.nzListen here: Apple : https://podcasts.apple.com/nz/podcast/field-treatments-in-sun-damaged-skin-w-dr-chin-yun-lin/id1845748299?i=1000755425551Spotify: https://open.spotify.com/episode/3CPztsA04YtvzodwM7s2AI?si=c3ed7ee2635f4f83
The diagnosis is in the first minute w Maureen Bisognano.
Do we really hear our patients? Or just listen long enough to respond? In today’s fast-paced clinics, true listening is often the first casualty. Yet it’s far more than courtesy: it’s a clinical tool that builds trust, uncovers what matters most, improves outcomes, and even protects clinicians from burnout.I talk with Maureen Bisognano, President Emerita at the Institute for Healthcare Improvement and global leader in healthcare quality. We explore how curiosity and “proximate listening” can transform patient care, what telehealth teaches us about paying attention, and leadership strategies to create a culture that truly listens.We also share Bill’s story- a 90-year-old patient whose case shows how listening can be the difference between misdiagnosis and the right care.Listening isn’t optional—it’s essential.Practical clinical pearls:Start with “what matters.” Asking “What would make a good day for you?” or “What’s most important for you today?” often reveals the patient’s real priorities and builds trust quickly.Use open-ended questions wisely. Replace “Do you have any questions?” with “What questions or concerns do you have?” it affirms curiosity and doesn’t add much time.Sit when you can. Even a moment sitting down makes patients feel heard and cared for, and increases satisfaction.Let design help you. Face the patient while typing, use an AI scribe, reduce noise or distractions where possible, small environmental shifts signal attention.Empower through listening. Ask colleagues “What do you think?” or “If you were in my chair, what would you change?” to invite practical solutions and strengthen teamwork.Foster resilience by sharing stories. Creating moments to eat together, debrief, or reflect with peers reduces burnout and builds a culture of support.Guest bio:Maureen Bisognano, President Emerita and Senior Fellow, Institute for Healthcare Improvement (IHI), previously served as IHI’s President and CEO for five years, after serving as Executive Vice President and COO for 15 years. She is a prominent authority on improving health care systems, whose expertise has been recognized by her elected membership to the National Academy of Medicine (IOM), among other distinctions. Ms. Bisognano advises health care leaders around the world, is a frequent speaker at major health care conferences on quality improvement and is a tireless advocate for change. She is an Instructor at the Harvard School of Public Health. She chaired the Advisory Board of the Well Being Trust, co-chairs the Massachusetts Coalition for Serious Illness Care with Dr. Atul Gawande, and serves on the boards of the Commonwealth Fund, Indiana University Health and Nursing Now. Prior to joining IHI, she served as CEO of the Massachusetts Respiratory Hospital and Senior Vice President of The Juran Institute.Resources:Berry LL, Bisognano M, Twum-Danso NAY, Awdish RLA. The Value — and the Values — of Listening. Mayo Clin Proc. 2025;100(9):1482-1486. doi:10.1016/j.mayocp.2025.06.002Abrahams R, Groysberg B. How to Become a Better Listener. Harv Bus Rev. 2021 Dec 21. Available from: https://hbr.org/2021/12/how-to-become-a-better-listenerEmail me:thespecialistgp@outlook.co.nzListen here: Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg
Perimenopause- early identification and intervention w Dr Megan Ogilvie.
How comfortable are you managing Mary? She’s 45, fit, still having regular periods, but struggling with poor sleep, anxiety and irritability. Is this stress or the start of perimenopause?Dr Louise Kuegler talks with reproductive endocrinologist Dr Megan Ogilvie about the early, often missed phase of the menopausal transition. Long before cycles become irregular, fluctuating hormones can drive mood change, worsening PMS and PMDD, migraines, joint pain and sleep disturbance, leaving many women feeling unlike themselves.We explore why perimenopause is a time of heightened mood vulnerability, who is most at risk, and how to recognise symptoms that do not fit the classic teaching.The discussion moves into practical, primary care management, including when to consider SSRIs, the combined oral contraceptive pill, menopausal hormone therapy, or cycle suppression, and how to navigate the growing interest in natural therapies safely and realistically.A clinically grounded, myth busting conversation designed to help you spot perimenopause earlier and treat with confidence.Practical clinical pearls:Early symptoms: Mood changes may precede menstrual changes; affect ~25% of women. Symptoms can mimic cardiology or rheumatology presentations.Alternative preparations: Have a limited role; use with caution and be aware of potential interactions.Combined oral contraceptive pill: Can provide both symptom control and contraception.Menopause Hormone Treatment: Use initially as a cyclical trial, then consider moving to continuous therapy after 6–12 months. Annual review once stabilised. Always consider ongoing contraception needs. Investigate abnormal PV bleeding.Consider newer agents and cycle suppression for PMS/PMDD: Seek specialist input if needed.Guest bio:Dr MEGAN OGILVIE Business Director at ERH Associates Subspeciality expertise in menopause, PCOS, athlete hormone health. PMS/PMDD, VSCs and gender-affirming medicine. Megan completed her endocrinology training in Auckland and then undertook a fellowship in London at St Bartholomew's and University College of London Hospitals. Since returning to New Zealand, Megan has worked in both general and reproductive endocrinology at Fertility Associates and at Auckland District Health Board, and now at ERH Associates. Megan has particular reproductive endocrine interests in menopause, polycystic ovarian syndrome, gender-affirming care, as well as athlete hormone health and energy deficiency. Megan was a founding member of WHISPA (a medical advisory board to High Performance Sport New Zealand, now disestablished) and has run training workshops for High Performance Sport NZ in the area of female athlete hormone health. Megan is the New Zealand representative on the board of the Australasian menopause society.Resources:https://www.menopause.org.au/images/stories/education/docs/AMS_Diagnosing_Menopause_Symptom_Score.pdfhttps://www.menopause.org.au/hp/information-sheets/perimenopauseMagraith K, Stuckey B, Baber R. Perimenopausal Hormone Therapy Assessment and Prescribing. Medicine Today. 2022 August (23):61-67Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. J Womens Health (Larchmt). 2019 Feb;28(2):117-134.Faculty or Sexual and Reproductive Healthcare. FSRH Guideline for women aged over 40 years. Contraception for Women aged over 40 years. FSRH Clinical Effectiveness Unit; 2017(Amended 2025. (To download: https://www.fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/)Email me:thespecialistgp@outlook.co.nzListen Here:Apple: https://podcasts.apple.com/nz/podcast/the-specialist-gp/id1845748299Spotify: https://open.spotify.com/show/3485r5V7iF251QH9dpnC1i?si=356c46bdbbf44219
Hooded eyelids w Dr Sid Ogra.
Dr. Louise Kuegler and Dr. Sid Ogra discuss the clinical presentation, implications, and management of hooded eyelids. They explore the functional and cosmetic concerns associated with this condition, emphasising the importance of proper assessment and referral pathways. Dr. Ogra shares insights on the surgical options available, the criteria for referral, and the long-term outcomes and patient satisfaction associated with eyelid surgery. The conversation highlights the often-overlooked functional component of hooded eyelids and the need for primary care physicians to recognise and address these issues.Practical clinical pearls:Ask about function, not just appearance. Patients may present for cosmetic reasons, but targeted questions about visual fields, eye strain, or difficulty with reading/driving often reveal functional impairment.(Function is more commonly impaired than you think and most patients with this issue present for functional reasons)Use simple examination tools. A visual field test, photographs, or even observing brow elevation can help demonstrate functional impact in primary care before referral.(All important markers of functional impact are easy to diagnose without special equipment)Document carefully. Insurers and specialists often require evidence of functional impact (e.g., reduced visual fields, visual obstruction) — clear notes and photos can strengthen a referral.Blepharoplasty has evidence-based benefits. Beyond cosmesis, studies show improvement in visual fields and patient-reported outcomes — it can be both functionally effective and cost-effective when appropriately indicated.Know your referral pathways. Many specialties perform this surgery, but referral for functional assessment should occur when there is any concern about impairment or underlying eye pathology.Guest bio:Dr Sid Ogra. MBChB, FRANZCO. Specialist in eyelid and tear duct disorders (Oculoplastics) – in adults and children. Specialist in Cataract surgery including premium lenses and correction options:Oculoplastic Fellowship, Hereford, UK 2019Observerships in Stanford (USA), and Seoul (South Korea)Sid is a well-established adult and paediatric eyelid specialist and also has a busy cataract surgery practice. He is also servicing Queenstown as well as most regions in Auckland.After graduating medical school (with distinction) in Auckland, Sid knew that Ophthalmology was the right fit for him. He completed his Ophthalmology training in Auckland, Rotorua, and Wellington, and was able to travel to the UK to further refine his skills in Oculoplastic surgery. Further experience followed at the prestigious Byers Eye Institute in Stanford, USA, as well as Samsung Medical Centre in Seoul, South Korea.He has a strong belief that doctors and patients must work together as a team to achieve the best results. This means empowering his patients with all the relevant knowledge, discussing the options, and coming to a decision together regarding the best fit for them.Resources:Domela Nieuwenhuis, I., Luong, K. P., Vissers, L. C. M., Hummelink, S., Slijper, H. P., & Ulrich, D. J. O. (2022). Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study. Aesthetic Surgery Journal, 42(4), 340–348. https://doi.org/10.1093/asj/sjab389An, S. H., Jin, S. W., Kwon, Y. H., Ryu, W. Y., Jeong, W. J., & Ahn, H. B. (2016).Effects of upper lid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis. International Journal of Ophthalmology, 9(9), 1320–1324. https://doi.org/10.18240/ijo.2016.09.15Email me:thespecialistgp@outlook.co.nzListen Here:Apple: https://podcasts.apple.com/nz/podcast/hooded-eyelids-w-dr-sig-ogra/id1845748299?i=1000747579880Or wherever you get your podcasts.#HoodedEyelids #Dermatochalasis #FunctionalEyelids #Ophthalmology #OculoplasticSurgery #Blepharoplasty