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, FRANZCO

Ophthalmologist | Uveitis and Medical Retina Specialist

Rachael 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-screening

Green 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/ta543

Listen Here:

#GLP1 #EyeHealth #DiabetesCare

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 infective

What early management should prioritise

When antibiotics are actually needed

Red flags and when to escalate

Practical 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: Clindamycin
• Breast 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-spectrum

https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

https://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/guidelines

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:

1. HBOT has well-defined, evidence-based indications, and referrals should be made only to accredited facilities.
2. For decompression illness and arterial gas embolism, air or gas embolism, carbon monoxide poisoning, sudden acute hearing loss consider referring urgently for hyperbaric assessment.
3. Confirm the facility’s accreditation and safety protocols before referring.
4. Discuss suitability with a hyperbaric service early if in doubt.
5. 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.nz

Listen here:

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

Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

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:

1. What “field treatment” really means in everyday general practice
2. When to move beyond spot cryotherapy and treat the whole area of sun damage
3. How to choose between topical 5-fluorouracil, imiquimod, and photodynamic therapy
4. Preparing patients for treatment reactions and improving adherence
5. When to refer and when you can confidently manage in primary care

This 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 :

1. 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.
2. 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.
3. 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.
4. 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.
5. 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).
6. 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-keratosis

https://dermnetnz.org/cme/lesions/topical-treatment-of-photodamage

https://dermnetnz.org/topics/5-fluorouracil-cream

https://dermnetnz.org/topics/imiquimod

Guest 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.nz

Listen here:

Apple : https://podcasts.apple.com/nz/podcast/field-treatments-in-sun-damaged-skin-w-dr-chin-yun-lin/id1845748299?i=1000755425551

Spotify: https://open.spotify.com/episode/3CPztsA04YtvzodwM7s2AI?si=c3ed7ee2635f4f83

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.2025.06.002

Abrahams 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-listener

Email me:

thespecialistgp@outlook.co.nz

Listen here:

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

Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

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.pdf

https://www.menopause.org.au/hp/information-sheets/perimenopause

Magraith K, Stuckey B, Baber R. Perimenopausal Hormone Therapy Assessment and Prescribing. Medicine Today. 2022 August (23):61-67

Maki 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.nz

Listen Here:

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

Spotify: https://open.spotify.com/show/3485r5V7iF251QH9dpnC1i?si=356c46bdbbf44219

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 2019
• Observerships 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/sjab389

An, 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.2016.09.15

Email me:

thespecialistgp@outlook.co.nz

Listen Here:

Apple: https://podcasts.apple.com/nz/podcast/hooded-eyelids-w-dr-sig-ogra/id1845748299?i=1000747579880

Or wherever you get your podcasts.

#HoodedEyelids #Dermatochalasis #FunctionalEyelids #Ophthalmology #OculoplasticSurgery #Blepharoplasty

Practical clinical pearls:

Decompression illness is an umbrella term covering decompression sickness and arterial gas embolism occurring after diving, aviation, and even spaceflight.

Symptoms most commonly present immediately or with in the first hour of resurfacing.

Sick divers need urgent assessment including a thorough neuro examination.

First aid includes 100% oxygen, Non-steroidal anti-inflammatories and IV fluids and consider recompression.

Talk to a friend at the NZ Emergency diving services by calling 0800 433 711- they will advise next steps including the need for evacuation to a hyperbaric oxygen chamber.

If diving overseas consider joining DAN- Divers alert network, use their insurance and call them if you run in to trouble USA +19196849111

Guest bio: Simon Mitchell is an anaesthesiologist at Auckland City Hospital, a diving physician at North Shore Hospital (Auckland), 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:

Mitchell, Simon J, Michael H Bennett, and Richard E Moon. “Decompression Sickness and Arterial Gas Embolism.” Ed. by C. Corey Hardin. The New England journal of medicine 386.13 (2022): 1254–1264. Web.

Mitchell, Simon J et al. “Pre-Hospital Management of Decompression Illness: Expert Review of Key Principles and Controversies.” Diving and hyperbaric medicine 48.1 (2018): 45–55. Web.

https://www.nzunderwater.co.nz/emergency

https://dan.org/

Local healthpathways.

Email me:

thespecialistgp@outlook.co.nz

Listen Here:

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

In this episode, I’m joined by Dr Samantha Murton, Fellow of the Royal New Zealand College of General Practitioners (FRNZCGP). Together, we unpack what Fellowship really represents, why the title Specialist GP is so important, and how it sets us apart from general registrants or other health professionals.

We talk about the training pathway, the value of the title, and how recognition translates into patient trust and safer care. Sam also explores the international perspective — why family physicians in the UK are paid on par with hospital specialists — and asks why New Zealand still lags behind.

This conversation is a call to action: for GPs to proudly use their specialist title, for patients to understand its importance, and for all of us to advocate for recognition and pay parity in primary care.

In this episode we cover

• What FRNZCGP means and why it matters
• Why the title “Specialist GP” makes a difference
• The importance of distinguishing Specialist GPs from other health professionals
• The training pathway and what it represents
• How recognition impacts patient care and trust
• International comparisons: the UK vs New Zealand
• Why advocacy is crucial for the future of General Practice
• What we can each do to support the cause

Email me

• thespecialistgp@outlook.co.nz

Listen Here:

• Apple: https://podcasts.apple.com/nz/podcast/specialist-gp-why-recognition-matters-w-dr-samantha-murton/id1845748299?i=1000743708878
• Spotify: https://open.spotify.com/episode/1955idYIvAmXOyO9tuSMC2?si=QqgAmS_VSjGeGP_LedYnrQ

In this episode we cover:

1. Who is using oral nicotine products
2. Safety and harms
3. The role of oral nicotine in smoking cessation
4. A case discussion
5. Policy, advocacy, and guidance
6. Looking forward

Practical clinical pearls:

1. Know what’s out there – pouches and lozenges are on the rise.
2. Ask routinely – patients may use them alongside smoking or vaping.
3. Safer ≠ safe – risks include nicotine dependence, oral disease, and cardiovascular harm.
4. Evidence is limited – they don’t outperform proven NRT.
5. Advocate – clinicians and parents should push back against normalisation of nicotine and call for strong regulation.

Guest bio:

Dr Jude Ball is a senior research fellow affiliated to the ASPIRE Aotearoa tobacco control research centre University of Otago, HePPRU, and the Adolescent Health Research Group (the team behind the Youth 2000 survey series). She joined the Department in November 2014 with a background in critical psychology, health promotion and applied research. She completed a PhD in 2019 exploring the drivers of long-term trends in adolescent risk behaviour, in particular smoking, cannabis use, binge drinking and sexual behaviour. Her research focuses on the impact of the changing social context on youth trends, and the inter-relationships between smoking and other risk behaviours in young people. Alcohol and drug harm and mental health promotion are also areas of research interest.

Resources:

https://www.phcc.org.nz/briefing/oral-tobacco-and-nicotine-products-quitting-aid-or-teen-addiction-risk

https://www.phcc.org.nz/briefing/oral-nicotine-products-expanding-nicotine-marketplace

https://www.phcc.org.nz/briefing/can-oral-tobacco-and-nicotine-products-help-people-stop-smoking

https://www.phcc.org.nz/briefing/nicotine-pouches-and-young-people-evidence-aotearoa-new-zealand

https://vapefreekidsnz.org/

https://www.asthmafoundation.org.nz/resources/quit-vaping-reference-guide

Email me:

thespecialistgp@outlook.co.nz

Listen Here:

Apple: https://podcasts.apple.com/nz/podcast/oral-tobacco-and-nicotine-products-in-aotearoa-nz-w/id1845748299?i=1000742210847

Spotify: https://open.spotify.com/episode/2oubyAdg31qly39OtvfGLV?si=3YdIDBoJSDeZq7XhCP6rXg

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

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

Key Discussion Points

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

Practical Clinical Pearls

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

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

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

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

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

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

Clinician Wellbeing

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

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

Email: thespecialistgp@outlook.co.nz

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

In this episode we cover:

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

Practical clinical pearls:

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

Resources:

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

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

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

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

Email me:

thespecialistgp@outlook.co.nz

Listen here:

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

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

In this episode we cover:

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

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

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

• How pornography shapes expectations and behaviour

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

Practical Clinical Pearls:

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

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

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

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

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

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

Resources:

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

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

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

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

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

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

In this episode, we cover

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

Practical Clinical Pearls

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

Email me

1. thespecialistgp@outlook.co.nz

Visit our website

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

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

 In This Episode We Cover 

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

 Practical Clinical Pearls 

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

Listen here:

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

Contact me:

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