In this episode of The Good GP, Dr Krystyna de Lange is once again joined by Dr Karen McGraith, for the second part of a two-part series focusing on the pharmacological management of osteoporosis. Dr McGraith is a member of the Medical and Scientific Advisory Committee with Healthy Bones Australia and the immediate past president of the Australasian Menopause Society.

They begin with a review of the clinical criteria for initiating pharmacological treatment in osteoporosis, highlighting the latest RACGP and Healthy Bones Australia guidelines. Outlining which patient groups should be considered for treatment, including those with minimal trauma fractures, based on T scores, and those assessed using FRAX risk calculations.

Providing insights into choosing between these treatments, taking into account the patient's age, fracture risk profile, comorbidities, potential adherence, cost, and PBS eligibility. Discussing risk-benefit considerations for each class of medication, as well as patient education, monitoring for side effects, and specific prescribing considerations such as dental health and renal function.

Dr McGraith addresses the importance of ongoing monitoring, including when to repeat bone mineral density testing, the rationale behind “drug holidays” for bisphosphonates, and the need for continuous therapy with denosumab. Highlighting key guidance points around therapy duration, transitioning between agents, and when to involve specialist care.

Links & Resources:

• Healthy Bones Australia fact sheets - https://healthybonesaustralia.org.au/your-bone-health/
• Australasian Menopause Society Practitioners Toolkit for the Management of Menopause - https://www.menopause.org.au/hp/information-sheets/practitioners-toolkit-for-management-of-the-menopause
• RACGP and Healthy Bones Australia Clinical Guidelines - https://healthybonesaustralia.org.au/health-care-professionals/guidelines-statements/

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, Dr Krystyna de Lange is joined by Tasmanian General Practitioner and medical educator Dr Karen McGraith for a two-part series on osteoporosis. Discussing on the current Australian approaches to osteoporosis screening, assessment, and diagnosis, with emphasis on practical considerations for GPs.

Dr McGraith outlines the latest guidelines from the RACGP and Healthy Bones Australia, including distinctions between population screening and case finding for osteoporosis. Providing criteria for bone density assessment, such as age thresholds, specific medical conditions, and medication use. Identifying patients with minimal trauma fractures is highlighted, as well as groups who may be at high risk due to factors like glucocorticoid use, early menopause, and various systemic diseases.

They also discussed the use of risk assessment tools, namely the FRAX and Garvan calculators, to better predict fracture risk in patients with non-modifiable and lifestyle-related factors. Dr McGraith also provides a clear overview on interpreting bone mineral density (BMD) reports, including the significance of T-scores and Z-scores and when to investigate for secondary causes of osteoporosis.

Dr McGraith emphasises patient education and non-pharmacological management strategies, including nutrition (adequate calcium and protein intake), vitamin D sufficiency, exercise (resistance, impact, and balance training), and falls prevention.

Links & Resources:

• Healthy Bones Australia fact sheets - https://healthybonesaustralia.org.au/your-bone-health/
• Australasian Menopause Society Practitioners Toolkit for the Management of Menopause - https://www.menopause.org.au/hp/information-sheets/practitioners-toolkit-for-management-of-the-menopause
• RACGP and Healthy Bones Australia Clinical Guidelines - https://healthybonesaustralia.org.au/health-care-professionals/guidelines-statements/

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Tim Koh speaks again with Dr Bhavesh Patel, a Queensland-based paediatric surgeon, about foreskin problems in boys, an area where general practitioners often face questions from families but might have limited training or exposure.

Dr Patel outlines the normal development of the foreskin, clarifying common misunderstandings around the expected age of retraction. He explains that full retraction occurs at a median age of 10.4 years, with wide normal variation, and describes how outdated perceptions have contributed to anxiety and misinformation among families.

Giving practical advice for parents regarding hygiene and caring for the foreskin, he emphasises avoiding forced retraction and outlining appropriate bathing routines. They identify normal findings such as the presence of smegma and occasional ballooning during urination, and distinguish them from signs that may indicate pathology.

Treatment options were also discussed, starting with conservative management such as topical steroid creams, highlighting a regime that achieves a high rate of success. Dr Patel also touches on the management of preputial adhesions and when to consider surgical intervention.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of This Could Save Your Life podcast, hosts Dr Catherine Bourke and Dr Anna Mullins delve into the importance of the four-year-old health check. The value of continuing care from pregnancy through the first five years of life and how these regular check-ups play a critical role in monitoring a child's health and development.

Anna and Catherine provide a detailed overview of the key components involved in a four-year-old health check. Including screening for developmental milestones across four major areas: gross motor function, cognition and fine motor skills, communication, and social and emotional development. They emphasise that early intervention helps in addressing any concerns that may arise during these assessments.

They also covered the physical examination aspect of the health check, focusing on ears, eyes, dental, growth charts for height and weight, and the importance of discussing bowel health with children and their families.

They share insights into preventative health measures for this age group, topics such as sun safety, sleep hygiene, screen time, physical activity, and the benefits of reading with children. Along with the significance of these measures in promoting long-term health and school readiness.

Links & Resources:

• https://raisingchildren.net.au/toddlers/nutrition-fitness/physical-activity/physical-activity-how-much
• https://raisingchildren.net.au/babies/play-learning/media-technology/screen-time

This Could Save Your Life Podcast is under The Good GP podcast, a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

In this episode of The Good GP, host Dr Tim Koh is joined by Dr Bhavesh Patel, a Queensland-based paediatric surgeon, to discuss the assessment and management of scrotal problems in boys, a common area of concern for general practitioners.

Dr Patel outlines the common scrotal issues encountered in newborns and children, including hydroceles, inguinal hernias, undescended testes, and varicoceles. He explains the typical presentations of these conditions and highlights key distinctions, such as the differences between retractile and undescended testes, as well as the nuances of diagnosing these conditions in a clinical setting.

Providing guidance on the natural history and management of hydroceles, saying that most hydroceles resolve without intervention within the first 1–2 years of life.

On the subject of undescended and retractile testes, Dr Patel advises on clinical assessment, the importance of careful examination, and when follow-up is necessary. They also address counselling parents regarding potential long-term risks, monitoring strategies, and indications for referral.

Additionally, they also covered the evaluation of inguinal hernias presenting as scrotal swellings and the differential diagnosis of other less common scrotal conditions, such as lymphatic malformations and testicular tumours.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Maria Li welcomes Dr Arthur Price, an immunologist based in Wellington, New Zealand, to discuss penicillin allergy—one of the most frequently reported and commonly misunderstood drug allergies in general practice.

Dr Price clarifies the true prevalence of penicillin allergy, explaining that while approximately 10% of patients admitted to hospital carry a penicillin allergy label, only about 10% of those actually have a genuine allergy. Emphasising that most patients with a penicillin allergy label can be safely de-labelled after proper assessment.

They address the typical presentations of penicillin allergy. Outlining three main patient groups: those who clearly are not allergic based on history (such as patients with only gastrointestinal side effects or late-onset rashes), those with uncertain or vague histories (including childhood reactions where details are unclear), and those with definitive immediate or severe delayed reactions (such as anaphylaxis or severe cutaneous adverse reactions like Stevens-Johnson syndrome). Dr Price provides practical advice on history-taking to help GPs risk stratify and identify true penicillin allergy, including key questions to ask about timing, symptoms, and the nature of the reaction.

Discussing the investigation and referral pathways for suspected penicillin allergy. Dr Price recommends that patients with unclear or potentially significant histories should generally be referred to an immunologist for assessment, rather than managed solely in primary care. He highlights the limitations of current tests and the importance of specialist input.

For general practitioners, Dr Price advocates a proactive approach to reviewing penicillin allergy labels and encourages considering referral for possible de-labelling where appropriate. They highlight the value of accurate documentation and patient education in ensuring safe and effective future care.

Links & Resources:

The ASCIA guidelines Arthur referred to in the podcast:

https://www.allergy.org.au/images/stories/hp/info/ASCIA_HP_Consensus_Penicillin_Allergy_2020.pdf

Aimed at immunologists, so while GPs may find it useful for context and interest, it’s not something intended for day-to-day practice in primary care

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Maria Li speaks with Dr Arthur Price, a clinical immunologist with expertise spanning food allergy and immunodeficiency, on the frequently overlooked condition known as oral allergy syndrome (OAS).

Dr Price begins by defining oral allergy syndrome as a mild form of food allergy where symptoms—typically oral itching—are limited to the mouth, lips, and throat following the consumption of raw fruits, vegetables, or certain nuts. He highlights the prevalence of OAS, noting that it affects up to 10% of the general population and is even more common among patients with hay fever and eczema.

Covering typical clinical presentations seen in general practice, commonly triggered foods (such as apples, stone fruits, and hazelnuts), and the distinct lack of systemic symptoms in classic OAS cases.

They provide practical advice on recognising OAS, taking a thorough history, and distinguishing it from more severe or systemic food allergies. Dr Price emphasises the importance of a clinical diagnosis and discusses why routine allergy testing is seldom indicated unless the case is atypical. They also talked about the management of OAS, the role of dietary avoidance, the use of antihistamines if symptoms do not resolve quickly, and reassurance regarding the very low risk of severe or life-threatening reactions.

Discussing the impact of food preparation (e.g. tolerance of well-cooked fruits vs. raw forms), when to consider referral to allergy specialists, and how to support patients in making sensible, evidence-based decisions about food avoidance while maintaining good quality of life.

Links & Resources:

• https://www.allergyuk.org/wp-content/uploads/2022/03/Oral-Allergy-Syndrome-v5.pdf
• https://www.allergy.org.au/patients/food-other-adverse-reactions/oral-allergy-syndrome
• https://www.bsaci.org/wp-content/uploads/2024/03/Pollen-Food-Syndrome-PIL.pdf

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Julia Rawlinson is joined by Dr David Manners, respiratory consultant and lung cancer and bronchoscopy subspecialist at Midland Hospital, to discuss the National Lung Cancer Screening Program launching across Australia on 1 July. To outline the rationale behind the new guidelines, highlighting that lung cancer remains the leading cause of cancer-related mortality in Australia, typically presenting at a late stage when curative treatment is less likely.

Dr Manners explains the evidence base for low-dose CT screening, referencing the US-based NLST and European Nelson studies, both of which demonstrated a significant reduction in lung cancer mortality among high-risk individuals. He also provides an overview of international screening efforts, comparing Australia’s rollout with programs in the US, Europe, and Canada.

Eligibility criteria for the Australian program are detailed: patients aged 50 to 70 years, with a smoking history of 30 or more pack years, and for ex-smokers, having quit within the past 10 years. The reporting pathway and follow-up guidelines for detected nodules are also covered, including the importance of family history in risk assessment.

They also covered why the Australian eligibility criteria were chosen, based on international evidence and local health economics analysis, and emphasises that the screening program is intended for asymptomatic individuals.

For further information and resources about the National Lung Cancer Screening Program, please refer to the resources below:

• CPD and training: https://lungfoundation.com.au/health-professionals/training-and-events/national-lung-cancer-screening-program-health-workforce-education/?utm_source=Google&utm_medium=PerformanceMax&utm_campaign=NLCSP_2025&utm_content=PMAX&gad_source=1&gad_campaignid=22441651848&gbraid=0AAAAABIcwmqPnfnhOcrfcfcgRcZryqtqb&gclid=EAIaIQobChMI-vuFxd-TjgMVtahmAh2vtAmiEAAYASAAEgLwK_D_BwE
• Programme Guidelines - pdf download: https://www.health.gov.au/sites/default/files/2025-04/national-lung-cancer-screening-program-guidelines.pdf
• Pack year calculator: https://www.mdcalc.com/calc/10187/pack-years-calculator

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.