The Good GP

In this episode of The Good GP, host Dr Kristiana Pederick welcomes Dr Justin Ng, a specialist cardiologist and electrophysiologist specialising in the diagnosis and management of arrhythmias. They discuss common presentations of bradycardia and how to distinguish between physiological and pathological low heart rates.

Dr Justin highlights red flags in the presentation, investigation, and general management of bradyarrhythmia, as well as the uses and limitations of wearable tracking devices, such as smartwatches.

They explore typical presentations of bradycardia, including syncope, near-syncope, reduced exercise tolerance, and cognitive decline in older adults. Dr Justin emphasises the importance of clinical context when distinguishing between physiological and pathological bradycardia, taking into account the patient's age, fitness level, symptoms, and the circumstances in which a low heart rate is identified.

They also discuss management principles, including reserving pacemaker implantation for symptomatic or irreversible cases. The importance of taking a thorough patient history and correlating symptoms with documented bradycardia is emphasised to help determine the urgency of management and guide further investigations.

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. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode of The Good GP, Dr Krystyna de Lange speaks with Dr Steph Daly, GP with a special interest in aged care and dementia, about the introduction of plasma biomarkers, specifically the p-Tau 217 blood test for Alzheimer’s disease. They explore what the p-Tau 217 test measures, its reliability, and its role in primary care.

Dr Steph Daly outlines that the test shows high positive and negative predictive value for Alzheimer’s pathology when used in the appropriate, symptomatic patient group, typically those over 55 presenting with clear cognitive or memory symptoms. Discussing the practical process for GPs to request the test, expected costs, and considerations for both urban and rural settings.

They emphasise the need for pre-test counselling, careful patient selection, and the importance of structured clinical assessment to ensure meaningful use of the test. The application of this biomarker in asymptomatic individuals is not recommended at present, due to limited clinical utility and potential psychological harm.

Listeners are encouraged to approach the test thoughtfully, seek additional education, and use it initially in patients where clinical suspicion of Alzheimer’s disease is already high.

Links & Resources:
Prognostic Value of Blood-Based P-Tau217 Levels for Progression to Cognitive Impairment study: https://jamanetwork.com/journals/jama/article-abstract/2851720
The Nun Study: Insights from 30 years of aging and dementia research: https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.14626
Link to webinar and information on biomarker study currently being carried out in Australia: https://www.australiandementianetwork.org.au/improved-extended-study-blood-based-biomarkers-for-alzheimers-disease-in-primary-care-project/

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. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode of The Good GP, host Dr Krystyna De Lange speaks with Dr David Leitinger, a GP with a special interest in addiction medicine, about the practical use of naltrexone for managing alcohol use disorder (AUD).

Dr Leitinger explains how naltrexone, an opioid antagonist, disrupts the endorphin-mediated reward of alcohol consumption, helping patients gradually reduce intake and unlearn habitual drinking behaviours. He highlights that naltrexone can be prescribed while patients are still drinking, not only during abstinence, and discusses flexible prescribing methods including daily dosing and the “Sinclair Method” of targeted dosing prior to drinking.

Important considerations covered include contraindications such as concurrent opioid use and the approach to temporary cessation if opioid analgesia is needed. Dr Leitinger reassures that naltrexone is generally safe in patients with liver disease and recommends baseline and follow-up LFTs, though testing should not be a barrier to therapy.

A case study illustrates practical patient outcomes, expectations, and follow-up. Strategies for supporting patients through lapses and individualising success measures are discussed, as well as where naltrexone fits alongside other first-line options like acamprosate. The value of harm reduction and ongoing patient support in primary care is emphasised.

Link & Resources:
AJGP article on naltrexone in alcohol use disorder: https://www1.racgp.org.au/ajgp/2026/january-february/naltrexone
Community Access to Pharmacotherapy for Alcohol (CAPA) EOI Form: https://forms.cloud.microsoft/Pages/ResponsePage.aspx?id=xMYIFZVfdU-KZ5mS34Mn6CJfQHBGKCREk2C2wuYgdyNUM0IzSDc4WTVXMkNGT1VXWkYxMlNGQ0FIVy4u&origin=QRCode
A 2-step reduction in WHO alcohol risk drinking levels (rather than abstinence) for harm reduction: https://pmc.ncbi.nlm.nih.gov/articles/PMC12739655/
Stronger evidence for the effectiveness of naltrexone: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2727384

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. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode of The Good GP, Dr Julia Rawlinson speaks with Dr Florence Martin, an epidemiologist specialising in pregnancy pharmacoepidemiology. Dr Martin discusses her recent study examining the relationship between first trimester antidepressant use and miscarriage risk, using UK primary care data from the CPRD GOLD database.

Dr Martin explains the definitions used for trimesters and miscarriage, and highlights the understanding confounding by indication; how underlying depression, rather than the use of antidepressants, may skew observed associations in raw data. After adjusting for confounding factors, her research found only a modest increase in miscarriage risk for women using antidepressants in the first trimester, with the absolute risk rising slightly from 13.1% to 13.6%.

She further outlines the difference in risk between women who were already taking antidepressants when becoming pregnant and those who started during the first trimester. The findings suggest no increased miscarriage risk for continuing users, while those newly starting medication may show a slight increase, potentially due to residual confounding or early pregnancy detection bias.

Dr Martin encourages GPs to communicate absolute risk clearly and to consider each patient’s context when discussing antidepressant use in pregnancy.

Link & Resources:
https://bjgp.org/content/75/761/e843

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. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode of the Good GP, Dr Julia Rawlinson speaks with Dr Julia Feutrill, consultant psychiatrist at King Edward Memorial Hospital and co-director of the Elizabeth Clinic. They discuss the complexities of antidepressant use during pregnancy, providing GPs with practical advice for navigating these conversations.

Covering key assessment considerations, such as the severity of illness, history of hormonal sensitivity, trauma, and family psychiatric history. Dr Feutrill stresses the need to treat symptoms to remission rather than opting for subtherapeutic dosing, highlighting the low absolute risk of congenital malformations from antidepressant medications, especially compared to other modifiable risk factors.

Sertraline is identified as the antidepressant with the most robust safety data for pregnancy. Examining neonatal adaptation syndrome and outlines current understanding regarding dose adjustments during pregnancy. Guidance is provided on managing abrupt discontinuation and when GP referral to psychiatry is appropriate.

Dr Feutrill also draws attention to the growing recognition of hormonal sensitivity’s impact on mental health and encourages GPs to consider hormonal and neurobiological factors in their assessment and management.

Link & Resources:
Mothersafe NSW - https://www.seslhd.health.nsw.gov.au/royal-hospital-for-women/services-clinics/directory/mothersafe
TGA - Obstetric drug information services - https://www.tga.gov.au/resources/health-professional-information-and-resources/australian-categorisation-system-prescribing-medicines-pregnancy/prescribing-medicines-pregnancy-database/obstetric-drug-information-services
Perinatal Mental Health Guidelines - https://www.cope.org.au/uploads/images/Health-professionals/COPE_2023_Perinatal_Mental_Health_Practice_Guideline.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. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!