The Specialist GP

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 otherwise
Any 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 changing
HPV-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 parallel
If 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-up
Māori 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 prevention
The 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/e003800

Bio:
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...

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 individuals
2. 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 differentiate
3. 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 exercise
4. 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 REDs
5. 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-z
Everett 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/s40279-024-02130-0
Gould 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-1947-3174
Mountjoy 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-2023-106994
Listen here:
https://open.spotify.com/episode/5QdH4aQrAnt5weLop0pTqR?si=3155a7cc6fef4381
https://podcasts.apple.com/nz/podcast/underfueling-early-intervention-w-drs-megan-ogilvie/id1845748299?i=1000777449686

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=1000775543755
https://open.spotify.com/episode/51OZdA07VjFoAAgEIsXhoX?si=158e5ed969174f69

#glp1 #obesitymedicine #universityofauckland

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-latta
Krebs 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=1000773646680
https://open.spotify.com/episode/5hlyWpPXYAWbjNSdczRmtz?si=ae8f51c9e81741ee

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.html
Listen here: