The Specialist GP

In this episode, we talk with Professor Simon Mitchell about decompression illness, an umbrella term that includes decompression sickness and arterial gas embolism which may occur after diving, aviation, and spaceflight. We explore what happens in the body during these conditions, the key risk factors, and how they can present with sometimes subtle and nonspecific symptoms. Simon discusses how to recognise and assess those who may have decompression illness, the role of investigations, and the principles of treatment including recompression and hyperbaric oxygen therapy. We also cover who to call, what to expect in the management pathway, and clinical pearls for primary care and emergency clinicians.
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.
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Episode overview
What does it mean to be a Specialist GP — and why does it matter?
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

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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

Dr. Louise Kuegler discusses the rising prevalence of oral tobacco and nicotine products, particularly among youth in New Zealand, with Dr. Jude Ball. They explore the differences between oral tobacco and nicotine products, their usage patterns, safety concerns, and the implications for public health. The conversation also touches on the role of these products in smoking cessation, regulatory challenges, and the need for further research in this area.
In this episode we cover:
Who is using oral nicotine products
Safety and harms
The role of oral nicotine in smoking cessation
A case discussion
Policy, advocacy, and guidance
Looking forward

Practical clinical pearls:
Know what’s out there – pouches and lozenges are on the rise.
Ask routinely – patients may use them alongside smoking or vaping.
Safer ≠ safe – risks include nicotine dependence, oral disease, and cardiovascular harm.
Evidence is limited – they don’t outperform proven NRT.
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

Episode Overview
Suicide continues to be a major public health issue in Aotearoa New Zealand, touching every clinician working in primary care. General Practice is often the first, and sometimes only, point of contact before a suicide attempt — meaning GPs are uniquely placed to identify risk, provide support, and intervene early.
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: [email protected]
Website: https://www.thespecialistgp.co.nz/

Dr Louise Kuegler and Professor Ian Reid explore osteopenia—what it means, why it matters, and how it fits into fracture prevention. Drawing on the latest evidence, including Prof Ian Reid’s and Prof Mark Bolland's work, we discuss diagnosis, lifestyle strategies, treatment thresholds, and patient-centred approaches to protect bone health and prevent future fractures. An update for Zolendronate use is also discussed especially in the context of osteopenia.
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:
Aim for a BMI >20 to protect long-term bone health. Educate adolescents and young adult women that being underweight increases lifetime fracture risk.
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.
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).
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).
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
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Listen here:
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