The Specialist GP

Are GLP-1 receptor agonists putting your patients’ eye health at risk? Here’s what you need to know.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, FRANZCOOphthalmologist | Uveitis and Medical Retina SpecialistRachael 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-screeningGreen 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/ta543Listen Here:#GLP1 #EyeHealth #DiabetesCare

Hyperbaric oxygen therapy (HBOT) which is used across a wide range of acute and chronic conditions, but for most clinicians, it remains something of a mystery outside of diving-related emergencies.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:HBOT has well-defined, evidence-based indications, and referrals should be made only to accredited facilities.For decompression illness and arterial gas embolism, air or gas embolism, carbon monoxide poisoning, sudden acute hearing loss consider referring urgently for hyperbaric assessment.Confirm the facility’s accreditation and safety protocols before referring.Discuss suitability with a hyperbaric service early if in doubt.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.nzListen here: Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

Do we really hear our patients? Or just listen long enough to respond? In today’s fast-paced clinics, true listening is often the first casualty. Yet it’s far more than courtesy: it’s a clinical tool that builds trust, uncovers what matters most, improves outcomes, and even protects clinicians from burnout.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.2025.06.002Abrahams 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-listenerEmail me:thespecialistgp@outlook.co.nzListen here: Apple : https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybg

Dr. Louise Kuegler and Dr. Sid Ogra discuss the clinical presentation, implications, and management of hooded eyelids. They explore the functional and cosmetic concerns associated with this condition, emphasising the importance of proper assessment and referral pathways. Dr. Ogra shares insights on the surgical options available, the criteria for referral, and the long-term outcomes and patient satisfaction associated with eyelid surgery. The conversation highlights the often-overlooked functional component of hooded eyelids and the need for primary care physicians to recognise and address these issues.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 2019Observerships 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/sjab389An, 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.2016.09.15Email me:thespecialistgp@outlook.co.nzListen Here:Apple: https://podcasts.apple.com/nz/podcast/hooded-eyelids-w-dr-sig-ogra/id1845748299?i=1000747579880Or wherever you get your podcasts.#HoodedEyelids #Dermatochalasis #FunctionalEyelids #Ophthalmology #OculoplasticSurgery #Blepharoplasty

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 coverWhat FRNZCGP means and why it mattersWhy the title “Specialist GP” makes a differenceThe importance of distinguishing Specialist GPs from other health professionalsThe training pathway and what it representsHow recognition impacts patient care and trustInternational comparisons: the UK vs New ZealandWhy advocacy is crucial for the future of General PracticeWhat we can each do to support the causeEmail methespecialistgp@outlook.co.nzListen Here:Apple: https://podcasts.apple.com/nz/podcast/specialist-gp-why-recognition-matters-w-dr-samantha-murton/id1845748299?i=1000743708878Spotify: https://open.spotify.com/episode/1955idYIvAmXOyO9tuSMC2?si=QqgAmS_VSjGeGP_LedYnrQ

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 PointsCurrent suicide data and inequities across age, gender, and ethnicityThe most common risk factors and protective factors in suicide preventionHow to conduct a safe, empathic, and thorough risk assessmentWhen and how to involve specialist mental health servicesSupport options for clinicians following patient suicide or distressing eventsPractical Clinical Pearls1. 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 WellbeingCaring 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.nzAoake te Rā – free counselling for people bereaved by suicide | 0800 000 053 | www.aoaketera.org.nzAfter a Suicide NZ – www.afterasuicide.nzEmail: thespecialistgp@outlook.co.nzWebsite: https://www.thespecialistgp.co.nz/

What are the realities of sexting and porn exposure among young people — what’s normal, what’s harmful, and how clinicians can respond with empathy and insight. To help unpack this, Dr Louise Kuegler is joined by Dr Claire Meehan, Senior Lecturer in Criminology at the University of Auckland. Through a real case, we discuss what happens when intimate images are shared without consent, and how to guide conversations that move beyond shame and fear toward trust, consent, and safety.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 consentPractical 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 onlinehttps://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.

Episode Overview  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/id1845748299Spotify: https://open.spotify.com/episode/33slefeXuzUH3coNCiWQ49?si=oRH4uIa4QnuxMfkIJ7sybgContact me:https://www.thespecialistgp.co.nz/