The Specialist GP

Perfectionism is common in medicine, where high standards, conscientiousness and a strong commitment to patients are valued. But when striving for excellence becomes an unrelenting need to get everything right, it can affect wellbeing, clinical practice and the ability to switch off. Dr Louise Kuegler is joined by Dr Sandra Spilg, Specialist GP, coach, mentor and professional supervisor, to explor...

People living with mental illness or substance use challenges experience significant inequities in physical health outcomes, with physical illness often diagnosed later or overlooked altogether. Diagnostic overshadowing where symptoms are attributed to an existing mental health, substance use, disability or a chronic health condition rather than investigated fully remains a major issue in healthca...

Kindness at work is not the same as being nice. In this special one-year anniversary episode of The Specialist GP, we welcome back the podcast’s very first guest, Dr Nicki Macklin, to explore kindness in healthcare, leadership and the supervisor–supervisee relationship. We explore what kindness really looks like when we are busy, under pressure and responsible for supporting other people’s learnin...

In one of my most challenging conversations of the year, Dr Diana Kopua asks us to slow down and look differently at ADHD. Equity CME poinst can be claimed. We meet Wiremu, a 22-year-old Māori man who comes to primary care with his auntie after his boss suggests he might have ADHD. He is struggling to stay focused at work and complete his apprenticeship theory, and it would be easy to move quickly...

Varicose veins are common presentation in primary care, but knowing who to reassure, who to investigate and who to refer isn't always straightforward. Today we are doing something different- we are going work through five real-world quick-fire cases to highlight practical assessment and management of VV’s. I am joined by Dr Sam Dunn. Practical clinical pearls: 1. Pregnancy- Treat the symptoms, not...

Frailty is a common but often under-recognised clinical syndrome that has significant implications for health outcomes in older adults. In this episode, we explore how frailty develops, who is most at risk, and why early identification matters. We discuss practical approaches to assessment in primary care, the consequences of frailty, and evidence-based strategies to help patients maintain functio...

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, appropria...

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...

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 l...

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 bot...

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 medi...

Who should receive vitamin D in pregnancy and infancy? We focus on risk identification, prevention strategies, and the clinical recognition of deficiency, including nutritional rickets. Vitamin D deficiency remains an important and preventable issue, particularly in at-risk populations. To explore this topic, we are joined by Professor Ben Wheeler, a Paediatric Endocrinologist and Paediatrician. P...

Dr Louise Kuegler and Dr Sid Ogra explore the assessment and management of eyelid lesions in primary care. They discuss a clinical case of a 67y female with a non healing lesion on the eyelid. Unpacking how to distinguish benign from malignant lesions, highlight key red flags such as non-healing or changing lesions, and emphasise the importance of early recognition and timely referral. The convers...

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 h...

What if that red, painful breast isn’t an infection — and antibiotics aren’t needed? Mastitis is now seen as a spectrum, often inflammatory rather than infective. Treating it as routine infection risks overprescribing and missing early, effective care. Talking to Lactation medicine physician Dr Yvonne Le Fort we unpack the case of Kim, a well 26-year-old female, three months postpartum with a tend...

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...

What if the rough, scaly patch you freeze in clinic today is just the visible part of widespread sun damage? Treating only what you can see may mean missing the bigger risk. We explore how recognising and treating the entire sun-damaged area reducing progression to squamous cell carcinoma and improve long-term outcomes. I’m joined by dermatologist and Mohs surgeon Dr Chin-Yun Lin , who shares prac...

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 Improvemen...

How comfortable are you managing Mary? She’s 45, fit, still having regular periods, but struggling with poor sleep, anxiety and irritability. Is this stress or the start of perimenopause? Dr Louise Kuegler talks with reproductive endocrinologist Dr Megan Ogilvie about the early, often missed phase of the menopausal transition. Long before cycles become irregular, fluctuating hormones can drive moo...

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 sa...

Decompression illness, an umbrella term that includes decompression sickness and arterial gas embolism which may occur after diving, aviation, and spaceflight. with Professor Simon Mitchell 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...

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 trainin...

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 chal...

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...

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 us...