The Pages section of GPnotebook comprises more than 30,000 concise, interlinked clinical reference articles, each focused on a specific primary care topic.
Welcome to the inaugural Aussie “in focus” email from GPnotebook. These monthly updates will come in digestible portions for busy clinicians, to help keep you in the loop about updates to the GPnotebook website.
As a busy GP myself, I often read updates over my lunch break – not an ideal habit, but it works for me. With that in mind, I’ll present each email in the form of a meal, including entrée, mains and dessert. You can watch, read and listen your way through.
Entrée (watch)
This short GPnotebook TV segment by Dr Lisa Devine reviews a research paper about monitoring type 2 diabetes in general practice. Lisa highlights the importance of using investigations judiciously, noting the risks associated with both over-testing (with potential for over-diagnosis) and under-testing (which may lead to missed diagnoses).
I particularly enjoyed this research paper because it is highly applicable to general practice. Too often as a GP I find that research does not apply to my patients; it is done in tertiary hospitals, or highly controlled settings, and does not account for the complexity of the “real world” of primary health care.
The researchers combined guidelines with “grassroots”, interviewing GPs to find out when and why tests are being ordered in the care of people with type 2 diabetes. I wonder if your own practice reflects their findings?
Mains (read)
“Could we do some hormone tests to see if I might be going through menopause?”: How many times have you heard this request? With an increasing awareness of menopause in the general community, we can expect more women to present wondering whether their various symptoms could relate to menopause.
The recent Medicare introduction of an item number for “women’s health checks”, and the addition of some menopausal hormone therapies to the Pharmaceutical Benefits Scheme, have also increased menopause in the consciousness of Aussie primary care clinicians. Unfortunately, it seems to have also boosted the number of non-clinicians who, often through social media, advertise blood tests and “tailored compounded hormone replacements”.
I’ve had patients who have spent hundreds of dollars having their hormone levels “checked” by unaccredited companies and providers. They are then told it will cost hundreds of dollars more to “balance” their hormones. At some point they decide to come in for a GP perspective. It is important for us to have the most up-to-date evidence about the place for blood tests in diagnosis or direct treatment of peri-menopausal symptoms.
This recently updated page on GPnotebook provides a helpful summary of the current evidence around checking oestradiol and follicle-stimulating hormone. Tempting as it may be to measure these, the article steps us through why it’s just not helpful.
In my experience, women are grateful to understand the reason behind me not ordering these tests. Once they are educated about the “why”, they find it easier to ignore the intuitive pull towards measurement through blood tests and are open to the range of other ways we can measure and monitor their health.
The final paragraph in the article notes more helpful and evidence-based strategies than measuring serum oestradiol levels.
Dessert (listen)
Perhaps not the most tasteful topic to address during “dessert”, but this highly relevant podcast episode on post-nasal drips by Dr Roger Henderson is well worth a listen. Post-nasal drip is such a common problem in Australia, especially from allergic rhinitis in springtime, that it can become easy to forget the wide range of other potential causes.
Roger reminds us that a post-nasal drip is a symptom not a diagnosis. Patients may present with a range of clinical features, including recurrent throat clearing, hoarseness, cough, sore throat and globus. His structured approach to evaluation is easy to follow and highly practical.
We owe it to our patients to consider less common causes, many of which can still be diagnosed by a thorough history-taking and examination, with no need for investigations. I appreciated the reminder to consider laryngopharyngeal reflux (with this, symptoms of heartburn are not always present), and to never ignore unilateral foul-smelling nasal discharge in a child.
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