Speaker 1: Hello, I'm Francesca Rudkin and I'm Louise Area. And this
Speaker 1: is season four of our New Zealand Herald podcasts The
Speaker 1: Little Things, a podcast where we have common sense conversations
Speaker 1: about women's wellbeing at all ages and stages.
Speaker 2: And today we are going to take a close look
Speaker 2: at someone we see a little or a lot, depending
Speaker 2: on that age and stage. So a GP visit can
Speaker 2: be as simple as a fifteen minute appointment to establish
Speaker 2: maybe if you saw throat, who's a viral or bacterial infection,
Speaker 2: But it is sometimes a start of a long and
Speaker 2: difficult pathway of diagnosis and treatment and hopefully recovery for
Speaker 2: anyone of gosh many illnesses and injuries that could befall us.
Speaker 1: I mean, how many times have you got we're not
Speaker 1: going to go because they're just going.
Speaker 3: To tell me it's viral.
Speaker 2: Oh well, yeah, that's true a lot all the time.
Speaker 2: But that's finally sunken now and she's right and it's
Speaker 2: all been okay, touch.
Speaker 1: Work, that's right. So the GP is our go to
Speaker 1: when something's up for us or obviously I loved ones
Speaker 1: and I think Francisca we're both been quite lucky. Our gp'
Speaker 1: has been with us for many, many years. Yeah, like
Speaker 1: pre kids, through the reproductive years and beyond.
Speaker 3: I think I was twenty five when I started going
Speaker 3: to my.
Speaker 1: Think you know I was about to say, yeah, yeah,
Speaker 1: I started.
Speaker 3: Going to my GP. She's not loved to retire until I.
Speaker 1: The thing, right, they're going to retire, They're probably going
Speaker 1: to be older the last one we start seeing them.
Speaker 1: So at some point mine did retire. But I was
Speaker 1: really lucky because she had a daughter who's a GP
Speaker 1: who talk over her practice and she's divine, so that
Speaker 1: comfort and continuity is something with you know, a lot
Speaker 1: of us have had in our GP, and it's a
Speaker 1: relationship though that we still might take for granted. I
Speaker 1: think at times, Look.
Speaker 2: I've been pretty lucky in my life. I haven't had
Speaker 2: to go to the doctor an awful lot. But I
Speaker 2: think since hitting peri menopause, I've come to value my
Speaker 2: doctor even more because there's just so many mysterious aches
Speaker 2: and pains and symptoms that are more than likely peri menopause,
Speaker 2: but you shouldn't just presume they are, Like, it's really
Speaker 2: important to still make sure it's not something else. And
Speaker 2: that's something that my GP is very open to and
Speaker 2: very good at you know, she'll treat everything seriously and
Speaker 2: won't just sort of say, oh, that'll be agent stage.
Speaker 2: Inevitably it is just agent stage, which is good, Which
Speaker 2: is good, But I do worry that she might be
Speaker 2: getting a little bit sick of me, now, you know.
Speaker 3: I mean we do.
Speaker 1: Every single guest we've had it's talked about menopause has
Speaker 1: really reiterated that go if it's something that's bothering you,
Speaker 1: you know, it still might be something you can get
Speaker 1: some relief from.
Speaker 3: Of course, your GP was with.
Speaker 2: You when you would well you know, she was very
Speaker 2: much with you when you were diagnosed with breast cancer.
Speaker 1: Yeah so she which is yeah, she's a major, she's
Speaker 1: your first person. Right you go to hear you you're
Speaker 1: hoping she's going to say what you want to hear.
Speaker 1: And she did. She said, this is too big to
Speaker 1: be a chairman, this is a sist. But she did
Speaker 1: see me on the right clinical pathway anyway from Mamma
Speaker 1: GRAMM and ultra sound, which I was only just do
Speaker 1: for and then yeah, we're not too about out to
Speaker 1: be a big mean tripling itt of tumor. I was
Speaker 1: a bit cross with her, which was not fair, you know,
Speaker 1: shooting the messenger, But we were genuinely both a bit devastated.
Speaker 1: I mean, imagine she had to tell me, you know,
Speaker 1: forty four mother of three. Absolutely, it was just horrendous.
Speaker 1: But I remember her face as we discussed it, and
Speaker 1: it was clear that the diagnosis was a surprise to
Speaker 1: her too, so so our GPS can still be surprised.
Speaker 1: She sent me on the right clinical pathway so fast
Speaker 1: my head spun, and as awful as it was, having
Speaker 1: here in my corner was invaluable.
Speaker 2: And I presume that you know, as you go through
Speaker 2: that journey, you're engaging with lots of different specialists along
Speaker 2: the way, but you still come back to your GP, right,
Speaker 2: you still come back. That's that's that person that's there
Speaker 2: in the long run for you.
Speaker 1: And she still came back to me. You know, she'd
Speaker 1: check in with me, she'd given me a call or
Speaker 1: send me a message or something. And you know, that's
Speaker 1: the genuine joy of a good relationship with your GP.
Speaker 3: Absolutely.
Speaker 2: And the thing about GPS is I might be able
Speaker 2: to you might visit and they can to tap you
Speaker 2: on the spot and off your head home and you
Speaker 2: don't think about things again, or you end up on
Speaker 2: the kind of health journey like you went on, lou
Speaker 2: But they really are there for us in the best
Speaker 2: and worst of times. But do we really understand their
Speaker 2: role in our well being? And do they understand us
Speaker 2: and what we expect or.
Speaker 3: Want from them.
Speaker 1: It might be a bit of a mystery to try
Speaker 1: and answer these questions, though, we as well as pick
Speaker 1: her brain for some health advice. We've invited a GP
Speaker 1: A general practitioner, Doctor Preyer Alexander, on the pod today.
Speaker 1: Doctor Preyer is passionate about sharing accurate health information. I've
Speaker 1: listened to a lot of her podcasts. She hosts the
Speaker 1: Happy to Health podcast, and she's the author of a
Speaker 1: couple of books. Dr Preyer Alexander, thanks for joining us today.
Speaker 4: Thank you for having me.
Speaker 1: So prayer on researching today, it became clear to us
Speaker 1: that general practice is probably a little bit more complex
Speaker 1: than we fully realized. You know, having years and years
Speaker 1: of having visited one, I still was surprised at some things.
Speaker 1: When I was doing a bit of research, I was
Speaker 1: ready to fire off lots of general health questions and
Speaker 1: we will get to some of those. But first, if
Speaker 1: we could like just a bit of a view of
Speaker 1: what general practice is, Like, what do you want people
Speaker 1: to know about general practice and seeing the doctor?
Speaker 4: Where to begin? And I'm glad you said that because
Speaker 4: I think a lot of people don't realize the breadth
Speaker 4: of what we do. I think it's important to say
Speaker 4: that GPS do literally everything. So that's why I entered
Speaker 4: the profession, because I kind of wanted to not give
Speaker 4: up on pediatrics or older patients or preventative medicine. And
Speaker 4: so where's GPS. We'll see children. We do six week
Speaker 4: checks postpartum for mum and baby. We do vaccinations for
Speaker 4: all age groups. I look after them parents then their parents,
Speaker 4: so you know, grandparents, people with osteoporosis, dementia, diagnosis. I'm
Speaker 4: supporting people through fertility, journey, through pregnancy, through miscourage, through
Speaker 4: termination of pregnancy. I'm talking about contraception and bone health
Speaker 4: and bow cancer. So we do everything. I think that's
Speaker 4: what I love people to know that we are the
Speaker 4: experts in kind of everything, and we know a little
Speaker 4: bit about most things, and if we need help, we
Speaker 4: can always call it in and refer you to a
Speaker 4: non GP specialist. But we're also the people who do prevention,
Speaker 4: Like there's no one who does preventative medicine like GPS,
Speaker 4: where they're preventing dementia, preventing heart disease, preventing breast cancer,
Speaker 4: cervical cancer. We're doing the screening test, We're talking to
Speaker 4: people about diet, physical activity, you know, stress management, all
Speaker 4: of this stuff. And so it really is such a
Speaker 4: rewarding but incredibly exhausting job. I love it, but we
Speaker 4: get to see everybody. I never know what's coming through
Speaker 4: the door, which keeps it very exciting. But often I
Speaker 4: have no way and I say to patients, I don't
Speaker 4: know what this is. I know it's not terrible. Let's
Speaker 4: catch up in four to six weeks and see how
Speaker 4: things have moved. But we just we don't have all
Speaker 4: the answers. But that's what keeps it exciting.
Speaker 2: So, Priya, I'm not very good at going to the GP,
Speaker 2: and by the time I get there, I tend to
Speaker 2: have a couple of things on my list. So how
Speaker 2: do you feel when people walk kind and go I've
Speaker 2: got a little bit of a list for you.
Speaker 4: Look, I think it's good because it means the patient's
Speaker 4: thought about it before coming into the consulting room, and
Speaker 4: there's actually research that suggests people do a lot of
Speaker 4: planning and thinking before they come and see us. The
Speaker 4: thing with a list is honestly as a GP, if
Speaker 4: you've got a couple of things, book a double give
Speaker 4: us time to actually work through the list and give
Speaker 4: the problems the time they need and deserve. Sometimes I
Speaker 4: say to people, and it's few too many things for
Speaker 4: a single console. I think we need to put these
Speaker 4: really priority things on for today and let's delegate issues three,
Speaker 4: four and five to another console if you're happy to
Speaker 4: come back with the list. What I tend to do
Speaker 4: is the GP. And this is what you mentors have
Speaker 4: suggested to me through teaching, is I try and get
Speaker 4: it off you. So when you say I've got a list,
Speaker 4: I go, Can I hear the list before we even
Speaker 4: get into it. Can I get the list and write
Speaker 4: it down? Because sometimes what you've done is you've gone,
Speaker 4: this is really important to me. But the chest pain
Speaker 4: that I've been having on and off, I'm going to
Speaker 4: mention that at the end, Whereas I want to know
Speaker 4: about the chest pain first and put it to the top.
Speaker 4: And so you might find the GP kind of going, oh,
Speaker 4: can I hear the list first before we get into
Speaker 4: all the nitty gritty And that's because we're trying to
Speaker 4: triarge and time manage and there's so many things going
Speaker 4: through our brain that I just want that list so
Speaker 4: I can figure it out.
Speaker 1: Do you know what? That is?
Speaker 3: So true with that list.
Speaker 2: There's been a couple well, there's been things on it
Speaker 2: which I didn't think were all that important, and I
Speaker 2: might have just thrown it in at the end of
Speaker 2: the not went oh okay, maybe you should have started
Speaker 2: with that, and I'm like, oh, oh okay, sorry about that.
Speaker 1: I'm the opposite. I don't make a list and then
Speaker 1: I go for what it was acute, and then I
Speaker 1: walk out and go, oh, man, I should have mentioned that.
Speaker 4: You know, so this can be good because then you
Speaker 4: don't forget those little things like patients will go on
Speaker 4: my list. I've got cervical cancer screening. I'm up to date,
Speaker 4: and they go, no, you're not. Let's get that up
Speaker 4: to date. Let's tick that one off.
Speaker 1: Some of them will be easy, some of them will
Speaker 1: be harder. I've heard you talk about the Golden Minute
Speaker 1: in terms of gpre pratics. Can you tell us what
Speaker 1: that is and how why it's important.
Speaker 4: I can now it's definitely not my thing. The golden
Speaker 4: minute is described in research and my mentor Dodor Andy Morgan,
Speaker 4: who's an amazing GP now retiredly came on my podcast
Speaker 4: to talk about the Golden minute and it changed the
Speaker 4: game for lots of people listening. But essentially, it's that
Speaker 4: minute where you come into the consulting room and you
Speaker 4: get out the crux of the issue. It's the first
Speaker 4: minute and ideally it should be uninterrupted with empathetic listening
Speaker 4: from the GP, with kind of eye contact nodding, but
Speaker 4: no verbal interruption ideally, and it's a really powerful minute because,
Speaker 4: as Andy describes it, it really gives you the crux
Speaker 4: of the issue. Most of the time after the minute
Speaker 4: of the patient going I've had this lightheadedness. It tends
Speaker 4: to happen when I get out of bed. I've noticed
Speaker 4: it for about three weeks since the weather's been warmer.
Speaker 4: In that minute, I'm going, this is postural hypotension due
Speaker 4: to a weather change because it's hotter, and probably a
Speaker 4: bit of dehydration. So it's very powerful for the practitioner
Speaker 4: because we get all these little bits and bobs, but
Speaker 4: it's very powerful for the patient because they feel heard,
Speaker 4: uninterrupted and they get their time. And so yeah, that
Speaker 4: is the golden minute. But if you look at studies,
Speaker 4: most of the time patients get interrupted within about I
Speaker 4: think it's eighteen seconds.
Speaker 1: Yeah, because I mean you think about it, it's only
Speaker 1: one fifteenth of a consult, right, you know, it's really
Speaker 1: not that much time. But the patient feels seem heard
Speaker 1: and listened too. And I guess my thing is, yes,
Speaker 1: So if we're not getting that, if we're going to
Speaker 1: our GP and they are typing away or not looking
Speaker 1: at us, what can we do as a patient?
Speaker 4: Well, I think you've got options. I think if you
Speaker 4: feel comfortable enough and it takes some courage, I can
Speaker 4: understand that. And you need to have a good enough
Speaker 4: therapeutic relationship. You can say, hey, you know, I really
Speaker 4: feel like I need a little bit more here, do
Speaker 4: you mind if we just talk this through before you
Speaker 4: start typing? So sometimes you could actually talk to the GP,
Speaker 4: and I think often the GP might go I had
Speaker 4: no idea, So this teaching might not be across the board.
Speaker 4: Maybe the GP hasn't heard about it or other health professional.
Speaker 4: The other thing is if you you know, I think
Speaker 4: if you're going into a consult and you're having this
Speaker 4: thing where you're going, I don't think I'm being seen
Speaker 4: and heard. I don't feel like, you know, this is
Speaker 4: my safe place. I'm leaving the consulting room not feeling
Speaker 4: very validated. Maybe with more questions that are unanswered, you
Speaker 4: can try another GP. I think people are really nervous
Speaker 4: to do that, and we don't mind. We don't mind
Speaker 4: if you don't see another GP. Feel empowered because I
Speaker 4: have tried four or five until I've landed on someone
Speaker 4: where I go this person treats me not like a doctor,
Speaker 4: and actually, you know, treats me like a patient. It's
Speaker 4: taken me four or five to get Then I don't
Speaker 4: feel guilty. I'm like, no, you're not the one for me.
Speaker 4: You might be fantastic for other people that you're not
Speaker 4: the one for me, So don't feel guilty about it.
Speaker 4: You don't need to say to the GP, just sltting
Speaker 4: you know. I'm going to go and just go for it.
Speaker 4: Ask your friends who do you see? What's the consult like?
Speaker 4: Do they listen to you? Are they typing away? What's
Speaker 4: the consulting room like? All those things, ask your friends,
Speaker 4: go and try a few options.
Speaker 2: It's interesting you say that because I moved and I thought, gosh,
Speaker 2: I need to find a GP. Maybe that's a little
Speaker 2: closer to home for my children when they were young.
Speaker 3: So I did that.
Speaker 2: I went and got all the recommendations. Every single doctor
Speaker 2: I got a recommendation for I rang those clinics and
Speaker 2: the lists were shut, and you were like, oh, you're joking. Okay,
Speaker 2: so you know, I sort of a bit stuck.
Speaker 4: I know that's Look, it's a tricky one. Often the
Speaker 4: people that are being highly recommended are after so it
Speaker 4: makes it difficult sometimes though, So if you go online
Speaker 4: to book with me, the books are shut. But I
Speaker 4: do have other avenues in which people can get in.
Speaker 4: So I think call the practice manager or reception and
Speaker 4: just ask, you know, does it look like they're taking
Speaker 4: any new patients? How do new patients get on the books?
Speaker 4: You know, is there a month that the books are
Speaker 4: going to open? Because there are off and things happening
Speaker 4: behind the scenes. But you've got to make the phone call.
Speaker 2: And I suppose you could also say to them, hey, look,
Speaker 2: is there another GP there who could see me, who
Speaker 2: works in the same way and sort of has a
Speaker 2: similar I don't know approach to practice as the doctor
Speaker 2: I wanted to get into. I suppose you just have
Speaker 2: to keep asking questions, don't you.
Speaker 4: Yes, you do. That's what I do, though, I would
Speaker 4: ask them, is there someone who's similar, because at my
Speaker 4: clinic there is a GP who's quite similar, you know,
Speaker 4: not identical, but you know, I say to my patients
Speaker 4: if I'm not here, this is the person I would
Speaker 4: go and see. And a lot of patients got, oh,
Speaker 4: I really like them. Some people will move there. They're
Speaker 4: easy to get into. I can get in on the
Speaker 4: day with my kids because I don't tend to have
Speaker 4: that on the day availability. So yeah, I think that's
Speaker 4: a great way to do it, to ask if there's
Speaker 4: someone kind of the same ILK.
Speaker 1: Certainly within our practice it's hard to see sometimes it's
Speaker 1: hard to see your primary providers. So depending on what
Speaker 1: the issue is, if it's a pretty straightforward thing, you know, oh,
Speaker 1: it doesn't matter who I see in the practice, that
Speaker 1: ethos is kind of similar, and I know that they'll
Speaker 1: refer back if there was anything else. I was diagnosed
Speaker 1: with breast cancer two thousand and craky sixteen and it was.
Speaker 1: It was terrible shock for my GP as well as
Speaker 1: myself because it wasn't what she was expecting it to be.
Speaker 1: But when the real tough thing for somebody is waiting
Speaker 1: for results, right, And I've also heard you talk about
Speaker 1: the power of time, and my surgeon also like there
Speaker 1: may or may not be a time where we will
Speaker 1: have all the information. How do you manage that with
Speaker 1: a patient? Because the anxiety is off the charts.
Speaker 4: It is. And I'm sorry to hear about your diagnosis,
Speaker 4: but you're so right that the you're okay.
Speaker 1: Now, she's good, one boot down, but I'm good, You're good.
Speaker 4: Look that uncertainty, that time waiting can be incredibly anxious,
Speaker 4: confusing time for patients. And I've got a couple of
Speaker 4: patients who've been through very tumultuous, traumatic weights. You know,
Speaker 4: waiting for the amniocentesis result is a congenital abnormality in
Speaker 4: this baby that is going to be life changing. Waiting
Speaker 4: for genetic results, you know, do I hold the same
Speaker 4: genes as my mother? And will I need to have
Speaker 4: a mastectomy and a hysterectomy, and I'm of childbearing age.
Speaker 4: Waiting weeks for those results, weeks or like you would
Speaker 4: have had, you know, waiting for your biopsyr results. This
Speaker 4: isn't this and it takes time, and you're going, how
Speaker 4: does the pathologist take that long? It is And I
Speaker 4: actually see patients in that anxious waiting time, and I
Speaker 4: just focus on all the strategies that we have to
Speaker 4: try and help the brain, you know, manage the stress.
Speaker 4: And it's nothing sexy or fancy. It's like, you know,
Speaker 4: can we be out in nature, physical activity, reduce the caffeine.
Speaker 4: Are we getting any sleep? Can I support you in
Speaker 4: any other way? Can we bring the brain to the
Speaker 4: present so it's not ruminating on what if, what if?
Speaker 4: What if? And going on, oh my gosh, what did
Speaker 4: I do to cause this? How I cause the cancer?
Speaker 4: How do we bring the brain to the presence of
Speaker 4: mindfulness meditation using apps? And I just say to patients,
Speaker 4: let's not enter the black hole. Let's just stay here,
Speaker 4: and let's just not go into the wad if black
Speaker 4: hole and just look straight in front of us, which
Speaker 4: is we just need to survive till tuesday, and on
Speaker 4: Tuesday we have that appointment for the results. It's just
Speaker 4: baby steps, and some of my consults are just supporting
Speaker 4: people through that. It's not easy.
Speaker 2: It's that whole thing about saying, you know, if there's
Speaker 2: nothing to worry about, don't worry.
Speaker 3: We'll worry about something.
Speaker 4: When we have.
Speaker 3: Something to worry about, you know, we have the information.
Speaker 2: That's when we can we can start worrying and also
Speaker 2: start doing something about it. And I wonder too, if
Speaker 2: it's really difficult for patients who feel like there is
Speaker 2: something wrong but we can't get to the bottom of it,
Speaker 2: and they're coming to a GP for a diagnosis and
Speaker 2: not really getting anywhere. You know what I mean, you
Speaker 2: could do what you mentioned there is go and get
Speaker 2: a second opinion. What advice do you have to those
Speaker 2: patients who really feel that there is something in miss
Speaker 2: but can't quite we can't get to the bottom of it.
Speaker 4: That's tricky, and I think you need a really good,
Speaker 4: strong GP in your passenger seat where you on a
Speaker 4: journey like that, someone who can nut it out with you.
Speaker 4: And sometimes when you can't get to the bottom of
Speaker 4: a problem. And again my mentor talks about that on
Speaker 4: my podcast about some there are some problems with no bottoms,
Speaker 4: some problems just we just never quite figure out that
Speaker 4: tingle in the left hoole on a Tuesday. I just
Speaker 4: I can't pinpoint it. And so for some people, the
Speaker 4: reassurance of this is nothing nasty. I don't know what
Speaker 4: it is, but I've excluded all the nasty things is enough.
Speaker 4: For some it might not be. But I think having
Speaker 4: a really strong therapeutic relationship with the person in the
Speaker 4: passenger seat, the GP on the journey is important. You've
Speaker 4: got to trust them, You've got to feel validated and heard,
Speaker 4: and you're right. Second opinions can be really important. It's
Speaker 4: not uncommon for me to say it or patient I
Speaker 4: reckon it might be worth seeing another GP here because
Speaker 4: I'm feeling out of my depth. I know, I don't
Speaker 4: know if I've got the kind of crux of this issue.
Speaker 4: And a fresh set of eyes can be incredibly powerful.
Speaker 4: And it's not a slight on me. You know, I
Speaker 4: don't have all the answers, and sometimes my mind is
Speaker 4: on one track and I go I didn't even think
Speaker 4: about ankializing spondelitis for this back paint. Thank goodness, I
Speaker 4: got a fresh set of eyes, because that's changed the
Speaker 4: whole journey here and we've actually got you know, interventions
Speaker 4: now that are yielding benefit. But look, I would say
Speaker 4: it's not easy for people who've got kind of a
Speaker 4: constellation of symptoms where you're going, I just want to
Speaker 4: put my finger on it. I'm just acknowledging that it's
Speaker 4: not always easy for either the patient or the health
Speaker 4: professional trying to support you.
Speaker 1: Do you get as worried as we do when you're
Speaker 1: running behind on a consult?
Speaker 4: Yes, so I do. Yesterday I ran what thirty minutes?
Speaker 4: I never run thirty normally fifteen. I consider fifteen still
Speaker 4: within with.
Speaker 1: ID two, I can live at fifteen.
Speaker 3: Yeah, fifteen.
Speaker 4: My patients go, oh, you're still on time. Thirty. I
Speaker 4: just had a couple of very complex cases and people
Speaker 4: who needed some additional attention and reception kind of look
Speaker 4: at me like, oh you are you okay? And I
Speaker 4: start to I get very flustered. But do you know
Speaker 4: what I have to do as the GP. I just
Speaker 4: have to take a breath, and sometimes I go, I'm
Speaker 4: going to run two extra minutes late and go to
Speaker 4: the bathroom and just have a moment to break this
Speaker 4: and just empty my bladder reset so that I can
Speaker 4: give the next patient the time and the effort and
Speaker 4: the energy and the brain space that they deserve, because
Speaker 4: no one deserve you know, needs to be rushed out
Speaker 4: the door. The parent who brings in their child with
Speaker 4: is this asthma? When I'm running half an hour late,
Speaker 4: still needs that fifteen minutes.
Speaker 1: So really you should probably think about that. You're feeling
Speaker 1: as much as we are.
Speaker 4: Yeah, and we're not in there kind of you know,
Speaker 4: dancing around. I say to patients and they go prayer.
Speaker 4: I know most of my patients don't. They're like, I know,
Speaker 4: you're not doing anything weird. Just it's fine, right?
Speaker 2: Should we get stuck into some medical questions about what
Speaker 2: we should be seeing our GP for and what we
Speaker 2: should be keeping an eye on it as women with
Speaker 2: a lot on our plates.
Speaker 1: So in terms of screening, you talked before about some
Speaker 1: screening things like if were nonsense to how often would
Speaker 1: you say, I mean mammograms you usually have them once
Speaker 1: a year and this you know you feel something obviously,
Speaker 1: is it?
Speaker 4: So in terms of if you're well and prevention, cervical
Speaker 4: cats a screening, breast cancer screening, and bow cancer screening
Speaker 4: when it's age appropriate. Skin cancer is a big one
Speaker 4: and that should really start. That depends on your family history,
Speaker 4: your skin type, your sun exposure history. So it's worth
Speaker 4: chatting to your GP. Should I get a baseline and
Speaker 4: they will usually guide you when you need another skin check.
Speaker 4: But don't forget that if you're well, just checking in
Speaker 4: with your GP on stuff like your mental well being
Speaker 4: is select quality. You know, is there anything that I
Speaker 4: should be tweaking? I've just found this out in my
Speaker 4: family history. I've had three relatives with cardiac disease. Is
Speaker 4: there something I should be doing well? Hey, yes, that
Speaker 4: increases your risk. We should check your questrol and if
Speaker 4: fasting sugar. So there is a little bit more. But
Speaker 4: the cancer screening is a really big one, and skin
Speaker 4: cancer stuff that people often forget.
Speaker 1: And so the self service most of us, many of
Speaker 1: us will have been called in for our self service
Speaker 1: civical screening. Is that Is there any evidence yet that
Speaker 1: that's achieving what it was set out to do? Oh?
Speaker 4: Yes, that's been a game change.
Speaker 1: It.
Speaker 4: So there's so many people who are avoiding that awful
Speaker 4: test with the speculum because you know, we've got to
Speaker 4: remember that for some people due to previous trauma, maybe
Speaker 4: due to cultural background, that invasive test of the speculum
Speaker 4: going into the vagina finding the cervix, taking example, was
Speaker 4: a complete deterrent for some people getting the test. So
Speaker 4: self collection being able to do the swap yourself has
Speaker 4: absolutely changed the game for a lot of people, and
Speaker 4: more people are doing it because it's acceptable to them.
Speaker 4: I can do it in the bathroom. Fine, I'll do it,
Speaker 4: and I'm up to date. Now it's easy. It is
Speaker 4: really good. So what I say to patients when they
Speaker 4: come in and they say I'm due for my test,
Speaker 4: I say, well, you've got two options. For most people.
Speaker 4: If you go and do self collection, you're just as
Speaker 4: good at finding human pablomavirus or HPV as what I
Speaker 4: am with my test. And finding the cervix with the speculum,
Speaker 4: we're equally good at finding it. The only difference is
Speaker 4: if I do the test, they can look at the
Speaker 4: cells under the microscope. If they need to.
Speaker 1: You may be called an after the self service for it.
Speaker 4: Yes, I plenty should collect xample. So if there's HPV,
Speaker 4: then we'll need to go in and potentially take a sample.
Speaker 2: Because when I went and did my self service one
Speaker 2: which I thought was fantastic and such a great tool
Speaker 2: for people who just you know, feel very awkward about
Speaker 2: going and having a smear. When they said to me,
Speaker 2: I'll look by the way if this, if it pings
Speaker 2: for I think it was two types of HPV, we
Speaker 2: will get you back.
Speaker 3: Full the smear.
Speaker 2: I kind of went, ah, why should have just come
Speaker 2: and had the smear, But of course it was negative
Speaker 2: and it was great and it was done and dusted
Speaker 2: and it was a breeze, so I kind of I
Speaker 2: had to go full circle on that one prayer.
Speaker 4: So people don't get HPV detected. So it's about six
Speaker 4: to eight percent will so remember you're probably in the majority.
Speaker 2: Right So here in New Zealand with smears, our civical
Speaker 2: screening program, if you have a service and your age,
Speaker 2: we're doing twenty five to sixty nine. If you have
Speaker 2: ever been sexually active that they would like you to
Speaker 2: have regular HPV screening. C Vical screening is recommended every
Speaker 2: five years or every three following immune deficient and we've
Speaker 2: actually now extended our screening to people age seventy to
Speaker 2: seventy four who.
Speaker 1: Have been its criky. So isn't it We're never going
Speaker 1: to be We're going to be doing this for ages.
Speaker 4: But because you're preventing cervical cancer.
Speaker 1: I just wondered if there was an age where you go, well,
Speaker 1: that's not going to happen anymore.
Speaker 4: Sadly the cells. You know, this stuff is kind of
Speaker 4: a risk always. But there are some patients of mind
Speaker 4: who you get to seventy four here and go, oh, prayer,
Speaker 4: I might just keep doing the five yearly screen. And
Speaker 4: I go, great, why wouldn't we keep preventing cancer? Like
Speaker 4: I'm a massive nerd, but I think preventing cancer like
Speaker 4: that's pretty cool, you know. Yeah, Like I'm a clinician
Speaker 4: who's sitting there reducing the risk of people getting cervical cancer.
Speaker 4: I'm like, that's pretty amazing.
Speaker 1: Yeah, that's kind of a superpower, isn't it. My mother
Speaker 1: actually died from beal cancer at forty four, so that
Speaker 1: she had five children, So all of us have had
Speaker 1: coloes from quite young, and some of us have had
Speaker 1: poly ups that would have been something that would have
Speaker 1: been something if they'd been left right. So that's literally
Speaker 1: saved our Paul Musk. But you know, five offspring, have
Speaker 1: you know, some of us had probably had our lives
Speaker 1: saved by that. Yeah, absolutely, I don't I don't mind.
Speaker 1: I like the sandwich afterwards, and the cup of tea
Speaker 1: and the cup of tea and the drugs I found
Speaker 1: are you talking about?
Speaker 2: Yeah?
Speaker 3: I found it fascinating.
Speaker 2: I was dozy but awake, and I was just watching
Speaker 2: the video and asking lots of questions. And the woman
Speaker 2: doing it did say to me, gosh, this is quite
Speaker 2: lovely to have a conversation with someone on the table.
Speaker 2: Normally they just passed out and don't want anything to
Speaker 2: do with this.
Speaker 3: And I was just like, what's that? Or what's that?
Speaker 3: Oh gosh, what's that? It was? It was? It was.
Speaker 2: Look, the actual colonoscopy itself was great. The night before
Speaker 2: I thought the universe was balling out of me, but
Speaker 2: the actual thing not a problem.
Speaker 3: Incredible. What we can do?
Speaker 2: Hey look saying talking about the importance of trying to
Speaker 2: capture cancer and things. And I suppose this comes down
Speaker 2: to us. We really should kind of have a warrant
Speaker 2: of fitness type appointment every year with our GP where
Speaker 2: we get our blood tests done and you know, we
Speaker 2: tack off the list, you know, tack those things off
Speaker 2: the list. Are you up to date with your mammograms
Speaker 2: and things like that? Is there an age that this
Speaker 2: should kick in or should we have always been doing it.
Speaker 4: Look, I think if you want to be absolutely optimizing prevention,
Speaker 4: seeing your GP once a year is a good idea.
Speaker 4: And I see most of my patients at least once
Speaker 4: a year because either you're in your late twenties and
Speaker 4: people are in that reproductive age starting to think about
Speaker 4: potential pregnancy and so then I need to start flagging
Speaker 4: preconception care, which is huge. Or someone might be in
Speaker 4: their early thirties and maybe they're thinking about fertility preservation,
Speaker 4: and so that's a good time to check in and
Speaker 4: ensure no doors close on people if they don't want
Speaker 4: them to. Or you might be in that next patch
Speaker 4: which is kind of perimenopausal and schemic heart disease risk
Speaker 4: and other things start to climb. So can we optimize
Speaker 4: and reduce your risk of bone health problems or heart
Speaker 4: disease and cerebravascular disease, Or you're kind of further along
Speaker 4: and it's oustereoporosis risk and reducing the risk of dimension.
Speaker 4: At every life stage, there is something and through about
Speaker 4: it all, we should be talking about your mental well
Speaker 4: being doing a blood pressure check. I'd just say on
Speaker 4: your comment about blood tests. Not everybody needs a blood
Speaker 4: test every year, and so that's really important that for
Speaker 4: some people it might be indicated at forty forty five,
Speaker 4: we might say now's the time to start checking your
Speaker 4: cholesterol and your sugars and all those things. But for
Speaker 4: someone well in their twenty thirties, I go, unless there's
Speaker 4: a problem or your preconception, or we're checking buyin deficiency
Speaker 4: because you've got symptoms. We don't want to jub you
Speaker 4: unless there's a clear indication because it can cause more
Speaker 4: harm because we detect incidental things that lead us down
Speaker 4: parts of investigation that we're never going to cause you problems.
Speaker 4: So I think a yearly check is a good idea.
Speaker 4: It's certainly not going to be harmful. And if anything,
Speaker 4: you're going to leave the room with some tips on
Speaker 4: something like sleep or physical activity or dietary interventions. Or
Speaker 4: I didn't realize that I needed a second dos as
Speaker 4: of a measles containing vaccine. Given there's measles. It's an
Speaker 4: outbreaking Australia at the moment. In Vietnam and US, you
Speaker 4: will come out hopefully with some pearls.
Speaker 1: Yeah, and I think too, knowing what I have learned
Speaker 1: through this podcast and other podcasts and amazing people about
Speaker 1: peering menopause. I would really suggest anyone from I don't know,
Speaker 1: thirty eight forty, I don't know, you know, go And
Speaker 1: I'm not talking about getting the necessary and the hormones ticked,
Speaker 1: because we know that that's just an on the day thing,
Speaker 1: but just if there are things cropping up, you know,
Speaker 1: and the mental health and the stress, that's something I
Speaker 1: wish that I had kind of looked into more in
Speaker 1: my early forties because yeah, because everything just piled on, right,
Speaker 1: and then obviously the diagnosed of breast cancer was like
Speaker 1: just bring on as a pad at this point, Yeah,
Speaker 1: because it was all too much, right, So yeah, I
Speaker 1: just really would urge people if they think they're just
Speaker 1: not in their normal place. You know, I don't know
Speaker 1: what age, but if you're just not in a normal place,
Speaker 1: you're gply still the right person to start with, isn't it.
Speaker 4: Start with us? We can sift through Yeah?
Speaker 2: Sorry, no, no, I was just going to say, there
Speaker 2: used to be a huge it's sort of a thought
Speaker 2: that if you went to your doctor and mentioned something
Speaker 2: about your mental health that might potentially end up on
Speaker 2: an insurance. Insurers like we used to be worried about
Speaker 2: insurers could access when it came to our medical records.
Speaker 2: And how I think finally we're all just going no,
Speaker 2: we're more important.
Speaker 3: Our general well being is more important. Just it doesn't matter.
Speaker 3: Stop thinking about things.
Speaker 1: Get well.
Speaker 3: I don't know why that was. I agree.
Speaker 1: I think we just reluctant to talk about mental health
Speaker 1: at all. I think, and I think.
Speaker 4: That stigma is slowly going, certainly in some spaces more
Speaker 4: than others. But it's wonderful. That's you know. I talk
Speaker 4: about social media and I'm on social media as a
Speaker 4: as a health professional. But it's got pros and cons.
Speaker 4: One of the pros is that a lot of the
Speaker 4: stigma around, particularly the mental health space, has been addressed.
Speaker 4: I do feel like people are more likely to come
Speaker 4: in and go I'm not feeling like myself. I do
Speaker 4: have really down days. I have had these thoughts, and
Speaker 4: often it's because they've seen someone share their story on
Speaker 4: social media.
Speaker 1: Yeah, that's fantastic, how doctor Google? You know, people seeking
Speaker 1: their first I know, even my children when it comes
Speaker 1: to skincare go to Blinky TikTok and stuff before they
Speaker 1: talk to me about it. How is that impacting general
Speaker 1: practice and what's the solution to the Smith's information.
Speaker 4: Oh goodness, this is a passion topic of mine. Look,
Speaker 4: as I said, I think social media has pro and cons.
Speaker 4: One thing social media has done, though, is given unqualified
Speaker 4: influences in the health space, often with huge platforms, And
Speaker 4: I'm talking about people like Gneth Paltrow, Kim Kardashian, there
Speaker 4: are people in Australia and New Zealand. It's given people
Speaker 4: a platform and it does mean that if people are
Speaker 4: you know, sharing inaccurate health stuff, it can spread quite
Speaker 4: widely into a lot of damage. And we've seen that
Speaker 4: particularly in the vaccination space with for instance, measles in
Speaker 4: the United States, and that's very complicated, but you do
Speaker 4: have people fueling this information and generating feared, confusion, anxiety,
Speaker 4: and it's very hard once the seed is planted to
Speaker 4: to take someone back. It's really hard. So I think,
Speaker 4: you know, we've said I feel like I've said this
Speaker 4: for years, and there are a lot of people saying
Speaker 4: this in government spaces as well, that there should be
Speaker 4: more regulation of what people are allowed to share on
Speaker 4: social media, particularly when it comes to health, because someone
Speaker 4: like me is appropriately bound by UTPRO guidelines, you know,
Speaker 4: medical boards and my college and the Therapeutic Goods Administration,
Speaker 4: and I've got strict rules on what I can and
Speaker 4: can't do, which is good because it protects the public.
Speaker 4: But the same restrictions and regulations are not applied to
Speaker 4: people without any qualifications, and so they can just tell
Speaker 4: you all sorts of stuff about avocado curing cancer. This
Speaker 4: is the stuff I've seen, complete myths with no evidence,
Speaker 4: and there's no repercussions, and so I think something desperately
Speaker 4: needs to change in that space. I think people are
Speaker 4: becoming hopefully more aware. You've had Apple sided Vinegar come
Speaker 4: out with Bell Gibson. People are talking again about how
Speaker 4: did this happen? And someone like me and you know
Speaker 4: other health professionals are going, this is still happening. This
Speaker 4: isn't a once soft story. I've seen many more Bell Gibson's,
Speaker 4: you know, perpetuating health misinformation and disinformation, you know widely.
Speaker 4: I think people are starting to go, well, how do
Speaker 4: I avoid it? You've got to follow people ideally with
Speaker 4: you know, credentials, who are qualified, who are not conflicted,
Speaker 4: who are not trying to sell your supplements. You know,
Speaker 4: there's all these things to kind of look for. But
Speaker 4: it's a muddy space. I would say that as I
Speaker 4: see things and I go I can't believe this is
Speaker 4: still happening, and I don't know often how to rebut
Speaker 4: it without platforming the person who's spread the mis information.
Speaker 4: So it's a complex space.
Speaker 2: The video popped up recently and it was fel side
Speaker 2: of vinegate. You rub it on your stomach and it
Speaker 2: will help get.
Speaker 1: Rid of your Oh god.
Speaker 4: Much, I know. And these are vulnerable people. That's the thing,
Speaker 4: because people are vulnerable, and then that feeds on the
Speaker 4: diet culture stuff. Right, why do we need to lose
Speaker 4: our belly fat? Like having tummies come in all different
Speaker 4: shapes and sizes, why do we need to change our
Speaker 4: tummy and then the diet culture stuff which is then
Speaker 4: wrapped in wellness. I could go on and on here,
Speaker 4: but yeah, it's a muddy space.
Speaker 2: You're listening to the little things and our guest on
Speaker 2: the podcast today is general practitioner doctor Preat Alexander, the
Speaker 2: host of the podcast, Happy to help.
Speaker 1: We'll be back after this break.
Speaker 2: We were just talking before the break, we were just
Speaker 2: talking about diet culture, which is just it must be
Speaker 2: so on Well, we've done a lot of podcasts on it,
Speaker 2: and we find it really infuriating. How do you deal
Speaker 2: with that with women and their weight? And you know
Speaker 2: when you might need to step in when we should
Speaker 2: be thinking about maybe stepping in and doing something about it.
Speaker 4: Look, I think it's tricky. I have a lot of
Speaker 4: conversations about diet culture in the consulting room because it
Speaker 4: creeps in more than you'll know. And I think it's
Speaker 4: important for me to acknowledge as a health professional that
Speaker 4: weight steamer or prejudice about weight definitely exists within healthcare.
Speaker 4: There is research that shows that that there are biases
Speaker 4: that the healthcare system has against people of higher weight,
Speaker 4: and diet culture is blooming everywhere. It is so pervasive
Speaker 4: and insidious, and you know, young kids start to get
Speaker 4: these biases, to start to develop these beliefs about the myths,
Speaker 4: you know, the moral hierarchy of bodies. It's best to
Speaker 4: be at the top and thin than anything. Not that
Speaker 4: is not good enough. We need to strive towards thinness
Speaker 4: because we'll be better and happier and more successful. You know,
Speaker 4: that's the really I guess zoom out version of diet
Speaker 4: culture it's far more complex than that. But in the
Speaker 4: consulting room, I'll talk about it often, and I have
Speaker 4: very complex discussions about weight and you know, both about
Speaker 4: people with higher weight will often come to me and say, prayer,
Speaker 4: I'd like to shift my weight for health reasons, to
Speaker 4: reduce my chronic disease risk, or my cat's a risk.
Speaker 4: And it's important for me as the GP to just
Speaker 4: explore relationship with food and body and you know, ensure
Speaker 4: that I'm not potentially going to perpetuate any harm here
Speaker 4: if there are diet culture beliefs and you know, precipitate
Speaker 4: potentially in eating disorder is possible.
Speaker 3: It's really complicated.
Speaker 4: Oh, it's so complicated. And I've done additional training in
Speaker 4: the space, and as my husband says, he's like your
Speaker 4: superpowers having those really tricky conversations socially, like I can.
Speaker 4: I can get to the but it is even with
Speaker 4: the training and the experience, it is a really difficult space.
Speaker 4: And often I'm having conversations with patients in the consulting
Speaker 4: room who go, I hadn't even realized I had these
Speaker 4: beliefs around food.
Speaker 2: I just really appreciate you acknowledging the nuances of our weight,
Speaker 2: because there's a lot of people who see it very
Speaker 2: black and white, you know, like if you carry a
Speaker 2: better weight, that's the crux of the problem. Loosen what
Speaker 2: you know, like it can be seen very black and
Speaker 2: white by.
Speaker 4: It can and weight is not a be all and
Speaker 4: end all, Like I say this to patients all the time.
Speaker 4: Is not about the number, the scale, or the VMI
Speaker 4: or the dress sizes, Like your health is not defined
Speaker 4: by your weight. That's not the sole thing I'm looking
Speaker 4: at when I'm looking at your overall health picture, Like
Speaker 4: that's about your sleep quality, your stress management, your blood pressure,
Speaker 4: up to date with your preventative health checks, what are
Speaker 4: your ours doing, your gut health. It's so complex, I
Speaker 4: don't even know how we define health. But it's certainly
Speaker 4: not about your blooming weight. And for people, I agree
Speaker 4: with you, this black and white notion of I can
Speaker 4: look at someone and tell whether they're healthy, you cannot. No,
Speaker 4: I can, as a GP. Weight is nothing to do
Speaker 4: with it.
Speaker 1: There are just so many things we could be talking about.
Speaker 1: One thing we did want to get to a lot
Speaker 1: of our listeners may have well, I'm past the point
Speaker 1: of worrying about contraception. Believe it or not, but a
Speaker 1: lot of us have teenaged daughters or even granddaughters or whatever.
Speaker 1: What's the goal with the palette the moment, I feel like, anecdotally,
Speaker 1: I'm hearing a lot about young women using IUDs, but
Speaker 1: I have no idea what's the go these days?
Speaker 4: What's the go? The go is there are options, and
Speaker 4: it's an exciting time I reckon. So there are options
Speaker 4: when it comes to contraception, and every option has risks
Speaker 4: and benefits, and there is a lot to weigh up.
Speaker 4: I talk constantly on social media and in the consulting
Speaker 4: room about the sea saw. People have heard me talk before,
Speaker 4: go oh no, just go on again. I thought, well, like,
Speaker 4: I bring this out in the consulting room. But everything
Speaker 4: has the seesaw where you've got some benefits. And for
Speaker 4: the pill, it might be well, it will help my acne.
Speaker 4: I can have control over my period. It will reduce
Speaker 4: my iron losses. If you've got policis to go viering syndrome,
Speaker 4: it's going to protect my endometril lining and reduce my
Speaker 4: risk of endometric cancer because I have long cycles. There
Speaker 4: might be some benefits and there are some risks. It
Speaker 4: might increase my breast cancer risks slightly above the baseline,
Speaker 4: but hey, the baseline risk is low, so it's only slightly.
Speaker 4: I'll take that. Might have a slight risk of clotting,
Speaker 4: but again that risk is low. You know, you've got
Speaker 4: to put up the risks and benefits for everything, for
Speaker 4: the intra uterine device or the IUD, for the progesterone
Speaker 4: only pill, the combined or a contraceptive pill, the whatever
Speaker 4: it is you want to do. But the key takeaway
Speaker 4: is what is available to you is going to be
Speaker 4: dependent on your medical history. So for some people, the
Speaker 4: combined or a contraceptive pill. If you've got a history
Speaker 4: of migraine with aura, we ideally do not use the
Speaker 4: pill because of the increased clock and stroke risk. If
Speaker 4: you're over thirty five and a smoker, or we ideally
Speaker 4: avoid the pill. And this is like who World Health
Speaker 4: Organization charted. We ideally avoid it due to stroke risk.
Speaker 4: And so it depends on your medical history, what we're
Speaker 4: trying to treat, what's acceptable to you. Some people go,
Speaker 4: I'm not going to take a pill every day. Well,
Speaker 4: I don't think the combined or a contraceptive pill is
Speaker 4: the one for you. That's where an IUD would be better.
Speaker 4: But it's nuanced, it's individual. And what drives me slightly
Speaker 4: bananas is that on social media people will go on
Speaker 4: and go, hey, I had this. It was terrible, heavy
Speaker 4: vaginal bleeding. No one should have it. Well, hey, that's
Speaker 4: your experience. Wait a minute, I've got ten patients who've
Speaker 4: had a wonderful experience with it, and I think we
Speaker 4: need to be so careful with how we digest that
Speaker 4: kind of information on social media.
Speaker 1: That is the key time. If a kid is starting
Speaker 1: to be six, I don't know, between sixteen and twenty
Speaker 1: or younger probably in lots of cases, what they are
Speaker 1: the ones that are that are getting their information from
Speaker 1: their peers from social media. So that's a that's a
Speaker 1: tough one for you guys.
Speaker 2: It is.
Speaker 4: It's tough, and I don't know how to get to
Speaker 4: that age. I don't know how many of the age
Speaker 4: groups follow me actually, but you know, actually targeting content
Speaker 4: to that age group is quite difficult because the people
Speaker 4: they tend to follow are very different to me. And
Speaker 4: I think I'm still cool for a thirty eight year old.
Speaker 4: My daughter's like, Mum, don't come into school, but I'm
Speaker 4: the cool I'm the cool mom. They come to the
Speaker 4: mum on TV with books like surely we want this mom,
Speaker 4: but no, I'm still not cool. So you actually they
Speaker 4: need some qualified voices, or some very clever, qualified voices
Speaker 4: in that space, giving those people some reliable information.
Speaker 1: And I guess that's why I'm asking, even though in
Speaker 1: a funny way, my daughter's eighteen, it's really none of
Speaker 1: my business. But I also go is she asking the
Speaker 1: right questions? Is she having symptoms that she's not talking about?
Speaker 1: How's it going for her all that, you know, because
Speaker 1: she's moved away now, And I'm like, I don't know,
Speaker 1: and I just think about her health. Is that not
Speaker 1: just being a control freak? I am thinking about her health?
Speaker 4: Yeah? No, And you are thinking about her health, and
Speaker 4: I think you're wondering, well, what information has she got
Speaker 4: access to and issue basing yes decision on that information.
Speaker 4: You want people to make informed decisions, but with accurate
Speaker 4: and reliable, balanced information. So I think you're just being worried,
Speaker 4: and rightly so, Priya.
Speaker 2: What other areas of health are you seeing large amounts
Speaker 2: of confusion or misinformation around At the moment, We've.
Speaker 4: Had the RSV vaccine roll out in Australia, so respiratorys
Speaker 4: insitual virus for pregnant people, which has been amazing of
Speaker 4: confusion there due to misinformation online. So that is a
Speaker 4: place where I'm counseling a lot of people at the
Speaker 4: moment and busting the myths and answering their questions. And
Speaker 4: I think a lot of stuff steal around anything in
Speaker 4: the kind of period, women's health space, heavy vaginal bleeding,
Speaker 4: healthy pain. You know, people are now going is this normal?
Speaker 4: Is this that people are confused? But because we're talking
Speaker 4: about it more, I've got more people coming in going
Speaker 4: I've been having this kind of really bad mood change
Speaker 4: for ten years before my period. People are their forties
Speaker 4: and I'm like, whoa, this is florid, PMS or PMDD,
Speaker 4: let's treat it.
Speaker 2: It's because when someone times when we were young, well,
Speaker 2: this is just what you're going to experience and you
Speaker 2: just have to put up with that, and it's going
Speaker 2: to happen.
Speaker 3: Once a month and get on with it. And now
Speaker 3: all of a sudden, we're all going.
Speaker 1: I didn't need to be that much pain? Are you
Speaker 1: kidding me?
Speaker 4: I know, Well, that's that's a flaw of you know, look,
Speaker 4: that's an element of medical misogyny, which is a lot
Speaker 4: of us have been told that's quite normal, just get
Speaker 4: on with it. And now we're going we'll hold on
Speaker 4: a minute. People are waiting years and years and years
Speaker 4: and years for a diagnosis of endometriosis with pelvic pain,
Speaker 4: which impacts their mood and their sleep and their quality
Speaker 4: of life. So we're very much trying to shift away
Speaker 4: from that. But you know, the health profession has been
Speaker 4: part of the problem.
Speaker 1: Yeah, for sure. So look, I mean we all know
Speaker 1: that there are lifestyle changes we can make for a
Speaker 1: better general health. And you have talked about lifestyle prescriptions
Speaker 1: that you often give you patients and your professional opinion,
Speaker 1: is it one or more little thing that you think
Speaker 1: we can do to help ourselves with reasonably quick positive outcomes.
Speaker 4: This is not marketable, but the secret is. But the
Speaker 4: stuff that works is the stuff that you already know
Speaker 4: that's not very sexy but has the most evidence behind it.
Speaker 4: And I really mean this, and this is the stuff
Speaker 4: I've just prescribed five patients yesterday in the consulting room.
Speaker 4: It's moving the body as much as you can. So
Speaker 4: our guidelines in Australia, so one hundred and fifty three
Speaker 4: hundred minutes of monro intensity exercise per week, which is
Speaker 4: so boring. But I just say to patients, if you
Speaker 4: can move most days for at least thirty minutes, you're winning.
Speaker 4: And if you sedent tree, anything is better than nothing.
Speaker 4: It doesn't have to look sexy or fancy or include
Speaker 4: the active where any movement is good. Eating rainbows is good.
Speaker 4: So your diet is actually bloody important, and it's gotten
Speaker 4: so confusing now people are like, I'm hearing bad this
Speaker 4: and this and this, and I just say to patience,
Speaker 4: not all my patients can afford to go and see
Speaker 4: a dietitian, and dietitians are amazing in this space if
Speaker 4: you can, if you have access to one, and the
Speaker 4: financial means. But eating more fruit and veg, whole grains,
Speaker 4: limiting processed foods, salty foods, refined sugars is good. You know,
Speaker 4: the Mediterranean diet is kind of a way of living.
Speaker 4: I say, you know, it's not a diet per se.
Speaker 4: It's just lots of fruit and vege and less bread, meat,
Speaker 4: less dairy, and you know, red wines included, thank goodness.
Speaker 4: So you know, that's got evidence for reducing cardiovascular disease
Speaker 4: and some cancers. But your diet is so hugely critical
Speaker 4: in your chronic disease risk, in your cancer risk. And
Speaker 4: now we're learning about gut health and the relationship with
Speaker 4: the immune system, with the brain and mood. What you
Speaker 4: eat can impact your depression risk. What you eat can
Speaker 4: actually help manage depression symptoms. We know tweaking the diet,
Speaker 4: so food is important. Sorry this is long, so moving
Speaker 4: body and food. Getting enough sleep, you know, so not sexy,
Speaker 4: but getting good quality and enough sleep is absolutely critical.
Speaker 4: Turn your screens off in that one hour before bed
Speaker 4: wind down, use background noise if you need it. Cut
Speaker 4: caffeine after two pm. It's got a long half life
Speaker 4: impacts in nighttime select quality. Being connected, socially connected, loneliness
Speaker 4: is bad for health, for physical health, increases your risk
Speaker 4: of heart disease and dementia, and for mental well being.
Speaker 4: It's bad so being connected. And you don't need to
Speaker 4: have millions of friends, but if you've got someone you
Speaker 4: can call in a deep dark moment, you're winning. That's
Speaker 4: good for your health. A couple of people, that's a win.
Speaker 4: And the other one I think is being out in nature.
Speaker 4: You know, there's a lot of evidence. There's actually a
Speaker 4: research published in Nature suggesting one hundred and twenty minutes
Speaker 4: in nature every week is good for mental and physical
Speaker 4: well being just being outdoors. So it's not sexy. When
Speaker 4: I say to patients, you know, they're like, oh, how
Speaker 4: can I optimize this. I just had a patient the
Speaker 4: other day. We excluded all the organic stuff, checked viroid,
Speaker 4: iron deficiency, couple of unusual symptoms, and she said, I
Speaker 4: think I'm just fatigued. I've got all these things on
Speaker 4: my plate and I think it's fatigue. And I said, well,
Speaker 4: I agree with you. We've excluded the other stuff. There's
Speaker 4: no red flags here. I'm going to write some things
Speaker 4: down for you to do. And I wrote them down,
Speaker 4: and sometimes I feel a bit like a you know,
Speaker 4: a muppet, and I'm like, this is stuff you probably
Speaker 4: no But she went, you know what, this is the
Speaker 4: stuff I'm not doing. I've got now tangible things to
Speaker 4: work on. I'm going to imp I'm going to put
Speaker 4: this on my fridge. I am going to think of
Speaker 4: you before bed. I'm going to eat more rainbows in
Speaker 4: the canned vedge and do some of the recipes, and
Speaker 4: I said, let's catch up in two to three months,
Speaker 4: and let's see.
Speaker 1: I'm going to put it on my fridge. I mean,
Speaker 1: I think I do those things, but sometimes you need
Speaker 1: to do a bit of a self audit and go
Speaker 1: do I do I? Actually, I definitely don't with the
Speaker 1: phone before. But I know that. But but it's hard.
Speaker 4: It's not easy. But I get bogged down. And sometimes
Speaker 4: I say to Will, my husband, you know all, we've
Speaker 4: got to get the pillars. We call them the pillars
Speaker 4: at home. I'm like, we need to cement the pillars
Speaker 4: in and we'll go to bed at and I'm thirty
Speaker 4: and we'll read and there's no alcohol, and you know,
Speaker 4: I reduce my caffeine intake. It's hard, we're busy, we've
Speaker 4: got full plates and kids, and you got to the
Speaker 4: back of the list. But just cementing the pillars yields benefit.
Speaker 4: And just going back to diet culture, the physical activity
Speaker 4: and the diet stuff does not have to change the
Speaker 4: way your body looks. It does not have to yield
Speaker 4: weight loss for it to your benefit. Moving your body
Speaker 4: yields benefit for the body in the brain, even if
Speaker 4: nothing shifts in your body.
Speaker 2: Do you know what I love about all that information. Prier,
Speaker 2: You're right. I think at the end of the day,
Speaker 2: when you're reminding someone of all these things, they do
Speaker 2: know it. And so I think we need to back
Speaker 2: ourselves more. I think when we find ourselves having a wobble,
Speaker 2: we need to actually stop and go.
Speaker 3: I know what to do.
Speaker 2: Take one step at a time, take a look at
Speaker 2: each of those pillars. So yourself out before you before
Speaker 2: you sort of, you know, you start thinking that you
Speaker 2: know everything's the world's going to end and and the
Speaker 2: free and yes, you can take control of it, and
Speaker 2: you can do it.
Speaker 4: It's not marketable, you know, like people will sell you lots,
Speaker 4: but there's lots of sexy, fancy things that cost a
Speaker 4: lot of money. And I said in my patients, I'll
Speaker 4: save you the pennies. You can get rid of all
Speaker 4: of them. Let's work on the pillars and put them
Speaker 4: in your diary like I put physical activity in my
Speaker 4: diary on the to do list.
Speaker 1: Well, journaling is supposed to be good for us too,
Speaker 1: so we can journal what we did, can't we hear?
Speaker 2: Oh, doctor Preyer, Alexander, I cannot thank you enough for
Speaker 2: your time. It has been a delight to meet you.
Speaker 2: As Lou said, we're both big fans of the Happy
Speaker 2: to Health podcast and we really really appreciate you taking
Speaker 2: the time to talk to our listeners.
Speaker 3: It's been fabulous.
Speaker 1: Thank you, so much better than a visit to the doctor.
Speaker 4: You'll go and see you doctor day.
Speaker 3: How gorgeous is doctor Preyer, Alexander.
Speaker 1: She's so sweet? This is the only I mean, I'm
Speaker 1: so passionate. I have what she does. I haven't really
Speaker 1: needed to, you know, video, any of our podcasts, but
Speaker 1: if I was ever going to, it would be that one.
Speaker 1: You need to know how passionate this woman is. The
Speaker 1: hands are going, she's gesticulating. She is really passionate about health.
Speaker 2: Can I just say, next time I go into the
Speaker 2: doctor with my list, I'm going to go, oh well,
Speaker 2: Doctor Preyer says that this list is absolutely fine. How
Speaker 2: are going to make life easier on you? Let me
Speaker 2: tell you what's on it, and let's start with the
Speaker 2: most important thing that's right, And then if we don't
Speaker 2: look to be honest with you, I have been very good.
Speaker 2: I've reduced my list to maybe one two things. Maybe
Speaker 2: it'll be like this is the main thing. But look,
Speaker 2: while I'm here, is this a concern? So I'm getting.
Speaker 1: Better, and you know, I'm going to go in and
Speaker 1: it's just so expensive. To be honest with you, it
Speaker 1: is expensive. And we didn't cover that too much because obviously,
Speaker 1: you know, I think if you're making the most of
Speaker 1: your GP visit, you've got to think of it as
Speaker 1: an incredible investment in your own well being. And I'm
Speaker 1: going to go in and thank my GP for that
Speaker 1: golden minute that she always gives either me or my
Speaker 1: child whoever's there. She really does and it's invaluable.
Speaker 2: Yeah, my doctor doesn't turn to her computer to near
Speaker 2: the actually the end of the appointment, So that's I
Speaker 2: thought that was really interesting that being highlighted. Do you
Speaker 2: know though, I really appreciated and I hope that most
Speaker 2: gps are the same about how nuanced weight is and
Speaker 2: how you shouldn't both just us in the general public
Speaker 2: and doctors, we shouldn't make presumptions about people's life and
Speaker 2: lifestyles and their health from their weight.
Speaker 1: I have just heard so many people say that it's
Speaker 1: one of the first things. I don't think my doctor
Speaker 1: has ever asked me to get on the scales. I
Speaker 1: can't remember the time when.
Speaker 3: She should be waited.
Speaker 2: I'm way quite often when she just asks me. But
Speaker 2: bless my doctor, she doesn't make the point these folks
Speaker 2: at all South, Where where do things go when they
Speaker 2: get worse?
Speaker 1: Well, if the weight's going up, it's But then if
Speaker 1: you're feeling like it's I don't know.
Speaker 2: I warn't the center of gravity right now. But as
Speaker 2: we're just you're a very active person.
Speaker 1: As we've just mentioned, it doesn't matter what the what
Speaker 1: the whatever it's called.
Speaker 2: It it's also she has reminded me that you know,
Speaker 2: you've got an eighteen year old daughter. I've got a
Speaker 2: sexteen year old daughter, an eighteen year old son, and
Speaker 2: we need to be making sure that we are talking
Speaker 2: to them about their health in general and what they
Speaker 2: need to be doing and what they need to have done,
Speaker 2: and that they are not resorting to doctor, Google or
Speaker 2: social media.
Speaker 1: Yeah, like strange old things like I said to about
Speaker 1: you know, I've seen my son put a little bit
Speaker 1: of toothpaste on set. I did that.
Speaker 3: I know we did, a teenager.
Speaker 1: Where did we get it from? We just must have
Speaker 1: passed it around the school because we didn't have social media.
Speaker 1: But yes, I think prier agazine. Yeah, oh yeah, as
Speaker 1: a favor to our GPS or any of our health professionals.
Speaker 1: Parents need to get ahead of that right and just say, well,
Speaker 1: don't get your information off TikTok for a health issue.
Speaker 1: My god, I can only think some of the consequences
Speaker 1: could be terrible.
Speaker 2: All right. If you're in a little bit more of
Speaker 2: prayer for fact based, reliable health information. You can find
Speaker 2: Preyer on social media just look up doctor Preyer Alexander.
Speaker 2: She also has her Happy to Health podcast and two
Speaker 2: books aimed at healthy families, Eat Sleep, Play, Love, and
Speaker 2: her cookbook Full Plate, One.
Speaker 3: Meal for the Whole Family.
Speaker 2: Thank you for joining us on our new Zealand Hell
Speaker 2: podcast series Little Things. We hope you share this podcast
Speaker 2: with the women in your life so that we can.
Speaker 1: All make the most of our GPS time and ours.
Speaker 3: I like that noise.
Speaker 1: You can follow this podcast on iHeartRadio or wherever you
Speaker 1: get your podcasts, and for more on this on other topics,
Speaker 1: head to zet Herald dot co dot z and we'll
Speaker 3: Catch you next time on the Little Things