Ep108. Doctors Orders! Why you need a GP with A/Prof Magdalena Simonis AM

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Well, hello there listeners. It's Suzy New from the Australian Society of Anesthetist, and thank you for listening to our

podcast. It's called Australian Anesthesia, and it's where we talk about all things relevant to anesthesia here in Australia.

Before I dive into who and what we're talking about in this episode, I wanna try something a little different. Firstly, for

context, this is the first intro I've recorded since we had the fantastic National Scientific Congress in Canberra world done to

the organizing team there. It was a great meeting, and as always, it was great catching up with so many people. I want to say

a really big thank you to all the people who came up and said hello to me and mentioned the podcast. In fact, some people

specifically sought me, I think specifically sought me out because of the podcast. Big shout out to you.

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I think there was Zane Ryan, and unfortunately, I have lost the piece of paper that I use to jot your names down. So big

apologies if you did come and say hello, and I said I'd give you a shout out. Do email me so I can go ahead and do that.

Anyway, we had some really good conversations about the podcast, so I thought I might tackle some of those questions

with each episode as a little intro, because on reflection, I thought some of the tips and things I've learned through

podcasting have been useful for me. And hopefully these might be useful for you too with your patients, your leadership

development, or even if you're giving a presentation, these are all things which I'm interested for all of us to do well, myself

included. So to kick things off, the question or the comments I get a lot are to do with my voice.

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First of all, thank you for those lovely comments. They tend to be along the lines of me having quite a calming voice. And

the question that usually goes with that is whether that is intentional or whether I have trained in it. So first I wanna answer

yes, this is my natural voice, but also during my podcasting course and in my podcasting network, we do discuss voice

work. And so I've, I suppose, read about it, listened to it, watch it on YouTube, and practiced it with some of my podcasting

peers. If you are not a podcaster, what can you take away from this? For this, I want to point you in the direction of a chat by

the name of Chris Foss, who is a former FBI hostage negotiator, who does a lot of work on negotiation and coaching for

people in business, as well as in the FBI for handling these tricky conversations.

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And he coins the voice, the late night FM DJ voice, this is what he says is the default for hostage negotiators. The

characteristics of it are speaking slowly, deliberately, and with a downward inflection at the end of a sentence, it comes

across as being reassuring, possibly curious. And what it does is it slows down the thinking of your counterpart, keeps 'em

calm, and also helps to create a sense of authority. So an example, one of the questions Chris fos encourages us to ask is,

how am I meant to do that? If I ask it as a, how am I meant to do that, that tone implies that I think the question or potentially

the person who asked that question is stupid. You know, I'm sounding a bit defensive if I ask it as a, how am I meant to do

that? I convey curiosity, collaboration, and hopefully I'm inviting the person that I'm asking it to, to be part of finding the

solution.

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He, of course, is an expert in this. He goes into it in much more detail. I encourage you to either read his book, listen to his

audio book. He's got an extensive library on YouTube and you might be able to find it on a podcast somewhere. But he, he

talks about this a lot and he does it really, really well. I know we are not hostage negotiators, but this might be useful for

negotiating with patients or colleagues in our clinical and leadership work. So potentially during this podcast, you might be

able to hear when I use it, I'm often also approaching my guests with curiosity, and some people when they get on the

podcast are bit nervous, not, not in this case, but I'm also trying to use it to convince a sense of calm, because I want them

to be in a calm, explanatory state of mind when I am asking them some questions, potentially some tricky questions.

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Anyway, think about it, try it out. If you want, reflect on it. Let me know what you think, and also let me know what you think

about having these little podcasts slash communication tips included. Alright, moving on. My next guest is Dr. Magda

Simonis and she's a tour de force. I've had the great fortune of meeting Dr. Simons through our roles on the A MA Federal

Council. I always love catching up with her. And I went and said hello during the A MA National Convention earlier this year,

and we had this conversation and her ideas just blew me out of the water because I, like, hopefully many of you have my

own gp, or at least I think I do. But after talking with Dr. Simons who was a GP herself, I see that there is a whole lot more I

could be doing with that gp, with that professional relationship to keep me healthy. And I like to think of myself as someone

who knows about healthy lifestyles. You know, I love exercise, I love eating really well, and I thought I knew a thing or two

about preventative medicine, but one thing this conversation did highlight to me was how much there is out there. And

really when it comes to my own health, it's best to leave it to the experts. Alright, enough about me and my health. Let's get

into it.

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Thank you. Thanks for giving up some time. Oh,

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You're

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In Melbourne, so this is grand final public holiday for you too, right?

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Indeed. It's one about prized days off. So I have a long weekend, an imposed holiday.

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I'm so honored that you're spending part of your public holiday with me. Thank you very much.

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It's fantastic. I'm really happy to,

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I just love that conversation that we had at a MA federal council and I wanted to share it with all the people that listen to the

podcast. So I was hoping we should just go through some of the things that you talk about with your patients as a gp.

Mm-hmm . Through the lens of having a patient who's medical. So perhaps through different stages of their

career. And I know you've got a big, big focus on not just a big focus, but I know you are an expert in women's health. So

did you wanna focus on women in particular or did you wanna tackle both? Not

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Really, because I do, I see an equal number of males and females. My practice is really mixed and I see a lot of male

colleagues. So I think that that is also something that I'd really like to talk about because, well, one of the things there that,

you know, you uncover, much like our conversation at the AMA is that they can get to like 60, 65 and have never had a gp.

Never. In fact, you're rather proud of it. So I think one of the difficulties, and that's not just the men, I mean for women it's

quite different because they'll need to have a screening test, they'll need to have their breast check or they'll need to come

and see someone for their hormone placement and all the other gynecological things that force women to seek doctor.

Whereas men don't have those prompts throughout that phase of family building, which is where so much of their need gets

you really unserviced and unattended to.

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And I think one of the things I have to say front as a doctor who says quite a good proportion of doctors is that they're not

good patients. So, and it's across the board. I don't think it's discipline specific, I think it's just that we know too much. And I

think to some extent, everyone assumes they know more than the, they're sitting in the room with, especially when they're

not a gp, they basically don't come for recalls or you have to chase them up to give them their results. You have to chase

them up for their recalls. They'll book appointments they don't come to, and then there's the sort of the casual, oh, Friday

night you get an sg, I'm a script. Or can you write me a referral too? Because I'm gonna go see I've already made an

appointment for and you don't really know what it's about. Yeah,

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Yeah,

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Yeah. So there are all those sorts of intrusions and establishing that professional boundary or professional relationship is

something that we need to try and learn. Because I think that I've been a patient and I know that when I've had to make

decisions about something, I've really enjoyed trusting the expertise of the person that I've gone to see. And I've let them

really guide my decision rather than the other way around. Even though I've had lots of questions. I mean, questions are

fabulous. Having the dialogue is wonderful, but saying, no, I don't wanna have a PSA at the age of 70. I've never had one

and I have no symptoms. Makes me feel a little uncomfortable as a, I think saying I don't have any health issues. I've never

really needed a doctor because I've been really well and then they have a blood pressure of 1 58 on 95 and they had no idea.

And you don't know how long they've been walking around with that for. There are lots of things like that that we discover.

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And I'm glad you brought this up 'cause I did wanna bring it up at some stage in the podcast and that is what it's like for

doctors to see a gp. And you've definitely mentioned some of the barriers there. One of the barriers I find that I have is I

think my problem is too small to handle, too small for a gp. Oh, this is just something I can just take some Panadol for and it

will go away. And you feel like, oh, you're just wasting someone's time and you've got a really great strategy, I think for that.

Particularly for, as your patients get on a bit, what do you do?

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Well, I, I treat my doctor patients as much as the way I do everybody else. I just say, you have to book and really you should

book a regular health appointment once a year with your GP and you should be well when you make that appointment and

expect that on the day that you come, you've probably got not much to talk about. Let the GP sometimes guide that by

asking you some questions that you might not have thought about or bring your questions with you. For instance, there will

be the routine screens, the preventative health checks in general practice, what we talk about, we talk about the preventative

guidelines according to the phase of life that you're in, right? Mm-hmm. Mm-hmm. The stages of life. And certainly we

should look at doctors in the same way, the different phases of life that you're in, but also the different stages of

professional career that you're in and the demands that that imposes on you really impact, I think to some extent all the

other health factors too.

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So the busier you get, the more research you do, you sit more, don't you, when you're researching, you're sitting in front of

a computer, then you see your patients, then your rushing home, then you're doing the quick meal, then you're having a

bottle of wine or something to wind down or with your partner. They're the sorts of things that just get absorbed into life.

Mm-hmm and don't get broken down into impacts on health potential impacts on health. So lifestyle and the

context and the stage of life that you're in is really important. They're all very important. So as a gp, I, I encourage that kind

of book an appointment regardless. So when you receive that email from me or that that message from a practice that says,

you know, your time for a health check with the doctor, just book it

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In. That's mind blowing to me. So you aren't asked to make that appointment when we are. Well, mm. I love that concept. I

think almost everyone listening to this podcast go, that's not me, .

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Yeah. Because prevention happens when you're well, doesn't it? It does not happen when you have a symptom or a

condition. And this is also the opportunity we have to talk about prevention and that includes a variety of things from

vaccinations to skin screening for women, knowing your breast and making sure that throughout that life cycle we have a,

an understanding of what those changes are like and making sure you're having your breast screen, knowing your family

history, me knowing your family history. Yeah. And what genetic predisposition you might be exposed to from early on

down the track. Things that we need to be aware of in terms of mental health, family history, your own personal mental

health. Did you have mental health issues when you were a young person through high school, through secondary school?

What are the triggers? What are the sort of circumstances that might bring these things out?

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And how are things at work? A lot of it has to do with our mental health too, because so few of us are willing to talk about

that until something really, really goes wrong and we're not coping. And I think that we carry a lot of stress. I think we carry

a lot of pressure. The expectation we impose in ourselves to always be at the top of our profession doing really well. Every

interaction we have with a patient, we've gotta be switched on regardless of whether we've got pain, whether we are hungry,

full bladder, a headache or something terrible going on in our personal life. And wearing that mask and really having to bury

that takes its toll. We're human. So there are opportunities to talk about that. Then for women, obviously there are

reproductive stages of life, but I like to talk to our women doctors about preconception counseling.

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I think that's really something that we don't take into consideration. Even professional women who you think women will

time their pregnancies end up pregnant unexpectedly sometimes. And it really throws a spanner in the works for their stage

of life and what they're doing. So there's sometimes a bit of a crisis around that. Mm-hmm. So preferably planning those

opportunities. I also talk to my female patients who are doctors who are outside of a relationship. Not yet in a partnership.

Women face all sorts of men too, but in particular women who haven't partnered yet, they haven't met the right guide and

they would love to have a child, they would love to have a family. So I talked to 'em about freezing their eggs, looking at

other options. Have you thought about down the track? Have you thought about where you're at when you're 40? When

you're 38, you're now 32. Have you given me some thought? I just plant that seed. Yeah. Yeah. And some have said, oh you

know now. And I say, well give it a thought if things happen, but this is the perfect time to be saving your eggs. If that's

something you really want in your life,

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Particularly for anesthetist. That's a time in your life when you're caught up with exams, trying to finish training and you're

not necessarily thinking about your future self and what that looks like in a family context. And you may not have had

someone to say, Hey, have you thought about that? So that's a really good point.

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And then of course for men and for women, the baseline cholesterol, knowing at some stage in your life, knowing what your

diabetes risks are, doing, the cholesterol, urea, electrolytes, uric acid, liver function, general screen in women's course

anemia, that's you know, low iron. We need to have that baseline at some point.

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things going on where

What age do you start thinking about doing those baseline tests roughly? I mean obviously it'll depend on history and other

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There's a family history, this is where family history comes in and it's really important. Does a family history of heart

disease, I'd suggest that even in their thirties. Yeah, certainly. Because prevention again happens when you're early before

the disease occurs. We know that atheroma, by the time you're 40, 45, you could still have significant ather. So it's worth

knowing. I've picked up with one young man, both his parents and my patients and they've both got hypercholesterolemia.

So when he attended my rooms at 25, I did his baseline cholesterol. He came for something completely different and he has

familial hypercholesterolemia and he's on medication. So yeah, under cardiologist. So these are things that we do need to

know. That's why your family history, very important.

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Yeah. And I remember being offered screening sometime in my thirties or early forties or something and I just thought, what

now? I mean like most other doctors probably I'm fit and healthy. I exercise, I eat well. Like why would I wanna check my

cholesterol? I thought that was pretty mind blowing to be offered it by my GP at the time. So I'm hoping someone out there

listening might also have that little bell ring to make that appointment with their GP to go for that preventative screening.

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I think it's also important, you see this is the other difficulty a lot of our colleagues anesthetists who understand physiology

and biochemistry so well. Yeah. You're the experts in this will self manage that now I think. Yeah. So I have so many

on medication that has been prescribed by, well who prescribed.

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It's very easy for us to slip into work and check our own blood pressure.

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And these are the sorts of conversations I have often with my patients who are doctors. And I try not to be judgment 'cause

it's important not to be. I understand it's the pressure we're under and time is pressure, time is also money and why should I

see someone who's just a GP for some as simple as this?

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So that's coming back to that other point I was making. It's like, well if it's just my blood pressure, I can take a tablet and I

don't want to disturb, I don't wanna waste someone else's time. This is simple, I can handle this. That's the kind of mentality.

Yeah.

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So they're the sorts of things in terms of preventative and early things. And certainly as we're approaching 40, so at 40 in

general practice, we have the 40 plus health screen, which is where we do the baseline sugars. Yes. So looking for diabetes,

the risk, and also the cholesterol. So that is a government funded MBS item number. Yes. And you can book a long

appointment. You do the full adult health check. So

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People in their forties, we should be getting into at 40. At 40 at

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On the knock. Yes.

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Check our

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Sugars, sugar. That's right. And with women in particular, I talk to them about their breast cancer risk depending on their

family history. Again, at that point because waiting. So then from 45 onwards we have the other 45 year screen. So if alls

clear at 40 to 43, you don't really need to do another blood test if everything's fine, do

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You throw in an E cg? So should that also be getting done in our forties?

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Not necessarily. No. ECG and screening ECGs are still charged. Certainly a history of arrhythmia. If they're having

palpitations, I definitely would because you do have the conversation around heart health it, it's never too early to start. But

we do have that particular trigger point in our program, in our preventative health programs. And again at 45 to 49 we have

the other health check, which is the 45 to 49 health check, which is when you called into the doctor's office to have your

health screen, which includes a review of your cholesterol, your sugars, and your other heart disease risk factors. Now we

also have the fecal OC blood test, which is available from 45 onwards. And although you'll not receive the prompt from the

government in the mail, you can just Google order poo test and click on that. I love

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That order poo test.

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I do that with my patients all the time. In fact, when they say, oh no, I say, have you done it? No. So I say, write this in your

thing and they write it and I say, no, press enter. And it comes up. They say order poo test. Just that I say yes . So

have a bit of a giggle and then scroll down. The first or second item is National Cancer Australia audit. Hit click on that and

order test then and there. And I'll send you a kitten at your home. Easy peasy. So

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You can opt in from 45, but then they send it to you

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From 50 onwards. From

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50 onwards. Yep,

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That's right. Of course the blood tests, right? And that includes your blood pressure, weight and waste measurement and

looking at all the other health factors, your immunizations, mental health and your cancer risks. And then from 50 onwards

with both men and women, we've got the regular health checks, which include the fecal of blood tests. I do maintain that

men should have a psa, certainly the prostate specific antigen, if there's a positive family history of that, of a father, a

brother, certainly under the age of 60, I'd recommend doing a test somewhere around 45 or even earlier a baseline. And

especially now that there's a charge to that. I think the MBS rate of that is now probably about 50 or, but I think it's a

worthwhile test to have. I've detected early prostate cancer in younger men and it's alarming because you think, yes, how

aggressive would this be?

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Had it been left another 10 years? And I think that they're asymptomatic, but it's just one of those accidents that occurs now

and again, and I think that we need to encourage our male colleagues to have their peers say, there's nothing more

devastating than hearing that you know, someone that you're managing who's not had this done or delayed it or didn't want

to do it, ends up with a prostate cancer. And you think really, you know, I would certainly recommend and certainly from

with a family history from 40 or 45 depending on the family history and certainly from 50 as a baseline. Definitely. And then

you see what, where they fit in that sort of range. And so if they're under, you know, 0.9, then you can not do one for another

two or three years. But if there are any, you know, over say 1.2 or something, then you'd probably check it again in a year or

two.

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Yeah. I wanted to ask, hypothetically speaking or I have a friend .

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Yes, yes. I have a friend. We all have a

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Friend. We all have a friend, probably some of the listeners who perhaps got to a certain age 50, 55, 60, and they haven't

done any of their screening, don't see their GP regularly. They've had the letters coming from the government, they've been

asked to do a poo test, they've been asked to do a breast testing, they're due for their cervical pap smear. And there's a lot

of things on that to-do list. So how can they prioritize this list? Yeah,

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That's a really good question Suzy, because it's a lot of time that's involved in having your fasting blood tests. So you've

gotta time that in the morning. So if you're an citizen, you're got early lists. I mean how early is early for you, for you? Eight

in the morning is late in the day. Oh yeah. That's when most of the pathology groups open. Yeah. So timing that fasting

blood test unfortunately for us tends to be hopefully on a Saturday. If you can find a place near home, admittedly I do them

opportunistically and I just say, look, you know you're 50, you haven't done anything. Why wait? You can read the room,

read the situation and make it as easy as possible. So certainly with the bloods, I just take the opportunity and do them as

they're, even though they're not fasting and if there's something abnormal there, then you talk about that.

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And they're usually quite interested in knowing what their fasting blood levels are after that. Mm, true. Even more so. And

then, which should do maybe say three or six months down the track after that conversation around, you know, a bit of

weight loss, bit of management diet, let's recheck this in about three, three to six months. Yeah. Mm-hmm . And

so certainly the P test is a pretty easy one to do. I encourage patients and doctors in particular, I describe what it involves

and it's really not intrusive at all. Mm-hmm. It's hard for those who don't have a regular bowel pattern because you do need

to have three separate samples. And if you poo every second day, which a lot of women do, you know, not as regular as

men, that can make it a bit of a drawn out process. Mm-hmm . No one likes harboring a little specimen of poo in

their fridge at home.

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, I didn't realize it's gotta live in the fridge too.

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There's certainly skin checks every single year. And I encourage self-checking. Mm-hmm . Self-testing. So

examine your skin, know your skin, but your GP can do that. You don't need to see a dermatologist. If you've got really

complex skin, you've got really fair skin with around 200 dysplastic looking, then certainly have a regular relationship with a

dermatologist. Mm-hmm That's something that I encourage, but for the most part, most gps will do. I still

remove lesions, undergoing bit of change. Make it easy for the person, let's just whip it out. Let's just do a quick biopsy and,

and if it needs further excision, then refer to a plastic surgeon.

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I love that you as a GP add that perspective. 'cause I think that's often what doctors can also lose perspective with is when

do you go to a specialist and when can you manage it with your gp?

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Well the thing is that a lot of my colleagues that end up in my room end up admitting that at some point they had a

colonoscopy or they had a stress echocardiogram or they had this, but they never saw a GP for any of that. They tapped on

the cardiologist friend. Yeah. Who did the test and that's all good, but no one's actually looking after their holistic care.

Yeah. And no one's monitoring the progress of their condition. There are other aspects to health other than investigations

that are either proving you've got a condition or not got a condition. So it's not just about having a condition, it's about

knowing what else is potentially gonna go wrong or how you can support your health better. Yeah. So lot have been on

medication without ever having seen a gp. That shouldn't be the case. You've gotta have renal function chats about that.

Yeah. Outsource it. Let someone else take care of you. You can have the dialogue. You don't have to come every single time

for every little bit. Having a telehealth consultation works. Mm. True. Even once a year face to face you do need have the

once a year face to telehealth is great for all the other interim conversations.

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Before I interrupted you, you're about to go on about adding to that to-do list of screening tests,

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Mammograms. Yeah. Now look, breast screen I think is excellent. So a lot of colleagues wanna have a 3D Thomas and thesis

and ultrasound, which is great. I'm happy to arrange those. They do have a very high false positive pickup rate, however, so

things that are identified on the 3D tosis may well result in you requiring a fine needle biopsy unnecessarily. I think just

something for our doctor colleagues here to be aware of because we all know our area very well, but not necessarily

everything else that's going on in the medical world. And certainly in the preventative screening world, which I'm very

deeply involved with. I'm also on the breast screen Australia expert advisory group for as a, and so we're looking at breast

density now and there are a lot of changes ahead in terms of the management of different densities of breast for everyone in

the community. I still maintain, breast screen is fabulous. It's reduced cancer related deaths from breast cancer by close to

% since: 1991

Speaker 1 00:26:38

Yeah. Amazing. So

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We've all heard the stories of women who've been regularly who still have breast cancer and we know that women who have

very dense breasts and you cannot feel dense breasts. Right.

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Sounds like you'll able to.

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classification.

So you can't feel dense breasts. So it's not something you can clinically determine. It's only determined it's a radiological

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Oh, okay.

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And there's category A, B, C, or D, A and B are not particularly dense and they have a very high, so the two dimensional

breast screen every two years through breast screen, any breast screen you do around the country, be it in a mobile van or

be it in a hospital center. The standard is excellent. They have a really high sensitivity in the mid nineties to .

Right. Really high, really reliable. If you have a category C or D, then you have more dense breasts and remember nothing

you can palpate. So it's not about how you breasts look when you take off your bra. And the two dimensional breast screen

that is available through the breast screen wherever you go and is uniform across the country, does not have the same level

of sensitivity for those kinds of breasts.

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Oh, okay.

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Right. So it might be 67%.

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Wow. There's some subtlety and nuance there, isn't there?

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There is. So you've got very dense breasts where we also know there's a higher association with breast cancer.

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Yeah. Right. Wow. Okay.

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And also hormone replacement therapy increases the density of breasts. So we also take into, it makes it also harder to

detect things in dense breasts.

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I see.

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So therefore with those women, with our patients, with our colleagues, we need to have that conversation. We'll be having

that conversation. It's all gonna come back to the gp. Yeah. Because the recommendation issued by breast Screen Australia

and by all the breast screen services so far, the only state that hasn't started informing its clients of breast density is

nd. But they're to do that in: 2026

of late, they'll have received a letter saying your breast screen is normal, however you are classified as birads D. Please

speak to your doctor about this, your general practitioner about this to discuss any further investigations that might be

necessary.

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So go to your screening, get that ball rolling, then get the information, go back to your gp, start putting the picture together.

So of course I've been focused on my lane in anesthesia and these developments have been changing. I don't do a regular

breast list with the breast surgeons. I know some of my colleagues do, so they're probably completely familiar with these

guidelines. But for me, certainly not. This is new. Fantastic. This is why you need a good gp.

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Yeah. So the question there is what do you do when you have, do you have just a conversation say, oh let's keep going.

There is another test that you can do, which is sort of the Peter McCallum they've developed. And I prevent, I use it all the

time with my patients. I should know it's Peter Mac, prevent breast cancer. It's the tool, it's an online tool. If you have never

had breast cancer before, then you can go in other, you've family history of breast cancer and relative, then I think that sort

qualifies you out doing this and gives you sort a sort of a percentage risk at the end of it. It takes about 20 minutes.

Mm-hmm . So I usually give my patients that link. I ask them to go home and do that. Sometimes if we have a

bit of time, if they've made a longer appointment, I'll go through the whole thing with them.

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We do the survey together, helps me also understand more about their potential risk. Mm-hmm . And then you

have the conversation with the gp. Look, your risk category is relatively high here, so we should probably go and proceed

with some other test. And the question there is, what do you do? Do you do the 3D tomo with ultrasound? Which of course

has a very false positive pick rate and not that much more accurate than the 2D. Not that much more better. But the faster

period tests of course are mammograms, contrast, ct, invasive dye, the whole thing, expensive screening, expensive or MRI

breasts. I mean, who can afford that. So they're the complex conversations that we'll be having with our patients, but also

complex conversations that we'll be having with our colleagues around what do we do to better screen you to better serve

you given you've got very dense breasts. Not only do you need to have your breast screen, but you need to know your

breast density. So they're key points to take home. Alright.

: 00:31:13

So we've covered doing your POO test. We've covered doing your breast screening, you mentioned doing and

: 00:31:18

The prostate.

: 00:31:19

Did you mention PSA before? Anything else you wanna add to doing PSAs and prostates?

: 00:31:23

Just do them basically. Yeah, really just do them. I think it's a disease that's so common. I know the older you are and if it's

positive and you develop the prostate cancer, the less likely you're to dial the consequences of it. But there's this whole

argument about do you still do PSAs over the age of 70? We're living till our nineties. I have patients who are living well into

our eighties and nineties and thriving. That's when they get into their other phase of life, writing their books, emeritus

professors, and doing all sorts of exciting things. That's true. So I think it depends on the individual. Certainly I recommend

doing them at that age. And if it's elevated outside of the range, certainly we have that conversation. If there's a prostate

cancer and it's been identified and it's under surveillance, you can watch. And that's usually under the care of a urologist.

So that's not gonna be managed by the GP I would refer. Right. But you have that three-way relationship, the patient or your

colleague, the urologist and the gp. Just monitoring that over time.

: 00:32:27

Okay. So we've talked about breast screening, poo screening, prostate screening for PSAs. Is there anything else that we

should be thinking about?

: 00:32:35

Yeah, sure. Osteoporosis. So bone density, we need to know about that at the onset of menopause or if there's a family

history of osteoporosis that's premature. You've got celiac disease for instance, or thyroid disease or some other

autoimmune disease, or you've been on steroids or you've got a connective tissue disorder requiring long term treatment

that can all compromise your bone density. So for anyone out there who's on medication for any of those conditions, bone

screening for osteoporosis with a bone density is recommended earlier rather than later. And certainly if you've had an

eating disorder like anorexia nervosa where you've had a amenorrhea, that's very important for our younger women. Yeah.

And for our younger men too. Yeah.

: 00:33:21

And there's a high prevalence or incidence of that in particularly, you know, successful women who might end up entering

medicine and that's something that they could have forgotten about from their teenage early adult years. That's

: 00:33:32

Right. So

: 00:33:32

That's important to think about.

: 00:33:33

Important to think about. And then there's cervical screening of course for women. The interesting thing now there is that

you can do it every five years. You can also do the self test. Oh, okay. So the self test, as opposed to having a speculum

uncertainty, vagina, you can just basically insert a cotton tip. It's like a long cotton tip into your vagina, twirl around about

20 times. And it really just screens for the presence of human papillomavirus. It's a PCR test. Mm-hmm . Much

like the rats that we do. But I do say to my female patients that it's not a bad idea given that we are doing them every five

years. If you've got any discomfort, burning itch, any symptoms, it's worth having a physical examination. Certainly for VUL

changes, VUL sclerosis, it's a vulva, which is a pre-cancerous condition, can be quite silent in women.

: 00:34:25

And I've seen that occur. I do like the self-test, it's convenient, it's easy. And I know that a lot of our colleagues opt for that

now, but just remember that any gynecological symptoms, abnormal bleeding or outside of your period or postmenopausal

bleeding to have a physical examination. And I hopefully I've mentioned also immunizations. Right? So pertussis is one of

those things that I talk to people about opportunistically. Mm-hmm . So it's now, you know, booster, make sure

you're up to date with that. We've got PSAs going around, obviously in the line of work you're in. And COVID and influenza.

Yeah. Really important. Yeah.

: 00:35:00

And pertussis is an interesting one because we're often vaccinated as teenagers, but the immunity wanes and you're

reminded probably when in your childbearing years it's time for a booster. But then after that we don't often get another

prompt.

: 00:35:12

Yeah. Look, we don't really know how long the pertussis antibodies last. We suspect somewhere around the 10 year mark.

So somewhere around the 10 year mark just have boost. I automatically put that in the recall list. Alright.

: 00:35:26

So it is a bit of a checklist, but you can get through it. It is manageable with the support of your gp.

: 00:35:31

I think it's so important to not self-manage. It's very hard to let go our of our control, understandably. We can't let go of

control in our work and we can't let go of control of our own decision making. Yeah. When it comes to patients, you sort of

understand that you wanna protect your patient and do the best you can, but when it comes to you, all our other biases

have a role and interfere. So it's good to have that objectivity of someone who doesn't have those.

: 00:36:05

Yeah. I think this leads nicely into what I've been thinking in the back of my mind, because we have such a problem trusting

someone with this decision making. What are the things we are looking for? How do we find them?

: 00:36:15

I think it's word of mouth. Ask colleagues that have got a good gp, say, Hey, do you have someone that you could

recommend? And most of us will open up another appointment for a colleague. You just do. I think

: 00:36:28

A great GP is a great regardless. Or do you think sometimes it's just that you have someone that you click with more than

another person or someone is more able to trust a certain type of GP more than another type?

: 00:36:40

Really good question, Susie. I think it's both. So a GP might have a particular approach, which is very direct or

conversational. It depends on personality. I mean, we're human, aren't we? Mm. So it's like finding a good counselor

sometimes when patients come back and say, oh, we didn't click. And other patients rave about them. They're very good as

clinicians. So I think it's the same with doctors. It's great to have a relationship with someone that you don't mind gonna

have a chat with. Yeah. Because a lot of important stuff comes out through the chat.

: 00:37:16

Absolutely. Yeah. And speaking of the chat, you must have a huge network. You've been president of the Victorian Women's

Medical Society, you're on multiple boards, you've been involved with a MA at so many levels. Do you come across your

patients in your network

: 00:37:31

All the time?

: 00:37:32

And how do you manage that?

: 00:37:34

Oh, I think we all sort of do. I, I don't find that disturbing for me. I say hello, no one needs to know that I'm their gp, but

usually they divulge that I'm their gp, which puts me in a bit of an awkward position sometimes actually, because I wanna be

seen as not just their gp, especially when we're friends or not friends, because I try not to see my friends quite seriously. I

don't, although friends will ask my opinion, but I try not to see my friends. I would refer to someone else. But certainly, you

know, you develop that camaraderie, you know, you could easily be friends, but then you see each other in a professional

setting or you see each other in a meeting on a committee or something else. And they don't need to disclose on their GP

unless there's a conflict of interest for some other reason. Whether it be research related project or something to do with

that.

: 00:38:25

I wanna come back because I just really wanna get this point across about doing an annual wellness check with your gp,

making that appointment when you're, well, when should we start making that annual check-in?

: 00:38:37

I say from 18 onwards. I get that drummed into the teenagers. I like to see the students and I like to have an approach where

they feel they can walk in when they're in a crisis or they have access through telehealth for a crisis, because that's when

things really do and can go wrong. I encourage that through the parents. As a gp, I'm so lucky I see young women in their

forties that I've known since they were 14 for their, have these would've known life so complicated. So annually from uni

days onwards, you know, there's so much to do. Even as a uni student, you've got your St I screens, you've got your mental

health, you've got your diet. And sometimes I think we just need to have someone external drumming into the importance of

opportunistic exercise and lifestyle choices. So one of the things you've probably observed in your colleagues over the

years, some just gain a lot of weight because it's just lifestyle related. We have difficulty prioritizing our health and ourself.

We feel guilty when we're exercising and taking time away from doing work. We feel guilty doing things that have to do with

us and our personal needs. And in drumming that in, you're entitled to look after, take the time, do the exercise, choose the

right foods, what's your sleep like, what's your stress like? These issues exist all the way through and at different levels.

: 00:40:04

All right. So take home message everyone and your wellness check, find a good gp, start building that relationship if you

don't already have one.

: 00:40:12

Yeah. Great.

: 00:40:14

Is there anything else that you would like to say? This has been fantastic. I hope it's inspired some people to pick up the

phone and call their gp, but is there anything else you wanna add?

: 00:40:22

Oh, I just wanna say thank you for inviting me and I hope that our colleagues out there actually do take something home

from this and the importance of follow up also with the gp. So yeah, the once a year physical check is one thing, but also

just make sure that you do have a follow up. I know you can access your results and you understand them, but it's

important also to have that conversation about next steps and next recalls too. And bring your list with you when you do

have an appointment. If you do have any issues, bring your list of issues, whatever they're, and talk about them. Hopefully

you can feel that you've got a trusting person in that room that you can just talk with about all sorts of things. Not just

health too, but life and all the other things that impact you.

: 00:41:05

Oh, wonderful. Look, absolutely inspiring having a chat with you this morning. Thank you so much for your time.

: 00:41:11

Lovely to see you in this context too. Thank you.

: 00:41:19

Well, I hope you enjoyed that conversation with Dr. Simons. And more importantly, I hope that it has inspired you to do one

of three things and they are to one, book an appointment with your gp if you're overdue. If you haven't seen them in the last

12 months, just get in there. It's preventative care and it's good for you. Or number two, ask around, start looking for a gp.

Ask your friends. Ask family who you trust. And number three, if this is the time for you, if you're at a certain age in your life

and you should know what they are, 'cause you would've received the letters from the government, then book in for that

screening test, whether that be the bowel screening, the breast screening, or book in with your GP for A PSA, I will put the

links for ordering a free bowel test kit in the show notes.

: 00:42:01

Or you can have the joy of searching order a pues yourself as Dr. Simon suggests. And finally reminding you to drop me an

email if you'd like a shout out on the podcast. I am, as I said earlier, really, really thankful to everyone who came and said

hello to me during the NSC. And also let me know what did you think about my leadership slash comm tips from what I've

learned as a podcaster that I presented at the start of the podcast. If you wanna do some research for yourself, then look up

Chris Voss. That surname is spelled VOSS or in NATO alphabet. That's Victor, Oscar, Sierra, Sierra. And you are looking for

a late night FM DJ voice. Did you enjoy those insights? Did you just wanna get straight into the conversation? Do you

wanna hear more insights? Let me know so I can keep developing this podcast for you. The best way is to email me on

podcast at asa org au. In the meantime, keep being wonderful, healthy, and as always, hope you're staying safe and well out

there.