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