BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition affecting attention, impulse control and emotional regulation across the lifespan. Although pharmacological treatment is often effective, many patients benefit from additional psychological and lifestyle-based interventions that support daily functioning. OBJECTIVE:The aim of this article is to provide an overview of evidence-based non-pharmacological strategies for ADHD that may assist patients in general practice. DISCUSSION:ADHD management typically involves a multimodal approach combining pharmacological and non-pharmacological interventions. Psychological approaches such as cognitive behavioural therapy and behavioural parent training can support executive functioning, emotional regulation and adaptive coping. Environmental supports, including school-based interventions and organisational strategies, may improve functioning. Lifestyle factors such as sleep, exercise and regular routines also influence symptom management. General practitioners play an important part in psychoeducation, early intervention and referral to appropriate psychological or allied health services.
BACKGROUND:Lipoprotein(a) (Lp(a)) is an atherogenic, low-density lipoprotein (LDL)-like particle whose concentrations, mostly genetically determined, are elevated in about 20% of individuals. It is a major and under-recognised independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. OBJECTIVE:To review current evidence, international recommendations and future directions around testing and management of elevated Lp(a). DISCUSSION:Among other high-risk groups, measuring Lp(a) is recommended in people with ASCVD or aortic valve stenosis, especially if they are of young-onset, familial, unusually severe or progressive. Indeed, some international guidelines advocate measuring Lp(a) in all adults as part of cardiovascular risk assessment. While specific Lp(a)-lowering therapies are not yet available, risk-reducing measures for people with raised Lp(a) include addressing absolute ASCVD risk by diet and lifestyle measures, along with pharmacological LDL-cholesterol reduction. Aspirin might also have a role in primary prevention. Lp(a)-lowering therapies that act by preventing its formation are the subjects of ongoing clinical trials focused on cardiovascular outcomes, the first of which is expected to report in late 2026.
BACKGROUND:Artificial intelligence (AI) is thought by many to likely underpin the next revolution in clinical medicine. The rapidly evolving terminology in AI - including terms such as 'generative AI', 'machine learning' and 'natural language processing' - can present a barrier to clinical adoption. OBJECTIVE:The aim of this article is to give a non-technical overview of AI and its medical applications, with particular emphasis on large language models. DISCUSSION:The term 'AI' suggests semantic understanding. This impression is reinforced by text output eerily similar to human writing. However, AI has not yet become intelligent in the common understanding of that word. The apparent semantic understanding is not actually there. Knowing this is crucial to avoiding misapplications of this nevertheless revolutionary technology.
BACKGROUND:As demand for attention deficit hyperactivity disorder (ADHD) treatments increases, Australian governments are relaxing the requirements for general practitioners (GPs) to prescribe Schedule 8 psychostimulants. Depending on state or territory legislation, GPs will likely increase their involvement in the assessment and management of children and adults with ADHD. OBJECTIVE:This article summarises the medicolegal issues that might affect GPs when initiating, continuing and monitoring ADHD medications in children and/or adults. DISCUSSION:Psychostimulants are restricted medications that carry risks of misuse and dependence. GPs must comply with state and territory prescribing laws and the requirements of the Pharmaceutical Benefits Scheme (PBS). Patients must be carefully assessed and warned of risks. Treatment via telehealth can raise medicolegal issues, given inherent limitations of the online environment, the requirement to verify patients' identity and to ensure that a genuine therapeutic need exists. Treatment in children can be especially complex when separated parents disagree. GPs need to understand how to manage these challenging and emotive situations.
BACKGROUND:A Medicare-funded 3-year-old health check is being introduced from November 2026 as part of Thriving Kids. Most key developmental milestones are expected to be met in the first 3 years. By age 3 years, more than one in five children have at least one developmental vulnerability, hence this is a timely opportunity for early recognition and support. OBJECTIVE:This article outlines how to perform a general practice 3-year-old health check by applying the health assessment framework to a case study. DISCUSSION:The strength of the ongoing relationship between a general practitioner (GP), a child and their family means general practice is ideally placed to assess a child's development and wellbeing with awareness of their broader community context. GPs can provide monitoring, education, supports and/or referral where appropriate. The opportunity is not simply to detect delay earlier, but to convert a trusted GP relationship into timely developmental support, parental capacity-building and practical community connection.
BACKGROUND AND OBJECTIVES:Weight stigma contributes to health inequity for pregnant women living in larger bodies. General practitioners (GPs) are an important gateway into maternity care. Our aim was to explore GP views on weight stigma in maternity care to inform recommendations for non- stigmatising care. METHOD:Participants were Australian GPs providing maternity care who ranked highly on fat-acceptance survey scores. Twenty semi-structured interviews in 2024 explored GP backgrounds, beliefs and behaviours when treating larger‑bodied women. Interviews were analysed using reflexive thematic analysis. RESULTS:Participants had experienced weight stigma both personally and professionally. Participants reported using reflective practice to reduce their weight-based biases. Recommendations for organisational improvement included revising guidelines, communication skills training, and funding for rural services. DISCUSSION:Findings suggest that reflective practice could be encouraged to decrease weight stigma in maternity care.Recommendations could provide a blueprint for policymakers, educators and practitioners who wish to reduce weight stigma in maternity care.
BACKGROUND:Methamphetamine use is a prevalent but under-recognised cause of acute and chronic cardiovascular conditions. Deaths from methamphetamine-associated cardiovascular conditions (MACCs) increased seven-fold between 2009 and 2020 in Australia, and MACCs were the leading cause of natural death among people who use methamphetamine. Prognoses for the primary MACCs are optimistic with abstinence and medical management early in disease progression, underscoring the utility of screening; however, screening is underutilised because of unfamiliarity, stigma and lack of guidelines. OBJECTIVE:This article provides expert and evidence- based recommendations to guide screening, management and harm reduction relevant to MACCs. DISCUSSION:Screening for and managing cardiovascular conditions are central concerns for any clinician treating a patient who uses methamphetamine, and a high suspicion of cardiovascular disease is warranted. There should be a low threshold for screening patients with a history of past or present methamphetamine use.
BACKGROUND AND OBJECTIVES:Medical regulators play an important part in protecting the public from harm. This includes receiving notifications about general practitioners (GPs) who are impaired in their ability to provide safe care because of a health condition. We sought to understand the prevalence and characteristics of health-related notifications to inform efforts to support GP wellbeing while protecting patient safety. METHOD:We linked 10 years of notifications to the Australian Health Practitioner Regulation Agency (Ahpra) with workforce demographics. We described characteristics of health-related notifications and calculated the odds of receiving a notification. RESULTS:GPs received 40% of notifications about doctors from 2012 to 2022. Health impairments represented 2.8% of notifications. The most frequent health- related concerns were drug or alcohol use for male and rural GPs, mental health for female GPs and cognitive issues for older GPs. Over a third (38.8%) of health-related notifications were raised by another health practitioner, and 17.3% led to restrictions on practice. DISCUSSION:Health-related concerns are a small proportion of notifications about GPs but can have serious consequences. Targeted interventions may support GP wellbeing.
BACKGROUND AND OBJECTIVES:Diagnoses of attention deficit hyperactivity disorder (ADHD) in Australian children are increasing, and assessment wait times remain long. Expanding diagnosis and management to upskilled general practitioners (GPs) has been proposed, but evidence is limited. To describe the referral pathways, wait times and medication outcomes in the first 207 children diagnosed with ADHD in 2023-26 by four GPs trained in ADHD management in Nepean Blue Mountains Local Health District, New South Wales. METHOD:Prospective cohort study evaluating an integrated model of ADHD care delivered in two general practices. GPs diagnosed 207 children aged 4-17 years, mean age 11 years (112 boys, 91 girls, 4 non-binary). RESULTS: The majority of participants (57%) were referred by GPs from other practices. Median time to first appointment was 3 weeks. Of 121 children currently stabilised on medication, 118 were prescribed stimulants. Among 85 with serial teacher ratings, inattention hyperactivity with aggression (IOWA Conners) scores improved significantly (P<0.001). Five children were referred to other specialists (paediatrics/psychiatry). DISCUSSION: These preliminary findings suggest that trained GPs might deliver timely and effective ADHD care in primary care settings.
BACKGROUND:Research increasingly highlights that building meaningfulness is a promising approach to mitigating burnout among doctors. OBJECTIVE:The aim of this paper is to describe a practical model that identifies opportunities for everyday tasks to be adapted to better support general practitioners' (GPs') wellbeing. DISCUSSION:The model integrates research with GPs and other doctors highlighting the centrality of meaningfulness and integrates this with the Job Demands- Resources model. Each task comprises demands that require the GP to invest energy. This investment can vary based on what external supports are available and the GP's psychosocial context. Importantly, the greater the task aligns with a GP's values, the more rewarding it becomes. Ultimately, the balance between the demands and rewards of the task determines whether it supports or diminishes a GP's wellbeing. By articulating this process, the model offers individuals and practices opportunities to review how they can maximise meaning and reduce demands facing GPs to support their wellbeing.
BACKGROUND:Performance and image enhancing drugs (PIEDs) include a diverse range of substances used to improve physical performance, muscle mass or appearance. While historically associated with elite sport and bodybuilding, use has expanded to broader populations. Most PIEDs used outside clinical settings are non-prescribed and obtained through informal or online markets, creating additional health risks. OBJECTIVE:This article aims to support general practitioners (GPs) in engaging with patients who use anabolic androgenic steroids and other PIEDs and to outline practical harm reduction strategies for monitoring and managing associated health risks. DISCUSSION:People who use anabolic androgenic steroids and other PIEDs might be reluctant to disclose use because of stigma, fear of judgement or concerns about confidentiality. A non-judgemental, harm reduction approach can facilitate disclosure and enable clinicians to provide appropriate monitoring, screening and education, as well as reduce potential harms by supporting safer practices and managing adverse effects.
BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is increasingly managed within general practice in Australia, supported by evolving shared-care models and expanded general practitioner (GP) involvement. OBJECTIVE:Medication plays an important part in improving day-to-day functioning in patients significantly affected by ADHD. It should be used in conjunction with robust and evidence-based psychosocial supports and psychoeducation. This article aims to provide a practical guide for GPs in Australia seeking to initiate stimulant or non-stimulant medication. DISCUSSION:Medication initiation and adjustment should occur over multiple appointments and involve shared decision making with a focus on functional outcomes rather than symptom scores alone. Side effects should be monitored for carefully and timely escalation to non-GP specialists made as required. Response to medication varies from patient to patient, hence different medication management options are provided, both stimulant and non-stimulant, to be employed as a component of multi-modal patient care.
BACKGROUND:The process of excising and repairing skin cancers has the potential to be highly complex. This is especially the case on the head and neck or where a complex closure is required. To optimise decision making, it is important that at the planning stage all of the various, potentially competing, considerations are made explicit and appropriately ranked in relation to the four surgical hierarchical goals which are: (1) curing the cancer; (2) avoiding functional disturbance; (3) avoiding complications; and (4) achieving good cosmesis. OBJECTIVE:We wished to design an easily remembered formal process that would not only assist doctors ensure they had considered all the relevant variables but that would also help rank these in terms of surgical importance prior to making a surgical plan. An appropriate acronym is an efficient means of ensuring the most important considerations are made explicit first (establishing the hierarchy) and that all the relevant information is gathered. Only then does the solution phase proceed. This is the basis of 'CHAIRS' which stands for: Cure the Cancer; Hole; Area/Alignment; Icebergs/Incidents; Reservoirs; Solution(s)/Salvage. DISCUSSION:CHAIRS enables structured, orderly preoperative planning crucial for achieving favourable outcomes in skin cancer surgery. It provides less experienced doctors a framework to work with, and more experienced ones with a back-up first principles approach. It is easy to learn, remember and teach.
BACKGROUND AND OBJECTIVES:Uncertainty is often considered a defining feature of general practice, yet empirical comparisons across medical specialties are limited. This study investigates whether uncertainty is uniquely prevalent in general practice or a commonality of clinical work across medical disciplines. METHOD:A bibliometric analysis of 3757 articles from PubMed (1966-2025) was conducted. A total of 287 relevant studies were categorised by specialty and study type to assess thematic focus and empirical content. RESULTS:Publications on uncertainty were comparable in number between general practice (n = 87) and non-general practice specialties (n = 94), with general practice publications showing a higher proportion of empirical studies (67% vs 61%). A recent acceleration in non-general practice literature suggests growing interdisciplinary interest. DISCUSSION:Findings challenge the narrative of general practice exceptionalism regarding managing uncertainty, suggesting that uncertainty is a systemic feature of medical practice. This has implications for medical education, professional identity and cross-specialty collaboration.
BACKGROUND:The menopause transition marks a period of accelerated cardiovascular risk in women, highlighting the importance of opportunistic screening and intervention in midlife primary care. OBJECTIVE:This article summarises current evidence linking menopause with cardiovascular disease (CVD) and appropriate interventions, including lifestyle optimisation and menopausal hormone therapy (MHT). DISCUSSION:The midlife acceleration of CVD risk is driven by distinct cardiometabolic and vascular changes, with ovarian ageing independently associated with adverse lipid profiles, fat redistribution, vascular dysfunction and metabolic syndrome. Early, premature, surgical and symptomatic menopause further amplifies risk. Lifestyle optimisation and lipid-lowering therapy remain powerful strategies to mitigate these changes. MHT, although not recommended solely for primary or secondary CVD prevention, may be offered for symptom management and bone protection in appropriately selected women, and in cases of premature, early or surgical menopause. Midlife consultations provide a unique window for general practitioners to opportunistically risk stratify, initiate preventive measures and support informed MHT decision making, thereby shaping long-term cardiovascular trajectories.
