Abstract
Website of the month
The Health Foundation produces a range of free resources available both online and in print. Browsing the lists of projects might give you ideas for your own quality improvement activity. I enjoyed reading some patients’ viewpoints of consultations; a different perspective from our own worries about what we do in consultations.
Fischer, M., & Ereaut, G. (2012). When doctors and patients talk: making sense of the consultation. Retrieved from www.health.org.uk
Clinical skills assessment videos
One of our Innovait team has recommended the Pennine consultation videos. You might find they stimulate discussion and give you ideas for your clinical skills assessment (CSA) revision.
www.youtube.com/user/mattandhazelsmith/videos?shelf_id=1&view=0&sort=dd
SARAH
The Social Action, Responsibility and Heroism Act (2015) offers support to ‘Good Samaritans’ who help out at incidents and are subsequently sued for negligence. Courts are instructed to take into account whether the person acted for the ‘benefit of society’ and took a ‘predominantly responsible approach’.
Presenteeism
Several articles in the December 12 issue of the BMJ discuss the reasons behind doctors’ presenteeism. As well as reference to sources of help, our duties as a doctor under Good Medical Practice are discussed, with a reminder that we must protect patients and colleagues from any risks posed by illness.
Davies, M. (2015). Medicolegal aspects of working whilst unwell. BMJ, 351(8037), 13.
Mims Learning
If you like your reading interspersed with pictures, you might enjoy Mims Learning, a monthly educational journal, available in print or at mimslearning.co.uk/. The November 2015 issue included questions and answers on a variety of respiratory topics, a range of journal updates and a summary of National Institute for health and Care Excellence (NICE) guidance on the management of coeliac disease.
Menopause management
Over my career, I have watched hormone replacement therapy move from being viewed as a panacea for most ills in women over 40, to a high-risk medication to be prescribed only with caution. This oscillation in popularity frequently occurs with the introduction of new drugs. NICE has contributed welcome advice on the diagnosis and treatment of the menopause. Advice on diagnosis reminds us that measurement of hormone levels is not usually necessary in women over 45. The guidelines give clear descriptions of the risks of cardiovascular disease, breast cancer and venous thromboembolism.
NICE. (2015). Menopause: Diagnosis and management. Retrieved from www.nice.org.uk/guidance/NG23
Flu vaccines in pregnant women
A large prospective cohort study in Sweden has shown that the flu vaccine during pregnancy does not affect the risk of stillbirth, early neonatal death or later mortality of the infants.
Ludvigsson, J., Strom, P., Lundholm, C., Cnattingius, S., Ekborn, A., Ortqvist, A.,… Stephansson, O. (2015). Maternal vaccination against H1N1 influenza and offspring mortality: Population based cohort study and sibling design. BMJ, 351, h5585. doi: 10.1136/bmj.h5585
Progesterone and miscarriage
I find management of patients with recurrent miscarriage quite difficult; a group where I find it difficult to distance myself from the sadness. Studies that increase our knowledge about treatments help the discussion. A multicentre placebo controlled trial of vaginal progesterone up to 12 weeks gestation showed no difference in live birth rate in women with recurrent miscarriage.
Coomarasamy, A., Williams, H., Truchanowicz, E., Seed, P., Small, R., Quenby, S.,…, Rai, R. (2015). A randomized trial of progesterone in women with recurrent miscarriages. New England Journal of Medicine, 373, 2141–2148. doi: 10.1056/NEJMoa1504927
Sources of information
When you join a practice in a new area, it is worth ensuring that you make sure you are on the mailing lists for local information. Our latest pathology newsletter, as well as updates on a variety of clinical topics, gave us a list of abnormal results likely to generate a telephone call to the surgery or out-of-hours provider. Our safeguarding newsletter is always informative, and highlights both national and local issues. If you are lucky enough to still have a functioning local postgraduate centre, you might want to ensure that you get added to the contact list.
Marburg Heart Score
A small primary care-based study has shown that use of the Marburg Heart Score can add to clinical judgement in the diagnosis of coronary heart disease. Five findings (gender/age, history of cardiovascular disease, pain on exercise, pain not reproducible on palpation and belief by the patient that the cause is cardiac) are used to give a numerical score.
Haasenritter, J., Donner-Banzhoff, N., & Bosner, S. (2015). Chest pain for coronary heart disease in general practice: Clinical judgement and a clinical decision rule. British Journal of General Practice, 65, 583–584. doi: 10.3399/bjgp15X687385
Use of herbal medicines
Patients often ask about the use of herbal medicine, sometimes when desperate and having run out of options in terms of prescribed medication. Though a lack of evidence for efficacy makes it easy for us to explain why we would not recommend these medicines, sometimes the patients just want to know whether it is safe, or how it may interact with other medications they are prescribed. Advice for patients exists on the NHS website. It recommends that if patients purchase herbal medicines, they should look for the ‘Traditional Herbal Registration’ (THR), which does guarantee that the product has been measured against set standards, as opposed to buying items online. Websites such as NHS Choices and Patient.co.uk often have further information for patients about specific herbal medicines.
NHS Choices. (2015). Herbal medicines. Retrieved from www.nhs.uk/conditions/herbal-medicines/Pages/Introduction.aspx
Sharing information
The General Medical Council (GMC) has run a consultation on confidentiality, particularly to explore aspects of discussing a patient with relatives and carers. Particular issues that have been flagged are the situation when a patient is too ill to indicate what he/she is happy to have shared, when family members disagree about what a patient who lacks capacity to decide should be told, and when someone close to a patient wishes to share concerns. The consultation was due to finish at the end of February 2016, so you should be able to read the new version of the guidance on the Good Medical Practice section of the GMC website (www.gmc-uk.org).
Abuse of prescription drugs
Death rates from overdose of prescription drugs exceed those from illegal drugs. Patients may become addicted to drugs originally prescribed for medical reasons or may take prescription drugs as part of a tendency to misuse drugs in general. Early requests for repeats or frequent ‘lost’ prescriptions may be warning signs. Benzodiazepines, opiates and cough and cold remedies are common drugs that are misused. Tramadol and dihydrocodeine have some serotonin-reuptake inhibitory effects so may produce specific psychological effects. In the United States of America, oxycontin has become a very common drug of abuse.
The King’s Fund has produced a 6- minute video giving an alternative view of mental health service provision in England. The animation describes mental health provision as illustrated by the journey of three people who have mental health problems.
King’s Fund. (2015). An alternative view of mental health services in England. Retrieved from imeo.com/141796283