Abstract
Website of the month
Fixers are young people who have a burning desire to help other people learn from their experiences, and are helped by a team at fixers.org to create and spread whatever material is necessary to do this. The charity has activities in all four UK countries, and resources in both English and Welsh.
State of child health
The UK ranks 15th out of 19 Western European countries for infant mortality. There is a strong link between deprivation and mortality. The UK has high rates of smoking in pregnancy, child smoking and alcohol consumption and high obesity levels.
Many of the solutions lie beyond health care, but what about looking at aspects of preventative care in your surgery and asking yourself what you could help change? You can read the document at www.rcpch.ac.uk/state-of-child-health/report-in-a-glance
Laughing at cancers
Clinicians often deal with stress by use of dark humour. There is a literature on the use of humour by people with cancer. An article in the Journal of Pragmatics analyses the comments on ‘warped’, a social media thread, and identifies some positive aspects of the use of humour, for example space to discuss sensitive topics, empowerment and a sense of belonging to a group.
Demjen, Z. (2016). Laughing at cancer: Humour, empowerment, solidarity and coping online. Journal of Pragmatics, 101, 18–20
GP Health Service
An NHS GP Health Service has been set up in England. The self-referral service focuses on mental health problems ranging from stress to addiction. The programme is run by the London-based team Practitioner Health Programme set up by the former RCGP Chair Clare Gerada.
gp.health@nhs.net
Men with osteoporosis
Despite a perception that osteoporosis is a female disease, one in eight men over 50 will have a fragility fracture during their lifetimes, and the mortality after hip fracture in men is double that of women.
Khan, U. & Das, G. (2016). Men with osteoporosis: The lost tribe. Geriatric Medicine, 1(47), 15–18
Paperwork
Life is busy for us all. A group of GP practices in London, AT Medics, has shared their journey, teaching their administrative team to safely deal with the bulk of their correspondence, and to ‘signpost’ patients to the most appropriate person or service to deal with their problems.
atmedics.com/wp-content/uploads/2016/12/NHSEngland-ATMedics-innovations-case-study-160728.pdf
Confidentiality
The General Medical Council has updated its guidance on confidentiality. There is detailed information on the guidance, summarised guidance and a range of case studies and materials. The site reminds us that it is our professional responsibility to remain up to date. Of note are the sections on training, confidentiality in patient areas (e.g. waiting rooms and reception) and on fitness to drive.
www.gmc-uk.org/What_s_changed_in_the_confidentiality_guidance_FINAL.pdf_69098866.pdf
Palliative care
Marie Curie has launched a palliative care knowledge zone. The topics are divided into symptom control, conversations focused on the individual needs of patients and carers, and a section on a variety of different diversity issues, for example homelessness and learning disability.
patiezonewww.mariecurie.org.uk/professionals/palliative-care-knowledge-zone
Open tabs
Dr Tom Nolan has written a BMJ opinion piece likening a busy morning surgery to a computer running with multiple tabs open. He describes using 15-minute appointments to allow him to ‘close’ some tabs, and refers to a 60:20:20 rule, 60% of time for planned work, 20% for unplanned work and 20% for socialising, for example a chat over coffee or a clinical meeting.
Nolan, T. (2017). Freeing up some cognitive bandwidth in general practice. BMJ, 356(8094), 317
Private work
GPs working for the NHS are restricted in terms of services for which they can charge patients (traditionally a small range including travel vaccines, private certificates and medical reports). With initiatives such as charging for ‘quick access’ or ‘log’ consultations, the boundaries are becoming blurred. There is specific General Medical Council ethics advice about the topic.
Genetic testing in bowel cancer
Recent National Institute for Health and Care Excellence (NICE) guidelines advise that all patients diagnosed with colorectal cancer should be offered genetic testing to look for abnormalities that could indicate Lynch syndrome, a hereditary cause of colon, womb, stomach and ovarian cancer. If found, further testing should be carried out for diagnosis, and family members can then be screened. Lynch syndrome is thought to account for 1/30 cases of colon cancer.
Sleep problems in children
There has been a lot of press coverage recently regarding the increasing problem of sleep disorders in children. Blue light from phones, tablets and television, and caffeinated and sugary drinks, are thought to be possible contributory factors. The patient.co.uk website and the Royal College of Psychiatry offer useful information for patients, parents and physicians.
www.rcpsych.ac.uk/healthadvice/parentsandyouthinfo/parentscarers/sleepproblems.aspx
Pre-natal screening for gender
Although not a problem we may become directly involved in, pre-natal screening for gender may be an issue we are aware of within our patient population, or that patients approach us about. While in some NHS centres in the UK, parents to be are no longer able to find out the sex of their baby, this service is offered by many private clinics. A new report suggests that testing for gender should be banned, and only offered if being used to diagnose a medical condition.
Non-invasive prenatal testing: Ethical challenges. (2017). Nuffield Council on Bioethics. Retrieved from nuffieldbioethics.org/wp-content/uploads/NIPT-ethical-issues-full-report.pdf
Vitamin D in pregnancy and breastfeeding
Most GPs are aware of the fact they should be counselling women about taking folic acid pre-conception and for the first 12 weeks of pregnancy. Guidelines from the Department of Health also state that pregnant and breast-feeding women should take a daily supplement of 10 micrograms of Vitamin D. This is available free of charge to all women via the Health Start Scheme.
Neurological problems
This website has been developed by a neurologist in Scotland to provide information and support for patients suffering from functional neurological problems, such as functional limb weakness, sensory symptoms and headache. Functional problems can be challenging to discuss with patients, especially when symptoms are neurological in origin with potentially worrying underlying causes when patients initially present and may be undergoing investigations. The website provides information on various treatment modalities, as well as patient stories and may be a useful resource for some patients.
Polycystic ovarian syndrome in adolescents
Not a common problem, but one recently encountered by News and Views. This can be challenging to know how to manage, as often teenage girls are not yet considering fertility issues, yet the diagnosis of polycystic ovarian syndrome at a young age can come as understandably upsetting news. Essentially the same management guidelines as for other women apply, though it may be worth discussing with your local gynaecology department as they may wish to see the patient to discuss the diagnosis and future implications. A review in Paediatrics highlighted recent recommendations: The combined oral contraceptive pill is first-line management as it improves irregular cycles and hyperandrogenism.
Rosenfield, R. L. (2015). The diagnosis of polycystic ovary syndrome in adolescents. Pediatrics, 136(6), 1154–1165. doi: 10.1542/peds.2015-1430
Record keeping in primary care
This is something I often struggled with as a registrar, not knowing how much detail to include in clinical notes and even now probably having a tendency to document too much. The RCGP have a free online module for members on data quality, protection and patient access that may be interesting to complete and consider whether there are any changes that can be made to your practice.