Abstract
Texting patients
Many surgeries remind patients about appointments by text, and some text investigation results. The General Medical Council has recently published an update on the use of texts, particularly with reference to pressures to consult via text.
Contraception advice
The Faculty of Sexual and Reproductive Health produces regularly updated summaries and guidance. For members, additional benefits include live and recorded webinars, and personalised responses to evidence requests.
Chronic pain
Tackling chronic pain is challenging. I was shown a YouTube video that gives a short summary in simple terms and sets out a structured management approach. You could watch this in a tutorial or in a study group and discuss.
Sessional working
There are many different ways of being employed as a sessional GP. The British Medical Association sessional GP pages give information on a variety of topics, including the minefield of working within innovative organisations.
NHS health practitioner programme
The NHS Health Practitioner Programme is a self-referral service for GP trainees and general practitioners in England. It is provided by health professionals specialising in mental health to support doctors and is available in various locations across England. The programme recognises that doctors often find it difficult to access mainstream mental health or addiction services owing to concerns that the individual may not receive a completely confidential service. The Health Practitioner Programme can help with mental health concerns, such as stress or depression and addiction problems that might affect work. There is a recognised tendency for doctors to manage their own health problems or self-medicate and this may lead to problems going unreported. This service aims to help doctors with early intervention and support so that doctors can continue to provide safe care to their patients.
UTIs in children
Urinary tract infections (UTIs) are common in children, with 3.7% of boys and 2% of girls estimated to have experienced an infection before the age of 1 year. The main reason for the recent change in guidance is to give general practitioners more support in their antibiotic decision- making. The updated National Institute for Health and Care Excellence guidelines state that children between the age of 3 months and 3 years should not be given antibiotics if their dipstick test is negative. Infants under 3 months old in whom a UTI is suspected should be referred to a paediatric specialist. There is new advice for when clinical symptoms and dipstick tests do not correlate.
Prenatal antidepressants
Decisions about keeping or starting women on antidepressants make for difficult consultations. A large population-based cohort study in Denmark of nearly 1 million singleton births showed a significant difference in the risk of developing a psychiatric disorder in the children of mothers who continued their antidepressant treatment during pregnancy. The article discusses the caution needed when interpreting the data and makes suggestions for future research. The article stresses the need for absolute risk reporting to help us have useful conversations with patients.
Liu, X., Agerbo, E., Ingstrup, K., Musliner, K., Meltzer-Brody, S., Bergonk, V., & Munk-Olsen, T. (2017). Psychiatric disorders after prenatal antidepressant exposure. BMJ, 358(8120), 354–355
Greater trochanteric pain syndrome
The September British Journal of General Practice gives a useful review of greater trochanteric pain syndrome including a differential diagnosis and summary of treatment options. Older references may describe the conditions as troachanteric bursitis.
Speers, J., & Bhogal, G. (2017). Greater trochanteric pain syndrome: A review of diagnosis and management in general practice. British Journal of General Practice, 67(663), 477–478
Depression prevention
A large Norwegian cohort study has shown that compared with participants who do no exercise, relatively small amounts of exercise (1 to 2 hours a week) seem to significantly reduce the risk of developing symptoms of depression.
A systematic review of 13 trials found that exercise significantly reduced depressive symptoms in postpartum women. These may be further reasons for promoting exercise as part of a healthy lifestyle. In pregnancy, the advice could be supplemented by use of a freely available infographic.
Harvey, S., Øverland, S., Hatch, S., Wessely, S., Mykletun, A., & Hotopf, M. (2017). Exercise and the prevention of depression: Results of the HUNT Cohort Study. Retrieved from: doi.org/10.1176/appi.ajp.2017.16111223
Prithett, R., Daley, A., & Jolly, K. (2017). Does aerobic exercise reduce postpartum depressive symptoms? A systematic review and meta-analysis. British Journal of General Practice, 67(663), 452
Learning disability and EOL information
It may be difficult to give people with learning disability information about end-of-life (EOL) care. Marie Curie has produced some easy-to-read booklets about living with or caring for someone who has an illness that may soon become terminal.
Topics covered include self-care, feelings and financial advice.
www.mchft.nhs.uk/information-for-patients/patient-leaflets/marie-curie-easy-read-leaflets/
Liberty protection safeguards
The Law Commission has proposed a Mental Capacity (Amendment) Bill proposing changes to the current controversial Deprivation of Liberty Safeguards (DOLS). As part of the Mental Capacity Act the DOLS were designed to protect people in care homes and hospitals. The amendment would include people aged 16 and above, in a wider variety of circumstances. The Law Commission has produced both a summary and an easy-read summary of the full document.
www.lawcom.gov.uk/project/mental-capacity-and-deprivation-of-liberty/
Antibiotics and sore throats
A United Kingdom-based prospective cohort study of adults presenting with sore throat in primary care showed that delayed antibiotic prescribing gave as much symptomatic relief as immediate prescribing.
Moore, M., Stuart, B., Hobbs, F., Butler, C., Hay, A., Campbell, J., … , Little, P. (2017). Symptom response to antibiotic prescribing strategies in acute sore throat in adults: The DESCARTE prospective cohort study in UK general practice. British Journal of General Practice, 67(662), 404
Flash points
The Royal Society for Public Health and the Royal Photographic Society have published all of the shortlisted photographs from flash points: a photographic exploration of health across the life course, a competition looking for the best photograph portraying health and different stages of life. Looking at the photographs might provoke a different type of discussion about health. The winning photograph shows the care between a daughter and her elderly mother. My favourite was of a mother caring for her son.
www.rsph.org.uk/our-work/campaigns/flash-points.html
Miracle in the Touch of a Mother by Natasa Balogh, reproduced with the permission of the Royal Society for Public Health.
William Pickles Lecture
Clare Gerada gave the 2017 William Pickles lecture at the RCGP giving her thoughts about using the best of our past, but moving on to make the best of the future for general practice
Gerada, C. (2017). RCGP William Pickles Lecture: A new kind of doctor. British Journal of General Practice, 67(663): 475–476.