Abstract
Hold still
The National Gallery has created a digital exhibition of 100 photographs (chosen from over 31 000 submissions). Portraits of the UK during lockdown represent three core themes: Helpers and Heroes, Your New Normal and Acts of Kindness. The exhibition can be seen online at www.nag.org.just/hold-still/images/lockdown-life/
The photograph that most gripped me was Lockdown Life – Paul and Simon by Rebecca Douglas – which shows the two men looking out of the window of their fifteenth floor flat in Margate. I wonder which one you would choose.
Race and racism
COVID-19 has highlighted the inequities in our society in general and in the health professions. BJGP Open has started a programme of work on race and diversity, starting with a special edition of the journal featuring experiences of racism in primary care. The RCGP has committed to a series of plans to tackle racism within the College and within the system. I would recommend reading and sharing with colleagues to help decide what action to take. To quote the authors of the editorial ‘It is incumbent upon all of us in primary care to be aware of the issues around race, to speak up and to support each other in tackling this challenging issue’.
Dambha-Miller H, Chaudry U and Adams O (2020) Race and racism in primary care. A special collection from BJGP Open. DOI:10.3399/BJGPO.2020.0175.
Thrombocytosis and non-malignant disease
It is well established that a raised platelet count can be a feature of underlying malignancy. A recent cohort study published in the British Journal of General Practice (BJGP) investigated for a link between new thrombocytosis and non-malignant disease. The authors found that those with a raised platelet count (platelets >400) were more likely to have Inflammatory bowel disease (IBD), chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, iron deficiency or anaemia giant cell arteritis compared with those with a normal platelet count and suggest that ‘clinicians can use these findings as part of their holistic diagnostic approach’.
Clarke C, Hamilton W, Price S, et al. (2020) Association of non-malignant diseases with thrombocytosis. British Journal of General Practice 70(701): e852–e857. DOI: 10.3399/bjgp20X713501.
The hilarious world of depression
My only problem with podcasts is finding the time to listen to them – there are so many intriguing episodes filling my podcast library! The latest to be added to the list is the Hilarious World of Depression, run by a comedian called John Moe. Moe covers a wide range of topics through conversations with guests including other comedians, and receives fantastic reviews, rated as 4.8/5. Worth a listen.
Wellcome Trust photography prize
I was delighted to come across for the first time the Wellcome Trust photography prize. This annual competition sets out different categories each year. In 2020 there was a focus on mental health, and the winner was Arseni Neskhodimov with his self-portrait in a series of photos entitled ‘Prozac’. The shortlisted entries can be viewed at the webpage below and are well worth a look; I was captivated and moved by many of the images. For any budding photographers, the categories for the 2021 prize are mental health problems, infectious diseases and global heating.
Different sex development
A moving piece by Jo WiIliams in the British Journal of General Practice describes her encounter with a GP in her twenties who told her the truth about Androgen Insensitivity Syndrome (AIS). She had been diagnosed with this condition as a baby, but the truth about this diagnosis was kept from her until she was in her twenties and a GP sat down with her to explain her medical history. Dr Williams is now a trustee of DSD (Different Sex Development) Families, a charity that provides information and support for individuals and their families,
Williams J (2020) Tale of a good GP. British Journal of General Practice 70(701): 598–599. DOI: 10.3399/bjgp20X713729.
OCD UK
I recently came across this website and charity in trying to support a patient I was seeing. We are lucky in the part of Scotland I practise to have some great mental health resources, however in addition to local support I think condition-specific websites such as this can be useful. In particular, OCD UK run ‘Parent Project Webinars’ specifically aimed at parents and carers of children aged 5–18 who suffer from OCD (obsessive compulsive disorder).
Interview with Dr Roger Neighbour
I would be surprised if anyone reading these words has not also spent considerable time reading the words of Dr Roger Neighbour. His published works, including The Inner Consultation, are essential reading for all GPs in training. I very much enjoyed this article in the RCGP’s GP Frontline magazine and finding out more about this renowned individual. I did not expect to come away from the article wanting to read more about transcendental meditation – it is always good to be surprised!
Openshaw D (2020) Big interview: The inner legend. GP Frontline. RCGP 17: 6–8.
Perinatal care
MBRRACE-UK (Mothers and babies: Reducing risk through audits and confidential enquiries across the UK) produces 3-yearly reports – the National Confidential Enquiry into Maternal Deaths. The most recent report highlighted inequalities in maternal mortality. Asian women have double, mixed ethnicity triple and black women five times the risk of dying in pregnancy. The two most common causes of late maternal deaths (between 6 weeks and 1 year after delivery) were suicide and cancer. The National Institute for Health and Care Excellence (NICE) recommends maternal checks that count as a separate appointment from the baby’s 6- to 8-week-check. From 2021 this has been included as an obligatory part of the GP contract in England. A rapid report has looked at the learning from COVID-19 related and associated deaths in the UK. Many of the recommendations are for secondary care but the narratives (in blue boxes in the report) show how we need to be aware in primary care. We need to share with women of BAME (Black, Asian and minority ethnic) background or other risk factors, such as hypertension, diabetes or obesity, that they may be at higher risk of complications of COVID-19. The report recommends that referral with mental health problems on more than one occasion should be regarded as a red flag for pregnant women. Changes in access to healthcare during COVID-19 may make some groups less likely to get the care they need. Three of the maternal deaths discussed in the report were women who presented late/stayed at home because of fear of infection in hospital/were advised to stay at home. I wonder what systems your practice has in place to follow-up women with possible serious infections or to ‘chase’ women who do not attend planned postnatal checks.
Knight M, Bunch K, Cairns A, et al.; on behalf of MBRRACE-UK (2020) Saving lives, improving mothers’ care. Rapid report: Learning from DARS-CoV-2 related and associate deaths in the UK March-May 2020. Oxford: National Perinatal Epidemiology Unit, University of Oxford.
Bridge-it
The Bridge-it study showed that women who were given a 3-month prescription for the progestogen-only pill and an invitation to their local reproductive and sexual health clinic, as well as their emergency contraception, by participating pharmacists were more likely to be taking effective contraception at follow-up 4 months later.
Cameron S, Glasier A, McDaid L, et al. (2020) Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): A pragmatic cluster-randomised crossover trial. The Lancet 396(10262): 1585–1594.
Chronic pain
As more guidelines positively deter the use of many painkillers for chronic pain, we need to find other ways to help patients manage. Hannah Vickers has written an article with some ideas about what has helped her, in particular the use of language, for example describing her daily exercises as ‘training’ rather than physiotherapy to remove reference to injury or disability.
Vickers H (2020) Reframing my chronic pain. BMJ 371(8263): 79.
ORCID iDs
Clare Etherington https://orcid.org/0000-0002-1446-627X
Kathryn Steven https://orcid.org/0000-0002-7534-2932