Abstract
Planning and Personal Development Plan
For me there always seem to be two starts to the year, New Year in January and the start of the academic year around August. August also coincides with trainee doctors rotating and moving up into the next year of training. I always welcome new starts as an opportunity to set intentions and plans. You might well be considering what to write in your Personal Development Plan (PDP). With medical students I try to encourage them to think outside the box, and to consider at least one PDP item not related to medicine, something they will do, for their own enjoyment. What would you include?
You are not a frog
Many of you may have already come across this fantastic podcast by Dr Rachel Morris. The podcast is aimed at GPs and other busy professionals, and addresses many issues faced by GPs. Podcasts are wide ranging and include dealing with stress and burnout, planning a career you love, and creating healthy and happy workplaces. I really recommend taking a look. Consider signing up for the weekly newsletter.
Mental health in children
I recently read a viewpoint piece by Dr Katie Musgrave in Pulse regarding mental health in children. In this short piece, she raises the question of whether offering cognitive behavioural therapy and counselling is always the right thing for children, when perhaps what may be more important is providing a loving, supported, sociable environment for them to grow up in. I think this piece is worth everyone reading and reflecting on. It has made me consider not only the children I see in practice, but my own children, and my friends’ children. This piece reminded me of the words I often hear in relation to raising children ‘it takes a village’. A worthwhile read.
Musgrave K (2021) If anxiety was an infectious disease we would be declaring an epidemic. Available at: www.pulsetoday.co.uk/views/katie-musgrave/if-anxiety-was-an-infectious-disease-wed-be-declaring-an-epidemic
Balance training for older adults
I read with interest a research article that examined a structured balancer programme ‘StandingTall’. In adults aged over 70 and independent in all activities of daily living, participation in the programme did not reduce falls at 12 months compared with a control group, but was associated with a reduced risk of falls over 24 months. Reading this article made me consider trying to identify strength and balance resources or activities for older patients and discussing the importance of completing these exercises on a regular basis. The NHS website has a useful section on physical activity for older adults, including balance, flexibility and strength exercises.
Delbaere K, Valenzuela T, Lord S, et al. (2021) E-health StandingTall balance exercise for fall prevention in older people: Results of a two year randomised controlled trial. BMJ 373: n740. DOI: 10.1136/bmj.n740.
www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/
Rehabilitation
The National Institute for Health and Care Excellence (NICE) has produced the first guideline on mental health rehabilitation for adults with complex psychoses. From a primary care point of view, we will need to recognise that patients need early, local referral for rehabilitation. The BMJ has produced a useful summary.
Killaspy H, Baird G, Bromham N, et al. (2021) Rehabilitation for adults with complex psychosis: Summary of NICE guidance. BMJ 372(8277): 157–159. DOI: 10.1136/bmj.n1.
Bias
Doctors are not immune from unconscious (implicit) bias – described by Sarah Mumford in a recent BMJ article as ‘what happens when our brains make snap judgements about people, places, and things based upon past experiences’. The article gives examples of types of bias that we may use every day, such as anchoring, availability or confirmation bias. The article suggests we should regard implicit bias training as a developmental process that is ongoing, applied to the whole team, rather than just single episodes of ‘awareness’ training. We are encouraged to make rapid decisions in time- and resource-limited environments, so there is also pressure to make assumptions. I am conscious that our new ways of working may be creating new biases. We are encouraging patients to contact us via our electronic system. We have a policy that tries to ensure that those who have difficulty accessing technology, for whatever reason, are not disadvantaged. However, I hear comments along the lines ‘he’s only 26, How can he possibly tell us he can’t manage an e-consult?’ I wonder how many reasons you could think of that would stop a young man in a city suburb from accessing a surgery website. Perhaps you could run a team meeting looking at some of the biases in your newly created systems.
Oxtoby K (2020) How unconscious bias can discriminate against patients and affect their care. BMJ 371(8268): 268–270. DOI: 10.1136/bmj.m4152.
Rebecca Lee Crumpler
I read with interest in The Lancet about Dr Rebecca Lee Crumpler, the first Black female physician in the USA, graduating in 1864. Only last year, in July 2020, was a granite headstone mounted on her grave, and as highlighted by Ferry, the author of the piece, she is a role model to many. I was delighted to come across this piece and to be educated about this remarkable woman.
Ferry G (2021). Rebecca Lee Crumpler: First Black woman physician in the USA (2021). The Lancet 397(10274): 572. DOI: 10.1016/S0140-6736(21)00301-9.
Clinical Practice Research Datalink
Does your practice belong to the Clinical Practice Research Datalink? About 20% of United Kingdom general practices contribute anonymised data. If your practice does not belong, exploring the process and joining would make a good quality improvement project. If your practice does belong, you could look at what use the practice makes of its membership. For example, recent reports generated have included prescribing and patient safety for patients with learning disability and/or autism, and prescribing sodium valproate to women of childbearing potential.
The applications forms and further information are available from www.CPD.com
Giddiness
Many patients with giddiness are not found to have serious, named treatable disorders, but the condition can severely limit activity. Both The Brain and Spine Foundation and Movement for Life produce useful fact sheets on rehabilitation exercises.
Brainandspine.org.uk
Reducing opioids
Treating chronic pain is complex. During my career none of the ‘new’ painkillers have provided benefits without the problems associated with the side effects of taking long-term medication. Guidelines now promote lifestyle changes, but these can be difficult to explain and share with patients. The Live Well with Pain website has resources for both clinicians and patients, including a section on ‘shifting the conversation’ with ideas about listening to the patient’s pain story and using ‘Six Questions’ to help come up with a shared plan. The Foundation for Positive Mental Health has a useful app called FeelingGood:positive mindset.
livewellwithpain.co.uk
Books for diversity
There are many lists of books that people can read to help think about diversity in the workplace. Many are business or America orientated, but I think if you pick a title or topic that interests you it could make you think. Sharing a list around your practice or your training scheme might be a good start to a session on diversity. Do let us know if you find useful books and we could share them in another News and Views.
Ward M (2020) 15 books all managers who want to build diverse and happy teams should order right now. www.businessinsider.com/12-books-diversity-in-2020-every-leader-should-know-about-2020-1