Abstract
Medical humanities
I (KS) am working enthusiastically on a project based around the medical humanities. While there are many passionate advocates for the humanities within medical education and in clinical practice, for some this may come as a new concept. When did you last pick up a book, look at a photograph or listen to music and reflect on your role as a doctor, perhaps as a patient or the emotions we deal with each day? Interested? The Centre for Medical Humanities at Durham University hosts ‘The Polyphony’, a website platforming a fascinating range of content around the humanities within healthcare.
The way ahead
I spend a good deal of time at present pondering the future of general practice, as I suspect do many GPs. A good read was the June 2021 issue of the BJGP, which focused on ‘Consultations’. Among a broad array of ideas and possibilities, one that struck me was the consideration by the editor of 25 consults by 2025 (referencing a paper published 5 years ago focusing on general practice in Europe). Change is certainly needed – but how?
Lawson E (2021) Setting the limits of consultations. British Journal of General Practice 71(707). DOI: 10.3399/bjgp21X715709
Digital first
The rapid adoption of enforced digital first consultation has generated a great deal of debate. My personal belief is that it is not the modality; digital can be done well and face-to-face can be done poorly, but the connections that we make that are key. I enjoyed Bergman’s social connectedness article and thought that the table ‘Ways to invest in relationships during telehealth encounters’ is useful for all encounters and might be helpful in thinking about consultations for the RCGP exams.
I asked the opinions of our patient group and got 37 responses highlighting continuity of care as their biggest worry. Interestingly they also were happy to engage digitally if that saved us, the clinicians, work, and expressed concern about our job satisfaction if we were busy, rushed and trapped alone in front of a screen.
The Healthwatch paper gathers the views of 40 000 patients. While access to medical care is at such a premium, it is really important that we listen to the voice of people who, for whatever reason, struggle to contact us.
And no apologies for a third reference: Trish Greenhalgh and Rebecca Rosen have written a short and eloquent summary of the ‘messiness’ of practice. If you read all three of these, they would make a really good basis for a discussion in your practice or training group.
Bergman D, Bethell C, Gombojav N, et al. (2020) Physical distancing with social connectedness. Annals of Family Medicine 18(3): 272–277.
Greenhalgh T and Rosen R (2021) Remote by default general practice: Must we, should we, dare we? British Journal of General Practice 2021; 71(705): 149–150. DOI: 10.3399/bjgp21X715313.
Healthwatch (2021) Locked out: digitally excluded people’s experiences of remote GP appointments. Available at: www.healthwatch.co.uk/sites/healthwatch.co.uk/files/Digital%20Exclusion%20v4.pdfHypertension (accessed date 24 June 2021).
Specialists?
Another post of interest was Rammya Mathew’s blog post around the concept of GPs as ‘specialists’. I found the consideration of how secondary-care consultants work versus how we work as ‘lone rangers’ in general practice very thought provoking, with lots of ideas springing to mind about what the general practice specialist ‘team’ would look like.
Mathew R (2021) Should GPs be more like hospital specialists? British Medical Journal 373: n 1496. DOI: 10.1136/bmj.n1496.
Polycystic ovarian syndrome diagnosis
I read with interest a piece questioning the changing diagnostic criteria for polycystic ovarian syndrome (PCOS). The authors describe that widening the criteria based on the Rotterdam criteria has led to potential overdiagnosis of PCOS, differing metabolic subtypes within the PCOS umbrella and the risk of hypothalamic amenorrhoea being missed and thus mismanaged. Worth a read.
Copp T, Doust J, McCaffery K, Hersch J and Jansen J (2021) Polycystic ovarian syndrome: Why widening the diagnostic criteria may be harming women. British Medical Journal 373: n 700. DOI: doi.org/10.1136/bmj.n700.
Wild swimming
Back in January, News and Views asked whether readers were going to take the plunge in a New Year’s ‘dook’. Over the summer I braved the waters of the North Sea among many others. In fact, wild swimming seems to have exploded over the last year. Researching sea swimming I came across an interesting blog post in which a contributor said their GP had recommended wild swimming for a rheumatic condition – which led me to think – would I recommend it to patients? Especially, given the risks involved? The Outdoor Swimming Society provide a wealth of useful information for patients who are interested.
SH24
Sexual Heath 24 (SH24) is a not-for-profit organization working with the NHS to provide free sexual healthcare. The suite provides information for patients about sexual health and contraception, and free self-test kits for sexually transmitted infections (STIs) can be ordered from the site – with free treatment also available if tests are positive. It is interesting to see these forms of healthcare developing, providing an increasing range of platforms through which patients can access services.
Sleep and exercise data – useful?
There are plans to enable patients to add data about sleep and exercise to their healthcare records, published in a draft document by the Department of Health and Social Care in June, with a further publication due at the end of 2021. While I think there are benefits to highlighting the vital role that sleep and exercise play in health, the blog piece by Constanza Pearce identifies potential issues with this, for example filling the GP records with unnecessary data.
Pearce C (2021) Patients to add ‘sleep and exercise’ data to GP record, Government plans. PULSE Online. www.pulsetoday.co.uk/news/technology/patients-to-add-sleep-and-exercise-data-to-gp-record-government-plans/ (accessed date 24 June 2021).
Diet in childhood
This article in ‘Nutrients’ compared the nutritional status of a cohort of German children, looking at differences in children following an omnivorous, vegetarian or vegan diet. There seems to be some conflict in this area, which I think can be quite emotive, as we all want the best for our children. However, this study reassuringly identified that vegan and vegetarian children did not have any nutritional risks compared with omnivores, and in fact the vegan children had a healthier cardiovascular profile in terms of the lowest non-high-density lipoprotein (HDL) and low-density lipoprotein (LDL)-cholesterol values. However, some supplements for vegetarian and vegan children (B12 in particular) are recommended – further information is available on the Plant Based Health Professionals website.
Alexy U, Fischer M, Weder S, et al. (2021) Nutrient intake and status of German children and adolescents consuming vegetarian, vegan or omnivore diets: results of the VeChi Youth Study. Nutrients 13(5): 1707. DOI: 10.3390/nu13051707.
Preventing diabetes
In recent weeks, there seem to have been a spate of patients in my clinical practice with raised random glucose levels, yet not meeting the diagnostic criteria for diabetes. Like Type 2 diabetes, it is thought by experts that pre-diabetes may also be linked to more severe COVID-19 disease, with the suggestion that patients presenting with COVID-19 be screened for HBA1c. I wonder if a more concerted effort is needed not just to identify, but to monitor and work with these patients. Within certain parts of England, patients can be referred to the Diabetes prevention programme.
https://preventing-diabetes.co.uk/
Sathish T and Chandrasekaran ND (2021) Is prediabetes a risk factor for severe COVID-19?. Journal of Diabetes 13(6): 521–522. DOI: 10.1111/1753-0407.13165.
Military metaphors
In the summer, I participated in a fantastic online workshop led by Dr Nicola Davis (@DrNicolaDavis) examining military metaphors and cancer, with some great group discussions. This led me to spend some time reflecting on the ‘weight' of our words when speaking to patients. Is there a value in words like ‘battle' and ‘fight' in dealing with cancer? Do we pay enough attention to the words our patients choose to use?
Dealing with darker nights
And finally, for some of us of more than others, the shorter days and darker nights may result in feelings of low mood. The Guardian article below contains ideas about how to optimise light exposure during winter months. In practise, something as simple as having 15 minutes outside at lunchtime may be helpful.
Daoust P (2018) Winter blues? A practical guide to getting more light in your life. The Guardian. www.theguardian.com/lifeandstyle/2018/nov/05/winter-blues-practical-guide-more-light-in-your-life
ORCID iDs
Dr Clare Etherington https://orcid.org/0000-0002-1446-627X
Dr Kathryn Steven https://orcid.org/0000-0002-7534-2932