Abstract
COVID-19
I am writing this 3 weeks into the vaccination programme, when Scotland has just gone into another lockdown and we are awaiting a similar announcement in England. With anecdotes of people who had the vaccine in the trials (now unblinded) being spared serious illness or indeed any symptoms at all, we can just dare to hope that by the time this is published some of the current tragedies will be diminishing.
In a world where, in London we are currently struggling, and I am sure will be caught up by other areas only too soon, it is proving quite hard to stay positive. A random list of things that have helped:
Practice Zoom meetings at 11 am every day, with space for feelings as well as practicalities A healthcare assistant who has organised birthday cards for everyone who has had a pandemic birthday (all of us by the time you read this) A reception and administration team who have helped us actively look for groups of patients who cannot use the virtual systems because of language, poverty and other reasons A patient group who, despite many members initially shielding, managed to set up virtual meetings and help with ideas and support throughout People who made us scrubs, including the Darth Vader set for our senior partner who has been running our local hot hub Our local sports club who had a new wooden floor and multiple new low level electric sockets installed so we could set up a vaccine centre in the middle of a large housing estate for easy access. A team that has covered and supported anyone off sick or caring for family members
The list makes me remember that it has not been all bad. I feel very proud of all we have achieved and I expect most of you could come up with similar themes.
Thanks to Dr Amol Kelshiker who allowed me to use the picture of him bringing in the first Astra Zeneca COVID vaccinations.
Cancer symptoms
During the pandemic, sadly many patients will have had delays in diagnosis, investigation or management of an underlying cancer. A good infographic for waiting rooms and practice websites that displays some of the most common presenting symptoms of cancer can be found on the Cancer Research UK website at the link below. This hopefully will help patients to identify whether or not their symptoms could be serious and reassure them about contacting their general practitioner.
Balint groups
I am sure Balint groups will have been covered in News and Views in previous issues, however I felt it worth writing about again. Many trainees will have been introduced to Balint during their training and may even be part of a local group. The aim of Balint is to enable individuals to raise, discuss and process the emotional side of their practice and to consider in depth the doctor–patient relationship. Given what we are all living through, as doctors and patients, it may be something some may wish to try to help deal with a very challenging time in practice. Information about local groups is available on the Balint UK website. Virtual groups are now also available.
Support through divorce
Divorce rates have been rising for some time and the stress of the COVID-19 pandemic may have put additional pressure on many relationships. We may see the impact of this in adults and children presenting with both physical and mental health problems. The website relate has a range of resources for individuals going through separation or divorce, covering financial and legal issues to dealing with thoughts and emotions. The National Society for the Prevention of Cruelty to Children (NSPCC) and the charity Young Minds also offer helpful resources for parents trying to support their children.
www.relate.org.uk/relationship-help/help-separation-and-divorce
Medical anniversaries 2021
For those with an interest in history, at the start of the year I came across Jeffrey Aronson’s ‘Medical Anniversaries’ piece in BMJ Opinion. Each year, he describes various medical anniversaries in multiples of 50 – so for example, years ending in 21 or 71. For example in 1721, there were smallpox epidemics in the USA and the UK, and in 1921 insulin was first isolated. Complete with pictures, photographs and interesting stories, this is really worth a read during a coffee break. Any for any mathematicians, there are also some interesting points about why 2021 is such a special number.
Aronson J. When I use a word … Medical Anniversaries in 2021 (2021). BMJ Opinion. Available at: https://go.shr.lc/39Coycr
A melanoma epidemic?
I read with interest an article in the New England Journal of Medicine in which the authors propose that the suggested melanoma epidemic is not necessarily the product of increased ultraviolet exposure, but of increased screening and over-diagnosis.
Welch H, Mazer B and Adamson A (2021) The rapid rise in cutaneous melanoma diagnoses. New England Journal of Medicine 384(1): 72–79. DOI: 10.1056/NEJMsb2019760.
Planning the perfect holiday
Hopefully as the summer months approach, the worst of the winter lockdown and COVID-19 spike will be behind us, the vaccinations programme will be well underway and many of us will be looking forward to some well overdue time off. A BBC article considers the different facets that are thought to contribute to creating the ideal holiday – some food for thought?
www.bbc.com/worklife/article/20190404-how-to-calculate-your-perfect-holiday-length
Chemo brain
Friends with cognitive issues after chemotherapy have flagged ‘chemo brain’ to me. One of the BMJ ‘What your patient is thinking’ articles expressed the patients wish that her healthcare professionals had flagged cognitive and psychological after-effects, along with the descriptions and plans for physical chemotherapy symptoms.
Papautsky E (2020) It felt like I was living in a fog. BMJ 369(8247): 331. DOI: 10.1136/bmj.m923.
www.mayoclinic.org/diseases-conditions/chemo-brain/symptoms-causes/syc-20351060
Rare diseases
There are a large number of rare diseases, but we will each only come across a few of them in our clinical careers. A recent British Journal of General Practice article lists some of the useful resources.
www.orpha.net is designed for both patients and clinicians and contains literature on rare diseases and on patient organisations and research and clinical experts.
www.geneticalliance.org.uk brings together patient organisations working on rare diseases and support for families with undiagnosed genetic conditions.
Crow A, McAneney H, Cupples M, et al. (2020) A quick reference guide for rare disease: Supporting rare disease management in general practice. British Journal of General Practice 70(694): 260–261. DOI: 10.3399/bjgp20X709829.
Early trauma
During my time as a GP, evidence about the negative impact of adverse childhood experiences has grown.
www.acesonlinelearning.com gives a useful introduction to the topic, with a free certificate of completion on correctly answering the embedded questions.
Modifying risk factors for atrial fibrillation
I was interested to see a description of ‘holiday heart’ – atrial fibrillation following excessive alcohol consumption. I seem to have missed this term in my GP career. The term was used in the description of an Australian multi-centre study showing people with paroxysmal or sustained atrial fibrillation had reduced recurrence if they abstained from alcohol. I subsequently found a review of the evidence for modifying risk factors, including diabetes, alcohol intake and obesity in the prevention of atrial fibrillation.
Voskoboinik A, Kalman J and De Silva A (2020) Alcohol abstinence in drinkers with atrial fibrillation. New England Journal of Medicine 382(1): 20–28. DOI: 10.1056/NEJMoa1817591.
Brandes A, Smit M, Nguyen B, et al. (2018) Risk factor management in atrial fibrillation. Arrhythmia and Electrophysiology Review 7(2): 118–127. DOI: 10.15420/aer.2018.18.2.
Transition to adult care
Over the years I have seen a variety of problems when children with long-term conditions transition to adult care. Lucy Watts gives a patient’s view of this and makes suggestions for how the process could be improved.
Watts L (2018) Stepping up to adult services. BMJ 362(8169): 412–413. DOI: 10.1136/bmj.k3886.
ORCID iDs
Dr Clare Etherington https://orcid.org/0000-0002-1446-627X
Dr Kathryn Steven https://orcid.org/0000-0002-7534-2932