Abstract
Greener practice
As I write this, COP26 (Conferences of the Parties) has just come to an end, in a flurry of last-minute changes to agreements.
At home and at work the use of disposable masks and equipment has certainly increased my carbon footprint. As we redesign our service, we are working with our patient participation group to explore ways of greening our practice. The greener practice website has a variety of educational material and waiting room videos, including Aarti Bansal’s Ten Top Tips article.
Rammya Matthew, a London GP, writes regular BMJ articles about environmental issues. Her most recent discusses reducing unnecessary tests, to improve life both for individual patients and society.
Mathew R (2021) How we practise requires radical reform. BMJ 375(8318): 443.
John Maddox award
Dr Mohammed Sharif Razai, a London GP and academic, has won the Early Career John Maddox Prize for his work tackling racial health inequalities. In his acceptance he made a powerful statement ‘stand up for what is right and never sidestep controversy even if it receives a hostile reception in high places’. I admire his courage in speaking out, and an international system that values such work.
The winner of the main John Maddox award was Elisabeth Bik, who was recognised for her work on exposing data manipulation and plagiarism. Her website has information about problematic papers and advice about how to post concerns and contact journal editors.
scienceintegritydigest.com
Good childhood report
The Children’s Society produces an annual report on wellbeing. Of note, children are most unhappy about school and about their appearance. The report contains references to their experiences of COVID; many have been very resilient, but an estimated quarter of a million children have struggled.
www.childrenssociety.org.uk/information/professionals/resources/good-childhood-report-2021
Bread exam
The British Islamic Association has worked with influencers around the world using kneading bread as a metaphor for breast self-examination. It is hoped this will be a ‘safe’ way of highlighting breast checks to women who feel uncomfortable talking to or visiting medical professionals.
www.famouscampaigns.com/2021/02/the-british-islamic-medical/
Languages of pain
Even for my patients who speak English as a first language, describing symptoms such as pain can leave them struggling for words. During lockdown, with our reliance on phone calls, listening to the choice of words has become very important, as we have lost visual cues. I think it is that extra reliance on words that made Joanna Burke’s article on the language of pain resonate. She outlines the way words used to describe pain have changed with the introduction of technology for both investigation and treatment. The opening image is of a scene from a play where a vomiting woman is asked ‘how are you feeling today?’. The references to the ‘feigned solicitude’ of healthcare professionals is thought provoking.
Bourke J (2012) Languages of pain. The Lancet 379: 2420–2421.
World Health Day
This month World Health Day falls on 7th April. Given the immense challenges of the last 2 years, is there any way your practice could use this as an opportunity to celebrate the achievements of practice and community? Successful COVID vaccination campaigns, new services? Or could it be a way to highlight ways for your local community to improve their health? Local walks, mental health services and voluntary organisations that support patients?
Rewilding general practice
I listened with interest to the British Journal of General Practice podcast with Dr Iona Heath on ‘Rewilding general practice’, a follow-up to an editorial she has written for the journal. The podcast and editorial consider the ‘delicate ecosystem’ of primary care, and thoughtfully consider potential approaches and ways of moving forward as a profession.
Heath I (2021) Rewilding general practice. British Journal of General Practice 71(713): 532–533. DOI: 10.3399/bjgp21X717689.
Career planning
It is getting to the time of year when many trainees may be considering what they will do at the end of GP training. The beauty of General Practice is its flexibility: Locum, salaried or partnership roles, and the opportunities for a portfolio career in a variety of areas. This flexibility is something I have very much appreciated and has allowed me to balance clinical practice and roles in teaching and research with parenthood. Websites, such as the British Medical Association, GP Online and the Royal College of General Practitioners, offer a wealth of information about career opportunities and development. Look at what your local medical school and postgraduate GP training unit may be offering in terms of roles in education or research. In NHS England, it is important to be aware of schemes, such as the ‘New to Partnership Payment Scheme’, that offer financial incentives for those considering partnership, training hubs and other hosts for fellowships.
Emollient or steroid first?
I am writing this after finding that a patient and I had differing answers to this question! The National Eczema Society suggests that it does not matter which order creams are used, as long as there is a gap between application. The updated National Institute for Health and Care Excellence (NICE) guidelines on topical steroids suggest that patients should ‘ideally use their emollient first’ and apply the steroid 15–30 minutes later.
https://cks.nice.org.uk/topics/eczema-atopic/prescribing-information/topical-corticosteroids/
Liver health
Having always wondered whether we are pro-active enough with patients with mild non-alcoholic fatty liver disease, or borderline liver function tests, I read with interest a comment piece in The Lancet focused on liver health. The article highlights some of the major issues impacting on liver health: Obesity, diets containing highly processed foods, alcohol misuse and chronic hepatitis, and raises more joined up working between primary and secondary care and between specialities as important in addressing these. It also introduces the new EASL (European Association for the Study of the Liver) – Lancet Liver Commission.
Kleinert S and Horton R (2022) An urgent challenge for Europe: From tackling liver diseases to protecting liver health. The Lancet 399: 7–9. DOI: 10.1016/SO140-6736(21)02726-4 (Published 02 December 2021).
Childhood constipation
A common issue seen in practice, I recently came across a 10-minute consultation piece on childhood constipation. This article is a concise, up-to-date review of ways of approaching this problem and refers to current NICE guidelines. However, while I appreciate diet alone is unlikely to address childhood constipation and the recommendation that laxatives are used promptly, I do wonder whether the role of diet, both exploring it and giving advice about it, is given enough attention. Constipation is not only an issue for children, and I wonder whether educating parents and young people about the important role of dietary choices in preventing constipation as early as possible is something we should be paying more attention to.
Bradshaw O, Foy R, Seal A, et al. (2021) Childhood constipation. BMJ 375: e065046. DOI: 10.1136/bmj-2021-065046.
Open learn
The Open University offers many free courses, including a large section on health, sports and psychology, education and technology.
ORCID iDs
Dr Clare Etherington http://orcid.org/0000-0002-1446-627X
Dr Kathryn Steven http://orcid.org/0000-0002-7534-2932