Abstract
Serotonin and depression
A major review has challenged the serotonin theory of depression and sparked considerable debate. This challenge is not new, but it does remind us to think carefully about how we use ‘scientific’ explanations for many treatments that we use, and that it is acceptable to share uncertainties with our patients.
Moncrieff J, Cooper R, Stockmann T, et al. (2022) The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry. Online publication 20 July 2022. DOI: 10.1038/s41380-022-01661-0.
Bystander behaviour
This week I read information from the British Medical Association (BMA) about the uncertainty of the employment status of ‘locally employed doctors’ (trusts have many different names for these grades). The variability of access to supportive education was highlighted. In the same ‘catch up’ on medical reading I spotted an article about shortage of lockers in hospitals, meaning that many people have no access to safe storage space at work (and I know that there are similar issues in primary care premises). It made me wonder how we might make a difference and stand up for our colleagues. What would it take to help a colleague attend educational events, or offer to share secure storage space? I am sure there are many areas we can think of small ways to make a difference.
Nature prescriptions
Scotland has led the way in pilots of ‘nature prescriptions’ – calendars and leaflets highlighting outdoor activities. The Royal Society for the Protection of Birds website now has a report highlighting the effectiveness of the project in urban Edinburgh.
London loos
Age UK has surveyed older Londoners about public toilet provision. This may not sound medically relevant, but over half of participants sometimes reduce how much they drink before they go out, and 40% said that they spend less time in a place because of lack of loos. There were quotes from people who avoid going out to places without loos, and positive quotes about feeling confident to be out all day if they know the venue has provision.
The recommendations included accessible access, good signage and publicity and apply across the whole country, not just London.
www.ageuk.org.uk/bp-assets/globalassets/london/campaigns/out-and-about/ageuk_london_loos_final.pdf
Conflict resolution
I think many of us are seeing more angry patients and more angry colleagues. It can be hard to find the energy to fend off complaints and confrontations. The Medical Defence Union has a free webinar entitled: Resolving conflict with compassion.
www.themdu.com/guidance-and-advice/podcasts-and-videos/resolving-conflict
Activism
When we are busy with exams and need people to write references for us, it may be difficult to think about what we can do to make a difference. Two American physicians pose some interesting answers to the question ‘should clinicians be activists?’.
Pollock K and Ansell D (2022) Should clinicians be activists. American Medical Association Journal of Ethics 24(4): E254–260.
Psychosis
If you prefer to listen rather than read, you might be interested in this podcast featuring Richard Bentall about the use of talking therapies in psychosis
Bentall R (2021) The life scientific. BBC. Available at: www.bbc.co.uk/sounds/play/m000sj7c (accessed 02 October 2022).
Hair love
This short movie might invite discussion about diversity, family, love and care giving. I wonder how many different tutorials or group sessions could be run with this as the starting block?
Inequalities in asthma
Asthma UK has produced a report on health inequalities and asthma. Reading the document and its summary of possible actions might give ideas for quality improvement projects in your surgery.
Green spaces
There is a lot of interest in the use of green spaces for wellbeing. I wonder if all our cities have hidden gems. On my walk home from the tube station is a tiny window box whose owner grows bok choy for many months of the year. I have created a walk to the surgery that involves crossing a series of small parks and green spaces. Several of these have visibly involved the community during lockdown. The walk grounds me before the chaos of the surgery day.
Dementia diagnosis
Patients have already asked me about better tests for dementia since newspaper headlines about an Alzheimer’s UK paper. The authors used data from UK Biobank to look at cognitive performance before and after diagnosis of diseases such as Alzheimer’s. Prevention mainly focuses on lifestyle modification. I wonder how much of an incentive being able to stratify risk will give.
Swaddiwudhipong N, Whiteside D and Hezemans H (2022) Pre-diagnostic cognitive and functional impairment in multiple sporadic neurodegenerative diseases. Alzheimer’s and Dementia 1–12. Online publication 12 October 2022. DOI: 10.1002/alz.12802.
Physiotherapy
The delivery of physiotherapy has changed dramatically with the technology changes adopted during lockdown. The Lancet has published the results of a large UK-based multicentre randomised controlled trial on people with shoulder pain. For those with rotator cuff symptoms, one-off advice by a physiotherapist with a home exercise programme was as effective as supervised physiotherapy. Corticosteroid injections improved pain and function short term (at 8 weeks), but there was no difference by 12 months.
Hopewell S, Keene D, Marian I, et al. (2021) Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): A multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. Lancet 398: 416–428.
Burnout
A large systematic review and meta-analysis has shown that burnout is associated with lower job satisfaction and more thoughts about leaving the role. Physicians with burn out were twice as likely to be involved in patient safety incidents.
The associated BMJ commentary flags the complexity of factors underlying burnout and the importance of staff wellbeing for safe healthcare systems.
Hodkinson A, Zhou A and Johnson J (2022) Associations of physician burnout with career engagement and quality of patient care. BMJ 378: e070442.
Weig M (2022) Physician burnout undermines safe healthcare. BMJ 378(8352): 396–397.
Research alerts
The National Institute for Health and Care Research (NIHR) produces alerts and themed summaries of NIHR research. The summaries are written in plain English and highlight areas for change. You can sign up to the NIHRE newsletter
Climate change
In October 2022 a whole edition of the BMJ was devoted to climate change. Although many of the changes to improve the green credential of the NHS would need to be systemic, there is a growing movement for all of us to play our part. Our local Greener Practices group gives monthly ‘Quick tips’. Amanda Woodgate who co-chairs the East Midlands Greener Practice listed a few ideas.
Automatically think about options that are better for the patient and the planet, for example does a particular patient need a prescription or would lifestyle measures be of benefit? Talk about the environment: We are able to cascade our ideas through many short contacts. Involve your practice in thinking greener. Her practice now has a ‘green team’.
Waters A (2022) How can I make the NHS greener? BMJ 379(8356): 117.
