Firstly some listening, a helpful follow on from Inside Health as ever. Looking at the evidence for the Fast Diet 5:2 etc the opinion is there isn't enough evidence yet to support its recommendation beyond other 'move more eat less' diets, but as one helpful comment from a listener the following week pointed out, the idea of only dieting 2 days per week is both new and more achievable, so what's the harm? I'm recommending the Fast Diet which is a few quid on Amazon and written by a GP. It's top of the best sellers list bit I don't think I can take credit for that!
I've zipped through Jon Ronson's excellent Psychopath Test, lots to think about regarding diagnosis if psychiatric illness, the use of checklists to define illness and the use of medication.
Sunday, 28 April 2013
Wednesday, 20 March 2013
Francis Report & all calories are not equal
A cold snowy morning! Time to get things done that don't involve leaving the house!
So, I've been following various reports about the Francis Report before I decide what I think and how it should affect me and my practice. Yesterday I listened to the BMJ round table podcast with Mr Francis himself and various other senior figures in the health service. Only one piece of journalism in the mainstream press gave me pause for thought. It was by Roger Taylor who also has a book coming out about the NHS.
He described how a successful hospital can still have thousands of adverse events reported including serious injury and death due to medial error and still be thought of as a good hospital. So, for people working in a system and there being more than an 'acceptable' number of errors not spotted, isn't so surprising really.
He also mentioned a consultant in Mid Staffs who was running an exemplary department and managed to do so through the crisis, but unfortunately this wasn't expanded on. It strikes me he is the has something valuable to contribute to the debate.
The round table was interesting, but didn't really come up with anything above and beyond what has been extensively written about. It seems a pity to me, with so many senior figures in one place they couldn't come up with some answers.
Much more interesting was a San Franscisco Medic on another BMJ podcast, discussing how all calories are not equal and how processed foods trigger insulin release and further cravings for more calorie dense fattening foods. He went pretty fast and I found it hard to keep up so I might have to listen to that one again! The basic message was cut right down on processed foods, high fibre foods help digest sugars hence whole fruit and whole grains being preferable to anything in a packet.
This is useful to me and my family personally as I have time and resources to cook good food. Helping my patients? I guess it's a question of encouraging people to buy fruit and veg and eat more home cooked food. Although with no fresh fruit and veg shop locally and many of my patients having no cooking skills at all, I'm not sure how far I will get with my more deprived patients.
So, I've been following various reports about the Francis Report before I decide what I think and how it should affect me and my practice. Yesterday I listened to the BMJ round table podcast with Mr Francis himself and various other senior figures in the health service. Only one piece of journalism in the mainstream press gave me pause for thought. It was by Roger Taylor who also has a book coming out about the NHS.
He described how a successful hospital can still have thousands of adverse events reported including serious injury and death due to medial error and still be thought of as a good hospital. So, for people working in a system and there being more than an 'acceptable' number of errors not spotted, isn't so surprising really.
He also mentioned a consultant in Mid Staffs who was running an exemplary department and managed to do so through the crisis, but unfortunately this wasn't expanded on. It strikes me he is the has something valuable to contribute to the debate.
The round table was interesting, but didn't really come up with anything above and beyond what has been extensively written about. It seems a pity to me, with so many senior figures in one place they couldn't come up with some answers.
Much more interesting was a San Franscisco Medic on another BMJ podcast, discussing how all calories are not equal and how processed foods trigger insulin release and further cravings for more calorie dense fattening foods. He went pretty fast and I found it hard to keep up so I might have to listen to that one again! The basic message was cut right down on processed foods, high fibre foods help digest sugars hence whole fruit and whole grains being preferable to anything in a packet.
This is useful to me and my family personally as I have time and resources to cook good food. Helping my patients? I guess it's a question of encouraging people to buy fruit and veg and eat more home cooked food. Although with no fresh fruit and veg shop locally and many of my patients having no cooking skills at all, I'm not sure how far I will get with my more deprived patients.
Tuesday, 19 February 2013
Cochrane collaboration podcast and Inside Health
I listened to my first Cochrane podcast and can report it was pretty good. Compared to the slick production of Inside Health it's about dry and the speaker obviously less experienced at broadcasting, but still engaging and I'll listen to some more.
The podcast I listened to was about the use of SSRIs after stroke and although not directly relevant to my daily practice, I enjoyed hearing about a novel use of a well known drug.
Inside Health continues and one good item on Parkinson's disease but I was less impressed with an article by a family planning specialist about continuing use of the combined pill in older women. The specialist highlighted all of the benefits of taking COCP but didn't mention the possible side effects once. If I was a patient I would have been left thinking there was no possible side effects and would have a very biased opinion of the class of drugs.
The podcast I listened to was about the use of SSRIs after stroke and although not directly relevant to my daily practice, I enjoyed hearing about a novel use of a well known drug.
Inside Health continues and one good item on Parkinson's disease but I was less impressed with an article by a family planning specialist about continuing use of the combined pill in older women. The specialist highlighted all of the benefits of taking COCP but didn't mention the possible side effects once. If I was a patient I would have been left thinking there was no possible side effects and would have a very biased opinion of the class of drugs.
Tuesday, 5 February 2013
Lots of listening and reading.
So, Inside Health is back on the air and as usual has lots to discuss and think about! I'm up to date with the episodes and have particularly appreciated the article on dry mouth and current cancer treatments.
I'm proud to announce I finished Bad Pharma last week, within the 3 weeks of the library book loan too! I talked about it to a friend and colleague and she asked if reading it had changed my prescribing. I think that is a really hard question to answer quickly!
The book is pretty forthright about my responsibility as a doctor regarding prescribing and Ben Goldacre really knows his stuff. He also makes good points about getting the right information to GPs to be able to make a good decision when prescribing.
He highlights the arbitrary nature of some of our decisions and how easy it would be to fix indiscrepancies by entering all patients into trials as a matter of course as opposed to the current state of affairs.
So, how will it change my prescribing? I would like to think I prescribe mainly tried and tested generics based on current best evidence already. I hope it will make me more enquiring about prescribing decisions from secondary care. I hope I will share the vagarities of some decisions with my patients where good evidence isn't available more openly.
The book is very critical of medical journals and editorial decisions and champions the Cochrane Collaboration throughout the book. I guess the CC wouldn't be my first port of call for day to day decisions, but maybe I should look at it more- i shall subscribe to their email alerts and have a listen to the podcasts they do.
I'm proud to announce I finished Bad Pharma last week, within the 3 weeks of the library book loan too! I talked about it to a friend and colleague and she asked if reading it had changed my prescribing. I think that is a really hard question to answer quickly!
The book is pretty forthright about my responsibility as a doctor regarding prescribing and Ben Goldacre really knows his stuff. He also makes good points about getting the right information to GPs to be able to make a good decision when prescribing.
He highlights the arbitrary nature of some of our decisions and how easy it would be to fix indiscrepancies by entering all patients into trials as a matter of course as opposed to the current state of affairs.
So, how will it change my prescribing? I would like to think I prescribe mainly tried and tested generics based on current best evidence already. I hope it will make me more enquiring about prescribing decisions from secondary care. I hope I will share the vagarities of some decisions with my patients where good evidence isn't available more openly.
The book is very critical of medical journals and editorial decisions and champions the Cochrane Collaboration throughout the book. I guess the CC wouldn't be my first port of call for day to day decisions, but maybe I should look at it more- i shall subscribe to their email alerts and have a listen to the podcasts they do.
Tuesday, 1 January 2013
Measles
First things first, Happy New Year! Resolution number 1, record more of my learning!
So, the spotty 20 year old I saw before Christmas had Measles confirmed on a viral swab. I've reviewed her notes and she missed her MMR, despite it being clearly recorded she was safe to have it and should do so.
The girl has epilepsy and learning difficulties so we think that's why her carers chose not to give it. She's been registered her whole life with the surgery.
A quick look at the Medscape App reminded me of all the points I had forgotten about Measles.
The girl presented with a florid rash , I was reminded of the 3 C's, which I hadn't asked about and learnt Vitamin A can reduce symptoms but I'm not sure if that's only for deficient individuals.
I also learnt that Measles directly suppresses immune response, making secondary bacterial infection a risk, not just viral sequelae.
So learning points?
Check childhood immunisations when reviewing patients with learning difficulties, consider diagnosis in unvaccinated individuals with 3 C's
My senior colleague saw 1 case in the 80s and none since so hopefully it will be a long time before I see another!
So, the spotty 20 year old I saw before Christmas had Measles confirmed on a viral swab. I've reviewed her notes and she missed her MMR, despite it being clearly recorded she was safe to have it and should do so.
The girl has epilepsy and learning difficulties so we think that's why her carers chose not to give it. She's been registered her whole life with the surgery.
A quick look at the Medscape App reminded me of all the points I had forgotten about Measles.
The girl presented with a florid rash , I was reminded of the 3 C's, which I hadn't asked about and learnt Vitamin A can reduce symptoms but I'm not sure if that's only for deficient individuals.
I also learnt that Measles directly suppresses immune response, making secondary bacterial infection a risk, not just viral sequelae.
So learning points?
Check childhood immunisations when reviewing patients with learning difficulties, consider diagnosis in unvaccinated individuals with 3 C's
My senior colleague saw 1 case in the 80s and none since so hopefully it will be a long time before I see another!
Thursday, 6 December 2012
Delicious Food and Dilemmas!
A wonderful Christmas meal atSilversmiths was my GP group treat for being so good in 2012!
We managed not to talk just about how great the food was, we also chewed over some meaty clinical dilemmas.
Ranging from pregabalin, it's use and misuse, chronic pain management in general and our frustrations with thesis services. Reorganising and managing reception/admin teams, nail biting and whether a particular little girl was in need of psychological assessment and knees!
A very pleasant and fruitful way to catch up and mull over some big issues for 3 hours!
We managed not to talk just about how great the food was, we also chewed over some meaty clinical dilemmas.
Ranging from pregabalin, it's use and misuse, chronic pain management in general and our frustrations with thesis services. Reorganising and managing reception/admin teams, nail biting and whether a particular little girl was in need of psychological assessment and knees!
A very pleasant and fruitful way to catch up and mull over some big issues for 3 hours!
Tuesday, 20 November 2012
Diagnosing patient's preference
Is it just me, or did I miss something? The editorial with the above title in BMJ this month make me chuckle, then sigh and shake my head!
http://www.bmj.com/content/345/bmj.e7745?etoc=
Surely this is what we spend our days in General Practice land doing already? I'm sure I was marked on it when I submitted videos for MRCGP nearly 10 years ago? Why are the words communication skills not used?
I particularly like the tantalising comments about the possibility of reducing costs by asking patients what they really want. I also liked the editorial comments about making the patient part of the team, making the decision together with clinicians.
I did, of course listen to the podcast and the authors seem very genuine and again, there is no mention of General Practice or any mention of communication skills training.
I guess if there is any change in secondary care as a result of these papers, that must be a good thing. I'm just amazed this is where they are at.
http://www.bmj.com/content/345/bmj.e7745?etoc=
Surely this is what we spend our days in General Practice land doing already? I'm sure I was marked on it when I submitted videos for MRCGP nearly 10 years ago? Why are the words communication skills not used?
I particularly like the tantalising comments about the possibility of reducing costs by asking patients what they really want. I also liked the editorial comments about making the patient part of the team, making the decision together with clinicians.
I did, of course listen to the podcast and the authors seem very genuine and again, there is no mention of General Practice or any mention of communication skills training.
I guess if there is any change in secondary care as a result of these papers, that must be a good thing. I'm just amazed this is where they are at.
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