Abstract
New Year's resolutions
At this time of year, you may be thinking about whether you have kept your New Year's resolutions. A podcast from the Mental Health Foundation provides ideas about New Year's resolutions, how to stick to them and how this can improve mental and physical wellbeing. This could be worth listening to for some inspiration, both for you, and to recommend to patients who may present with resolutions to lose weight, exercise more or stop smoking.
Mental Health Foundation. (2015). New year's resolutions – a healthy diet. Retrieved from www.mentalhealth.org.uk/help-information/podcasts/new-years-resolutions-a-healthy-diet/
Resilience for the future
Resilience has been brought up as a topic by News & Views in the past. Ten factors have been associated with stronger resilience, these include using social support and being physically fit. Are these areas you could work on to improve your resilience?
Lown, M., Lewith, G., Simon, C., & Peters, D. (2015). Resilience: What is it, why do we need it, and can it help us? British Journal of General Practice, 65(639), e708–e10. doi: 10.3399/bjgp15X687133
Use of medical apps
We have often reported in News & Views new apps that become available for use in healthcare. However, a report in the BMJ highlighted that not all medical/health apps developed are of equally high quality. Currently, apps are regulated by the Data Protection Act and the European directive on Misleading Advertising, with certain medical apps also regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA) if deemed to be a medical device. Currently the National Information Board is working on developing a ‘stronger endorsement process’ for apps, and new reforms from the European Commission are expected around the start of 2016. Until stronger regulations are in process, one source of information may be the app review site ‘iMedical apps’ with all apps on the site reviewed by physicians, trainees and allied healthcare professionals.
Armstrong, S. (2015). Which app should I use? BMJ, 351, h4597. doi: 10.1136/bmj.h4597. Retreived from www.imedicalapps.com/
Physical activity for post-menopausal women
A study recently reported on the Arthritis Research Campaign website highlighted that physical activity appears to have a greater effect on post-menopausal women than pre-menopausal women. The authors suggest that this highlights the importance of recommending even small-scale increases in physical activity in menopausal women, with links for patients to read more about improving their health through exercise. There is additionally a webpage on exercise and arthritis for those with joint problems.
Arthritis Research Campaign. www.arthritisresearchuk.org/news/general-news/2015/october/physical-activity-has-a-greater-impact-on-postmenopausal-women.aspx
Use of herbal medicines
Patients often ask about the use of herbal medicine, sometimes when desperate and having run out of options in terms of prescribed medication. Though a lack of evidence for efficacy makes it easy for us to explain why we would not recommend these medicines, sometimes the patients just want to know whether it is safe, or how it may interact with other medications they are prescribed. Advice for patients exists on the NHS website. It recommends that if patients purchase herbal medicines, they should look for the ‘Traditional Herbal Registration’ (THR), which does guarantee that the product has been measured against set standards, as opposed to buying items online. Websites such as NHS Choices and Patient.co.uk often have further information for patients about specific herbal medicines.
NHS Choices. (2015). Herbal medicines. Retrieved from www.nhs.uk/conditions/herbal-medicines/Pages/Introduction.aspx
Coeliac disease
Guidelines for the diagnosis and management of coeliac disease have been updated. The list for offering adults serological testing includes persistent unexplained gastrointestinal symptoms including irritable bowel, persistent tiredness, mouth ulcers, autoimmune thyroid disease, first degree relatives of people with coeliac disease and type 1 diabetes. There may not be adequate facilities in your area to provide the specialist and dietetic input recommended. You could think of quality improvement activity related to the guidelines, e.g. looking at testing uptake in patients with irritable bowel syndrome, or whether coeliac patients are being offered annual reviews.
NICE Guidelines. (2015). Coeliac disease: Recognition, assessment and management. Retrieved from www.nice.org.uk/guidance/ng20
Commissioning care
A recent analysis has shown large variations (around 50%) in the rate of knee arthroscopy for osteoarthritis between England and Scotland. The benefit of arthroscopy in the management of knee osteoarthritis has been questioned in a series of studies, including a Cochrane review. You are training in a world where you may be asked to commission services within your local area. You may wish to consider how you and your peers are being trained to take these sorts of decisions.
Hamilton, D., & Howie, C. (2015). Why do rates of knee arthroscopy differ between England and Scotland? BMJ, 351, 18–19. doi: 10.1136/bmj.h4720
Calcium supplements
A pair of meta-analyses have shown no convincing evidence that calcium supplements reduce fracture risk, and little that it increases bone density beyond the first year of supplementation. Many of your patients will ask you about dietary supplements. You might want to ensure that your training equips you to give simple advice about healthy diets.
Tai, V., Leung, W., Grey, A., Reid, I., & Bolland, M. (2015). Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ, 351, 11. doi: 10.1136/bmj.h4183
Bolland, M., Leung, W., Tai, T., Bastin, S., Gamble, G., Grey, A., & Reid, I. (2015). Calcium intake and the risk of fracture systemic review. BMJ, 351, 12. doi: 10.1136/bmj.h4580
Avoiding medical errors
You will see many thousands of patients during your GP career. It is inevitable that you will make some mistakes. The two most common types of error are diagnostic and prescribing. I recently read an article describing some of the errors we tend to make, e.g. ‘anchoring’, where we seize on a couple of features early on in the consultation or ‘representative restraint’ where we look only for the typical features of an illness, and ignore atypical presentations. The article describes some ways to try to avoid error in your own practice and within your team.
Coxon, J., & Rees, J. (2015). Avoiding medical errors in general practice. Trends in Urology and Mens Health, 6(4), 13–17. doi: 10.1002/tre.467
Deaths from asthma
One of our local GPs is passionate about sharing the message that asthma is a chronic disease and that we should be treating the underlying condition not just the attacks. In his blog he describes acting as an expert witness in the coroner's investigation of the death of a 14-year-old girl from asthma; a death that the coroner deemed to have been preventable.
Levy, M. (2015). Preventable asthma deaths-time for national action. Retrieved from endasthmadeaths.wordpress.com/2015/10/17/preventable-asthma-deaths-time-for-national-action/
Marburg Heart Score
A small primary care-based study has shown that use of the Marburg Heart Score can add to clinical judgement in the diagnosis of coronary heart disease. Five findings (gender/age, history of cardiovascular disease, pain on exercise, pain not reproducible on palpation and belief by the patient that the cause is cardiac) are used to give a numerical score.
Haasenritter, J., Donner-Banzhoff, N., & Bosner, S. (2015). Chest pain for coronary heart disease in general practice: Clinical judgement and a clinical decision rule. British Journal of General Practice, 65, 583–584. doi: 10.3399/bjgp15X687385
Essay prize
If you would like to do something different for your portfolio, you could enter the Hektoen Essay Prize (submission date 31 March 2016). The website makes suggestions of the sorts of topics in which they are interested, with a specific prize for an essay related to wars and veterans, and another prize for general medical topics, e.g. medical education, book reviews, famous clinicians or hospitals.