Abstract
New Year
As ever, Kathryn and I would like to wish you the best for the coming year. You have probably had Foundation or GP training that has been very different because of the pandemic. We hope you have been supported to fill your gaps, and to take the time to care for yourselves. Many local areas are providing a variety of wellbeing services. I doubt over the New Year period there will be a single newspaper without some reference to resolutions and wellbeing. We hope that many of you have already built in some stress busting in your lives. If reading this makes you feel you should, but haven’t had the energy, then maybe a look at resources specifically for trainees and doctors would help.
www.practitionerhealth.nhs.uk/accessing-the-service-in-scotland
www.nimdta.gov.uk/general-practice/gp-appraisal/resources-for-doctors-in-difficulty
The past and the future
January is named after the god Janus, who was two facing and so could see both the past and the future. 2022 saw the UK emerge from the COVID-19 pandemic, and those years will have had a lasting impact on most of us. Hopefully many of our readers will have had an opportunity to rest over the festive season, and perhaps to reflect, as Janus may have done, on the year past and the year ahead.
Types of talking therapies
When reviewing the National Institute for Health and Care Excellence (NICE) guidelines on depression, which were updated in June 2022, I reflected that the different types of psychological or ‘talking therapies’ may seem bewildering to both practitioners and to patients, particularly if patients are selecting an approach as part of online access to therapies. The NHS has a helpful page ‘Types of talking therapies’, which briefly outlines each form of therapy. A useful resource I will be directing medical students to this year!
Our plan for patients
At the time of writing, Dr Coffey’s ‘Our plan for patients’ has just been published. Within this document is the clearly stated aim that all patients will be able to get an appointment within 2 weeks. What are your thoughts on this, given your own experience as both a patient and a healthcare practitioner? A reasonable objective, or a government target with little to support achievement in the face of the current GP crisis?
www.gov.uk/government/publications/our-plan-for-patients/our-plan-for-patients
Physician burnout
A student recently mentioned that an individual commented that if the student was considering a career in general practice, they hoped they wouldn’t be working part time. I have worked part time, in part due to family commitments and in part due to a portfolio career, so interesting discussion ensued! The same week, Hodkinson et al. (2022) published in the British Medical Journal on physician burnout, highlighting that ‘physician burnout is associated with poor function and sustainability of healthcare organisations’. It is essential we look after ourselves and each other, take steps to recognise and prevent burnout, and support future generations of doctors in building happy, healthy, balanced lives and careers. Again, at this time of year, it is a good time to reflect on whether you are achieving this for yourself?
Hodkinson A, Zhou A and Johnson J (2022) Physician burnout undermines safe healthcare. British Medical Journal 378: e070442. DOI: 10.1136/bmj.o2157.
Vitamin D testing
Currently, GPs in my region are not able to routinely request Vitamin D testing and this is in-keeping with advice from McChesney at al. (2022). However, there are circumstances when it may be useful. Consider your local practice – are you able to request this test? It may be an interesting area to audit and to establish whether it is indeed a necessary test. (PS – are you taking your Vitamin D?)
McChesney C, Singer A, Duquette D, et al (2022). Do not routinely test for Vitamin D. BMJ (Clinical research edition) 378: e070270. DOI: 10.1136/bmj-2022-070270.
Hippocrates prize
Poetry and medicine are passions of mine that I have written about in InnovAiT. However, I am taking the liberty of again raising the synergy between the two, propelled by the recent obituary in the BMJ of Donald Singer, who co-founded the Hippocrates prize, and a wonderful piece by Whittle et al. (2022) exploring the role of poetry in reflective practice in this very journal. For readers and would-be readers, explore this wonderful medium, and what can be gained. For writers, the Hippocrates prize for poetry normally has a closing date at the end of February so you have plenty of time to reflect and write for the 2024 prize.
Illman J (2022) Donald Singer: Pharmacologist who jointly founded the Hippocrates Prize for Poetry and Medicine. BMJ 2022; 378: o1886. Doi: 10.1136/bmj.o1886.
Whittle B, Macgregor K and Cooper M (2022) Can poetry help GPs and GP trainees to develop their reflective practice? InnovAiT 15(6): 323–329. DOI: 10.1177/17557380221086310.
Email awareness
After a very busy week dealing with swathes of emails, jumping between different accounts, I came across this helpful article by the Medical Defence Union on ‘avoiding email dangers’. This is worth reviewing and considers a few different issues I had not thought of, such as ensuring email signatures are up to date.
www.themdu.com/guidance-and-advice/guides/avoiding-email-dangers
Gout
I note current newspaper articles referring to the ‘resurgence of a Victorian disease’, by which they mean gout. This may mean that patients who have suffered bouts of joint pain are triggered to seek advice. I like the BMJ visual summaries. The article summarises NICE guidance, that now focuses on gout as a long-term condition.
Neilson J, Bonnon A, Dickson A, et al. (2022) Gout: Diagnosis and management—summary of NICE guidance. BMJ 378: o1754.
Medical photography
Lockdown has dramatically changed our use of images. There is good guidance for the medicolegal aspects. A recent BMJ article gave helpful tips for improving the quality of images taken on mobile devices. Advice, such as using flash or as much daylight as possible and avoiding being too close to the subject, could be included in the instructions we give to patients.
Zeolite T, Blome-Eberwein S, Forbes S, et al. (2022) Medical photography using mobile devices. BMJ 378(8351): 370–373. DOI: 10.1136/bmj-2021-067663.
Transitions from fertility to maternity care
I was involved, in a minor capacity, in the production of a new Royal College of Nursing publication highlighting the complex journey for women having fertility treatment as they get handed over to routine antenatal care. For many women, getting and being pregnant has been a long and frightening experience. This publication gives advice aiming to support the process. While you visit the website, I can recommend exploring some of their other resources.
Pelvic floor exercises
I only know how to describe pelvic floor exercises because I was taught them in my antenatal classes. The BMJ has written a practical guide with some basic information we can share with patients, and advice about referral.
Okeahialam N, Oldfield M, Bonfield C, et al. (2022) Pelvic floor muscle training: A practical guide. BMJ 378(8352): 409–411. DOI: 10.1136/bmj-2022-070186.
