Deep Breath In

Reproductive coercion and narrative medicine with Annabel Sowemimo and John Launer

Reproductive coercion may feel like something that we don’t see very often in general practice, but a 2022 poll carried out for BBC Radio 4 of 1,060 UK women between the ages of 18 and 44 found that half of them had experienced some form of reproductive coercion. This week, we speak to returning guest Annabel Sowemimo about the various forms that reproductive coercion can take, and who might be at risk of experiencing it. We discuss how we, as GPs, can identify these patients, and, once we’ve done so, how we might be able to help them. Later on, we talk to our BMJ columnist, John Launer, about how narrative medicine approaches can help to reach a better & more satisfying resolution to a consultation “puzzle” for you and for the patient.
Our guests:
Annabel Sowemimo is a community sexual health registrar, based in Leicester. She is also a PhD candidate at King’s College London, and is the co-founder of the charity Reproductive Justice Initiative.
John Launer is a GP educator, working for Health Education England. He is also a freelance educator and writer, as well as being a columnist for ‘The BMJ’.
Further reading:
‘How to recognise and respond to reproductive coercion’. BMJ 2022;378:e069043. https://www.bmj.com/content/378/bmj-2021-069043
‘John Launer: The art of paying attention’. BMJ 2022;378:o2294. https://www.bmj.com/content/378/bmj.o2294
‘Careful, kind care is our compass out of the pandemic fog’. BMJ 2022;379:e073444. https://www.bmj.com/content/379/bmj-2022-073444

Coaching with Claire Kaye

In general practice, it can often feel like a lot is changing beyond our grasp. On top of this, the pandemic has left many healthcare professionals self-reflecting on their careers and lives, and trying to work out what they really want going forward.
This week, we speak to Claire Kaye about her role as a coach for doctors. Claire talks to us about the benefits of coaching, including helping to get rid of internal & external noise, shaping the mindset, and coping better with change. She also offers advice on the best ways to approach coaching in order to achieve a positive outcome.
Our guest:
Claire Kaye, formerly a GP, is an executive coach. She specialises in career development.
Instagram: @drclairekayecoaching
LinkedIn: @drclairekaye
Website: www.drclairekaye.com

Patient access to notes with Charlotte Blease, Brian Macmillan and Gail Davidge

The possibility that patients will suddenly have access to their notes has caused some anxiety for GPs in England. The department of health's plans to allow patients to prospectively access their medical record lead to fears about increased workloads, misunderstandings, and safety - and the plans have now been pushed back.
In this podcast the Deep Breath In team are joined by the authors of a recent article in The BMJ to explore those fears, hear about the potential benefits, and understand the evidence behind open notes.
Our guests;
Charlotte Blease, and interdisciplinary health researcher at OpenNotes, Beth Israel Deaconess Medical Center/Harvard Medical School.
Brian McMillan, a GP and senior clinical lecturer at the University of Manchester
Gail Davidge, research associate at the University of Manchester
The article they're discussing is a practice pointer on Adapting to transparent medical records: international experience with “open notes”
https://www.bmj.com/content/379/bmj-2021-069861

Surrogate endpoints with Huseyin Naci

This week, we’re joined by Huseyin Naci to discuss the recent press release from Eisai and Biogen announcing the Phase III trial results for lecanemab for use in Alzheimer’s disease, and the FDA’s decision to accept the drug onto its accelerated approval pathway. We talk about the pros and cons of using surrogate endpoints to predict clinical outcomes. How can we strike a better balance in clinical trials between generating high-quality and trustworthy evidence, and the urgent needs of patients with life-limiting conditions and very few available treatment options?
Our guest:
Huseyin Naci is an associate professor of Health Policy at the London School of Economics and Political Science (LSE). He is also an advisor to the Analysis section of The BMJ.

GP Crisis with Rebecca Rosen

The GP crisis with Rebecca Rosen
This week, we discuss the ongoing GP crisis, an ever-topical subject, in light of recent UK governmental changes. In early September, Thérèse Coffey laid out her plans for the NHS in the House of Commons, but, with general practice struggling so much as it is, is she proposing practical and feasible solutions, or will her initiatives be merely papering over the cracks? We’re joined by Rebecca Rosen to discuss whether or not there’s any real substance behind the proposed changes, how to manage patients’ expectations around access to care, and how primary care practitioners might be best supported in order to help ease the strain on them.
Our guest:
Rebecca Rosen is a GP in South East London, and a senior fellow in Health Policy at the Nuffield Trust.

Physician experience, and gout with Katherine Hall and Alastair Dickson

In this episode of Deep Breath In, we'll be considering how a physicians personal experience of illness - either themselves, or as a parent or carer, might affect their approach to management of it in a patient.
We'll also have an update on the NICE guideline for treatment of Gout - particularly highlighting changes around uses of urate lowering therapy, and how often we should be testing patient's serum urate levels when they're experiencing flare-ups.
Our Guests.
Katherine Hall is the associate dean of medical admissions at the university of Otago, and has researched how physician experience affects their practice.
Alastair Dickson is a GP, and lecturer at Hull York Medical School. He co-authored The BMJ article on management of gout.
Reading
Gout: diagnosis and management—summary of NICE guidance
https://www.bmj.com/content/378/bmj.o1754

Musculoskeletal pain and osteoarthritis with Imran Sajid

Musculoskeletal (MSK) pain and osteoarthritis are clinically common in general practice, but with the new draft NICE guideline on osteoarthritis (published in April 2022) recommending a move away from pharmacological treatments and instead promoting self-management, some GPs have been left wondering how best to manage MSK pain going forwards . In this week’s episode, Dr. Imran Sajid talks to us about the importance of educating patients on what arthritis really is – moving away from the term “wear and tear” – and of taking a thorough history of a patient’s pain journey in consultations. He also gives practical advice on how we might approach non-pharmacological management of MSK pain with our patients.
Our guest:
Imran Sajid is a GP with a special interest in MSK medicine. He is the clinical lead in MSK & Diagnostics for NHS North West London, an adjunct lecturer in Health Policy at the University of Global Health Equity, as well as being a qualified personal trainer.
Further reading:
‘Osteoarthritis: assessment and management, draft for consultation, April 2022’. NICE. 2022. https://www.nice.org.uk/guidance/gid-ng10127/documents/draft-guideline
‘The tear, flare, and repair model of osteoarthritis’. BMJ 2022;377:o1028. https://www.bmj.com/content/377/bmj.o1028

Retention with Pamela Curtis and GP trainees

Despite the Conservation party manifesto for the 2019 general election promising to deliver 6,000 additional full-time equivalent GPs, worryingly, the NHS lost 717 FTE GPs between March 2019 and March 2022, and the Health and Social Care Committee’s July 2022 report on workforce was scathing about the Government’s failure to act decisively on the chronic staff shortages across healthcare in the UK. This week, we speak to more colleagues from the RCGP conference: first, we talk to Pamela Curtis about the challenges of returning to general practice after a break; secondly, we speak to a group of GP trainees about their innovative platform, The Big GP Consultation, and hear their thoughts on shaping the future of general practice.
Our guests:
Pamela Curtis is a salaried GP working at NHS Bristol, North Somerset and South Gloucestershire ICB.
Veena Aggarwal, Devina Maru, Liam Loftus and Rachel Weaver are all GP trainees, and are part of the team for The Big GP Consultation.
Further reading:
House of Commons Health and Social Care Committee. Workforce: recruitment, training and retention in health and social care. 2022. https://committees.parliament.uk/publications/23246/documents/169640/default/
The Big GP Consultation. https://thebiggpconsultation.co.uk/

Continuity with Martin Marshall and Emma Gladwinfield

In this week’s episode, we share our experiences of attending the recent RCGP Annual Conference, and our thoughts on the topics that were covered in the talks at this year’s event. We talk to RCGP Chair, Martin Marshall, about continuity of care, which he states is one of the defining features of general practice. Evidence has shown that continuity of care is associated with better health outcomes for patients, but how can doctors convince politicians and policymakers of the benefits of it? We also speak to Emma Gladwinfield, a GP in Rossendale, about how connecting with schools, churches and community centres is helping to build relationships with patients and deliver care in her local community.
Our guests:
Martin Marshall is the Chair of the RCGP, a GP in Newham, East London, and Professor of Healthcare Improvement at UCL.
Emma Gladwinfield is a GP in Rossendale, East Lancashire.
Further reading:
‘Tackling the crisis in primary care’. doi:10.1136/bmj.o1485. https://www.bmj.com/content/377/bmj.o1485

Adverse drug reactions with Anders Holt and Corine Ekhart

As more and more pharmaceutical products come onto the market, there are so many potential drug interactions, and adverse reactions, to bear in mind during a consultation in primary care. In this week’s episode, we speak to Anders Holt, the author of a recent research paper looking at co-prescribing nitrates and sildenafil, which is surprisingly common, and adverse events associated with this. We also discuss the neuropsychiatric side effects of montelukast with Corine Ekhart, and talk about the challenges of striking the right balance between highlighting a rare but important side effect and causing the patient anxiety about taking the medication.
Our guests:
Anders Holt is a PhD candidate at Copenhagen University Hospital, Denmark.
Corine Ekhart is a pharmacist at the Netherlands Pharmacovigilance Centre Lareb in 's-Hertogenbosch, the Netherlands.
Further reading:
‘Adverse Events Associated With Coprescription of Phosphodiesterase Type 5 Inhibitors and Oral Organic Nitrates in Male Patients With Ischemic Heart Disease : A Case-Crossover Study’. doi:10.7326/M21-3445 https://www.acpjournals.org/doi/10.7326/M21-3445
‘Neuropsychiatric reactions with the use of montelukast’. doi:10.1136/bmj-2021-067554
https://www.bmj.com/content/376/bmj-2021-067554