Deep Breath In

Violence against GPs with Adam Janjua, Marcela Schilderman, and Anita Bignell

A recent investigation, by The BMJ, showed a worrying increase in incidence of violence, directed to wards GPs, and reported to the police. In this episode of Deep Breath in, Tom and Jenny are joined by Gareth Iacobucci, assistant news editor for The BMJ who broke the story.
They'll hear from a GP affected, and get some advice on preventing violence, and deescalation, from two mental health experts, who deal with the most agitated patients.
Our guests:
Adam Janjua, a GP in Fleetwood, Lancashire.
Marcela Schilderman, a consultant psychiatrist at South London and the Maudsley NHS Foundation Trust
and Anita Bignell, a mental health nurse, at South London and the Maudsley NHS Foundation Trust
Reading list
Violent incidents at GP surgeries double in five years, BMJ investigation finds
https://www.bmj.com/content/377/bmj.o1333

Milk allergies with Nicola Brathwaite

Consultations about suspected cow’s milk protein allergies are quite common in primary care, but these allergies can be a challenge to diagnose, particularly as symptoms can manifest in many different ways, and testing can be complicated. We talk to Dr. Nicola Brathwaite about the diagnosis and management of cow’s milk protein allergies in infants, and our discussion includes how to navigate consultations with parents who may be distressed and fraught with anxiety over their baby’s symptoms, and how best to manage the reintroduction of milk back into the diet.
Our guest:
Nicola Brathwaite is a paediatric allergy consultant at King's College Hospital, London. She completed her specialist training in Paediatrics and Paediatric Allergy in Cape Town, South Africa.

Parosmia with Emily Woodroofe and Claire Hopkins

Parosmia – a distorted sense of smell, and a delayed post-covid symptom – affects approximately 50% of people who experienced loss of smell during their initial covid infection, and it is currently attracting a lot of media attention. We hear from Emily Woodroofe, a third year medical student, about what it’s like to have parosmia, before we speak to Professor Claire Hopkins about what GPs need to know about it, and how they can best support their patients who are experiencing what can be a distressing symptom.
Our guests:
Emily Woodroofe is a third year medical student at Barts and The London School of Medicine and Dentistry.
Claire Hopkins is an ENT consultant, and professor of Rhinology at Guy’s and St. Thomas’ NHS foundation Trust.
Further reading:
‘Parosmia—a common consequence of covid-19’ https://www.bmj.com/content/377/bmj-2021-069860

What’s in store for general practice in the UK

With the focus on covid, and the pressure on hospitals, it may be easy to overlook what’s happening in general practice in the UK - but changes are afoot. Our new health secretary Sajid Javid doesn’t seem to like our long standing GP practice arrangement, NHS England has imposed new weekend working arrangements on the already stretched service, and the workforce pressures continue.
In this episode of Deep Breath In, our GP panel of Tom Nolan, Navjoyt Ladher, and Jenny Rasanathan are joined by Gareth Iacobucci, The BMJ’s assistant news editor, to give them the lowdown on what’s happening around primary care, who some of the key players are, and what his predictions for 2022.

Great Explanations

We see patients all the time who ,more than any drug or cure, just want an explanation for their symptoms, to understand why they feel the way they do.
But giving an explanation isn't necessarily straightforward, we're unsure of the diagnosis, we might worry about how the explanation might be received, or a 10 minute appointment just isn't time to go into all the details.
In today's episode, we've enlisted the help of consultation skills expert, Roger Neighbour, and hear how important a great explanation is from The BMJ patient editor Amy Price.
Our guests:
Roger Neighbour is a retired GP and a former president of the Royal College of GPs. He has written the books on consultations skills, and teaches courses on how to put those skills into practice.
Amy Price is a patient, a researcher editor for The BMJ's patient and public partnership, and a senior research scientist at Stanford School of Medicine.

Diagnostic excellence with Hardeep Singh, Denise Connor, and Gurpreet Dhaliwal

Diagnosis is a complex categorisation task driven by mental models that reside in long term memory. Through education and experience, clinicians form scripts that encapsulate their knowledge of specific conditions and develop diagnostic schemas that structure their approach to a specific health problem.
This cognitive process also intersects with systems, teamwork, and social factors that can enhance or reduce diagnostic accuracy.
In this podcast, we hear about five techniques that can help with the accuracy of those mental models, and mitigate against some of the external factors which may reduce diagnostic accuracy.
Our guests;
Hardeep Singh trained as a GP before moving to becoming a general internist and professor of patient safety research at Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston.
Denise Connor is an associate professor of medicine at University of California San Francisco and a practicing internist at San Francisco Veterans Affairs Medical Center.
Gurpreet Dhaliwal is a general internist at the San Francisco Veterans Affairs Medical Center, and a clinician educator.

Ramadan with Ammad Mahmood and Sahira Dar

As Ramadan draws near, clinicians may be approached by their Muslim patients to discuss managing their health conditions during the month of fasting. How should someone with a chronic condition, such as diabetes or epilepsy, time their medications during this period? Can a person who’s pregnant or breastfeeding partake in fasting? What alternative options are available to someone whose health needs make participating fully in fasting too risky?
In this week’s episode, we discuss the many questions doctors and patients may have around this topic with Ammad Mahmood and Sahira Dar, authors of a recently published article in The BMJ on advising patients with existing conditions about fasting during Ramadan, and talk about the importance of individualised advice and shared decision making.
Our guests:
Ammad Mahmood is a neurological trainee, currently undertaking a PHD in stroke imaging at the University of Glasgow.
Sahira Dar is a GP, practising in Glasgow, with special interests in lifestyle medicine and mental health issues.
Further reading:
‘Advising patients with existing conditions about fasting during Ramadan’ by Ammad Mahmood, Sahira Dar et al. https://www.bmj.com/content/376/bmj-2020-063613

Vaccine mandate’s unintended consequences

There was a proposed vaccine mandate for NHS staff in the UK (now abandoned) but in other countries mandates continue, but are they without harm, and do we have evidence about how effective they are?
In this episode, we'll be discussing how a proposed vaccine mandate would have affected GP practices in the UK, particularly when it comes to the demographics of staff who have not accepted the vaccine.
We'll also be discussing direct and indirect evidence which might have helped us assess the efficacy of a mandate.
Our guests;
Steve Mowle is a GP in South London, and honorary treasurer, of the Royal College of General Practice.
Juan Franco is a GP at the Hospital Italiano de Buenos Aires, Argentina, and Vice-Chair of the Research Department at the Instituto Universitario Hospital Italiano (IUHI), where he is also Director of the Cochrane Associate Centre.

How can a patient sue for their conception?

A recent case against a GP in England has worried the profession - does the fact that a patient, born with a neural tube defect, successfully sued their mother's GP open up the floodgates for litigation? How will that effect the way that you practice?
In this episode we're joined by Claire Dyer, The BMJ's legal correspondent, who explains how that case unfolded.
We also have a clinical update on childhood constipation, and the authors of a recent article in The BMJ give their tips on getting kids to drink movicol.
Show jumper wins case against mother’s GP for “wrongful conception” that resulted in her disability
https://www.bmj.com/content/375/bmj.n2999
Childhood constipation
https://www.bmj.com/content/375/bmj-2021-065046

Christmas 2021 with Inga Usher and Aswin Chari

With Christmas 2021 only just around the corner, we round off the year by chatting about our ‘Deep Breath In’ highlights, and by sharing some of the great feedback we’ve received from our listeners. We talk to Inga Usher and Aswin Chari, whose study comparing neurosurgeons with aerospace engineers (“It’s not brain surgery” vs. “It’s not rocket science”) was featured in The BMJ’s 2021 Christmas issue. Finally, we end the episode with a quiz on ICU slang (what on earth does ‘closest crocodile to the canoe’ mean?), 2021 NICE guideline updates, and, finally, the Bristol stool chart. Merry Christmas!
Our guests:
Inga Usher is a final year clinical PhD student at UCL Cancer Institute, studying a rare bone cancer, chordoma, and an aspiring neurosurgeon.
Aswin Chari is a neurosurgical trainee at Great Ormond Street Hospital, London.
Further reading:
SEED Eating Disorder Support Services: https://seed.charity/
Mitchell and Webb brain surgeon & rocket scientist sketch: https://www.youtube.com/watch?v=THNPmhBl-8I
“It’s not rocket science” and “It’s not brain surgery”—“It’s a walk in the park”: prospective comparative study: https://www.bmj.com/content/375/bmj-2021-067883
Just a smidge, or a bridge too far? Slang use in the ICU: https://www.bmj.com/content/375/bmj-2021-067900