Deep Breath In

Green general practice with Richard Smith and Aarti Bansal

Following the recent COP26 Climate Change Summit, we discuss, in this week’s episode, the announcement that some 50 countries have committed to reach net zero carbon emissions within their healthcare systems by, or before, 2050. We talk about the role that GPs can play in reducing the carbon footprint of their practice, how to tackle climate anxiety, and how integrating greener practices into our healthcare systems aligns with better health benefits for our population as a whole – both now and in the future.
Our guests:
Richard Smith is the chair of the UK Health Alliance on Climate Change, and former editor of ‘The BMJ’.
Aarti Bansal is a GP, working in Sheffield, and the Net-zero NHS GP lead for the Humber, Coast and Vale Health and Care Partnership. She is also the founder of Greener Practice.
Further reading:
Greener Practice website: https://www.greenerpractice.co.uk/
Greener Practice guide to inhaler prescribing: https://www.greenerpractice.co.uk/greener-practice-guide-to-inhaler-prescribing
https://www.bmj.com/content/375/bmj.n2416
https://www.bmj.com/content/375/bmj-2021-067199

The GP crisis with Gareth Iacobucci and Lucy Martin

Primary care in the UK is in crisis. General practice was already under huge strain, as a result of the pandemic, high levels of seasonal respiratory viruses, as well as chronic understaffing and underfunding, but recent negative media campaigns against GPs, amidst the health secretary’s plans to publish ‘league tables’ of GP practices, have added to this and have led to increased demoralisation among doctors.
In this week’s episode, we discuss the current political climate affecting the NHS, perceptions of our healthcare system, and how this has changed over the last 10-20 years. If GP ‘league tables’ are not the answer, what creative solutions are needed in order to encourage new GPs into primary care, and to retain doctors in the workforce?
Our guests:
Gareth Iacobucci is the assistant news editor for ‘The BMJ’.
Lucy Martin is a GP, working in Dudley, as well as the acting medical director for Dudley Integrated Health & Care NHS Trust.

Eating disorders with Simon Chapman, Zoe John and Victoria Adeniji

Over the past 18 months, eating disorder specialists have seen a huge rise in the number of referrals, and experts have said that the pandemic has created “the perfect storm” for eating disorders, especially among children and young people. As GPs, what do we need to know about eating disorders? What red flags should we look out for, and how do we approach this thorny issue with our young patients? In this week’s episode, we talk to Dr. Simon Chapman about spotting the signs of an eating disorder, and we get advice on management. We also chat to Zoe John and Victoria Adeniji, who are both in recovery from their eating disorders, about their experiences and about how GPs may best support people with a history of eating disorders in their care.
Our guests:
Simon Chapman is a consultant in paediatrics and adolescent medicine at King's College Hospital, London. He is also the medical lead for the Maudsley Centre for Child and Adolescent Eating Disorders.
Zoe John and Victoria Adeniji are ambassadors for Beat, the UK’s eating disorder charity.
Further reading:
The MARSIPAN guidelines: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr189.pdf?sfvrsn=6c2e7ada_2
Online resources on the Beat website: https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/downloads-resources/

Obstructive sleep apnoea with Sophie West and Robert Koefman

Fatigue is one of the most common presenting symptoms GPs see in a consultation, and it feels like, during the pandemic, more of us than ever have been experiencing excessive tiredness. With our guests this week, Sophie West and Robert Koefman, we discuss the new NICE guidelines on obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome, and how sleep apnoea seems to be both under-diagnosed and over-diagnosed in primary care. We talk about the diagnostic challenges of this condition, particularly with the limitations of the available screening tools, the long list of comorbidities that may be linked to OSA, and the difficulties of remote consultations, as well as the huge benefits using a CPAP machine may provide to a patient.
Our guests:
Sophie West is a respiratory consultant, based in Newcastle upon Tyne. She is also the lead of the Newcastle regional sleep service.
Robert Koefman is a GP at Binfield Surgery in Berkshire. He has also been involved in ENT and community sleep clinics for over 20 years.

Headaches and team debriefings with Heather Angus-Leppan and Michaela Kolbe

A slightly different spread of this episode of Deep Breath In, Navjoyt Tom and Jenny are discussing two separate topics, headaches and team debriefings.
Firstly headaches, the team discuss why so many GPs find headaches to cause the most anxiety in their practice, and get some advice on migrainous headaches from Heather Angus-Leppan, consultant neurologist at the Royal Free London NHS Foundation Trust (also discussed vaccinations and CVST in our covid vaccination episode).
Secondly, team debriefings - seeking support from colleagues is essential, but the way in which teams discuss problems can be helpful or harmful. Michaela Kolbe, psychologist and director of University Hospital Zurich's simulation centre joins us to give some tips on how to make those team meetings work better.
Reading list
Team debriefings in healthcare: aligning intention and impact
https://www.bmj.com/content/374/bmj.n2042

Fitting IUDs with Rebekah Fenton

Doctors are taught from medical school about the benefits of IUD, and are often advocates of them to patients.
However, recent media attention on the pain that some women suffer when having their IUD's fitted have started conversations about the need for cervical blocks, and more honest counselling of women about the procedure.
Rebekah Fenton, adolescent medicine fellow at Lurie Children's Hospital of Chicago joins us to talk about how she councils her patients, and why the most important thing is to make sure women are in charge of their reproductive healthcare decisions.

Covid in children with Greg Zimet and Amanda Kvalsvig

As the scientific community in the UK still debates whether to vaccinate kids under 16, that leaves us as an outlier to the rest of the world where parents are being encouraged to seek the vaccination of the children.
In this episode Tom, Jenny and Navjoyt discuss the questions that they're getting in their surgeries, and get some advice on how parents regard vaccinating their children, how to think about transmissibility vs severity when it comes to childrens' risk, and some ways of helping to motivate vaccine uptake.
Our guests;
Amanda Kvalsvig is a senior research fellow at the University of Otago, and her work as an epidemiologist has helped to inform the New Zealand government's covid-19 response.
Greg Zimet is a clinical psychologist and professor in the Department of Pediatrics at Indiana University. His work has focussed on vaccination in children - particularly the HPV vaccine.
Further reading
Covid-19 vaccines for teenagers: conversations and consent
https://www.bmj.com/content/374/bmj.n2312

The complexity of primary care - with Rani Lill Anjum

There's a plan from the Royal College of General Practitioners, to stop the profession buckling under the huge pressure applied by the workforce crisis and covid 19.
The steps outlined are very practical, but do they really get to the heart of the problem with the way in which primary care is practiced in 2021.
In this episode, Tom, Jenny and Navjoyt are joined by Rani Lill Anjum, a philosopher from the Norwegian University of Life Sciences who thinks about causation in healthcare - and what this means for the doctor patient relationship.

Prediabetes or a borderline HbA1c result - with Sam Finnikin and Seamus O’Mahony

A borderline hba1c result will initiate a conversation with a patient - but how useful is that "prediabetes" check-in, and can GPs ever adequately describe what the elevated risk of having a risk factor actually means for a patients health?
Our guests in this episode are
Sam Finnikin, an academic GP from the University of Birmingham, who gives some helpful tips on explaining that risk, and reminds Tom that fear is not a good motivator of behaviour change.
Seamus O'Mahony is a retired gastroenterologist, and author. He explains the process which births a new diagnosis, and why he feels that creeping disease definitions are undermining the medical profession.
Further reading
A borderline HbA1c result
https://www.bmj.com/content/365/bmj.l1361
The epidemic of pre-diabetes: the medicine and the politics
https://www.bmj.com/content/349/bmj.g4485
Time to question the NHS diabetes prevention programme
https://www.bmj.com/content/351/bmj.h4717

Lockdown dementia with Jason Karlawish and Jennifer Watt

The pandemic had a high mortality toll in care homes, but measures to try and reduce that, through extreme social isolation, has had its own cost.
Social interaction, particularly with close family, is more than just a quick hello - evidence shows that mental stimulation can help with cognitive decline, and the lack of that interaction may have hastened progression of dementia in some patients.
In this podcast, the team talk about what GPs can do to support patients in care homes, and we find out about some non-drug interventions patients can try.
Our guests;
Jason Karlawish, is a geriatrician, and co-director of the Penn Memory Center, he's also author of the book "The Problem of Alzheimer's
How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It"
Jennifer Watt is a geriatrician, and assistant professor at the university of Toronto, and one of the authors of the recent systematic review and meta-analysis of comparative efficacy of interventions for reducing symptoms of depression in people with dementia
- https://www.bmj.com/content/372/bmj.n532
Reading;
Washington Post article: https://www.washingtonpost.com/health/2020/09/16/coronavirus-dementia-alzheimers-deaths/?arc404=true
Jason Karlawish and his book https://www.jasonkarlawish.com/the-problem-of-alzheimers
This American Life episode: https://www.thisamericanlife.org/737/the-daily
The Daily episode on aducanumab, "some hope is better than having no hope" https://www.nytimes.com/2021/07/07/podcasts/the-daily/aduhelm-alzheimers-fda-drug.html