Deep Breath In – Details, episodes & analysis

The BMJ's long running "10 minute consultation" series is being questioned - can you do everything we suggest in 10 minutes? Can GPs really do any meaningful consultations in 10 minutes?

That's the question that our three guests have been asking - and they join Tom Nolan, to discuss what they found.

 

Our guests;

Alice Harper is a GP trainee in Bristol and an academic clinical fellow at the University of Bristol

Carol Sinnott is a GP in Ireland, and a senior clinical research fellow at THIS institute at the University of Cambridge

Jess Watson is a GP NIHR clinical lecturer in general practice at the University of Bristol

 

Reading list;

Great expectations? GPs’ estimations of time required to deliver BMJ’s ‘10 minute consultations’ The BMJ's 10-Minute Consultation  

 

 

Is cancer screening worth it, and how can GPs have that conversation?

This episode of Deep Breath In explores the intricacies of assessing risks and benefits of cancer screening, featuring Michael Bretthauer's insights from a JAMA Internal Medicine study.

That meta-analysis combined efficacy of various cancer screening studies - and found most screenings showed minimal gains in extending overall life expectancy, though some slightly reduced cancer-specific mortality.

That leaves GPs with the challenge of communicating these nuanced findings to patients. Michael explains how he tries to convey complex concepts to patients, despite the societal inclination toward extensive testing despite low risks.

 

Reading list;

Jama paper - Estimated Lifetime Gained With Cancer Screening Tests A Meta-Analysis of Randomized Clinical Trials

The BMJ analysis  - Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit

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

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

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

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.

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.

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 (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

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/