Deep Breath In

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;

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

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

As news about the climate breakdown hits, it's hard not to feel the stirring of climate anxiety. One way to mitigate that is by taking action, but it's hard to know where to start, and what GPs themselves can do.

In this podcast, we hear about 5 ways in which you can start bringing a sustainable outlook to primary care, and engage colleagues and patients in making a difference.

Our guests;

Tamsin Ellis, director of Greener Practice, and a GP in London

Fran Cundill, chair of the south Yorkshire Greener Practice group, and GP in Sheffield.

Resources;

Find out about how some clinical staff are starting to push their healthcare systems to be greener in The BMJ's podcast series Planet Centred Care

For all the BMJ's coverage on tackling the climate emergency https://www.bmj.com/campaign/climate-emergency

There have been so many conflicting views in the media lately on the management of menopause, and HRT has barely been out of the press at all in the last couple of years. As a result of the myriad uncertainties around menopause, many women are left feeling like they’re having to fend for themselves, and that their concerns are not being heard by their doctors. Taking segments from The BMJ’s webinar in May on known unknowns of menopause, we discuss the controversies around HRT; how we can give women balanced and realistic information about menopause and managing their symptoms; and how we can reframe the messaging around the menopausal transition in a more positive and hopeful way, in order to help empower women in navigating this normal life stage.

Our guests: 

Martha Hickey is Professor of Obstetrics and Gynaecology at the University of Melbourne. Her clinical and research interest is around menopause.

Margaret McCartney is a GP in Glasgow, and a freelance writer & journalist.

Resources:

‘Therapy for the effects of menopause’ (webinar) https://www.youtube.com/watch?v=-hQX2SGlcvY

‘ Normalising menopause’ BMJ 2022;377:e069369

There's never enough time in the day to be a GP, but it's still hard to say no to that one patient, or to a colleague who is asking for your help.

Our Guest;

Rachel Morris trained as a GP, before leaving the profession to become a coach for GPs, and other medics. Her work focusses on burnout, and how to take practical steps to stop the process. She also hosts the You Are Not A Frog podcast.

Links;

www.youarenotafrog.com

www.shapestoolkit.com

***Click here for a bonus resource on how to design your ideal working week***

Common themes for discussion on this podcast include overdiagnosis, approaches to the testing, the ins and outs of explanations, as well as other issues facing GPs who are overburdened, and have limited time and resources to treat patients. A topic which draws all of these themes together is prostate cancer screening.

The BMJ recently published a feature which asked whether the UK is ready to roll out a nationwide prostate cancer screening programme, and the linked analysis paper, authored by Dr Andrew Vickers and colleagues, argued that the current model of screening, which determines testing by shared decision making, is the worst approach for detecting prostate cancer.

We spoke to Andrew Vickers to discuss this further, and our second interview was with Dr Sam Merriel, regarding the emerging evidence that suggests that taking an MRI scan prior to biopsy could decrease harms associated with overdiagnosis and overtreatment of prostate cancer.

Our guests:

Andrew Vickers is an attending research methodologist in the Department of Epidemiology and Biostatistics at Memorial Sloan Kettering Cancer Center, New York.

Sam Merriel is a GP, and a researcher on cancer diagnostic testing at the University of Exeter.

Further reading:

‘Is the UK really ready to roll out prostate cancer screening?’ BMJ 2023;381:p1062 

‘Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit’ BMJ 2023;381:e071082 

While the pandemic has officially declared over, the ongoing effects of a covid-19 infection are still being felt in the community. In this Deep Breath In, Jenny, Tom, and Navjoyt are joined by two leading experts on long covid. 

They discuss the changing profile of people being referred to specialist clinics, the way in which different strains may have different long term outcomes, and what can be done to limit the risk of developing long covid.

Our guests:

Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford. 

Harsha Master is the GP lead in COVID rehabilitation at Hertfordshire Community Trust, and helped design the long covid clinical pathway there.

Talking about sexual health may be common-place with younger patients, but the sexual wellbeing of older adults is often neglected in a consultation. However it's important for doctors to be aware of changes to patients sex lives, given the link between intimacy and wellbeing.

In this podcast, the team discuss how to create that culture of openness that encourages older adults to share problems they may find embarrassing, what signs may indicate that it's worth initiating a question about sexual health, and making sexual function a routine part of the discussion about the effects of medication.

Our guests;

Sharon Hinchliff is a professor of psychology and health at the University of Sheffield.

www.agesexandyou.com

www.ageoflove.org

www.joanprice.com 

Website: www.drclairekaye.com

‘Stopping antidepressants’. Royal College of Psychiatrists. 2020. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants