Deep Breath In

Deep Breath In

By The BMJMedicineHealth & Fitness
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Deep Breath In episodes

  • 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

    46 min
  • 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

    43 min
  • 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.

    50 min
  • 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/

    55 min
  • 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.

    46 min
  • 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

    46 min
  • 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.

    56 min
  • 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

    57 min
  • 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.

    52 min
  • 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

    57 min

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