GP Sceptics

https://drjustincoleman.com/wp-content/uploads/2020/04/alcohol_gp_sceptics_final.mp3 (43 mins)

GP team Liz Sturgiss and Justin Coleman bring the GP Sceptics podcast back to life, and this time it’s all about alcohol…but not in a good way.

Liz leads a Monash University project called REACH — for you, that’s “Reducing alcohol-related harm in General Practice”. As usual, I’m just the guy who asks the dumb questions on your behalf, as you while away your time during coronavirus lockdown.

This podcast is all about encouraging behaviour change.

The experts in the podcast are Liz herself (you’ll recognise her distinctive voice and smart questions) and two of our favourite GP-experts (see below) who have built their careers on maximising the chances of someone reducing their alcohol intake as a result of an ordinary consultation with their GP.

Nothing fancy, but if every GP got 10 per cent better at it, the effect on Australia’s physical and mental health would be formidable.

Dr Paul Grinzi is a GP in North Melbourne who educates about alcohol and other drugs for the RACGP. We ask him about his tricks of the trade when it comes to taking an accurate history of alcohol consumption, and he describes how to subtly prompt patients to come up with their own ideas of what might motivate them to change.

I loved his concept of GPs being ‘actively curious’ in what makes the patient tick. Listen in to find out how to become a ‘travel agent of change’.

Dr Hester Wilson is a Sydney GP, a lead clinician in the GLAD (GP Liaison in Alcohol and other Drug) Project, and Chair of the RACGP Addiction Medicine Network. She discusses the new Australian Guidelines on reducing health risks from drinking alcohol (2020).

Although you may have never thought of yourself as a cheerleader, Hester describes how GPs should cheer people on towards healthier behaviours.

Finally, Liz takes me to task with a ‘What would Justin do?’ dilemma, which quite frankly was my easiest yet. I blitzed it!

Happy listening to your 43 minutes of GP education. Soundcloud and Apple links will be added soon.

Few ever talk about it, but it’s not just doctors who are courted by the medical industry. Nurses are also frequently targeted when it comes to promoting pharmaceuticals and medical devices.

Barely anyone except Quinn Grundy talks about it, in fact, so Liz Sturgiss and Justin Coleman point the microphone at this registered nurse who did her PhD on that very topic.

The extent of what Quinn reveals will surprise you…it most certainly surprised all the nurse managers who were sure she would find nothing when she started digging.

From surgical devices to wound dressings and pharmaceutical purchasing committees, it turns out nurses have far more influence on where money gets spent than most people assume, not least the nurses themselves.

The only ones not surprised are the companies who have been pouring substantial resources into reps educating nurses, thereby ensuring their brand features prominently when it comes to spending taxpayers or patients’ money. Unlike marketing to doctors, there are no legal restrictions to marketing to most nurses, and few health services have even considered the issue.

I know nurses at my general practice continue to see ‘educational’ reps who promote expensive wound dressings, glucometers and other devices, a full 10 years after our GPs stopped seeing reps altogether.

The discussions around the ethics of this seem to be a decade behind, within a nursing profession which is otherwise such a champion at the forefront of promoting best practice.

Dr Quinn Grundy is a postdoctoral research assistant at the Charles Perkins Centre at the University of Sydney, soon to assume a faculty position at the University of Toronto.

She has just launched her wonderfully titled book Infiltrating Healthcare: How Marketers Work Underground to Influence Nurses   [The code DNB290818 gives a 15% discount]

Quinn mentions the dataset Pharmaceutical industry payments to healthcare professionals which is my go-to database for discovering the degree of links between doctors quoted in media articles and the pharmaceutical industry. That dataset was almost going to sit on my website here, actually, after a friend of mine collated all the reports mandated under the Medicines Australia transparency arrangements. However, I figured the University of Sydney had better lawyers and thicker skin, so I facilitated its publication there.

Also in the podcast, Liz delves into the Therapeutic Guidelines series and finds they come up clean as a whistle when it comes to independent expertise. Such a fantastic evidence-based resource for prescribers! Justin interviewed Susan Phillips, the CEO of eTG, at the recent GP18 conference.

In the final segment we look at the latest controversy from wonderful troublemaker John Ioannidis who has dreamed up a world where professional associations don’t get to author their own guidelines.

By Kat Ritchie

What keeps a doctor resilient, when dealing with a high-pressure job helping patients who are distressed and traumatised?

How can doctors balance empathy with self-care? Does easing a patient’s burden imply carrying it for them?

Dr Genevieve Yates teaches the art of resilience to doctors around the nation, and here we distil one podcast-worth of her wisdom.

Listen to it after a long day at work, or when you’re feeling vulnerable.

Even better, listen in bed, where Justin’s soporific opinions will guide you towards a replenishing sleep. Look after yourself, folks.

In Liz’s Special Source, Liz takes a look at the funding and influences behind ‘Therapeutic Guidelines’ — hint: it comes out clean.

Liz reveals her pin-up nerdy-researcher boy (Justin’s is Ben Goldacre), and we invite Dr Google into the GP surgery.

All this and more, in our final podcast for this ‘RACGP Year’ (October to October).

NEXT UP will be our live podcast at the annual RACGP conference in Melbourne. (Yes, that IS Justin’s photo on that link page. My, doesn’t he look worth listening to!) 

We invite all of GP17 to join us in an hour of fun as we go live for the first time on the Saturday morning, at GP Sceptics live podcast – Interpreting media headlines.

Our Guest:

Dr Genevieve Yates is a multi-talented GP who does a little bit of everything. She is the RACGP Queensland Censor, teacher for MDA National, facilitator for the Black Dog Institute, was previously Assoc Director of Training for NCGPT, and has won Australia’s Medical Educator of the Year. She is an accomplished author, plays violin in the Australian Doctors’ Orchestra, acts on TV and on stage, and co-wrote GP the Musical. Quite frankly, she makes us sick.

References:

Balme E, Gerada C, Page L. Doctors need to be supported, not trained in resilience BMJ Careers, Sept 2015

Kearns H, Gardiner M. The Ultimate Time Management Guide for GPs (and in fact anyone in general practice) Published by Thinkwell

Beyond Blue National Mental Health Survey of Doctors and Medical Students 2013

Heneghan C, Goldacre B, Mahtani K. Why clinical trial outcomes fail to translate into benefits for patients 

Interesting reading: 

Doctors’ Mental Health Program A Beyond Blue program for health services

Unexplained, by Kat Ritchie

https://drjustincoleman.com/wp-content/uploads/2017/08/pod11_timo_completel1.mp3

Medically unexplained symptoms (MUS) are physical symptoms not sufficiently explained by an underlying medical condition after adequate examination and investigation, over a period of time (usually defined in months, rather than weeks).

GPs face patients in this situation regularly, and not surprisingly, find it difficult to deal with. Our training focuses on reaching elusive diagnoses through the scientific method of testing and discarding hypotheses until – eureka! – we land upon the right one.

But what happens when, like the stockade, that eureka fails us?

And if you think that’s frustrating for the diagnostician, try being the patient!

In this podcast, we interview a GP from the Netherlands who is at the forefront of this field. Dr Tim Olde Hartman was the lead author of the MUS guidelines (pdf) developed for the Dutch College of General Practitioners.

The guide’s popularity soon made it clear that this is a universal problem around the world, nowhere more apparent than in general practice. When a series of specialist appointments have failed to diagnose a medical cause for a persistent symptom, the advice is inevitably “go back and see your GP”.

This podcast is for those GPs.

Liz was lucky enough to meet Tim Olde Hartman during a sabbatical to the Netherlands, where she teed up this podcast interview.

In Liz’s Special Source segment, we discuss the wonderful HANDI guide – the RACGP Handbook of Non-Drug Interventions.

Justin’s factoid “Null but not void” looks at the media’s responsibility to write articles about negative findings, not just positive ones.

Enjoy!

References:

Dr Tim Olde Hartman’s profile at Radboud Institute for Health Sciences

Olde Hartman T et al. NHG Guideline on Medically Unexplained Symptoms (MUS) Huisarts Wet 2013;56(5):222-30.

den Boeft N et al. How should we manage adults with persistent unexplained physical symptoms? BMJ 2017;356:j268

RACGP The Handbook of Non-Drug interventions (HANDI): making effective non-drug treatments more visible and easier to use.

Jaklevic M Null but not void: Why health journalists need to stop ignoring negative studies Health News Review, March 2017

Interesting reading:

van Dessel N et al. Cochrane Systematic Review: Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults

Mice-level research, by Kat Ritchie

We invite Dr Tim Senior to reflect on being a GP for disadvantaged groups. He discusses General Practitioners at the Deep End, an initiative involving 100 general practices serving the most socio-economically deprived populations in Scotland.

Tim works at Tharawal, an Aboriginal and Torres Strait Islander health service in Western Sydney, and is also a prolific writer and thought-leader in Australian general practice. Although Tim has never advertised the fact, @TimSenior plus @realDonaldTrump together have almost as many twitter followers as @KimKardashian.

Justin calls out a couple of Australian researchers who overplayed a ‘breakthrough’ anti-ageing pill that has only been tested in mice.  In doing so, Justin happily overplays his own role in the subsequent Media Watch TV episode where he was (very briefly) shown raising an eyebrow about the miracle pill.

And we introduce the new segment ‘Liz’s special source’.

This segment is a chance for Liz to showcase a reliable, independent source of medical information. First up is the Trip Database, which Liz actually uses mid-consultation.

Tim is wise, Liz is sharp, and Justin can only admire them both from the shallow end.

References: 

General Practitioners at the Deep End, University of Glasgow website

Tim Senior on twitter

Media love a miracle, Media Watch episode 3 April 2017, ABC television.

Trip database, which describes itself as “a smart, fast tool for you to find high-quality clinical research evidence”. And we agree.

Justin’s lycra legs, by Kat Ritchie

Justin dons his finest lycra and tackles Dr George Crisp, WA chair of Doctors for the Environment Australia.

How do health gains in the doctor’s surgery stack up against environmental and population-based interventions? Could the nanny state be good for our grandchildren, and does Liz actually believe in wind farm health conspiracies?

Liz wonders if her recent public health-screening day with medical students did anyone any good, while Justin suspects that ego is, at least in his case, a dirty word.

We encourage listeners to join Doctors for the Environment Australia 

References:

The Cost-Effectiveness of Environmental Approaches to Disease Prevention Chokshi D, Farle T. N Engl J Med 367;4 July 2012

Upstream or downstream? By medical student Victoria Smith Med J Aust 2015; 203 (10): 412-413