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GP Horizon - Keeping the Conversation Going

Rima Aboud - GP Horizon - 15 May, 2018

I qualified as a GP in 2015 and I was so used to attending my weekly VTS sessions I assumed that meeting up with my First5 group at least monthly was the natural next step. However, it wasn’t until I qualified that I appreciated the value of having protected time to discuss the trials and tribulations of General Practice, and more importantly, get answers to the questions that aren’t covered in the guidelines or trying to work out what the next best step would be in an unusual presentation. I found it near impossible to find a time when everyone could meet on a regular basis (clinics would overrun, that end of the day home visit would crop up….) and when we did manage to meet up, there wasn’t near enough time to discuss everything that had cropped up in our preceding weeks clinics such is the vastness of General Practice.  

I found that I was texting my GP friends in between patients to ask a quick non-urgent question. Sometimes, this worked well but often my friends would be in their own clinic and fielding their own questions, on holiday or simply didn’t know the answer!

Then I thought it’d be really great to be able to text a whole community of GPs in a supportive and collaborative environment where there is no such thing as a stupid question. This idea inspired me to develop GP Horizon - a secure and (really) simple way to post questions to other GPs. GP Horizon is available as an app on iOS and Android (search for GP Horizon) or via the web at gphorizon.com

Rima Aboud, GP Horizon


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MSK Conditions: Assessing the Shoulder Joint

Dr Mike Smith MBBS MRCS(Eng) MRCGP - 3 May, 2018

We see a lot of musculoskeletal complaints in primary care. A lot of these are shoulders.

After being a GP for just a few months, and sick of diagnosing ‘Shoulder Sprain’, prescribing NSAIDS and saying to return if worse, I decided that I wanted to be better.

Better at giving a more specific diagnosis, better at knowing when to refer and when to investigate, and better at offering a treatment plan that’s actually likely to improve my patients condition.

And so I asked a good physio friend of mine whether she could make me better at assessing the shoulder joint. She’s an Extended Scope Physiotherapist, and was running MSK clinics at the local community hospital, on behalf of the local acute trust.

I explained that when anyone presented with shoulder pain, we only had 10 minutes to take a history, do an examination, diagnose and start treatment.

I don’t know”, she replied, “It’s going to be tricky

That’s what I thought”, I said, thinking of how I was going to learn more than 120 eponymous tests for the shoulder, never mind trying to perform them.

“I mean”, she continued with a smile, and “what are you going to do for the remaining 8 minutes?

What followed was probably the most educational hour of my life, and something that changed my practice forever.

I learnt who does and who doesn’t get frozen shoulder.

I learnt the spectrum of disease that affects the rotator cuff.

I learnt the limited value of a plain x-ray in the majority of shoulder complaints.

I also was told the real reason behind the silly amount of eponymous tests.

The ultimate test came on holiday in Ireland last Christmas with my mother, who had let everyone know in the car, in the hotel and on the ferry that she had a worsening shoulder problem, which was limiting her activities.

It all came to a head in a small Irish Pub, outside Killarney, County Kerry, where my mother was lamenting what the point was of having a son as a GP, if he was unable to sort her shoulder out.

After a 3 minute chat, and an examination not unlike the ‘Macarena’, I was able to give an accurate diagnosis and treatment plan for her, and am pleased to say she is back to playing bridge with her friends on the South Coast of England, without a mention of her shoulder.

Her GP (a semi-retired Irish chap who I know quite well) even sent me a text.

“Just to say your diagnosis and treatment was spot on. Your mum came to see me for a second opinion!”

Praise indeed.

10 years on, and after many sessions volunteering with Orthopaedic Surgeons, Rheumatologists and more usefully Physiotherapists, I now consider myself an expert in the subject matter.

I find myself prescribing, referring and investigating less (except when I need to of course.) I have shared my knowledge with thousands of GPs, Nurses and other staff, and I hope am making a difference to both mine and their patients.

Working with NB Medical, we have assembled the best team of MSK experts we could find, and put together a programme of case studies, videos and punchy talks to cover, literally from head to toe, all the common MSK conditions you a likely to encounter.

Come and join us.

The weather will be better then!


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Treating Friends & Family Members

Ahmed Rashid - 17 May, 2018

I sometimes wonder what happens when specialists are asked by non-medical friends or family members about conditions outside their specialty area. What happens, for example, when a cardiologist is asked about a non-cardiac problem, like a rash, a red eye, or depression? Do they have a go at answering even though it’s not really their ‘thing’? Do they remember anything vaguely useful from their medical student or junior doctor days?

Of course, as medical generalists, most topics are considered fair ground for us as GPs, and we can usually provide some useful advice or reassurance. Maybe that’s why we’re so often asked for medical advice by friends and family, whether directly on a phone call or WhatsApp message, or on a more casual basis, perhaps over coffee or even at a birthday party.

In a new Dutch primary care study, trainee and experienced GPs took part in focus group discussions about their experiences of treating friends and family. The trainees were family medicine residents, equivalent of GP registrars in the UK, and the experienced GPs were family medicine supervisors, equivalent of GP trainers in the UK.

A range of factors emerged as important considerations that helped participants decide on how to handle these requests. The first and central factor was defined as “orientation to the situation”. This involved answering questions such as: who is this person, what is he or she asking from me, and where are we located at this particular moment?

A number of other factors followed this. These included the nature and strength of your relationship with the individual, the amount of trust in your own knowledge and skills, the expected consequences of making mistakes, the importance of work-life balance, and the risk of disturbing the patient-doctor relationship. Whilst senior GPs seemed to apply quite nuanced considerations to their response, the junior participants experienced far more difficulties.

Overall, the paper highlights the considerable complexity of the decisions GPs make about treating friends and family members. Although GMC guidance is clear that doctors should avoid it all costs, this paper highlights that the reality is not as clear cut as this. As we so often see, the world of general practice lives in the shades of grey between the black and white of guidelines.

Ahmed Rashid


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Working As One with Health Poverty Action

Jessica Doyle - Health Poverty Action - 10 May, 2018

Health Poverty Action (HPA) was founded by a UK doctor in 1984 to support people in places where other organisations could not or would not go. HPA continues to stand with those who are unfairly excluded and to support hardworking health professionals working in tough circumstances across countries in Africa, Asia and Latin America. Under-resourced health systems, remote locations and discrimination can make it hard for them to do their jobs.

HPA are delighted that NB Medical have chosen to support them through their new campaign, ‘As One’. ‘As One’ gives UK health professionals the opportunity to support, empower and share expertise with their colleagues working abroad from right here in the UK to empower.

This support will make a huge difference. In Guatemala for instance, many indigenous women rely on Traditional Birth Attendants (TBAs) to deliver babies. These incredible TBAs often walk several miles to visit pregnant women and deliver their babies with minimal resources. In some communities, TBA support is the only maternal health support these mothers receive, and so the TBA role is essential. However, these TBAs often face barriers, for instance, when they reach the home, the mother may agree to see them, but her husband could deny entrance. In other cases, TBAs can be threatened with violence if they try to enter the house. Despite these challenging circumstances TBAs persevere to serve their local communities.

TBAs until now have had no access to medical training, but relied on knowledge passed down from generation to generation. HPA is now providing this training for TBAs, giving them the knowledge to identify danger signs in pregnancy. This means TBAs are now referring their patients to health centres before any medical complications become too serious.

Anastacia Perez is a TBA working in Guatemala, she says “you need to see danger signs, or the mother and baby die. I have seen changes [through HPA training] – the people now go to health posts…. TBAs get support, and when TBAs ask for help they get cars, or children would die. The health posts and TBAs work together and communicate well. If a TBA sees a danger sign, they get the woman to the health post or hospital. Health post staff will come, and together they will convince the family to take the woman to hospital. Both sides are vital in reducing maternal deaths”.

Anastacia Perez.jpg

Picture of Anastacia Perez, Traditional Birth Attendant, Guatemala, January 2018.

HPA is only too aware that training health staff is the first step. They are also working with health centres and the government to ensure they are held accountable, and provide quality, culturally appropriate healthcare to indigenous groups, without discrimination. By educating TBAs and health centre staff, trust has been improved and more patients are being referred to health centres to receive the healthcare they deserve. Together, these changes are making a huge difference to indigenous people living in remote communities and helping to reduce maternal mortality.

TBAs.jpg

Picture of TBAs in Santa Maria, Totonicapán, Guatemala, January 2018.

NB Medical delegates can support the ‘As One’ campaign by getting involved in either of the following ways: 

1)     Practical support from here in the UK

An opportunity for health professionals here in the UK and abroad to share their expertise with each other. The idea is to learn from one another and exchange knowledge e.g. specialist digital support groups, designing online training, mentoring schemes etc. By sharing values and knowledge, we hope colleagues all over the world can support each other. To find out more click here.

2)     Financial support

We are encouraging UK health professionals to donate medically related costs to build capacity and support other health professionals with additional training and resources. You can donate anything from cremation form fees, the equivalent of paying for a colleague’s lunch, a one off locum fee, price of medical insurance, or even the cost of a journal subscription. To donate click here.

Check out our ‘As One’ website to learn more about the ways in which you can support your colleagues working abroad, from right here in the UK.

Jessica Doyle, Health Poverty Action


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