Category: Management of disease

World Health Day 2017 – ‘Depression: let’s talk’

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By Dr David Kessler
Reader in Primary Care
Centre for Academic Mental Health &
Centre for Academic Primary Care

 

 

 

 

 

 

There has been a transformation in social and scientific attitudes to depression in my working lifetime. It is no longer acceptable to stigmatise mental illness or psychological distress. The idea that the common mental disorders of depression and anxiety are an inescapable part of being human has been replaced by a belief that these disabling extremes of sadness and worry are treatable conditions.

Changes in the treatment of depression have been part of wider cultural changes. There is an increased openness about sadness and distress, and a widespread belief, beginning with Freud, that at the very least ‘neurotic misery can be transformed into ordinary unhappiness’. The invention of psychotherapy has spawned numerous schools and sub-disciplines, but all hold to the common belief that with help, … Read more

Are some patients more equal than others? Looking back at the Cancer Drugs Fund

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Padraig Dixonby Dr Padraig Dixon
Senior Research Associate
Centre for Academic Primary Care

Imagine being given £400m of taxpayers’ money to spend on drugs for the benefit of NHS cancer patients. How would you decide which therapies to fund? Would you decide that all cancer patients should benefit equally, or would you decide to spend more on particular types of cancer, or on particular types of patient?

These issues were confronted by the Cancer Drugs Fund (CDF), the 2014/15 expenditures of which were £416m (against a budget of £280m). The CDF was created to make available to patients in England cancer drugs not recommended by the National Institute of Health and Care Excellence (NICE) on the basis of cost-effectiveness, not yet appraised by NICE or which were being used outside market authorisations.

The effects of the CDF on population health are controversial: one estimate is that the CDF has caused five … Read more

Why GPs need training about domestic violence and children

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Eszter Szilassy2by Eszter Szilassy
Senior Research Associate
Centre for Academic Primary Care

While violence against men continues to fall in the UK, women affected by violence and domestic abuse are bearing the brunt of a hidden rise in violent crime. This rise coincides with the austerity-led cutting of domestic violence services.

Domestic violence and abuse (DVA) damages physical and mental health resulting in increased use of health services by survivors of abuse. The prevalence of DVA among women attending general practice is higher than in the wider population. Women experiencing DVA are more likely to be in contact with GPs than with any other professionals. Reduced investment in specialist domestic violence services further increases the demand for direct general practice responses to DVA. Although victims tend not to disclose spontaneously to their GP, they have an expectation, often unfulfilled, that doctors can be trusted with disclosure, and can offer them … Read more

To test or not to test, that is the question

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Jessica Watsonby Dr Jessica Watson
Research Fellow
Centre for Academic Primary Care

‘If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health’
– Mark Cuban, Twitter

With this one tweet Mark Cuban started a twitter storm. Advocates argued that the future of medicine lies with new technologies, with online companies and even future smartphone dongles allowing patients’ to test their own blood for everything from allergies to zinc.

This brave new world overlooks the responsibility of doctors to ‘first do no harm’. I have been qualified as a doctor for over 10 years but am still in training as a GP registrar and ‘junior doctor’. I have gradually learned that my well-meaning enthusiasm to do more and more tests to try to find out what is wrong with patients can quickly lead to … Read more

Why are so many children given antibiotics for a cough?

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Christie CabralBy Dr Christie Cabral
Research Associate
Centre for Academic Primary Care

When I first started researching infectious cough in children, lots of clinicians told me they couldn’t understand why so many parents brought in children who were well enough to turn the consulting room upside down before they even started the examination. As a parent of two young children myself, I had some idea, but as a qualitative researcher, I was keen to get a balanced view.

In the TARGET Programme* we wanted to answer two questions. Given that most coughs will get better on their own:

1) Why do so many parents consult when their child has a cough?
2) Why do so many clinicians prescribe antibiotics for children with coughs?

We conducted five qualitative studies and began to notice common themes, not just across the studies but also shared by parents and clinicians. We found normative beliefs … Read more