Tag: primary care

Why doctors need to improve the way we discuss assisted dying

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Dr Paul Teed
PhD candidate
Centre for Academic Primary Care 
University of Bristol
@DrPaulTeed

Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.

At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad.

The situation requires clarification. Currently, if a doctor in the UK writes a specific report to help with an assisted death abroad (three organisations in Switzerland accept UK citizens), the General Medical Council (GMC) may view this as a “fitness to practice” issue.

However, if a doctor provides copies of medical records, even with the … Read more

How do we teach clinicians to talk about the end of life?

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by Dr Lucy Selman
Research Fellow
Centre for Academic Primary Care
@Lucy_Selman

 

In a systematic review published this month, we identified 153 communication skills training interventions for generalists in end of life care. In randomised controlled trials, training improved showing empathy and discussing emotions in simulated interactions (i.e. with actor patients) but evidence of effect on clinician behaviours during real patient interactions, and on patient-reported outcomes, was inconclusive.

The global increase in the proportion of older people and length of life means providing end of life care is now increasingly the responsibility of generalist as well as specialist palliative care providers. But many clinicians find communicating about end of life issues challenging: how do you best discuss imminent mortality, limited treatment options, what to expect when you’re dying, or a patient’s preferences for end of life care?

When this communication is done poorly, or not done at all, … Read more

Insights from the Oxford International Primary Care Research Leadership Programme

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by Dr Alyson Huntley
Research Fellow
Centre for Academic Primary Care, University of Bristol
and
Dr Sarah Tonkin-Crine
Health Psychologist
Nuffield Department of Primary Care Health Sciences, University of Oxford

Two individuals are supported by the NIHR School for Primary Care Research (NIHR SPCR) to attend the Oxford Leadership Programme every year. This year researchers Drs Alyson Huntley from the Centre for Academic Primary Care, University of Bristol and Sarah Tonkin-Crine, from the Nuffield Department of Primary Care Health Sciences, University of Oxford attended the first week of events at St Hughs’ College, Oxford.

As cohort#12 of the International Primary Care Research Leadership Programme we were lucky to stay at St Hugh’s College, Oxford during a very hot and sunny week in July. After arriving at the college on Sunday afternoon we were given our timetable and a list of our cohort members spanning the UK, Catalonia and … Read more

Confessions of a NIHR Knowledge Mobilisation Research Fellow

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by Dr Lesley Wye
Senior Research Fellow
Centre for Academic Primary Care

 

For 25 years, I have been a frustrated researcher. Like many, I came into the field of research to make a difference. But as the years passed, I realised that research had little influence on healthcare policy making or practice. I wanted to do something, so in 2009 I applied for a NIHR post-doctoral fellowship to skill up research teams to make a bigger impact. The feedback on my (unsuccessful) application was that researchers just had to publish in the BMJ and things would change (if only!).

Imagine my delight when a few short years later, the NIHR Knowledge Mobilisation Research Fellowship scheme was launched. Its aim was to create a “cadre of knowledge mobilisers”, proficient both in the practice and research of knowledge mobilisation (or ways of sharing knowledge). In 2014, I became one of them.… Read more

Safety-netting advice: my experience as an Academic Foundation Programme doctor

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by Dr Peter Edwards
Research Associate/Academic Foundation Year 2 doctor
Centre for Academic Primary Care

One in a Million logo

 

 

 

 

Patients can deteriorate rapidly.

I know this from working in both general practice and as a hospital doctor in A&E.

During the early stages of an illness it can be difficult for even the most experienced healthcare professionals to determine whether a patient has a minor self-limiting illness or is harbouring a more serious condition. In addition, growing problems such as antibiotic resistance and multimorbidity mean that sometimes even when a doctor makes a correct diagnosis, patients do not always get better with the first round of treatment and may require further medical help.

We cannot, and it is not clinically appropriate, to admit everyone to hospital to observe them until they feel 100% better.

That is why it is important that healthcare professionals provide patients with safety-netting advice. Safety-netting … Read more

Measuring outcomes in primary care

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by Dr Mairead MurphyDr Mairead Murphy
Senior Research Associate
Centre for Academic Primary Care

With ninety percent of patient interaction with health services going through primary care, it’s not surprising that primary care clinicians and researchers try to figure out ways to improve primary care services. Interventions are many and varied, and result in important questions about their effectiveness. Do electronic consultations offer a good service to patients? If GPs introduce advice on healthy lifestyles into the consultation, does it make patients healthier? What about increasing the duration of GP appointments to ten minutes – does this improve outcomes for patients? Or ensuring that patients always see the same named doctor? Or painting the waiting room green?

Questions like these are normally answered by administration of a generic patient-reported questionnaire. By comparing the responses of groups of patients (say those with eight minute consultations and those with ten minute consultations), researchers can … Read more

Why healthcare services have a problem with gambling

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Dr Sean Cowlishaw
Dr Sean Cowlishaw, Research Fellow at the Centre for Academic Primary Care

by Dr Sean Cowlishaw, University of Bristol

I have a problem with gambling. There’s not enough of it.

That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.

The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling … Read more

Why GPs should teach

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by Simon ThorntonSimon Thornton
GP Engagement Lead
Centre for Academic Primary Care

‘Encourage more GP practices to teach medical students‘.

Sounds simple doesn’t it? That was the brief for me starting as GP Engagement Lead in September 2016. Teaching is something I’m passionate about and is one of the highlights of my week in practice. It’s always a good day at work when I’ve had students with me and I love to share my enthusiasm for teaching with other GPs.

However, encouraging GPs to take on new work, as exciting and rewarding as it is, is difficult at a time of unprecedented workload and pressure in general practice. Enter ‘Step up and Teach’ – a campaign we’re running to highlight the benefits to practices of teaching medical students. The question we want practices to ask themselves is ‘can we afford not to teach?’.

Reasons to teach

We already know … Read more

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