Domestic and intimate partner violence

This is common and includes physical, sexual, emotional, and psychological abuse. It is rarely an isolated event, and often escalates in severity and frequency. Do not hesitate to ask directly about this in consultations. Distinguish between generalized aggressors, family only aggressors, and non-family only aggressors. Once violent always violent?

. . . . . . . . . . . . . Read This »

Why do patients change their doctor?

The most common reasons are that either the patient has moved, or the doctor has retired or is perceived to be too far away. There are additional reasons:

Patient needs:
One doctor for all the family	5%
Wants woman doctor	4%
Wants alternative medicine	2%
Obstetric needs	1%

. . . . . . . . . . . . . Read This »

Health promotion by nurses

Nurses are the experts in this field but even they are not very effective in reducing coronary risk. In the community-based OXCHECK randomized trial (N = 6124, aged 35-64) serum cholesterol fell by only 0.08-0.2mmol/L and there was no significant difference in rates of giving up smoking, or in body mass index. Systolic (and diastolic) BP fell by ~2.5% in the intervention group receiving dietary and lifestyle advice.

. . . . . . . . . . . . . Read This »

Reducing alcohol intake

With the toll that excess alcohol takes in terms of personal misery and the national purse (>1600 million/yr in the UK), the need to reduce alcohol intake should rank as one of the leading aims of preventive care. The reason why alcohol is not at the top of the agenda is not just that doctors are so fond of it (the profession has three times the national rate of cirrhosis),

. . . . . . . . . . . . . Read This »

Helping people quit smoking

(AAAA=ask, advise, assist, arrange follow-up.)RCT78 Ask about smoking in all consultations, not just those on smoking-related diseases (be subtle; patients won't listen if you do not share agendas).

. . . . . . . . . . . . . Read This »

Useful Agents in Terminal Care

Pain

Remember that pain has physical, emotional, and spiritual components: all aspects need to be addressed. Diagnose and monitor each pain separately.

. . . . . . . . . . . . . Read This »

Advice for an NHS patient who wishes to complain

Who should I complain to?

Tell someone close to the cause of your complaint such as a doctor, nurse, receptionist, or practice manager as soon as possible (within 6 months of the incident, or within 6 months of discovering that you have a problem). It is often possible to sort out the problem at once. This is called Local Resolution.1 You can telephone or write to the practice complaints officer or to the individual concerned.

. . . . . . . . . . . . . Read This »

Description About Health Education

What is education? four incomplete answers

• Education is the system used for passing down, from one generation to the next, society's values, attitudes, and culture. Thus are crime, duplicity and double standards (and, on a good day, idealism) perpetuated in a kind of cultural inheritance.
• Education is an activity carried out on ignoramuses by

. . . . . . . . . . . . . Read This »

Advice to consider before a Hajj journey to Mecca

Hajj is a 5-day Muslim pilgrimage to Mecca to celebrate Abraham's readiness to sacrifice Ishmael. Its yearly date is unfixed. Pilgrims renew their faith shoulder-to-shoulder, as a sacred duty, with 2 million Muslims from all over the world. 20,000 travel from the UK, and another 29,000 also make a lesser pilgrimage to Mecca called Umrah.

. . . . . . . . . . . . . Read This »

Bedside manners in a multicultural world

Eastern manners

Do not expect an Afro-Asian to answer intimate questions,without first explaining about confidentiality.

• Avoid prolonged eye contact and loud speech (indicates lack ofrespect).
• Control your gesticulations (thethumbs up sign is consideredrude).
• A psychiatric referral may destroy eligibility formarriage.
  

. . . . . . . . . . . . . Read This »

Nocebo effects

Pharmacists often leaflet customers with long lists of their drugs side-effects, which, like Voodoo death, may become self-fulfilling prophesies. When one of the authors (JML) gives diamorphine IV to patients having a myocardial infarction, he says

. . . . . . . . . . . . . Read This »

Psychosomatic linkages

Endorphins, catecholamines, cortisol, and psychoneuroimmumunology. NB: It is not the case that there is a placebo-responsive personality.

. . . . . . . . . . . . . Read This »

The placebo effect

Placebo effects are very powerful and are important not just in research, but also in demonstrating to us how our demeanour may be just as important as the drugs we give. It is often said that if two obstetric units (for instance) do things quite differently (eg for or against artificial rupture of the membranes) then if one unit is vindicated by research, the other unit must be wrong. This need

. . . . . . . . . . . . . Read This »

Protocols, targets, and guidelines

• Freedom from only doing ordained tasks is essential for mental health.
• Beware accepting a protocol without knowing if it will affect your sympathy and time to communicate.
• Is the protocol independently validated. What is its hidden objective, eg cost-containment, conformity, self-advertisment, empire-building, or care? Reject protocols which don't specify conflicts of interests: most protocols (87%) are written by people with financial links to drug companies.
  

. . . . . . . . . . . . . Read This »

Problems and Solution Evidence-based Medicine (EBM)

This is the conscientious and judicious use of current bestevidence from clinical care research in the management of individualpatients taking into account their values.

. . . . . . . . . . . . . Read This »

Primary care and shared care clinics

Examples of mini-clinics which are conducted in primarycare

• Well-woman/well-man clinic
• Elderly nonattending patients
• Giving-up-smoking clinic
• Joint outreach clinics with a consultant who shares care (egorthopaedics)
• Antenatal clinic
• Cardiac1 & hypertensionclinic
• Citizen's advice clinic
• Diabetes clinicMET40
• Asthma clinic

. . . . . . . . . . . . . Read This »

Metaphysics at the bedside and the world's worst patient

We often find ourselves sitting on beds trying to persuade wayward people to courses of preventive action which will clearly benefit them, usually at some distant time in the future. We think this very clarity should be enough to persuade the person to act.

. . . . . . . . . . . . . Read This »

Prevention through the human life cycle

In all disease the goal is prevention. This is not to say that preventive activities are without side-effects. Classification: preventing a disease (eg by vaccination) is primary prevention. Controlling disease in an early form (eg carcinoma in situ) is secondary prevention. Preventing complications in those already symptomatic is tertiary prevention.

. . . . . . . . . . . . . Read This »

On the impossibility of being a good doctor

Here is a list of some of the things pundits tell us we should be doing when we meet patients (don't get depressed yet: we promise there is a solution):

. . . . . . . . . . . . . Read This »

Self Care and Empowered Self Care

Simple self-care constitutes the health activities which we do on our own and within familiessuch as brushing our teeth, or going to bed with aspirins during 'flu. Empowered self-care is what can happen when primary, secondary (district general hospital), and tertiary care (eg regional burns units and cancer specialisms) work together with social services within the context of the family life cycle.

. . . . . . . . . . . . . Read This »