Diary

GPST issue 13 Diary

CONSULTATION SECRETS How long do you let your patient speak before you feel compelled to butt in? Apparently US researchers found that patients were only allowed to finish their opening statement in less than a quarter of consultations, and that many doctors interrupted after around 18 seconds. A more recent study of UK GP consultations paints a more encouraging picture with those in their first two years of GP training interrupting after around 36 seconds. Experienced GPs seemingly hold out even longer, until around 51 seconds. London GP Dr Graham Easton ponders these issues and more in his new book The Appointment: What Your Doctor Really Thinks During Your Ten-Minute Consultation. He also shares his tips for signalling when it’s an appropriate time for the patient to leave. Techniques include breaking eye contact (“that’s easy, just look at the computer”), and altering your body position away from the patient (both of which risk irritating patients). Alternatively, he says doctors can try speaking faster and louder than the patient, sitting up straighter, handing over a prescription or patient information leaflet, or picking up the patient’s bag or walking stick for them. Finally, he adds, “there is the nuclear option: stand up and go and open the door. I’ve been known to use that.”

HOPING TO NEVER RETURN Diary has heard many tales in recent years of brave souls who have posted “hilarious” out-of-office email messages, but has never dared stray beyond a safe, functional alert. We could only dream of equalling the boldness of some of the employees whose comedy gold has featured in the internet’s summer news feeds. The ill-advised notices include: “On holiday. Hoping to win the lottery and never return” and “I am away from the office right now. Unfortunately I will be back tomorrow.” The love-my-job theme continues with “I’ve run away to join a different circus”, while another cynic offers: “I am out of the office from dd/mm to dd/mm and will not be checking email. It’s likely your note will be swallowed in a sea of inbox banality, never to be seen again. If you require a response, please re-send your email after dd/mm.” And finally, winning the award for “most likely to backfire” must surely be: “I am currently out at a job interview and will reply to you if I fail to get the position.”

BASH BACK GP bashing has long been a cherished sport among certain tabloid and broadsheet newspapers – not to mention names (…Daily Mail). But recent statistics released by insurers 1st Central reveal that doctors do a fair bit of bashing on their own, albeit of a different kind. Analysis of accident claims in 2015 ranks doctors at number three on the list of worst drivers by profession – just behind solicitors and accountants. No doubt it’s with all that racing about in expensive high-powered cars bought with outrageous salaries…or so the trope goes, as opposed to doctors driving home while exhausted from overwork. So who are the safest drivers according to the analysis? Roofers top the list followed by farm workers and builders. Perhaps most worrying – number 10 on the worst list was train driver.

WINTER IS COMING Rural Scotland needs GPs and the government has shown it is willing to pay. One hundred new GP training places were recently advertised and some with a £20,000 “Golden hello”. The one-off bursary will be paid for posts that have “not been filled recently” – many of these in isolated rural communities. Diary suggests that NHS Scotland could also enhance the offering with a bumper supply of vitamin D. Recently the Scientific Advisory Committee on Nutrition (SACN) recommended that everyone in the UK take 10 mg daily supplements in autumn and winter to protect bone, teeth and muscle health. Given that in mid-winter the sun barely breaks the horizon in some northern parts we feel it only fair to equip eager recruits. Sadly whisky is no substitute.

CHEWING KALE Health experts have railed against the Department of Health’s “watered down” obesity strategy which asks the food and drinks industry to “work towards” lower sugar content in products. Hence the burden remains on healthcare professionals to encourage healthy eating among patients – including advice on avoiding fad diets. To this end the British Dietetic Association (BDA) compiles a yearly five worst celeb diets to avoid. Here below Diary offers a pocket countdown of 2016. Trim Secrets (5): buy capsules to take three-times daily along with a 1,500 calorie diet and regular exercise (or skip the pills and lose weight anyway). Super Elixir (4): powder bought at £96 per month to regulate your body’s acidity levels (or you could just eat a balanced diet with fruit and veg and trust your body to regulate acid balance naturally). Bulletproof diet (3): drink daily ‘Bulletproof coffee’, essentially black coffee with some added butter and MCT (medium-chain triglycerides) oil. Foods are classified in three categories - bulletproof, suspect or kryptonite - with rules on timing of meals. All-kale and chewing gum diet (2): that’s it really; just eat kale and chewing gum (and be in close proximity of a toilet). No sugar diet (1): tall order unless this means processed sugar (not fructose, lactose, etc). BDA says: “It’s not about a single food or nutrient, we advocate a whole diet approach.” So forget the Donut Diet.