User blog: Rcgp Learning
Alopecia is a general term for hair loss. However, there are different types depending on the severity and underlying cause of the hair loss. Alopecia areata is a non-scarring hair loss, which results in a small, round patch of baldness on the scalp. It can also affect hair across the body, such as facial hair, body hair, eyebrows and eyelashes. For some people, larger areas can be affected, such as the whole scalp (alopecia totalis) or the whole scalp and body (alopecia universalis)².
Alopecia Awareness Month takes place in September and aims to raise awareness of alopecia and the impact it has on those it affects. It is estimated that the lifetime prevalence of alopecia areata in the UK is 1.7%, with both men and women affected¹. Patients with concerns about hair loss symptoms are likely to visit their GP initially, so it is useful to have some understanding of alopecia and the different ways it can present.
Alopecia areata is an autoimmune condition which occurs when T-lymphocytes attack the hair bulb. There is a genetic predisposition in some families and it can also be associated with other autoimmune conditions, such as thyroiditis, lupus erythematosus, vitiligo and psoriasis¹. Unfortunately, there is no known cure and hair regrowth cannot be guaranteed. The chances of the hair growing back depends on the amount that is lost in the first place. People with small bald patches may experience full regrowth within a year, whereas people who lose half of their hair may not make a full recovery².
Another cause of alopecia is androgenetic alopecia, which can affect men or women and for which there is a genetic link. Treatments for this include antiandrogens and hair transplants, which are not usually available on the NHS.
Telogen effluvium is another common form of alopecia. It occurs when hair follicles move from the anagen phase to the telogen phase too early. Around 85% of scalp hairs are in the anagen phase, which means that the hair grows by 0.5-1.5cm a month and lasts in the scalp around three-five years. Telogen is when the hair follicle is approaching the end of its lifecycle. The hair is fully keratinized and the follicle is dormant, lasting in the scalp around two-three months¹.
The normal hair cycle is illustrated in the diagram below:
Acute telogen effluvium can happen suddenly and generally comes on about three months after a trigger. Common triggers include childbirth, severe trauma or illness, a stressful or major life event, rapid weight loss, severe skin problems affecting the scalp or a new medication¹’³. Patients may notice large numbers of hairs on their pillow, hairbrush or in the plughole. In most cases, hair growth returns to normal within a few months¹. If the hair loss carries on for more than six months, this could suggest chronic telogen effluvium. It is more common in women and is linked to female pattern hair loss, thyroid disease and iron and vitamin D deficiencies¹.
The RCGP has recently developed an eLearning course with Alopecia UK, with the aim of increasing GPs’ knowledge of hair loss conditions. You can access the Alopecia eLearning course here. The course is FREE to access and gives you at least 0.5 CPD Credits upon completion. For more information on hair loss conditions, you can also visit the Alopecia UK website here.
¹ Royal College of General Practitioners. Alopecia eLearning course. [Internet]. Available from: http://elearning.rcgp.org.uk/course/view.php?id=283
² British Association of Dermatologists. Alopecia Areata Patient Information Leaflet. [Internet]. Available from: http://www.bad.org.uk/for-the-public/patient-information-leaflets/alopecia-areata
³ British Association of Dermatologists. Telogen Effluvium (a type of hair loss) Patient Information Leaflet. [Internet]. Available from: http://www.bad.org.uk/for-the-public/patient-information-leaflets/telogen-effluvium
The first week of August marks World Breastfeeding Week, which aims to encourage mothers around the world to breastfeed and therefore safeguard the health of their babies. August was chosen because the Innocenti Declaration was signed in August 1990 (and later updated in 2005) by governments and various health organisations to protect, promote and support breastfeeding¹. The awareness week is coordinated by World Alliance for Breastfeeding Action (WABA), a global network consisting of several organisations such as World Health Organisation (WHO), United Nations Children’s Fund (UNICEF) and La Leche League International (LLLI)². World Breastfeeding Week has taken place every year since 1992, and has a different theme and focus each time. As well as a theme, each year there are four objectives: Inform, Anchor, Engage and Galvanise.
The theme for this year’s World Breastfeeding Week is ‘Foundation of Life’, which references the health benefits that breastfeeding provides for both mother and baby: breastfeeding exclusively for 6 months can help protect against infections and therefore reduce newborn mortality. It also provides an important source of nutrients and energy in early life and reduces the likelihood of obesity in childhood and adolescence. For the mother, a longer duration of breastfeeding can reduce the risk of developing breast or ovarian cancer ³. According to a 2014 study on 10,000 new mothers in the UK, breastfeeding was also linked to lower rates in post-natal depression. Mothers who planned to breastfeed and actually went on to breastfeed were 50% less likely to suffer with post-natal depression than those who hadn’t planned to and didn’t breastfeed.⁴
To get the optimum benefits from breastfeeding, WHO and UNICEF recommend the following³:
- early initiation of breastfeeding within one hour of birth
- exclusive breastfeeding for the first six months of life
- combination of nutritionally adequate solid foods with continued breastfeeding up to two years of age and possibly beyond
Despite the benefits the rates for breastfeeding in the UK are among the lowest in the world⁵. According to the latest Infant Feeding Survey in 2010, only 34% of babies in the UK were receiving any breastmilk at six months⁶, compared to 49% in the US and 71% in Norway⁵. Breastfeeding initiation was at 81% and went down to 1% for exclusive breastfeeding by the six month mark⁶.
The Infant Feeding Survey also states that eight out of ten women stop breastfeeding before they want to. Common reasons for stopping breastfeeding included problems with the baby’s latch, painful breasts or nipples and feeling that they had an ‘insufficient’ milk supply⁶. Although most of these issues may be addressed initially with midwives, health visitors and lactation consultants, it’s important for GPs to have enough knowledge about them to advise mothers at their 6-8 week check. For more information about how to deal with these common problems appropriately, you can consult the NICE Clinical Guideline on ‘Postnatal care up to 8 weeks after birth’. NHS Choices also provides more information about specific conditions such as mastitis and tongue-tie. GPs can signpost patients to organisations such as The Breastfeeding Network and LLLI for further support and advice.
Although breastfeeding is the recommended infant feeding method by many health organisations, GPs may also be asked for advice on formula feeding as an alternative. While the role of the primary care team is crucial in promoting exclusive breastfeeding both pre and post natal, it is crucial to offer support to women who chose the alternative. The RCGP offers a FREE eLearning course on Infant Nutrition, which covers the basics of formula feeding and provides an understanding of common feeding problems.
For further information about breastfeeding and the GP’s role, the RCGP has recently launched an eLearning course on Breastfeeding, which is FREE to all healthcare professionals.
¹ World Health Organisation (WHO). World Breastfeeding Week 1-7 August 2016. [Internet} Available from: http://www.who.int/mediacentre/events/2016/world-breastfeeding-week/en/
² World Health Organisation (WHO). BREASTFEEDING: Foundation of Life. 2018. [Internet]. Available from: http://worldbreastfeedingweek.org/
³ World Health Organisation (WHO). Infant and young child feeding. February 2018. [Internet]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding
⁴ Borra, C., Iacovou, M. & Sevilla, A. Matern Child Health J (2015) 19: 897. Available from: https://doi.org/10.1007/s10995-014-1591-z
⁵ Victora CG, Bahl R, Barros AJD, et al, for The Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–90
⁶ McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ (2012) Infant Feeding Survey 2010, Health and Social Care Information Centre. Available from: https://files.digital.nhs.uk/publicationimport/pub08xxx/pub08694/infant-feeding-survey-2010-consolidated-report.pdf
At RCGP, we want to do our best to deliver the best support and value possible, especially when it comes to your learning. That’s why we’re pleased to announce that from this month, GP SelfTest will now be a FREE learning resource for all RCGP members.
RCGP has invested in GP SelfTest as an online tool for all our members, whatever stage of your career you are. You may be a trainee starting out on your journey into general practice and need support with familiarising yourself with the RCGP curriculum and revising for the Applied Knowledge Test (AKT) or further along in your profession as an independent GP, preparing CPD for your appraisal and revalidation. GP SelfTest can help you to identify your learning needs and build upon these to improve your practice.
With GP SelfTest, all RCGP members can now have FREE unlimited access to different tests, thousands of questions written by GPs and comprehensive feedback with up-to-date resources to aid your further study.
With close to 6,000 users, here’s a little of what some GPs have to say about using GP SelfTest:
So why not join them today and see how GP SelfTest can support your learning? Don’t miss out and claim your free access here.
Please note, if you are an RCGP member who has recently purchased a subscription and would like to discuss a partial refund, please contact our GP SelfTest team on: GPSelfTest@rcgp.org.uk
At the RCGP you are part of a community. A community that provides its members with networks for support and advice, a collective voice for GPs and opportunities for innovation and research. It’s a community that values your learning and wants to ensure you’re always learning, throughout your career as a GP.
Developed by GPs for GPs, the college offers many high-quality educational resources. As well as supporting your learning, these resources are a great way to boost your CPD credits. As an RCGP member, you can also benefit from accessing the majority of our resources for free.
There are currently two topics in this brand new resource, with many more being added over the next year. As an introduction to the Educational Libraries, this blog post outlines some of the ways you can utilise this resource to meet your learning needs.
How can these libraries help me?
The Educational Libraries provide you with a great opportunity to explore other aspects of general practice.
Supporting your CPD, these libraries bring together national guidelines and educational resources such as eLearning, journal articles and podcasts that are relevant to GPs and other primary healthcare professionals. Information on relevant courses you can attend are also included to help you learn from peers, gain networking opportunities and to really get the most out of being a GP.
What is included in this series?
Content from the Women’s health library has been viewed over 29,000 times since its launch in May 2017.
Content from the Dermatology library has been viewed over 6,000 times since its launch in March 2018.
How can I access the Educational Libraries?
Visit the RCGP’s online learning environment and select the ‘Educational Libraries’ section on the homepage.
You’ll find that the resources have been organised in a clear and user-friendly format designed to help GPs meet their learning needs and improve opportunities to specialise and diversify in their career.
1 May marks World Asthma Day, an annual event organised by the Global Initiative for Asthma (GINA). The event aims to raise awareness and improve asthma care around the world¹. It’s estimated that around 5.4 million people in the UK are currently receiving treatment for asthma, which amounts to around one in 12 adults².
According to Asthma UK, around three people die each day from asthma attacks and the UK has one of the highest death rates from asthma in Europe².
The National Review of Asthma Deaths (NRAD) was the first UK-wide investigation into asthma deaths, which looked into the 195 deaths that occurred between 2012 and 2013³. The review considered various areas of asthma care, such as use of NHS services and prescribing and medicines use. Another area that was investigated was ‘medical and professional care’ which found that out of the 195 people that died, only 44 (23%) had been provided with personal asthma action plans (PAAPs). For 84 people (43%), there was also no evidence that an asthma review had taken place in general practice within the last year before their death³.
The review also found that 61% of the deaths were of people that suffered from only mild or moderate asthma³. The NRAD concluded that their asthma was likely to have been poorly controlled and undertreated, which highlights the need for good control. While asthma is managed in both primary and secondary care, it is likely that patients will return to primary care to regularly monitor and review their asthma.
The 2016 guideline produced by the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) states that asthma is best monitored in primary care by an annual clinical review. For adults, they recommend that the following factors should be monitored and recorded⁴:
- Symptomatic asthma control
- Lung function assessed by spirometry or by peak expiratory flow (PEF)
- Asthma attacks, oral corticosteroid use and time off work since last assessment
- Inhaler technique
- Bronchodilator reliance
- Possession of and use of a self-management plan/personal action plan.
To monitor symptomatic asthma control, both the BTS/SIGN and NICE guidelines recommend using a validated questionnaire that uses directive questions, such as the Asthma Control Test or the Royal College of Physicians’ ‘3 questions’⁴’⁵. To help with identifying and managing any red flags that arise as a result of the clinical review, the NICE Clinical Knowledge Summary for asthma can be accessed here.
NICE have recently issued some updated guidelines for the management of asthma and you can access a summary of the updates here.
The RCGP offers various eLearning materials on asthma and the following resources are FREE to all healthcare professionals:
Asthma – 1 CPD credit
Common atopic presentations in primary care – 5 minute screencast on asthma
Single Inhaler Therapy for Asthma – 5 minute screencast
RCGP members can also benefit from access to the following resources:
EKU18 – Wheeze & Asthma in Young Children
EKU 2017.2 – Management of asthma
EKU 2018.2 – Diagnosis, monitoring and chronic asthma management
EKU podcasts – Asthma: introduction to Asthma, Asthma: NRAD report and Asthma Management Guidelines, Asthma: Management of the Asthma Patient
- Tiotropium in asthma: what is the evidence and how does it fit in?
- Over diagnosis of Asthma in Children in Primary Care
- Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children
- Does inhaler choice matter?
- Systematic meta-review of supported self-management for asthma: a healthcare perspective
- Vitamin D supplementation to prevent asthma exacerbations
(1) The Global Initiative for Asthma (GINA). World Asthma day. Available from: http://ginasthma.org/wad/
(2) Asthma UK. Asthma facts and statistics. Available from: https://www.asthma.org.uk/about/media/facts-and-statistics/
(3) Royal College of Physicians. Why asthma still kills. The National Review of Asthma Deaths (NRAD). [May 2014]. Available from: https://www.rcplondon.ac.uk/file/868/download?token=JQzyNWUs
(4) British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN). British guideline on the management of asthma. . Available from: https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/
(5) NICE. Asthma: diagnosis, monitoring and chronic asthma management (NG80). [November 2017]. Available from: https://www.nice.org.uk/guidance/ng80
It is estimated that around 17% of the UK’s population have Irritable Bowel Syndrome (IBS)1, but there is no single cure that works for all patients. April marks IBS Awareness Month, aiming to spread important information about diagnosis and management of this often uncomfortable and painful condition.
A recent development in IBS treatment is the introduction of the low FODMAP diet – standing for Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols.
The low FODMAP diet was developed in Australia by a team at Monash University in Melbourne2 after finding that foods high in certain short-chain carbohydrates can cause gastrointestinal discomfort. Short chain carbohydrates are poorly absorbed in the small intestine and are found in various foods, such as wheat, rye, pulses, lactose, fructose and some fruit and vegetables. These high FODMAP foods increase the amount of water in the small intestine which can contribute to loose stools. They start fermenting when they reach the colon, which may increase gas production and subsequently cause symptoms such as wind and bloating3. You can find examples of high and low FODMAP foods on the Monash University website here.
A 2017 review that assessed the results of published clinical studies on FODMAP, concluded that up to 86% of patients with IBS saw an improvement in overall gastrointestinal symptoms4.
As the symptoms of IBS can be similar to those of other diseases such as Inflammatory Bowel Disease (IBD) or bowel cancer, the NICE Pathway for IBS recommends looking for red flag indicators when a patient presents with IBS symptoms, to assess whether the patient should be referred to secondary care for further investigations5. More information about these red flags can be found here in the NICE Pathway.
While the efficacy of the low FODMAP diet seems impressive, patients should be referred to a dietitian before attempting it on their own, as recommended in the NICE guidance on IBS6. When a patient is referred to a dietitian, there will be three stages:
- Low FODMAP Diet - the patient will reduce their intake of high FODMAP foods for two-six weeks to establish whether the symptoms will respond to the change in diet.
- Re-challenge phase – if symptoms have improved, high FODMAP foods will be introduced for six-eight weeks so the patient can identify which FODMAPs trigger their symptoms.
- Adapted diet – the dietitian will personalise the diet to the patient, so they only avoid their ‘trigger foods’ and can resume a more normal diet2.
For further information about gastrointestinal conditions, the RCGP offers the following eLearning courses that are FREE to all healthcare professionals:
Inflammatory Bowel Disease - 0.5 CPD credits
Managing uncertainty in lower gastrointestinal tract presentations - 0.5 CPD credits
Diagnosis and Management of Coeliac Disease - 0.5 CPD credits
RCGP members can also benefit from access to the following content:
(1) Khanbhai. A and Singh Sura. D. Irritable Bowel Syndrome for Primary Care Physicians. [March 2013] Available from: http://www.bjmp.org/content/irritable-bowel-syndrome-primary-care-physicians
(2) Monash University. The Low FODMAP Diet. [Internet] Available from: https://www.monashfodmap.com/
(3) Magge. S and Lembo. A. Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome. [Nov 2012] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966170/
(4) Nanayakkara. W.S. (et al). Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. [June 2016] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918736/
(5) NICE pathways. Irritable bowel syndrome in adults overview. Interactive flowchart. Available from: https://pathways.nice.org.uk/pathways/irritable-bowel-syndrome-in-adults
(6) NICE. Irritable bowel syndrome in adults: diagnosis and management (CG61). [April 2017] Available from: https://www.nice.org.uk/guidance/cg61/chapter/1-Recommendations#dietary-and-lifestyle-advice
The Dermatology library is the latest addition to the RCGP’s Educational Libraries. It has been developed in partnership with the Primary Care Dermatology Society (PCDS) and the British Association of Dermatologists (BAD) and is free to access here.
The Dermatology library brings together national guidance, dermatology resources and RCGP accredited courses relevant to GPs and other primary healthcare professionals. It presents a variety of resources to suit your preferred method of learning, including screencasts and podcasts. The major areas in dermatology are presented in a clear and user-friendly format providing you with quick access to topics of interest, including:
• Dermatology overview
• Infection and infestation
• Genetic and systemic disorders
• Inflammatory conditions
• Specific lesions
• Urticaria and blistering.
These resources will support you as a GP to meet your clinical and CPD needs and improve your opportunities to specialise and diversify in your career, supporting the GPs with Extended Roles (GPwER) programme and accreditation process.
The Dermatology library will form part of a series of clinical, non-clinical and professional educational libraries the RCGP will publish with specialist organisations. In this series, you can also access the Women’s Health Library here.
March is just around the corner, which means that time is running out to complete your appraisal and boost those Continuing Professional Development (CPD) points. If you’re looking for a way to save some time and ease the stress of preparing for your appraisal, the RCGP’s GP SelfTest tool may be the answer.
With around 5000 users over the past year, GP SelfTest is already a popular tool on the RCGP’s eLearning website. You may have seen that it’s a useful tool for AKT preparation, but qualified GPs can also benefit from using GP SelfTest for their CPD and to meet the requirements for their appraisal and revalidation.
GP SelfTest provides an easy way to identify your educational needs and focus on the key areas that form part of your professional development plan (PDP). The Curriculum Wide Learning Needs Assessment test is particularly useful for this, as the results provide a breakdown of any topics that need some improvement. You’re then signposted to any ‘Curriculum Resources’ on the RCGP eLearning website that can help with this.
While you’re busy working on your PDP, you can also clock up some CPD credits to add to your log. You can capture and track your improved learning with the results and certificate that GP SelfTest provides. The certificates automatically update with your results and the dates you completed your tests, so you don’t have to remember this information yourself. By adding these certificates to your portfolio and recording any improvements in your results, you can easily demonstrate to your appraiser that you’re fit to practise. You can read more about CPD credits and appraisal here.
There is also a reflection notes section on GP SelfTest, where you can capture your thoughts on what you have learned and ask yourself questions such as:
How will this learning/improved knowledge from GP SelfTest impact upon your practice?
What have you done differently with your improved learning?
What impact will your improved learning have on your patients?
Has it helped you with a Quality Improvement Activity (QIA)?
Your notes can be printed with a certificate of your test results, and used as evidence of your CPD.
To start making your appraisal preparation quicker and easier, you can purchase your subscription to GP SelfTest here. If you need some more information first, you can find out more about the tool and how it can benefit you by visiting the GP SelfTest homepage here.
It’s estimated that over 1 million sexually transmitted infections (STIs) are acquired every day worldwide (1). Last year in England alone there were around 420,000 diagnoses of STIs, with chlamydia accounting for 49% of these (2). Despite the prevalence of STIs, many patients still choose not to go for regular sexual health checks. According to Public Health England’s 2017 report on STIs and chlamydia screening, there has been a decline in the number of STI tests carried out over the last 5 years (3).
National STI Day was launched a few years ago to encourage people to take responsibility for their sexual health and attend regular testing. It has been chosen to take place on the 14th January of each year, so that it falls two weeks after New Year’s Eve: a day when traditionally more alcohol than usual is consumed and people are more likely to engage in sexually risky behaviour. Various papers have demonstrated the link between alcohol, risky sexual behaviour and STI diagnoses, with women being more affected than men. (4) (5). This two week period after New Year’s Eve was deliberately chosen as the most common STIs can take two weeks to be detectable (6).
Despite that fact that STIs can lead to serious health problems, it seems that not everyone is as informed as they should be about the importance of safe sex. In 2016, the Family Planning Association (FPA) conducted a survey of more than 2,000 people aged 16 and over across the UK to find out what they knew and thought about safer sex and STI testing (7). Out of the findings of the survey, the following statistics are perhaps the most concerning:
- 68% said that they had never had an STI test
- 52% didn’t know that you can get an STI from oral sex
- 71% said they did not use any form of condom the last time they had sex
- Only 9% learnt at school about how to find and use sexual health services
While genitourinary medicine (GUM) clinics are commissioned to screen for and treat STIs, patients frequently present in general practice to seek advice about STIs and contraception. It's important that GPs are able to have open and honest conversations about sex and sexuality, and know where to signpost patients to sexual health services outside of general practice.
There are a range of sexual health services available in the UK, but as the RCGP highlighted in the 2016 ‘Time to Act’ report, there is evidence of restricted access to contraception and STI testing depending on patients’ location or age (8). The report also expressed concerns about the way sexual and reproductive health services are commissioned and the training available for GPs in sexual and reproductive health (SRH) available to GPs. You can read the full report here.
The RCGP offers various eLearning materials on sexual health and contraception and the following resources are FREE to all healthcare professionals:
Sexual Health in Primary Care – 2 CPD credits
Contraception – 1 CPD credit
HPV - the essentials – 0.5 CPD credits
Women’s Health Framework – Sexual and Reproductive Health Resources – some content is only free to RCGP members
RCGP Members can also benefit from access to the following resources:
EKU4 – Managing of genital chlamydia trachomatis infection
EKU9 – HIV in primary care and ‘HIV in primary care’ podcast
EKU2017.2 – Routine investigation and monitoring of adult HIV-1 positive individuals and increasing uptake of HIV testing
EKU hot topic (December 2014): HIV infection – Treatment and research
(1) World Health Organisation. 2016. ‘Sexually transmitted infections (STIs) factsheet’ [Online]. Available from: http://www.who.int/mediacentre/factsheets/fs110/en/
(2) Public Health England. 2017. ‘Infographic: Sexually transmitted infections and chlamydia screening in England, 2016’ [Online]. Available from: https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables
(3) Public Health England. 2017. ‘Sexually transmitted infections and chlamydia screening in England, 2016’ [Online]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/617025/Health_Protection_Report_STIs_NCSP_2017.pdf
(4) Hutton et al. 2008. ‘The Relationship between Recent Alcohol Use and Sexual Behaviours’. [Online]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588489/
(5) Connor et al. 2015. “Alcohol Involvement in Sexual Behaviour and Adverse Sexual Health Outcomes from 26 to 38 Years of Age”. Plos One. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135660
(6) National STI Day website. http://www.stiq.co.uk/about/
(7) Family Planning Association. 2016. ‘Sexual Health Week 2016’ [Online]. Available from: https://www.fpa.org.uk/sexual-health-week/sexual-health-week-2016
Royal College of General Practitioners. 2016. ‘Sexual and Reproductive Health Time to Act’ [Online]. Available from: http://www.rcgp.org.uk/-/media/Files/Policy/Media/8895-RCGP-Sexual-Health-online.ashx?la=en
Dr. Sam T. Claus was in the middle of a pleasant dream involving a mug of hot chocolate, several mince pies and a re-run of “It’s a Wonderful Life”. Inexplicably, the film was interrupted by a beeping noise and he woke to realise that his pager had gone off. Cursing the day when he decided to work in a practice that still does its own on call, he dialled the messaging service.
An hour later he was trudging through the snow to see Rudolph, a regular patient with a distinctive rhinophyma. Rudolph claimed this was due to rosacea, but Sam had his suspicions. Rudolph had told the messaging service that he was light-headed and thought it was his heart. Sam had other suspicions.
Sam found Rudolph on the sofa worse for wear snuggling with the remnants of a bacon sandwich. Concerned that getting close to Rudolph’s breath might get him into trouble with the local constabulary, Sam made a brief assessment and told Rudolph the unsurprising news that he had a hangover.
“But that’s not possible Doc”, exclaimed an indignant Rudolph “I’ve done my research”.
He pulled out a bag full of packets including some long-acting propranolol, a sachet of dried yeast and some fructose tablets.
“I’ve been online doc, any one of these will sort out a hangover and I took all three. There must be something wrong with me”.
“Aha” said Sam “you’ve consulted Dr. Google? I’m afraid he has led you astray. A meta-analysis of online hangover cures1 has clearly shown that none of them are any use – the only prevention is to drink moderately, or not at all. Have some paracetamol and lots of water– you’ll feel better soon”.
Sam left Rudolph to sleep it off, heading for the local nursing home where he was due for a ward round. He paused to pick up his beagle, Comet, this being an enlightened home which felt that the residents would benefit from contact with animals. As he made his rounds, Sam couldn’t resist the chocolates on most of the nursing stations and he reflected on how likely it would be that the boxes would still be there that evening. Probably not, a study having shown that the mean survival time of a chocolate on a hospital ward is 51 minutes2, with half the box generally being eaten in under two hours.
Sam’s mood worsened when he was asked to see Mrs. Blitzen, an elderly woman with severe diarrhoea following a course of co-amoxiclav. Cursing the overuse of broad-spectrum antibiotics, Sam approached her room and was amazed to see Comet race ahead of him, bark and lay down against her door. A sudden flash of recognition hit Sam as he remembered that Comet had taken part in a study whereby beagles were trained to detect Clostridium difficile and could do so with over 90% sensitivity and specificity3. Pulling on his gloves he prepared to dazzle the nurses with his quick-fire diagnostic skills.
Later that evening, a colleague now on-call, Sam was delighted to find that “It’s a wonderful life” was actually on the TV. Settling down with a hot chocolate and a plate of mince pies he reflected on his day and the curiosities that he might come across the next time he had the joy of holding the on-call pager.
- Pittler Max H, Verster Joris C, Ernst Edzard. Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials BMJ 2005; 331 :1515
- Gajendragadkar Parag R, Moualed Daniel J, Nicolson Phillip L R, Adjei Felicia D, Cakebread Holly E, Duehmke Rudolf M et al. The survival time of chocolates on hospital wards: covert observational study BMJ 2013; 347 :f7198
- Bomers Marije K, van Agtmael Michiel A, LuikHotsche, van Veen Merk C, Vandenbroucke-Grauls Christina M J E, Smulders Yvo M et al. Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study BMJ 2012; 345 :e7396