15.00 Heck, I’ve just had some of my medical history snatched from me. Because I’ve always thought I was penicillin allergic (rash as a child after a probably unnecessary antibiotic prescribed by an overworked GP – some things never change). But in fact, I’m not, probably – only 1-10% of those with self reported penicillin allergy really are, according to first-up speaker of the afternoon, Dr Chris Rutkowski, consultant allergist.
Also, the oft-reported cross reactivity between penicillin and cefalosporins of 20% is, in fact, ‘minimal’. That’s two learning point boxes ticked in two minutes.
‘Dementia?’ There’s an element of preventability, apparently
Want another? OK. Now, you wouldn’t normally go to an allergist for tips on consultation technique, not unless it’s ‘How do I understand what a patient with gross lip and tongue swelling is trying to tell me?’ But this one is too good to ignore. The allergist’s way of getting the patient’s story is, ‘Please tell me, in one sentence, your problem.’ Nice, will use that.
Next up, CRP testing for respiratory tract infections in primary care. And a massive irony alert: one of the scheduled speakers is unable to attend because of, yes, a respiratory tract infection. Which, obviously, will only be acceptable if her CRP is >100.
Anyway, CRP testing reduces antibiotic prescribing, obviously. It also reduces reattendance rates, rather less obviously.
And so to the final big interview – with Dr Charles Alessi, senior adviser, Public Health England. Now, previous big interviewees have wheedled out of it by not turning up, but he used the different tack of not waiting for his interlocutor, so he interviewed himself for a bit. Fortunately, the Pulse editor turned up in time to give him a proper grilling.
This included our ed explaining how, during his own recent health check, he was virtually encouraged to drink more alcohol, being well within the recommended limits. ‘So do you think these health checks represent value for money?’ Yes, despite this.
‘Dementia?’ There’s an element of preventability, apparently.
‘Is there a risk that GPs are becoming public health doctors by default?’ Yes. That’s the idea, even if the computer-generated pop-up health promotional agenda swamps that of the patient, says Dr Alessi.
Why are GPs still being phoned at 6pm on a Friday to arrange the shovelling of anti-flu drugs down their nursing home inmates?’ Pass.
And so on. Hmmm. End up feeling less optimistic than yesterday. But, heck, it’s nothing a glass of champers and a squid massage won’t sort out.
13.05 Packed house for our great leader. And Chaand did a brilliant job, even when faced with the question of the conference, specifically, ‘When are we going to hear about the rescue package and what is the GPC going to do when it’s unsatisfactory?’ (summary answer, ‘there is no magic bullet’, and I don’t think he meant for Jeremy Hunt).
On the proposed locum fee tariff, he was pleasingly defiant. ‘We have no idea how they’ll do it.’ Presumably because they have no idea, either. ‘But we should carry on as we are, and challenge it head on.’
On reducing patient demand, he was innovative, suggesting that we use buses. Not to ship heartsinks off to Skegness for a very long holiday, but to display ‘Bugger off and leave us all alone’ ads (my words, obvs) as have been used already to steer punters away from A&E.
And on the requirement to publish our income, he was radical. Do the sums right (ie core income only) and it’ll work to our advantage, he pointed out, because the figures will be so low as to show that we’re amazing value.
And this was echoed by our next speaker, the ever excellent and entertaining Dr Peter Swinyard. He highlighted that his income published as per contractual requirement is £24,000 p.a. Either things really are bad or his maths is. Whichever – if the Mail wants to splash with that kind of figure, go ahead, make our day.
To stimulate recruitment, Peter’s considering an ad, ‘GP wanted, dead or alive’. But I’m not sure that even the Hell-bound deceased will be tempted back for less than thirty grand a year.
10.45 Blimey. It’s not often that a ten minute talk makes me fall off my chair. But I’m still floored, to be honest. Why? A fusillade of facts from cardiologist Dr Aseem Malhotra in the Big Debate, ‘Is impractical clinical guidance putting patients and doctors at risk?’
Well, it seems the issue isn’t just that the guidance is impractical. It’s all over the shop. With the result that we have, ‘An epidemic of misinformed doctors and misinformed patients.’ For example, a reanalysis of current statin data by a respected French cardiologist has suggested that, guess what? Statins don’t work. Not at all. Not in primary prevention. Not in secondary prevention.
Want more? OK. Clinical research isn’t to be believed. Most new drugs aren’t really new at all. And the most powerful cardiological intervention of all is…wait for it…a Mediterranean diet.
The other speakers calmed us down a bit, albeit with wise words. We’re supposed to use clinical judgement but the more tick boxes we have, the more our hands are tied, said Dr Zoe Norris. Medicine is art as much as science, and guidelines stop us using our brain, said Dr Dermot Ryan. Spot on. Pretty much everyone agreed. Now, will someone help me up and bring me some olives?
09.40 Utter decadence. I thought this was supposed to be a CPD learning activity. Yet are there people wandering around here glugging champagne. At 8.30 in the morning. Still, it’s helping to keep that mood buoyant.
Had a delayed epiphany this morning while shaving, as you do. The words of Steve Brown, GPSI in ENT who gave yesterday’s session on vertigo came flooding back. ‘Learn the Epley manouevre’, he said. ‘It cures patients, and how often can you say we do that?’
Good point, and maybe this is an overlooked cause of the profession’s malaise. We never cure people. We tell people they don’t need antibiotics because they’ll get better on their own. We stick them on drugs to prevent things that probably wouldn’t happen anyway. And we tell them we can’t solve their fibromyalgia because we don’t know what causes it, though we do know there’s a lot – an awful lot – of it about.
But BPV? Lie down, move here, turn that way, do this, da-daaaa, you’re cured mate. It’s magic, and very satisfying. I’m hard pushed to think of anything else we can cure like that. Ear wax, maybe. Maybe the champagne will inspire you to more examples, let me know if so.
Anyway, if only Jezza could do this to the profession. Tell us to lie down, it’ll all be fine, I’ll just turn you this way and that, then it’ll all be fine. We sit up and the dizziness and nausea we all feel driving into work each day is gone. So maybe that’s in the long awaited huge package. A massive great Epley for us all.
8.05 ‘You’re all looking quite chipper’ said Nigel Praities, Pulse editor, by way of an opening gambit at Pulse Live yesterday. ‘Whereas I’d expected you all to be mere husks of human beings.’ And I’d been thinking exactly the same: everyone was so sodding cheerful. Maybe it was the glorious spring-is-sprung weather, perhaps they’d put something in the coffee or maybe it was just a relief to be plucked from the coalface.
Whatever. We were treated to a cracking opening debate about whether Noctors will solve the workforce crisis, in which we discovered that ace Pulse blogger Dr Shaba Nabi’s mum’s GP (are you following this?) gets down on one knee whenever he sees her (her mum, not Shabi). That’s setting the bar quite high, particularly when mine are lucky if I make eye contact.
And if you’re wondering how to get your pet Noctor to be taken more seriously by the punters, Dr Stephanie de Giorgio advocates that they wear paramedic greens. And be a paramedic, possibly.
Such was the dizzy Pulse Live whirl that I barely had time to whizz round the stands stuffing my face with sweets and my pockets with post-its. But I did glimpse the helpful (‘Rota Hell?’ and ‘Revolutionise appointments!’), the disturbing (‘How fast are your hands?’) and the utterly perplexing (Flexi Shiatsu, which I’d always thought was a type of dog, but which turns out to be some sort of massage device involving what is quite possibly a luminescent squid pummelling your neck and which is apparently so ideal for stressed GPs that I’ve booked myself in for a session tomorrow).
Not that I really needed my shiatsus flexing, because I was still feeling pretty relaxed and optimistic by the last session, given by Dr Robert Varnam. If ever a man had feet firmly planted in two camps, it is he – because, on the one foot, he is head of general practice development, NHS England and, on the other, his practice is suffering the prevailing PMS financial shafting.
He suggested 10 high impact actions, none of which involved punching a politician, but all of which were actually pretty sensible. ‘In 10 years time,’ he said, in reference to the future of general practice, ‘It’s going to be the same sort of people doing the same sort of work, because what we do is really important.’ Which I really liked, but not as much as his reply to questions about eight to eight seven day access. ‘Let’s see what the next few weeks brings,’ he replied, enigmatically. And the sun was still shining when I left.
Mind you, it’ll probably piss down today. So I’ll need that squid.
