Copperfield at Pulse LIVE: ‘I’m attracted to your sheep’

With Pulse LIVE underway, Dr Copperfield shares his thoughts on the event throughout the two days in this blog.

Tuesday 26 March

The first thing I see is a sheep. Not a real sheep, obviously. But a sheep nonetheless, almost life-size, in the sponsors’ area. Something to do with a new drug for insomnia, but I was unable to focus on the blurb I was hearing because I realised I’d said, ‘I’m attracted to your sheep.’ Quite an icebreaker, and frankly one I regretted.

Things improved after that and I learned a lot in the day’s sessions. That heart failure is bad. CKD is bad. Cancer is bad. Arrhythmia is bad. Bad, bad, bad. Bad. But badder than all of those is ‘Overdiagnosis’, the subject of an excellent session revealing that it’s bad for patients because it turns them from well to ill and bad for us GPs because it’s like us cranking up the speed of our own treadmill.

What else did I learn? The answer to the great debate, ‘Have we swapped a recruitment crisis for a retention crisis?’ And the answer is, yes. Or no. Or both. Look, it was hard to concentrate because I’d just come from a harrowing session on ‘Covid-19 in perspective’ which brought back horrible memories. It also taught me that virus-wise, we should avoid bats, civet cats and (especially) camels. Sheep, I think, are OK. Thank God.

Wednesday 27 March

10:55am:

Onto Day 2. And the sheep mascot is looking, well, yes, I’ll say it, sheepish, maybe because of Wales’ tragic defeat on penalties last night. I avoid eye contact and head straight for the massive scrum at the stand dishing out what my wife insists are highly desirable skin care freebies, the failure of which to procure, she assures me, will result in the loss of testicles/marital status/both. This is a threat issued by her every year and which I have always survived, though today’s haul (a dandruff treatment) might leave me vulnerable.

I seek refuge in today’s first session on ‘Tips and tricks to encourage sexual health testing’ mainly, if I’m honest, because I’m intrigued by the ‘tricks’ bit. And the main one is to destigmatise and demystify testing options, one way being to resolve the ‘walk of shame’ with specimen pot to toilet, though repositioning your loo is easier said than done. Ultimately, anyway, that walk should end at the STI clinic, because treatment, and especially contact tracing, is mind bogglingly complex. Interesting stats, though: syphilis, chlamydia and gonorrhoea are on the rise. And that after a big dip in Covid (excluding, presumably, cohorts who had illicit lockdown parties).

Next up, chronic pain. Why? Because a) There’s a lot of it about b) I console myself every Monday by remembering that, no matter how bad my morning surgery is, I could be running the local pain clinic. But that second point is batted back cleverly by the speaker pointing out that a) The pain clinic sets realistic targets in term of aims of treatment b) If it goes pear-shaped despite that, they simply send the patient back to their GP for ongoing care. Damn. Fascinating fact, though: the word for anaesthesia in Chinese is ‘cannabis intoxication’.

12:40pm:

There’s a bit of a theme developing here: Time’s Up. We heard it in the chronic pain talk – as in, time’s up for opioids. We’re seeing it in the final session of the same title by the chair of GPC England. And it was a definite backdrop to the session on AI in primary care – specifically, is time up for clinicians, as patients turn by default or design to the GP in ChatGPT?

So there was a definite frisson of future-fear in the room. And there was good news and bad news. On the one hand, that calculator you’re using right now to work out whether you can afford to retire is a form of AI. So it’s nothing new. And the biggest impact is likely to be in admin as, for example, it automatically records our consultations in the form of coherent notes, saving us masses of time and typos.

On the other, it’s getting increasingly brilliant at diagnosis and – sit down as you read this – it’s outscoring us in empathy.

The excellent speaker tried to reassure us by saying that clinicians won’t be replaced by AI, but by clinicians who use AI. And if you’re not convinced by that, at least it was nice to hear that AI will mean time’s up for radiologists and cardiologists before GPs.

Frankly I needed a little lie down after that. So I missed the next session, which was stupid. But then AI is, sometimes, too. According to the speaker, if you correct it that 2+2 is actually 5, it may agree with you because it suffers from sycophancy. Maybe there is still hope for us.

3:55pm:

I’ll level with you here. One reason I choose to go to the B12 talk is the exclamation marks. These are terribly neglected in lecture titles. The hyphen and the colon: commonplace. The question mark? Less frequently seen and always tempting. But the exclamation mark? Never! And yet here we had two!! Thus: ‘Vitamin B12 deficiency. Think it is trivial at your peril! Insidious devastating and potentially deadly!’ OK, some commas needed but who cares when you have those exclamation marks?!

Also, I’ve had my run-ins with the B12 lobby in the past so I want to reassess the current state of play. Which is pretty much that NICE guidance is complex, B12 is a multisystem disorder that can present in a zillion ways and testing can be confusing and unreliable. Where that leaves us, I’m not 100% sure. But it is interesting!!!

Onto meningitis and meningococcal disease, which I’m hoping will be more clear-cut. I’m immediately charmed by the speaker as he explains that, as a paediatrician, he’s in awe of the job we GPs do. Yay! Then some chilling pictures and horror stories that bring us back to earth. The word coming up repeatedly is ‘difficult’. But the other key word, thank Gawd, is ‘rare’.

Of course, spotting B12 deficiency and meningitis might be easier if we weren’t addled by workload. So a session on Safe Working Guidance is just the thing. Well, sort of. Bit of a rehash of tools and resources. And the comment that ‘You’re probably doing this already.’ Well, yes, and it’s not working.

And so to the final session, portentously titled, ‘Time’s up,’ given by the GPC England lead. ‘It has taken many years to break general practice and it will take many years to repair it,’ she says in a rousing speech. ‘The referendum is a temperature check and I think we’re at boiling point’. The reaction of the audience suggests it agrees. Whatever happens, she explains, it will take balls and hard work, adding, ‘I’ve got balls and we all like hard work’, a sentence pleasing and surprising in equal measure, but confirmed by the high quality of swearing on demonstration.

I’d loved to have heard more, but the patients are calling and, yes, time’s up.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield