There's never enough time in the day to be a GP, but it's still hard to say no to that one patient, or to a colleague who is asking for your help. In this episode of Deep Breath In, we'll hear from Rachel Morris, about why it's so hard to so hard to say no, particularly for doctors. She'll challenge us to think about what the real effects of piling on more work are, and give us some strategies to help us say no in our every day lives.   Our Guest; Rachel Morris trained as a GP, before leaving the profession to become a coach for GPs, and other medics. Her work focusses on burnout, and how to take practical steps to stop the process. She also hosts the You Are Not A Frog podcast.   Links;   www.youarenotafrog.com www.shapestoolkit.com ***Click here for a bonus resource on how to design your ideal working week***

Common themes for discussion on this podcast include overdiagnosis, approaches to the testing, the ins and outs of explanations, as well as other issues facing GPs who are overburdened, and have limited time and resources to treat patients. A topic which draws all of these themes together is prostate cancer screening. The BMJ recently published a feature which asked whether the UK is ready to roll out a nationwide prostate cancer screening programme, and the linked analysis paper, authored by Dr Andrew Vickers and colleagues, argued that the current model of screening, which determines testing by shared decision making, is the worst approach for detecting prostate cancer. We spoke to Andrew Vickers to discuss this further, and our second interview was with Dr Sam Merriel, regarding the emerging evidence that suggests that taking an MRI scan prior to biopsy could decrease harms associated with overdiagnosis and overtreatment of prostate cancer.   Our guests: Andrew Vickers is an attending research methodologist in the Department of Epidemiology and Biostatistics at Memorial Sloan Kettering Cancer Center, New York. Sam Merriel is a GP, and a researcher on cancer diagnostic testing at the University of Exeter.   Further reading: ‘Is the UK really ready to roll out prostate cancer screening?’ BMJ 2023;381:p1062  ‘Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit’ BMJ 2023;381:e071082

While the pandemic has officially declared over, the ongoing effects of a covid-19 infection are still being felt in the community. In this Deep Breath In, Jenny, Tom, and Navjoyt are joined by two leading experts on long covid.  They discuss the changing profile of people being referred to specialist clinics, the way in which different strains may have different long term outcomes, and what can be done to limit the risk of developing long covid.   Our guests: Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford.  Harsha Master is the GP lead in COVID rehabilitation at Hertfordshire Community Trust, and helped design the long covid clinical pathway there.

Talking about sexual health may be common-place with younger patients, but the sexual wellbeing of older adults is often neglected in a consultation. However it's important for doctors to be aware of changes to patients sex lives, given the link between intimacy and wellbeing. In this podcast, the team discuss how to create that culture of openness that encourages older adults to share problems they may find embarrassing, what signs may indicate that it's worth initiating a question about sexual health, and making sexual function a routine part of the discussion about the effects of medication. Our guests; Sharon Hinchliff is a professor of psychology and health at the University of Sheffield.Rebecca Mawson is a GP in Sheffield. Resources;Practice Pointer How to support the sexual wellbeing of older patients www.agesexandyou.com www.ageoflove.org www.joanprice.com

The theory that depression is caused by serotonin deficiency has become embedded in our practice over the years, and can be a persuasive explanation of the condition for patients considering starting antidepressants. We talk to Tony Kendrick about the evidence (or lack thereof) to support this hypothesis, and what that means for the efficacy of antidepressants, particularly SSRIs. Later on, we speak to Mark Horowitz to discuss how to come off antidepressants safely, and manage withdrawal symptoms, and how to advise and support our patients as they gradually reduce, then stop, their medication. Our guests: Tony Kendrick is a retired GP, and NICE committee member for the 2022 guideline update on depression in adults. He is also a professor of Primary Medical Care at the University of Southampton. Mark Horowitz is a training psychiatrist, working as a clinical research fellow at North East NHS Trust, and as an honorary clinical research fellow at UCL, he is also the co-founder of outro.com. Further reading: ‘Antidepressants and the serotonin hypothesis of depression’. BMJ 2022;378:o1993 https://www.bmj.com/content/378/bmj.o1993 ‘Stopping antidepressants’. Royal College of Psychiatrists. 2020. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants

How long would it take GPs to enact all of the guideline recommendations that they might be expected too? Far more GP hours than exist in any healthcare system, but as medicine has turned its attention to primary prevention, and expanded the populations whose health we seek to improve, those guidelines are taking up more and more time. A recent analysis in The BMJ has proposed the concept of “Time Needed to Treat” and implores guideline makers to take account consultation time as a precious, finite, resource when thinking about their recommendations. In this episode of Deep Breath In, we’re joined by Minna Johansson, family doctor and director Global Center for Sustainable Healthcare, who co-authored that analysis to talk about how the concept has gone down, and what it might mean for rethinking what primary care is supposed to do. Reading list: Guidelines should consider clinicians’ time needed to treat https://www.bmj.com/content/380/bmj-2022-072953

Reproductive coercion may feel like something that we don’t see very often in general practice, but a 2022 poll carried out for BBC Radio 4 of 1,060 UK women between the ages of 18 and 44 found that half of them had experienced some form of reproductive coercion. This week, we speak to returning guest Annabel Sowemimo about the various forms that reproductive coercion can take, and who might be at risk of experiencing it. We discuss how we, as GPs, can identify these patients, and, once we’ve done so, how we might be able to help them. Later on, we talk to our BMJ columnist, John Launer, about how narrative medicine approaches can help to reach a better & more satisfying resolution to a consultation “puzzle” for you and for the patient. Our guests: Annabel Sowemimo is a community sexual health registrar, based in Leicester. She is also a PhD candidate at King’s College London, and is the co-founder of the charity Reproductive Justice Initiative. John Launer is a GP educator, working for Health Education England. He is also a freelance educator and writer, as well as being a columnist for ‘The BMJ’. Further reading: ‘How to recognise and respond to reproductive coercion’. BMJ 2022;378:e069043. https://www.bmj.com/content/378/bmj-2021-069043 ‘John Launer: The art of paying attention’. BMJ 2022;378:o2294. https://www.bmj.com/content/378/bmj.o2294 ‘Careful, kind care is our compass out of the pandemic fog’. BMJ 2022;379:e073444. https://www.bmj.com/content/379/bmj-2022-073444

In general practice, it can often feel like a lot is changing beyond our grasp. On top of this, the pandemic has left many healthcare professionals self-reflecting on their careers and lives, and trying to work out what they really want going forward. This week, we speak to Claire Kaye about her role as a coach for doctors. Claire talks to us about the benefits of coaching, including helping to get rid of internal & external noise, shaping the mindset, and coping better with change. She also offers advice on the best ways to approach coaching in order to achieve a positive outcome. Our guest: Claire Kaye, formerly a GP, is an executive coach. She specialises in career development. Instagram: @drclairekayecoaching LinkedIn: @drclairekaye Website: www.drclairekaye.com

The possibility that patients will suddenly have access to their notes has caused some anxiety for GPs in England. The department of health's plans to allow patients to prospectively access their medical record lead to fears about increased workloads, misunderstandings, and safety - and the plans have now been pushed back. In this podcast the Deep Breath In team are joined by the authors of a recent article in The BMJ to explore those fears, hear about the potential benefits, and understand the evidence behind open notes. Our guests; Charlotte Blease, and interdisciplinary health researcher at OpenNotes, Beth Israel Deaconess Medical Center/Harvard Medical School. Brian McMillan, a GP and senior clinical lecturer at the University of Manchester Gail Davidge, research associate at the University of Manchester The article they're discussing is a practice pointer on Adapting to transparent medical records: international experience with “open notes” https://www.bmj.com/content/379/bmj-2021-069861

This week, we’re joined by Huseyin Naci to discuss the recent press release from Eisai and Biogen announcing the Phase III trial results for lecanemab for use in Alzheimer’s disease, and the FDA’s decision to accept the drug onto its accelerated approval pathway. We talk about the pros and cons of using surrogate endpoints to predict clinical outcomes. How can we strike a better balance in clinical trials between generating high-quality and trustworthy evidence, and the urgent needs of patients with life-limiting conditions and very few available treatment options? Our guest: Huseyin Naci is an associate professor of Health Policy at the London School of Economics and Political Science (LSE). He is also an advisor to the Analysis section of The BMJ.