COVID warriors

3 July 2020

Like many of your families, our four kids all enrolled in the QUB paediatric study, 'Seroprevalence of SARS-Cov-2 infection in healthy children'.

We had our second sample to give on Saturday and, like for the first sample day, it was good to get out of the house for a change.

Role of medical research into COVID-19

I had a great chat with one of the lead investigators during the week, Dr Sharon Christie from Royal Belfast Hospital for Sick Children (RBHSC) to catch up and discuss the initial findings.

The preliminary results show that in London there is an overall antibody incidence of 12%, Glasgow has 8%, whereas Belfast to date has 0%. None. No cases.

These are remarkable findings and it was good to talk it over with Sharon and speculate on the possible causes. 

Is it because we shut down our society earlier? Did we observe the lockdown better? Did the collapse of Flybe reduce the spread to our island? 

These are interesting results indeed and the team intend to perform further anti-body testing on the samples to ensure accuracy.

As we have discussed earlier, COVID-19 has made the impossible happen with clinical research. From its inception to start took 17 days which is remarkable and was generously supported by the Ulster Independent Clinic. 

It will be good to follow this piece of work which will help shine some light on our knowledge gaps and it is great to have had such good support from general practice families.

You can hear an interview with some of our brave 'COVID-19 warriors' - listen in at 52:30.

Medical research in general practice has never been so important and the PRINCIPLE Trial is still keen to encourage practices to participate.

They are looking to recruit patients between 50-64 years with co-morbidities and patients over 65 without co-morbidities.

Patients will have had a symptom of cough, high temperature or positive COVID-19 test within the last 15 days. The study team can be contacted by phone on 0800 138 0880 or via email.

The study patient eligibility criteria can be found on the website. There are four practices in Northern Ireland taking part in the study, so it would be great to have a higher representation in this important work.

Literary doctors

After leaving the clinic, we made our annual family trip to the bookshop prior to our summer holiday.

This is normally one of my favourite times of the year - choosing the books I intend to get time and head space to read. Our trip this year was marred as our trip to France had been cancelled.

On Saturday 'A Fortunate Man' was beautifully narrated on BBC Radio 4.

I must confess - although cited frequently as an inspiration by heroes of our profession like Doctors Iona Heath and Clare Gerada - I never warmed to it and always felt it paternalistic and slightly controlling. The story is very sad and shows the devotion of a Dr Sassall in the Forest of Dean.

Dr Gerada rightly highlighted the issues behind the story at the recent Northern Ireland Medical and Dental Training Agency (NIMDTA) celebration for our ST3 colleagues and her point was well made.

Make sure you do go the extra mile for your patients when appropriate, but when it starts to become 'self-sacrifice' it is time for internal alarm bells to ring.

"I am overworked and proud of it," was a chilling quote from Dr Sassall who sadly took his own life.

If you are struggling with the difficulties of work, NIMDTA is still running their excellent mentor programme and RCGP has some excellent resources.

If you like, contact me directly on the email below and I will do my best to help. 

It was great to catch up with some colleagues this week about their own medical literary heroes.

While many highlighted it was real people that inspired them to be a good doctor, it was still a great exercise.

My own literary doctor favourite was Dr Spencer in 'Danny the Champion of the World' by Roald Dahl, and while the story may not have met today’s child protection whistleblowing standards, I still dream about the pie his wife, Mrs Spencer, baked for Danny!

I also liked Dr Urbino in 'Love in the time of Cholera' by Gabriel García Márquez.

Other colleagues have cited The Fat Man in 'The House of God' by Samuel Shem and 'Dr Zhivago' by Boris Pasternak.

Have you a favourite medic in literature? Get in touch and we can compare books.

Anticipatory medicine

It has been good catching up with colleagues this week and we are all saying the same things - our practices are getting busier.

I was glad to get stuck into some 'normal' GP work again last week and spent some time performing some end of life care.

My patient has advanced dementia, diabetes and of course lived alone, relying on his neighbouring sister to support him.

It really highlighted to me the importance of a specialist generalist, advocating for the patient and considering their specific circumstances.

The use of advance care planning is still as important in patients' homes as care homes, and I feel strongly that anticipatory medication has massive potential to keep patients in their own home and their preferred place of death.

I use the READ code 8BMM-1 (issue of a palliative care 'just in case' box). This winter I will see how to use this data for an audit or QI project.

Compared to the number of drugs available in my grandfather’s day, the current edition of the British National Formulary, (BNF) has 1,600 pages.

There is strong evidence that exercise is the most important and effective intervention in reducing death for all conditions (all-cause mortality).

We all know it works but as my sister, Ellie, who is a physiotherapist says: "Exercise may be the best medicine - but for many it is a difficult pill to swallow!".

Age NI has a helpful newsletter for elderly patients during lockdown and one of Northern Ireland’s greatest heroes, Dame Mary Peters has a new exercise class tailored for the elderly at home.

National Cancer Diagnosis Audit

The importance of exercise to all patients rose to the fore with me this week. One of our patients has just been diagnosed with a right renal carcinoma.

It is confined within the capsule, but he has been advised he will have to wait up to six weeks prior to laparoscopic nephrectomy.

Many studies have shown that his physical fitness will improve his postoperative outcomes - both mentally and physically - so it was great to be able to refer him to the excellent Macmillan 'Move More' scheme.

This is a regional scheme, and while they are unable to meet patients face to face at present, they can still provide individual fitness and exercise programmes.

Contact details for the leaders of the programme can be accessed now, and an update video has been released.

Prior to the pandemic, we had worked with Cancer Research UK (CRUK) to see if we could find ways to improve how quickly our patients are diagnosed with cancer.

The National Cancer Diagnosis Audit (NCDA) pilot is going ahead again and if you’ve not already registered, I would encourage you to reconsider joining this important audit.

The NCDA is a partnership between NI Cancer Registry, CRUK and RCGP. It looks to examine the pathways from presentation to diagnosis in a non-judgemental manner.

Its aim is to get a better understanding of our role and potentially identify ways we can improve care for our patients. I would be very grateful if you would consider taking part in this work which I do not feel will be onerous.

Northern Ireland’s data capture is organised differently. However, if you wish to see how the wider project is progressing in the UK and what it could offer, further information is available on the Cancer Research UK website.

If you would like to learn more, please email Lisa Cohen for further information.

Guillain-Barre syndrome

I found this letter about Guillain-Barre syndrome in adults in Italy interesting.

I remember clearly caring for a patient who suffered from Guillain-Barre syndrome during my registrar (ST3) year.

He had been successfully treated prior to my arrival with intravenous immunoglobulins, but I was shocked to have to deal with such a rare disease.

What hit home to me was the impact the disease had on his life. He was a very keen tennis player and it impacted enormously on his work and pleasures.

BJGP did a good short summary article about Guillain-Barre syndrome which is worth reading.

I am unaware of an increase in Guillain-Barre syndrome post-COVID-19 but it is something worth looking out for and it will be interesting to see what comes out of international literature.

I’m on holiday next week and I feel I have never needed a rest as much. If you need your batteries charged, please take time off.

Following our meeting with colleagues who have concerns about the COVID-19 centres, I am very grateful to many of you who have been in touch to say that you still support them going forward and feel the decision to implement them in such quick time was the correct one.

There are going to be significant challenges this winter and we must be strong and united to face them together.

There will be significant changes to how our health service is organised, but we will keep promoting the importance of general practice to all those in authority. 

I look forward to catching up in a fortnight. In the meantime, take care and get some rest.

Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful 'Dear Colleague' initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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