Primary healthcare news, information & resources

What we've been reading - August

Keeping up with medicine is made easier when we share clinical stories with our colleagues. On this page we share brief learnings and articles that have interested our GP liaison team during the month of August. If you come across an article, video or resource you think clinical and management teams should know about, send it to

Chronic rhinosinusitis - thoughts from Dr Jo Scott Jones

I was partly drawn to this topic by a podcast called 'POEM of the week' - not because last week ended with national poetry day, but because 'Patient Orientated Evidence that Matters' has long appealed to my sense that without evidence behind what we do, we might as well by waving burning cinnamon sticks over acute abdomens. 

The podcast referred to the 'SNOT-22' Sinonasal Outcomes Test - a 22 item academic score for sinus symptoms, and I was hooked. Bottom line - nasal irrigation works, adding manuka honey doesn't reduce the impact and may be a little better, steam inhalations on the other hand - no great effect. 

DynamedPlus (follow the link for log in details) gives a great overview of this and many other issues, from an evidence base. I find it important to refresh my memory of even the common stuff, and make sure I'm up to date. 

Staying well under pressure: how stress affects the body - thoughts from Dr David Maplesden

David Maplesden, Pinnacle MHN GP liaison was struck by the simple wisdom here in an Employment Assistance Programme (EAP) newsletter 'Vitae'

Teaching patients how to say "no" can be the key to helping them get themselves out of really sticky situations. GP level counselling often involves supporting people as they make the changes in life they need, including just stopping doing things. 

It is probably true that many primary care professionals could also benefit from learning to say "no" as part of their own stress management. A key message: "When you say 'no' you will have more time and energy to say 'yes' to the things you really want." 

Practice influencing clinical updates - thoughts from Dr David Maplesden

We get bombarded with 'clinical updates' from so many sources it is difficult to register them all. However, a few I've come across on skimming such sources recently include some that might influence my current practice (and therefore that of my colleagues).

  • Turmeric supplements have the potential to significantly increase international normalised ratio (INR) in some patients on warfarin. With Richie McCaw and others pushing such supplements in TV ads, their use might become more widespread.    Read the Medsafe warning here

  • From the latest BPAC update on gout management:  Allopurinol can be initiated during an acute flare of gout; there is little evidence supporting delaying treatment until the flare has settled. This is quite a change from traditional teaching and might make the transition from acute to long-term management a little less complicated. 

  • Also from BPAC is an update on recognition of sepsis with links to some excellent NICE (UK's National Institute for health and Care Excellence) resources. In my work as an HDC advisor I have seen several cases of patients dying at home (in hindsight of sepsis) within hours of being seen by their GP.  It is acknowledged that recognition of the 'septic' patient can be difficult, but it is even more difficult (and difficult to defend the missed diagnosis) when vital signs (including respiratory rate) have not been recorded. The NICE resources include easily printed 1-page algorithms for recognition of sepsis in various age groups.

  • From the NZ/Australia Choosing Wisely website: Don't prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection. About half of nails with suspected fungus do not have a fungal infection. Because other nail conditions, such as nail dystrophies, may look similar in appearance, it is important to ensure accurate diagnosis of nail disease before beginning treatment. The Choosing Wisely website has a wealth of management 'pearls' put out by various specialist groups and mostly aimed at promoting appropriate use of resources.

RNZCGP conference - thoughts from Dr Maree McCracken

As Jo mentioned in last weeks Pin Points, the college conference this year had me thinking hard about equity and how we can support equity from an organisational perspective. 

The key note speaker Dr Camara Jones challenged us to scan systems for racial disparities, in opportunities as well as outcomes, and address the the mechanisms that caused these. For us in the primary mental health team, that means thinking about why our high needs populations might 'DNA' their counselling appointments and working out how we can make it more worthwhile and/or easier for them to get the help they need. Getting consumer feedback and asking "how can we do better for you". We could do this in our general practices too. 

Dr Jones defines health equity as: "Assurance of the conditions for optimal health for all people. To achieve it we need to value all individuals and people equally, recognise and rectify historical injustices, and allocate resources according to need. Health disparities will be eliminated when health equity is achieved."

A lofty goal, one that I hope we will achieve in New Zealand. Dr Jones also had a knack for telling stories about equity that made sense. In this Ted Talk she shares her best stories to illustrate different aspects of the equity challenge - including why it's hard for privileged populations to see the inequity. This short clip on the cliff of good health is also worth a watch.

RNZCGP conference - thoughts from Dr Jo Scott-Jones

This week was the RNZCGP conference in Auckland and the programme was packed with more information than you could shake a stick at.

There were heaps of Pinnacle GPs in attendance, not only in the audiences, but also presenting and involved in the official RNZCGP events. 

The main theme was equity, and I know Maree McCraken is going to write about that in the next Pin Points, so apart form the amazing David Tipene-Leach and the Wahakura Lens, and Camara Jones and her gardening analogy, one of the highlights for me was meeting Brigadier Ben Kite OBE - the head of UK military intelligence.

(That's a sentence I never thought I would say, and I know my family will think I have completely sold out to the establishment if they hear me say it. I can just see my mum now, weeping as she burns my collection of Socialist Worker's Party newsletters.)

He talked about a lot of things that we are not allowed to talk about..which could be the end of this article, but I think it's OK to share his tips on leadership which he concluded his main speech with.

To be a successful leader (and we are all leaders ) we need to:

  1. Be confident, whether we feel it or not. Be confident, because you know things other people don't know. Everyone does.
  2. Create the right environment for others to flourish.
  3. Trust others, delegate to the point of discomfort.
  4. Be a real partner, collaborate with others.
  5. Understand the people around you and what motivates them emotionally and intellectually.
  6. Get a mentor, and be a mentor.

And drink your martini, six parts vodka, one part vermouth, shaken... 

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