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 February. If you come across an article, video or resource you think clinical and management teams should know about, send it to firstname.lastname@example.org.
This year's Salvation Army report Are You Well? Are We Safe? takes a wellbeing approach to considering our social progress as a nation. It looks at the differences between those of us who are doing okay and the most vulnerable New Zealanders. The report shows a lack of tangible progress in key areas including record levels of household debt and a growing gap in educational achievement between poorer and more well off communities. The report also shows rising rates of offender recidivism and evidence of increasing levels of activity related to social hazards such as alcohol, drugs and gambling.
Pinnacle practices have been encouraged to focus, through their practice development plans, on youth and Māori. The report shows a significant gap between Māori and non-Māori in all areas of wellbeing, and thinking about our focus on youth in teenage pregnancy rates, and in infant mortality.
I know practices are all doing everything they can for each patient they see, and this is an important job. Reports like this add further fuel to our fires at practice, network, and system levels to do things differently, to have greater impact, through being more accessible to the most vulnerable in our communities.
It's not easy to address problems like this especially when you are 'bum up, head down' in a busy "doctor-in-a-box" medical practice.
Fortunately you are part of a network which is designed to help. Start by talking to your practice support team about what other practices are doing to make changes and improve their systems.
The latest figures available for new registrations of cancer make sobering reading and may be worth highlighting in a practice clinical meeting if you are talking about your Māori health plans, or how to improve screening uptake.
We all know the reasons why we do these things, we all have memories and stories about individual patients, these figures - showing again the startling difference in rates of most cancers for Māori add to those stories and challenge us to do better - in early detection and referral, but also in prevention.
All of these cancers are associated with smoking, many with obesity and many with diets high in processed foods and red meat. In the words of the great song "we didn't start the fire" but we can help to put it out.
My patient had found that over the years, steroids "worked" until she stopped using them, then her face would flare until she started again.
Her skin was thinning and she was seeking stronger creams as the over-the-counter stuff wasn't working.
She bounced away from me when I told her I wasn't going to give her stronger steroids, she found an alternative source, but eventually came back in a much worse state.
It was a nightmare helping to get her out of the cycle of steroid use. We decided to moisturise, moisturise, moisturise.
I'm still convinced that the major cause of her improvement (and return to a near normal complexion now) was time and stopping the medication, but had I thought of it at the time, this article in DermnetNZ would have given me a few more options than we tried.