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 November. 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.
Dr David Mapelsden, Pinnacle MHN GP liaison, reflects on an article about the impact of the electronic health record in America where the insurance-based system creates pressures on record keeping. Let's hope New Zealand never heads down this route!
"This is an interesting article by Atul Gawande on the frustrations of electronic patient records and how some US physicians are using 'scribes' (third party note takers) to try and relieve the burden of transcribing and allowing more dedicated patient time."
"The numbers needed to treat to benefit non cancer chronic pain with cannabis are very high (24) , the number to harm (6) very low" - this is the best systematic review of this subject to date, but it appears that the country heads down this pathway without much concern for the science - there are many treatment counselling challenges ahead for GPs and this paper may help make some sense. I will be telling people "the pooled change in pain intensity (standardised mean difference: -0.14, 95% CI -0.20 to -0.08) was equivalent to a 3mm reduction on a 100mm visual analogue scale greater than placebo groups" - only using less technical language (i.e. "it doesn't work well in the studies").
It may be of interest to note the FDA in America has never approved marijuana as a treatment for any condition. It may be semantics but it may be helpful to remember there is no such thing as "medical marijuana", there are cannabis derivatives which may (or may not) have an impact on a limited number of conditions.
Stockings E, Campbell G, Hall WD, et al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018 Oct;159(10):1932-1954. doi: 10.1097/j.pain.0000000000001293. (Review) PMID: 29847469.