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 January. If you come across an article, video or resource you think clinical and management teams should know about, send it to email@example.com.
The doctor's bag is very important and the contents of it vary according to the individual doctor and their pattern of work. There is no standard "doctor's bag." Access to patient records and decision support through a mobile device is of huge value and should be available where possible. At the least a mobile phone should have pre-programmed numbers for ambulance, local hospital, the practice and a colleague or supervisor available.
In response to a recent member request, I've developed this Doctors Bag resource, adapted from a UK resource.
Katie Harris - dietitian from the Pinnacle MHN extended care team in Taupo sent through this interesting report on the value of whole grains and fibre in the diet.
The case for eating carbs has never been stronger, as a New Zealand-led systematic review finds people with a diet high in fibre - specifically whole grains - have lower rates of a range of chronic diet-related diseases. Rates of heart disease - including death, colon cancer and type 2 diabetes were lower in people who eat at least 25g of fibre each day - and benefits increased with intake. Most people consume about 20g of fibre each day. The study, which looked at 40 years of data, looks to inform new global recommendations on fibre intake. There were less clear benefits from eating foods with a low glycaemic index and glycaemic load.
Along with the recent "diet for the planet" published in the Lancet and the Tairawhiti based study showing the impact of a whole food plant based diet, it's pretty clear that "fibre" has a lot of evidence behind it.
The problem is how to get this across to patients.
Dietitians as part of the extended care team, like Katie Harris in Taupo and Sarah Tuki in New Plymouth, undertake a Master's degree after their undergraduate course and are experts in evidenced based nutrition, motivation and patient engagement, as well as tailoring a person's lifestyle to their actual needs.
It's worthwhile having a "set-piece" discussion at a practice clinical meeting to provide clarity about what diet advice your team gives to patients beyond the mantra "eat food, not too much, mostly plants."
Well - the
jury is not even out yet, they are having a tea and biscuit break whilst more evidence is gathered based on this BMJ "Sixty seconds" article from January 2018.
It makes sense that abstinence will lead to short term improvement in blood glucose and liver function tests (although if you are drinking so much your liver function tests are out of kilter, perhaps a longer term approach is worth thinking about!), but it could be that there is a "rebound effect" in February to make up for lost time, and a reinforcement that alcohol is not an issue because you have demonstrated to yourself you can abstain for a few weeks, when really the social and physical issues remain.
So far there is no evidence that having a "dry January" causes harm, the rebound effect doesn't happen, in fact people self report drinking less six months after a "dry January" and the indications are that it helps people assess their relationship with alcohol. And it's always good to review relationships, especially with your best friends.