Have you ever felt like it is groundhog day? You are having the same conversation with the same patient and with the same outcomes. You are being very sympathetic and trying hard to help the patient make positive changes. But every suggestion you make garners the response: “Yes but I can’t do that because…”, “Yes but I’ve tried that”, “Yes but my friend said there was a tablet I could take”. That “yes but” is an indicator that motivational interviewing (MI) is likely to be helpful.
Measuring your blood pressure: what you need to know about ambulatory blood pressure monitoring
The new NICE guideline on hypertension: using ambulatory blood pressure monitoring in practice
All change: Using ambulatory blood pressure monitoring to diagnose hypertension in primary care
Measuring blood pressure (BP) is one of the commonest tests we carry out in primary care – generally taking several measurements with a digital BP monitor on at least two clinic visits before diagnosing hypertension. Ambulatory blood pressure monitoring (ABPM) has traditionally been used in secondary care hypertension clinics, and in some larger general practices. But new guidelines from the National Institute for Health and Clinical Excellence are making ambulatory monitoring part of routine practice for the diagnosis of hypertension in primary care. What are the new guidelines recommending and why the change to ABPM?
Thromboprophylaxis to prevent hospital-acquired thrombosis: an important opportunity for primary care
It is clear that hospital admission causes many preventable deaths from venous thromboembolism (VTE) yet the general public and, I would suggest, primary care health workers, still think of air travel as the main risk factor. Is there a role for primary care in helping to reduce the numbers of patients with hospital-acquired VTE?
Viewpoint
Twenty-five years ago, few healthcare professionals associated osteoporosis with an increased risk of broken bones, and there was no internationally recognised definition of the disease. There were no NHS dual X-ray absorptiometry scanners, treatment options were limited, and the care and support offered to those with osteoporosis was a long way below the standards delivered by health professionals today. There was also no UK-wide charity to raise awareness of the disease.
Taking control of urinary continence in women
Urinary continence problems are common in women, and result in significant costs to patients, carers and the NHS, both for treatment and coping strategies such as pads and appliances. Despite this, continence rarely gets the attention that some other, less prevalent conditions receive, and there is evidence of both under-diagnosis and inadequate management.
Put out the fire of vulvodynia
Most often described as a burning pain, vulvodynia is a chronic pain syndrome that affects all or part of the vulva. Diagnosis of this distressing condition is frequently delayed and management is challenging. But careful diagnosis and appropriate referral can help to minimise pain and enable women to regain control of their lives.
Pass it on: the reality of inherited cancer risk
Many people have close relatives with cancer, and the possibility of inherited risk is increasingly raised during a GP consultation, often by patients themselves. It is important to identify the small but significant proportion of people who are at greatly increased risk of developing cancer as a result of their family history. But most patients with a family history are not at higher risk, and can be managed in primary care.
Editorial
It looks like it is going to be a long hard winter. The media have already been reporting restrictions on referrals and rising waiting times. It is likely that things can only get worse given the pressures on primary care trusts and local authorities. At times of economic stringency, women’s sexual and reproductive health can seem an easy target. But this is short-sighted and probably not costeffective given the UK’s high rates of teenage pregnancy and sexually transmitted infections. It is time for an approach to service configuration that goes beyond knee-jerk slash and burn.
Colposcopy after cervical screening
Colposcopy – detailed examination of the cervix under magnification – remains the standard assessment tool for cervical abnormalities found on screening. An invitation to attend the colposcopy clinic can cause anxiety, but women can be reassured that it is a safe procedure and that many problems can be treated in just one visit.
