Monthly Archives: October 2015


Day after day in the surgery we hear about the hardships and sadnesses. Often  what we hear or read in the news is all too much and many people have stopped watching or reading the news as they can’t cope with what they see or read. Many of us have challenges of our own which are a struggle in themselves and hearing about things which we can’t do anything about is all too much. For those who do struggle or know what it is like to go through bad times this poem might strike a note.

After a while – Veronica A. Shoffstall

After a while you learn
the subtle difference between
holding a hand and chaining a soul
and you learn
that love doesn’t mean leaning
and company doesn’t always mean security.
And you begin to learn
that kisses aren’t contracts
and presents aren’t promises
and you begin to accept your defeats
with your head up and your eyes ahead
with the grace of woman, not the grief of a child
and you learn
to build all your roads on today
because tomorrow’s ground is
too uncertain for plans
and futures have a way of falling down
in mid-flight.
After a while you learn
that even sunshine burns
if you get too much
so you plant your own garden
and decorate your own soul
instead of waiting for someone
to bring you flowers.
And you learn that you really can endure
you really are strong
you really do have worth
and you learn
and you learn
with every goodbye, you learn…

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Posted by on October 24, 2015 in Training and Advice


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Dear GP,

I usually write to you to request a prescription. When I have an appointment, I usually talk to you about my ailments – about what is not good. Nowadays that relates to chronic illness.

Today I write to share positive: the privilege of participating in LIVING WELL – the self management programme that aims to help live with long term health conditions – group engagement with individuals who combine together a broad age group with a broad range of illness. I gained from it; I enjoyed it! I use the word enjoy because we shared the experience of illness in the context of our everyday living and although suffering was there, morbidity was nowhere!

Upon first encounter I was amazed to learn that regardless of age and condition, we all shared a similar experience which presents itself in what we have identified as the ‘symptom cycle’, such as the never ending loop of pain, difficult thoughts and emotions, poor sleep, physical limitations …. I gained tools to help manage and ‘break the cycle, to gain more better moments than moments that feel unmanageable. This was nice. Some of the tools are familiar, ones we put to use in our everyday – at work or at home, such as problem solving, decision making, communication (with doctors, for example), however, it became evident to me that we don’t always identify this so we don’t necessarily put our management tools to use in an effective way in the course of an illness in the everyday.

Hey, one doesn’t train to be a patient!

LIVING WELL encapsulates this and in an intense 6 session period, equips us with a toolbox that we can dig into at any given moment. Practice starts together; the work, we each have to continue to apply later. LIVING WELL is a lesson in responsibility and ownership of one’s condition. True, everything is good in ‘class’ and like learning to swim, you might get the moves when you’re in the pool having a lesson but next time you step into the water on your own, you might still feel you are going to drown. I do know it takes time to master tools but I also know that I have been equipped with a framework. I also now know that there is a strength from experiencing a group face to face.

LIVING WELL has enabled me to form a sense of community thanks to caring instructors who themselves experience long term health conditions and have participated in a course prior to becoming the guide. This is also thanks to an amazing group of people who, like me, may have had a sleepless night last night and not because we were out clubbing but because the challenges to go out to ‘a club’ can be immense. ‘Club’ here merely symbolises engaging with life in the everyday. I have learned new strategies that others use on how they may cope with a sleepless night, I hope they have learned something from me. So, we have gained and you do too. As we have learned about responsibility and ownership of how we engage with our long term health conditions,

LIVING WELL demonstrates how we can better engage with our doctors. You have come to know me overtime through my condition. You can understand the importance of this course for me. I strongly hope there will be future opportunities for existing groups to meet again in session for further learning.

But,without patients wanting to participate in the first place there will be no LIVING WELL. I am apprehensive that the course has now ended; someone else might be apprehensive about starting. Can you please continue to promote the LIVING WELL programme in your surgery to your patients, and amongst your colleagues so their patients can ‘LIVE WELL’ too? It has been a privilege,


Grateful patient



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Posted by on October 20, 2015 in Training and Advice


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Happiness is defined as a mental or emotional state of well-being defined by positive or pleasant emotions ranging  from contentment to intense joy.


I would like to share this short story my daughter sent me yesterday:-

The 92-year-old, petite, well-poised and proud lady, who is fully
dressed each morning by eight o’clock, with her hair fashionably
coifed and makeup perfectly applied, even though she is legally blind,
moved to a nursing home today. Her husband of 70 years recently passed
away, making the move necessary.

After many hours of waiting patiently in the lobby of the nursing
home, she smiled sweetly when told her room was ready. As she
maneuvered her walker to the elevator, I provided a visual description
of her tiny room, including the eyelet sheets that had been hung on
her window. “I love it,” she stated with the enthusiasm of an
eight-year-old having just been presented with a new puppy.
“Mrs. Jones, you haven’t seen the room …. just wait.”
“That doesn’t have anything to do with it,” she replied. “Happiness is
something you decide on ahead of time. Whether I like my room or not
doesn’t depend on how the furniture is arranged, it’s how I arrange my
mind. I already decided to love it. It’s a decision I make every
morning when I wake up. I have a choice; I can spend the day in bed
recounting the difficulty I have with the parts of my body that no
longer work, or get out of bed and be thankful for the ones that do.
Each day is a gift, and as long as my eyes open I’ll focus on the new
day and all the happy memories I’ve stored away, just for this time in
my life.”

She went on to explain, “Old age is like a bank account, you withdraw
from what you’ve put in. So, my advice to you would be to deposit a
lot of happiness in the bank account of memories Thank you for your
part in filling my Memory bank. I am still depositing.”

And with a smile, she said: “Remember the five simple rules to be happy:
1. Free your heart from hatred.
2. Free your mind from worries.
3. Live simply.
4. Give more.
5. Expect less



Posted by on October 20, 2015 in Training and Advice




imageAs a GP I regularly see young women who are anxious about not getting pregnant and if they have been trying for 12-18 months or sooner if over the age of 36yrs, despite having regular unprotected sex we consider that they may be infertile and need further investigation.
Around one in seven couples may have difficulty conceiving. This is approximately 3.5 million people in the UK.
About 84% of couples will conceive naturally within one year if they have regular unprotected sex.
For every 100 couples trying to conceive naturally:
84 will conceive within one year
92 will conceive within two years
93 will conceive within three years
For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring within the next year is 25% or less.

There may be physical problems or often they are not conceiving due to a stressful, unhealthy lifestyle or for no apparent reason, which infact amounts to 15% of women. Hence, my first bit of advice is to advise a couple to have some quality time together and forget about babies and not infrequently within a couple of months they report back with a positive pregnancy test! One couple having been trying to conceive for several years and were due to go to India I suggested they forgot babies but to make sure they visited the Taj Mahal and looked into each other’s eyes. Needless to say 9 months later they were blessed with a beautiful son. I have watched some of these babies grow up and I couldn’t help but smile to myself when several of these, now grown up babies have approached me to do a work experience or help with their application to university or even medical school!  (recruiting preconception- has Jeremy Hunt heard about that!)

Moreover, over the decades, the availability of treatment and the type of women receiving it has changed dramatically. Dr Robert Forman worked with the British doctors who “created” Louise Brown, and is now medical director of the CRM Care London clinic, part of the country’s biggest fertility company, with seven “branches” in the UK and Ireland. Care now performs more than 7,000 cycles of treatment a year and boasts success rates of up to 50 per cent. When IVF started, it was purely for women with blocked fallopian tubes,” says Dr Forman. “One of the biggest changes over the years is that we are now increasingly treating people who are not technically infertile. It is single women who are opting for egg freezing or donor insemination, gay couples coming for treatment, as well as those who can conceive but have genetic testing of embryos, for instance, to screen out cystic fibrosis if they know they are carriers of that gene.” Recently we were delighted to facilitate a referral of a gay couple for successful IVF and for this family to be part of our practice and there are others in different situations who now feel confident to ask for support in preparing to conceive and then have their antenatal care within the practice.


However, infertility has become an industry and very costly to couples who take the route of IVF when in some cases a simple alternative could solve the problem. The NHS alone doesn’t carry all this demand: it only funds 41% of the IVF cycles in England and Wales, with more than half of people paying to sort out the problem for themselves – or at least trying to sort it out. We as GPs try to do as much before referral to avoid unnecessary IVF. As I read in one article about infertility,  “If you’re having sex three times a week, you have a much greater chance of success, rather than just waiting for that ovulation window. We need to talk about these things as well as IVF.” It would be useful to read the article on infertility in NHS choices website prior to consulting your GP before rushing off to ask for IVF independently.

Age-based infertility (rather than infertility that would exist regardless of age) is on the increase because it’s more socially acceptable, and indeed more possible, to delay motherhood than it was 30 years ago. This isn’t scaremongering, it is fact. Now they have recourse to a solution; but IVF is expensive and requires an average of four cycles to work – at roughly £5,000 a cycle, if it’s on the NHS – and the more that women “delay” their childbearing years (whether by design, accident or life circumstance), the heavier the demand for IVF. It was recently written in the press that schools are advising girls not to leave it ‘too late’ to have a baby.

Having conceived pregnancy is not always straight forward and employers are not always sympathetic  and women are expected to continue and cope with all that comes their way. There are many questions to be asked as women prepare to enter this new world of motherhood.

Eventually, the precious baby arrives but more and more mothers are isolated with no grandmother or extended family nearby to advise them how to deal with the numerous problems of caring for a baby ensue. We frequently see mothers in surgery coming to ask us for advice, which we are happy to help but attending a surgery or urgent care centre alongside ill patients is not ideal for a new mother and baby let alone being inconvenient for both. Hence, when Diana Hill an award-winning BBC science documentary film-maker.attended one of our Multi-Disciplinary Group meetings to talk about her company, “The Essential Parent Company” which she created with  Dr Rebecca Chicot a Cambridge PhD in Child Development and Parenting I felt it was an excellent resource to share with patients especially new mothers.

For a limited period of time there will be free access and if those viewing the videos give favourable comments there is a chance this may continue.


Professor Robert Winston, a pioneer of fertility and reproductive health pioneer has been a key advisor and provides expert information in maximising the chances of getting pregnant

With expert team of obstetricians, midwives, antenatal dietitiants and antenatal health experts The Essential Parent Company brings the most trusted advice to help you have a healthy and happy pregnancy, labour and birth.


With expert partners The Royal College of Paediatrics and Child Health, UNICEF UK Baby Friendly as well as midwives, paediatricians, sleep experts, paediatric dietitians, development psychologists and The Essential Parent Company present trusted video demos and advice to help have a safe, happy and healthy baby. With advice on feeding, sleeping, crying and everyday care and health they aspire to give a one stop hub for warm, expert advice.




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Posted by on October 18, 2015 in Training and Advice


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