My thoughts on GP in #GP150w

As I log off, I look around my cluttered desk and consider what sort of a day I have had. In between the piles of prescriptions and medical certificates, the answer lies in the form of coffee stained crockery.

I started the day with all the optimism and cheer of “Christmas Reindeer”, but as the triage phone call list lengthened and appointments became more scarce, “I’ve been to Dubai”, the largest drinking receptacle available, came into its own.

With no time for coffee room chat over lunch owing to a home visit to a recently widowed patient, I began afternoon surgery thirsty. Not only for fluids, but for conversation with my colleagues.

Keeping up with the next two hours of clinical conundrums and patient expectations was made hugely easier by the kindness of my colleague bringing my afternoon brew, especially when it was wrapped in star spangled mug labelled “SuperDoc”.

UK Maternal Mental Health Matters Awareness Week

elephant mum and baby

In 2017, the Internet offers us an infinite amount of information at our fingertips which gives us the potential to find an answer to almost any question we have. Although digital navigation skills were not taught when I started at medical school in 1998, I have learnt these since and now see the Internet as an integral part of my doctor’s bag, squashed between the more familiar items of stethoscope and digital thermometer. For GPs to take full advantage of all the Internet can offer to their consultation skills, they must be able to find what they are looking for with speed and be sure that source is accurate, up to date and where relevant, evidence based.

A typical day in GP may mean I communicate with over 60 patients; telephone calls, face to face consultations, email queries and home visits. The diverse range and presentation of clinical conundrums is one of the aspects of my job I enjoy the most although it means having to retain the broadest possible knowledge base. The fast changing rules and recommendations for all areas of general practice are a constant challenge to keep up with. Even before a quick mid-surgery coffee break, I may have used “Dr.Google” several times already. To check the time until driving is recommended after keyhole surgery for gallbladder removal or what tropical diseases a patient might have picked up from an insect bite on the edge of a river in South Africa.

Mental Health is an area where the use of digital technology can be hugely helpful but it is also an area where there are vast amounts of material, tools and platforms available to choose from. Deciding which one is most suitable is a challenge for both those personally affected, and those professionals supporting them. The Royal College of GPs (RCGP) has developed both a Perinatal Mental Health Toolkit as well as a Mental Health Toolkit which are free, open access collections of hundreds of resources to help with this challenge.

With this week being Maternal Mental Health Awareness week, it is a great opportunity to share a link to the Perinatal Mental Health Toolkit with a wider audience. For professionals, there are many useful links to help with prescribing issues and to give advice to women to help them make an informed choice about the safest choice of medication in pregnancy and breastfeeding. There are several Top Tip style documents about communication, red flag signs to identify more serious illness as well as links to further learning. For patients, there are links to many information leaflets, third sector organisations, online peer support groups, digital media sources of help amongst many others.

http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx

During Maternal Mental Health Matters Awareness Week, why not have a look at the RCGP PMH Toolkit and see how digital technology can help you with Perinatal Mental Health issues whether personally affected, or professionally supporting those who are?

 

Dr Carrie Ladd

@LaddCar

maternalMHmatters – Maternal Mental Health Awareness Week

guinea-pigs-playing-ping-pong

Monday 1st May 2017

In 2017, the Internet offers us an infinite amount of information at our fingertips which gives us the potential to find an answer to almost any question we have. Although digital navigation skills were not taught when I started at medical school in 1998, I have learnt these since and now see the Internet as an integral part of my doctor’s bag, squashed between the more familiar items of stethoscope and digital thermometer. For GPs to take full advantage of all the Internet can offer to their consultation skills, they must be able to find what they are looking for with speed and be sure that source is accurate, up to date and where relevant, evidence based.

A typical day in GP may mean I communicate with over 60 patients; telephone calls, face to face consultations, email queries and home visits. The diverse range and presentation of clinical conundrums is one of the aspects of my job I enjoy the most although it means having to retain the broadest possible knowledge base. The fast changing rules and recommendations for all areas of general practice are a constant challenge to keep up with. Even before a quick mid-surgery coffee break, I may have used “Dr.Google” several times already. To check the time until driving is recommended after keyhole surgery for gallbladder removal or what tropical diseases a patient might have picked up from an insect bite on the edge of a river in South Africa.

Mental Health is an area where the use of digital technology can be hugely helpful but it is also an area where there are vast amounts of material, tools and platforms available to choose from. Deciding which one is most suitable is a challenge for both those personally affected, and those professionals supporting them. With this week being Maternal Mental Health Awareness week, it is a great opportunity to share a link to the RCGP Perinatal Mental Health Toolkit with a wider audience.

This is a free, open access collection of over 400 resources to help with this challenge in the important area of Perinatal Mental Health which affects up to 1:5 women and 1: 10 men during the period of pregnancy and the first year after birth. For professionals, there are many useful links to help with prescribing issues and to give advice to women to help them make an informed choice about the safest choice of medication in pregnancy and breastfeeding. There are several Top Tip style documents about communication, red flag signs to identify more serious illness as well as links to further learning. For patients, there are links to many useful information leaflets, many brilliant third sector organisations, online peer support groups and digital media sources of help amongst many others.

http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx

During Maternal Mental Health Matters Awareness Week, why not have a look at the RCGP PMH Toolkit and see how digital technology can help with Perinatal Mental Health issues whether you are personally affected, or professionally supporting those who are?

Dr Carrie Ladd, 1st May 2017

@LaddCar

What a difference an hour can make – Training GPs in Perinatal Mental Health

guinea-pigs-playing-ping-pong      Thursday 9th February 2017

Guinea Pigs playing Ping Pong. Not an image I have used in my power point presentations before but it certainly caught people’s attention. Let me explain…

Discussions have been happening for a while between the team at MABIM and Dr Judy Shakespeare (RCGP PMH Clinical Champion) and towards the end of last year things started to take shape. The idea was to develop a training package for GPs and other practice staff in Perinatal Mental Health (PMH) with a view to rolling out the package over the 4 locations in which they work – Blackpool, Gloucester and Haringey & Southend.

PMH has been a priority area for the RCGP for the last 3 years and so Judy and myself (RCGP PMH Clinical Fellow) set about designing the session with the first location being Southend, 7th February. We realised quickly that there was a limit to what we could fit into 1 hour and deciding what to leave out was the tricky part. However, we both passionately believe that by learning a little more, asking questions slightly differently and being aware of the issues around perinatal mental illness, GPs can hugely improve their practice. This will lead to picking up more cases earlier and prompt treatment sooner, meaning less women slip through the net. We know that most women prefer to disclose mental health symptoms to their GP therefore a GP education session really is a golden opportunity for us to encourage behaviour change leading to positive impact, even in just one hour.

The 10 minute slots we had split the session into merged together well and we covered many aspects of perinatal mental illness including discussing 3 case histories (antenatal depression, postpartum psychosis and perinatal OCD). Barriers to diagnoses were suggested on post it stickers and collated to form a helpful discussion of those relevant to women and those to professionals. It was interesting to see many of these matched the findings of the Falling Through The Gaps report.

We discussed the educational resources we have produced with the RCGP including the RCGP PMH Toolkit .  Also  the e-learning for health 5 module series and the NICE Top Tips summary document  http://www.rcgp.org.uk/clinical-and-research/toolkits/~/media/92F73D8AA0014DEAB37B55CDF7F2CE2B.ashx

As many readers will know I am fairly busy on Twitter in the mornings mostly thanks to an early rising pre-schooler. I have met several of my twitter contacts in person and was excited when I saw that this first MABIM session was going to be in Southend as I knew Laura (Clark) (@butterflymum83) and Sarah (Wood) (@LotusPetalPND) lived nearby. I was delighted when they agreed to come and talk to the group. I was also interested to hear more about how  they had set up their own peer support group in conjunction with the local PMH services.. The voices of women with lived experience can be incredibly powerful in improving health services and today was no exception. Laura and Sarah brought to life the slides, case histories and theory we had been presenting by their honest and moving stories. To see two women who had been so unwell a few years ago now having the confidence, passion and motivation to use their experience to help others was truly inspiring and I am sure the audience will remember their words for a long time.

And so to the guinea pigs…We explained at the start of the session that this was a pilot session and so we were trialling several learning methods and tools to see what worked for the audience. Feedback was encouraged via feedback forms and through the usual channels used by Southend CCG –an online survey I understand. Overall we think it went well with a good level of dialogue between speakers and audience, some great questions and a distinct lack of people leaving early/to go to the toilet/to fetch a drink. Perhaps a roving mic would have been helpful as the amp wire nearly caught me out a few times! As many will know, GPs often have a healthy competitive streak and so a quiz was introduced on each table with only eight questions which had one word answers – the first table to complete won a box of chocolates which seemed to be go down well, as did the image of guinea pigs playing pingpong!

@LaddCar

It can be difficult, being super-mum.

Before you raise your expertly plucked eyebrow, please understand I mean that ironically. No-one else expects me to be that toned, honed, all achieving gladiator of a woman, except me. I know I am far from alone in wanting to succeed, to exceed in fact, at everything I do. But despite an 8th day being on my Christmas wish list, last time I checked there were only 7 days in the week.

Successfully combining my role as a part-time NHS GP with being a full-time mum is a challenge and at times, feels harder than it should.  I never considered my life as a binary choice in terms of being a mother or having a career and made naive presumption that one day I would have both. Now that I am in that fortunate position, I have to fit a whole week of being 1400 people’s GP into just 3 days and a whole week of being 2 people’s mum into the rest of the time. It’s easy to feel that you are not giving either audience your full attention.

Much more helpful than a sense of under achievement for me and other GP parents is the notion of collaboration between these two roles.  My experience as a parent gives me valuable insight into the challenges of parenting and provides some practical information too which can make all the difference in the consulting room when building trust and rapport with parents. Understanding how frustrating it is when a 6month  breastfed baby refuses to take a bottle of milk or what devilish tricks or chocolate buttons are needed to persuade a stubborn toddler to take his penicillin helps you understand better the situation being discussed.

My medical knowledge as a GP is useful, of course, when my own children complain of various coughs and colds as I know how to safely manage most things myself. Also useful when reassuring my husband that our son’s momentous tantrums are well within the normal range for a 2-year-old. More importantly, I come home with a sense of gratitude. I hear a whole lot of life in my consultations, talking to up to 60 patients a day and it makes bedtime stories even more precious.

And so the two roles can enable each other to flourish – synergy if you like.

There are times during my working day, when the triage call list extends off my screen, the electronic prescription requests reach treble figures and my coffee is stone cold that I wonder, would I rather be a stay-at-home mum?  One advantage of working part-time, is that you never have too many consecutive days to consider this question. In fact, it was approximately 08.15am when I heard a crash and went into the lounge to find my youngest jumping on the coffee table, my tax return papers all over the floor and peeking out from under them – my laptop. I had my answer.

It is important to recognise the limits and the opportunities being a GP parent offers and learn to say yes when it matters, and more importantly – no when it doesn’t. You don’t need to join the PTA the first term your child starts school but for the same reasons, you don’t have to complete that extra dermatology qualification in your first few years of being a GP. By accepting occasional mediocrity in both your macaroni cheese and your medical knowledge of malaria, you give yourself a more realistic chance of success in finding that star-spangled Lycra fits you and your mum-tum.

 

#Hopedec09 – How to ignite a flame? Fuel, Oxygen and a Spark.

You might think a reference to one of my school chemistry lessons is an odd way to start a blog but bear with me.
It was the first and most prominent theme that came to mind as I travelled back on a packed evening train from Paddington yesterday evening. I had spent the afternoon at an event held in Westminster with over 150 people from the Perinatal Mental Health (PMH) community. They included leaders in this field from a variety of specialties – Health Visitors, Midwifes, Obstetricians, GPs, Psychologists, Psychiatrists – all working in very diverse roles but united by the same objective – to improve care for women, men and their families experiencing PMH problems.
As well as professionals, there was a large number of women, and some men, who have been personally affected and listening to some of their stories told was a maelstrom of emotions. Empathy, concern, guilt, shock and above all, compassion. But a very rich source of fuel for this particular fire to be started.
All those who speak publicly about their own personal tragedy deserve some respect but not all can make such a lasting impression as did Antoinette Sandbach, MP. She has become a passionate advocate for improved perinatal bereavement support, health professional training and hospital facilities after experiencing her own personal tragedy. She spoke with such honesty, such visible pain, that all of us came away knowing there is much work still to be done in this important area.
Cutting edge research on the economic and the biomedical arguments for the prevention, early detection and prompt treatment of PMH illness were persuasive. Dr Alain Gregoire, Prof Vivette Glover and Anna Day spoke with passion, conviction and their experienced words held everyone’s attention. Some memorable points: 10% of childhood behavioural, cognitive development and emotional difficulties may be attributable to perinatal mental health problems although this is not an inevitable consequence for the vast majority of PMH illness. And as if this wasn’t enough science to motivate us all to do more – 70% of our brain’s development happens in the first 2 years of life, the other 30% happen in utero. Tackling PMH issues really is a chance to improve not only the lives of the parent in front of us, but their children as well.
Lindsay Robinson spoke eloquently, emotionally and connected with the audience in a very powerful way. Her delayed disclosure, diagnosis and appropriate treatment for postnatal depression which followed undetected antenatal depression was heart-wrenching to hear. But equally powerful was her courage to share her story in the hope of helping others to have a better experience of early motherhood than she had. Similar motivation had prompted Sanchita Islam to share her narrative which illustrated the huge challenges and complexities of living with a chronic severe mental illness like schizophrenia.
Powerful fuel indeed.
There was also some news of policy progress from Dr Giles Berrisford, Associate National Clinical Director for Perinatal Mental Health. He outlined the current situation: only 15 % of the UK having robust perinatal services but that this postcode lottery is finally being addressed with £360 million investment coming over the next 5 years. As well as supporting the development of many specialist PMH community teams across the country, this money will also support 4 new Mother and Baby Units across England so offering many more beds than are currently available for those women with the most severe type of PMH problems.
However, there is no money pledged yet for a Mother and Baby Unit in Wales and there was a strong Welsh presence yesterday including Mark Williams who is one of the leading PMH voices in Wales raising awareness of how fathers as well as mothers may be affected. The impact and reach of his work is admirable and his story again is one that has, and will, motivate many others to come forward and seek the help they need.
As Beverley Turner outlined – the importance of words cannot be underestimated, women too often become “passengers” in their own journey when it comes to pregnancy, birth and parenting. There needs to be more discussion, more debate, more myth busting – and we all have a role to play in that dialogue.
There is a feeling of momentum in PMH at the moment with more awareness, more investment and an increasingly vocal community on social media breaking down some of the stigma of PMH illness. This together with the collective buzz of optimism and tangible sense of hope as was seen in the audience yesterday must be the oxygen to this flame. Remembering the days of starched white coats and blue Bunsen burners – to ignite a fire with fuel and oxygen, all you need is a spark.
And that bright spark was Mr Raja Gangopadhyay, an obstetrician with a special interest in PMH, who by organising #Hopedec09, has done something very wonderful indeed. He has ignited a fire in the hearts and minds of those within the PMH community to continue in their work to improve the lives of all affected by PMH problems for this generation, and beyond.
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“Mums, Mental health and Welsh cakes”

My first post for @HuffPostUK!  published 29/11/16

Vacant seats in our surgery waiting room are a lot like my granny’s welsh cakes – a bit too thin and never quite enough of them, especially these days. Once the front doors open at 8.30am there is a constant hustle and bustle past ever patient receptionists – gouty toes throbbing, the widowed sobbing, young children whimpering, sports injuries limping. They scan the room for the few places to sit and once spotted, move with some speed to claim them. Some concentrate on avoiding eye contact, others look for those they know – old friends, new in-laws, next door neighbours. The electronic call system interrupts the chitchat and by the time that person is up and walking down the long corridor to see their GP or Nurse, someone else has slipped onto the warmed up seat. I sometimes wonder what impression this might give someone new to the surgery of what to expect the other side of my consulting room door.

“Is the doctor busy? Yes. Is she running late? Almost certainly. Is she going to be able to help me today? Perhaps she won’t have time.”

Consider this scenario: an anxious new mum, sat in those seats in the corner trying to settle her 6 week old colicky baby. Whilst half the waiting room coo over this new bundle-of-joy, she is feeling confused and holding back the tears. It may have taken significant courage to actually pick up the phone and book this appointment. She may feel like she is a terrible mother, not deserving of such a beautiful baby. She is quite likely to have considered if coming today will lead to social services getting involved. But she’s made it and now she’s sitting in front of me, crying her eyes out, mascara running down her tired face. I have only 10 minutes to help fix her broken world and for a few seconds, I hesitate. I feel a searing pang of guilt for not having had the same experience of motherhood. And then 13 years of training kicks in.

I listen, validate, listen, reassure, listen, offer hope, and listen again.

There are many common misconceptions about Perinatal Mental Health problems (affecting pregnant women and those up to one year after giving birth) and Health Professionals of all specialities can make a real difference by correcting these myths.

“Yes, parenthood is hard but no, not all women experience these symptoms. No, this is absolutely not your fault. No, this doesn’t make you a bad mother. And no, I’m not phoning a social worker.”

By the time I reach the point of discussing treatment options, I am inevitably running late but I need to keep going. Talking therapies may be helpful, referral to our Health Visitor, online Cognitive Behavioural Therapy, local Mother and Baby group details, Third Sector organisations offering on-line supervised peer support and for some, safe medication options. Too much to take on board today, perhaps, so I will signpost her to the RCGP Perinatal Mental Health Toolkit and arrange a follow up consultation in a week or two. I keep listening and help her formulate a plan that she finds acceptable. The recipe for recovery from mental illness is complex, unique to each person and sometimes difficult to find. A bit like the secrets of grandmothers and their welsh cakes. By the time she leaves my room and walks back out into that waiting room, she has something that she doubted I had time for, she has hope.

Launched by the Royal College of General Practitioners in July this year, the Toolkit is a free, open access collection of over 400 resources to help GPs and other health professionals support women and their families facing perinatal mental health problems, as well as having a section specifically for patients too. Find out more here:

http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx

If you think issues in this blog sound familiar for you, a friend or relative – please do speak to your GP and get the help you need.

https://drcarrieladd.wordpress.com/

@LaddCar

Dr Carrie Ladd is a GP in Oxfordshire and works with the RCGP as a Clinical Fellow in Perinatal Mental Health.  Earlier this year, she received some payment from NHS England to create this Toolkit but receives no ongoing funds to promote it.

Tags: Mums, Mental Health, Perinatal Mental Health, GP