When did respect for family GPS end?
The difficulties encountered by many in making an appointment to see their family doctor can only get worse, given – as reported in this paper last week – almost half of those interviewed in a recent survey intend to retire within the next five years.
The list of reasons cited include (predictably) “excessive bureaucracy – we are grossly over-managed”; “unrealistic patient expectations”; “lack of recognition of the value of general practice”; “unsustainable increase in workload, leading to stress and exhaustion”.
Some of these are more remediable than others, but reading Another Doctor in the Forest,
Dr Chris Nancollas’s vivid and entertaining account of his time as a GP in the Forest of Dean, it is salutary to note that, compared to nowadays, his workload was truly staggering.
Besides two always busy surgeries a day, there would be a dozen or more house calls spread over an area of 70 square miles, while he was also on call for emergencies every second night and weekend.
“The job may have been my life,” he writes, “but it was a life worth living, and our patients made us aware they appreciated our efforts.” How times change!
Sound sleep advice
Repetitive nightmares, as mentioned last week, predispose to sleep deprivation and exhaustion by causing those experiencing them to wake in such an agitated state, they have difficulty dropping off again. So, too, nocturnal panic attacks. A reader writes: “I wake with my heart racing, breathless and my body tingling.”
The general view would be that these are no different from daytime episodes due to stress or chronic anxiety – but it is necessary to consider whether there might be some underlying physical cause that needs addressing.
The possibilities here are, first, acid reflux – being woken by the discomforting pain of heartburn, gasping for breath from a reflexive increase in respiration. Alternatively, the acid can tip over into the larynx, irritating the vocal cords and causing them to contract – laryngospasm – resulting in a sudden awakening from sleep due to feelings of acute suffocation and intense fear.
Then, the impaired ventilation of the lungs in those with obstructive sleep apnoea can convey the impression of being choked, so the patient wakes, struggling to breathe and with the heart racing. Appropriate treatment of both conditions should abolish the “panic attacks” and ensure a good night’s sleep.
Post-flu fatigue
This week’s medical query comes courtesy of Mrs JS from Dorset, who writes that several of her acquaintances had a nasty bout of flu this winter, despite having had the jab.
Three months on, “we are simply not the people we were,” she writes – with markedly reduced energy levels and cognitive function. Their respective family doctors have given the usual advice on coping with post-viral debility, but might anyone, she wonders, know some way they might “restore our confidence and ability to get on with our lives”?
Bell-ringing benefits
Finally, along with the merits of hymn-singing in boosting the lung function of those with respiratory problems, as recently mentioned, Prof Antony Narula, formerly of London’s St Mary’s Hospital, commends another church-related activity.
“Several of my patients have benefited from bell-ringing,” he writes, which he attributes to a strengthening of their extra thoracic muscles.
A survey of campanologists published in the British Medical Journal several years ago revealed several further advantages. A man with a couple of slipped discs found that pealing the large bells provided excellent relief from his back pain, “especially if the sally was caught high”.
Another reported that it had loosened the contractions of his hand and elbow following a serious road traffic accident.
Furthermore, the rhythmical action of pulling on the rope encourages the flow of blood and lymph back up the arm – an effective preventive measure, as observed in this column before, against lymphoedema, the swelling that so often complicates breast cancer surgery.
Please email your medical questions confidentially to Dr James Le Fanu at drjames@telegraph.co.uk