Quick Post – Top Tips to Prevent a Fall: A Truly Twittering Collaboration

At first glance it is easy to dismiss Twitter as being the domain of people with both too much time on their hands and hot air in their mouths, but that would be to ignore some of the fabulous collaborative work that can take place when like-minded people are connected together.

It is hard to see how anything other than Twitter could have connected an Occupational Therapist from Leeds with the Chair of the Royal College of General Practitioners in London. Even the fact that they fall either side of the great spelling divide that separates the Clares and Claires of this world, could not prevent Claire OT (@claireOT) from getting together with Clare Gerada (@clarercgo) to produce an excellent, elegantly simple guide to preventing falls in the elderly. If this issue affects you in any way, they are happy for it to be shared and it is well worth a look:

10-Top-Tips-for-Falls-Prevention

Quick Post: Which Word Best Describes the Optimal Diagnosis of Dementia?

In my post: Early Diagnosis of Dementia, Cui Bono I questioned the use of the word “Early” and how it could easily be transformed in the minds of policy makers away from getting prompt diagnosis to those who are unwell and in need, into screening the healthy for early signs of the disease.

My preferred term was to talk of ‘Prompt’ diagnosis – but is it the best word for the task? Prompt implies a lack of delay for those who need to be referred, but does it sufficiently involve the patient? There was a fascinating discussion on Twitter last night where people came up with some great alternatives – each significantly changing the emphasis on what we should be trying to achieve. I have brought the discussion together into a short Storify post which can be viewed here and is worth a quick read.

The Binscombe Express rides again! The Triumph of Common Sense and the Power of Twitter

When the Infection Control lead for Surrey PCT advised me that the wooden train set in my consulting room would be deemed an unacceptable infection risk by the Care Quality Commission (CQC), I responded like most of us do when faced with a powerful figure in authority. That is to say: I muttered about it, sulked a bit, complained loudly to my family, and then assumed that nothing could be done. After a few days I thought I would write a blog on the subject – after all, then I could mutter, sulk and complain for a bit longer, and to a few more people – but I still assumed that nothing could be done, and duly complied with the order from above.

It was when I shared the blog on Twitter that things started to get interesting. It stimulated a moderate response at first, but an encouraging one. One or two people commented and added their complaint to mine, there was the odd retweet and I at least felt listened to. Then, on Sunday night I came across a tweet concerning a piece of research that demonstrated how unlikely it was to transmit infection via inanimate objects – like toilet seats and library books. Emboldened by the previous support I had received, and empowered by this piece of evidence, I posted a link to the blog again, and asked if anyone was aware of any research on the subject of toys in GP surgeries, stating that I might try to contest the instructions we had received.

They say that timing is vital on social media sites, and (by accident rather than design) the timing on this one was just right – it was about half an hour after Andy Murray’s heart-breaking defeat in the final of Wimbledon and the Twitter world, which had been in a peculiar slumber during four tense sets of tennis, had suddenly woken up. Maybe it was a lingering desire to support the cause of the under-dog, or perhaps the idea of bureaucrats taking a child’s toys away really struck a chord, but within minutes GPs and patients alike were tweeting and retweeting faster than I could keep up.

The cause came to the attention of Margaret McCartney, a GP in Glasgow who knows how to fight for a just cause (her blog is well worth a look, as is her book The Patient Paradox). She immediately involved the CQC in the conversation (I had not even thought they might be on Twitter!) and resolved to get a response from them the next day. Before I had finished my morning surgery there was a clear statement from the CQC (see comments on my previous blog) that they had no problem whatsoever with toys, wooden or otherwise, and that Infection Control teams were being over zealous in their advice. By mid-afternoon Surrey PCT had backed off somewhat, issuing a media statement to that effect, and I was being interviewed by The Telegraph!

I am delighted that Binscombe children will now be able to play trains in my room for years to come, and my faith has been restored in the CQC. I’m just as encouraged by the media attention this has received – there was an article in The Telegraph yesterday, the story was also picked up by the GP magazine Pulse, and the Radio 4 programme Inside Health. When I talk to other GPs I find that many are under the same pressure from their Infection Control teams as I was, and we need to get the right message out there.

One of the remarkable features of Social Media is the way it connects people from different disciplines – like GPs, patients and health journalists – and gets them talking together. Even two years ago it was unfeasible that most ordinary GPs would communicate directly with health journalists, and now it can happen on an almost daily basis. Whatever else we think about this internet age there is no doubt that there has never been more opportunity for ordinary people to have an impact – whether it is a GP from Godalming scoring a minor success like this, or something more dramatic like a 14 year-old girl changing the editing policy of a major teen magazine, there is a vehicle for your voice to be heard if you have something interesting enough to say, and the passion to shout about it.

And as for the Binscombe Express? Well the discerning eye will have noticed from the photograph that it is in need of a little attention – sadly, the original 6 carriages I started with 10 years ago have dwindled down to only 3 – the result of some toddlers appreciating its appeal a little too much. Like any responsible Railway Proprietor, however, I intend to invest for the future and replace the missing carriages – well, at least I plan to raid the children’s old Brio set that’s stored away in the loft and see what I can find. Let’s hope they won’t notice!

To Tweet or not to Tweet?

It has taken me a while, but I think I finally get Twitter. I like to think of myself as an early adopter of new ideas and novel technology, but like most of my non-tweeting friends, I assumed that this strange world of 140 characters would be full of the banal comments of the very dull, or the vain utterances of the very famous. Surely even the wit of the excellent Stephen Fry could not compensate for this tedium, and don’t I already get enough of this on Facebook anyway? (except, of course, that I don’t have a single celebrity friend to boast of there).

My brief flirtations with the little blue bird were not helped by the dominance of @ signs and # tags, coupled with confusing, abbreviated hyperlinks, which hampered my attempts to decipher anything at all. I thought it best left for those with more time than sense, and left it sitting comfortably next to day time television as something to avoid.

Recently, however, I have become a convert, and like all new converts I feel a need to evangelise. If you have no desire to succumb to my attempt to persuade you to join up, you would do well to stop reading now – but if you enjoy reading new things on the internet, like this blog, then the chances are that Twitter is for you. The first thing to say about it, is that it is not at all like Facebook. The latter has the potential to both connect you to your family and friends and bore you silly in equal measure, while the former has almost nothing to do with people you actually know, and everything to do with people you would like to be influenced by. If you like where someone is coming from then you can follow their tweets, read what they are reading and be challenged by their point of view, all with the assurance that if you become irritated or offended by their utterances then the unfollow button is just two clicks away.

The beauty of Twitter is not the occasional amusing comment, but the links to interesting newspaper articles, web-based resources and the general intellectual stimulation that is out there. In all my attempts to find other blogging doctors, a Google search has only every resulted in a handful of contenders. Within a week of tweeting among the health community I now have GP blogs coming out of my ears, each one unique and interesting, tackling the same issues I face, but with its own perspective. I have discovered health resources that I never knew existed, and been prompted by the latest research as soon as it is published.

Twitter works much like a newspaper, and the great thing about it is that it is customisable and personal. My own Twitter Gazette, as you might expect, has a weighty health section with several GPs, Health Correspondents from major newspapers, British Medical Journal columnists and the like. A much lighter general science supplement comes next – with the New Scientist taking a lead here – and political interest is kept going mostly by following programmes on Radio 4. I love the fact that my newspaper can combine both print and audio media, or link to the videos of You-Tube or TED talks. What is more, the Sunday supplements that usually go straight into the recycling in my house – namely Fashion, Travel and Money Matters, can be completely absent with no wasted resources. Most of the content I have chosen is of a fairly serious nature, as I hope to learn something and not just be entertained, but since every decent newspaper has a good cartoonist, I follow Larry the Cat for some light relief. This spoof cat from No10 gives an amusing, irreverent insight into life with the PM!

Like any newspaper, I can read it carefully from cover to cover, or I can skim through it if time is short. Unlike my e mails, or even Facebook messages for that matter, if I miss a day or even a week it really doesn’t matter. I may be a little out of touch with the news, but no-one is going to ask why I haven’t replied to their urgent message, and nor will I have an overflowing in-box when I return. Unlike my newspaper, however, I can choose to interact with my virtual newsfeed if I choose to. I can put my own tweets out there, retweet what I find interesting, reply to tweets and join in conversations.

However, what I like most of all about this new medium is that it has something delightfully subversive about it. I think this stems from the fact that most of the content I read has nothing to do with Rupert Murdoch, or anyone like him. For once, I can choose to follow the thoughts of those without an editor hovering over them to make sure that they follow the political agenda of whichever media mogul owns their pen.

So, I shall be tweeting from now on. Love it or hate it, I’d be fascinated to know what you think about the site, and delighted if you would be interested in following me.

Maxims, Axioms and Chronic Pain

There is a maxim that has evolved in western, orthodox medicine that goes something like this: Pain has a cause, the cause can be found, eliminate the cause to eliminate the pain. Coupled with the unearned and undeserved faith that modern medicine always has the technology to search and destroy the cause of pain, this has become deeply embedded into our health belief systems.

On the whole, it is an ideology that serves us well – whether you have sat on a drawing pin, suffered a heart attack or developed appendicitis, there is a cause for your pain and it can be successfully diagnosed and treated, with complete resolution of pain as the expected result. The problem is when a maxim (something that is generally true) starts to gain the status of an axiom (something that is so scientifically self-evident that it is true by definition), and this subtle shift has happened in the popular perception of pain, leaving a trail of confused chronic pain sufferers in its wake.

When pain first develops doctors will try their best to diagnose and treat it. Usually, either because of these attempts or despite them, the pain will resolve in a relatively short space of time. When it persists this usually results in more tests, scratching of heads, experiments with treatment (every prescription is an experiment) and referrals to clever doctors in specialist hospitals for…more tests and more experiments. Often, this too will result in the cause being found and a successful treatment – but what about when it doesn’t? What about a patient who has chronic regional pain syndrome – where all the tests are normal and there is no prospect of a magic bullet to target the cause of the pain? Or severe abdominal adhesions, where the cause is all too evident, but there is no treatment? Patients with these conditions, and many others like them, are not only left in chronic pain, but also confused and bewildered by a medical mindset that promised more than it could deliver, that seems to work for everyone else, but not for them.

Thankfully, in recent years there have been great advances in the understanding of the mechanisms underlying chronic pain, and pain management has begun to get the attention it deserves. Any changes in the attitude to pain, however, take a long time to trickle down into public consciousness. In the meantime there is a significant need to provide readable, supportive information for chronic pain sufferers so that they can move beyond popular perceptions into a greater understanding of their condition.

The world of Twitter is a great way of discovering new resources, and I have just come across two websites that are well worth a look at. The first is the Pain Toolkit which is a very user-friendly site that encourages people to take control of their situation with pain, and work with health professionals rather than rely on them. The second is an excellent self-help leaflet on chronic pain produced by Moodjuice. The Moodjuice website itself is worth a look at as well, as it covers other aspects of emotional health, and is full of very readable self-help leaflets.