Author: BJGP Life

Exercise and sudden death in older athletes

John Brooks is a GP from Congleton. The early works of Morris and Rose suggested that those who were more physically active had less coronary heart disease than those who had a more sedentary way of life. The rise in popularity of running in the 1970s and 1980s led to some exaggerated claims that marathon running could somehow give immunity to coronary heart disease. Cases of sudden death in marathon races get a lot of publicity but the risk is probably no higher than people going about their daily activities. Sudden death from cardiovascular disease in young athletes is low and thought to be mainly due to inherited or congenital abnormalities. The most common of these is hypertrophic cardiomyopathy with a smaller group made up of such conditions as Wolf-Parkinson White syndrome, Marfan’s syndrome and mitral valve prolapse1. The cause of the sudden death is a fatal cardiac arrhythmia that occurs in a seemingly fit athlete. Gentle jogging three times a week seems to be relatively safe and good for your health2 but how safe is long term endurance and intensive exercise particularly as we get older ? This question is important for those athletes who want to perform well at club level and elite athletes. Studies of cardiac adaptation to acute and chronic participation in endurance sports have shown both enzyme changes and evidence of cardiac remodelling.3 We...

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BJGP Book Review: Out of Chaos Comes a Dancing Star

Out of Chaos Comes a Dancing Star: Notes on Professional Burnout by Chris Ellis. OpenBooks Press, 2014, PB, 95pp, £18, http://www.lastoutpost.info This book review was written by Ami Sweetman and was in the April 2015 issue of the BJGP. The author of this book has a fellowship and doctorate in family medicine, and from 2005 to 209 was an associate professor of family medicine at the University of the United Arab Emirates. He is now back home, semi-retired, and doing family practice in Pietermaritzburg, South Africa. The opening quote from the philosopher Friedrich Nietzsche sets the tone, ‘Out of chaos comes a dancing star’, which in its fuller context reads: ‘One must have chaos in oneself to give birth to a dancing star.’ The text derives from his collection of notes taken from experience, workshops, and courses on the management of stress and burnout in medical doctors, and those involved in the healing professions, although he says it applies to all professionals whether in law, business, or driving the school bus. Stress is a common theme risking progression to burnout. His work shows that understanding another person’s trials and tribulations can be a source of inspiration. Although the text has a serious undertone it sparkles with wit throughout. Insights into some of the struggles experienced by healthcare professionals are revealed, creating an awareness of the similarity of concepts and conditions encountered by all doctors....

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The BJGP Student Writing Competition

A huge thanks to everyone that submitted entries to this year’s competition themed ‘The GP in the Digital Age’. We have received many wonderful entries and we are just in the final stages of judging. The people on the shortlist have now been notified by email and we will be announcing the winners next...

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Essential law for GPs: if CPR would be futile what do I tell my patient?

Adam Sandell is a GP in Cumbria, and a barrister at Matrix Chambers. If CPR would be futile, do I have to tell my patient about a decision not to attempt it? The busy-doctor answer: Normally, yes. In more detail: Mr Bloggs has end-stage COPD. He knows he’s unwell. But he’s an anxious man with an anxious family. He hasn’t asked you about prognosis. And he’s deteriorating. Forward planning seems wise: indeed, the General Medical Council says that, when patients become clinically unstable and there’s a foreseeable risk of arrest, a judgment about the likely benefits, burdens and risks of CPR should be made as early as possible. You reckon CPR would be futile, so a decision not to attempt cardiopulmonary resuscitation (‘DNACPR’) looks right. Were Mr Bloggs to arrest, pummelling his chest in the back of an ambulance to nowhere will do no-one any good. So surely there’s no need to cause him further distress by discussing this with him? It’s futile, so isn’t it as relevant as discussing whether you’re going to certify him fit to climb Kilimanjaro? Not so, said the Court of Appeal last year in a case called Tracey. Mrs Tracey had lung cancer and was on a ventilator following a road accident. An intensivist completed a DNACPR form without discussing it with Mrs Tracey (who was apparently conscious and communicating at the time)...

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Essential law for GPs: discussing treatment risks

Adam Sandell is a GP in Cumbria, and a barrister at Matrix Chambers. A Supreme Court judgment last week changed the law about the discussions we need to have with patients about the risks posed by treatment. “Doctor knows best” has just suffered another stroke. The busy-doctor version: We must discuss with patients any material risks involved in proposed treatment, as well as reasonable alternative approaches. A risk is ‘material’ if the patient is likely to attach significance to it. Ask yourself whether knowing about the risk might alter the patient’s decision: if so, tell the patient about it. If you’re more interested: Remember the Bolam test? Bolam’s the case about breaching your duty of care. You’re not negligent if you act in accordance with a practice accepted as proper by a responsible body of medical opinion, so long as the practice isn’t nuts. Until now, Bolam was how the courts determined what we have to tell our patients about the risks of treatment. You didn’t have to discuss a particular risk if there were other suitably-qualified doctors who wouldn’t have done so. That’s been changed by Montgomery, a Supreme Court case last week. Mrs Montgomery was small, diabetic and pregnant with a large baby. Her obstetrician didn’t normally warn such women of the risk of shoulder dystocia because she believed the risk of serious harm to be small,...

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The British Journal of General Practice and BJGP Open are bringing research to clinical practice. This is where we add the debate and opinion to help ensure everyone benefits from that research.

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