The ‘Davina’ effect, menopause and general practice responses to celebrity stories

Nada Khan is an Exeter-based NIHR Academic Clinical Fellow in general practice and GPST4/registrar, and an Associate Editor at the BJGP. She is on Twitter: @nadafkhan

I recently wrote an article here on BJGP Life about HRT shortages.  The current issues with HRT supply are attributed to an imbalance between supply and demand, with a marked rise in the number of women using HRT. Part of that increased demand has been attributed to a TV documentary about the menopause released a year ago by Davina McCall, which has led to what some call the ‘Davina effect’.  The follow-up to last year’s documentary aired recently on Channel 4, leading to industry and government warnings about further HRTshortages driven by demand.

What I find interesting about this kind of high-profile programme is the impact that it has on patient behaviour, and the resulting consequences for healthcare professionals.  Celebrities influence how people think, and act.  Jade Goody, a British reality TV star, died of cervical cancer in 2009, and the publicity surrounding her death is thought to have increased attendance at cervical cancer screening (the so-called ‘Jade Goody effect’).¹  Similar short term effects were seen in increased rates of breast cancer screening following Kylie Minogue’s diagnosis of breast cancer (the ‘Kylie effect)² and Angelina Jolie’s decision to have a risk-reducing mastectomy in the context of BRCA1 status.³ The makers of the more recent Davina McCall documentary say that they expect ‘another wave of women to go to their GPs’ asking about HRT.  But what about the impact of these high-profile cases, or documentaries on us in general practice, and how do we as GPs respond?

Unfortunately, a high proportion of women will never seek help for their symptoms around perimenopause and menopause.⁴  Of those women who do seek help, the majority will see their GP as a first port of call.  Let’s assume that, as a result of a high profile documentary on menopause, more women in the UK will try to speak to their GP about starting, or adjusting their treatment during the menopause.  Is this in itself, a good thing?  Vasumathy Sivarajasingam wrote here in BJGP Life about breaking the silence around the menopause, and makes the point that we don’t speak enough about the menopause with our patients, or offer HRT when its potentially indicated.  While raising the profile of the menopause can hardly be seen as a bad thing, some in the health care profession find this kind of programme difficult, especially if coverage suggests that some GPs are incompetent or dismissive of women’s concerns.

My own scanning of social media and discussions with colleagues led me to categorise responses to Davina McCall’s programme as below:

– GPs who feel that this kind of programme portrays untruths and is ‘GP-bashing’.  These GPs might feel defensive, or angered by anti-GP sentiments in the media or from patients.

– GPs who feel that they are effective advocates for their patients going through the menopause.  These GPs might feel vindicated by their actions.

– GPs who feel that they want to advocate for women through the menopause and welcome this kind of programme.  These GPs might feel a need to increase their knowledge in this area given that they expect to have more conversations with patients about the menopause and HRT.

Our alignment with one or more of the above groups might be fluid or overlapping, but perhaps it is worth reflecting on our own responses.  Negative stereotypes of GPs are entrenched in the media and can contribute to emotional exhaustion and subsequently impact decisions about whether to leave practice.⁵  Barry and Greenhalgh suggest that we should rise to the challenge, and develop our own counter-narratives when GPs are depicted in the media as clinically incompetent.⁶

Patients might have questions about the information provided in Davina McCall’s programme, and The British Menopause Society has produced a response which provides some information about indications for HRT, prescribing testosterone and specialist clinics.  Can we harness the power of celebrity?  Celebrity stories can influence health seeking behaviours, and using these narratives may be an effective way to communicate with patients about health promotion.⁷  At the very least it’s worth acknowledging the impact of high-profile stories on our patients, the portrayal of general practice in the media, and ultimately, our own responses and actions as a result.

References

1. Lancucki L, Sasieni P, Patnick J, Day TJ, Vessey MP. The impact of Jade Goody’s diagnosis and death on the NHS Cervical Screening Programme. J Med Screen. 2012;19(2):89-93.
2. Kelaher M, Cawson J, Miller J, Kavanagh A, Dunt D, Studdert DM. Use of breast cancer screening and treatment services by Australian women aged 25-44 years following Kylie Minogue’s breast cancer diagnosis. Int J Epidemiol. 2008;37(6):1326-32.
3. Evans DG, Barwell J, Eccles DM, Collins A, Izatt L, Jacobs C, et al. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Breast Cancer Res. 2014;16(5):442.
4. Constantine GD, Graham S, Clerinx C, Bernick BA, Krassan M, Mirkin S, et al. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reprod Health. 2016;22(3):112-22.
5. Sansom A, Terry R, Fletcher E, Salisbury C, Long L, Richards SH, et al. Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England. BMJ Open. 2018;8(1):e019849.
6. Barry E, Greenhalgh T. General practice in UK newspapers: an empirical analysis of over 400 articles. Br J Gen Pract. 2019;69(679):e146-e53.
7. Marlow LA, Sangha A, Patnick J, Waller J. The Jade Goody Effect: whose cervical screening decisions were influenced by her story? J Med Screen. 2012;19(4):184-8.

Featured image by Francisco on Unsplash