Alex Burrell is a GP in Bristol.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.
Sit-stand desks
I have a few colleagues in my practice who use sit-stand desks, and being stood rather than slumped during the lunchtime admin push must be doing some good for their physical health. I have, however, always wondered how this works during consulting and worry about being stood looming over patients in a very physical representation of the power imbalance. This study in general practices in England addresses these fears:1 42 GPs were given a sit-stand desk to use for 4 weeks and both GP and patient views on standing during consultations were gathered. Interestingly, only 44.4% of GPs used their sit-stand desk during face-to-face consultations every day, probably explained by the fact that GP preference whether to stand or sit was based on what the patient was doing. Most patients had no preference whether their GP was sitting or standing and thought it had either no impact or a positive impact on the doctor–patient relationship, the GP’s ability to listen, and the patient’s ability to understand the issues discussed.
Gallstones
Unusually for Yonder, this next study is a ‘Parallel group, multicentre patient randomised superiority pragmatic trial’:2 adults with symptomatic uncomplicated gallstones were randomised to either laparoscopic cholecystectomy or observation/conservative management. The primary outcome was quality of life over 18 months, with secondary outcomes over 24 months follow-up including condition specific quality of life, persistent symptoms, complications, and need for further treatment. There was no evidence of difference in overall quality of life, complications, or need for further treatment, but condition-specific quality of life and persistent symptoms did favour surgery. The within-trial economic evaluation is interesting: switching from current standard practice of laparoscopic cholecystectomy to conservative management would result in a ‘saving of £55,235 per [quality-adjusted life year] forgone.’ The authors conclude that conservative management may be a ‘cost-effective use of NHS resources in selected patients’ in the short-term, but longer-term follow-up is needed.
Student interest in general practice
Recruitment and retention are key to increasing the GP workforce: we will only be able to recruit if medical students are interested in general practice and see it as a stimulating and sustainable career option. This pilot teaching study involved 18 fifth-year medical students at Queen Mary University of London, incorporating 120 teaching hours over 36 months running concurrently with students’ usual GP placements.3 Six strategies were used in this educational approach: mentorship and storytelling; community home visits; interactive patient cases; innovation and research; the business of medicine; and GP speciality clinics. The overall aim was to ‘challenge existing misconceptions and ignite interest in a career in general practice’. In mid- and end-of-placement questionnaires, perceptions of and interest in general practice had improved qualitatively and quantitatively. Providing students with these ‘immersive, hands-on experiences’ and long-term access to a GP mentor seems to be key. A future study following these students up and exploring why they subsequently did or did not go in to general practice could be valuable.
Family healthcare patterns
Functional somatic symptoms (FSS), physical symptoms that cannot be explained by organic pathology, are the focus of this Danish study.4 FSS are more common in patients with a family history, which the authors suggest is at least in part due to social learning from ‘parental cognitive, emotional and behavioural responses to their own and their child’s symptoms’. To understand whether family healthcare behaviours contribute to ‘transgenerational transmission of FSS’, they therefore explored associations between healthcare use during the child’s first years of life (aged 0–4 years) and childhood FSS at age 5–7 years. Parental healthcare use, including GP and secondary care contacts, was associated with child FSS at 5–7 years, though this was a small effect size (odds ratio 1.02, 95% confidence interval = 1.01 to 1.04, P = 0.04). This pattern does feel like it plays out anecdotally in clinic: a useful next step could be designing and testing an intervention to try to break the cycle, though there may be many contributing and confounding factors.
References
1. Biddle GJH, Thomas N, Edwardson CL, et al. Feasibility and acceptability of general practitioners using sit-stand desks: a feasibility trial. BMJ Open 2024; 14(6): e084085.
2. Innes K, Ahmed I, Hudson J, et al. Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT. Health Technol Assess 2024; 28(26): 1–151.
3. Jerjes W, Kelada M. Revitalising interest in general practice: innovative educational strategies to transform medical student perceptions in the UK. Educ Prim Care 2024; DOI: 10.1080/14739879.2024.2364869.
4. Hogendoorn E, Münker L, Rimvall MK, et al. Family healthcare patterns as a proxy for transgenerational transmission of functional somatic symptoms in early childhood – a longitudinal cohort study. J Psychosom Res 2024; 184: 111805.
Featured photo by TheStandingDesk on Unsplash.
