Screening is often held up to the general population as ‘a good thing’, rivalled only by apple pie and motherhood, but many GPs will, as Mant alludes to in his editorial this month on health checks and screening, have reservations at some level. Screening and cardiovascular health feature strongly in the BJGP this month and we present research that will inform debate on the best approaches. NHS Health Checks are explored further in the Debate & Analysis article by Dalton and colleagues but Mant suggests that ‘this NHS preventive flagship merits scuttling because it’s unfit for purpose.’
Perhaps some GPs feel in their bones, without being able to name it, the pull of ‘quaternary prevention’. This is defined by WONCA as ‘action taken to identify patients at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable’.1 It’s a concept whose time may have come and, of course, it’s not just patients who suffer harm from overmedicalisation. The editorial by Dobbin on burnout draws this out and it is implicit in Nigel Mathers’ perceptive James Mackenzie Lecture, recognising the pressures on the system and the individual, and offering GPs the ‘Tao of family medicine’, an approach that might just help keep burnout at bay.
Communication is key, as ever, and research by Korhonen and colleagues recognises the importance of a patients’ self-rating of their health to pick up disease that is otherwise missed in screening processes. We also publish a systematic review looking at screening for cardiometabolic risk in primary care (Koekkoek et al), and research on the prevalence and cost of treating uncomplicated stage 1 hypertension (McManus et al). Research showing the marked variation in cardiovascular risk prediction tools exposes the need for doctors and patients to have these discussions. Julia Langan Martin and colleagues present evidence of how physical health indicators are not being recorded in major mental illness.
Baby boomers may wince, but the editorial on the future funding of health and social care in England by Stephen Gillam is a clear-eyed appraisal of the enormous challenges that lie ahead. Lim and colleagues report on delays in diagnosis in symptomatic cervical cancer (not to be confused with screening) and the accompanying editorial by Fiona Walter et al teases out practical measures practices can adopt.
Elsewhere in the BJGP we cover sight-threatening diabetic disease (Symes et al), use of non-contact infrared thermometers (Wang et al), and we have a Research into Practice article on the management of atrial fibrillation (Fitzmaurice and Hobbs). The importance of clinical intuition has been shown in areas such as serious childhood illness,2 but doctors may have a blind spot when it comes to alcohol. Research in the BJGP this month (Saeys and Cammu) suggests that doctors smoke less but, in line with the old saw, drink more than their patients. Our relationship with alcohol is complex but this fits with evidence showing GPs are poor at picking up problem alcohol drinking unless it lurches into full-blown dependence.3 Moscrop and MacPherson present the case, in a Debate & Analysis article, that if we are really going to address health inequities we should consider recording patients’ incomes. It is, as they acknowledge themselves, an uncomfortable proposal but one with huge potential.
Finally, you will notice that further improvements to the BJGP website have now been rolled out. You’ll find all our content — from the current issue to the first publication in 1953 — is now easier to access on desktops and mobile devices, with new mechanisms to comment and engage in debate.
- © British Journal of General Practice 2014