Fibromyalgia
Many of my GP role models have been fascinated by fibromyalgia as a diagnostic category and I think that probably has something to do with the unique way in which it crosses the boundaries between biology, psychology, and sociology. It causes much controversy and both doctors and patients seem to be divided in their approaches to it. Over the years since it was first described, the diagnostic criteria have evolved to include fatigue as a key feature. A recent Norwegian study explored how women who had previously suffered from fibromyalgia described tiredness as part of their journey.1 They identified a ‘storyline’ with four key sub-narratives. The first was alarming but ignored tiredness prior to diagnosis. The second was paralysing tiredness during the illness. The third was making sense of tiredness during the recovery process and the final one was integrating tiredness into their current lives. There was a variety of different ways in which women drew on the links between past, present, and future, and varying degrees of success in balancing tiredness with everyday life.
Dentists
We’ve long known about links between oral and general health. In the last decade, though, the evidence has grown and there is now a large body of work showing associations between periodontitis and chronic diseases such as cardiovascular disease and dementia. This finding suggests that cooperation between medics and dentists is an important part of holistic, person-centred health care. In Germany, much like in the UK, medicine and dentistry are educationally and organisationally separate. A German research team recently completed an exploratory study about interprofessional collaboration between GPs and dentists.2 They found that both groups had knowledge gaps about the other profession. Of note, dentists were generally supportive of more collaborative working, whereas GPs felt it was not necessary.
The authors suggest that better links in undergraduate and postgraduate training pathways might be the best way to get the two professions to work together more effectively in the future.
Cancer survivorship
With cancer treatments improving, the focus on survivorship care has continued to grow in recent years. This includes dealing with long-term physical, functional, and psychosocial impairments with a focus on improving quality of life. Although much cancer treatment and follow-up is coordinated by hospitals, the continuous and holistic nature of primary care services makes them ideally suited to coordinate cancer survivorship care. A Dutch research team sought to investigate patients’ opinions about survivorship care.3 Their interviews with patients with colon cancer showed that, although increased GP involvement was considered beneficial, increases in workload and access to secondary care were important considerations. Similarly, although the eHealth application was considered promising, patients were cautious and had particular reservations about the loss of personal contact with a health professional. Irrespective of the setting or format, cancer survivorship care looks set to be an area of increasing importance in the years ahead.
Chocolate
Tabloid newspapers seem to love stories linking foods to health problems. They tend to focus particularly on the commonest and most widely eaten foods (like chocolate) and on the most serious of health problems (like heart failure). A group of Swedish researchers recently provided some material for tabloid journalists with a prospective cohort study of 31 917 healthy middle-aged men who monitored their chocolate consumption online through a self-administered questionnaire.4 Participants were followed up for 14 years using linked records. They found that there was a J-shaped relationship between chocolate consumption and heart failure incidence. Moderate chocolate consumption led to a lower rate of heart failure hospitalisation and death, although the protective association was not seen in individuals who ate more than one serving per day. Whether this study provides anything more than tabloid headlines remains to be seen.
- © British Journal of General Practice 2017