Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
Life & Times

Yonder: Obesity communication, opioid deprescribing, actinic keratosis, and artificial intelligence

Ahmed Rashid
British Journal of General Practice 2019; 69 (684): 350. DOI: https://doi.org/10.3399/bjgp19X704417
Ahmed Rashid
UCL Medical School, UCL, London. Email:
Roles: GP and Senior Clinical Teaching Fellow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: ahmed.rashid@ucl.ac.uk@Dr_A_Rashid
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading
Figure1

Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature

Obesity communication

It’s easy for policymakers and commentators to suggest that GPs should opportunistically offer weight management advice. Clinicians recognise, though, that initiating these discussions can be extremely challenging. Not only do they require a considerable amount of time that often isn’t available, but they also have the potential to be perceived as offensive, which means that they could cause disharmony in the clinician–patient relationship, potentially undoing years of carefully developed bonds. A team of researchers recently used discourse analysis to examine how UK GPs talk about obesity.1 Their findings suggest that GPs both reproduce and resist moral discourse surrounding body weight. They construct obesity as an individual behavioural problem, while simultaneously acknowledging the sociocultural, social identity, and stigma issues that are associated with it. They suggest that these competing frameworks may contribute to increased tension and powerlessness for GPs. The paper concludes that this uncertainty among GPs actually echoes the societal and political landscape they are working with, and therefore has no simple solutions.

Opioid deprescribing

Opioid analgesic drugs should not be first line in chronic non-cancer pain and the harms associated with their use have been well documented. In the last couple of years there has been considerable focus on this problem in the US, and other countries are following suit. In Australia, the use of opioid analgesics has quadrupled in the last two decades and a recent study in an Australian primary health network investigated influences on opioid deprescribing.2 In a survey of GPs, only half agreed that opioid analgesics should be reserved for people with acute cancer pain or palliative care. GPs were less likely to deprescribe when effective alternative treatments were lacking, and various patient factors (for example, fear of weaning) were reported to decrease the likelihood of deprescribing. Overall, many GPs held attitudes at odds with local guidance. The authors suggest the GPs need more training. I wonder whether they actually need more nuanced and realistic guidelines.

Actinic keratosis

Actinic keratosis (AK) is a long-term skin condition caused by chronic skin exposure, and the incidence is steadily increasing. The current management of AK varies widely within and between primary and secondary care. Like their UK counterparts, Dutch GPs are the gatekeepers to specialist care, and are therefore critically important to the overall healthcare impact of high-volume conditions such as AK. In a recent study from the Netherlands,3 GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK. They mainly applied cryotherapy or referred to secondary care due to lack of experience, varying in their applications and providing mostly patient-driven follow-up care. A more joined-up approach between dermatologists and GPs is the main recommendation from the authors, along with improved patient resources to support the shared decision-making process.

Artificial intelligence

You can’t open a medical magazine or journal nowadays without reading about how AI is going to ‘disrupt’ medicine and health care. I like to think that GPs are (rightly) some of the most sceptical of all healthcare workers, so I was interested to read a survey of UK GPs’ opinions about the likelihood of future technology to fully replace GPs in performing six key primary care tasks.4 Perceived limitations included the beliefs that communication and empathy are exclusively human competencies; many GPs also considered clinical reasoning and the ability to provide value-based care as necessitating physicians’ judgements. Perceived benefits of technology included expectations about improved efficiencies, in particular with respect to the reduction of administrative burdens on physicians. Overwhelmingly, GPs considered the potential of AI to be limited. Given the current political preoccupation with ‘digital health solutions’, let’s hope that clinical considerations are not sidelined in policy decisions.

  • © British Journal of General Practice 2019

REFERENCES

  1. 1.↵
    1. Blackburn M,
    2. Stathi A
    (2019) Moral discourse in general practitioners’ accounts of obesity communication. Soc Sci Med 230:166–173.
    OpenUrl
  2. 2.↵
    1. White R,
    2. Hayes C,
    3. Boyes AW,
    4. et al.
    (2019) General practitioners and management of chronic noncancer pain: a cross-sectional survey of influences on opioid deprescribing. J Pain Res 12:467–475.
    OpenUrl
  3. 3.↵
    1. Noels EC,
    2. Lugtenberg M,
    3. van Egmond S,
    4. et al.
    (Feb 22, 2019) Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists. Br J Dermatol doi:10.1111/bjd.17818, [Epub ahead of print].
    OpenUrlCrossRef
  4. 4.↵
    1. Blease C,
    2. Kaptchuk TJ,
    3. Bernstein MH,
    4. et al.
    (2019) Artificial intelligence and the future of primary care: exploratory qualitative study of UK general practitioners’ views. J Med Internet Res 21(3):e12802.
    OpenUrl
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 69 (684)
British Journal of General Practice
Vol. 69, Issue 684
July 2019
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Yonder: Obesity communication, opioid deprescribing, actinic keratosis, and artificial intelligence
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Yonder: Obesity communication, opioid deprescribing, actinic keratosis, and artificial intelligence
Ahmed Rashid
British Journal of General Practice 2019; 69 (684): 350. DOI: 10.3399/bjgp19X704417

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Yonder: Obesity communication, opioid deprescribing, actinic keratosis, and artificial intelligence
Ahmed Rashid
British Journal of General Practice 2019; 69 (684): 350. DOI: 10.3399/bjgp19X704417
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • Obesity communication
    • Opioid deprescribing
    • Actinic keratosis
    • Artificial intelligence
    • REFERENCES
  • Figures & Data
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Despite coronavirus, general practice is still the best job in the world
  • Addressing the elephant in the room: COVID-19 vaccine hesitancy in Black and Asian communities
  • Yonder: Social distancing, point-of-care ultrasound, Irish GPs’ educational needs, and retirement
Show more Life & Times

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242