Archive | November, 2014

It’s a fat world, after all.

17 Nov

We know that weight matters. We know obesity is a major health issue and that many illnesses are solely or largely due to being overweight.  Yet surprisingly often, neither doctor nor patient will raise the issue of being overweight. Obesity is – if you excuse the expression – the elephant in the room.

Why do doctor’s not raise the issue?  Sometimes because it’s just too difficult a problem to deal with. Sometimes because we are afraid of insulting a patient or hurting their feelings. Sometimes because we’ve tried so often before (with that patient, or with others) that it’s easier just to give up.

And patients? Well sometimes it’s because they have tried and tried and have also given up. Other times it’s because they don’t think doctors can do much to help.  And sometimes it’s because they don’t realise – or admit – that they have a problem.

In fact the vast majority of obese patients don’t recognise that they have an issue.  A study published this week in the British Medical Journal looked at patients who were obese and what terms they would use to describe their own weight.  In medical jargon, the word obese means a BMI* of 30 or more; Overweight is a BMI of 25 or more.

Amongst patients who are obese only 10% would use that term to describe themselves.  Even the term overweight was only used by about 30%. In both cases, men were less likely to use the term which most accurately describes their condition.

If patients don’t perceive themselves as being overweight or obese, they are less likely to think about the health issues and consequences, much less raise the issue with their doctor.

One of the interesting findings in the study is that it was first conducted in 2007 and again in 2012. The results showed that whilst the number of people who are obese is increasing, the number of people who use the term to describes themselves is decreasing.

Perhaps we live in a world where obesity is now so common that we simply fail to recognise it when we see it – especially in ourselves.

So next time you see your doctor – if they don’t take the initiative to weigh you – then you be the one to raise the issue.

* BMI stands for body mass index. The formula is  Wt (in kg) divided by height (in Metres) squared

BMI = wt/ht^2.   So if you are 75kg and 1.7m tall, your BMI is 75/(1.7)^2 = 75/3.0625 = 24.5.

http://bmjopen.bmj.com/content/4/11/e005561.short?g=w_open_current_tab

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Pop that pill

11 Nov

Lots of patients have trouble taking their medication but German researchers have described two methods that work for most people.

For those trying to swallow capsules, they recommend an old but effective trick. Instead of tipping your head backwards, put the capsule on your tongue, close your mouth, tip your head forward so your chin almost touches your chest then sip water and swallow. Because capsules are light and usually float, the water will lift the capsule up and it will swallow down easily.

For those needing to take a tablet, try putting the tablet on your tongue, purse your lips tightly around a drink bottle and suck in fluid. Swallow immediately. The trick is not to allow any air – if you are doing it right the drink bottle will collapse in slightly because you are sucking so hard.

Try these methods next time you or your family have issues with medication. If they are still not able to get their medication down, come see us about alternatives.

PLANning your visit

6 Nov

A great initiative to come out of New Zealand has been an education campaign to help people PLAN their visit to the GP.
PLAN stands for:
*Prepare – think about what you want to discuss. Make a list of issues; write down key symptoms, dates or events.
*Listen and share – (though really the order is share your experience, feelings, concerns and thoughts with the doctor first, then listen to them after)
*Ask questions – about the tests, the treatment and the explanations. If something isn’t clear, it’s probably because the doctor hasn’t explained it properly
*Notes – write down what you need to do next.

It’s a great structure for a consultation and we’d encourage you to prepare for your visits in that way.

The will to will

2 Nov

We had an interesting phone call last week from a patient wanting to know how to ensure his father’s will would be valid. The elderly father (not a patient of our clinic) wanted to update his will. The solicitor insisted he receive approval from his GP regarding his mental competency to draft the will and therefore sent him to his own GP. The GP performed a brief exam of his mental state and declared that he (the GP) would not be able to provide endorsement of mental competence, and that the patient would need to see a specialist.  The patient who rang us wanted to know if that was correct.

By coincidence, a couple of days later one of the leading medical defence companies put out an advisory note for GPs about what to do when asked to assess a patient for competence.  Essentially, the GP needs to be sure that the patient understands the implications of the will that they are drafting and that there be no evidence that they are under any pressure to fashion it or sign it by any particular family member.

To assess competency, the GP will usually perform a mini-mental status exam – a series of questions that demonstrate short term memory, long term memory and interpretation of instructions. The test is not particularly sensitive but is quick, simple to apply and a reasonable first effort to assess someone’s mental capacity.  Neither a pass nor “fail” (there isn’t actually a fail score – just an indication of degrees of impairment) is an absolute guarantee of competence or incompetence but is a reasonable indication.

The GP would also need to be certain that the patient preparing the will understands the implication of the document they are signing; that they have a good understanding of the assets they are willing and that they have thought about the implications for anyone else that may have a claim to the estate but is not included. Note that some patients with early dementia would still be able to satisfy those standards.

Assuming the above criteria are met, the GP would be able to confirm that the patient has competence to prepare their will. The onus on the GP is actually quite high, and many GPs are very nervous about being subsequently dragged into a court dispute over the will which may involve them being grilled on their experience, expertise and the exact details of the assessment they performed. Therefore if your GP does refer you (or a family member) to a neurologist, geriatrician, psychiatrist or neuropsychologist for further assessment, its not being done just to annoy you, but because the GP is simply not in a position to unequivocally sign the paperwork.

And of course one implication of the above is that you should prepare your will (or ensure your parents prepare theirs) BEFORE any question of impaired competency arises.