Tag: consultations

A GP’s tips to other clinicians when speaking with people who want to lose weight

kaitiscotlandLeave a comment
Photo by Vitaly Gariev on Pexels.com

Adapted from BMJ 24-31 January 2026 Dr Ellen Fallows. British Society of Lifestyle Medicine.

Although the NICE guidelines say that clinicians should always ask permission before discussing obesity with patients, in my experience as a GP, this is still seen as a barrier to mutual understanding by patients.

Unless a patient has come to the surgery to discuss weight loss, I have not found it helpful for me to bring the subject up. Instead, I use the time to explore potentially modifiable drivers of symptoms that matter to the person in front of me. This means less time assessing the degree of obesity, and more time assessing its causes.

For instance, if a patient has knee pain or type two diabetes, I could ask: Do you ever have difficulty making ends meet at the end of the month? When did you last eat a green leafy vegetable? Are you a shift worker? What does your job involve?

Understanding a person’s life can avoid discussions about numbers on scales. Often fatigue, pain and low mood, matter more to the patient than body mass index.

New weight loss medications are seen as simple quick fixes, but weight tends to return once they are stopped. These treatments have their place, but need to be used alongside core interventions such as help to improve diet, relationships, and sleep, increasing physical activity, and reducing stress and harmful technology use.

GPs may be able to help their patients get adjustments made to shift work, or increase activity through discounts to council run gyms, or referrals to a social prescriber, health coach or dietician. Multiple symptoms can improve with these interventions without discussing weight.

The most important question is: What matters most to you right now about your health? This gets back to old style GP work rather than ticking off the QOF indicator markers that were often surrogate markers for poverty, food insecurity, sedentary and stressful jobs, shift work, social isolation, technology harm, and smoking and alcohol use.

Ultimately this approach can avoid adding to polypharmacy and overprescribing harms, when for many people the problem is food.

What experts say about getting blood out of stones

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Is getting blood out of you a trial for health care staff? If so, help is at hand, according to Associate professor Keith Dorrington and Clinical Pharmacologist Jeffrey Aronson from Oxford University.

They reckon, that perhaps taking blood in the opposite direction, could be the solution for someone for whom the regular tourniquets, hands and feet in hot water, hanging the arm or foot down and gently tapping and stroking veins has failed.

When you have a chronic condition like diabetes, but possibly more so with cancer treatments, someone is always after blood samples. Sometimes a lot. A good sized black pudding’s worth some days. Or at least that is how it seems. When the red stuff fails to flow, all sorts of tricks can be employed but sometimes all you get is tears on both sides. From my own experience I would say that sometimes the best thing to do is to leave it to someone else. Once you have tried two or three times, confidence is lost on both sides and it is best to jack it in.

William Harvey described the circulatory system in the 17th century. The blood flows from the heart to the periphery, that is the hands and feet, and then back up arms and legs via the veins to the lungs and then back into the heart. The Oxford due have discovered that if you put in a small venflon into the smallest vein it will gradually fill up with blood that was intended to go back to the lungs if you put it in facing the fingers.  Worth a try?

Based on BMJ Article 17 Jan 2015

Your (burnt out) doctor will see you now……

EmmaLeave a comment

There never has been some mythical golden age when every patient got the time they really needed with their General Practitioner, but seeing your GP is expected to get even harder.

Reviews by both the Centre for Workforce Intelligence and GP taskforce have concluded that the UK has too few GPs and the ones that we do have are increasingly stressed, burnt out and feel unable to deliver health care safely.

GP funding is 8.3% of the cost of the NHS in return for providing 90% of medical contacts. This percentage of funding is at an all-time low. Failure to keep pace with the aging population, complex illness, cancer survivors, the rising female workforce, the doubling of specialist doctor workforce and the tendency for GPs to prefer portfolio careers to full time General Practice all have played a part in the current workload/manpower mismatch.

Dr Veronica Wilke, professor of primary care from the University of Worcester, says, “Students and trainees who witness stressed, burnt out GPs, who feel isolated and unsupported, are unlikely to choose general practice for a career. Preventing attrition in the existing workforce is as important as recruiting new trainees. Hospitals have fewer beds, and the call is for more care in the community. GPs and primary care nurses are retiring, leaving and emigrating. Cornwall, Reading and Bristol cannot recruit enough GPs to keep practices open and training schemes remain unfilled.”

So, what can you do to prevent your GP getting sectioned into the local mental hospital or running off to Australia?

Here are my tips:

  1. Think about what you want to achieve in your consultation with your GP.
  2. You only have ten minutes, so either one big thing or two small things is realistic.
  3. Write these things down. Use the Patient Concerns Questionnaire from our book.
  4. Do you need to see a GP for any of these things? Sometimes a nurse, health visitor or health assistant would be more suitable. There are often ways for obtaining results or repeat prescriptions or immunisations that the practice has already set up.
  5. Make the appointment in the name of the person who is to be seen.
  6. Don’t ask for other family members issues to be squeezed in while you are there.
  7. If you can possibly come to the surgery instead of asking for a house call do this.
  8. If your issues can be dealt with by phone is there a way this can be sorted out by the practice?
  9. Be as well educated as you can about the illnesses you have and on keeping yourself fit and well.

Now, it’s time we heard from you.

Have you noticed any change in how your General Practice care has been affected by the manpower crisis?

Have you any other tips to help patients get efficient service from their GP team?

Any tips for these stressed GPs and practice nurses?

Based on an article by Veronica Wilkie: BMJ 2014;349:g6274