Deep Breath In

Prostate cancer screening with Andrew Vickers and Sam Merriel

Common themes for discussion on this podcast include overdiagnosis, approaches to the testing, the ins and outs of explanations, as well as other issues facing GPs who are overburdened, and have limited time and resources to treat patients. A topic which draws all of these themes together is prostate cancer screening. The BMJ recently published a feature which asked whether the UK is ready to roll out a nationwide prostate cancer screening programme, and the linked analysis paper, authored by Dr Andrew Vickers and colleagues, argued that the current model of screening, which determines testing by shared decision making, is the worst approach for detecting prostate cancer. We spoke to Andrew Vickers to discuss this further, and our second interview was with Dr Sam Merriel, regarding the emerging evidence that suggests that taking an MRI scan prior to biopsy could decrease harms associated with overdiagnosis and overtreatment of prostate cancer.   Our guests: Andrew Vickers is an attending research methodologist in the Department of Epidemiology and Biostatistics at Memorial Sloan Kettering Cancer Center, New York. Sam Merriel is a GP, and a researcher on cancer diagnostic testing at the University of Exeter.   Further reading: ‘Is the UK really ready to roll out prostate cancer screening?’ BMJ 2023;381:p1062  ‘Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit’ BMJ 2023;381:e071082   

Long covid update with Trish Greenhalgh and Harsha Master

While the pandemic has officially declared over, the ongoing effects of a covid-19 infection are still being felt in the community. In this Deep Breath In, Jenny, Tom, and Navjoyt are joined by two leading experts on long covid.  They discuss the changing profile of people being referred to specialist clinics, the way in which different strains may have different long term outcomes, and what can be done to limit the risk of developing long covid.   Our guests: Trish Greenhalgh is a former GP of 30 years who is now Professor of Primary Care Health Sciences at the University of Oxford.  Harsha Master is the GP lead in COVID rehabilitation at Hertfordshire Community Trust, and helped design the long covid clinical pathway there.

Supporting the sexual wellbeing of older adults - with Sharon Hinchliff and Rebecca Mawson

Talking about sexual health may be common-place with younger patients, but the sexual wellbeing of older adults is often neglected in a consultation. However it's important for doctors to be aware of changes to patients sex lives, given the link between intimacy and wellbeing. In this podcast, the team discuss how to create that culture of openness that encourages older adults to share problems they may find embarrassing, what signs may indicate that it's worth initiating a question about sexual health, and making sexual function a routine part of the discussion about the effects of medication. Our guests; Sharon Hinchliff is a professor of psychology and health at the University of Sheffield. Rebecca Mawson is a GP in Sheffield. Resources; Practice Pointer How to support the sexual wellbeing of older patients www.agesexandyou.com www.ageoflove.org www.joanprice.com 

Antidepressant withdrawal with Tony Kendrick and Mark Horowitz

The theory that depression is caused by serotonin deficiency has become embedded in our practice over the years, and can be a persuasive explanation of the condition for patients considering starting antidepressants. We talk to Tony Kendrick about the evidence (or lack thereof) to support this hypothesis, and what that means for the efficacy of antidepressants, particularly SSRIs. Later on, we speak to Mark Horowitz to discuss how to come off antidepressants safely, and manage withdrawal symptoms, and how to advise and support our patients as they gradually reduce, then stop, their medication. Our guests: Tony Kendrick is a retired GP, and NICE committee member for the 2022 guideline update on depression in adults. He is also a professor of Primary Medical Care at the University of Southampton. Mark Horowitz is a training psychiatrist, working as a clinical research fellow at North East NHS Trust, and as an honorary clinical research fellow at UCL, he is also the co-founder of outro.com. Further reading: ‘Antidepressants and the serotonin hypothesis of depression’. BMJ 2022;378:o1993 https://www.bmj.com/content/378/bmj.o1993 ‘Stopping antidepressants’. Royal College of Psychiatrists. 2020. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants

Time needed to treat, with Minna Johansson

How long would it take GPs to enact all of the guideline recommendations that they might be expected too? Far more GP hours than exist in any healthcare system, but as medicine has turned its attention to primary prevention, and expanded the populations whose health we seek to improve, those guidelines are taking up more and more time. A recent analysis in The BMJ has proposed the concept of “Time Needed to Treat” and implores guideline makers to take account consultation time as a precious, finite, resource when thinking about their recommendations. In this episode of Deep Breath In, we’re joined by Minna Johansson, family doctor and director Global Center for Sustainable Healthcare, who co-authored that analysis to talk about how the concept has gone down, and what it might mean for rethinking what primary care is supposed to do. Reading list: Guidelines should consider clinicians’ time needed to treat https://www.bmj.com/content/380/bmj-2022-072953