Medical Protection Society – Sessional GP Issue 6

The MPS continue with their excellent twice yearly edition of Sessional GP. I’m still writing the back page article for them – this time it’s The irony of complaints where I get to muse on the various aspects of complaining and moaning that we all do in the NHS.

Sessional GP is a good idea. There is a very real risk that sessional and locum GPs can feel excluded from many publications that emphasise practice-specific systems and risks. Of course, it’s not like we do radically different jobs to GP principals but there are some subtle and meaningful differences.

It’s all available for free online. If you want to delve into the individual articles you can follow these links:

Or you can read an interactive version of the PDF at the link below:


Read More

The SMMGP Clinical Update

I’m continuing to write the SMMGP Clinical Update on a bi-monthly basis. It’s a summary of some of the key clinical papers on substance misuse relevant to primary care. Generally, it’s around 3000 words long and I might cover anything from seven to ten papers in that. There is a summary of the methodology and findings of the paper and I make an attempt to put it all into some sort of appropriate context. The team at SMMGP read it through, make helpful comments, and try to filter out any blatant libels. It’s available at under the ‘Resource Library’ heading. If you’ve an interest in substance misuse in primary care then you should join SMMGP – it’s free.

I’ve been writing this every couple of months since August 2009 so I’ve now racked up quite a few of these – my next one will be my 20th Clinical Update.

The last one was the Aug-Sep 2012 version and covered the following papers:

Prevalence of common chronic respiratory diseases in drug misusers: a cohort study. Palmer F, Jaffray M, Moffat MA, et al. Primary Care Respiratory Journal. Published online: 8 August 2012.

An interesting retrospective study from Scotland looking at this sorely neglected area. And there are few surprises in the findings – even without smoking (and smoking is pretty terrible in this group) respiratory diseases are much more likely.

Persistent cannabis users show neuropsychological decline from childhood to midlife. Meier MH, Caspi A, Ambler A, et al. Proc Natl Acad Sci USA Published online: 27 August 2012.

This is a deeply impressive study based on the New Zealand Dunedin cohort. It goes a long way to settling a fair few questions around harms from cannabis – and adolescents looks particularly vulnerable.

Substance misuse of gabapentin. Smith BH, Higgins C, Baldacchino A, et al. Br J Gen Pract 2012;62:406–7.

A brief report/letter in the BJGP highlights an issue that won’t come as a surprise to many folk working in substance misuse (or particularly prisons). Gabapentin is highly abusable and this report points out some of the issues.

Retrospective accounts of injection initiation in intimate partnerships. Simmons J, Rajan S, McMahon JM. Int J Drug Policy 2012;23:303–11.

This qualitative study does what a good qualitative study should – it’ll really make you step back and consider some of your attitudes. Recommended.

Brief case finding tools for anxiety disorders: Validation of GAD-7 and GAD-2 in addictions treatment. Delgadillo J, Payne S, Gilbody S, et al. Drug Alcohol Depend 2012;125:37–42.

This UK study studied whether or now GAD-7 is actually of any value in an addiction setting.

Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme. van Beurden I, Anderson P, Akkermans RP, et al. Addiction 2012;107:1601–11.

This Dutch study had a bit of a torrid time as they struggled with poor recruitment and not very impressive participation. Some good lessons on how we might go about improving the management of alcohol problems in general practice.

Buprenorphine/naloxone and dental caries: a case report. Suzuki J, Park EM. Am J Addict 2012;21:494–5.

This was just a short case that reported on a woman who developed marked dental caries while on buprenorphine/naloxone. It’s a good opportunity to reflect on the dire state of oral health in many of those with substance misuse issues.


Read More

Couple of BJGP articles

I’ve had a couple of articles in the BJGP in recent months.

I wrote a piece on tobacco and the role of harm reduction. I’ve written on this before (here is one of my old Northern Doctor posts on the subject) and it seems to stir up some good discussion. I know NICE are consulting on this – I think it could become a hot topic in the next year or two. So, I thought it might provoke a little controversy but I’ve not heard a peep. Interestingly, I did get an email from Big Tobacco asking me if I would meet them to discuss my work. I haven’t followed up on that.

I also wrote a book review for Margaret McCartney’s The Patient Paradox. I’m sure you’ve read it already. You can buy it from Pinter & Martin here. I’ve just noticed that P&M are using a quote from my review.

The arguments are measured and well-referenced; the conclusions are distressing… Read this book. But don’t expect to be able to practice medicine in the same way again.



Read More

Medical writing with Scrivener – books, blogs, anything…

Arranging words in ScrivenerOK, something a little different for a blogpost this time. I thought I’d put down a few words on the writing software Scrivener and I’ve added a screencast too.

Scrivener is fairly well known amongst fiction writers. It has enormous functionality and it can be used just as easily for writing non-fiction. It was originally written for Mac (and was one of the reasons I came back to Macs after a few dispiriting years of being distracted and frustrated by Windows) but there is a Windows version now available. Scrivener is particularly useful for longer projects but it can be easily adapted for all kinds of writing. I have a number of different Scrivener files that I use for different non-fiction writing projects and ideas. These include a non-fiction book and my blog but I also use a Scrivener file for any freelance writing where I can record market research, pitches, article research, drafts and finally PDFs of the published articles.

It is easy to create new text documents in any folder in Scrivener. You can then write each small section and move them around to get the order correct. In fiction this lends itself well to the natural breakdown of a novel into books, chapters, sections and scenes. The book can be written one scene at a time and then scenes can be easily moved around. The ‘scrivenings’ mode allows any combination of scenes to be viewed and read together. Non-fiction can, of course, also be split down and each section written independently. It works just as well. Rather than managing a big unwieldy Word document (or multiple Word documents in a folder) bigger projects are logically split into their individual elements. It is also very easy to import all kinds of media and other documents (such as PDFs of research papers) into Scrivener where they are easily available for reference.

But Scrivener is not just for books, dissertations or other long works. Any writing that tends to hang together can be collected together in one place.

For instance, I write the regular Clinical Update for SMMGP. Check out this screencast for a quick tour of how I use Scrivener to help with that.

Scrivener can be used to write your blog. It gives me an easy way to take a look back at previous posts (mainly to check I’m not recycling my usual tics and cliches) and it is the perfect place to jot down ideas, collate research, write drafts and refine posts. As I show in the screencast I’ve found the splitscreen option particularly useful. The thing about Scrivener is that it is a bit of a beast – the features and functionality are stunning. But you don’t need to know much about it to get cracking and the introduction videos and support at are excellent.

Read More

Northern Doctor’s Antidote and the new blog

I used to have another blog, Northern Doctor’s Antidote, that I started in 2008. When it kicked off I can recall reading in one blogging guide that it was inexcusable to let a blog slowly languish, to let it atrophy and die a slow lingering web-death. I felt that was indeed happening so I pulled the plug. No valedictory message and no fuss. After all, let’s not over-egg it, no one really cares. Or very few anyway.

I had a lot of fun with the blog. The ‘antidote’ bit of the name came from Adam Smith’s quote:

Science is the great antidote to the poison of enthusiasm and superstition.

I still believe that but my views since 2008 have, perhaps, become more nuanced. The way the science is presented to the world is a serious problem and medical journals are, in many ways, deeply flawed. In addition to that there is a lot of nonsense out there; it would be a lifetime’s work to debunk all the myths, half-truths, woo, Big Pharma and media guff in the world. I certainly plan to continue blogging in that vein and doing my wee bit but I needed a new home. I have posted a handful of the old Northern Doctor posts here just to kick things off.

Read More