As doctors describe dealing with up to 70 patients a day, college warns of risks to public health
GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.
Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.
Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.
The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.
Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”
One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”
Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.
Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.
It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.
“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”
Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”
He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.
Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”
Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”
Physician says president has benefited from ‘a lifetime of abstinence from tobacco and alcohol’ though he could stand to exercise more
He does not exercise, has a long history of eating McDonald’s and drinking Diet Coke, and is just short of obese. Yet Donald Trump’s health is “excellent”, his mind is “sharp” and he only needs four or five hours’ sleep a night, the presidential physician said on Tuesday.
How can that be? “Some people have just great genes,” a navy doctor, Ronny Jackson, told reporters at the White House. “I told the president that if he had a healthier diet over the last 20 years, he might live to be 200 years old … But I would say the answer to your question is he has incredibly good genes and it’s just the way God made him.”
It is the kind of language that the US president will appreciate. But it drained the room like air escaping a crumpled balloon. Some in the media had come to bury Caesar, not to praise him, only to find the good doctor swatting away every sceptical question with a sunny optimism that would have been mocked as hyperbole if it had come from Trump’s own mouth.
“He is fit for duty,” Jackson insisted, disappointing the president’s critics, then rubbing salt in their wounds. “I think he will remain fit for duty for the remainder of this term and even for the remainder of another term if he’s elected.”
There was also news that will come as little surprise to anyone who follows Trump’s Twitter feed. “He doesn’t sleep much,” Jackson said, estimating that Trump got four to five hours a night. “He’s probably been that way his whole life. That’s probably been one of the reasons he’s been successful.”
It was an insight that evoked memories of the former British prime minister Margaret Thatcher, who got by on four hours a night.
The annual presidential physical exam, carried out last Friday, took about four hours and involved 12 medical consultants. Jackson, promising that he would hold nothing back, began with a summary of the findings: Trump is 6ft 3in tall and weighs 239lb. His body mass index (BMI) of 29.9 puts him in the category of being overweight for his height. A BMI of 30 or higher is considered obese.
His blood pressure was 122 over 74, which is normal, and his total cholesterol was 223, which is higher than recommended. He has a resting heart rate of 68 beats per minute, with regular rhythm and no abnormal sounds.
Jackson said he would increase Trump’s current low dose of the statin drug Crestor in an effort to get his so-called “bad” cholesterol, or LDL level, below 120; it is presently 143. Trump is also taking the medications aspirin, Propecia – to prevent male pattern hair loss – and a multivitamin.
“The president’s overall health is excellent,” Jackson said. “He had great findings across the board but his cardiac health stood out. Hands down he is in the excellent range … He continues to enjoy the significant long-term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol.”
And yet Trump, 71, the oldest person ever elected to the presidency, is infamous for long decades of dining on burgers and doing little to keep fit apart from regular rounds of golf. Jackson admitted: “I would say right now, on a day to day basis, he doesn’t have a dedicated, defined exercise programme, so that’s what I’m working on.”
But even nothing has its upside: “The good part is we can build on that prettily easily.” There were chortles in the room.
Jackson found yet more grounds to be positive: travelling overseas last year, on 14 or 16-hour days, the staff were exhausted but “the president had more stamina and more energy that just about anybody there”.
But the doctor will work with the first lady, Melania Trump, to develop an aerobic exercise routine for the president. “The president has acknowledged that he’d be healthier if he lost a few pounds,” he said.
As for Trump’s diet, that too has improved, according to Jackson. “He’s gone to the White House now: he’s eating what the chefs are cooking for him. They’re cooking a healthier diet for him now and we’re going to continue to work on them, make that even healthier.”
The check-up also included a cognitive assessment at Trump’s own request, in part as an attempt to combat a recent spate of stories raising concerns about his mental health following the publication of Michael Wolff’s book Fire and Fury. At the time, Trump tweeted that he was a “stable genius”.
The president did “exceedingly well”, scoring 30 out of 30 on the Montreal Cognitive Assessment which screens for illnesses such as Alzheimer’s and dementia. Jackson added: “He’s very sharp. He’s very articulate when he speaks to me and I’ve never known him to repeat himself around me. He says what he’s got to say. He speaks his mind. I’ve found no reason whatsoever to think the president has any issues whatsoever with his thought process.”
And although Trump is facing a nuclear showdown with North Korea, criticism from the media and record low approval ratings, it seems he never gets stressed. “I’ve never seen the president stressed out about too much … He has a very unique ability to just get up in the morning and reset.”
There were questions about TV, Twitter and drugs, but still Jackson failed to throw the reporters a bone during the hour long session. Jackson said Trump had told the White House press secretary, Sarah Sanders, to allow the doctor to remain at the podium and not leave any questions unanswered.
King’s Fund says physical health services are still getting bigger budgets, five years after ministers promised ‘parity of esteem’
Mental health care providers continue to receive far smaller budget increases than hospitals, five years after ministers pledged to create “parity of esteem” between NHS mental and physical health services.
The disclosure, in a new report by the King’s Fund, has sparked concern that mental health patients are receiving poorer quality care because of the widening gap in income.
Budgets of NHS mental health trusts in England rose by less than 2.5% in 2016-17, far less than the 6% boost received by acute trusts and those providing specialist care.
It is the fifth year in a row that NHS bosses gave physical health services a larger cash increase, even though ministers have repeatedly stressed the need to give mental health services more money.
Mental health trusts in England received income increases of just 5.5% between 2012-13 and last year, whereas budgets for acute hospitals rose by 16.8% over the same period, new research by the thinktank shows.
The author Helen Gilburt, a fellow in health policy at the King’s Fund, warned that the continuing inequality in funding was preventing mental health trusts employing enough staff, which is damaging patient care.
“While the NHS is in a difficult position, the slow growth in mental health trust funding and the problem of not having enough staff are both having a real impact on patients, who are having to put up with services that are being stretched to the limit,” she said.
Paul Farmer, the chief executive of the charity Mind, said: “Mental health has been under-resourced for too long, with dire consequences for people with mental health problems.
“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line.”
More positively, 84% of mental health trusts last year received a budget increase from NHS clinical commissioning groups (CCGs) – a rise on the 51%, 60% and 56% which had done so in the previous three years. The mental health investment standard, brought in in 2015-16, compels all CCGs to give mental health services an annual rise which at least mirrors their own budget increase.
Gilburt said, however, that “the [overall] funding gap between mental health and cute NHS services is continuing to widen. As long as this is the case, the government’s mission to tackle the burning injustice faced by people with mental health problems will remain out of reach”.
NHS England said funding for mental health services rose in 2016-17 by 6.3% to £9.7bn, compared with a smaller increase – of just 3.7% – in other parts of the health budget. It said mental health was also receiving a slightly larger share of overall CCG spending, at 13.6%.
The Labour MP and former cancer patient tells how her mission to change Britain’s drinking culture is not a moral crusade – it’s about saving lives
After the elation of becoming an MP in May 2015, Thangam Debbonaire was still getting used to life at Westminster when she got the bad news. “I was diagnosed with breast cancer on 16 June 2015,” says the Labour MP for Bristol West, recalling the date with calm clarity. Days later she had to forsake her new home at parliament and begin undergoing the rigours of chemotherapy. She finally returned, in good health, in March 2016. “Rosie Winterton, Labour’s chief whip at the time, said: ‘Come back when you’ve finished treatment.’”
Determined to carry on as normally as possible, she set up her constituency office, hired staff and worked as much as she was able. “Casework was done, emails were answered and constituency visits were made when I was in my good weeks,” says Debbonaire. “On a chemotherapy cycle the first week’s pretty awful. But on the second and third weeks I tended to do constituency work.” One of the emails she received then turned out to be fateful and life-changing.
“A publican in my constituency complained to me that the new safe drinking guidelines, which had been published in January 2016, had obviously been over-influenced by teetotallers. I was about to email this person back saying ‘yes, that sounds terrible. I’ll investigate’. But then I thought, ‘hang on, I’m not sending that reply until I’ve read the research,’’’ she recalls. Her inquiries proved revelatory.
“After reading a lot of research about alcohol I learned what a unit was and how to calculate it, for example. And I realised that there is no such thing as a safe level of alcohol consumption and that alcohol causes at least seven forms of cancer, including breast cancer. I didn’t know that before.”
Scientific research has produced enough hard evidence in recent years for charities such as Cancer Research UK and the World Cancer Research Fund to state with certainty that alcohol is a direct cause of seven forms of cancer: of the liver, colon, rectum, larynx, oropharynx, oesophagus and breast. Worryingly, though, opinion polls show that only small numbers of people know there is a causal connection between the substance and the disease. One survey last week found that only 10% mentioned cancer when asked which diseases and illnesses were linked to alcohol.
“After my treatment, I was at a course in Bristol run by Macmillan Cancer Support to help women who’ve had breast cancer with the emotional, physical and other impacts of the disease,” says Debbonaire. “The first thing most women wanted to know was: what do I have to do to reduce my risk of getting cancer again? The health practitioners there told us that one thing was reduced alcohol consumption. I wasn’t drinking anyway, what with chemotherapy and nausea, so I thought: that’s fairly easy, I’ll just not drink,” she says, sitting in her Westminster office.
She was approaching her 50th birthday. “I wasn’t teetotal, and I’d drunk all my life, mainly wine or a cocktail, but I’d never been a big drinker. I drank quite sparingly. The last time I’d been significantly merry was the night in February 2015 I gave up my job [with Respect, which helps perpetrators of domestic violence], went out with my colleagues and had cocktails. But I just decided it was easier then to have a default setting of ‘I won’t drink’ as a way of reducing my risk,” she recalls.
She wrote back to the publican, thanking him for raising the issue of alcohol. “I said: ‘I know your pub – I’ve drunk in your pub and I will do so again, though I’ll probably have an orange juice. I’m pretty sure that these new guidelines, from the chief medical officers of the four home nations, aren’t going to stop people going to your pub and you might want to think about offering a wider range of non-alcoholic drinks and snacks.’ He wrote me back a really nice email. He was really sweet and he didn’t argue, which I was really impressed by – he sort of took it on the chin.”
Their exchange of views, and her journey of discovery about alcohol, prompted other lifestyle changes too. She now runs three times a week, five kilometres on two weekdays in the various royal parks near Westminster and 10km every weekend in Bristol. She also eats far more fruit and vegetables.
“The last thing I do every night is chop up four portions’ worth of vegetables – red, yellow or green peppers, carrots and courgettes – put them in bags and during the day reach for them, rather than biscuits.” Angela Merkel did something similar a few years ago to help her lose weight.
But her new-found knowledge about alcohol’s potential toxicity has also unleashed an almost missionary zeal to raise awareness about its role as a cause of cancer, using her platform at Westminster. She is seeking a parliamentary debate and planning a campaign of oral and written questions to ministers on the subject. She is also working with alcohol and cancer charities and is keen to see graphic warnings put on cans and bottles of wine, beer and spirits, warning drinkers that alcohol and cancer are linked, modelled on those seen on cigarette packets.
“The two most dangerous drugs – alcohol and tobacco – are both entirely legal,” says Debbonaire, an ex-smoker, with a mixture of disgust and wonderment. She reels off a list of alcohol-related harms, including broken marriages, rotted livers and injuries caused or sustained. She is keen to tackle what she describes as “widespread ignorance” that leads to disease and death.
For example: “Of the many MPs across all parties I’ve spoken to about alcohol and cancer, the only ones who knew about the link with breast cancer were those who had had the disease themselves.”
Did her moderate drinking cause her cancer? “I don’t know if my particular cancer was causally related to alcohol, [but the] chances are reasonable that there was a causal link. My dad died of bowel cancer, which is one of those linked to alcohol. Two of my aunts had breast cancer. I had an alcoholic grandfather in India and other relatives in India who died of alcohol-related diseases. So alcohol has caused my family, and me as part of that, great harm.”
She is appalled at parliament’s intimate relationship with alcohol. “Yes, I worry about the drinking culture at Westminster. There are – what? – eight or 10 bars? There’s free alcohol at receptions. I’m concerned that alcohol is built into the parliamentary way of working. With late-night votes you’re certainly aware that some people have been drinking. This is not a moral judgment; I worry about colleagues’ health because of the lifestyle in this place. Alcohol is worryingly prevalent.
“In my third or fourth week as an MP, just before I was diagnosed with cancer, but when I knew it was a possibility because I’d already found the lump, Charlie Kennedy died in his early fifties. He comes here to Westminster as a young man for the first time [after being elected in 1983 at the age of 23], finds this [drinking] culture with, you know, ten million bars or whatever there were in those days, late nights, overnight sittings. What’s he going to do?
People said that the smoking ban was nanny state nonsense. I said it too… but it has helped people to quit
“Mr Speaker has encouraged the provision of mental health support [for MPs], which is very good,” she adds. “I’m quite idealistic about parliament. I think it ought to be a place where high standards are set – not just on expenses and sexual harassment, but on health and wellbeing, too. I would be delighted if there were more gyms and fewer bars.”
Debbonaire knows fellow MPs may think her a puritanical bore. “I’m not trying to kill anyone’s joy. I think alcohol can be a lovely thing. I had a glass of champagne at my niece’s wedding in September – though only one. But I’ve seen my own dad deteriorate from bowel cancer and visited a liver ward in Bristol where people in their 20s or 30s look 30 or 40 years older from drinking.”
She acknowledges that some will portray her as a nanny state ideologue. “People probably said seatbelts and the drink-drive limits were nanny state nonsense. They definitely said it about the smoking ban; I said it about the smoking ban. But seatbelts and not drinking and driving have saved countless lives, and the smoking ban has helped people to quit. “Apart from the link with cancer, alcohol causes a massive drain on the NHS, costs lots to the police and the courts and affects the economy by causing lost days at work. “Why wouldn’t we want to shift that behaviour? Nanny state? Well, I’m a Labour politician. I’m a social reformer, not a libertarian rightwinger. Interfering, for the common good, is what we do,” she says firmly.
Inquest hears Emily Hartley, 21, who had mental health problems, had been sentenced for breaking bail conditions
A 21-year-old woman was found dead in prison while serving a sentence for arson after setting herself on fire, an inquest jury has heard.
Emily Hartley died in the grounds of HMP New Hall near Wakefield on 23 April 2016. She had been allowed into the exercise yard of the women’s prison at about 3pm and was found hanged.
Wakefield coroner’s court heard on Monday that Hartley had been remanded in custody in May 2015 after setting fire to herself, her bed and curtains in the multiple occupancy building in which she was living.
After her arrest, a court decided to send Hartley to a bail hostel, rather than transfer her to a secure hospital. After breaking her bail conditions, she was sentenced to two years and eight months in prison for arson and sent to New Hall in November 2015.
Deborah Coles, the executive director of the charity Inquest, said before the hearing: “Emily was the youngest of 12 women to take her own life in prison in 2016.
“Just like the many women who died before her, she should never have been in prison in the first place. This inquest must scrutinise her death and how such a vulnerable young woman was able to die while in the care of the state.”
Hartley was diagnosed with bipolar disorder as a teenager, a diagnosis that was later dropped in favour of one of emotionally unstable personality disorder. She had been addicted to drugs was repeatedly admitted to mental health units, and made previous suicide attempts, the inquest heard.
Giving evidence to the court, Hartley’s mother, Diane Coulson, said her daughter had complained that despite being monitored under suicide and self-harm management processes, which meant she had to be observed twice an hour, nobody was checking on her for hours at a time.
In the weeks before her death, Hartley told her mother she was feeling the lowest she had ever felt.
In a statement, Coulson described her daughter as a “proper little madam, really gorgeous and lovely”. She was said to be a talented actor and musician.
“Emily wanted to have children and a normal life and she wanted someone to love her unconditionally,” Coulson said.
In a letter given to a psychiatrist a week before she died, which was shown to the jury, Hartley said: “I don’t want to die, I want to permanently end my problems.”
She said she wished every day that she had succeeded in killing herself. Coulson said it had been a relief when Hartley was sent to prison because “at least she would be safe”.
During the hearing, the senior coroner for West Yorkshire, David Hinchliff, asked Anthony Fitzhenry, a clinical matron involved in Hartley’s care in prison, whether or not he agreed that it was “not the best therapeutic environment” for people with mental health problems.
“It would depend on the quality of the alternative,” he said. Fitzhenry agreed with the coroner’s suggestion that there were insufficient secure alternatives for people in Hartley’s position.
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.
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Care staff are increasingly likely to see sepsis, but there is no standard training to make them aware of the symptoms to look out for in clients
I am a survivor of sepsis. Not once, not twice, but eight times.
Sepsis – also known as blood poisoning – kills more people than bowel cancer, breast cancer and prostate cancer combined. It affects more than 260,000 people and claims 44,000 lives every year in the UK. But it is not spoken about in training for social care workers, even though they are increasingly likely to see it.
Sepsis is triggered when the body tries to overcompensate for an underlying infection and too many white blood cells are released into the bloodstream. An example you may see in the social care context is kidney and chest infections. It looks like common flu in the early stages, but it can lead to life-threatening septic shock.
There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the “sepsis six”. Although there is no standard training, there are some symptoms care professionals can look for in a client:
Are they sleepy?
Is their breathing rapid or shallow?
Do they have a raised temperature?
Is their complexion mottled?
Do they seem confused, distracted or agitated?
Have they spoken of feeling the worst they have ever felt?
Taking their temperature at home may be the best indication of whether someone has sepsis until a medical professional is available, but you should try to get the person to a medic as soon as possible after identifying the symptoms.
Most importantly, when you speak to the medic, follow the “just ask” protocol; ask if they think it could be sepsis and give a good, rounded history of the individual. If you are not familiar with the patient, a synopsis of their medical condition should be placed at the front of their care plan.
One of the occasions when I had sepsis offers a pertinent example of why care workers should be aware of the condition’s symptoms. I had been feeling ill for a couple of hours and had told my care workers. They said we should see how it goes – and went back to their mobile phones. This continued until my husband returned from work and, within minutes, he noticed that I was pale and flushed and that my head was nodding. He touched my cheeks and realised I had a temperature – 39.9 degrees at that point. Paul called for an ambulance and asked the paramedics if it could be sepsis; they immediately started to check for the signs using the “sepsis six”.
I spent four weeks in hospital, with a stay in intensive care on high impact antibiotics. I was told that if Paul had not acted so decisively and asked the correct questions, that I may not have received the correct treatment that saved my life. Coincidentally, Paul and I met in hospital when we were both being treated for sepsis.
Please do not underestimate the importance of recognising sepsis and simply asking medics: “Could it be sepsis?” And if you’ve had sepsis before, tell those caring for you about your history – sepsis can and does come back often.
• Damian Bridgeman is a social entrepreneur, disability rights activist, and board member of Social Care Wales. He is speaking at an event on this topic in London on 18 January. For more information on sepsis, visit the Sepsis Trust
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PR campaigns that suggest it is OK to feel down on one day in January don’t help. But I have found ways to support my own mental health
Today, 15 January, is apparently Blue Monday, a term coined by the psychologist Cliff Arnall in 2005 after a publicist at a British holiday company persuaded him to create a “scientific formula” to find out “the most depressing day of the year”. He took into account weather, debt, time since Christmas, time since failing in our new year’s resolutions, motivational levels, and the feeling of a need to take action. Not content with his attempts to quantify sadness, he also calculated that 24 June or other dates close to midsummer would be “the happiest day of the year”.
The bleak midwinter can obviously cause a slump in mood and there are some who suffer from seasonal affective disorder. But it’s important to acknowledge that, despite the PR over this particular date, depression can strike on any day, at any time of year. I have suffered bouts of clinical depression and anxiety since childhood. I’ve experienced it on winter days when the sky is leaden and the sun snuffed out, when the weather seems to perfectly mirror my mood, but depression has also crept upon me on the brightest summer day. Indeed, it’s those sunny days that can feel most alienating as they’re at odds with the bleakness of mood. I’ve suffered from depression on spring days when the world around me is blossoming, and on autumn days when the leaves are turning a glorious burnished copper. Depression does not discriminate – it can strike anywhere, anytime, anyone.
And it can be made worse when superficial marketing campaigns suggest it is OK to feel depressed on specific days – with the implication being “cheer up, love” the rest of the time. To emphasise this, the mental health charity Mind has set up the #BlueAnyDay hashtag. Meanwhile the Samaritans advise: “Forget ‘Blue Monday’ and instead join Samaritans for ‘Brew Monday’.”
I recall the times I didn’t think I’d survive, not only Blue Monday, but any day. But the world continued, and so did I. So over the years I’ve been creating and fine-tuning my own personal formula for alleviating my depression and anxiety on blue days, grey days, golden days, and every other colour day of the year. I’ve come up with the following selected list.
Walking: When I started walking regularly, early in the morning and at night, I felt my mood begin to lift, the anxiety start to dissipate with each footstep. Exercise is scientifically proven to boost endorphins. I’ve been practising this regularly on bright days and dull days alike, and my depression has been lifting. And on these chilly winter days there’s a particularly pleasurable glow when walking helps to warm me.
Nature: Spend some time outdoors, in green places. I live in a city, and changing my morning walk so it passes through a park rather than along a busy, blaring, polluted main road has done wonders for my mental health. It’s also helped me to connect more with the cycles of life, and of light – gaining a sense that now we’ve passed the winter solstice the days are lightening. And I know that even when they darken again, eventually the light will flood in once more. I’ve learned to find value in both the darkness and the light.
Altruism: In the midst of my depression I signed up for volunteering at Crisis, and spent Christmas Eve into Christmas Day volunteering at a homeless shelter. The simple act of helping others can do wonders for one’s own wellbeing.
Art: Reading improves wellbeing and builds empathy. And music lifts my mood (Blue Monday by New Order, any day).
Food: I realised that unhealthy eating was affecting my mood. So now I feed both body and mind with healthy stuff.
A note on pills: If you’re currently on medication, do not feel ashamed about it. At the moment I’m on SSRI medication and there’s still so much stigma around it I feel it needs mentioning.
Openness: Even with all this, it’s not a perfect formula nor a complete solution, and there are days that dip into darkness seemingly without explanation – and it’s OK not to always feel OK. Everyone will have their own formulas and sometimes they will fail – because life is messy, complex, and feelings are not always quantifiable.
“Our lives begin to end the day we become silent about things that matter,” said the great Martin Luther King – and for a long time I was silent about my depression. Today is also Martin Luther King Day and I find a certain happiness in commemorating that and taking courage in his words, in the need to end the silence about something which is still so stigmatised.
• Anita Sethi is a freelance journalist, writer and broadcaster
• In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.
I am a GP partner in Oxford. I have worked in the NHS in Oxford for 20 years, barring two years in a post in rural Canada. In July 2017, we returned to the UK and a friend of mine, who’s a cardiothoracic anaesthetist, commented on my bounding neck pulses as we were chatting over a beer. A little later that day, I had a listen to my heart and even I, a GP, could hear a loud murmur. I asked one of my colleagues to have a listen, just to check I wasn’t being paranoid. I think he was trying to make me feel better and reassured me: “It’s probably just a flow murmur.”
Nevertheless, I saw my GP that day. With detached, mildly mounting alarm I registered the abnormal findings she discovered. High blood pressure, wide pulse pressure, mild tachycardia and, of course, The Murmur. Her worried expression made me more alarmed than the findings, and I found myself trying to reassure her that everything would be OK.
It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night.
I saw the cardiologist in October and as soon as he mentioned he wanted to get the medical student, I knew I was in for some bad news. He told me I had severeaortic regurgitation, where blood flows in the reverse direction from where it’s supposed to as the heart pumps. He said he’d see me in six months and by that time I would have a new aortic valve. My reaction was silence, followed by expletive-laden surprise, not least as I had had no symptoms at all. Also, doctors never get sick.
It’s funny how that kind of news affects you – for a week or so, I was mentally crossing things off the list of things I could do with the rest of my life, and confronting the possibility that I might not see my daughter grow up.
In December, I was very relieved to get a date for my operation in January 2018 but my urgent surgery was cancelled when I called in at 10am on the day of admission. It’s difficult to describe the sense of loss that I felt. It came as a surprise, even for someone who works in the NHS every day. I really did not know what to do with myself.
As doctors in the NHS, we are trained from an early stage to soak up punishment, not to complain and to always carry on. But with my patient’s brain, I idly wondered how other people might be coping with similarly disorientating news all over the UK. About how they might be thinking how unfair this was, and what would they do now. Lives put on hold, terrible feelings of uncertainty, resignation and finally acceptance. After such news they must love, fear and hate the health service all at the same time. Nevertheless, the NHS is so beloved that it would never cross their minds that the government would have deliberately underfunded it for the last seven years. Some people might think it’s pretty decent of ministers to apologise for all the disruption, and that the government, to its credit, is forward-planning for a winter crisis.
The fact is, of course, that it is not, and that the crisis was entirely avoidable and is down to consistent underfunding. Doctors and the Kings Fund predicted it, even the head of NHS England predicted it. It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night. I’m not sure how much more short-notice my surgery cancellation could have been, and yet here was my ultimate boss telling me that this was being done to avoid just such upheaval.
I was back to work the next day and I have my game face firmly back on, but I can’t deny it has been disruptive and upsetting. I’m determined not to let any of these developments compromise my patient care and commitment to the NHS. I am sanguine, but waiting hopefully for another appointment. I understand that this situation may well occur again. In that circumstance, I look forward to a time when the apology from my health secretary and prime minister will be replaced by sustained hard investment in the NHS. Platitudes and short-term measures will not save or improve it. And yet, as many commentators have already suggested, perhaps that is this government’s point.
Workplaces should start catering for the menopause in a comparable way to pregnancy, according to one of Britain’s leading women’s health experts.
Myra Hunter, emeritus professor of clinical health psychology at King’s College London said that menopausal symptoms remained a “taboo issue” in many workplaces and, while policies to support pregnant women are now standard, there is still little awareness of the impact that the menopause can have on women who are often at the peak of their career.
“Often there’s a will to address this among managers, but they just don’t know how to talk about it,” said Hunter. “Women want it to be raised if appropriate. They don’t want to be treated as ill, they just want some understanding and awareness of it.”
The call comes as Hunter and colleagues publish the results of one of the first major studies looking at how symptoms such as hot flushes affect women at work. The study, which tracked 124 female employees in the public and private sectors, found that such symptoms could have a significant impact, but that following a simple programme of cognitive behavioural therapy, delivered via a self-help booklet, hugely reduced the degree to which women felt their symptoms were problematic.
The menopause occurs at the age of 51 years, on average, and the way women experience this transition can vary a lot. About 80% of women experience some hot flushes and night sweats and for 20 to 30% these symptoms are severe enough to have a significant impact on quality of life. Some women also report tiredness, “brain fog”, mood swings and loss of confidence. For some women, the transition period lasts just a few years and in others it can last a decade.
There is no strong evidence that the menopause causes women to leave jobs in large numbers or that it has a negative impact on professional performance. “The evidence we’ve got from surveys, it’s subjective, but it suggests that women might over-compensate,” said Hunter.
The trial recruited 124 women who were struggling with their symptoms (the women experienced 56 flushes on average each week). Half the women were provided with a self-help booklet that provided guidance on how to cope with work stress, how to discuss the menopause at work and which challenged negative stereotypes associated with the menopause, such as “being past it”.
The booklet also set women cognitive behavioural therapy (CBT) exercises, in which they were asked to write down the thoughts they have during hot flushes, for instance, and then challenge these beliefs.
“If a woman has a hot flush half the anxiety is about how people see her,” said Hunter. “There’s embarrassment and anxiety about being joked about and a big concept is hiding symptoms in fear of being ridiculed.”
“Really, we shouldn’t feel like that and when women verbalise it, it does appear ridiculous,” she added.
Women who were given the booklet reported a noticeable reduction in both their symptoms and how problematic they were. When they were followed up after five months, the number of hot flushes they experienced was reduced by one third, they reported better quality sleep and viewed their symptoms more neutrally. In interviews after the trial, 82% said the intervention had reduced the impact of their symptoms and 37% had spoken about their menopause to their line manager.
Kathy Abernethy, chair of the British Menopause Society and a specialist nurse, welcomed the work, saying that a social shift was underway with people generally becoming more open about discussing the menopause.
This trend, she said, has been partly driven by celebrities who “have decided that it’s not something embarrassing to talk about”. Far more women in their 50s are also in work than in the past. According to the Department for Work and Pensions, the proportion of women aged 50 to 64 with jobs has risen by more than 50% in the past 30 years.
“Women simply want to know workplaces are taking it seriously,” Abernethy added. “Awareness is a key thing. If managers are aware of the menopause it means the whole thing becomes a non-issue, like pregnancy.”
Tina Weaver, CEO of the charity Wellbeing of Women, which funded the research, said the study offered practical and accessible interventions to help women. “It’s alarming so many women suffer from these debilitating symptoms and feel so unsupported during the menopause that they drop out of the work force,” she said. “This natural process has been overlooked and considered a taboo for too long.”
The findings are published in the journal Menopause.
‘Some days I felt like I needed a badge saying “Stand clear: menopausal woman approaching!”’
Angela Bonnett, 57, had a successful career in finance and by her early 50s was a senior project manager at a well-known financial institution in the City. “I’d spent 30 years being an excellent performer at the top of my tree,” she said.
Five years ago, she entered the menopause and found professional skills that she’d come to take for granted – her razor sharp memory and a cool disposition – suddenly foundering. “I felt all those things were falling away,” Bonnett said.
She experienced hot flushes in meetings, night sweats that disturbed her sleep, sudden mood swings, problems concentrating and irritation. “Everything that you’ve ever read about the menopause seemed to happen to some degree,” she said. “Some days I felt like I needed a badge saying ‘Stand clear: menopausal woman approaching!’”
In work, she noticed herself making careless mistakes, struggling to recall names or conversations she’d had a day earlier – “things that were just alien to me”.
She took detailed notes to prompt her memory and worked harder to compensate for tiredness. She began wearing layered clothes so she could “quickly disrobe” when she was hit by a hot flush in a meeting and took to carrying a fan she had picked up on holiday in Spain.
“Initially I had some reservations that people would know why I’m doing this,” she said. “But in the end I thought, either I’m going to explode or I need to cool down.”
As a rule, Bonnett did not share personal problems at work. “I prefer to keep the two separate,” she said. And the menopause felt like a particularly personal experience. “Whether you want someone to know your periods have stopped – it’s quite core to who you are.”
However, when she found herself snapping at a colleague – a reaction that was completely out of character – she decided she needed to raise the issue with her manager.
“Previously I’d been quite sensitive in situations at work, but from nowhere there would come a really sharp, nasty response to people that made the whole room gasp,” she recalled.
The lack of an established protocol made raising the issue at work feel potentially awkward. Eventually she emailed her line manager, a man in his mid-30s, with a newspaper article in which a high level lawyer described the challenges she’d faced at work due to menopausal symptoms. “This allowed me to introduce the subject using outside information and explain what I was going through,” she said.
Bonnett says her boss was not unwilling to help, he was simply oblivious. “It was an education for him. He said ‘I had no idea you were going through this’. I said ‘It’s because I’ve been working extra hard to make sure I carry on performing’.”
Once aware of her situation, Bonnett’s manager was understanding and reassured her that she should feel free to come in late or leave earlier, if she needed to. The message was: whatever you need to do to cope, that’s fine.
“Just having that reassurance made it a lot easier,” Bonnett said. “I didn’t need to do any of those things, but knowing he knew was sufficient and removed a lot of the anxiety.”
Polly Toynbee’s article (The Tories knew there would be an NHS winter crisis but did nothing, theguardian.com, 3 January) notes that Jeremy Hunt “sent out a civil servant, Prof Keith Willett, director of acute care [to be interviewed on the radio], because he couldn’t be asked the crucial political question. Is “couldn’t be asked” another of the Guardian’s famous spelling mistakes? Alan Gavurin London
• It’s good to discover we share people’s childish pleasures (Letters, 4 January). We clear up after our dog using a piece of Guardian broadsheet, instead of a plastic poo-bag. It’s surprisingly effective, better for the environment and rubs the faces of the worst people in the world right in it. I notice a former Trump aide on the front page of today’s paper. Looking forward to tomorrow’s walk. Bigly. Sue Western Bristol
• Like many of your readers, I too am looking forward to the new tabloid format – it will make my subversive activity more effective. The Daily Mail always takes centre stage on newsagents’ stands, and I like to cover the top of the pile with a copy of the Guardian. Cathleen Palmer St Albans, Hertfordshire
• Andrew Dean (Letters, 4 January) notes the preference of robins for dry shelter, including empty garages. When a robin nested in our garage, we obligingly parked the car in the road so the fledglings could be raised in peace. The car was broken into and the cat ate the robins. Jan Hopkins Walton-on-Thames, Surrey
• I believe there stands the Admirals Hard in Plymouth (Letters, 4 January). Ken Aplin Ampthill, Bedfordshire
• The council has stopped replacing the street sign for Back Passage in the City of London. John Whitehead London
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