London journal of primary care最新文献

{"title":"Vulnerable leadership.","authors":"Louise Younie","doi":"10.1080/17571472.2016.1163939","DOIUrl":"https://doi.org/10.1080/17571472.2016.1163939","url":null,"abstract":"© 2016 The author(s). Published by informa uK Limited, trading as Taylor & francis Group. This is an open access article distributed under the terms of the Creative Commons attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. CONTACT Louise younie m.l.a.younie@qmul.ac.uk At a medical humanities educator workshop, a few years ago, we asked participants to bring an image or poem that they resonated with from the ‘Out of Our Heads’ website. 1 Images and words were shared with the group along with why they had been selected. Towards the end of our semi-circle was a senior clinician and an educator. His chosen image was one of a patient, sat in foetal position on a waiting room chair (http://www.outofourheads.net/oooh/handler.php?id=459). He had chosen this image because it reminded him of the patients’ vulnerability. He paused. It reminded him also of his own vulnerability. During the coffee break a fifth-year medical student shared with me how his words had been the most useful utterance she had heard for months, having just completed her finals. I probed a little deeper. She told me of student stress and bravado. To hear someone further down the line able to talk about his own vulnerability was, to her, like a breath of fresh air. I have pondered this anecdote for a number of years in the context of medical education and medical practice, and more recently in the light of my own dance with death through cancer. Why is it, I wonder, that we so rarely share our experiences of vulnerability either as students or qualified health professionals? I know from my own experiences that vulnerability and being a patient go hand in hand. As a patient there is little choice, but to embrace our fragile state when our mortal body has been assailed by some kind of pestilence. But for the healthy doctor who wields power in the lives of those struck by disease, vulnerability can be and often is held at arm’s length. Research suggests, however, that feelings of professional uncertainty do abound especially for students and young doctors in emotionally laden situations. [1] So it may be that we feel vulnerable but do not share or talk about it. A student writes about sitting in a breast cancer clinic and in one day hearing three people receive a diagnosis of breast cancer, the youngest being just a couple of years older than herself: We were discussing how it is almost taboo to show emotion about things like this, not only on the wards but also when chatting afterwards to other students. There is an unwritten rule that you have to prove ... that you can cope with hearing/having to give bad news and be absolutely fine with it. That’s the mark of a good doctorleaving it all in the hospital.[2]","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 3","pages":"37-38"},"PeriodicalIF":0.0,"publicationDate":"2016-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1163939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Poetry of Medicine.","authors":"Sophie Ratcliffe","doi":"10.1080/17571472.2016.1163950","DOIUrl":"https://doi.org/10.1080/17571472.2016.1163950","url":null,"abstract":"<p><p>Outlining an educational initiative for those who work in the National Health Service (NHS), this article argues that literary reflection has been too easily seen as a simple tool which may improve the practitioner's empathic skills and benefit patient-centred care. Using anecdotal feedback, the author reports ways in which a series of literary workshops held for professionals in the NHS have added to practitioners' general sense of well-being. Feedback shows that participants perceived literature in the workshop setting as being more than an enabler of 'empathy'. They reported that reflecting on literature in a group setting is an opportunity to think about their own autonomy, pleasure and creativity. The article concludes with a reflection about priorities in regulatory culture, its relationship to burnout, and ideas for future work.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 3","pages":"39-41"},"PeriodicalIF":0.0,"publicationDate":"2016-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1163950","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast lump in a patient with Type 1 Diabetes.","authors":"Aditi Sharma,&nbsp;Sarah Ali,&nbsp;Senan Devendra","doi":"10.1080/17571472.2016.1163937","DOIUrl":"https://doi.org/10.1080/17571472.2016.1163937","url":null,"abstract":"The detection of a breast lump causes understandable fear of breast cancer in both the patient and the clinician. Patients usually first present to their general practitioner with the finding. Although majority of palpable breast lumps are benign, a thorough history, examination and timely onward specialist referral to the breast team for further investigations is essential to confirm the diagnosis, and therefore alleviate patient concerns. Here, we take the opportunity to report a case of diabetic mastopathy – an important yet-not-so-widely known complication of long-standing Type 1 diabetes that presents as a palpable breast lump in a young patient.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 3","pages":"42-45"},"PeriodicalIF":0.0,"publicationDate":"2016-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1163937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can active music making promote health and well-being in older citizens? Findings of the music for life project.","authors":"Susan Hallam,&nbsp;Andrea Creech","doi":"10.1080/17571472.2016.1152099","DOIUrl":"https://doi.org/10.1080/17571472.2016.1152099","url":null,"abstract":"<p><p>Although there is now an accepted need for initiatives that support older people's well-being, little attention has been paid to the potential for music making to effect a significant contribution to the quality of life of older people. The research summarised here explored the role of music in older people's lives and how participation in community music making can enhance their social, emotional and cognitive well-being. The research comprised three UK case study sites, each offering a variety of musical activities. At each site, a sample of people aged 50+ (total <i>N</i> = 398), some of whom had recently begun musical activities and others who were more experienced, were recruited to complete questionnaires that assessed quality of life. A control group (<i>N</i> = 102) completed the same measures. In-depth interviews were carried out with a representative sample, followed by observations of musical activities, focus groups and interviews with the facilitators of the activities. Higher scores on the quality of life measures were found consistently among the music participants, in comparison with the control group with ongoing benefits into the 4th age. Analysis of the qualitative data demonstrated: (1) <i>cognitive benefits</i> including challenge, the acquisition of new skills, a sense of achievement, and improvements in concentration and memory; (2) <i>health benefits</i> including increased vitality, improved mental health and mobility and feelings of rejuvenation; and (3) <i>emotional benefits</i> including protection against stress, protection against depression, support following bereavement, a sense of purpose, positive feelings, confidence and opportunities for creativity. Participants also identified a number of barriers to participation including lack of information about opportunities for making music. Ways that GP surgeries might support participation in music making are considered.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 2","pages":"21-25"},"PeriodicalIF":0.0,"publicationDate":"2016-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1152099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Honesty, candour, and transparency: clinical implications.","authors":"Andrew Papanikitas","doi":"10.1080/17571472.2016.1146464","DOIUrl":"https://doi.org/10.1080/17571472.2016.1146464","url":null,"abstract":"<p><p>In advance of a medical conference on the duty of candour for medical ethics educators, this paper discusses the duty of candour as a significant development in the culture of medicine. Those who teach medical ethics need to assess its implications for their own practice. It is also a duty that needs to be critically examined in light of both patients' interests and clinical work environments if it is to be practical and not meaningless rhetoric. Two examples of ways in which that critical examination might take place are outlined.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 2","pages":"30-31"},"PeriodicalIF":0.0,"publicationDate":"2016-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1146464","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The music of trees: the intergenerative tie between primary care and public health.","authors":"Peter Whitehouse","doi":"10.1080/17571472.2016.1152100","DOIUrl":"https://doi.org/10.1080/17571472.2016.1152100","url":null,"abstract":"<p><p>Stories help us frame and understand complex ideas and challenges. Metaphors are particularly powerful linguistic devices that guide and extend our thinking by bridging conceptual domains, for example to consider the brain as a digital computer. Trees are widely used as metaphors for broad concepts like evolution, history, society, and even life itself, i.e. 'the tree of life'. Tree-like diagrams of roots and branches are used to demonstrate historical and cultural relationships, for example, between different species or different languages. In this paper, we describe a theatrical character called a tree doctor which is a living metaphor. A human being, namely the author, lectures, acts or dances as a tree and offers lessons to Homo Sapiens about 'holistic' ideas of health. The character teaches us to not only see the value of our relationships to trees, but the importance of seeing forests as well the individual trees. The metaphorical statement that we should not 'miss the forest for the trees' means we should learn to think of health embedded in systems and communities. In medicine, we too often focus on individual molecules, pharmaceuticals, or even patients and miss the bigger picture of public and environmental health. In a time of great ecological system change, the tree doctor points to broad ethical responsibility for each other and future generations of humans and other living creatures. The character embraces arts and particularly music as a powerful way of infusing purpose and improving the qualities of our lives together, especially as we age. The tree doctor knows the value of intergenerational relationships. But it also points to intergenerative innovations across many cultural domains, disciplines and professions. The tree doctor supports primary care and empowers the value of intergenerational relationships, art and music in the recommendations doctors make to patients to improve their health and well-being.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 2","pages":"26-29"},"PeriodicalIF":0.0,"publicationDate":"2016-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1152100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining art and science in healthcare.","authors":"Paul Thomas","doi":"10.1080/17571472.2016.1169746","DOIUrl":"https://doi.org/10.1080/17571472.2016.1169746","url":null,"abstract":"This Issue of LJPC contains two papers that provide new insight into the old puzzle of how to combine Art and Science in health and health care. Through a discussion of music and metaphor, Hallam and Whitehouse show that Art and Science provide complementary insights into how to live a healthy life. Art is good at forward-looking co-creative activities. Science is good at the more retrospective task of working out what actually worked – for example whether an antibiotic defeated a bacterium in an experiment. Both are needed. A healthy person moves their life story forwards in a healthy way by creatively interacting within a complex world. Toon explains this well – health is an aliveness of spirit that enables someone to develop a flourishing life story.[1] In a similar vein, Antonovski has argued that being healthy means rising above adversity.[2] Health is an active thing that helps someone to live in the moment and turn bad things into good. Of course disease can get in the way of health, but the absence of disease does NOT make someone healthy. Indeed, the onset of disease often has the effect of waking someone up to the need to start living their life in a healthier way. Health care needs to help people to be healthy as well as cure their illnesses. Hallam’s paper has already caught readers’ attention, achieving 240 downloads merely in the time it has been sitting on the LJPC website waiting for publication. It shows a range of health benefits to people aged over 50 when they take part in musical activities. But look at what those benefits are:","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 2","pages":"19-20"},"PeriodicalIF":0.0,"publicationDate":"2016-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1169746","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34519342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The royal society of medicine open section's medical humanities conference: physician resilience and compassionate practice.","authors":"Amelia Martin","doi":"10.1080/17571472.2015.1135652","DOIUrl":"https://doi.org/10.1080/17571472.2015.1135652","url":null,"abstract":"© 2016 The Author(s). Published by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. CONTACT Amelia Martin amelia.ep.martin@googlemail.com The RSM Open Section’s medical humanities conference held on the 5th of October set out to explore the relationships between literature, the humanities and healthcare. Clinician resilience and compassionate care were explicit themes for the day. Professor Deborah Bowman, the voice of Radio 4’s Inside Ethics Committee launched the conference by exploring the parallels between Medicine and the theatre. She examined the work of Samuel Beckett, helping the audience to consider the ‘altered state’. Beckett’s line ‘to be what I always am, so changed from what I was’ [1], highlights ‘Consistency for person’ and how we, as healthcare professionals, ask about change. Bowman drew lessons from the theatre to be applied in practice to ‘attend to the objective and subjective, to attend to the abstract not in the room and to attend to the self and other’. These wider considerations can help healthcare professionals to hold onto compassion in medical practice which sometimes can be lost through the pressures of working within systems. Professor Bowman concluded that in order to ask someone to practise in a compassionate way, like an actor in a play, clinicians need rehearsal in order to be able to give voice to values.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 1","pages":"10-11"},"PeriodicalIF":0.0,"publicationDate":"2016-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1135652","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malevich, an hero pushed to death.","authors":"Francesco Carelli","doi":"10.1080/17571472.2015.1133951","DOIUrl":"https://doi.org/10.1080/17571472.2015.1133951","url":null,"abstract":"© 2016 The author(s). Published by Taylor & francis This is an open access article distributed under the terms of the Creative Commons attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. CONTACT francesco Carelli francesco.carelli@alice.it Kazimir Malevich (1878–1935) was a radical, mysterious and hugely influential figure in modern art. He lived and worked through one of the most turbulent periods in twentieth-century history. In 2014, Tate Modern in London presented the first major Malevich retrospective for almost twenty-five years. This groundbreaking exhibition drew on the world’s greatest collections of his work to offer an expansive view of his career. Having come of age in Tsarist Russia, Malevich witnessed the October Revolution first-hand. His early experiments as a painter led him towards the cataclysmic invention of Suprematism, a bold visual language of abstract geometric shapes and stark colours, epitomised by his piece: Black Square. A definitively radical gesture, it was revealed to the world after months of secrecy and was hidden again for almost half a century after its creator’s death. It sits on a par with Duchamp’s ‘ready-mades’ as a game-changing moment in twentieth-century art and continues to inspire and confound viewers to this day. The show explored his collaborative involvement with architecture and theatre, including his designs for the avant-garde opera Victory over the Sun. The exhibition also followed his temporary abandonment of painting in favour of teaching and writing, and his much-debated return to figurative painting in later life. Malevich’s work tells a fascinating story about the dream of a new social order, the successes and pitfalls of revolutionary ideals, and the power of art itself. This exhibition, for the first time, offered a chance to trace his groundbreaking developments not only through well-known masterpieces OPEN ACCESS","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 1","pages":"15-17"},"PeriodicalIF":0.0,"publicationDate":"2016-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1133951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of early bonding on the long-term mental health and resilience of children.","authors":"Robert Winston,&nbsp;Rebecca Chicot","doi":"10.1080/17571472.2015.1133012","DOIUrl":"https://doi.org/10.1080/17571472.2015.1133012","url":null,"abstract":"<p><p>Human babies are born very dependent on their parents. They undergo huge brain development, growth and neuron pruning in the first two years of life. The brain development of infants (as well as their social, emotional and cognitive development) depends on a loving bond or attachment relationship with a primary caregiver, usually a parent. There is increasing evidence from the fields of development psychology, neurobiology and animal epigenetic studies that neglect, parental inconsistency and a lack of love can lead to long-term mental health problems as well as to reduced overall potential and happiness. In this paper, the authors consider the evidence for this claim across several disciplines and conclude that the support of babies and their parents in the first two years of life to be a crucial aim of public health groups in the community.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 1","pages":"12-14"},"PeriodicalIF":0.0,"publicationDate":"2016-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1133012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}