Ann Kenny Mary, 2025. 288. The Episode: a True Story of Loss, Madness and Healing. HB: Sandycove, 978-1844886869. 18.99. ![Graphic][1]</img> Most of us go into medicine to help and to heal. While we learn to accept that this isn’t always possible, sometimes we do worse than simply not helping — sometimes we cause harm. By harm in this context, I am not referring to medical errors or hazardous prescribing but rather the kind of harm that comes from not caring, from being unkind, from treating patients as problems rather than people. Mary Ann Kenny describes this harm in her raw and intimate memoir, The Episode: a True Story of Loss, Madness and Healing . The book recounts her descent into psychosis after the sudden death of her husband — and the prolonged hospitalisation that followed several months later. It is a powerful and carefully documented account of Kenny’s inner turmoil and her outward experiences with the healthcare system. Kenny obtained and reviewed her full hospital records. Her ability to read, reflect on, and share these most intimate details that included nursing, medical, and child protection conference notes, is testament to her intellectual curiosity and deep personal courage. The book interweaves her own recollections with direct quotes from her medical records. It is a fascinating and well-written account — so compelling, in fact, that I read it in a single sitting. In the closing chapters, Kenny describes her episode as comprising three distinct but interlinked traumas: the first, the sudden loss of her husband, leaving … [1]: /embed/inline-graphic-1.gif

In March Professor Ahmed Rashid said farewell1 to Yonder, the column he founded in 20142 to shine a light on ‘hidden gems’: primary care research papers published in journals outside the medical mainstream that could broaden our horizons and the way we think about medicine.

Struggling to focus? Mystified that you're only managing to read more than half a page in a book before losing your thread? Scrolling mindlessly through social media for hours? You are not alone. In his new book, Johann Hari, mindful of his own and his family's inability to be fully present, addicted to technology and exhausted (and hating it), starts to explore the reasons why we are all struggling to focus. He challenges the reader (p.9 Many things probably leap to mind in general practice. Interrupt them constantly and make them switch from task to task every few minutes. Overwork them and stress them out so they are exhausted and unable to make decisions. Make them respond to correspondence and work-related issues 24 hours a day on a handheld device. This sounds cruel and malign, except that all of it is already happening. Terry Kemple, Terry is a retired GP living in Bristol and has various roles promoting greater sustainability in general practice. He is a past President of the RCGP.

Disease management programmes (DMPs) aim to deliver standardised, high- quality care to patients with chronic diseases. Although chronic diseases are common among people with intellectual disabilities (ID), this approach may be suboptimal for meeting their care needs. To examine differences between patients with and without ID who have a chronic illness in DMP enrolment and disease monitoring in Dutch general practice. Observational study utilising the Nivel Primary Care Database (2015-2018) comparing patients with ID and cardiovascular disease, diabetes mellitus, or chronic obstructive pulmonary disease (COPD) with matched (1:5) controls with these conditions but without ID. Using conditional logistic regression, enrolment in DMP per chronic disease was examined and differences tested between groups in the frequencies of consultations, medication prescriptions, and routine examinations. A total of 2653 patients with chronic illness with ID were matched with 13 265 controls without ID. Patients with both diabetes mellitus and ID were more likely than controls to be enrolled in DMP (odds ratio [OR] = 1.44, 95% confidence interval [CI] = 1.27 to 1.64). Independent of DMP enrolment, patients with chronic illness with ID were more likely than controls to have frequent consultations. Patients with both diabetes mellitus and ID and patients with both COPD and ID who were not enrolled in DMPs had more medication prescriptions than non-enrolled patients with diabetes or COPD but without ID (OR = 1.46, 95% CI = 1.10 to 1.95; OR = 1.28, 95% CI = 0.99 to 1.66, respectively). Most patients with ID and their controls enrolled in DMPs received routine examinations at similar frequencies. Although DMPs do not specifically address the needs of patients with both chronic illness and ID, these patients do not seem underserved in the management of chronic diseases in terms of consultation, medication, and tests.

Familial hypercholesterolaemia (FH) (prevalence 1 in 250) is an inherited condition that significantly increases risk of premature cardiovascular disease. Early diagnosis can potentially normalise cardiovascular risk with lipid-lowering medicines (statins and fibrates). Only 7% of patients with FH are identified in the UK. Improving identification, and understanding disparities in ascertainment and management, is an NHS priority. To assess determinants of lipid-lowering prescribing in ethnically diverse adults with an FH code. METHOD: Retrospective cross-sectional analysis of Lambeth DataNet, containing anonymised adult patient data from 41 practices in South London. Stata 17 was used to run sequential multilevel logistic regression models, adjusted for practice effects, to estimate the odds of no lipid-lowering prescription in FH-coded adults; this was assessed across 10 ethnic groups and other patient-level factors: demographic, socioeconomic, lifestyle, comorbidities, and practice factors (consultation frequency and practice list size). One hundred and sixty-one of 801 (20%) of adults with an FH code received no lipid-lowering medication. The fully adjusted model for no lipid-lowering prescriptions showed the following associations: age (years) odds ratio (OR) 0.93 (P<0.001, 95% confidence interval [CI] = 0.91 to 0.95), male sex OR 0.47 (P = 0.002, 95% CI = 0.29 to 0.76), diabetes OR 0.26 (P = 0.04, 95% CI = 0.70 to 0.96), hypertension OR 0.30 (P<0.01, 95% CI = 0.12 to 0.72), and frequency of GP attendance OR 0.48 (P = 0.03, 95% CI = 0.24 to 0.94). Sensitivity analyses examining determinants of high-intensity statin prescribing found similar results. The study suggests important determinants of lipid-lowering prescribing in an ethnically diverse adult population included older age, male sex, hypertension, and diabetes. Ethnicity showed no significant associations with lipid-lowering prescribing after adjusting for other determinants including deprivation measures.

Interprofessional learning (IPL) events can provide a supportive environment for GPs to improve care and health outcomes for vulnerable children, young people, and their families. Thirty GPs have facilitated small groups at an annual interprofessional domestic abuse conference since 2014. It was postulated that distilling GP learning from these events could provide a template for focused training to up-skill the local GP workforce. To identify how the facilitators' skills and expertise in eliciting and managing domestic abuse in front-line practice has developed personally and been translated into their surgery-based team. Nine from 18 invited GPs participated. Three had engaged between 7-9, 4-6, and 1-3 conferences. Two researchers conducted a 1-hour semi-structured interview. Thematic analysis was performed on the audio-recorded transcripts. Seven themes emerged: GP training - implementing a trauma-informed approach; safer environment - in the surgery, when consulting, and recording documentation; knowledge - Domestic Abuse Act 2021, local Independent Domestic Violence Advisor support; alert triggers - probability of coercion and control; consultation skills - normalising a safe enquiry, high level of professional curiosity; children - children as victims in their own right; legacy of DA on their behaviour and life course; and interprofessional working - greater confidence to proactively share information, informed respect of other agency roles and responsibilities. This impact study has provided a discrete evidence base from which to focus up-skilling of the local primary care workforce. This might include a possible educational template to improve interagency working in supporting adult and child survivors of DA with the legacy of this trauma.

Benign paroxysmal positional vertigo (BPPV) is a prevalent and disabling pathology. Its diagnosis and treatment according to clinical practice guidelines is carried out through canalicular repositioning maneuvers, but these maneuvers are not performed routinely in primary care consultations. To analyse the baseline data from the VERTAP randomised community trial that evaluates whether a blended course is effective in improving the adherence of primary care physicians to clinical practice guidelines. Baseline data 2021. 20 primary healthcare centers with an assigned population of 514157. sex, age, diagnoses related to vertigo/dizziness, anti-vertigo medications prescribed, number of referrals to the otolaryngologist and neurologist, complementary examinations, and sick leave. Vertigo/dizziness-related diagnoses totaled 21 359 cases, with a prevalence of 4.15%. Women made up 51.49% of cases. Median age was 52.00 (41.00, 65.00) years. Non-specific diagnoses totaled 18 617 (87.16%), including dizziness (n = 13 846, 64.83%), unspecified vestibular function disorder (n = 962, 4.50%), aural vertigo (n = 7, 0.03%), and other (n = 3802, 17.80%). Specific diagnoses totalled 2742 (12.84%), including BPPV (n = 1665, 7.80%), vestibular neuritis (n = 24, 0.11%), Menière's disease (n = 992, 4.64%), and central vertigo (n = 61, 0.29%). Anti-vertigo drugs prescribed included betahistine (n = 13 338, 62.45%), sulpiride (n = 3379, 15.82%), and dimenhydrinate (n = 20, 0.093%). Complementary examinations included computed tomography (n = 5704, 26.70%) and magnetic resonance (n = 604, 2.83%). One temporary disability for work (n = 1468, 6.87%); ≥2 temporary disability for work (n = 275, 1.29%). The majority of diagnostic records related to vertigo/dizziness were non-specific (9 out of 10). The number of prescriptions for betahistine, and referrals, mainly to an otolaryngologist, are considerable and an avoidable expense. Better knowledge about vertigo/dizziness in care could improve the diagnostic and therapeutic accuracy of this pathology as well as the social and health costs it produces.