Author Archives: Euan Lawson

About Euan Lawson

Euan Lawson is the Deputy Editor of the BJGP.

BJGP Open: adapting primary care for migrants

Photo by shawn at Morguefile.com

The aim of this paper was to provide some insight into how primary care is managing to offer care to migrants. In particular they were interested in looking at the challenges and the ways in which practices and practitioners were adapting to meet this need.

The first phase was an online survey. During this they surveyed 70 primary care practitioners. They then used responses to select eight case studies for a further qualitative phase. They had a mix of mainstream GP practices as well as specialist services that offered tailored services to refugees, asylum seekers and other migrants. There was one group interview (with three GPs from the same city) and seven further in-depth interviews. The descriptive analysis was structured around the principles of equitable care that drew on the framework from Browne et al.

They found that practitioners tended to focus on working with community and external agencies and adapted their own processes in order to avoid care. This was particularly evident in areas such as screening, vaccination, and health checks. The biggest barrier was the lack of funding and this was cited in 73% of cases. The organisation and partnerships were regarded as particularly important to ensure there is an awareness of wider social determinants, the impacts of trauma and violence, and all this had to be wrapped up into culturally-competent care.

Opinion: There is a small section in this paper that caught my eye in relation to burnout. Just over one-third (34%) cited personal fatigue/burnout/capacity as a barrier to developing services. The additional workload ramped up the stress for some healthcare professionals and in one of the services they had introduced life coaching. In another they had adopted debriefings that are similar to those used in conflict areas.

“I think in terms of values, everyone sees the work that we do in serving vulnerable groups as a privilege.”

I’d put a positive spin on the burnout angle – it can be enormously re-invigorating to get involved with marginalised groups. As one ‘mainstream’ GP stated: “I think in terms of values, everyone sees the work that we do in serving vulnerable groups as a privilege.”

There are some fine examples in this paper on how primary care can be developed to give a more “equity-oriented service”. It showcases how, despite all the appalling strain on the system, there are still ways for primary care to innovate to reduce health inequalities. More than anything we should be driven by the principle that we need to reduce health inequalities to improve our societies. And sometimes we need to hunt these people down. Whether it is people with learning disabilities, or the mentally ill, or people who inject drugs, the homeless or as in this case migrants and refugees – these are the groups of people that need our attention.

ResearchBlogging.orgSuch, E., Walton, E., Delaney, B., Harris, J., & Salway, S. (2017). Adapting primary care for new migrants: a formative assessment BJGP Open DOI: 10.3399/bjgpopen17X100701

Long Read: The changing face of general practice in the 20th century

Dr Stanley Jeffs

Dr Stanley Jeffs

Dr Stanley Jeffs is a retired GP who has made regular contributions to the College Journal. He is now 90 years old. His first article, An Epidemic of Lumbago, was published in 1961. You can download and read it from our archives here. He has suggested this contribution will be his last offering to the BJGP. It gives a fascinating glimpse into the history of general practice as well as much for us to consider for the future.

 THE CHANGING FACE OF GENERAL PRACTICE IN THE 20th CENTURY

By Dr S. G. Jeffs (a personal opinion based on doctors I knew)

Dr Joseph Porter

By my calculations Dr Porter must have been born about 1890. Certainly he was a medical officer in the First World War when his personal transport was a horse. Tall and with a slightly mischievous look on his face even in his old age, I first knew him in the late 1950s in Levenshulme, a district of South Manchester, where, at that time, there were eight doctors in practice, all within a thumbprint on the map. There were two partnerships of two and four single handed doctors. Three of the single-handed doctors lived above the surgery premises. The NHS had been going for a decade.

Dr Porter and I, both single handed, stood in for each other occasionally for emergency on-call, which, in truth, was not very often, quite rare in fact. The law at that time, required each doctor to be responsible for his patients’ care at all times all year round. Our trade union, the BMA, struck a really bad deal for general practitioners, and for junior house doctors too. So, if I wanted to go to the cinema for instance, I would arrange with the manager of the cinema to give his telephone number as my emergency contact number and he would provide an end seat for me in the auditorium. In that way, should an emergency arise, the usherette could find me easily without disturbing anyone else.

It was only a few years after I came to Levenshulme, about 1957, that Dr Porter took ill and he sent for me. I was not his physician and I regarded it as a privilege that another doctor wanted my opinion, an inexperienced youngster in his late twenties. At that time Dr Porter must have been nearing 70 so I was less than half his age. The diagnosis was easy. He was in congestive cardiac failure.
“I will have to admit you,” I said. “wherever I can find a bed. Would you like me to try Manchester Royal Infirmary first or Withington Hospital?”
Withington Hospital had been built originally as a workhouse and to many patients it still bore the stigma.
“It doesn’t matter to me,” he replied. Then taking my hand in his he said, “Will you look after my patients for me?”
“Of course I will,” I said.

There was a sort of unspoken brotherhood, an ethic that, regrettably, was dying with Dr Porter’s generation.

There was no question of money or how much extra work I would have to do. There was still at that time, a feeling among many doctors, but not all, of a sort of unspoken brotherhood, an ethic that, regrettably, was dying with Dr Porter’s generation. But I had had ethics rammed down my throat in medical school from the dissecting room to finals in medicine and considered it the right and decent thing to do to look after another doctor’s patients when he was sick.

Dr Porter was in hospital for three weeks and even when he was discharged he was too ill to continue in single-handed practice. It seemed natural at the time though I can’t remember now precisely how it came about, but we joined in partnership which, sadly, was to last only a few years. I can picture now, when Dr Porter died, one of his patients standing in the entrance hall of the practice, a man of about 50, his hat in his hand, a look of total dejection on his face, a man lost and alone in the world as if he had been one of the Children of Israel in the Sinai desert when Moses died, saying to me, and these are his exact words which I shall remember for ever: “The doctor’s dead. What shall I do?”

I don’t know how Dr Porter saw himself as a doctor but if I can put words into his mouth, perhaps he saw himself as a shepherd tending his flock. I shall never really know, but, together with his patients, I saw him as a deeply caring, godly man. He did his best to keep up with modem advances in medicine, and mostly succeeded, but the driving force within him was his devotion to his fellow man and his ability to help others through his medical training. Before the NHS, when all practice was private, his patients told me that, when they couldn’t afford to pay him, Dr Porter would smile, put his fingers in his waistcoat pocket, extract a two shilling piece or a half crown coin, and, giving it to the patient would say “I think you need this more than I do”.

Dr Porter did with words what I tried to do with Valium and he was far more successful than I was.

Many of his patients told me that, if one member of a family had a serious illness, like pneumonia, Dr Porter would summon the family together and, by the bedside, they would all go down on their knees and pray – pray that on the fifth day of the illness, when there would be a crisis, the good Lord would see fit to deliver him back to the fold of his family. And if the patient did die, Dr Porter would be there at the funeral to help and console the family. Dr Porter did with words what I tried to do with Valium and he was far more successful than I was. He gave his patients the will to strive to get better, not to sit back and complain and demand attention and blame others It was this very personal approach to each patients inner strength that made Dr Porter so loved.

Dr Alan Guthrie

I joined Dr Guthrie in 1973 in Chester. I was the third doctor in that practice that century. The first doctor practiced from about 1900 to the 1930s. Then Dr Guthrie till the 1970s. Then me. I stayed with him for three years while he prepared for retirement. As a GP, Dr Guthrie was quite different from Dr Porter – and from myself. I gained the impression that Dr Guthrie saw himself as a medical sorting house. His job was to look after a section of the community, 4,500 patients at one period but just over 2,500 when I joined him. Roughly, I would say, for practical purposes, in his mind he divided his patients into 2 groups – those who had serious illnesses or long term conditions that could become serious if unattended -and all the rest. The first group comprised all patients with cancer, suspicious lumps, serious disease of any organ, hypertension, diabetes, and so on. All these patients were sent to hospital for diagnosis and long term treatment.

Dr Guthrie never worked with any other professional. He left messages for the nurse but did now know her.

Dr Guthrie did not do any laboratory or X-ray investigations of his own, not even follow up. That was hospital work. All the rest of the patients, the second group so to speak, comprised every day illnesses and complaints. He was not as personal a doctor as Dr Porter who came before him, or as advanced in diagnosis and treatment as I had been taught to be, but nevertheless, I never found a carcinoma he had missed, nor any serious condition undiagnosed and untreated. He never worked with any other professional. He left messages for the nurse but didn’t know her. He did know the midwife but never worked with her. He refused to accept the need for a health visitor. “I am the health visitor,” he said when I queried him.

He knew all his patients he said, and he knew what was happening to them all the time. If he got a house call to a patient in St Ann Street, while he was there, he would knock on the door of every one of his patients in that street to know how they were getting on -even shout through the letter box. “It’s the doctor, are you alright?”. If the answer was “Yes thank you,” as it usually was, he’d go on to the next house, and so on. But, if the answer was “I’m not very well today, doctor,” or some similar reply, he’d stay and attend to that patients’ needs. In this way he’d do 40 “visits” a day. As I say, he kept an eye on his “flock” in a totally different way from Dr Porter. Dr Guthrie was not a personal doctor. He saw it as his job to look after the medical requirements of a section of the community, and by his standards he did it very well indeed.

Myself

I was a medical student from 1944 to 1950. It was a singular time in the history of medical education for three main reasons which shaped the outlook of those students who would become the future practitioners. Firstly, the profession was changing from being predominately an art form to becoming a blend of art and science. Secondly, the discovery of new drugs, particularly the antibiotics penicillin, sulphonamides, streptomycin, chloromycetin, revolutionised the treatment of bacterial illnesses. And thirdly, and possibly most importantly, the revulsion and abhorrence of the German and Japanese wartime crimes, produced a national, in fact an international, attitude of moral questioning – how could it have happened, what kind of animal was homo sapiens, what kind of world did we now want to build? This moral questioning went through the whole of society – including the undergraduate medical education.

Ethics was rammed down our throats from the dissecting room to finals in medicine. The cadavers we dissected, we were reminded, were once living human beings who loved and laughed and prayed to God and we should respect them. One student was failed in finals for not showing due care and consideration to his patient, even though his diagnoses and treatments in major and minor cases were correct. Not surprisingly the doctors who graduated at that time were to become creators of new, different and hopefully better things, pioneers in their field.

It was our generation which fought to create a College of General Practitioners with their own academic journal full of original contributions.

But the GPs of my generation were inheritors of a lowly position in the medical hierarchy. We were the dregs of the profession! Lord Moran PRCP called GPs – doctors who had fallen off the consultant ladder, not thinking that many of us, even the cleverest in my year, never wanted to be consultants in the first place. To be a consultant you had to have post-graduate training and pass further exams whereas GPs just went straight into practice and, theoretically, need never open another textbook or journal. Not surprisingly then it was our generation which fought to create a College of General Practitioners, to establish University departments of General Practice with their own lecturers and professors, their own academic journal full of original contributions in academic, community and social aspects of general practice.

I can only speak with direct knowledge for Manchester University but I have no reason to doubt that my experiences reflected national feelings and aspirations, and not only in Britain but also throughout Europe and beyond. The aim of our medical school at the time I was a student, through its pyramidal system of education (which in my opinion has never been bettered), was to produce a complete and highly competent, highly ethical doctor, with an enviable ability of bedside diagnosis and capable upon graduation, of looking after a section of the community in all its requirements including midwifery.

And so, as an illustration, in my first job, which was advertised simply as House Physician. I was expected to run a casualty department, to suture wounds down to the deep fascia, to take and interpret my own X-rays and plaster fractured upper limbs, and generally do everything a Casualty Officer needed to do short of specialised therapies. On other nights, I was expected to stand in as the doctor in charge of medical admissions in which role, in the hospital laboratory, I had to measure patient’s blood sugars and ureas, set up my own drips, and initiate whatever treatment was necessary. I was also asked once to anaesthetise for the gynae list when an anaesthetist failed to turn up. I was competent with gas, oxygen and ether – and happily all the patients lived and none got pneumonia!

Other doctors, who, on graduation, did not want to work in hospitals, were able to go straight into the community, deliver their patients babies and perform minor surgery in the local cottage hospitals. All this was possible because our teachers had aimed at producing graduates of wide ranging abilities with a strong ethical background. It was an exciting time. It was also the time of the birth of the NHS.

The science of medicine is what you do for the patient. The art is how you do it.

So when I joined Dr Guthrie in 1973 to look after 2,500 patients, not surprisingly, he was horrified at the changes I made. From there being just him and no-one else, suddenly there were two doctors plus a trainee (post-graduate student), a practice manager, a receptionist, a filing clerk, a nurse and her bath lady, a health visitor, and a midwife with her pupils, plus visiting other professionals from the community. At that time I saw myself as primarily a family doctor who practiced medicine half as an art and half a science. The science of medicine is what you do for the patient. The art is how you do it. The bedside manner of old is, for example, part of the “art.” I also saw myself and my contemporaries as the new general physicians who would, in time, replace hospital general physicians. Comprehensive specialties were breaking down into smaller more highly specialised units. No matter how much I pleaded with him, Dr Guthrie refused to allow my post-graduate students to sit in with him. He dido’t want any young whipper-snappers criticising him. I was sorry about that. They would have learnt so much from him. My generation then, were ethical revolutionaries with their feet finnly placed in the past but with their sights on a new future.

The Modern Graduate

We must be careful not to sacrifice the bedside for the laboratory, for then we will lose more than we will gain.

By the end of the 20th century the medical graduate has become primarily a scientist. To enter medical school (s)he must have the highest grades in physics, chemistry and biology, and graduate with, among some traditional learning, an enviable knowledge of human biochemistry.  So how will future generations think of the modern doctor? I used to teach my trainees that, in every age, there were some good things and some bad ones, and that they should try to keep the good which our predecessors established, like the trust and deep caring of Dr Porter’s time, and add to it the best of modern medicine. But, we must be careful not to sacrifice the bedside for the laboratory, for then we will lose more than we will gain.

Conclusion

Every doctor must be judged against the background of the times in which he lived. Did he, as a representative of the profession, serve his patients, and society, well? By creating an academic College and teaching programmes to help our juniors into their professional careers, I think we made a worthwhile contribution to society. From the point of view of the individual doctor and his professional relationship with his patient, Dr Porter’s generation produced outstanding physicians. Indeed, if I was ill, I would like to be cared for by someone like Dr Joseph Porter.

BJGP Blog Christmas charity: Help Malawi medics this Christmas

christmas_pound-1Perhaps you are thinking of giving of some money to charity rather than sending Christmas cards or maybe you want to give a different type of gift package. Or maybe you’d  just like to support a worthy cause. UK registered charity Medic to Medic supports disadvantaged students training at the College of Medicine in Malawi by providing student scholarships. Here’s an update on the work they do and the problems faced by medical students in Malawi.

“On the opening day of school, a few students litter the registry whilst a multitude are packed at the assistant registrar’s office pleading for waivers in order to get registered. Many have come as far as Karonga, the district bordering Tanzania and Zambia on the far north. The queue is slowly winding the pillars, meandering back and forth outside the assistant registrar’s office. At the dean of students’ office, there is an uncomfortable sight of premedical students wrestling the queue, pushing and dragging one another to the back on a hot summer day longing to meet the dean of students. Both students standing at the Assistant Registrar’s office and the Dean’s office have one problem akin to them; the insufficient tuition fee.

Following the overwhelming tuition fee hike of 600% at the College of Medicine, the students at the only medical school in Malawi are in dire situation and are languishing due to the inhumane hike. About 60% of the students have failed to register for the 2016/17 academic year and others have opted to withdraw temporarily on financial grounds.

The fee hike has rendered many students destitute as it comes at a time when Malawi’s economy has nosedived into oblivion. On the household level, most of the people in Malawi about 80% are in the rural areas and many of the students are from the rural areas where poverty has sky rocketed. In the villages, the parents can hardly afford three meals a day and most of them are going to bed on empty stomachs. If the parents can’t afford a descent daily meal, where will they get the huge money demanded of them to educate their children with the fees at 350,000 Malawi Kwacha (£400) per annum?  The only resort for the impoverished students is to ask for temporary withdrawal since they cannot get admitted in the college.

Malawi ranked the world’s poorest nation has been marred with intermittent blackouts, inconsistent water supply and insufficient harvest as the result of climate change. It is unbearable for medical students to be attending lectures as well as clinical sessions at the hospital on an empty stomach. Following the non-residential policy put in place about half a decade ago, more than half of the students at the college live outside the campus where their security is very unreliable, poor studying environment, pitiable sanitation and very high rentals.

Currently, the future of Malawi’s competent health practitioners hangs in the balance as mass withdrawal of the students on financial grounds has already commenced and it ought to deteriorate in the second semester if the current situation persists. The battle to reduce the fees had taken the students to the state president of the republic of Malawi who also doubles as the university of Malawi chancellor but it yielded almost nothing as the fees were only slashed by about fifty-five pounds from about four hundred and fifty pounds. The present situation for the medical students at College of Medicine is worrying.”  Fatsani Gundah, MBBS year 5 student.

UK registered charity Medic to Medic supports disadvantaged students training at the College of Medicine in Malawi by providing student scholarships. Scholarships cover the cost of tuition fees, provide a twice yearly stationery allowance, medical books, medical equipment and if funds allow, a laptop. This enables each student to study optimally so that they can fully concentrate on their studies and successfully qualify as health workers in Malawi, a country that has just 2 doctors for every 100,000 people.

Malawi desperately needs more health workers. It has some of the worst infant and maternal mortality ratios in the world. For many of the students training at the College of Medicine, the tuition fee increases are unattainable and there are more students struggling than ever before. Many students will be forced to drop out of their training, go back to their villages where the cycle of poverty will continue. Normally Medic to Medic have been able to take on 15 new students each year, but because of the 600% tuition fee increase, they have not been able to take on any new students.

This Christmas you can support Medic to Medic by buying a gift package for a loved one from their website. There are pre-set amounts starting from £10, through to £1,000. Each package goes towards a different aspect of a students training, ranging from paying for a stationery allowance, through to providing a laptop, medical pack and covering tuition fees. For each gift the recipient will receive a certificate, student profile, their latest student update and a selection of Medic to Medic gifts. Gifts can be sent direct to the recipient or back to the buyer. Packages can be sent internationally, although there is a minimum donation for these packages. It’s also possible for overseas friends to purchase gifts online in their own currency.

In an era when not knowing what to get someone for Christmas is such a first world problem, Medic to Medic offers a solution: an ethical gift of giving this Christmas.

For more information please visit:
www.medictomedic.org.uk
Email: info@medictomedic.org.uk
Call 0208 869 3603

Altmetrics at the BJGP: a beginner’s guide


Unsure about altmetrics? Check out this video, less than three minutes long, that will give you an introduction.

We’ve been using altmetrics at the BJGP for a while now. You can see them for each individual article by clicking on the ‘Info’ tab (as shown below).

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At the bottom of the Info tab is the altmetric information where the wider impact, beyond that of simple citations, of the article is represented in graphical form. For instance, here is the ‘donut’ for the article shown and you can click on it to visit its own Altmetric page.

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RCGP Conference 2015: Reflections on politicians and policy

Screen Shot 2015-10-01 at 10.41.07Euan Lawson is the Deputy Editor of the BJGP.

Today was the first day of the RCGP Annual Primary Care Conference and the sun was out in Glasgow.

Jeremy Hunt turned up for the last two years but we were informed by the President, Mike Pringle, that he had a genuine excuse for non-appearance this year. Two years ago Hunt spoke without notes and with an engagingly informal approach. He did the same last year and the audience weren’t quite so charmed and the cosy style felt a little forced. This year, he would have needed more than his warm fluffy personality to charm the audience given the seven day working proposals. Although not here in person, Hunt’s presence loomed large in discusssions. Maureen Baker spoke with great passion and no little anger voicing the concerns of many GPs. The whole of the speech is available at GP Online. Regarding the recent seven day working proposals she made the RCGP position clear:

She was disparaging of Jeremy Hunt’s “so-called” new deal and demanded George Osborne ensure that general practice received 11% of the NHS budget by 2020.

Jeremy Hunt may have been congratulating himself on avoiding the stress of facing several hundred irascible GPs, but it was a good gig for Shona Robison, the Scottish Government’s Cabinet Secretary for Health, Wellbeing and Sport. She was good enough to provide the following summary of her speech:

As Scottish Health Secretary, I appreciate the opportunity to welcome GPs from all over the UK to Scotland and the City of Glasgow and your discussions this week at the RCGP Annual Conference 2015 will make an invaluable contribution.   In Scotland we are committed to collaboration with doctors, not imposing change but rather working in partnership.  We are  taking this approach with junior doctors, where we have said we will not impose new terms and conditions.  We are doing the same with GPs, where we are collaboratively developing a new contractual framework for General Practice in Scotland.

GPs are at the heart of local communities. Without the hard work and commitment of GPs and their professional colleagues, like nurses, pharmacists and physiotherapists, our health system simply wouldn’t be able to cope.

GPs care for families, but also effectively ‘look after’ the rest of the NHS, influencing by their decisions and actions a significant proportion of the activity of the whole system.

The Scottish Government has always been committed to supporting vital, front line health care services. Investment has increased in every year of this Government, and is now £80 million higher than when we took office.

However I know that GP workload is increasing, as is the complexity of health care; and where more is being delivered outside hospital settings, resources haven’t always followed in a proportionate way. The profession also faces serious challenges over recruitment, retention and increasing workload.

That is why we have been working with GPs, to agree on the good ideas and fresh thinking that are required to transform the way we provide care in Scotland.  This strategic approach puts GPs at the heart of multi-disciplinary teams of professionals, making a real difference to local communities. I have backed this work by introducing a £60 million primary care fund.

This money is being invested now in supplying new pharmacists to support GP workload, on GP leadership and recruitment and retention, on ensuring the future of the Scottish School of Primary Care and on testing new models of primary care in many parts of Scotland – from Deep End practices in Glasgow and Edinburgh dealing with inequalities to GP clusters in Grampian who are innovating in the way that they engage with their local community.

The future NHS must be very different from the past. We must develop new models of care, fit for the needs of the 21st century and the challenges ahead.

I am very proud of the NHS in Scotland. I know that General Practice is crucial to dealing with the challenges ahead. There is a firm commitment from the Scottish Government, backed by sustained investment, to continue to work with GPs to ensure the best for communities, for our people and for our families.

She saved the best for the speech itself and two promises sparkled in the Glasgow sunshine. Firstly, she announced a plan to dismantle QOF in Scotland. Yes, I know – apparently, it has “had its time”. And, finally, as befits a consummate politician she came circling back around to prey upon Jeremy Hunt. She was “appalled” by the actions of Jeremy Hunt and that the threats to junior doctors are “beyond the pale”. She offered no less than a “cast iron” guarantee that the Scottish Government will not be following Hunt’s plans to cut junior doctor pay.

The Scottish contingent of GPs were glowing and it wasn’t the unexpected dose of Glasgow UV on their faces. Those of us heading south face a long trip back in a day or two.

Review: The Possibilities are Endless

IMG-low resEuan Lawson (@euan_lawson) is the Deputy Editor, BJGP.

In 2005, Edywn Collins had a brain haemorrhage. There’s no gentle intro to this film; it is immersive as we are plunged into a fragmentary sequence of memories, images and sounds. There’s footage of Helmsdale, the hills and the beaches where Edwyn and his family spend their time, and childhood memories collide with adulthood. Edwyn offers broken commentary, his voice hesistant, frequently stuck and unintelligible. Grace, his wife, speaks to Edwyn, and we can feel her at the bedside comforting him. It’s claustrophobic, frightening and frustrating. It’s also mesmerising and quietly horrific as we eavesdrop on an inner life where your brain is unanchored, adrift.

How do you reconstruct your life after a brain injury that leaves you with a hemiplegia and practically aphasic? His only words: Yes. No. Grace Maxwell. The possibilities are endless. He has to learn to read again. Edwyn draws the same rough portrait of a man again. And again. He struggles to remember how many days there are in a year. It took me a while to place Edwyn and it wasn’t until they showed a clip of his biggest chart hit, A Girl Like You, that I had him. A handsome, tall, prodigiously talented musician with a self-assured melodious Scottish accent. Grace and Edwyn just kept going, tiny amounts upwards and onwards. As Grace says, sometimes you just have to “suck it up”. The words of his songs start to come back to him and he sings again.

There is often a whiff of the condescending when relating life-affirming stories of the apparently afflicted. There’s no room in this story for any plastic admiration; nothing in this film plays on victimhood. It’s just Edwyn’s and Grace’s story with no smear of self-pity to blur the vision. This is not a motivational movie with the life story burnished so we may weep at the indomitable human spirit. It’s not making promises that by watching you will be a better person. Yet there is a quiet satisfaction here and an insight into brain injury that embraces the medium of cinema.

Spoiler: You will be disappointed if you are hanging out for a magical moment of recovery with all his memories and skills flooding back in an exultant moment of slow-mo triumph. Ultimately, we come to Edwyn as he his now: ribbing his wife; laughing with his son. He’s not where he was before 2005, perhaps not where he might have expected to be: but then who is? Edwyn is laconic: Possibly before my stroke I was a bit too focussed. He goes on in his staccato style: The next stage of my career. No, no, I was nice. Don’t get me wrong. But arrogant in a way. I’m over that phase.

[bctt tweet=”BJGP Blog: The Possibilities are Endless. A remarkable film with @EdwynCollins. #braininjury”]

Visit the website: www.thepossibilities.co.uk. The Possibilities are Endless is showing in selected cinemas in February and March, or you can buy and download it via the website in hard copy or digitally via the iTunes Store. Twitter: @EdwynFilm

 

The BJGP Blog

IMG-low resEuan Lawson (@euan_lawson) is the Deputy Editor, BJGP.

Welcome to the BJGP Blog.

The aim, as the tagline suggests, is to bring opinion to all facets of general practice and primary care. The BJGP is an academic journal; we publish research papers and we hope they influence policy and care. The BJGP Blog is something we want to do to add value to our output. There are dozens of potential ways journals may have influence: via the patient and the clinician as they come to decisions about the best care for that individual; commissioners facing choices about the future services in their locality; educators finessing the message for their learners; academics teasing out the nuances of research findings; and the list goes on.

Clinical topics, academic debates, policy and news, education, popular culture… we want to peer into all the nook and crannies at the BJGP Blog and we look forward to the discussion.

Please get in touch if you’d like to contribute.