InnovAiT: Education and inspiration for general practice

Fungi are a common cause of skin infections. The pathogens involved are usually dermatophytes and yeasts. This article covers the common types of fungal infections and provides information on how they can be recognized and managed in a primary care setting. Providing patients with advice on the preventative measures that can be taken is essential to prevent recurrent infections.

Approximately 15% of GP consultations in the UK are for a skin condition. In the general population, about 4.5% of people have a contact allergy to nickel and 1–3% to an ingredient in cosmetics. Studies suggest that skin disorders (29%) are the second most common cause of occupational disease after musculoskeletal conditions (57%).

Skin disorders are a common presentation in primary care accounting for up to 10% of GP consultations. Benign skin tumours make up a significant proportion of these, thus the ability to accurately assess and diagnose them and manage lesions appropriately is an essential competence in primary care.

The new MRCGP curriculum devotes a whole section to the care of people with mental health problems—and rightly so, for up to 30% of us will have some kind of significant episode of psychological disturbance in our lifetimes. Far more of us suffer transient but problematic psychological distress, especially when we or others for whom we care are unwell. So the GP registrar doing a routine clinic in UK general practice will find that as many as one in four of their patients are experiencing psychological symptoms, with higher rates in the elderly. Previous articles have covered the specific tasks of performing mental health assessments and diagnosing depression: this article aims to review the broader context of psychological distress in the consultation. It pays additional attention to factors associated with psychological distress to which GPs and other primary care staff should be alert and to ways of addressing these in a sophisticated and humane manner. Finally, I address the queston of self-management—that is minimizing the ‘human sponge’ effect often incurred by empathic GPs at the start of training.

Obsessive—compulsive disorder is a common psychiatric disorder characterized by intrusive thoughts or ‘obsessions’, which predispose to repetitive acts or rituals, known as ‘compulsions’. These compulsions are necessary to relieve the anxiety caused by the obsession. Patients have insight into the unnecessary nature of the symptoms but can find them hard to suppress. Inability to carry out everyday activities can lead to significant functional impairment. Many feel embarrassed and go to great lengths to conceal the disorder from others which can lead to a delay in diagnosis and management.

This paper describes the role of primary care clinicians in the management of people with psychosis. The paper uses the term ‘psychosis’ in the same way that severe mental illness is used in the Quality and Outcome Framework to mean those people who suffer from schizophrenia or bipolar disorder. The paper will cover some epidemiological characteristics of psychosis, features of people with acute psychosis, features of chronic psychosis and finally describe briefly changes to the Mental Health Act 2007 and the potential for these changes to affect the practice of medicine in primary care.

‘Smoking cigarettes causes lung cancer’. This may now seem like a somewhat uninteresting fact because it is such common knowledge, yet 60 years ago relatively few people were aware of this. It has only been with the aid of research methods and statistical techniques that such a consequence of smoking was introduced to society and is now well accepted. Such trends towards evidence-based medicine can only flourish in a culture of statistical literacy. Moreover, how can we even start to effectively critically analyse a scientific paper if we do not understand the basic statistical techniques the researcher has adopted? Part of the perceived complexity with this process is a (natural) fear of statistics and consequent lack of understanding of statistical processes. To obtain a functional level of statistical literacy, one must understand the vocabulary of statistical terms, statistical methods and the effect of statistics on study design.