Every GP out there can vouch for the fact that they spent over half a decade in university, another chunk of years after that studying and then subsequently being examined on all aspects of medicine, pharmacology and therapeutics. Our well-thumbed copies of the BNF never lie further than an arm’s reach on our work desks and, similarly, our friendly local pharmacists are on speed dial for a vast proportion of us.
The field of therapeutics is under constant change and review, with the management of conditions such as hypertension, asthma and hyperlipidaemia being frequently tweaked and adjusted to reflect the most up-to-date data from evidence based medicine and best practice. With this comes the constant challenge for us doctors to keep up-to-date and ‘in the know’ when it comes to managing many day-to-day conditions which are dotted throughout a day in the office.
I have witnessed the look on patients’ faces – usually a look of scepticism mixed with doubt – when I relay to them that the blood pressure medication they were put on a year ago is no longer the pill of choice for their condition. I suspect if I could read their minds they would be thinking something along the lines of: “That lady doctor hasn’t a clue about what she is doing” or “Would she make up her damn mind?” (complete with eye rolling and a tut-tutting sound).
Conventional medicine continues to steamroll along, with clinical trials and meta-analyses throwing more potent and efficacious drugs onto the market. We doctors now find ourselves with a vastly expanding and seemingly never-ending reservoir of wonder drugs which we can initiate with a scribble of a pen. Even as a young(ish) doctor, I find myself wondering when did the whole task of treating something so straightforward as hypertension or gout become so complex. I hear older colleagues reminisce about times when only a handful of tablets existed for the treatment of such day-to-day conditions, and I find myself feeling a pang of envy when I hear such tales.
Conventional medicine may well be going from strength to strength, but quietly and in a non-threatening manner, alternative health remedies and therapies have crept into the world of health and wellbeing. A trip to a local shopping centre for bread and milk will now likely take one past an alternative medical stall with its adverts for instant cures for insomnia, stress and male pattern baldness.
I have a curiosity and a touch of envy for how seemingly easy it is to cure such problems with a simple herbal remedy. The scientist within me wonders about what sort of clinical trials or studies were done, what the numbers needed to treat were, and about the P values and other statistical components that lie behind such wonder remedies.
While I will admit that I am not an advocate of alternative medicine, I have in recent months found myself utilising some non-conventional approaches to problems and ailments that I come across in my working day. Stressed out, tired and insomniac patients have been advised regarding sleep hygiene and, in addition, the purchase of Hello magazine has been recommended to aid with de-stressing and relaxation.
While sleep hygiene is a well-known and effective cornerstone in promoting healthy sleeping habits, I am unsure about how reading in a glossy magazine about how the royal family spends its week fits into the non-pharmacological treatment of insomnia? Saying all that, if such interventions cut down on prescribing of hypnotic medications, then surely I am on to a winner here?
A pretty manicure may well motivate a determined nail-biter to cease such a habit, and a deep-coloured nail varnish serves as a good way to conceal a minor fungal toenail infection, thus alleviating the need for a long, expensive course of anti-fungal. I have gone so far as to recommend the purchase of fancy hair clips and accessories to patients who are in turmoil about a visible scar they so desperately want to hide.
While my version of non-conventional medicine can on occasion be found peppered throughout my working week, I can say with certainty that evidence-based medicine remains at the core of what I do. After all, I did spend all those years of studying and reading to keep myself up-to-date.
It’s hard to shut out an inner monologue with questions regarding numbers needed to treat when it has been the soundtrack to my career for the past decade. I’m not sure I could simply pack that all in and set myself up in a pop-up shop, marketing manicures, hair slides and selling Hello magazine with a promise to cure everyday ailments. And unfortunately, as two of these are my guilty pleasures, I doubt I would get any work done!