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INSTANT WISDOM FOR GPs PEARLS FROM ALL THE SPECIALITIES INSTANT WISDOM FOR GPs PEARLS FROM ALL THE SPECIALITIES EDITED KEITH HOPCROFT BY CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2018 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-138-19620-9 (Paperback) 978-1-138-29692-3 (Hardback) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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For permission to photocopy or use material electronically from this work, please access www.copyright. com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Hopcroft, Keith, editor. Title: Instant wisdom for GPs : pearls from all the specialities / [edited by] Keith Hopcroft. Description: Boca Raton : CRC Press/Taylor & Francis Group, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2017033146 (print) | LCCN 2017033902 (ebook) | ISBN 9781315116808 (ebook) | ISBN 9781138196209 (pbk. : alk. paper) | ISBN 9781138296923 (hardback : alk. paper) Subjects: | MESH: General Practice | General Practitioners | Health Knowledge, Attitudes, Practice Classification: LCC RC46 (ebook) | LCC RC46 (print) | NLM WB 110 | DDC 616--dc23 LC record available at https://lccn.loc.gov/2017033146 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com CONTENTS Preface vii Acknowledgments ix Contributors xi Allergy 1 Tak Chin, Elizabeth Griffiths and S. Hasan Arshad Cardiology 7 Jerome Ment Care of the elderly 14 James Woodard Dermatology 21 David Rutkowski, Zak Shakanti and Matthew Harries Diabetes 28 Tahseen A. Chowdhury ENT 35 Andrew Bath, John Phillips, Peter Tassone and Stephanie Cooper Functional symptoms 42 Richard Davenport Gastroenterology 48 Stephen J. Middleton General practice 54 Keith Hopcroft General surgery 64 N.F.W. Redwood Gynaecology 70 Elizabeth Ball and Adam Rosenthal Haematology 77 Andy Hughes vi Contents Neurology 84 Richard Davenport Oncology 91 Karol Sikora Ophthalmology 96 Omar Rafiq Orthopaedics 102 Phil Clelland and John Leach Paediatrics 109 Peter Heinz Palliative care 116 Dylan Harris Psychiatry 123 David S. Baldwin Renal medicine 130 Aroon Lal Respiratory medicine 137 Rudy Sinha-Ray and Neal Navani Rheumatology 144 Charlotte Wing and Jessica Manson Sexual health 151 Michael Rayment Thyroid disorders 158 Mark P.J. Vanderpump Urology 165 Ian Eardley Index 173 PREFACE I’m fairly confident that, if anyone was dispensing Instant Wisdom on writing a book, they would say that no one ever reads a Preface. On that basis, I’ll keep this brief. The idea for this project has been kicking around in my brain for years. Partly because I’ve always loved those wise nuggets you occasionally pick up from a particu- larly good lecture or article. And partly because of the event that spawned Pearl #20 in the ‘General Practice’ chapter. Essentially, the book is an attempt to distil and collate gems of wisdom about medicine – derived from study, evidence, teaching and, especially, years of experience – that we all possess and which we might remember/reveal if we were held upside down and shaken long enough. Of course, true wisdom can’t be instilled by digesting a book. But something quite close perhaps can be, and it was an attractive enough notion for me to have a go. The logical way to structure the book is by speciality. As it will be of most interest to generalists – trainees, young GPs and established old timers like me who still genuinely learn something every day – I sincerely hope it comes across as true enlightenment rather than unrealistic specialist dogma. If it errs towards the latter, then I’ve failed in my editing duties. The fact that I’ve contrived the ‘General Practice’ chapter to be twice as long as all the others is some sort of insurance policy for this, plus it reflects the fact that, of course, general practice is the most difficult and wide-ranging speciality of all. As for how you read the book, that’s up to you. Dip in and out, or plough through methodically, as the fancy takes you. But I do hope it is read – and that, as a result, you feel that bit wiser, and your patients feel that bit better. vii ACKNOWLEDGMENTS Frankly, I’ve lost track of all the people I should thank, there have been so many. But special mentions to Richard Davenport, Nick Summerton, Shaba Nabi and Alistair Moulds. Hats off to CRC Press/Taylor & Francis for taking the idea, and me, seriously. Obviously, a massive thank you to all the authors for turning around such high qual- ity work within my deadline, with only a few needing the cattle-prod treatment (they know who they are). And, lastly, I’d like to thank, and dedicate the book, to all GPs and their staff – and especially those at Laindon Medical Group – because it’s their wisdom, and their hard work, that keeps the NHS afloat. ix