Tag Archives: Domhnall MacAuley

Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He recently attended the 2016 Primary Health Care Research Conference (PHCRIS) in Canberra, Australia
 

Grant Russell, newly elected for a second term as President of the Australasia Association of Academic Primary Care (AAAPC) was upbeat in his introduction to the second day of the meeting. He reminded us how the Canadian academic, Martin Bass, had warned against learned helplessness and he pointed out that primary care has much more influence than we give ourselves credit for.

Claire Jackson, one of Australia’s leading primary care researchers was introduced at her plenary lecture as “an eternal optimist”. True to form, she told us that there has never been a more exciting time to be in primary care research. She listed the national primary health care strategy, the primary care framework, and the 31 primary health networks. While there have been numerous health care reforms, each one has primary care at its centre and there is growing government awareness of the need to address complex chronic illness in community. ...continue reading

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Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He is currently attending the 2016 Primary Health Care Research Conference in Canberra, Australia

 

“This is the time to be in general practice...This is the time to be in general practice research,”
said Steve Hambleton,  former chair of the Primary Health Care Advisory Group, a body created to look at options to reform care for people with complex and chronic illness. Steve gave the opening conference address. He spoke about the advisory group's work, their wide ranging membership including family doctors, other providers and consumers, and he outlined three areas that would be major challenges in the future: chronic care, obesity, and preventable disease. Steve also reminded us that those patients with the greatest number of diseases see the greatest number of doctors. The final report, delivered on ...continue reading

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Couch potatoes say that you never see a happy jogger, and they might be right. Too many runners train too hard, think “no-pain-no-gain” and don’t take time to step back.  Intelligent middle aged high achievers (like us doctors) often make the same mistakes.  Forget the Sports Guru nonsense. Your body is not a highly tuned Grand Prix racing machine.  Most of us just chug along like a four-door family saloon. So, here are a few suggestions to help you avoid injury, burn out, and boredom. Basic, simple and obvious, they won’t sell many running magazines but they might be of some use to middle of the road athletes expecting miracles, underachievers who mismatch training loads and life circumstance, and obsessives who feel rest and relaxation should be avoided at all costs. ...continue reading

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DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

My programmed response is always to jump to the defence of primary care, but a report entitled “Chronic Failure in Primary Care” that was recently published by the Grattan Institute, a public policy think tank in Melbourne, Australia, raises interesting challenges.

It was written by Jo Wright, Hal Swerissen, a health policy expert from LaTrobe University in Australia, and Stephen Duckett, an economist who will be known to many Canadians from his time in Alberta. It is critical and challenging but behind the headlines there are some constructive ideas. ...continue reading

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DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

They found the body. A short paragraph buried in the newspaper. Dr Rose Polge left her hospital shift two months previously and had not been seen since. Her car was found parked by the sea.

A young doctor took her own life. I wanted to write about it at the time but it was difficult to find the words. It seemed to me a tragedy, a great loss of a young life full of potential. But, these words cannot capture quite what I felt. Where have we gone wrong?

It brought me back. I remembered my first year after qualification. It was brutal; a shock. Suddenly I felt I carried all the responsibility. I saw seriously ill patients in the middle of the night and had to make critical decisions. It was a small hospital. I was the cardiac arrest team. The tiredness was unrelenting, the gnawing anxiety continuous. ...continue reading

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Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

One of the best pieces of research with which I was involved was rejected by The BMJ when I was one of its medical editors. A qualitative study. it was exciting and innovative and it gave some remarkable insights into genetic medicine - or so I thought. I don’t know quite why it was rejected. Research submitted by members of the editorial team was assessed outside the normal process so I didn’t have access to the notes and it was never discussed with me. I published other studies in The BMJ both before and afterwards, but that paper was special and (many years afterwards) I still feel they made a mistake…but, every author thinks that, don’t they?! ...continue reading

JR_2016Joanne Reeve is an Associate Clinical Professor in Primary Care at Warwick Medical School in the UK, and the Chair of the Society for Academic Primary Care


A recent editors' blog by Domhnall MacAuley suggested that it is “difficult to see a future for academic general practice.” I propose that the solution lies in the broader discipline of Academic Primary Care (APC).

Academic Primary Care matters. APC is a distinct discipline driving improvement in primary care through education and research. Academic general practice lies at the heart of this wider multidisciplinary community committed to improving whole-person centred primary health care. The APC community lead health service research driving improvements in policy and practice in key priority areas such as antibiotic stewardship and cardiovascular risk management. But APC also tackles the distinct challenges facing the Primary Care community: for example, the need for new person-centred models of acute and chronic care to address problems of treatment burden and ‘too much medicine’. APC supports the redesign of Primary Care through re-engaging with the core principles of continuous, comprehensive, accessible, whole person-centred care. ...continue reading

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

The newspaper story about our research focused on the proportion of older people without sufficient leg strength to stand up unaided from sitting in a chair. At the time, it irritated me. We had just completed a major country wide health and activity survey with superb data on fitness at all ages....and they picked this one component. It was a huge piece of work. Our team had interviewed 1800 adults up to the age of 70 years old, measured VO2max together with ECGs on a treadmill, undertaken various strength tests in a mobile exercise laboratory that we transported to 14 different hospital sites, and taken fasting blood tests in peoples’ homes. My main interest in sport and exercise medicine was in promoting physical activity and - at the time - I thought I was a bit of an exercise guru. It wasn’t the headline I had hoped for and, furthermore, I was teased for weeks by friends and relatives. Everyone wanted to show me how they could all stand up unaided from sitting in their armchairs!

But, with a bit of hindsight, I can now say that perhaps the journalists were right. ...continue reading

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DMacA_ski_resizeDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Some years ago, out walking along the river, I met an ex-athlete friend . “I gave up running at 50,” he told me. "Too many of my friends were having heart problems”. This didn’t fit with what I believed about the benefits of exercise, so I didn’t give it a lot of thought.

More recently, however, when preparing a talk on sudden cardiac death, I came across a research paper from Sweden that followed up 52, 755 athletes who had completed the Vasaloppet a long distance cross country ski race (90k) and, curiously, showed that those who raced more often and faster, were more likely to have hospital admissions for cardiac arrhythmia. This seemed counter-intuitive. ...continue reading

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DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Reading a recent robust critique of the achievements and challenges to academic general practice in the UK, and a plea by senior academics for increased capacity in clinical academic general practice, I began to wonder.... How might we design general practice research for the future, what direction should a department of general practice take, and where does general practice fit into the future of clinical research? As an intellectual exercise, I allowed myself to think the unthinkable. And, for a general practice academic, brought up in family medicine and immersed in the traditions of personal primary and continuing care, this felt like heresy. At the very least, however, perhaps we should begin to think creatively about the future. What do you think?

It is difficult to see a future for academic general practice. ...continue reading