LGBT History Month by Laura Lennox

Laura L 1Good things to have come out of Dumfries, Scotland:

  • Calvin Harris, superstar DJ
  • LGBT Charter of Rights    
  • Big Burns Supper                                  
  • Please feel free to add more in the comments section at the end…..                      

February is LGBT History Month. LGBT stands for Lesbian, Gay, Bisexual and Transgender. LGBT History Month takes place in Scotland every February. It’s an opportunity to celebrate the lives and culture of LGBT people as well as the chance to raise awareness of the continual need to ensure all LGBT people feel valued, supported and included.

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Our Speech and Language Therapy Adult Service in NHS Dumfries & Galloway are currently undertaking the LGBT Charter of Rights. The LGBT Charter of Rights is a programme created by LGBT Youth Scotland. It developed from the findings of a group of young people in Dumfries (Phoenix LGBT Youth) who began exploring relevant topics to LGBT people and included education, social and health issues. It emerged that people who are LGBT still face discrimination and prejudice due to barriers in these areas. The LGBT Charter of Rights is a way to target these inequalities by providing a means for groups and organisations to change their policies and practice to work towards a fairer and inclusive society for people who are LGBT.

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The training we received from LGBT Youth Scotland focused on health & wellbeing issues in particular, based on the Life in Scotland for LGBT Young People: Health Report (2012). Just over half (56.5%) of LGBT young people (13-25yrs) feel safe and supported by the NHS in terms of their sexual orientation or gender identity. Women within the LGBT population (43.1%) and transgender young people (48.1%) are even less likely to feel supported by the NHS. What really stands out is the fact that 40.1% of LGBT young people consider themselves to have mental ill health. These facts and figures are unfortunately understandable when you consider any person who faces continual discrimination and prejudice for just being who they are.

Our Call to Action: As a National Health Service, we are required to demonstrate our commitment to equality and diversity in accordance with the Equality Act, 2010. Ensuring our legislation and policies meet the needs of the LGBT population is a part of this ongoing process. But it is much more than this. We, as individual staff members within the organisation, have a responsibility to actively take steps to identify and break down these barriers within our own practice and our own services to ensure that people who are LGBT are treated equally and fairly. For more information on how you can begin then please follow this link:    

Thank you.

Laura Lennox is a Speech and Language Therapist at NHS Dumfries and Galloway


Stressed about Stress by Amanda Taka

Stress is one of those words that has become intrinsic in our everyday vocabulary: we’ve all heard ourselves moaning “I’m so stressed!” What is it and how can we manage it?

Stress is defined in different ways by different organisations, but the common thread seems to be that stress is “feeling under pressure”. A small amount of stress is good for us: it keeps us motivated and helps us to do our best. However, when we are living with stress all the time, it can lead to a myriad of unpleasant feelings and physical symptoms can follow.

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Often we are quick to identify stress in others, but would we recognise it in ourselves? Symptoms associated with stress are wide ranging and initially we might not associate the physical symptoms as related to our mental wellbeing. There has been a tradition to separate mental and physical health, but evidence shows the link is greater than we previously may have understood. The jury is still out as to whether stress itself causes disease, but there’s lots of evidence to show that the unhealthy habits we rely on when we’re stressed contribute to many conditions.

Physical symptoms can include:

  • Sleep problems
  • Dizziness
  • Chest pain, palpitations
  • Dry mouth, lump in the throat, shaky hands
  • Lack of appetite, or conversely, comfort eating
  • Repetitive tic
  • Headaches
  • Diarrhoea or constipation
  • Loss of libido
  • Tearfulness/depression/anxiety
  • Worsening symptoms of long term conditions


  • Poor concentration
  • Difficulty making decisions
  • Irritability
  • A feeling that things are hanging over you
  • Excessive intake of caffeine, cigarettes or alcohol
  • Low self esteem/lack of confidence

This list is not exhaustive!

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What causes stress?

Here’s the tricky bit. We’re all different, so we all have different triggers. For example, one nurse would struggle to cope with the incessant physical and emotional demands of working in the Emergency Department, whereas that environment is perfect for a different nurse.

Acknowledged triggers of stress are as follows:

  • Work pressures, job instability, fear of redundancy
  • Parenting, family and relationship difficulties
  • Financial pressures
  • Bullying and discrimination
  • Loneliness and isolation
  • Living with a long term condition
  • Caring responsibilities

And one more for us workaholics:

  • Taking on too much responsibility and feeling you don’t have enough time to do everything!

OK, so it looks like life itself is stressful.

If you’re feeling like stress is starting to impact on the quality of your life then the first thing would be to get it down on paper. Spotting stress in its early stages can help prevent things from getting worse. Things to include in your “stress diary”:

  • Date, time and place of the incident
  • What you were doing, before, during and after
  • Who you were with
  • What were your feelings, before, during and after
  • Any physical sensations
  • Give the event a “stress rating” e.g 0 = no stress, 10 = the most stressed you could possibly feel.

Making a stress diary is helpful because it aids our ability to make connections between the context and the symptoms. Ideally, a stress diary should be continued for at least 2 weeks. This helps us to see things in perspective. Additionally, this is a vital piece of evidence to discuss with your GP if you’re feeling overwhelmed and unable to cope.

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Quick Fix

When I searched ‘wellbeing’ in Amazon at the beginning of the year, I was astounded at the number of different products that claim to enhance one’s wellbeing: necklaces, crystals and orthotic sandals sat alongside the list of ‘new age’ literature that was available. I’m not sure it’s something that can be bought. There’s certainly no single ‘cure all’ solution. Therefore it’s worth trying, or combining, a number of different approaches until you succeed. Most research shows the following are a good place to start:

  • Physical activity – doesn’t need to be a gym membership, incorporating 30 minutes of activity can help boost mood and clear the mind (remember it can be in blocks of 10 minutes)



  • Relaxation techniques such as mindfulness and breathing exercises are evidence based ways of reducing stress. Courses are available across the region, check the local press or for details.

Nursing is acknowledged to be a stressful profession. In our profession, we tend to put everyone before ourselves, but who looks after the caring professions? I passionately believe that we need to give ourselves the time and effort to look after our own mental wellbeing, and being aware of our stress levels is intrinsic to this.

Further self help resources to try:

  • Living Life telephone self help service and online programme for people with mild to moderate feelings of anxiety and depression using Cognitive Based Therapy. See for more info


  • Breathing space – confidential helpline that describes itself as a ‘first stop’ service which aims to listen and provide emotional support.



  • Steps to Deal with Stress – you may have noticed the little square booklets floating around NHS D&G, pick one up, they have great common sense tips to help with stress busting. More info at

A last word

If you or someone you know is struggling and self help techniques haven’t worked, you may need to seek expert help. For some people a combination of medication, talking therapy alongside some of the techniques outlined above are appropriate. Also, it’s worth remembering that the Samaritans have changed their number to 116 123. Further helplines can be found at

And remember… “taking on too many commitments” may lead to feelings of stress!

Amanda Taka is a Keep Well Nurse at NHS Dumfries and Galloway

The art of dying well by Margaret McCartney

Do we want to live as long as modern medicine allows us, or only so long as life is sweet?

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Death is our only shared destiny, but we are in a new era; it’s not unusual to have 70-year-olds looking after a 90-year-old parent. A few years ago we had to reorganise the shelving in the general practice where I work in order to accommodate the notes of our octogenarians and nonagenarians. In 1917, King George V sent out 24 messages to people having a 100th birthday. In 2011, the Queen sent 9,736.

This is worth celebrating. Just before Christmas, I was languishing in a long queue at the Post Office where a 93- and a 94-year-old were holding court, debating the standards of humour in the greetings cards display to such uproar that the postmistress had to pause to wipe tears of laughter away. Age does not mean a loss of fun, vivacity, or pleasure in living.

But age is still the most potent risk factor for death, and many older people at the end of life have its quality impaired by loneliness and, frankly, too much medicine. If we want good living right up until we die, we should be examining what makes it good — and what stops it being so.

At the heart of the problem is the difficulty in predicting death. There is good evidence that doctors overestimate how long people who are known to be terminally ill will survive: we have libraries stuffed with research papers, but no crystal ball. This matters because medicine is often conflicted over the question of preserving life at the cost of its quality. Treatments in hospital might reduce the size of a cancer, but prevent the patient from going home, where she’d prefer to be. Medication for the heart might cause fatigue or dizziness but give extra weeks or months of life. But if this means less walking and independence, is it worth it?

Death is inevitable, but frequently seen as an inadequacy in medicine or treatment. Harpal Kumar, the chief executive of Cancer Research UK, said on the radio recently that his aim was to ensure that no one died of cancer any more. But we are still going to die, so what are we to die of? Is every death to be fought back with all of medicine’s might, and to be always considered its failure?

Surprisingly, in older people, frailty is a bigger risk factor for death than cancer, organ failure or dementia. Frailty is a relatively new concept in medicine, though William Shakespeare described it well in As You Like It:

the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose well sav’d a world too wide
For his shrunk shank; and his big manly voice,
Turning again towards childish treble, pipes
And whistles in his sound

Frailty is often rapidly recognisable: low levels of activity, a loss in muscle mass, weakness, falls and easy tiredness. The months and weeks before death in an older person are frequently characterised by a series of crises, caused by something as seemingly small as a urine infection or a trip. But the background of frailty means less recovery each time, and a slow, or stepwise decline. If ageing is the cause of frailty, how can we treat it? Medicine has moved into a new era of riskfactorology. We are no longer concerned about people who have a disease, but people who have a risk factor for a disease. We search for blood pressure or cholesterol levels which are deemed high enough to then lower, to try to prevent heart attacks or strokes. We look for bone-thinning, in order to prescribe medicines to attempt to strengthen the bones and prevent a fracture; we offer flu vaccination to everyone over the age of 65.

All this results in more medicines being prescribed and taken. This might sound so reasonable that the mechanism GPs work to (monetary carrots for adhering to targets and shameful sticks whipped out by the Care Quality Commission when we fail to reach them) seems OK. But our riskfactorology results are for the risks and benefits for populations, not individuals, and the result is thousands of people being prescribed medication that they will never benefit from.

Take the medications designed to prevent osteoporosis, tablets called bisphosphonates, such as alendronic acid. These are taken by over a million people in the UK, usually once a week. Ideally, they prevent hip fractures or collapses of the spine. Hip fractures in frail older people can precipitate death, and are to be taken seriously. However, these medications usually don’t work. For example, the independent Cochrane Collaboration has found that for women with low bone density, or who have already had a fracture in the spine, long-term use of alendronic acid can cut the risk of hip fracture from two to one in 100. This is only a small reduction, although it can be described as a ‘halving’ of risk.

What about side effects? Some women will get none, others will feel sick and nauseated. Some women dread the day they take the tablet and feel they have to write it off. Some will consider that a price worth paying, others will not.

However, people aged over 65 are on an average of two drugs, and 10 per cent are taking five or more. In medical terms, this is an alarm signal — is this combination of medicines really doing more good than harm? Older people are chronically under-represented in clinical trials. So there might be trial data to show that a drug works pretty well in a 40-year-old — but will it have just the same effect in an 85-year-old? Our kidneys and liver — which metabolise our medication — tend to work less well as we age, meaning that standard doses can become toxic. And the drugs can interact with each other. Our nervous system is partly composed of unconscious nerves, controlling our heart rate, digestive systems and blood pressure. Many drugs have an effect on these nerves — from antidepressants such as trazadone, to medicine for diarrhoea like loperamide, to oxybutynin, for the bladder, and many antihistamines. The effect can be cumulative, risking falls and memory problems.

It’s this constant play of harm versus advantage, pro versus con, that characterises much medicine, taking in Shakespeare’s sixth and, then, seventh stages of life. Frailty is a risk factor for death, but most frail patients will not die that year. As a doctor trying to decide which prescriptions are worthwhile and which are not, I’m also keen that I try to understand what matters to patients. Is this side-effect worth it? Is this medication keeping you well or causing you problems?

Medicine can do great things — joint replacements can add life to years, heart attacks are treated with swift declogging of arteries, HIV can be managed long-term. But life through a medical prism is prone to give a medical answer to social problems. Loneliness is one of the biggest. Up to 16 per cent of our elders describe themselves as lonely. I’ve come across patients where the only conversation they’ve had all week has been with the doctor. People who are lonely are more likely to use NHS services, and loneliness is a risk factor for depression and earlier death, as big a risk factor as obesity or high blood pressure. Research points towards social interaction being protective against memory loss. Good health at the end of life is not just about medicine; it is about social activity and networks.

So where do doctors fit in? Just before Christmas there was a sudden (and, sadly for me, temporary) lull in the demand for appointments. Instead of the usual ten, I could spend 20 minutes with just one patient. I had a joyous couple of days, because I could look away from the computer, relax and listen without the constant narking pressure of running late. Suddenly, there was time to talk about what really mattered. With this illness, what are you thinking about the future? Is there anything that is worrying you? What are you enjoying just now? What do you hope for? Unleashed from the tickbox demands of the contract we GPs work to, general practice is fascinating, uplifting and profound in its humanity. Listen, and people talk.

It’s clear from the research that the vast majority of people with life-limiting conditions want their healthcare professionals to play it straight — most people want honesty. This does not mean that people should be told brutal truths in one unexpected sitting. It does, though, mean that talking about death and what quality of life means — for you — should be an unfolding, commonplace conversation.

This is hard, not just because it can feel awkward or upsetting. But the problem is plain. Medicine has a habit of almost unstoppable escalation. One treatment leads to a side effect, which can lead to another treatment, which can lead to another side effect: we can end up chasing tiny odds of benefit while the problem, staring us in the face, is that death is going to happen at some point no matter what we do. Too much medicine is capable of changing a peaceful death into a medical battleground, a peaceful death surrounded by family at home into a death in the bright lights of intensive care. Stepping off the medical escalator may take courage, not just for patients and families but also for doctors. Until we value a good death as much as we value a good life, we will fail to serve people well at the end.

This article was published in The Spectator on October 24th 2015. The original version can be found at

Dr Margaret McCartney is a GP in Glasgow and writes regularly for the BMJ and other publications.


A Message from the CMO @CathCalderwood1

I’m delighted to have been asked to contribute an update to the Dghealth blog.

This year has got off to a busy start for me with the launch by all of the four UK CMOs of the consultation on alcohol guidelines for lower-risk drinking, and my first annual report as Chief Medical Officer for Scotland, calling for a debate on Realistic Medicine.

The guidelines advise men and women not to regularly drink more than 14 units a week, spread drinking over three days or more if you drink as much as 14 units a week and if you want to cut down how much you’re drinking. A good way to help achieve this is to have several drink-free days each week. It can be a bit tricky to understand and remember how much alcohol is in drinks, and how this can affect our health. The low risk guidelines can help with this, if you choose to drink. No-one can say that drinking alcohol is absolutely safe, but by sticking within these guidelines, you can lower your risk of harming your health if you drink most weeks. I was pleased that the new guidance also takes account of the harmful effects of binge-drinking, and brings the rest of the UK into line with Scotland by advising women not to drink any alcohol during pregnancy.

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One of the ways I try to be accessible is via my blog and Twitter feed – it was interesting to see the comments on twitter around the alcohol guideline launch, ranging from welcoming to “killjoy”. Change is always going to cause a reaction – but since the guidelines are in response to evidence of the risk of alcohol causing cancer the UK CMOs have to get our message across, however difficult that may be, so people can them make their own informed choices.

The reaction to my annual report on Realistic Medicine has been more universally positive, in the media and through feedback on twitter and my blog. The report contains the traditional publication of “health of the nation” issues examining a range of population health surveillance data and outbreaks of disease etc but the key theme is ‘Realistic Medicine’ and what this can mean for the challenges that face doctors as a profession and in healthcare. I launched the report at the Western General Hospital in Edinburgh with Dave Caesar, Consultant in Emergency Medicine, NHS Lothian and Dr Caroline Whitworth, Renal Consultant, Royal Infirmary of Edinburgh.

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I followed this up with a discussion about the questions I raise in the report with a group of about 20 doctors from NHS Lothian. This is the beginning of engagement I want to undertake across Scotland to hear views of doctors who are well placed to come up with the answers to how we improve shared decision-making; ensure we deliver person-centred care; reduce unnecessary variation in treatment and outcomes; as well as reduce harm and waste (including over-treatment) for the people doctors treat. My team produced a very helpful infographic setting out these questions and we have a range of materials for anyone in the profession who wants to discuss this among themselves and feedback to me via the clinician survey.

I would welcome feedback from everyone on the report so l can use it to inform health policy. My role and that of my team consisting of the Deputy Chief Medical Officer, Dr Gregor Smith and senior medical officers and speciality advisers is to provide the clinical voice in decision-making. As healthcare professionals we have useful knowledge and expertise to guide policy and our input is vital. I would welcome your input to help us to carry out that role effectively. I can be reached in a number of ways: 



Twitter: @CathCalderwood1 []


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