The Magic Glove - Hypnotic pain management for children for taking blood

Neuroplasticity

What if we were trained with this concept? If you believed that nothing was fixed...

Motivational Interviewing

The Motivational Interviewing approach begins with the assumption that the responsibility and capability for change lie within the client. The therapist's task is to create a set of conditions that will enhance the client's own motivation for and commitment to change. Rather than relying upon therapy sessions as the primary locus of change, the therapist seeks to mobilize the client's inner resources, as well as those inherent in the client's natural helping relationships. MI seeks to support intrinsic motivation for change, which will lead the client to initiate, persist in, and comply with behavior change efforts. Miller and Rollnick (1991) have described five basic motivational principles underlying such an approach:


1. Express Empathy
2. Develop Discrepancy 

3. Avoid Argumentation 
4. Roll with Resistance 
5. Support Self-Efficacy

1. Express Empathy

The MI therapist seeks to communicate great respect for the client. Communications that imply a superior/inferior relationship between therapist and client are avoided. The therapist's role is a blend of supportive companion and knowledgeable consultant. The client's freedom of choice and self-direction are respected. Indeed, in this view, it is only the client who can decide to change and carry out that choice. The therapist seeks ways to compliment rather than denigrate, to build up rather than tear down. Much of MI is listening rather than telling. Persuasion is gentle, subtle, always with the assumption that change is up to the client. The power of such gentle, nonaggressive persuasion has been widely recognized in clinical writings, including Bill Wilson's own advice on "working with others" (Alcoholics Anonymous, 1976). Reflective listening (accurate empathy) is a key skill in motivational interviewing. It communicates an acceptance of clients as they are, while also supporting them in the process of change.

2. Develop Discrepancy

Motivation for change occurs when people perceive a discrepancy between where they are and where they want to be. The MI approach seeks to enhance and focus the client's attention on such discrepancies with regard to drug use. In certain cases (e.g., the "precontemplators" in Prochaska and DiClemente's model) it may be necessary first to develop such discrepancy by raising the client's awareness of the adverse personal consequences of his or her drug use. Such information, properly presented, can precipitate a crisis (critical mass) of motivation for change. As a result, the individual may be more willing to enter into a frank discussion of change options, in order to reduce the perceived discrepancy and regain emotional equilibrium. In other cases, the client enters treatment in a later "contemplation" stage, and it takes less time and effort to move the client along to the point of determination for change.

3. Avoid Argumentation

If handled poorly, ambivalence and discrepancy can resolve into defensive coping strategies that reduce the client's discomfort but do not alter drug use and related risks. An unrealistic (from the client's perspective) attack on his or her drug use tends to evoke defensiveness and opposition, and suggests that the therapist does not really understand.
The MI style explicitly avoids direct argumentation, which tends to evoke resistance. No attempt is made to have the client accept or "admit" a diagnostic label. The therapist does not seek to prove or convince by force of argument. Instead, the therapist employs other strategies to assist the client to see accurately the consequences of drug use, and to begin devaluing the perceived positive aspects of drugs. When MI is conducted properly, it is the client and not the therapist who voices the arguments for change (Miller & Rollnick, 1991).

4. Roll with Resistance

How the therapist handles client "resistance" is a crucial and defining characteristic of the MET approach. MI strategies do not meet resistance head-on, but rather "roll with" the momentum, with a goal of shifting client perceptions in the process. New ways of thinking about problems are invited but not imposed. Ambivalence is viewed as normal, not pathological, and is explored openly. Solutions are usually evoked from the client rather than provided by the therapist. This approach for dealing with resistance will be described in more detail later.

5. Support Self-efficacy

A person who is persuaded that he or she has a serious problem will still not move toward change unless there is hope for success. Bandura (1982) has described self-efficacy as a critical determinant of behavior change. Self-efficacy is, in essence, the belief that one can perform a particular behavior or accomplish a particular task. In this case, the client must be persuaded that it is possible to change his or her own drug use and thereby reduce related problems. In everyday language, this might be called hope or optimism, though it is not an overall optimistic nature that is crucial here. Rather, it is the client's specific belief that he or she can change the drug problem. Unless this element is present, a discrepancy crisis is likely to resolve into defensive coping (e.g., rationalization, denial) to reduce discomfort, without changing behavior. This is a natural and understandable protective process. If one has little hope that things could change, there is little reason to face the problem. 

Mindfulness - Easily Explained

Another fast phobia cure

Notice the fast simple technique that's used for this cure.

Punch Biopsy Excision of Skin Cyst - Squeeze and excise

This is one I did myself. Small hole. Next time we do it through a smaller orifice.

Principles of Medical Interactions according to Neurolinguistic Programming

• Everyone makes the best choice available to them at the time - accept, understand, and forgive

• There is no failure, only feedback - accept mistakes as a learning opportunity

• Behind every behaviour is a positive intention - be curious, find it, learn from it

• The map is not the territory - what you feel is only one way of looking at things, there are other ways that might prove more useful

• The meaning of communication is its effect - take responsibility for what and how you communicate

• We already have all the resources we need - tap into all your resources and divert them to where they are needed

• The person with the most flexibility has the most influence - the more choices of how to respond we have, the better. If one fails choose another 

• Mind and body are one - what affects one affects the other

• There is a solution to every problem - be curious and find it, be patient and keep trying different approaches

• What is true of someone else is true for us too - what we notice in others we have too - thats how we recognise it. 

• If you always do what you’ve always done, you will always get what you’ve always got - it’s you who has to change if you want a different result

Sebaceous Cyst Removal Using The Punch Biopsy Technique

This is a good method too!

Placebo studies from Harvard Medical School - the power of the consultation

Why wouldn't we add engagement if it would increase our chances of making medication more effective?

I always say we should try to sell the drug and not just give it. Say it with conviction, and engage the patient.

Language and Belief - The Magic of Belief: James Brown at TEDMEDLive Imperial College 2013

Connecting with people and realising the consultation is more powerful than you think.

Language and Belief - The Magic of Belief: James Brown at TEDMEDLive Imperial College 2013

Connecting with people and realising the consultation is more powerful than you think.

Dr. Hamilton Demonstrates "The Hold" - How To Calm A Crying Baby

please try and let me know if it works

Hiccups in General Practice

Very occasionally patients come in with this strange one. All the patients I have seen in General Practice share one common item in their history - they never learnt a good way to stop hiccups.

From the reading it involves some sort of resetting of the diaphragm that's going beserk.

This is my simple technique that is almost guaranteed to work that I have used effectively.

Drink continuously from a cup of water - sips will do, do not stop to breathe. Take 10 SLOW gulps - these can be small otherwise you might be full up of water. You will get an overwhelming urge to want to breathe, but the act of drinking causes an intake of air that will be sufficient to keep you oxygenated. When you have completed this exercise, you will be hiccup-free.

Not only is this episode over, this is a skill they will have for life.

I once got a bottle of Champagne for helping someone with his intractable hiccups.

Let  me know if it doesn't work in the comments section.

The expressive writing method - A simple method to improve grades?

Write for 15 minutes for 4 consecutive days.

Just try it and see what happens at the end of the exercise. It will surprise you.

It's great for people who don't like to talk to others.

Richard Bandler NLP Overcoming bad memories

This is a brilliant technique - you need to repeat it 3x for it to be more effective. Repeating this too many times results in amnesia, which is not a great idea as we don't want to repeat the same mistake again. Bad memories should be left there so that we can learn from them when we need to but not so they can cause emotional turmoil over and over again.

The Disease Does not know it.....

The response rate to these operations is quite high. When a patient was asked if they knew it was all a sham they said, " Yes, but the disease doesn't know that...".

Could this be why duct tape or any other treatment works for warts better than placebo?

Anthony Robbins - Swish Pattern - eg phobia cure, bad memories, etc

It's Not About The Nail

 A lesson not to rush in straight away and just listen to the patient.

Resolving Anxiety and Other Strong Feelings - another approach

Getting ready to locum

So you've finished your CSA. You're coming to the end of your Registrar year. Suddenly, you panic because once you finish, you'll no longer have back up from your trainer and you won't have a regular salary. You'll be SELF EMPLOYED, and you don't even know what that means!

These are some things I think you'll need to do to get ready for locuming:

1. Get used to 10 minute appointments
2. Find out where to advertise your services in advance so that you have work lined up for when you finish otherwise you won't be able to pay your mortgage! You can usually advertise for free on the local 'purple pages' of your LMC (local medical committee). You can also drop by to practices you're interested in and drop in your CV and speak to the practice manager.
3. Find out where the locum / sessional GP group meetings are - there is usually something going on locally with organised meetings monthly or speak to an experienced GP locum
4. Speak to the Out of Hours providers to see what you documents you will need to provide before starting
5. Understand that there are a few different clinical systems out there and that you may take time to get used to them or only accept work in practices with systems you are familiar with
6. Discuss billing (I will do a section on this or see www.gplocumweb.co.uk) - my feeling is that you should bill for your time. After all, if its 2 hours or 4 hours, its still your whole morning or afternoon working so you have lost half your day - bill for half the day. This is transparent and clear. Don't add transport - it is annoying - work it into your bill - if its a practice far away, bill them more. 
7. Register with inland revenue as self-employed (you have 3 months), speak to  your trainer about what you can claim as self-employed, and keep records. Get an accountant. Your home will be your base, so transport can be claimed back from inland revenue as a business expense. 
8. Once you start, have the numbers and addresses of the practice you are working at, the local hospital, and understand how that practice works - as a bare minimum, familiarise yourself with the computer system, how to refer to radiology and physiotherapy, dictate / write letters, and the location of the toilet. Do some online research before you start, but often you'll just have to try different practices to see if you like working there.