National Stress Awareness Day 2015- a reflection by a Student Health Service (SHS) GP

Yesterday was the UK’s ‘National Stress Awareness Day’. As part of this, the ‘International Stress Management Association’ has produced some excellent resources to help combat stress that can be accessed using the following link:
Reading the material on this website led me to reflect on how much of the work I do as a GP, on a day-to-day level is, in part, attributable to stress. Stress is of course a normal and natural part of everyday life that is necessary for our survival. At its best, stress helps us to function and optimise our performance, e.g. during exams. At its worst, stress can be destructive, causing both mental health issues as well as physical symptoms.
The link below gives a 10 point plan to help ‘stress bust’. As a GP at Student health, I would recommend reading these whether you are currently stressed or not. Practising stress busting techniques as part of everyday living e.g. exercise and taking time out, will prepare you well if times become tough.
The main problems that I see with stressed students often involve the following:
1. Lack of sleep habit/ structure leading to exhaustion, making stress all the more worse. Sleep issues are all consuming. Self-help advice ( may be all that you need, or else please consider talking to the professionals at Student Counselling Service or SHS.
2. Forgoing meals due to lack of time to eat/ prepare food or nausea associated with stress. Eating little and often will provide the brain and body with the much needed ‘fuel’ and usually combat associated nausea.
3. Stress leading to a sense of work becoming overwhelming so that it is impossible to consider prioritising. provides a list of work-shops that might help students with study skills. Making a timetable of tasks can help a stressed individual establish clear goals. Please also remember that tutors will be able to help prioritise tasks if you are struggling.
4. More and more I am seeing how recreational drugs and too much alcohol are playing havoc with my patients’ mood and ability to tolerate stress. They also cause problems with sleep quality and are known to have a serious potential impact on mental health.
5. Not taking any breaks as there is too much work. Very few people can work all day and night and keep going. Regular breaks and natural stress busters such as a quick burst of physical activity and laughter can be a fantastic way to recharge your batteries.
Please consider looking at the National Stress Day resources and if you are concerned about your ability to manage your stress, remember that there are many people at the university who would be delighted to discuss this e.g. tutors, hall wardens, the SCS, the chaplain and Student Health Service.

Please see our website for links to related mental health resources and self-help material (; ;

Sports injury? What to do, when to do it and why it matters

For many of you, the summer break means relaxing and perhaps doing less sport. Now that you are back at Uni and doing familiar, and in some cases, new sports, your fitness and agility are being challenged. If that results in joint, muscle or ligament injury, it can mean not only pain and swelling, it might mean time away from the sport, and the socialising that goes with it. So what do you do when you’re injured? When and where should you seek help?

Here are the basics.
The first 24 hours after injury: PRICE principles
PRICE stands for Protection, Rest, Ice, Compression and Elevation.

These principles guide care of joint, muscle and ligament injury.
Protection: Stop the activity which caused injury. Immediately post injury you should avoid excessive and painful movement. Use support such as taping, bracing, splints or crutches as needed.
Rest/relative rest: Give the injury time to heal by taking load off it
Ice: use for at least 10 minutes (but no longer than 20 minutes). Time between icing should be guided by pain, but can be less than 2 hours between applications. Take care not to give yourself an ice burn.
Compression: If there is swelling, you can apply compression with a bandage or tubigrip. Don’t use high levels of compression with elevation unless advised to do so by a Doctor.
Elevation: in most cases, this can help. To elevate, you bring the injured body part above the level of the heart, e.g. resting with leg up and well supported if ankle is swollen. It is important to slowly lower the injured and elevated body part when bringing it back towards the ground.
Though perhaps tempting to dull pain with alcohol, it’s best avoided, as it slows recovery. It may lead you to use the injured area more than you should.
After the acute phase of injury (i.e. once the injury starts to subside), you need to progressively load the injured part. For example, after an ankle sprain where there is no fracture, it is important to gently start walking as normally as you can for short distances when you feel you are able and pain has subsided a little.
When to seek help
Seek help immediately if there is
• severe pain and/or deformity
• joint dislocation
• concussion/head injury
• bone fracture
• significant bleeding/skin and tissue trauma
• severe pins and needles, numbness unexplained muscle weakness
For these significant injuries, attend a nearby hospital Accident and Emergency department.
Seek help from a GP or Physio if there is
• Ongoing severe, persistent pain and swelling which is failing to respond to PRICE after 48 hours
• Ongoing swelling
• Loss of range of movement (e.g. can’t lift arm fully or take weight on foot and ankle) strength and joint stability
• If you are unable to continue to do normal activities and sport due to your injury
Physiotherapists help reduce pain and dysfunction through using manual techniques and exercises. The sooner you seek help, the better the health professionals can help you get back to your best. If you don’t follow through on treatment, injuries can become recurrent, meaning more time on the side lines and away from the great social and health benefits sport brings. It might impact your studies too.
If you are worried that you will be told to stop sport and exercise, be assured that your physio or GP can help you consider options to reduce impact on the injured area and maintain your fitness.
Old and recurrent injuries
If you have an old injury that’s recurrent, or an injury from overuse, that can be managed too. It’s normal to feel the occasional ache or pain after trying a new activity or returning to sport after a break, but symptoms that persist or recur are usually a sign that your body is not working at its best. Physios are experts in body mechanics, and can help you understand the cause of the pain and manage it. They work closely with Student Health to manage medical issues and investigations if required.
See here for more on Physiotherapy at University of Bristol



Getting appointments at SHS; easier than before!

Whats new?!


At Students’ Health Service we are constantly aiming to improve the service we provide. In response to patient feedback we have made some signficant changes to the options you will have for getting help from us.

Whenever possible the website should be your first point of contact. New for this term you will find here the ‘webGP’ icon. Here you can find useful advice including a symptom checker, self-help guides and details of ways to contact the practice, including sending your doctor an e-consult for many common problems.

In addition to our doctors we have an experienced team of nurses, many of whom are prescribers (can write prescriptions for medicines), and new for 2016 we are going to have a clinical pharmacist too. To help you to see the right person for your needs, there is a guide to booking your appointment on the SHS website.

Whilst you can of course still come in to the practice, or telephone reception, it will now also be possible to book appointments online too. You can ask for a PIN number to access this service once the NHS has processed your registration with us.

Overall we are offering more appointments than ever before!

Please try out webGP before you book your next appointment if possible!

Thank you


DNP; a toxic choice for slimming/ body building. Beware!

GPs have recently received notice from Public Health England advising us about patients using a chemical known as DNP (2,4-Dinitrophenol) to supposedly aid with loss of weight, or body building. There has been a sharp increase in the number of cases since 2013.

Use of this chemical, sold as ‘fat burners’ or food supplements, has led to fatal outcomes in several cases. Most of those affected are teenagers or young adults.

DNP is not a licensed drug. It is an industrial chemical and is illegal for use in foodstuffs. It is NOT fit for human consumption.

Use of the chemical can cause multiple horrible side effects, from fever and vomiting, to headaches and irregular heart rate. Even with medical intervention it can lead to coma and death.

Please do not touch this chemical and discourage your friends from using it if they mention it, or consider it.

We are happy to talk to anyone who is worried about their weight, or wants help with weight loss. We have special services to help with eating issues, and weight loss if you are overweight.

Don’t suffer in silence. Dont use this chemical, it could be a fatal choice.



World Mental Health Day 10th October 2015

Every year the WHO leads a day of awareness on mental health related topics, and the theme this year is ‘Dignity in Mental Health’.
The aim is to campaign against discrimination and marginalisation, as well as stigmatisation, and to educate people as to what can be done to preserve the dignity of those with mental health conditions.
Here at Students’ Health Service we are proud to have recently been awarded a grading of ‘Outstanding’ by the Care Quality Commission (CQC) for our care of students with mental health conditions.
The whole team has worked really hard over the years to create a safe and welcoming environment for students who are struggling with emotional and psychological health conditions, and we have built up a solid network of services within the practice, which will support our students through their academic careers.
We provide a weekly visiting psychiatrist clinic, in-house Cognitive Behavioural Therapy (psychological support) for a variety of conditions, self hypnosis for anxiety, eating disorders referrals to a specialised local clinic, and we are soon to have our own team psychotherapist, to support our students with the most complex mental health needs.
We really believe that mental health is as important as physical health, and we will see a person with a mental health crisis for an appointment the same day, as we would see a person with chest pain, or difficulty breathing.
We work closely with the Student Counselling Service, and liaise with them, with patient consent, if it will help improve the student’s care.
We want our students to know that if they are worried about their mental health they can book an appointment to see a GP, and we will be non-judgmental, supportive and caring, will listen to their worries and discuss the situation, and we will do our best to help move things forwards, including liaising with academic departments, if requested by the student.
Don’t suffer in silence. Please talk to us.

The following links may also be of interst on World Mental Health day 2015.



Back Care awareness week 7-11 October 2015.

“The lack of physical activity is one of the top 4 leading causes of preventable death”. World Health Organisation statement.

So have you heard about the campaign to Get Britain Standing? And the ‘Active Working’ principles?
Nor had I till I read the Back Care info at
Active working is definitely a possibility for students! There are a few basic principles which I know some of the uni staff already practise, so why couldn’t you?!

Active Working Tips:
1. Keep moving around. Take frequent breaks
2. Take phone calls standing up, this also boosts confidence and voice quality
3. Try removing tables and chairs from meeting rooms. This leads to shorter meetings
4. Take the stairs instead of the elevator
5. Walk to a colleague’s desk, instead of emailing
6. Stand during presentations or speeches
Another popular move has been to have a sit-stand desk.
A height adjustable work station using it for between 15mins to 2 hours is seemingly a great way to stay fitter and keep those muscles working.
Apparently Winston Churchill did this, so you’d be following in some pretty impressive footsteps (or standing in them, at least!)
And you burn 40% more calories by standing at your desk.
Don’t forget that to prevent back problems in the first place you need to keep active, work your core muscles (yoga/ pilates), take care with lifting and carrying heavy items, and have a great posture when sitting eg in lectures/ in the library. Check out the link for exercises to help back health.

Finally, if you have severe back pain, with pain radiating down your leg, or from neck to arm, then please see the GP. We rarely x-ray backs anymore but we need to see you for assessment if you seem to be having nerve symptoms, like tingling/ numbness/ shooting pains or weakness of hand grip/ leg strength.
Physio clinics are a brilliant place to start for more mild to moderate back pain without nerve symptoms.

So, try Active Working, and keep your back healthy!

Who should help me when I’m ill?

You may have noticed that when you call to book an appointment our receptionist will ask you if the health concern you have is ‘Something the nurse could help with?’.

The reason for this is to try and ensure that our patients are seen by the correct professional from first contact with us. The receptionist will try to find out the ‘nature of the problem’, with the aim of helping you to waste minimal time in getting to the right appointment.

If you or the receptionist are unsure about who can help, then they will ask the GP who is with them in recpetion every morning, so that an expert opinion advises you immediately. The GPs won’t give medical advice over the phone at this point or do a consultation, but they will guide you to an appropriate clinician, which might also include a pharmacist or dentist, as many people phone to book a GP appointment for toothache, or conjunctivitis, when these can best be dealt with elsewhere.

An alternative to booking by phone is to book online of course, and if you are interested in this option just apply for the PIN number required, via our website. It is much more convenient than sitting in a queue of people waiting for us to get to your call.

Our phones ring constantly in the morning, so it helps us a lot if you can be brief and tell us the nature of the problem immediately eg ‘pill check up’, or ‘mental health’, and can be flexible around appointment timing options please, as we have a very large list size of patients, and not enough NHS funding for more staff (despite campaigning constantly for better funding for young people’s healthcare).

We always do our best to get you to the right appointment first time, it doesn’t always work, but our intentions are good, and your support is appreciated.

If your problem is a medically urgent one, then please state this and why and we will always see you the same day.

If you need a certificate, then please speak to our office team first, Option 2. You may not need an appointment.

Please don’t use A&E unless it really is an emergency eg broken bone, collapse etc, as the Out of Hours GP is available 24/7, just phone our usual number. A&E is under strain nationally, and we should try to keep it for what it is designed for please.

Thank you for taking the time to read this and understand our system. We are here to help!


FODMAPS; not a catchy name but a very important food group!

FODMAPS; what’s that about then?!

  • Fermentable
  • Oligo
  • Di
  • Mono-saccharides
  • And
  • Polyols

These are foods that have been found to make the symptoms of Irritable Bowel Syndrome worse.

Therefore people diagnosed with, or who think they might have IBS, should follow a low FODMAP diet. FODMAPS don’t get digested easily, they ferment and create gas (wind) in the bowel, and this leads to bloating, cramps and diarrhoea.

There are many other ways to also manage your symptoms, such as taking a daily probiotic capsule, and avoiding certain types of fibre (insoluble); found in wheat, bran, corn and wholegrains.

Most people find that decreasing fizzy drinks, caffeine and alcohol helps, as they can all increase the speed at which food passes through the gut, and so make IBS worse.

If you would like to discuss your IBS then do book a routine appointment with one of our GPs. You can also check out the FODMAP apps available online to help you plan your diet, and see which lovely foods you can eat in peace.

Sun; sometimes it’s good and sometimes it’s bad!

Feeling pale and pasty? Feel like a quick visit to the tanning salon to use the sun bed? Think again….

Research published in the British Medical Journal has shown evidence that the increase in use of artificial sources of ultraviolet radiation such as indoor tanning devices like sun beds is associated with an increase in risk  of the 3 main skin cancers including malignant melanoma, an aggressive form. This risk is increased if the first exposure to artificial UV radiation is before the age of 35 yrs.

The authors of the study estimated that 3438 cases of malignant melanoma could be prevented each year in Western Europe by avoiding exposure to indoor tanning. The World Health Organisation has now classified tanning beds as a group 1 carcinogen alongside tobacco smoking and asbestos.

Still feeling pale and pasty? Feel like planning a holiday somewhere hot and sunny? Think again…..

It has long been recognised that excessive exposure of the skin to the direct UVA and UVB rays of direct sunlight increases the risk of developing skin cancers of all types. Episodes of sunburn greatly increase this risk as skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Take measures to be ‘sun safe’

Avoid the sun when the sun is strongest in the middle of the day.

Cover up when you are out in direct sunshine for a prolonged time.

Use high factor sunscreen with UVA and UVB protection and reapply it regularly.

Still feeling pale and pasty? There is an answer……

Opt for a spray tan and take a walk, quite literally, on the sunny side of the street. Exposure to a moderate amount of direct sunlight is actually beneficial.

Vitamin D is vital for good health, growth and strong bones and is made in the skin with the help of sunlight. We also get a small amount from the foods we eat (oily fish, egg yolk and fortified foods eg. some breakfast cereals).

To prevent deficiency of Vitamin D it is estimated that we need 2 to 3 sun exposures per week in the summer months (April to September), lasting 20-30 mins, to bare arms and face. This needs to be in direct sunlight and not through a window. This is not the same as suntanning and sunburn should be avoided at all costs.

How can we help?

If you have any new or changing skin lesions, and particularly if you have been a heavy user of indoor tanning and sun beds, or have a history of multiple episodes of sunburn, the doctors at the Students’ Health Service

would be very keen to take a look at them. The earlier any skin cancer is caught, the better the outcome of treatment.

Further information:


Sun Awareness Fact sheet-

Sun and Health-


BMJ 6 October 2012 Volume 345.

Editorial p7, Research p14/15, Personal View p31

Eating Disorder Awareness Week 23rd Feb- 1st March 2015

This week is national charity B-eat’s Eating Disorders Awareness Week. B-eat aims to challenge stereotypes and increase understanding for the 6.4% of the adult population who show signs of an eating disorder, as well as their friends and families.

When attempts to diet get out of hand, and the pattern with food impacts on other areas of life, such as friendships, relationships, health, work or study, people are often thought to have an eating disorder. Usually people with eating disorders worry a lot about the physical appearance of their bodies.

Many of those experiencing eating disorders are students. In fact, First Step (Bristol’s primary care eating disorder service) receives more referrals from the Students’ Health Service than any other surgery in the city.

First Step is a free specialist service for people with eating disorders, including anorexia and bulimia. We offer advice and Cognitive Behavioural Therapy (CBT) sessions at Hampton House.

‘Over-evaluation of weight or shape, and their control’

Eating disorders have been characterised by Christopher Fairburn as an over-evaluation of weight or shape and their control. This state of mind is maintained by behaviours such as dieting, bingeing, exercise, purgeing, body checking and avoidance. The associated consequences of these behaviours, such as weight changes, preoccupation and social withdrawal tend to further increase the degree of importance given to body image and the need to control it.

One of the early challenges for people with eating disorders who are doing CBT is to experiment with eating three balanced meals and snacks per day. As other behaviours are reduced and consequences change, body weight and shape usually begin to feel less important. Body image dissatisfaction is also directly addressed in CBT.

So, we must love our bodies…?

One of my early lessons when training as a therapist was not to expect anyone to do anything that I wouldn’t be willing to do myself. I have endeavoured to carry on this ethos throughout my practice.

Last year, on a workshop with about 200 therapists, we were asked to raise our hands if we loved our bodies. One person raised their hand. It wasn’t me. This highlighted to me the danger of thinking of body dissatisfaction as a ‘symptom’ confined only to those with a diagnosable eating disorder.

‘Over-evaluation of weight or shape and their control’ is also not about vanity or a personal failing. It is a reflection of the culture that we live in, where the media links ever changing and increasingly unrealistic ideas of beauty to our fundamental human need for connection and acceptance from others. If everyone believed that they looked fine, and would be loved regardless of appearance, the diet and fashion industry would go under and the economy would take a serious hit.

So, you weren’t designed with an inbuilt immunity to the messages around you? Try not to beat yourself up about it. Neither was I. Feeling displeased with aspects of our appearance is a pretty normal reaction to our current times. People with eating disorders have often had these messages reinforced either subtly or explicitly by events in their lives.


Think you might have an eating disorder?

You can talk with your doctor at the Students’ Health Service about your situation and about referral to First Step. Choosing to do treatment is rarely easy, but it might be one of the most important things that you ever do.



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