2-Minute Clinic: Questions You're Afraid to Ask a GP

Article | Dr Roger Henderson, Senior GP, Media Advisor and Health Writer

During a GP appointment it’s especially important to ask questions, but some of us find this more challenging than others. Senior GP, media advisor and health writer Dr Roger Henderson responds to a series of questions that many people are afraid to ask a GP.

I seem to be stressed all the time. What simple tips do you have to help reduce this?

Many people are stressed at the moment, for all sorts of reasons. We mustn’t forget that stress is crucial in our lives – it’s what gets us out of bed in the morning and what gives us the motivation and energy to do many of our daily activities.

Too much of it, however, is bad for us.

There are lots of things that can help to reduce stress, including getting enough sleep, massaging your neck and shoulders (this is where stress often causes muscle tension) and allowing yourself at least 30 minutes for each meal. Eat slowly, and make sure your diet is balanced and providing you with plenty of energy.

Most important of all, though, is to learn to manage your time. When I ask people what makes them stressed, they usually tell me it’s because of not having enough hours in their day.

Try following these four steps to manage your time in a way that feels less stressful:

1. Understand where you spend your time. Think about how you could best prioritise and itemise the pressures in your life.

2. Organise your week. Plan the week ahead using a weekat-a-glance diary or by drawing up your own chart. If something prevents you from completing an activity, don’t worry. Just try to fit it in elsewhere or make it the first thing you plan for next week.

3. At the end of the first week, review at how it went. What were the big successes? Which scheduling details were less successful? Identify turning points – those times when you consciously decided to prioritise one activity over another.

4. Re-evaluate your goals and roles each week, so you can close the gap between what’s most important to you and how you spend your time.

As always, if you feel your stress is worsening and affecting your mental health then be sure to discuss this with your doctor.

I have dandruff and I’m increasingly embarrassed and worried about it. What’s the best way to deal with it?

Dandruff is what happens when the normal process of scalp skin cell renewal (or skin turnover) speeds up, so a greater number of dead skin cells are being shed. These cells are shed in clumps, which are big enough to be seen with the naked eye as flakes, especially when they land on dark clothing. The scalp may also feel slightly itchy.

Dandruff is very common, but it is most likely in your early twenties. The exact cause is still unclear, but one possibility is a fungus, the Malassezia yeast, on the scalp. Everyone has some Malassezia yeast on their skin, particularly in greasy areas such as the scalp and the upper back.

It feeds on the natural grease of the skin, from which it produces oleic acid. The oleic acid triggers a higher turnover of skin cells, resulting in dandruff. So, getting rid of the yeast should improve the dandruff.

Hormones may also be involved, because dandruff usually starts after puberty and it is more common in men than in women. For unknown reasons, people with some illnesses, such as Parkinson’s disease, can also be more likely to have dandruff.

Here are a few things to try:

• Hair gels and other hair products might irritate your scalp, so try doing without whatever you’ve been using or change to a different product.

• Try not to scratch your scalp. When you shampoo, massage your scalp without scratching.

• If your dandruff is mild, shampoo your hair twice a week using any shampoo labelled ‘frequent use, for dry hair’ (not an ordinary anti-dandruff shampoo). This will remove the flakes that are being shed, and the moisturiser in the shampoo will protect your scalp.

• Avoid dyeing your hair (unless you absolutely must!). We all have bacteria on our scalp, some of which are beneficial. These ‘good’ bacteria prevent dandruff yeast, but hair dyes reduce their numbers.

• For severe dandruff, try a shampoo containing selenium sulphide, which has an anti-yeast effect. (Don’t use selenium sulphide within 48 hours of applying a hair dye or a perm lotion). Some shampoos also contain zinc pyrithione, another anti-east chemical.

• The most effective treatment for severe dandruff is an anti-yeast shampoo containing ketoconazole which, in some countries, you can buy from a chemist without a doctor’s prescription. Wet your hair, rub the shampoo onto your scalp and leave it on for 3–5 minutes before rinsing off. Use it twice a week for 2–4 weeks to clear the dandruff, and then once every 2 weeks, using a normal shampoo in between.

My partner has told me that I have bad breath and I’m mortified! How can I cure this?

Bad breath (halitosis) affects many people, and it is usually caused by bacteria in the mouth – although there are many other possible causes. Men and women are equally affected, and it can occur at any age. The smell of your own breath is hard to check by yourself; breathing into your hands doesn’t give you a true answer, as you’re used to your own smells and tend to detect new odours only.

The most obvious mouth cause of bad breath is tooth decay, but gum disease and the build-up of plaque on the teeth also play a part – as does tonsillitis, catarrh and sinus problems. Other possible causes include a dry mouth, certain foods (such as garlic, onions and dairy products), and smoking and alcohol, which may also dry out the mouth and cause unpleasant breath.

The first thing to do here is to visit your dentist, as any dental problem can be readily corrected, and the halitosis subsequently cured.

If there’s no obvious dental problem, it is worth asking for a medical assessment or a general health check.

Things you can do at home are:

• Floss every day to remove any trapped food or plaque from between your teeth, as that can contribute to bad breath. By concentrating on tooth-brushing and flossing around the gums you could also prevent gum disease, which is a major factor of bad breath and tooth loss.

• Try using an alcohol-free, fluoride-based mouthwash after lunch to freshen your mouth, and use fluoridecontaining toothpaste when brushing.

• If your mouth is dry, it’s also important to stay hydrated with frequent sips of water (not fizzy or flavoured)

This article has been published for education and entertainment purposes. Please remember that GPs are here to help, so please don’t be afraid to speak to them about any concerns that you may have about your health and wellbeing.

#TeamBSA

Dr Roger Henderson

Senior GP, Media Advisor and Health Writer

Dr Roger Henderson has worked in the NHS for almost 40 years and has been a GP since 1990. He is a health broadcaster, conference speaker and columnist for many national newspapers and magazines, including The Times and The Spectator.

He is the consultant clinical writer for the Healthily website and a judge for the annual National General Practitioner Awards.

His spare time is spent wondering what it would be like to have some spare time. His website is www.drhenderson.co.uk.