Doc Martin GP

Doc Martin GP Dr Martin Brunet | GP and GP Trainer near Guildford UK | Videos on mental health topics
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05/07/2026

There’s only one way to really learn if a medication works, and that is through clinical trials. Understanding the mechanism of how a medication might work is important in developing new treatments, but it does not tell us if a drug works or not. Which is why the doubts about the serotonin theory for depression are interesting, and important for research, but should have very little bearing on anyone who takes them, or on me as a GP who might prescribe them.

The placebo effect is powerful, and so we need placebo-controlled trials to be able to work out if a medication is better than placebo, and the evidence is consistently that SSRIs are more effective than placebo. Does that mean I always prescribe them when someone has anxiety or depression? Absolutely not, because most people get better without them and all the other aspects of recovery - lifestyle changes, removing stressors, therapy and so on - are so much more important. But sometimes it is hard to do that, and these medications can really help.

Are there any downsides? Yes, and I have talked about these in previous posts and in my book Your Worry Makes Sense. I won’t cover that area in this post, as this post is trying to answer one question - do they work?

And anyone eagle-eyed may have noticed that the pill packet on the video isn’t for an SSRI at all! But you have to use what is at hand, don’t you! 😊😂

04/07/2026

The signs of burnout are there if we are prepared to look for them - it might be irritability, wanting to cry, feeling overwhelmed or like we just can’t seem to hold it together. And yet we may be so busy actually holding it together that we don’t have the emotional energy TO notice. Or we are in denial and we believe that if we just try hard enough it will all be alright - we’re too strong to break, surely?!

And yet there are only so many times that we can catch ourselves, pull ourselves together and get away with it. If we keep putting ourselves under the same pressure day after day then one day we won’t have the capacity to stop the fall, it will come with a bang and we will be left feeling totally shattered 😞🥹

I included a whole section on burnout in my new book ‘Your Worry Makes Sense’ because it is so common and so easy to miss the signs before it is too late. How do you spot those signs? What sort of person might burn out? What does burnout even mean? How do you prevent it? And how do you recover if it has happened? I try to tackle all these questions and more in a way that is easy to relate to and make sense of so that we can find a way through.

If you are affected by burnout then I hope the book will be a great source of comfort and understanding for you. If you’ve read it or are reading it then I’d love to hear what you think of it - has it helped you? What has been your experience of burnout? How are you planning your recovery, or how did you recover? I’d love to hear your thoughts in the comments! 😊

Your Worry Makes Sense is available now in print form, as an ebook and as an audiobook (narrated by me). Booking links are in my bio 😊👍

02/07/2026

I’m always on the look out for good books on mental health to recommend to my patients, and this is a great book on burnout by Dr Emma Hepburn. Emma is a clinical psychologist and talks from her experience as a psychologist, and also as someone who experienced burnout personally (and so had to deal with the very tricky experience of being that person who knows all about burnout and yet didn’t spot the signs in herself, which is SO easy to do!)

The book is in three parts and explores the nature of burnout, how to prevent burnout, and ‘relighting your fire’ (I love that expression!) if you have had burnout. Definitely a book to recommend!

Emma kindly sent me a copy of the book for my own use, but with no expectation that I would post about it here.

28/06/2026

Rumination is when we get stuck thinking about the past in a way that causes us distress or leaves us exhausted or paralysed into inaction. It’s very common, so if you do this you are not alone!

When we ruminate it usually revolves around themes of loss, regret, shame or past trauma. It may lead to worrying about the future because of the past, but primarily it involves thinking again and again about something in our past that distresses is. And because we can’t go back and change the past, we can feel very stuck. But there are always choices that we can make that can help change how we feel about the past, and that can affect how that past shapes our future.

Even the choice to set boundaries around how much we ruminate - like setting a time limit, choosing action over stewing in our thoughts or using mindfulness to take our attention elsewhere - can affect how we feel about the past. Because the more we ruminate about something the more we send a message to our brain that it must be important, and so the more we will ruminate about it in the future. It will seem bigger in our minds than it actually should be, and just starving it of attention can make it smaller.

We can also reframe how we view the past - instead of focusing on the sadness of loss we can draw our attention to the happiness of what we had before; instead of concluding that we are a bad person because of the thing we regret doing or saying, we can recognise that we said or did something that was wrong, that we have learnt from it and will be a better person moving forwards. Instead of dwelling on the negative voices from our past we could never please we can remember those who showed us kindness and encouragement.

None of this is easy, and therapy may be really helpful as you work on this, but there is always choice to do things that will help, even with the past that seems so unchangeable.

What do you think? Can we change the past? What have you found helpful? I’d love to hear your views in the comments 😊👍

24/06/2026

It is a reasonable thing to expect GPs to work weekends, so many other people do, after all, why shouldn’t GPs? In fact they do already work weekends, as there is a GP Out of Hours service that is 24/7, but what people usually mean is they want their GP practice to be open at a weekend. And it would be great, wouldn’t it, if you could call your own GP on a Saturday or Sunday the same as in the week?

The trouble is that there is always a tension between accessibility, cost, and continuity of care. It makes a huge difference seeing a GP who knows you (especially with something like mental health or complex health problems) and each GP can only be stretched so thin.

Now I know that some people will watch this and say that I should work weekends as an extra and not have a day off in the week to compensate for working a Saturday, but I know what that would do to my wellbeing, and so my compassion levels as a doctor and ability to do my job - it wouldn’t be good! But let’s say I had the capacity to do that, even then we have a problem, because no one should do extra work for free, and the country can’t afford (or would not be willing to afford) to pay for all the extra GP shifts it would entail.

There is also the problem that at a weekend all the other services I liaise with - like social services, the mental health team, schools, the coroner, medical secretaries and the wider members of the team at my practice, are either on skeleton staff or not there at all.

We need to remember what GPs are there for. Our primary role is not to take the pressure off A&E but to be the one part of the health service that truly looks at the whole person and over a prolonged period of time. We don’t discharge our patients and (apart from teeth!) we don’t say ‘that’s not my specialty.’ We work with people over time and really get to know them, their health, their priorities, their worries. And that really, really matters! And it’s best done in the week when we can be there the most for the patients that know us.

What do you think? How should we balance accessibility, continuity of care and cost? &e

21/06/2026

I love the idea of the Bank of Bad Days! 😊❤️ I’m not sure if came up with the idea or heard about it from someone else, but I first read about it in his book Reasons to Stay Alive, where he talks frankly about his own depression, and the many deposits he made in his bank while he was unwell, as well as how much the idea helped him.

So much about mental health is about reframing, and if we are having a bad day - maybe even the worst day - then seeing it as a deposit in our bank can be a great way of turning a negative into something positive. It f course we have to get through it first, but then all those other deposits can help us with that!

What do you think? Is this something that has helped you in the past? Is it a new idea and could help you in the future? I’d love to hear your views! 😊👍❤️

20/06/2026

I’m a GP but I don’t think GPs need more money to help their patients with mental health problems, and nor do I think we should be investing in secondary care to get them to lower their thresholds and see more patients. What I think needs a radical rethink is the way we fund therapy. It is great that anyone can refer themselves for talking therapy, but we are too afraid of them asking for too much of it, so that we limit it to 6 sessions, which works well for many people, but means that people with complex issues, like trauma, OCD, health anxiety, survivors of DA, and more are often not being helped into meaningful recovery.

What’s more, we limit therapy to a single modality, offering EMDR, for instance, when we know it would work so much better in some patients if it were combined with a physical therapy such as Pilates or yoga. When the 6 sessions are complete, patients often have to go through the whole assessment process again if they need more when a simple top up with the same therapist would make a huge difference, but they often have to start afresh with a new therapist.

We could learn a lot from what people can access privately, and from the huge changes that have developed in therapy in recent years. The NHS should be able to offer care that is good as what you might pay for. We need therapy centres that can deliver a wide range of treatments and support, tailored to the individual. Would it cost more? Of course! Would it be cost effective? I’m sure it would! Compared to the costs of hospital care, therapy is a very cheap intervention. If we helped people recover from trauma they would be less likely to end up in A&E in a crisis, with all its associated costs, would be more likely to be in work or education and less likely to end up on benefits. Unresolved mental health problems often have physical consequences, like alcohol and drug problems, or chronic pain, all of which are serious for the individual, but costly for the NHS.

What do you think? Do you agree? Or do you have other ideas? I’d love to hear your thoughts! 😊👍

18/06/2026

Isn’t it best to prepare ourselves for the worst outcome? That way we will be ready for it, and we won’t be disappointed if it happens? It’s so easy to convince ourselves that this is the safest way to live. Maybe something awful happened in the past, and we don’t want to get caught out again. The trouble is that now we are looking out for threat everywhere. To prepare for the worst case scenario we have to imagine EVERY worst case, and that is mentally exhausting, and often leads to actions such as avoidance or constant checking that can rule our lives. And the real irony is that it doesn’t prepare us like we think it will.

When something really bad happens then two seemingly opposite truths come into play. The first is that being prepared in an anxious way doesn’t help at all - when bad stuff happens it’s just bad and will always be hard; worrying about it before hand just wears us out and doesn’t make us better able to deal with it. But on the other hand, when bad stuff happens we will usually be better at dealing with it than we imagine - not because it’s less bad than we think, but because when we are worrying we are dealing with the uncertainty of what might happen, and when something bad has truly happened that uncertainty is no longer an issue. Of course we would prefer that it hadn’t happened. Something like a cancer diagnosis or major bereavement, for instance, will always be hard, but preparing for every worst case scenario doesn’t make it any easier, and can be a very restrictive way to live.

What do you think? Do you tend to think this way? Did you think this way in the past and now have changed? What helped to change you? Or do you think I’m wrong and that preparing for the worst case really does help? I’d be interested to hear any of your thoughts in the comments 😊👍

17/06/2026

Harm OCD is not uncommon, and can be devastating to live with, but it is rarely talked about. I have never been to any teaching on it as a doctor & although I have recognised it in several of my patients over the years, it is only recently, through a conversation with someone on social media that I learned it was called Harm OCD. This lack of awareness, among the general public and healthcare professionals, makes it even lonelier and harder to live with when you are affected 😞 The more we talk about it, the more we will be able to help.

It is particularly common, and especially distressing, in the postnatal period when people get obsessional thoughts that they could harm their baby, most often in mothers but it can be fathers too.

is an obsessional worry, characterised by intrusive, unwanted thoughts that you could harm someone. This might be worrying that you could commit an act of violence, but I have also seen the same happen with someone worrying they might harm themselves and could end up taking their own life, or worrying that they could be a pa******le. What marks Harm OCD apart from someone who actually has violent tendencies or is actively suicidal or who is at risk of paedophilia is that the thoughts appal and repel you - the actions you are worrying about are entirely contrary to your nature, which is why they cause such anxiety and stress when they pop into your head. There is nothing odd at all that weird thoughts pop into your head (we all have this sometimes, we just quickly dismiss them). But for you, the thoughts have stuck.

Two problematic ways of trying to deal with these thoughts then ensure that they keep coming back. The first is reassurance seeking, and the second is avoidance. Both reinforce the problem. The more you seek to reassure yourself that you are not violent the more you are thinking about violence, and the more you avoid (eg hiding the kitchen knives) the more you lose normal, healthy associations that balance intrusive thoughts.

Treatment can make a big difference here - primarily CBT and a treatment called ERP (exposure and response prevention), and there may be a role for medication (an SSRI). The key thing is you don’t have to manage alone!

14/06/2026

If you worry about things then this post is for you - and especially if you have health anxiety. Because when you have health anxiety, certain stories in the news will light up like a Belisha Beacon. It might be a celebrity who has announced they have cancer, or a tragic death in a young person from a frightening illness or a story of a missed diagnosis, or a health campaign telling you to get checked now. These stories make you feel unsafe and raise your threat levels, yet you feel compelled to read them and pay more attention to them than other stories, because they tap into your fears. This is confirmation bias and it’s as old as the hills. What is new, though, is the way algorithms multiply this bias - because the algorithms think you enjoy reading these stories - you don’t enjoy them at all, you just feel compelled to read them - and so the algorithms send you more of these stories, and the more you read them the more you get until it feels like everyone is getting cancer these days!

We need to be wise about algorithms and make sure they learn what we do and don’t want to see. I made the mistake of watching a few baseball videos once and for a while baseball was everywhere on my feed! Apologies to anyone who loves baseball, but it’s one sport I don’t get! However, all I needed to do was tell Instagram that I wasn’t interested in their suggestion and it soon learnt not to send me baseball! Do take control of what is likely to pop up on your feed and make sure it is full of things that do you good!

And for anyone watching this reel who has been worrying about my tremor and thinking the worst - it’s an annoying benign essential tremor and not serious so please be reassured about that! Thank you for wanting to keep me safe! 😊

What is this like for you? Do these stories draw you in like this? Are you aware of algorithms sending you more? How have you managed this? I’d love to hear in the comments 😊👍

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