Doc Martin GP

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

27/05/2026

If you are affected by RSD (Rejection Sensitive Dysphoria) then what are your treatment options when it comes to medication? I’m afraid I am at great odds here with Dr William Dodson, the man who coined the term RSD, since he recommends alpha-2-agonists like clonidine or guanfacine - BUT there is no published trial data at all to back this up.

It’s important to note that these are unusual drugs. They are a treatment for ADHD in children (although I have never known a child be prescribed them) but they are not licenced in the UK or USA for ADHD in adults. So this is not like optimising ADHD treatment, it is trialling something new - and when you do that you need evidence that the benefits outweigh the harms.

Dr Dodson quotes success rates of around 30% in his clinical practice, but this is not from a trial, it is just his clinical experience. This could be placebo, it could be 3 patients out of 10 or 300 out of 1000 - we don’t know as he hasn’t shown anyone the data. And yet, because he has written about it online, if you Google it you will be quoted this figure as if it is established proof!

Dr Dodson justifies his recommendation to treat without trial evidence on the grounds that people need treatment now and so it would be unethical to wait for the evidence. That is a very dangerous path in medicine and medical history is littered with treatments that were thought to be beneficial but did more harm than good. And what if he’s right and they are good treatments? Well without good trial evidence they will never become established as a mainstream treatment and people will miss out!

These drugs are also not without their issues - stopping them suddenly can cause a huge spike in blood pressure for instance - but then that’s ok because when did anyone with ADHD ever forget to take their medication??! He also recommends drugs called monoamine oxidase inhibitors (MAOIs) - really? These are old fashioned antidepressants that may have helped some people but caused a lot of problems, especially in their interactions with other medicines (including ADHD meds) and a wide range of foods. No thanks!

16/05/2026

Whenever someone complains to me that they ‘never get to see the same doctor twice these days’ it feels like a little bit inside me dies 😔 I know how hard we work at our practice to help patients see the doctor who knows them, and how many of our patients regularly see the same doctor, and I can’t be responsible for their experience, but as a GP I feel like I am somehow responsible for their complaint!

But also, I know what an easy complaint it is to make and how often it is made by people who don’t actually mind which doctor they see, because they don’t have a longterm condition and when they are unwell they just want to be seen quickly - in other words they rightly value speed of access over continuity of care. I’d be grateful if these people could kindly stop complaining about not having something they don’t really care about! 🥺

For some people, though, continuity of care does matter, but when I ask them if they tell the practice which doctor they would prefer to see, they look surprised that I could suggest such a thing! It seems too impertinent to ask and so they wait to see who they are given - but then complain about a lack of continuity of care if they don’t get it! If it matters to you then please let the practice know, and please tell them how urgent the problem is and how long you are happy to wait.

If you do all this and still never see the same doctor twice then maybe you do have something to complain about (but perhaps you could complain to your practice and not to me?! 😉)

02/05/2026

I’ve not invented a word before, but this is such an important concept that I thought it deserved its own word, and autocoregulation seemed to fit the bill! What do you think? I’d love it to catch on! 😊

It’s more than just self-soothing or calming your nervous system through grounding techniques or mindfulness (important as these are), it’s about recognising that our inner voice has an emotional temperature, defined by things like tone, pace, pitch and volume (and even though it is an unheard voice it still has all these qualities inside our head) and that how our body is feeling will naturally coregulate with the emotional tone of this inner voice.

If we want our body to feel less stressed or anxious, therefore, it is helpful to pay attention to this inner voice first. If we can pay attention to how we speak to ourselves and practise calming the inner voice, then the emotions in our body will naturally follow suit and autocoregulation will become a useful ally in dealing with stress. Once we start autocoregulating in a helpful way, then grounding techniques or distraction will be so much more effective 😊👍

What do you think? Do you relate to how we coregulate with our own inner voice? How do you calm your own voice and how does that help you? What do you think of the word autocoregulation? I’d love to hear your views! 😊👍

30/04/2026

This is such a great book from Carys Sonnenberg and her colleagues. It’s packed full of all the information you need for women’s health and is laid out in an accessible way that makes it a fantastic resource to learn a topic in detail or as a reference book for whenever you need to check something.

And in mental health it has a great section covering areas like PMS, PMDD, perinatal mental health and neurodiversity in women, which is obviously of great interest to me.

It’s been published by as part of their fabulous ‘made easy’ range of books. Scion provides fantastic books for GPs (including my own book on the consultation, The GP Consultation Reimagined, a Tale of Two Houses! 😊😉)

Full disclosure - I am yet to meet Carys in person but we have had some great interactions on social media and I love her work. She kindly sent a copy of the book to me and my practice which is how I got to look at it 😊

22/04/2026

wellbeing survey has shown that 85% of doctors report increased stress levels at work, while nearly half state that stress is putting their own physical and mental health at risk, and could put patients at risk due to the increased the risk of errors at work. These are concerning figures.

No-one goes into medicine expecting it to be easy, and it remains a hugely rewarding occupation, but we need to recognise the high stress levels within healthcare and do everything we can to support our work force, for the sake of both staff and patients. There are wider, systemic pressures that we can’t control, but a local Trust or GP practice can ensure some very simple steps are in place to support their staff.

Being able to connect with your colleagues during the working day can make such a difference; it engenders a shared sense of purpose and reduces the isolation a doctor can so often feel. When I meet my colleagues for coffee, it is the laughter and human connection I need as much as a few moments away from the coalface, or the food and drink. Food and drink is important, too, though - I, for one, become inefficient and irritable when I am hungry or thirsty! Doctors need to work in an environment where healthy food and drink are available and breaks are valued, which is why the MDU is calling for the government to ensure NHS employers provide staff catering and rest facilities, including for those working out of hours.

As doctors, we also need to learn to prioritise these simple measures ourselves - to make time to connect, take breaks to refuel, and also make sure that our life outside of work always has space for the things that bring us joy, and truly help us to rest and recharge when we are away from work. What do you think? If you are in healthcare, do you have the opportunity to take breaks and eat and drink healthily when you are at work? What measures are most important for helping you to deal with stress in your job? I would love to hear your thoughts in the comments! 😊

18/04/2026

How do we recover when we are unwell with a mental illness, maybe it’s burnout, or anxiety, or depression? If we’ve been signed off work we may never have prepared for this, or we may have a colleague who is signed off and not understand what that means or what they should be doing to get themselves well.

Well, obviously we may need to rest, but that doesn’t mean lying in bed with the curtains drawn. Mental rest could be quite active - it may well involve exercise or picking up a sport that we have long neglected but always found did us good, it may involve something creative like art, music or gardening. It might involve some time on our own, but could involve meeting a friend for coffee, or something social, like joining a community garden or a walking group. It might well mean doing things you enjoy, which might be hard to get your head around when you feel guilty about being off work.

It will be important to maintain routine, so that our sleep pattern doesn’t slip, to eat healthily and be careful around alcohol. We will need to say no to some things and say yes to others, with the emphasis shifting from what we feel duty bound to do towards what will help us recover and thrive once more, so that then we can be in the best place to pick up things that are important to us, like going back to work.

If we feel guilty about being away from work then it may help to recognise that as we take care of ourselves so we are also taking care of our colleagues by doing the right things so that we can return in the right way and at the right time.

And if your colleague is off work, then maybe the best message you can send them is one that encourages them to do something you know they have always enjoyed but not had time for recently.

If you’ve needed to recover from struggles with your mental health, what has helped you the most? I’d love to hear! 😊👍



The e

11/04/2026

If you have health anxiety then this is SO important to understand! We know that what we think can make us anxious, but it is just as likely that how anxious we feel at any given time will affect how we think! When we feel anxious our brain will recognise the feeling of threat and look for the source of danger, and so will be more likely to misinterpret innocuous symptoms as dangerous, raising our threat level further in an ever ascending cycle until we are really panicking!

So, if you catch yourself in this cycle, worrying about a symptom, seeking reassurance, looking at the internet for answers and feeling increasingly alarmed, remind yourself that your brain can’t be trusted to make the right decisions when it is feeling threatened like this. Instead of focusing on the content of what you are worrying about (the cause of your symptoms), change your focus to regulating your nervous system first. This might involve slowing your breathing, grounding techniques, physical activity or distraction. What is important is that it should help bring you down from the flight/fright response that was triggered by the symptom and the health worry. Once you are back in the green zone and the warning lights have quietened down, then you can start to carefully re-look at the symptoms that were worrying you (if they are still there, they may have even disappeared!) and decide if you need to act on them or not. I’m not saying this bit is easy, but it is a lot easier to do once we are calm than when we are panicking! 😊👍

I don’t think there is enough out there to help people with health anxiety! Maybe I need to write a book on it? Let me know what you think! I’d love to hear your views on anything to do with health anxiety! 😊👍

03/04/2026

Supporting someone else who is struggling with their mental health can be challenging. Carer burnout is a very real issue and it is so easy to make basic mistakes - like telling an anxious person that they have nothing to worry about or trying to help with their OCD using scientific logic.

We need to learn about what they are dealing with in order to avoid these mistakes, but not learn so much that we try to fix them, since that rarely ends well and we usually end up pushing our ideas on them when they are not ready, and when they are probably not the best ideas anyway!

We can help in other ways though - a very powerful tool is coregulation, where we help someone to regulate their nervous system by keeping our own calm so that they can come in tune with us. And setting boundaries is sometimes so important, not only to avoid carer burnout but also to help provide structure and consistency for the person we are supporting.

There are certainly more tips than just four so I feel that this one might need a sequel - what would be your tip for other people to learn from? 😊🤔👍

28/03/2026

So should RSD be a medical diagnosis? It isn’t recognised as such at the moment, and maybe it would help give it more prominence among doctors if it were to become a formal diagnosis? Certainly at the moment it’s not much talked about in GP circles.

And yet it seems to be more of a symptom (or a cluster of symptoms) than a medical condition. Often it occurs as part of ADHD, which is why has been talking about it on his excellent and published his new book on the topic (‘Why does everybody hate me?’ - I haven’t read it yet but it is my next audiobook to listen to and I think it will be great - do check it out). It is certainly important, and people who experience an RSD reaction really relate to the description of an unbearable, almost instantaneous and overwhelming physical and emotional reaction to rejection. But does it need to be a diagnosis? Labels are complicated and so I think we should only make a new diagnostic label if we are sure it will be helpful; and the problem with any diagnosis is that you need a clinician to make one. I can genuinely envisage long waits for people who know they are affected by RSD to ‘get their diagnosis’ of RSD, being left in limbo in the meantime. At the moment you don’t need a doctor, you can just learn about RSD, see how much you relate to it and then learn about what might help. I wonder if that isn’t a bit simpler? I’m ready to be persuaded, though, so I would love to hear your thoughts! 😊👍

14/03/2026

There’s a right-wing narrative that people with mental health problems are flakey, take time off because they don’t want to work and are ruining our country by living on benefits. When you hear this narrative, and hear how GPs are being pressured by their manipulative patients to sign them off work, just remember that the journalist has only chosen to interview GPs who might support this narrative, and that when I said I had a different view, they didn’t want to know.

12/03/2026

If our solution to the mental health crisis is to police fit notes and make it harder to be away from work when you are unwell then we will only make things worse. Of course there is always the chance that someone, somewhere is ‘milking the system’ but the vast majority of people I sign off work with their mental health don’t want to be off work and they don’t want to be unwell. As a GP I am here to listen to them, to support them and to believe them!

Instead of berating GPs for being soft on our patients, or blaming patients for being unwell, we need to improve the support to help people who are unwell, making it much more specific for the person and not one size fits all, improving trauma services, having neurodiverse awareness therapy, coaching, better support and access for people with ADHD and more - then we really could make a difference to people, and reduce the cost of welfare in the process!

In fairness to the BBC article there is some mention of this in the second half and there are some good initiatives mentioned, but it is government response that will matter here.

Address

Godalming

Website

Alerts

Be the first to know and let us send you an email when Doc Martin GP posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Shortcuts

Share

Category