On Decision Fatigue
75 blood results - 41 times ‘okay’. 32 times ‘must do something’. 2 times ‘oh #&%*$’.
The home of general practice and family medicine
Kieran Sweeney Prize winner 2025: The GP model for delivery of Primary Care is outdated for the society in 2025
Is it? We need a balanced healthcare system that can operate in both scientific and interpersonal modes, the left hand working with the right. Without general practice, primary care would simply be a community-based form of hospital medicine. We should aspire to
A plague of opinion
The door is barely opened. ‘I’ve a bone to pick with you’, wheezes Mick through the widening gap ...
Deep end – The scent of poverty
What exactly is this smell of poverty? It is so pervasive. I recognise it in an instance. This perfume should be called “Deep End”, and it gives every encounter with poverty a visceral olfactory dimension. Jen Foell reflects.
Poems of hope, beauty, and friendship
In John Walker Smith's poetry the reader is drawn into the narrative through his conversational approach which permeates the prose.He aims to speak to the reader and offers avenues for reflection, providing comfort and counsel.
Passport to medical freedom? Only for the lucky digitally enabled
...let’s talk a minute about what needs to happen so that the development and use of something like a patient passport can be done in a meaningful and inclusive way. It seems right that we talk about it here, as primary care
Book review: The Dysautonomia Project – Understanding Autonomic Nervous System Disorders for Physicians and Patients
"Dysautonomia, an invisible illness, may be one of the most misdiagnosed medical conditions of all time .. " – Elke Hausmann reviews The Dysautonomia Project - Understanding Autonomic Nervous System Disorders for Physicians and Patients.
Beyond mental or physical: Can critical realism unify medicine’s divided self?
Is it better to think of patients as a body and a mind, or as a single entity that has both physical and conscious attributes? Alistair Appleby invites us to reflect.
The story of a heart, by Rachel Clarke
This is a gripping story of two remarkable families, a remarkable heart and a remarkable organ donor system, faultlessly told. There will, I am sure, be a film of the book.
Why perpetuate NHS funding gaps?
In the second of two articles on NHS funding formulae, Rodney Jones looks at trends in death and the implications for cost pressures on the NHS. Why can’t government funding take into account the well-established nearness to death (NTD) methodologies, ending the
Unheard: the medical practice of silencing
The practice of silencing is unjust and unfair, but probably universal in medicine. Trisha Greenhalgh reflects on a 'powerful' new book that is packed with compelling patient stories and accessible summaries of the academic literature. And for the teachers and trainers among
GPs in the ambulance service: comparisons across the North Sea
We know ambulance trusts in the UK are increasingly employing GPs, and whilst the theory is there, we wanted to explore the evidence. What follows is a summary of our discussions exploring key similarities and differences in approaches to out-of-hours (OOH) care,
The inverse confidence law
"Confidence in the future of NHS primary care is thin right now. My resilience suddenly really matters. Are the two linked?" asks Saul Miller.
Physician Associates; Dissociated Doctors
Employing lower skilled healthcarers at the ‘diagnostic front door’ of general practice will not save money, resources, professional time or efficiently – it produces the opposite. David Zigmond invites debate.
Yonder: Care coordination, anal cancer prevention, lay online communication, and positive body image
Ahmed Rashid curates a selection of useful and interesting papers. This month: Care coordination, anal cancer prevention, lay online communication, and positive body image.
Shifting sands
"After a storm, the sand shifts. Amazing volumes appear and disappear from areas of the beach. Dunes are sliced away, leaving sand-cliffs. Others newly appear. Rock and the keel-spines of old wrecks are exposed that I never knew lay there at all.
A puff from the past: the foot pump nebuliser
"It was 1981. As a GP trainee I walked into the Automobile Association shop in Brighton and saw a cheap, yellow, elegant polypropylene car tyre foot pump. I realised that this would be ideal when attached to a nebuliser unit for asthma
Compassion Fatigue
In this poem Kathleen Wenaden considers compassion fatigue, a topic of some importance to GPs. When faced with 'an urge for fixing, for making better', is there really 'nothing left to give'?
A fantasy world
It’s liberating to imagine a world where GP expertise is recognised and valued. We can start right at the beginning of the Deep End GP meetings. Imagine that! A world with no more reports saying “GPs should…” but lots of “Hey, GPs,
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature (October 2023)
Pregnancy for deaf women, prison mental healthcare, sexual health non-attendance, and compassion
Expediency
So the NHS is in crisis. Again. Saul Miller argues that there is a thread that runs through all of these. It is the thread that is labelled expediency or short-termism.
The patient Earth is sick, but the medical doctors are mainly absent
So, doctors... are learning to be afraid of uncertainty, ordering ever more tests and prescribing more and more, to try – often in vain – to be sure... But where does that leave Patient Earth?
Stolen focus: why you can’t pay attention
In his new book, Johann Hari, mindful of his own and his family’s inability to be fully present, addicted to technology and exhausted (and hating it) starts to explore the reasons why we have are all struggling to focus.
Generating gender generalists
What are GP trainers' thinking? Saul Miller gives us a glimpse.
GPs: Tell your patients how your surgery works
Today it is for you and your colleagues to rebuild and sustain those relationships. You have a wonderful tool for doing this in your surgery’s website. Use it to tell your patients how your surgery works.
Time to think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children
Hannah Barnes has written a detailed account of what happened at the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDS). Margaret McCartney reflects on the risk that healthcare organisations run when worries from staff translate into organisational defensiveness.
Invisible work
The reporting of a limited set of nationally important diagnoses, some risk factors and some quantitative measures leaves a lot more of the work invisible. It is this invisible work that holds the health system together, argues Tim Senior.
How vaccines work: The science and history behind every question you’ve wanted to ask
GPs are not the target audience of this book. It a well-written potted history of the technology of vaccination. GPs may, however, find the book to be a well-written, highly accessible, and generally accurate resource to recommend to their patients...
Change and progress
In the surgery, patients still express the hopelessness of their lived reality: lives built around sitting; exercise options that are difficult to access geographically and financially; and the cheapest food options too often the ‘wrong’ choices...
Turning diversity from a barrier to a facilitator of empathy in healthcare
Most developed countries have increasingly diverse populations. This context presents a challenge to empathic healthcare, as well as an opportunity. Better communication, treating diversity as an opportunity, and formal training in empathy and diversity can help transform diversity from a potential barrier
Depression in older adults: why medication review should not be just a tick in the box
As depression in older people can present with somatic and cognitive symptoms, it is often attributed to normal ageing and may be overlooked by the clinician and the older adult. Carolyn Chew-Graham and colleagues share insights from the latest NICE guidance.
Can we take the heat?
With climate change resulting in increasing temperatures all around the world, what exactly does heat do to our cells and vital organs?
Book review: Jews Don’t Count
Andrew Papanikitas reviews 'Jews Don't Count' by comedian David Baddiel, a reflective essay that unpacks the idea that either you can’t be racist to or that is somehow ok to be racist to a Jew. Do some racisms or other sources of
Research Paper of the Year 2021: relevant to training and beyond
The winners are in for the Research Paper of the Year award 2021! Carolyn A Chew-Graham and Helen Leach present the winners and stand outs from this year's awards, with reflection on the importance of primary care research for GP trainees working
A short history of general practice: The changing gaze
Over forty years ago, Nicholas Jewson coined the term ‘medical cosmology’ as shorthand for the prevailing theories and practices that defined the nature of medical discourse at that time. Stephen Gillam examines the changing gaze of British GPs in this final part
A short history of general practice: Consumerist medicine
By the 1980s, general practice was a self-confident discipline with a burgeoning research base and enviable training standards able to attract those from the highest rungs of Moran’s infamous career ladder. Yet all was not well. Stephen Gillam's biography of the profession considers
A short history of general practice: Servants of the state
There is a tendency to assume that the National Health Service Act was the culmination of a single clear idea, realized in a glorious post-war dawn; the reality was messier. There was growing consensus in the years leading up to the Second
A short history of general practice: Professional roots
The commonest misconception is that general practice, the ‘jewel in its crown’, is largely a product of the NHS. This short series of articles hopes to inform, stimulate and provoke. Stephen Gillam starts with the journey from apothecary to general practitioner.
Book review: The long covid self-help guide: practical ways to manage symptoms
Trish Greenhalgh reviews a book intended as a supplement to the clinical care offered in specialist long covid clinics.
Editor’s Notes #004: The repeated failures of maternity care
Assistant Editor Nada Khan discusses the Ockenden Report -safe and effective maternal and postnatal care involves general practice.