Andrew Papanikitas is Deputy Editor of the BJGP. He is on X: @gentlemedic
An earworm, from the German ohrwurm, is a tune that gets stuck in your head. It is made worse by tasks that are too easy or too hard, and can (allegedly) be killed by a different tune or an engrossing task.1 Some tunes can be more catchy than others, and as I reviewed the selection of articles for the new year, the 1971 song Changes by David Bowie was echoing in my psyche. This is a time of changes, and some of those changes represent opportunities or existential threats. The idea of facing changes and indeed existential threats has formed the basis for a new-to-practice seminar I have been involved with for a couple of years. Existential changes, like global problems, can seem too much for mere GPs to do anything about. These could include the threats to our planetary ecosystems, the promise and perils of artificial intelligence (AI), or the junk food- powered treadmill of 21st century life. Before we get too depressed or scared, however, our Life and Times section illustrates a community of practice that not only seeks to understand change but engage with it.
Planetary primary care
Actions to reduce the climate impact of medicine can be individual, institutional, or even national and international, and ‘Reducing the carbon footprint of primary care has the potential to improve the health of our patients and communities, while decreasing workload and saving resources.’ 2 Michael Naughton and colleagues outline what GPs, partners, and local primary care leaders can do to reduce the carbon footprint of their practice(s). Terry Kemple reviews Environmentally Sustainable Primary Care: Good for the Planet, Good for Practices, Good for Patients by Matt Sawyer and Mike Tomson — ‘This is not a book to read once, skim, or leave on a shelf. It’s both an introduction and a practical guide to taking action. It explains where we are today and what we need to do next. The best time to read and act on it is now.’ 3
“… our Life and Times section illustrates a community of practice that not only seeks to understand change but engage with it.”
The algorithm will see you now
We walk a tightrope in medicine, balancing every day the unique and complex needs of individual patients with the standardised requirements of the rule-book that governs their care. There is danger in tipping too far in either direction. Ben Hoban makes a case for the importance of narrative in the face of quantitative targets for care.4 In Kez and the system, Saul Miller shares a cautionary tale of harm compounded by a system that responds rather than listening.5 Elke Hausmann reviews Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience by Brené Brown.6 The meaning and importance of attending to human emotions have special relevance in the care of (how do we keep forgetting this?) humans. Siân Rees and I share some considerations for commissioners, providers, and recipients of health care in the use of automation, machine learning, and AI.7
General practice wisdom for 2025
Alex Burrell looks Yonder and encounters articles on prescribing and deprivation, delayed antibiotic prescriptions, pre- hospital antibiotics in sepsis, and differential attainment.8 Adam Grice reflects on his experience as a GP and athlete.9 He asks, ‘what’s the best advice I can give my patients about nutrition?’ Both Alex and Adam are recent BJGP/BJGP Open fellows. I read their work and feel that the future is in safe hands — no pressure, gentlemen …
Shakespeare and the AI
Google’s AI informs me that ‘O brave new world, that has such people in ’t’ is a quote from William Shakespeare’s The Tempest.10 In the play, Miranda says this line when she first meets the other shipwrecked men and contemplates a life beyond the island she has been trapped since infancy. The quote is said in a tone of awe, as Miranda marvels at the possibilities that lie before her. As a responsible human author who has read, seen, and (a long time ago) performed the play, I find myself agreeing with this summary. However, it strikes me that while we can feel like little islanders contemplating the ‘brave new world’, we have a duty to be more than this. Read on.
References
1. Jarrett C. What triggers an earworm — the song that’s stuck in your head? 2011. https://www.bps.org.uk/research-digest/what-triggers-earworm-song-thats-stuck-your-head (accessed 5 Dec 2024).
2. Naughton M, Round T, Payne R. Climate change and primary care: how to reduce the carbon footprint of your practice. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740349.
3. Kemple T. Books: Environmentally Sustainable Primary Care: Good for the Planet, Good for Practices, Good for Patients. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740277.
4. Hoban B. Narrative and numbers. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740469.
5. Miller S. Kez and the system. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740265.
6. Hausmann E. Books: Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740289.
7. Papanikitas A, Rees S. Automation, machine learning, and AI: considerations for commissioners, providers, and recipients of health care. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740325.
8. Burrell A. Yonder: Prescribing and deprivation, delayed antibiotic prescriptions, pre-hospital antibiotics in sepsis, and differential attainment. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740253.
9. Grice A. The GP athlete: what’s the best advice I can give my patients about nutrition? Br J Gen Pract 2025; DOI: https://doi.org/10.3399/bjgp25X740337.
10. Shakespeare W. The Tempest. Act V, Scene I, 217–218.
Featured photo by Carlos Torres on Unsplash.
