"There has been recent media coverage around appropriate hormone replacement therapy (HRT) dosing, and subsequent focus in medical journals. The debate has become polarised and women's health is being impacted. I want to provide an explanation so we can all do our
Identifying the mind as a source of the body's pain can help a patient make great strides towards taking control of their health and reducing the impact chronic illness has on their day to day lives. Paul McNamara and Ella Butterworth explore
One of the first questions my GP supervisor asked was “What did you notice on the way here?” ... Her question appeared simple at first but revealed, what I thought to be, the greatest skill in being a GP; the art of
As we gear up for winter, should we be identifying and trying to proactively manage patients to prevent unplanned hospital admissions? Nada Khan examines the NHS England guidance.
Richard Armitage reminds GPs to think about medications prescribed outside the primary care setting especially when thinking about new symptoms, changes to medication or medication reviews.
What can we do in primary care to prevent cardiovascular complications of pre-eclampsia? Rebecca Wheater provides a number of suggestions ...
Hana MO Elhassan argues we should minimise health disparities through cultural competence. A good starting point is developing better awareness of common skin and hair care practices within various ethnic minority populations, and appreciating their clinical significance.
Yonder looks at prescribing cascades, teacher wait time, online services for mental health conditions, community DVT pathways
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) review has recently published a review of the quality of care provided to people diagnosed with endometriosis. What can we learn from this report, and what can GPs do differently to improve
Avoidant restrictive food intake disorder (ARFID) is classified as an eating disorder diagnosis. Clare Ellison and colleagues outline the potential signs of ARFID, detail an initial primary care assessment, and present resources for signposting and further CPD.
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
Hannah Milton reflects on the neuroscience of trauma and Adverse Childhood Experiences (ACEs) and how this can lead to what is termed ‘latent vulnerability’.
Will using a PPI increase my patient’s risk of dementia? I wouldn’t honestly know the answer offhand if a patient came to me asking this question clutching their newspaper. What are the tensions between the media and scientists, and the implications for
Biological causality for T4 monotherapy not working for some is now established. We can’t now attribute the 10%–15% of people with hypothyroidism not feeling better on T4 as wimps, laggards, or requiring psychological attention. Sarah Cathcart Evans reflects from personal experience of
The Lancet recently published a series on the menopause. GPs are consulting with large numbers of women around this time of life and will no doubt welcome a major medical journal addressing an area of rising need. Ellen Fellows argues that there
It used to be just in the context of type 1 diabetes, but the little white circles on people’s upper arms seem to be more ubiquitous, and it’s clear that the use of continuous glucose monitoring (CGM) is shifting from a medical
Investigations themselves can throw up results that are difficult to interpret, and they may reveal abnormalities of uncertain significance. To highlight these issues to our patients would constitute more ethical practice, would foster greater patient empowerment, and could result in a frame
Mavin Kashyap shares key practice insights from a specialist community healthcare service for asylum seekers and refugee (ASR) adults.
Ahmed Rashid muses about surgical site infection, opioid dependence, racial diversity, and 'Meals on Wheels'
The good news is that there are at least ten evidence-based ways to enhance empathy. These take little time and can pay back the moments invested (sometimes with compound interest).
Ahmed Rashid curates a selection of useful and interesting papers. This month: Care coordination, anal cancer prevention, lay online communication, and positive body image.
With the combination of a global pandemic, cost-of-living crisis and the Government’s austerity measures, over the last few years rates of DA are thought to have increased significantly. Paul McNamara and Anna de Natale reflect on how general practice should respond.
Ahmed Rashid curates a selection of useful and interesting papers. This month: Wait and see, identity loss, data failures, and patient organisations.
David Jeffrey argues that clinical curiosity is an essential part of a doctor’s empathy and clinical decision-making. It promotes reflective practice, critical thinking and stimulates lifelong learning.
People with chronic pain need personalised care – an approach offering patients choice and control over their mental and physical health, basing care on what matters to them personally, and focusing on individual strengths and needs. It is possible.
Chris Bird and colleagues held a workshop in March 2023 with parents, paediatric nurses, GPs, paediatricians, and engineers to identify problems associated with measuring oxygen saturations in infants and young children in primary care. Here they present their findings ...
Ahmed Rashid explores: Ethnic minority maternity experiences, colorectal resection, foreign medical aid, weight stigma and the lives of billionaires
Primary care mental health is a fundamental part of general practice, delivering care to many more people than specialist mental health services, and yet there is limited documented history of its development. We sought to address this gap in the narrative by
Maladaptive daydreaming is a relatively new concept in the field of psychology experienced by an estimated 2.5% of the population. Sara Noden analyses this proposed mental disorder and the implications for clinicians.
Lucy Chiddick argues that promoting school attendance is a complex task, best done by those with appropriate expertise. Where GPs engage with the issue there should be appropriate time and care, recognising that there are many drivers of absenteeism and that attendance
Vasumathy Sivarajasingam explores domestic abuse PUNs and DENs as a relevant appraisal topic linked to mandatory safeguarding, with links to learning materials, legislation and further articles.
"Withdrawal symptoms are not a sign that a patient needs the drug, but a sign that they need to reduce the drug more slowly" – Stevie Lewis and Mark Horowitz outline how to safely aid patients to withdraw from antidepressants
Pablo Millares Martin considers whether the problem list has become a problem (or remains a useful clinical tool).
So, how can GPs help their patients in facing transformative decisions? The advice, helpfully explained by Richard Armitage, is to reframe the decision-making process with which we approach them.
The Independent Pregnancy Loss Review, published in July 2023, offers recommendations to improve care for women and their families experiencing pregnancy loss, and includes specific advice for primary care.
"There is a lack of ADHD training for GPs, and GPs are often lacking accurate knowledge and confidence when dealing with ADHD in their practice. In light of this, we received 3-year funding from the ESRC to co-develop and evaluate tailored online
In general practice we can discuss end of life and treatment escalations decisions with patients before they become very unwell, and this is where the ReSPECT process could potentially give a space for a meaningful patient-centred discussion about preferences at the end
In an attempt to improve physical health outcomes in this group, patients registered at their GP practice as having a severe metal illness are eligible to undergo an annual health check in a primary care setting. Richard Armitage discusses recent progress.
So what now, given that suboptimal asthma care in the UK is increasing the morbidity and mortality of patients living with asthma coupled with rising asthma care-related carbon footprint? Vasumathy Sivarajasingam offers some useful reflections.
Yet, from speaking to other women with this condition, I have learnt that it is often their GP that they consult with first, asking: why are my periods lighter since my miscarriage? why have my periods stopped? Could something be wrong, as
