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Opinion

Medicine’s caste system of the mind

"Both patients had the same symptoms and required the same care. However, one mind made the work smooth; the other made it onerous. Without malice or awareness, the GP sorted them into different moral categories: the organised mind that deserves time, and
25 March 2026
4 mins read

Time is the physics of care

"Time is not simply a tool for scheduling health care; it is the very medium through which care’s quality, safety, and justice are realised. It compresses attention, creates inertia, imposes thresholds, and dissipates energy. If we want to understand why care sometimes
18 March 2026
3 mins read

Fine. Thanks.

What if we were to let the patient into our own inner world; of battling against the clock, the relentless stacking up of admin that occurs in real time as the consultation progresses ... the lack of time in our relationships at
11 March 2026
2 mins read

I’m a GP — do you still trust me?

Trust is not visible, but you miss it when you lose it. Trust develops from many inputs that include memories, beliefs, and emotions that help us predict how someone may act.
7 March 2026
4 mins read
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A syllabus for whole-person medicine

Understanding the whole person also means understanding who and what affects that person - who and what enables and inhibits a person’s ability to respond creatively to the ups and downs of daily life. Such spheres of influence and their effects are
27 February 2026
4 mins read

Who decides what counts as illness?

Patients’ apologies for “wasting time” are not personal quirks but learned responses to a system that often treats unexplained symptoms as data rather than lived experience.
25 February 2026
3 mins read

Let’s just do some bloods…

Anyone can implement a protocol. Anyone can order a blood test. The real skill of a primary care clinician is in navigating the complexity and finding a helpful path forward for the unique individual in front of us.
23 February 2026
3 mins read

The consultation beneath the consultation

I almost missed it. My instinct was to dive into the prescription screen. But something in her silence caught me. I paused and softened my voice. “You seem like you’re carrying a lot today.”
20 February 2026
4 mins read
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Ode to Diagnosis

Lines written by a doctor, after an elderly man presents with a positive PSA test, trying to decide what to do next. A poem.
6 February 2026
1 min read

Action required

Tired of scanning hospital letters to try and spot if there was anything that would necessitate action, it seemed like a simple solution: hospital teams would in future put any such information into a headed section...
5 February 2026
2 mins read
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Icarus Plummeting

Zigmond mercilessly describes the ways in which our healthcare systems have made us less able to listen to the patient’s experience, less able to see their experience in the context of their life, their family and their social circumstances.
31 January 2026
2 mins read
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How doctors learn not to listen

Students learn that ambiguity is risky, uncertainty should be resolved, and experience must be rendered legible through diagnosis. They learn to apply the gaze, filtering out the “noise” of life to find the signal of disease.
21 January 2026
3 mins read
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When normal tests end care too early

Medicine is remarkably effective at identifying disease. Yet when symptoms persist without a clear diagnosis, it often falters—not because knowledge is lacking, but because legitimacy quietly evaporates.
13 January 2026
3 mins read
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