David Mummery reflects on the professional and political waste land faced by UK general practice and on 'The Waste Land' by TS Eliot
As doctors we are committed to justice and an end to discrimination. So surely sex discrimination in medicine is a thing of the past? These four medical students from Kings are not so sure.
Afrosa Ahmed reflects on a telephone consultation that will change her patient's life forever. She missed the ability to reach out physically to her patient as she took in the news. We are human beings, who support one another in the consultation.
We are all hoping for a Covid vaccine that works. But even if we get one, will it be that simple? Ramiro Gilardino and Victoria Malek-Pascha consider five critical issues.
Why is the injustice of racism still an open sore in western culture? Paul Main takes our exploration forward with his review of two forceful books.
For a patient, time with their GP is everything; time to explain, connect, and trust. For the GP, time is just as essential. Not only for improved patient care, but for reflection on the enormous and constant changes to the profession. In
We are embodied social beings. We thrive on nurturing relationships. Touch forms a key part of those relationships in everyday life but is also a powerful form of communication for clinicians, allowing for wordless dialogue, presence and embodied empathy. Paquita de Zulueta
30 years ago we were told we were not treating pain adequately. There was a push to give people more analgesia. So, armed with our opioids and gabapentinoids we went and we medicated. But peoples' pain got worse. Katie Barnett examines what
Asthma treatment has improved markedly over recent years. But James Oxley wonders why we are not taking action to reduce environmental pollution from discarded inhalers.
Numbers have no voice. We, however, give them meaning. Using numbers we can twist the narrative to suit the point we want to make. Following his spectacular rise on social media Samar Razaq investigates the dark arts of manipulation, politics and statistics.
The UK Government’s Gear Change policy heralds a ‘bold vision for cycling and walking’, and has been a welcome development amidst the recent headlines of sadness and uncertainty. Heather Jones examines what is needed to make such a vision work.
While demand for services increases, the NHS continues to experience a significant workforce crisis. To help pool resources the NHS Long Term Plan aims to integrate services across sectors, but what will need to be done to ensure that the delegation of
The Citadel, a 1937 novel by A. J. Cronin, explores the themes of social and health inequalities, drawing from his personal experiences working as a doctor in Britain’s pre-NHS era. The protagonist, newly qualified and virtuous Dr Andrew Manson, begins his medical
Who would have wanted to be a lead clinician in Public Health England at the start of the pandemic? Judith Dawson finds that trying to balance the population losses against individual and economic loss is an impossible job. But in a typical
The primary care workforce has been right at the heart of the response to COVID-19, working hard in new and rapidly changing circumstances to ensure patient care continues to be provided to all those who need it in the community.
David Misselbrook discusses how two books, To Kill a Mockingbird and Sacred Hunger, have helped him understand more about why Black Lives Matter matters and have given him his own refresher course in racism.
General practice is well-positioned to identify and intervene in the wider determinants of health. Many of the ingredients are already in place: registered patient lists, extensive data, and the ability to engage both proactively and opportunistically with patients. But primary care’s responsibilities
Judith Dawson reflects on the draft NICE guidelines for the management of chronic primary pain. There is widespread use of ineffective and addictive pain medication of questionable benefit. However, implementing any change will depend on a cohesive approach across primary and secondary
Despite ‘seeing’ more patients remotely, we are becoming more isolated, living our lives in lonely clinics and solitary consultations. The art of medicine becomes abstract, doctors and patients united in their separation.
Under the Prevent policy, NHS Trust staff are trained to spot signs of radicalisation and refer cases to the government. Within a systemically racist social system this policy succeeds only in targeting minority groups and those who are most vulnerable. The abolishment
Ed Warren is a retired GP. He notes that a feature of getting older is that you have more opinions and are convinced that others want to hear them. He reflects on the ageing process, cognitive biases, coming to terms with his
The opportunities to treat more and more patients in less and less time is the unspoken aim of the improving of technology. But as we move into this future, we must continue to courageously ask both ourselves and our employers; is this
The Cumberledge report puts forward the case for radical reform. Dealing with those who have by our actions sustained loss and pain, even as a recognised complication of a necessary procedure, can be exceptionally challenging. It is important to be able to
Baroness Cumberlege’s report describes suffering that was “entirely avoidable, caused and compounded by failings in the health system itself” and her report advocates for radical reform. Let us be forever proud of the response to COVID. Let us urgently examine the collateral
If general practice becomes unsustainable, we will lose the most effective and efficient health service we have, and it will not be easily replaced. It’s time we involved GPs in the critical analysis of the holes in the system, before our capacity
So why am I more exhausted from a full day in practice when I have only seen four patients face-to-face, dealt with 30 or so patients over the phone and conducted a MS Teams practice meeting? The ambience around appears calmer –
Most clinicians will encounter cases of self-neglect during their career, which will vary from mild presentations to really disturbing cases where the self-neglect becomes extreme. What drives such behaviour and how do we manage it?
Described as the 'cornerstone of safe and effective practice', the physical examination has always been an integral part of what makes a competent GP. With recent evidence presenting a decline in GPs' physical examination skills over recent years, GP Simon Morgan reflects
When reading articles on digital innovation in the NHS audiences are finding that they need to update their editorial bingo ticket. Classics like culture change, interoperability or costs remain. But any self-respecting writer must now include something on how the NHS response
Might a headlong rush to implement ICSs erode the trust that those who have to work in and implement ICSs have for those who drive this agenda? When there is such fragility and strain across an entire service, a natural pause in
The effect of being stopped and searched by the police can be psychologically traumatic and leave one feeling scared, powerless and humiliated. I thought about my patients. A lot of patients I look after are black and I wondered about how negative
“Look sorry, right, no offence but we need a white doctor.” Dad looked at the wall as he spoke. It was almost as if something was compelling him. I really didn’t know what to say. I felt myself flushing, the prickle in
Health experts and politicians have warned for over 170 years that health inequality is killing those in the most deprived parts of society. We now witness the poorest in society disproportionately dying of COVID-19, suggesting that the social murder observed by Engels
The new GP contract in England now recognises the necessity for clinical pharmacists to ensure the optimal use of medicines for patients within all primary care networks. What about the benefits to the wider healthcare team within general practice?
Everyone of us in the health service has overheard unacceptable rudeness, sly put-downs, exclusion or smiling say-the-opposite-of what-you-mean British insincerity. We need to acknowledge that it is happening. There is no mysterious genetic or melanin fault causing excess deaths among health workers
How much does it take for us to genuinely express sorrow and compassion for the terrible trials our patients endure? We have pride in the NHS but we have prejudice too. Perhaps it is the NHS clinician that is Icarus, flying too
An individual working as a GP runs the risk of becoming an automaton. Evidence-based medicine and professional standardisation contribute to uniformity and by definition a reduction in diversity. Camus says that “if the world were clear, art would not exist” and I
Some reflections on retirement... Ours is a great community. I look back with thanks, but forward with both compassion for the world and belief in our ability to be better than this. And in a deeper parallel, just as we as individuals
Decision fatigue is something we have all experienced. We each have a finite amount of mental energy that we can expend on decision making before our brain starts to look for a shortcut. Decision fatigue is also a well recognised reason behind
As a 20-something millennial GP trainee, the sudden talk about the future of primary care is exciting. I once heard a futurologist say, “Don’t ask ‘what will it look like down line?’ ask ‘what do you want it to look like?’” I
The many and varied consequences of COVID-19 are felt disproportionally by those with less resources, both external and internal. We would do well to establish Far End practices and networks akin to our Deep End siblings. We should reach out to the