Whilst medicine exists as social science on a socio-political level, it also has deep roots in interpersonal relationships. Medicine as social science is public and political, but it is personal too. In general practice this is widely understood and must not be
Migrants are widely recognised to have complex and diverse health needs, but recent reform within the NHS includes the introduction of healthcare charges for many of them. These may create pressure on GP services, increase the disease burden and widen health inequalities,
Many former GPs may want to move along a different career pathway, but when they retire from clinical work they encounter barriers. Mona Aquilina argues that we need to harness and leverage the skills and energy of these doctors and she gives
Advances in medicine have led to major improvements in end-of-life care. But when a patient dies should doctors be aware of any factors in funeral care that can help the relatives? Dr Sarah Jones, a doctor turned Funeral Director, and Dr Julie
Community palliative care delivery is changing dramatically in response to the Covid-19 pandemic. But what of the unintended consequences of such rapid change? Ben Bowers and his co-authors examine key issues.
Primary care is changing at an unprecedented pace and the COVID19 pandemic has shown how being adaptable is vital to the future of general practice. Ria Agarwal and Sarah Mitchell ask whether Physician Associates may provide a way forward for end-of-life care
Editorial comment - today we publish two articles on current challenges in palliative care and possible ways forward. Compare and contrast!
This year Covid-19 has been a backdrop to profound human loss. Anupma Parihar reflects on the role of patients' narratives in preserving the dignity of our our patients within the consultation.
The COVID 19 pandemic has resulted in a dramatic shift from face- to-face to remote consulting within general practice. But how will this impact ongoing patient care? Victoria Tzortziou Brown, Simon Gregory and Denis Pereira Gray examine the evidence.
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