Yonder: physicians’ end of life care preferences, diagnostic labels, electronic health record interoperability, opioid prescriptions

Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.

Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.

Physicians’ end of life care preferences

The RCGP moved to a position of neither supporting nor opposing assisted dying being legal in March 2025, and the Royal College of Physicians has held a neutral position since 2019. At the time of writing, the assisted dying bill has just been approved by MPs in the UK. There is some evidence suggesting a link between doctors’ desires for their own end of life care and their clinical practice. This study surveyed doctors from North America, Europe and Australia on their preferences for end-of-life care in two hypothetical scenarios: advanced cancer and Alzheimer’s disease.¹ Of the 1157 respondents, more than 95% preferred to avoid life-sustaining techniques (CPR, mechanical ventilation, tube feeding) and around half considered euthanasia a good or very good option in each scenario. Current legislative environment, physician type, average number of end-of-life patients seen each year, and religiosity all impacted physicians’ preferences.

Diagnostic labels

Screening, testing asymptomatic individuals for a condition, can detect pathology before it may otherwise present and lead to earlier treatment. However, it can also mean a new diagnostic label for a patient. This Australian qualitative study with GPs and patients explored whether the potential impacts of diagnostic labelling were discussed before routine screening for non-cancer health conditions, specifically those likely to be found in age-related health checks for those age 40-65 years.² No GPs reported discussed the potential consequences of diagnostic labelling, and patients were unable to recall GPs raising this, but all felt it should be routine practice:
‘There’s no bigger responsibility in healthcare than respecting and being humbled by the fact that what we do will change the way someone experiences living. And so, we need to be very aware, but we also need to invite dialogue about that with patients. Because perhaps they don’t quite understand how profound these things can be, and we’re the professionals, we’re supposed to know.’

Electronic health record interoperability

Electronic health records (EHRs) have transformed the way healthcare is delivered, but in the UK we currently have a patchwork of EHR systems with limited data sharing capabilities. This can lead to minor administrative frustrations and major patient safety issues. This study surveyed NHS physician perceptions of current EHR interoperability, and investigate how a lack of interoperability affects patient care and safety.³

Most participants (91%) reported being able to view clinical information from their own healthcare facility, but only 38% reported visibility of clinical information outside their immediate healthcare setting, and 16% reported the ability for external providers to see their inputted data. Almost all (96%) participants reported difficulties retrieving clinical information from EHRs, with a quarter stating this occurred most of the time or always. Most participants (89%) believed the lack of interoperability may pose a risk to patient safety, and commonly reported consequences included repeat diagnostic investigations, prolonged length of stay in hospital, and prolonged clinic consultation times.

Opioid prescriptions

Opioid prescribing and opioid related deaths in the UK have been increasing over the last few decades. This study aimed to uncover potential disparities in opioid prescribing behaviour between UK-trained and non-UK-trained GPs in English general practices,⁴ building on previous research in the US which found a relationship between opioid prescribing and medical school rank suggesting that medical education played a role in opioid prescribing behaviour.⁵ Compared to GPs who received their medical degree from the UK, those trained in North America and the Middle East prescribed 30% and 10% more opioids respectively: those trained in Africa (5%), South Asia (2%), Australia, and the Pacific region (4%) prescribed fewer. The authors suggest this may be due to a number of factors including differing cultural expectations, medical training environments, and healthcare system priorities.

References

1. Mroz S, Dierickx S, Chambaere K, Mortier F, De Panfilis L, Downar J, Lapenskie J, Anderson K, Skold A, Campbell C, Campbell TC, Feeney R, Willmott L, White BP, Deliens L. Physicians’ preferences for their own end of life: a comparison across North America, Europe, and Australia. J Med Ethics. 2025 Jun 10:jme-2024-110192. doi: 10.1136/jme-2024-110192. Epub ahead of print. PMID: 40494645.
2. Sims R, Michaleff ZA, Glasziou P, Thomas R. Discussing the potential consequences of a diagnostic label before routine non-cancer screening: qualitative study with general practitioners and consumers. BJPsych Open. 2025 Jun 11;11(4):e106. doi: 10.1192/bjo.2025.5. PMID: 40495772.
3. Li E, Lounsbury O, Hasnain M, Ashrafian H, Darzi A, Neves AL, Clarke J. Physician experiences of electronic health record interoperability and its practical impact on care delivery in the English NHS: a cross-sectional survey study. BMJ Open. 2025 Jun 10;15(6):e096669. doi: 10.1136/bmjopen-2024-096669. PMID: 40499968.
4. Madia JE, Nicodemo C, Orso CE, Tealdi C. Overseas general practitioners (GPs) and opioid prescriptions in England. Health Policy. 2025 May 23;159:105362. doi: 10.1016/j.healthpol.2025.105362. Epub ahead of print. PMID: 40451133.
5. Schnell M, Currie J. ADDRESSING THE OPIOID EPIDEMIC: IS THERE A ROLE FOR PHYSICIAN EDUCATION? Am J Health Econ. 2018 Summer;4(3):383-410. doi: 10.1162/ajhe_a_00113. Epub 2018 Aug 17. PMID: 30498764; PMCID: PMC6258178.

Featured image by Angèle Kamp on Unsplash