Performance

e-learning | Managing abnormal liver function tests

This is a guideline on managing abnormal LFT that was published in 2017 by the British Society of Gastroenterology, but as it so useful I thought it worth summarising it. Key learning points for me: We should be investigating nearly all abnormal LFTs further and shouldn't use the duration or the degree of the abnormality…
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Stroke and TIA – initial management

This is an updated guideline from NICE on the management of stroke and TIA in over 16s. It was first published in 2008 and this update is from May 19. The most important change for us in this guideline is that they recommend that all patients with a suspected TIA now be seen by a…
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Being mindful of 
medical hierarchy

Medical hierarchy may present a challenge, and at times a possible reluctance, to open discussions about patients. Dr Rachel Birch, medicolegal consultant at Medical Protection, discusses possible reasons for this and provides helpful strategies to overcome this. Most doctors would agree that a medical hierarchy exists in the hospital setting, with junior doctors and specialist…
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e-Learning | COPD diagnosis and management

This is an updated guideline from NICE on the diagnosis and management of COPD, published in Dec 18. It's a pretty mammoth guideline, first written in 2004. There is a useful flow chart on management. One for the wall... There is a separate guideline on antibiotic prescribing in COPD, which I have done another post…
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Burnout and how 
to avoid it

Burnout among GPs can be an occupational hazard and is believed to be increasingly common. Dr Rachel Birch, medicolegal consultant at Medical Protection, discusses burnout and the steps that sessional GPs can take to avoid it. Case scenario Dr A is a locum GP undertaking 5-6 sessions per week in different practices. She has chosen…
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e-Learning | Management of Polycythaemia Vera

This is an updated guideline on the diagnosis and management of polycythaemia vera (PV) from the British Society for Haematology. It was published in Nov 18. PV is the same as polycythaemia rubra vera and PCV. Much of this is beyond what we need, but it outlines how we should be approaching a patient with…
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e-Learning | Ectopic pregnancy and miscarriage

This is an updated guideline on ectopic pregnancy and miscarriage from NICE (published Apr 19). It was last updated in 2012 when I originally wrote this blog post. The 2019 update doesn't add very much to what we were already doing. There are two new elements: Expectant management of women with a miscarriage before 6/40.…
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