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…
Read more

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…
Read more

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…
Read more

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…
Read more

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.…
Read more

e-Learning | Lower urinary tract infection (UTI)

NICE released new guidelines in Oct 18 on antimicrobial prescribing in lower urinary tract infection (UTI). Public Health England (PHE) has guidelines on the diagnosis and management of UTI, which were update shortly afterwards. There is separate advice on antibiotic prescribing in pyelonephritis, but this doesn't change practice. The PHE guideline especially is really useful.…
Read more

Podcast | I’m a GeriGP

NASGP member Eva Kalmus describes how she became co-chair of the new GeriGP group of the British Geriatrics Society (BGS), and why being a portfolio GP has never been boring. When I did my GP training, about half of the GP trainees undertook a self-made rotation of approved jobs, followed by a year in general…
Read more

e-Learning | Renal and ureteric kidney stones

This is a new guideline from NICE on managing renal and ureteric stones, published in Jan 19. I'll give a summary of what is new, then do a more detailed summary below. What is new in this guideline? Investigations should be done within 24 hrs of presentation... (I'll just stop for a little laugh here...).…
Read more