A bite-sized, regular chat for all healthcare professionals working in primary care. Episodes cover clinical tips and hot topics. New episodes published every Thursday or Friday.
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Echocardiography is an essential tool in a wide range of clinical scenarios. Appropriate use of an echocardiogram ("echo" scan) can improve clinical outcomes by increasing diagnostic accuracy, providing non-invasive or minimally invasive assessment of disease status and risk stratification and enabling real-time monitoring and guidance of intervent…
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The term goitre refers to an abnormal enlargement of the thyroid gland, typically caused by iodine deficiency or autoimmune diseases such as Graves' disease or Hashimoto's thyroiditis, as well as hormonal changes, thyroid nodules or thyroid cancer. Symptoms include a visible neck swelling, throat tightness, coughing, hoarseness and difficulty swall…
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Ep 118 – Altitude medicine: the role of the expedition doctor
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Global travel offers many opportunities for adventure – but some come with medical considerations. An infrequent but important consultation is altitude medicine for people planning to travel to areas high above sea level. In episode 80, Dr James Waldron and Dr Rashbal Ghattaora talked about how to approach a travel consultation, with notes on relev…
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Ep 117 – Improving early diagnosis of type 2 diabetes: addressing the challenge of undiagnosed cases
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Undiagnosed type 2 diabetes is an increasing and concerning trend in the UK, particularly among Black and Asian ethnic groups and in areas of high deprivation. Early diagnosis and management are crucial, particularly in younger adults and underserved populations. Therefore, education, screening, and tailored treatment pathways are needed, but reach…
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Transient loss of consciousness (TLoC) affects nearly half the population of the UK at some point in their lives and is not an uncommon presentation in primary care. In this episode, Dr Kate Chesterman discusses the initial assessment of these patients and the factors that will help to differentiate between vasovagal syncope, cardiac syncope and ep…
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Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, as well as being a major cause of infertility and pregnancy complications. It includes symptoms of hyperandrogenism, the presence of hyperandrogenaemia, oligo-ovulation or anovulation and polycystic ovarian morphology on ultrasound. It is strongly assoc…
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In this episode, Dr Hannah Rosa discusses erectile dysfunction. Using the latest guidelines, this episode takes you through everything to consider when first reviewing a patient with erectile dysfunction, including key points to cover in the history and examination and which investigations to order. A four-step approach to management is discussed, …
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Quitting smoking is the single most important thing a smoker can do to improve their health, and with the right combination of support, medication and determination, individuals can successfully overcome their nicotine addiction and enjoy a smoke-free life. For many, quitting smoking completely can be a challenge due to the addictive nature of nico…
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Ep 112 – Acne: getting the management spot on
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In this episode, Dr Hannah Rosa discusses a condition that affects 95% of people aged 11–30 to some extent: acne. The 2021 NICE guideline on acne vulgaris is explored in detail, and broken down into four steps: Getting the diagnosis of acne right, including how to grade its severity What constitutes good general skin-care advice Management options …
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Testicular torsion is a urological emergency that usually affects young men, and a high index of suspicion is vital to ensure prompt diagnosis and management. A history and physical examination consistent with testicular torsion requires immediate surgical assessment for scrotal exploration – and if the initial examination suggests testicular torsi…
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Disclosing sexual violence is a difficult and emotional prospect for a patient and the way a GP responds can set the course of that person’s journey. It is important we get it right, but it is a complex topic. In this second part of our series on sexual violence, Dr James Waldron is joined again by Hayley Wilson (Consent and Sexual Violence Develop…
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Hypothyroidism, or an underactive thyroid gland, is increasingly common as people get older, but it may often be undiagnosed or diagnosed late due to the insidious nature of some of its symptoms. These include fatigue, weight gain, sensitivity to cold, constipation, dry skin, hair loss and depression. Common causes of hypothyroidism include autoimm…
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Restless leg syndrome (RLS) is prevalent in around 5–10% of the population and can result in an impact on quality of life that is comparable to conditions such as type 2 diabetes and osteoarthritis. It can result in significant impairments in sleep, energy, daily activities and behaviour and is associated with anxiety and depression in those who ex…
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Benign prostatic hyperplasia (BPH) is an extremely common condition seen in clinical practice, and one which can cause considerable difficulties in older men. Common symptoms include frequent urination, difficulty starting urination, weak urine stream or the need to urinate during the night – all of which significantly impact on quality of life. Tr…
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Understanding sexual violence is vitally important in primary care. A GP may be the first (or only) individual spoken to by a person who has experienced sexual violence. But how often does the experience disclosed represent the full scope of the issue? How much sexual violence goes unreported? What has changed about our understanding of sexual viol…
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Ep 105 – Empathy: who cares? Exploring empathy in health care
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In this episode, Dr Hannah Rosa discusses a topic which is at the heart of good clinical care: empathy. Research has shown that empathy decreases as medical students progress through medical school and that in society empathy levels have fallen over recent decades. But what does this mean for us working in primary care? What are the benefits that i…
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Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that primarily affects the joints. Causing joint pain, stiffness, swelling and reduced joint motion, its exact cause is still unknown, but is believed to involve a combination of factors. In this episode, Dr Roger Henderson looks at the aetiology of RA, diagnostic testing and t…
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Ep 103 – Primary prevention of cardiovascular disease: what has changed in QRISK3 and why?
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In this episode, which has been recorded for Chronic Conditions Month 2024, Dr Yassir Javaid (GP with a Specialist Interest in Cardiology) examines the role of the QRISK3 calculator in the primary prevention of cardiovascular disease. He considers the development of the tool, the differences between QRISK2 and QRISK3 (including the additional risk …
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Diverticular disease is a condition characterised by the presence of small pouches, called diverticula, in the wall of the colon (large intestine). These pouches can develop when weak spots in the colon's muscular wall give way under pressure. Diverticular disease encompasses two main conditions: diverticulosis and diverticulitis. In this episode, …
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Coeliac disease (CD) is a chronic autoimmune disorder that primarily affects the small intestine and is triggered by the consumption of gluten, a protein found in wheat, barley, rye and sometimes oats. When individuals with CD ingest gluten, their immune system responds by damaging the lining of the small intestine. This damage impairs the absorpti…
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Ep 100 – Alcohol and health: a review of the latest research
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In this episode, Dr Hannah Rosa takes a look around the world at some of the different strategies that are being used to try to reduce the health complications caused by alcohol. She then looks at the latest research which links alcohol as a primary cause of a variety of cancers, before finishing with a consideration of the economic cost. Access ep…
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Ep 99 – Assessment and management of obesity
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Obesity is a medical condition characterised by excessive accumulation of body fat, to the point where it may have adverse effects on health. Its incidence is steadily rising in both young people and adults. It is typically measured using BMI, but this has limitations and may not always accurately represent the level of obesity. While genetics and …
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Ep 98 – Recurrent vulvovaginal candidiasis
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Recurrent vulvovaginal candidiasis is reported in 6% of women of reproductive age. It has a significant impact on an individual’s quality of life that is comparable to conditions such as asthma and migraine. Appropriate management of the acute infection and subsequent maintenance treatment can help to reduce the burden of this condition. In this ep…
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The most common cause of peptic ulcers (gastric and duodenal) is infection with Helicobacter pylori (H. pylori) or the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Other factors such as excessive alcohol consumption, smoking, stress and certain medical conditions may also contribute to the development of peptic ulcers. Symptoms o…
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Dysphagia refers to difficulty swallowing. It can occur at any age and may be caused by various conditions, including neurological disorders, muscular disorders, structural abnormalities, or even psychological factors. Dysphagia can range from mild to severe, and it can lead to complications such as malnutrition, dehydration and aspiration pneumoni…
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Trigeminal neuralgia (TN) is a condition characterised by severe, shooting pain in the face, along the trigeminal nerve. The pain can be triggered by even mild stimulation of the face, such as brushing teeth, touching the face or eating. It is often described as one of the most excruciating pains known to medicine and it can significantly impact a …
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Anal fissures are small tears or cracks in the lining of the anus which can cause pain, bleeding and discomfort, particularly during bowel movements. They are quite common and can be caused by various factors such as constipation, diarrhoea, childbirth or anal trauma. Treatment often involves keeping the stool soft and avoiding straining during bow…
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Haemorrhoids are a very common finding in the Western world and are often seen in our surgeries. They are frequently under-reported so their exact incidence can be difficult to quantify; however, estimates are that 50% of the population experience them by the age of 50. Because many people attribute symptoms of more serious pathology to haemorrhoid…
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We live in an age of increasing digital connectivity where technology plays an ever-prominent role in peoples’ lives. While social media can provide a platform for support and connection, we are all susceptible to the negative effects of overuse or misuse, particularly on our sleeping patterns and our mental health. In this episode, the second in a…
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Lateral hip pain is a common presenting complaint in primary care. It can result in significant morbidity with reduction in activity levels and associated implications for leisure activities, employment and overall wellbeing. In this episode, Dr Kate Chesterman reviews the likely differential diagnoses, including some key questions to consider when…
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We are constantly connected to the web! You are likely connected right now, trying to decide what podcast to listen to! In this episode, Dr James Waldron interviews Dr Alex Lai of the WorkWell Doctors in the first of a series about staying well in an increasingly digital world. How do we check in with our use of digital tools? What impact might it …
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Bowen's disease, also known as squamous cell carcinoma in situ, is a type of skin disorder characterised by the presence of precancerous or intra-epidermal squamous cell carcinoma. It was named after John T. Bowen, the dermatologist who first described the condition in 1912. Bowen's disease primarily affects the outermost layer of the skin (epiderm…
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Obsessive–compulsive disorder (OCD) is a prevalent mental health condition characterised by persistent, intrusive thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) aimed at alleviating anxiety. Individuals with OCD often find themselves trapped in a distressing cycle, as compulsions provide only temporary relief, perpetua…
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NICE published its last guideline on depression in 2009. Since that time, the prevalence of depression has increased, especially among vulnerable adults during the COVID-19 pandemic. NICE published a new guideline in June 2022 to reflect this. In this episode, Dr Roger Henderson looks at the new recommendations on managing depression in primary car…
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Many pathology tests are ordered unnecessarily in primary care and this can include testing for inflammatory markers. The most common examples of tests typically ordered are for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, with occasional requests for plasma viscosity (PV) too. Although such tests can be useful in givin…
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Sweating is a crucial way to reduce our body temperature, such as when doing strenuous physical activity or when in a hot environment. Hyperhidrosis is defined as excessive sweating beyond what is physiologically required or normal. It can be categorised as primary (idiopathic), secondary to other conditions, or as a side effect of some medications…
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Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but the diagnosis and management of this condition may present problems in primary care. Low levels of testosterone in men are associated with increased risk of incident type 2 diabetes mellitus, worse outcomes in chronic kidney disease and COVID-19…
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Ep 83 – Management of dry skin conditions in skin of colour
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Dry skin is an extremely common condition that occurs in all skin colours and ethnic groups; however, differences in skin colour can cause significant differences in the incidence, presentation and treatment of different skin conditions. Although dry skin may cause similar symptoms among different skin tones, the appearance may make it more challen…
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Although pityriasis capitis (dandruff) is not a serious medical condition, it causes significant embarrassment and self-esteem issues in many people who suffer from it. It is extremely common, affecting up to half the global adult population, and its recurring nature is often a source of frustration. It can impact on primary care workload and can a…
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Lyme disease can present a number of particular difficulties in primary care, and these are often linked to clinical findings and the availability and timing of testing. In this podcast, Dr Roger Henderson discusses those and looks at Lyme disease’s three stages — early, disseminated and late — and whether it can be diagnosed clinically if erythema…
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Ep 80 – Altitude medicine: heightening understanding of “travel consultations”
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With tourism having now rebounded from the declines during and after the coronavirus pandemic, our patients are once again travelling globally. But what happens when their destination is 5000 metres above sea level? Many GPs will have been faced with a “travel consultation”, but it can be a daunting prospect when carried out infrequently. What are …
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The number of young people struggling with anxiety and depression seems to be on the rise and resources to help these young people are increasingly stretched. In this episode, Dr Kate Chesterman and Dr Dave Ledward (GP with an interest in mental health) discuss the growing problem of managing the mental health of children. They focus on the vital r…
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In this episode, Dr Hannah Rosa is joined by Dr Shan, a GP colleague and father to Oscar, an 8-week-old baby. Together, they go through the 6-week baby check, while discussing the recently updated guidance from Public Health England. They also explore the key role that the examination plays in screening for a variety of physical conditions, which, …
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Ep 77 – Recurrent urinary tract infection
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In this podcast, Dr Kate Chesterman discusses recurrent urinary tract infection (UTI). She covers the pathophysiology, some risk factors for UTI recurrence and treatment options including lifestyle changes and the use of antimicrobials. She also focuses on non-antimicrobial management, including the current advice regarding the use of probiotics, c…
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Ep 76 – Passing the test of testosterone replacement: menopause and hormone replacement therapy (part 2)
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In this follow-up to episode 52, Dr James Waldron and Mr Sam Dobson (Consultant Gynaecologist, Sub-specialist in Reproductive Medicine and BMS-accredited Menopause Specialist) consider the impact of menopause on libido. They talk through the physical and psychological features of menopause that can lead to a reduction in libido, the conversations a…
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The call to adventure is felt by many and general practice is a career that can take you there! As GPs grow their portfolios, they look for interesting and unusual ways to forge their own paths. This can take them all round the world (and back again). In this follow-up to episode 71, Drs James and Rebecca Waldron continue their discussion about Reb…
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In this episode, Dr Kate Chesterman is joined by Dr Alex Brightwell (Consultant Paediatrician with a specialism in allergy) and Liz Ingham (Lead Paediatric Allergy Dietician), both of whom work at the Norfolk and Norwich University Hospital. Together, they explore paediatric dietary allergies. They discuss cow’s milk protein allergy (CMPA), includi…
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In this episode, Dr Kate Chesterman talks to Dr Briony Arrowsmith, who is a Consultant Paediatrician at the Haven, a sexual assault referral centre in London. They discuss the many and varied ways that sexual abuse can present, as well as the considerations surrounding who the abuse should be disclosed to. They talk through the physical health conc…
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Ep 72 – Back to basics: heart sounds and cardiac examination
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In this episode, which has been recorded for Chronic Conditions Month 2023, Dr Yassir Javaid (GP with a Specialist Interest in Cardiology) discusses auscultation of the heart sounds. Auscultation is an important aspect of the cardiac examination and can give an indication of significant underlying structural heart disease – particularly valve disea…
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The call to adventure is felt by many and general practice is a career that can take you there! As GPs grow their portfolios, they look for interesting and unusual ways to forge their own paths. This can take them all round the world (and back again). In the first episode in a two-part series, Drs James and Rebecca Waldron discuss adventure and exp…
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