Deep Breath In

Diagnosis is a complex categorisation task driven by mental models that reside in long term memory. Through education and experience, clinicians form scripts that encapsulate their knowledge of specific conditions and develop diagnostic schemas that structure their approach to a specific health problem. This cognitive process also intersects with systems, teamwork, and social factors that can enha...

As Ramadan draws near, clinicians may be approached by their Muslim patients to discuss managing their health conditions during the month of fasting. How should someone with a chronic condition, such as diabetes or epilepsy, time their medications during this period? Can a person who’s pregnant or breastfeeding partake in fasting? What alternative options are available to someone whose health need...

There was a proposed vaccine mandate for NHS staff in the UK (now abandoned) but in other countries mandates continue, but are they without harm, and do we have evidence about how effective they are? In this episode, we'll be discussing how a proposed vaccine mandate would have affected GP practices in the UK, particularly when it comes to the demographics of staff who have not accepted the vaccin...

A recent case against a GP in England has worried the profession - does the fact that a patient, born with a neural tube defect, successfully sued their mother's GP open up the floodgates for litigation? How will that effect the way that you practice? In this episode we're joined by Claire Dyer, The BMJ's legal correspondent, who explains how that case unfolded. We also have a clinical update on c...

With Christmas 2021 only just around the corner, we round off the year by chatting about our ‘Deep Breath In’ highlights, and by sharing some of the great feedback we’ve received from our listeners. We talk to Inga Usher and Aswin Chari, whose study comparing neurosurgeons with aerospace engineers (“It’s not brain surgery” vs. “It’s not rocket science”) was featured in The BMJ’s 2021 Christmas iss...

Following the recent COP26 Climate Change Summit, we discuss, in this week’s episode, the announcement that some 50 countries have committed to reach net zero carbon emissions within their healthcare systems by, or before, 2050. We talk about the role that GPs can play in reducing the carbon footprint of their practice, how to tackle climate anxiety, and how integrating greener practices into our...

Primary care in the UK is in crisis. General practice was already under huge strain, as a result of the pandemic, high levels of seasonal respiratory viruses, as well as chronic understaffing and underfunding, but recent negative media campaigns against GPs, amidst the health secretary’s plans to publish ‘league tables’ of GP practices, have added to this and have led to increased demoralisation a...

Over the past 18 months, eating disorder specialists have seen a huge rise in the number of referrals, and experts have said that the pandemic has created “the perfect storm” for eating disorders, especially among children and young people. As GPs, what do we need to know about eating disorders? What red flags should we look out for, and how do we approach this thorny issue with our young patients...

Fatigue is one of the most common presenting symptoms GPs see in a consultation, and it feels like, during the pandemic, more of us than ever have been experiencing excessive tiredness. With our guests this week, Sophie West and Robert Koefman, we discuss the new NICE guidelines on obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome, and how sleep apnoea seems to be bo...

A slightly different spread of this episode of Deep Breath In, Navjoyt Tom and Jenny are discussing two separate topics, headaches and team debriefings. Firstly headaches, the team discuss why so many GPs find headaches to cause the most anxiety in their practice, and get some advice on migrainous headaches from Heather Angus-Leppan, consultant neurologist at the Royal Free London NHS Foundation T...

Doctors are taught from medical school about the benefits of IUD, and are often advocates of them to patients. However, recent media attention on the pain that some women suffer when having their IUD's fitted have started conversations about the need for cervical blocks, and more honest counselling of women about the procedure. Rebekah Fenton, adolescent medicine fellow at Lurie Children's Hospita...

As the scientific community in the UK still debates whether to vaccinate kids under 16, that leaves us as an outlier to the rest of the world where parents are being encouraged to seek the vaccination of the children. In this episode Tom, Jenny and Navjoyt discuss the questions that they're getting in their surgeries, and get some advice on how parents regard vaccinating their children, how to thi...

There's a plan from the Royal College of General Practitioners, to stop the profession buckling under the huge pressure applied by the workforce crisis and covid 19. The steps outlined are very practical, but do they really get to the heart of the problem with the way in which primary care is practiced in 2021. In this episode, Tom, Jenny and Navjoyt are joined by Rani Lill Anjum, a philosopher fr...

A borderline hba1c result will initiate a conversation with a patient - but how useful is that "prediabetes" check-in, and can GPs ever adequately describe what the elevated risk of having a risk factor actually means for a patients health? Our guests in this episode are Sam Finnikin, an academic GP from the University of Birmingham, who gives some helpful tips on explaining that risk, and reminds...

The pandemic had a high mortality toll in care homes, but measures to try and reduce that, through extreme social isolation, has had its own cost. Social interaction, particularly with close family, is more than just a quick hello - evidence shows that mental stimulation can help with cognitive decline, and the lack of that interaction may have hastened progression of dementia in some patients. In...

Our environment moulds our brains, and alters development, and so there are culture-bound ways that our bodies express distress. In this week’s episode, we discuss the mysterious phenomenon of Sweden’s ‘sleeping beauties’: asylum-seeking children who were affected by resignation syndrome, which led them to become completely inert. We talk about the pros and cons of applying medical labels to peopl...

Burnout has become something of a buzzword recently, but has now been officially classified as a syndrome caused by the workplace. Over the course of the pandemic, clinicians have been under more stress than ever, and evidence shows that burned out doctors are more likely to make medical errors. As the pressure being piled onto GPs, and other medical professionals, is only increasing, the adage of...

In general practice, doctors commonly see patients who are experiencing varying degrees of health anxiety, which can be difficult to navigate. GPs often want to offer reassurance, but reassurance can be like a drug to these patients: the more reassurance they receive, the more they need. In this week’s episode, we discuss how new technology which allows patients to check symptoms at home (such as...

In this episode, we're bringing you the full interview, a deep breath, with Whitney Robinson, a social epidemiologist and associate professor at UNC Chapel Hill. Whitney gives us her take on how we should be thinking about risk when it comes to covid-19 infection and vaccine rollout. This is a nuanced conversation about the health and economic disparities of covid-19 the consequences of failing to...

There is a common perception of surgery that it’s an old boys’ club, and that anyone joining the profession is expected to match the archetypal personality type in order to fit in. Whilst this is starting to change in some specialities, it does still present a challenge, especially to junior staff trying to establish themselves. The relationship between primary and secondary care can be quite remo...

Two topics currently being hotly discussed in the media and in clinical practice are headaches after the COVID vaccine, and the impact that structural racism is having on vaccine uptake. Headache and fever are common symptoms after a vaccination, but there are concerns about the potential link between the AstraZeneca vaccine and blood clots, and these concerns, exacerbated by the recent frenzy of...

The past year has seen an increase in antibiotic prescriptions, especially for broad-spectrum antibiotics. This might be due to the rise in teleconsultations, which limit the ability to examine patients, causing GPs to experience higher levels of uncertainty in making diagnoses. This week, we discuss the impact that COVID-19, and COVID tests, have had on access to healthcare, the risk of antimicro...

The use of telemedicine is on the rise, and the pandemic has led to an increased demand for this service, due to the availability of face-to-face appointments being severely limited. In this week’s episode, we discuss the benefits and pitfalls of teledermatology. With long waits for secondary care referrals, teledermatology allows dermatologists to fast-track patients requiring urgent investigatio...

Suddenly 1.7m extra people have been told to shield from coronavirus, thanks to the QCovid algorithm, and that's causing confusion - ethnicity is one of the risk factors in QCovid, and yet there is a signal that there is lower update of the vaccine amongst ethnic minorities in the UK. In this week’s episode, we discuss how particular factors, such as age, ethnicity, and comorbidities, affect your...

In the UK, we are currently in the midst of our third lockdown since the pandemic began, and there has been a huge surge in people experiencing mental distress, anxiety and depression during the past year. The novelty of the first lockdown, in which people optimistically took up a variety of new activities, such as learning a language or baking endless loaves of banana bread, has long worn off, an...