Episodes

Emollients are moisturisers that help soothe, hydrate and protect the skin by forming an occlusive barrier to lock in moisture. They are commonly used to treat dry, rough and scaly skin conditions such as eczema, psoriasis and dermatitis, and work by softening and smoothing the skin, reducing water loss and improving the skin's natural barrier function. As a result, they play a vital role in skin care, especially for those with dry or compromised skin, and come in various forms, each suited to d...

Many children have additional needs, and occupational therapy can play an important role in helping these children take part in everyday activities as well as in supporting their families and carers. In this episode, Dr James Waldron talks with Dr Naomi Fox, a paediatric occupational therapist, about ways to improve care and consultations for children with additional needs. Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/paediat...

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 interventional procedures. However, there can be confusion surrounding when to appropriately refer a patient from primary care. In this episode, Dr Roger Hende...

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 swallowing or breathing. Untreated goitre can lead to complications and thyroid dysfunction. The prevalence of goitre in the UK is lower than in many devel...

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 relevant medications and counselling. In this episode, they consider the role of medics travelling with groups at high altitude – ideal information for tho...

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 reaching these groups can be challenging. In this episode, which was recorded for Chronic Conditions Month 2024, Dr Kashif Ali (GP Partner and Primary Care...

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 epilepsy. She gives guidance on referral criteria and signposts useful resources that help assess fitness to drive and provide important safety informat...

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 associated with complications that may arise from it, including insulin resistance, metabolic syndrome, fatty liver disease and an increased risk of develo...

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, along with guidance on referral and follow up. Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en...

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 nicotine, but various strategies and treatments are available to help support patients who are trying to stop smoking. Benefits are immediate, both in the...

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 The new MHRA guideline on isotretinoin. Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB...

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 torsion, the surgical approach should take precedence over other diagnostic tests. In this episode, Dr Roger Henderson discusses what to look for when diag...

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 Development Officer at Nottingham Trent University) to explore the consultation in detail. This episode discusses how to respond to a disclosure and the impo...

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 autoimmune diseases, thyroid surgery, radiation therapy, certain medications and iodine deficiency, which is the leading cause globally. Treatment typically ...

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 experience it. In this episode, Dr Kate Chesterman discusses the diagnosis and investigation of this distressing condition along with three principles t...

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. Treatment options vary depending on symptom severity and can include no treatment, medication, minimally invasive procedures or surgery. In this episode...

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 violence and its context? In this episode, the first of a series looking at this topic, Dr James Waldron speaks with Hayley Wilson (Consent and Sexual Vio...

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 increasing empathy in our clinical practice can bring, and how can we all develop this vital skill? Access episode show notes containing key reference...

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 the management pathway for patients with the condition. Access episode show notes containing key references and take-home points at: https://gpnoteboo...

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 factors now included in the updated calculator) and the strengths and limitations of QRISK3 in understanding a person’s cardiovascular risk. More inf...

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, Dr Roger Henderson takes an overview look at the symptoms and management of these as well as their prognosis and prevention. Access episode show note...

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 absorption of nutrients from food, leading to various symptoms and potentially serious complications. In this episode, Dr Roger Henderson looks at the diagnos...

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 episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-practice/ep-100-a-review-of-the-lat...

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 hormonal factors have a role in obesity, lifestyle choices (such as diet and physical activity level) and environmental factors also significantly con...