GPnotebook Podcast: Recent Episodes
GPnotebook
The GPnotebook Podcast is a bite-sized, regular chat for all healthcare professionals working in primary care. Episodes cover clinical tips and “hacks” as well as hot topics, with the aim of making our working lives a little easier and helping to improve the lives of our patients.
In this episode, Dr Hannah Rosa discusses hypercalcaemia and how it can be managed in five steps. She reviews when to suspect hypercalcaemia and the most common causes of a raised calcium. She also covers further investigations that can be undertaken in primary care, management in secondary care and follow-up in primary care. At the end, there is a chance to put the learning into a clinical context with a quick quiz.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/diabetes-and-endocrinology/ep-218-hypercalcaemia.
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In this episode, Dr Roger Henderson discusses illness anxiety disorder (IAD), a condition that presents unique challenges for both patients and healthcare professionals. Formerly known as hypochondriasis, IAD is characterised by a persistent fear of having or developing a serious medical illness despite appropriate evaluation and reassurance. These patients often present in primary care and specialist settings, frequently seeking answers for symptoms that may be minimal or entirely absent. Recognising the condition is important, as repeated investigations alone rarely alleviate distress and can contribute to unnecessary healthcare utilisation. This episode explores the clinical features, risk factors, diagnostic criteria, differential diagnosis and evidence-based management of IAD. It also discusses practical strategies for building therapeutic relationships and supporting these patients in a compassionate and effective manner.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/psychiatry/ep-217-illness-anxiety-disorder.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson provides an overview of alopecia, one of the most common yet often misunderstood conditions encountered in clinical practice. While hair loss is rarely life-threatening, it can have a profound impact on a patient’s psychological wellbeing, self-esteem and quality of life. Alopecia is not a single disease but a clinical sign with numerous underlying causes, ranging from temporary and reversible conditions to forms of permanent scarring hair loss; for GPs, distinguishing between these types is essential for accurate diagnosis, timely intervention and effective management. The episode covers the major categories of alopecia, reviews key clinical features and diagnostic approaches, and explores current treatment strategies. It also considers the important psychosocial effects of hair loss and the role GPs play in supporting affected patients.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/dermatology/ep-216-alopecia.
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Hiccups are a common symptom, with short-lived episodes usually being a source of amusement rather than distress. For these acute episodes, simple nonpharmacologic techniques are often effective. However, persistent hiccups greatly affect quality of life and can be difficult to manage. There is often significant diagnostic dilemma, with potentially serious and even life-threatening underlying causes needing to be considered. In this episode, Dr Kate Chesterman discusses the investigation and management of hiccups.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/general-practice/ep-215-hiccups.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson explores pneumococcal disease and the major changes coming to the UK pneumococcal vaccination programme in 2026. Although often overshadowed by other infectious diseases, Streptococcus pneumoniae remains a leading cause of preventable morbidity and mortality worldwide, particularly among older adults, young children and immunocompromised patients. This episode discusses the microbiology and clinical manifestations of pneumococcal disease, reviews the immunological principles behind current vaccines and examines why the UK is transitioning towards the use of the 20-valent pneumococcal conjugate vaccine, or PCV20. It also looks at the wider public health implications of these policy changes and considers how evolving serotype epidemiology continues to shape vaccination strategy in modern clinical practice.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-214-pneumococcal-disease.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson explores polymyalgia rheumatica (PMR), a common but often underestimated inflammatory condition affecting older adults. Although many clinicians recognise the classic presentation of shoulder and hip girdle stiffness, PMR is far more than a simple musculoskeletal complaint. Its overlap with giant cell arteritis (GCA), the challenges of long-term steroid management and the importance of recognising red-flag symptoms make it a condition that requires careful clinical judgement. Join us as we walk through the typical patient presentation, discuss the underlying inflammatory mechanisms, review current diagnostic approaches and explore practical management strategies, including relapse prevention and steroid-sparing therapies.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/rheumatology/ep-213-polymyalgia-rheumatica.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson looks at a condition every GP recognises, but not always in its earliest or most subtle form: shingles. Also known as herpes zoster, it is far more than just a painful rash – it’s the reactivation of a neurotropic virus that may have been lying dormant for decades within the nervous system. Here, we explore how and why that reactivation occurs and what clinical clues can help you identify the condition even before the rash appears. We walk through the typical and atypical presentations, highlight key complications and discuss why early treatment can make a meaningful difference to patient outcomes. We also consider high-risk groups, including older adults and immunocompromised patients, where the disease burden is greatest.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-212-herpes-zoster.
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In this episode, Dr Roger Henderson looks at a condition that many clinicians associate with pre-vaccine paediatrics, yet which still occurs: mumps. While its incidence has dramatically declined since the introduction of the measles, mumps and rubella vaccine, it has not disappeared. Here, we walk through why mumps still matters clinically, from its systemic viral nature and characteristic parotitis, to less obvious presentations like orchitis and aseptic meningitis. We also explore why vaccinated populations can still be affected, how diagnosis is confirmed in practice and what clinicians need to remember about public health reporting. Although usually self-limiting, mumps remains a notifiable disease with important implications for outbreak control and patient counselling in everyday clinical work.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-211-mumps.
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In this episode, Dr Hannah Rosa discusses bacterial meningitis and meningococcal disease, with a focus on the NICE guideline that was published in 2024. She reviews how to recognise bacterial meningitis and meningococcal disease and answers the key question: when to give antibiotics outside of hospital? At the end of this episode, there is a chance to put the learning into a clinical context with some clinical scenarios.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-210-bacterial-meningitis-and-meningococcal-disease.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson explores the growing clinical challenge of anabolic–androgenic steroid (AAS) misuse, a condition increasingly seen in everyday practice. Here, we examine how AAS use has shifted toward appearance-driven motivations, the role of muscle dysmorphia and the influence of gym culture and online communities. This episode highlights key pathophysiological effects, including hypogonadism, cardiovascular risk and neuropsychiatric complications. It also reviews how AAS misuse presents in real-world clinical settings, often through indirect signs rather than disclosure. Finally, it covers practical approaches to recognition, withdrawal management and long-term care, equipping GPs to better identify and support patients affected by this evolving, multi-system disorder.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/general-information/ep-209-anabolic-steroid-misuse.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson explores the pathophysiology, clinical features and management of myasthenia gravis, an autoimmune disorder affecting the neuromuscular junction. It highlights how antibodies, most commonly against acetylcholine receptors, impair neuromuscular transmission, leading to fatigable weakness that worsens with activity and improves with rest. The discussion emphasises key clinical presentations, including ocular, bulbar and proximal limb weakness, alongside the risk of life-threatening myasthenic crisis. Diagnostic approaches are reviewed, focusing on antibody testing and electrophysiological studies. Management strategies include symptomatic treatment with acetylcholinesterase inhibitors, immunosuppression and thymectomy in selected patients.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/neurology/ep-208-myasthenia-gravis.
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In this episode, Dr Roger Henderson looks at one of the most time-sensitive diagnoses in general practice: the transient ischaemic attack, or TIA. Often underestimated because symptoms resolve quickly, a TIA is in fact a powerful warning sign of an impending ischaemic stroke. For GPs, recognising and responding to this brief neurological event can make the difference between prevention and long-term disability. Here we break down the modern tissue-based definition of TIA, highlighting how it differs from older time-based concepts and why that matters in our clinical practice. We also explore the importance of sudden focal symptoms and discuss why the first 48 hours carry the greatest risk. We also look at key causes and outline practical approaches to urgent evaluation, risk stratification and management.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/neurology/ep-207-transient-ischaemic-attack.
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In this episode, Dr Roger Henderson explores hypertensive disorders of pregnancy – one of the most important and potentially life-threatening conditions encountered in obstetric care. Affecting up to one in 10 pregnancies, these disorders range from mild hypertension to severe complications such as preeclampsia, eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome. Despite advances in prenatal monitoring and management, they remain a leading cause of maternal and foetal morbidity worldwide. Here, we look at the underlying mechanisms, risk factors, clinical features and current management strategies, with a focus on practical insights to support clinical decision-making and improve outcomes for both mother and baby.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/obstetrics/ep-206-hypertensive-disorders-of-pregnancy.
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Liver disease is often overlooked in primary care, yet it is one of the fastest-growing causes of morbidity and mortality in the UK. Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), now affects around one-third of the UK population, with prevalence rising and all-cause mortality worsening over time. In this second episode of a series on hepatology and hepatitis, Dr James Waldron is joined by Dr Rik Fijten (GP Partner, Hepatitis C GP Champion for Bexley and GP Clinical Fellow in Gastroenterology) to explore why MASLD matters to GPs, why it is so common and why primary care is central to identifying disease early and preventing progression. They discuss why clinicians need to raise this often “silent” disease proactively and how it should be considered alongside diabetes, hypertension and weight management. The conversation covers how to approach abnormal liver function tests, how to assess fibrosis risk using simple non-invasive tools and how MASLD fits into the wider cardio–renal–metabolic model of long-term condition care. The episode also looks ahead to emerging treatments and what the future may hold for patients.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-205-metabolic-dysfunction-associated-steatotic-liver-disease-and-hepatitis.
Disclaimer
This content is for medical education purposes only and does not constitute clinical advice. While specific drugs and dosages may be discussed, clinicians should always refer to local protocols and official prescribing information before administering medication.
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Red legs are frequently seen in primary care but are often misdiagnosed. With a need for antimicrobial stewardship, it is important to identify the cause, rather than automatically rely on antibiotic prescription. Importantly, all that is red is not cellulitis; venous or varicose eczema is a common cause of swollen and red legs and requires a different management approach. In this episode, Dr James Waldron is joined by Dr Mark Graham (GP from Nottingham with experience in dermatology) to explore how to invest time initially to achieve the right diagnosis. The discussion considers differential diagnoses, clinical examination and management.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-204-red-legs.
Disclaimer
This content is for medical education purposes only and does not constitute clinical advice. While specific drugs and dosages may be discussed, clinicians should always refer to local protocols and official prescribing information before administering medication.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson explores an important and often overlooked area of head and neck oncology: oral mucosal cancer. As GPs, we frequently encounter oral lesions in primary care, and they are also often seen in dental practice, emergency settings and specialist clinics; however, distinguishing benign conditions from early malignancy can be challenging. Here, we break down the essential anatomy of the oral cavity, clarify how it differs from the oropharynx and examine the major risk factors driving disease development, including tobacco, alcohol, human papillomavirus (HPV) and immunosuppression. We also discuss clinical presentation, red-flag features, diagnostic pathways, staging principles and current management strategies. Most importantly, we focus on the role GPs play in early detection, timely referral and multidisciplinary care.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/ear-nose-and-throat/ep-203-oral-mucosal-cancer.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
In this episode, Dr Roger Henderson explores labyrinthitis from a GP’s perspective, moving beyond the textbook definition to focus on practical diagnosis, pathophysiology and management. Although often grouped broadly under causes of acute vertigo, true labyrinthitis is a distinct inflammatory condition of the inner ear that combines vestibular and auditory dysfunction. Its presentation can closely resemble more serious neurological pathology, including posterior circulation stroke, making accurate assessment essential in both primary and acute care settings. This episode examines the underlying causes, key clinical features, important differentials and evidence-based treatment strategies. It aims to refine our diagnostic reasoning, avoid common pitfalls and strengthen confidence when evaluating patients presenting with acute vertigo, hearing loss and associated neuro-otological symptoms in everyday general practice.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/ear-nose-and-throat/ep-202-labyrinthitis.
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Pityriasis rosea is a common and self-limiting condition, but it can cause significant anxiety and distress for patients. In this episode, Dr Kate Chesterman discusses the expected course and clinical findings that are associated with this condition, as well as exploring possible differentials, treatment options, potential complications and referral criteria.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/dermatology/ep-201-pityriasis-rosea.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
Hepatitis C was once considered a chronic, life-limiting condition with difficult treatments and significant stigma. Today, it is one of the great success stories of modern medicine: curable in the vast majority of patients with short courses of well-tolerated oral therapy. Yet, thousands of people in the UK remain undiagnosed. In this first episode of a series on hepatology and hepatitis, Dr James Waldron is joined by Dr Rik Fijten (GP Partner, Hepatitis C GP Champion for Bexley and GP Clinical Fellow in Gastroenterology) to explore why hepatitis C matters to primary care now more than ever. Together, they discuss who should be tested, how to interpret results, what happens after diagnosis and the central role GPs play in the NHS Hepatitis C Elimination Programme. This practical, confidence-building conversation focuses on normalising testing, reducing stigma and being curious, helping primary-care clinicians identify patients who could benefit from life-changing treatment.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-200-hepatitis-c.
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Gastric cancer is often described as a disease in decline, yet it remains one of the deadliest malignancies worldwide. For many GPs, it is a diagnosis that still arrives late, cloaked in vague symptoms and missed opportunities for early intervention. In this episode, Dr Roger Henderson takes a deep, clinically focused look at gastric cancer, from its evolving epidemiology and underlying biology to modern approaches in diagnosis, staging and treatment. He also explores why outcomes differ so dramatically across regions, how molecular insights are reshaping its therapy and what this disease continues to teach us about prevention and early detection.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-199-gastric-cancer.
Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.
Basal cell carcinoma (BCC) is a diagnosis most GPs encounter regularly, yet its familiarity often disguises its true impact. As the most common cancer in humans, BCC shapes clinical workload, healthcare costs and patient quality of life far more than its low mortality rate suggests. Although it is frequently described as slow growing and low risk, delayed recognition or inadequate treatment can lead to significant local destruction, functional impairment and disfigurement. In this episode, Dr Roger Henderson takes a closer look at BCC beyond the surface, exploring its clinical variability, underlying biology and evolving management strategies.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/oncology/ep-198-basal-cell-cancer.
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Glaucomas are a leading cause of irreversible vision loss worldwide. They encompass a range of disorders, including primary open-angle, angle-closure, normal-tension and secondary glaucomas, each with distinct pathophysiology, risk factors and clinical presentations. In this episode, Dr Roger Henderson looks at how elevated intraocular pressure drives optic nerve damage and also examines cases where pressure remains normal. He considers diagnostic strategies, including tonometry and visual field testing, and emphasises the importance of early detection. Finally, he covers glaucoma management, from pharmacologic therapy and laser procedures to surgical interventions and minimally invasive options, highlighting individualised approaches for each subtype.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/ophthalmology/ep-197-glaucoma.
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In this episode, Dr Roger Henderson looks at acute laryngitis, a condition that is both common and deceptively complex. Often dismissed as a simple cold-related voice change, acute laryngitis actually offers GPs insights into airway physiology, vocal mechanics and clinical reasoning. Understanding the nuances of this condition is essential. We look at its typical presentation, from sudden hoarseness and vocal fatigue to dry cough, and discuss red flags that signal more serious pathology. We also consider infectious and non-infectious causes, management strategies and the subtle ways patient behaviour and environment can influence recovery.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/ear-nose-and-throat/ep-196-acute-laryngitis.
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Cirrhosis represents the end stage of chronic liver injury, characterised by fibrosis and regenerative nodules that disrupt normal liver architecture. While the liver can compensate for years, patients often remain asymptomatic until complications such as ascites, variceal bleeding or hepatic encephalopathy arise. Understanding cirrhosis involves exploring its pathophysiology, systemic manifestations, diagnostic tools and management strategies. In this episode, Dr Roger Henderson discusses how chronic insults from viral hepatitis, alcohol or metabolic disease lead to progressive fibrosis, the development of portal hypertension and multisystem involvement.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-195-liver-cirrhosis.
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Plantar fasciitis is a common cause of heel pain, accounting for up to 15% of foot complaints requiring professional care and affecting both athletic and sedentary populations. It is best understood as a mechanically driven, degenerative condition resulting from repetitive loading that exceeds the plantar fascia’s capacity for repair, rather than a purely inflammatory process. Key risk factors include abnormal foot biomechanics, limited ankle dorsiflexion, posterior chain tightness, obesity and prolonged weight-bearing. In this episode, Dr Roger Henderson looks at the epidemiology and pathophysiology of plantar fasciitis, reviews key clinical features and examination findings, discusses differential diagnoses and appropriate investigations, and outlines evidence-based management strategies, with a focus on practical guidance for primary-care clinicians.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-194-plantar-fasciitis.
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Barrett’s oesophagus sits at the crossroads of gastroesophageal reflux disease and oesophageal cancer, making it a condition every clinician should understand. Although most patients with Barrett’s will never develop malignancy, it remains the only identifiable precursor to oesophageal adenocarcinoma, a cancer with rising incidence and high mortality. In this episode, Dr Roger Henderson looks at how chronic reflux reshapes the oesophageal lining, who is at greatest risk and how modern surveillance and endoscopic therapies have transformed management. He also discusses evolving guidelines, emerging technologies and practical implications for everyday clinical practice.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-193-barretts-oesophagus.
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In this episode, Dr Roger Henderson looks at adhesive capsulitis, commonly known as a frozen shoulder, reviewing its epidemiology, risk factors and underlying pathophysiology, as well as typical clinical presentations, disease staging and key examination findings that aid diagnosis in primary care. Diagnostic challenges, differential diagnoses and the role of imaging and injections are covered, alongside management strategies, prognosis and indications for surgical intervention, with particular attention to patients with diabetes and endocrine disorders who experience more severe and prolonged disease.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-192-adhesive-capsulitis.
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Intertrigo is an inflammatory condition of opposing skin surfaces, driven by friction, heat and moisture that weaken the skin barrier and invite secondary infections, especially Candida and bacteria. It affects all ages, from infants with diaper dermatitis to older adults with limited mobility. It is more common in hot climates and in patients with obesity or diabetes. Clinically, it presents with symmetrical erythema that may progress to maceration, fissures, discharge and secondary infection. The diagnosis is mainly clinical, with cultures or potassium hydroxide testing when needed. Management focuses on reducing moisture and friction, treating infections and using gentle barrier protection. In this episode, Dr Roger Henderson looks at how to identify and manage this condition, which is commonly seen in primary care.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/dermatology/ep-191-intertrigo.
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Chondromalacia patella (CMP), sometimes called “runner’s knee”, is a degenerative condition involving softening and breakdown of the patellar articular cartilage, most often due to abnormal patellofemoral mechanics, muscular imbalance or repetitive micro-trauma. It commonly presents with anterior knee pain worsened by stair descent, squatting, running or prolonged sitting. Diagnosis relies on clinical evaluation supported by imaging (especially magnetic resonance imaging) to assess cartilage integrity and patellar alignment. Most patients improve with long-term conservative therapy focused on quadriceps strengthening, hip stabilisation and activity modification. Surgical intervention is reserved for persistent, symptomatic cases or significant maltracking. Early recognition helps prevent progression to patellofemoral osteoarthritis. In this episode, Dr Roger Henderson looks at how best to recognise the condition in our surgeries and the best plan of action for our patients.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-190-chondromalacia-patella.
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Intermittent claudication is a hallmark symptom of peripheral arterial disease and reflects widespread atherosclerosis. It presents as predictable exertional leg pain caused by inadequate blood flow during exercise. The pain location helps localise arterial stenosis and diagnosis relies on history, examination and the ankle–brachial index, with imaging reserved for intervention planning. Management focuses on cardiovascular risk reduction, smoking cessation, supervised exercise therapy, antiplatelet treatment and statins. Revascularisation is considered only when symptoms continue to limit lifestyle despite optimal therapy. Although limb loss is uncommon, cardiovascular mortality is high, making systemic risk management essential. In this episode, Dr Roger Henderson gives an overview of the condition and looks at how best to diagnose and manage it.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-189-intermittent-claudication.
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Pityriasis versicolor is a fungal condition caused by overgrowth of Malassezia – a yeast that is commonly found on the skin in most people. In this episode, Dr Kate Chesterman discusses the clinical findings that become visible when there is overgrowth of this yeast and explores the treatment options available to manage initial and recurrent episodes.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/dermatology/ep-188-pityriasis-versicolor.
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In this episode, Dr Hannah Rosa, Dr Kate Chesterman and Dr Roger Henderson invite you to join them for the annual GPnotebook quiz. The GPnotebook education team have been reflecting upon all that they have learnt over the past 12 months, in both their day-to-day clinical work and through delivering GPnotebook Study Group meetings. This quiz is based on the facts that they have found the most useful, interesting and sometimes surprising. So, have a pen and a piece of paper ready and give it a go!
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/general-information/ep-187-quiz-of-the-year-2025.
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Olecranon bursitis is the inflammation of the bursa overlying the olecranon process, presenting as localised, fluctuating posterior elbow swelling that necessitates clinical differentiation between aseptic (traumatic, crystalline) and septic aetiologies for appropriate management. In this episode, Dr Kate Chesterman discusses the risk factors for olecranon bursitis as well as its diagnostic features. The differences in presentation between septic and non-septic cases are explored, and the management of both is reviewed. Also included are the criteria for secondary-care involvement and advice that we can pass on to patients to try to prevent recurrent episodes of this condition.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-186-olecranon-bursitis.
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Lung cancer is the leading cause of cancer-related death worldwide and is classified into two main types: non-small cell lung cancer (NSCLC), which accounts for most cases and the more aggressive small cell lung cancer (SCLC). Early detection is crucial for improving outcomes, but symptoms often emerge late in the disease course. In episode 126, Dr Hannah Rosa looked at the challenges of diagnosis, reviewed guidelines and latest research and discussed when to continue investigations after a normal chest X-ray. In this episode, Dr Roger Henderson gives an overview of detecting lung cancer in primary care and looks at treatment – including newer options for some late-stage cancers.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/oncology/ep-185-lung-cancer.
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Parvovirus B19 (slapped cheek syndrome) is a common and usually mild, self-limiting viral illness. Certain populations, such as pregnant women and their unborn babies, those who are immunocompromised or those with underlying haematological conditions, are at increased risk of complications as the virus can affect red blood cell production. In this episode, Dr Kate Chesterman explores the common signs and symptoms in healthy individuals, as well as discussing the investigation and management of those at higher risk of complications.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-184-parvovirus-b19.
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Post-traumatic stress disorder (PTSD) may develop (either immediately or delayed) following exposure to a stressful event or situation of an exceptionally threatening or catastrophic nature. It is characterised by four groups of symptoms: intrusion symptoms, avoidance, negative alterations in cognition and mood and alterations in arousal and reactivity. These symptoms must persist for more than 1 month and cause functional impairment for a diagnosis to be made. Its presentation is often comorbid with conditions such as depression, anxiety, anger and substance use disorder. In this episode, Dr Roger Henderson looks at the aetiology of PTSD, its assessment, treatment options and prognosis.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/psychiatry/ep-183-post-traumatic-stress-disorder.
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Melanoma is among the most common forms of cancer – and causes of cancer-related death – among young adults. Its prevalence in this group has been associated with sunbathing and sunbed use. Reducing exposure to ultraviolet light is critical in the primary prevention of melanoma. Clinical features of lesion asymmetry, border irregularity, colour variability, diameter and evolution over time should raise suspicion for melanoma and prompt further assessment with dermoscopy. In this episode, Dr Roger Henderson looks at melanoma, including the different types and how to recognise them, referral criteria, treatments and prognosis.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/dermatology/ep-182-melanoma.
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In this episode, Dr Hannah Rosa and Dr Will Hinchliffe (Consultant in Renal and General Medicine working in the north-east and north Cumbria) discuss the management of hyperkalaemia in primary care. They break the management down into six steps, so that when you are next faced with blood test results that show a raised potassium level, you will know exactly what to do. They first discuss who needs admission into hospital, then how to manage hyperkalaemia in the community and finally the role of potassium binders.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/renal-medicine/ep-181-management-of-hyperkalaemia-in-primary-care.
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In this final episode of a four-part series on HIV and primary care, Dr James Waldron is joined again by Dr Grace Bottoni (HIV and Hepatitis C GP Champion, Lewisham) and special guest Darren Knight (CEO of George House Trust). Together, they explore the importance of language in healthcare and how reducing HIV-related stigma is key to increasing engagement with primary care, improving lives and helping to prevent HIV transmission. This conversation brings together clinical insight, lived experience and practical strategies for making HIV care truly inclusive.
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https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-180-rethinking-hiv-reducing-hiv-related-stigma.
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Paraesthesia is an indication of an abnormality that impacts the sensory pathways at any point from the peripheral sensory nervous system right up to the sensory cortex. The essential tool for the diagnosis of this condition is obtaining a concise patient history. This history must accurately reflect the patient's experience, including the provoking and alleviating factors, along with any existing concurrent conditions, such as diabetes and all treatments that might potentially lead to neuropathies. Treatment is based on the relevant diagnosis and mechanism to address the cause. In this episode, Dr Roger Henderson discusses paraesthesia, covering its causes, investigations and treatment.
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https://gpnotebook.com/en-GB/podcasts/neurology/ep-179-paraesthesia.
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A tremor is defined as an involuntary rhythmic oscillation of one or more body parts, mediated by alternating contractions of reciprocally acting muscles. Tremors typically affect the upper extremities but can also affect the head, chin, voice or legs. Although some tremors may be mild and cause little impact to quality of life, requiring no treatment, others may impair activities of daily living or occupation, which may lead to embarrassment and social withdrawal. In this episode, Dr Roger Henderson gives an overview of the different types of tremor, looking at ways of distinguishing them and how each is usually managed.
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https://gpnotebook.com/en-GB/podcasts/neurology/ep-178-tremor.
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Postnasal drip is a condition where excess mucus from the nose and sinuses accumulates and flows down the back of the throat. This can lead to symptoms such as throat clearing, coughing, a scratchy or sore throat, hoarseness and bad breath. Common causes include allergies, colds, sinus infections, weather changes, acid reflux and irritants such as smoke. Treatment typically involves managing the underlying cause through medications such as antihistamines, decongestants and nasal sprays, as well as maintaining proper hydration. If symptoms persist for more than 10 days or are accompanied by fever or discoloured mucus, medical evaluation is recommended to rule out infections or other issues. In this episode, Dr Roger Henderson provides an overview of these areas to help us easily diagnose this common problem in our surgeries.
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https://gpnotebook.com/en-GB/podcasts/ear-nose-and-throat/ep-177-postnasal-drip.
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Lower urinary tract symptoms (LUTS) are storage, voiding and post-micturition symptoms affecting the lower urinary tract. LUTS can significantly reduce men's quality of life and may point to serious problems in the urogenital tract. The pathogenesis of LUTS is multifactorial and can include one or several diagnoses, commonly benign prostatic obstruction, nocturnal polyuria (polynocturia) and detrusor muscle instability. LUTS are common and not necessarily a reason for suspecting prostate cancer. In this episode, Dr Roger Henderson gives an overview of male LUTS, including investigations, referral criteria and treatment options.
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https://gpnotebook.com/en-GB/podcasts/urology/ep-176-lower-urinary-tract-symptoms-in-men.
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Scabies is a condition that can cause significant distress due to the intense itching associated with the condition and concerns about social stigma. In this episode, Dr Kate Chesterman discusses the risk factors for contracting scabies, the signs and symptoms associated with the condition, preferred treatment options and indications for involving secondary care.
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https://gpnotebook.com/en-GB/podcasts/dermatology/ep-175-scabies.
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Acute cholecystitis is often seen in primary care patients and is a major complication of cholelithiasis. Symptomatic gallstones occur in up to 10% of patients before developing cholecystitis. Patients typically present with pain and localised tenderness, with or without guarding, in the upper right quadrant. In this episode, Dr Roger Henderson provides an overview of this common problem, looking at its risk factors, causes, symptoms, investigations and the treatment options available, as well as the prognosis and advice to give our patients to help prevent recurrence.
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https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-174-acute-cholecystitis.
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Abdominal aortic aneurysms (AAAs) are potentially life-threatening and have a poor prognosis if ruptured. Arterial aneurysms are defined as a permanent localised dilatation of the vessel, enlarging significantly compared to a relatively normal diameter of the adjacent artery. An AAA is characterised by abnormal focal dilation of the abdominal aorta that is often detected incidentally or only at the time of rupture. In this episode, Dr Roger Henderson looks at AAA risk factors, clinical presentations, diagnostic investigations, screening, treatments and prognosis.
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https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-173-abdominal-aortic-aneurysm.
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Keloid scars are a form of abnormal scarring that occur in susceptible individuals and often appear to be more common in darker skin types. Often observed between the ages of 10 and 30 years, and associated with skin trauma or inflammation, their diagnosis is a clinical one. Unfortunately, no definitive treatment is currently available, but options include injectable preparations and cryotherapy, as well as surgery and radiotherapy. In this episode, Dr Roger Henderson looks at the aetiology, epidemiology and presentation of keloid scars as well as the efficacy of current treatments.
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https://gpnotebook.com/en-GB/podcasts/dermatology/ep-172-keloid-scars.
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What if one of the most misunderstood diagnoses of the past is now one of the most manageable chronic conditions? How can GPs play a pivotal role in tackling stigma, increasing testing and improving outcomes for people living with HIV?
Dr James Waldron is joined by Dr Grace Bottoni (HIV and Hepatitis C GP Champion, Lewisham) for a series of podcasts about HIV. Together, they explore a range of topics with experts in the field. In this third episode, they talk with Dr Emily Mabonga (Consultant in HIV Medicine, London) about pre-exposure prophylaxis (PrEP): who it is for, how to start the conversation and practicalities around access and dosing.
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https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-171-rethinking-hiv-prevention-and-pre-exposure-prophylaxis.
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Aortic stenosis (AS) is an obstruction of blood flow from the left ventricle into the aorta due to narrowing at the level of the aortic valve. In Europe, it is the most common valvular disease requiring treatment and is the second most frequent cause for cardiac surgery. By the age of 80, it occurs in almost 10% of adults and has a mortality rate of about 50% at 2 years unless the outflow obstruction is relieved. In this episode, Dr Roger Henderson looks at the aetiology, pathophysiology, clinical presentation, diagnostic evaluation, treatment options and prognosis associated with this common condition usually seen in our elderly patients.
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https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-170-aortic-stenosis.
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Shin splints are a common type of leg pain caused by repetitive stress on the bones and muscles in the lower leg, particularly around the tibia. The condition, also known as medial tibial stress syndrome (MTSS), is characterised by pain and tenderness along the inner or front of the lower leg. It is often triggered by activities like running, jumping or other high-impact sports. In this episode, Dr Roger Henderson looks at risk factors, how to diagnose it, typical treatment options and prognosis.
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https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-169-shin-splints-medial-tibial-stress-syndrome.
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In the UK, ectopic pregnancy is diagnosed in approximately 11 out of every 1,000 pregnancies and typically presents 6–8 weeks after the last normal menstrual period but can be earlier or later. The risk of ectopic pregnancy increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation or if the woman is pregnant despite intrauterine device usage. Classical symptoms and signs of ectopic pregnancy are pain, vaginal bleeding and amenorrhoea. Haemodynamic instability and cervical motion tenderness may indicate rupture or imminent rupture of an ectopic pregnancy. In this episode, Dr Roger Henderson gives an overview of how to accurately diagnose an ectopic pregnancy, the management pathway involved and the risks of recurrence.
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https://gpnotebook.com/en-GB/podcasts/gynaecology/ep-168-ectopic-pregnancy.
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Acute pancreatitis is an inflammatory condition of the pancreas, most commonly caused by bile stones or excessive use of alcohol. It is one of the most common diseases of the gastrointestinal tract leading to hospital admission. In most patients, the disease takes a mild course, where moderate fluid resuscitation, management of pain and nausea and early oral feeding result in rapid clinical improvement. The severe form is life-threatening, with mortality rates of up to 30%. In this episode, Dr Roger Henderson looks at how to quickly diagnose acute pancreatitis, what the common risk factors are, the treatment options and prognosis.
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https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-167-acute-pancreatitis.
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Hand–arm vibration syndrome is a chronic, progressive disorder of the upper limbs resulting from prolonged exposure to vibration. It encompasses vascular, neurological and musculoskeletal injury, often presenting with a combination of symptoms that may severely impact daily functioning and quality of life. This condition was historically observed among forestry workers and miners but now affects people in a broad range of industries, including construction, engineering, vehicle maintenance and utilities. In this episode, Dr Roger Henderson looks at how to recognise the condition in patients, as well as diagnostic tests, treatment options and prognosis.
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https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-168-hand-arm-vibration-syndrome.
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In the second part of a two-episode series on chronic kidney disease (CKD), Dr Hannah Rosa is joined again by Dr Will Hinchliffe, a Consultant in Renal and General Medicine working in the North East and North Cumbria. They discuss the management options for CKD that can be initiated in primary care. They first look at how to empower patients with lifestyle and dietary advice, then the medical treatment options we have for CKD and when to start them, before finishing with holistic care, especially with regards to cardiovascular disease. This episode is mainly based on the NICE assessment and management guideline for CKD, but it also draws on other recent guidelines from Kidney Disease Improving Global Outcomes (KDIGO) and the International Society of Nephrology as it aims to help you to improve the lives of your patients with CKD.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/renal-medicine/ep-165-chronic-kidney-disease-among-adults-in-primary-care-testing-diagnosis-and-referral.
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Cauda equina syndrome (CES) is caused by compression of the lumbosacral nerve roots that extend below the spinal cord. The most common cause is disc prolapse at the L4/5 or L5/S1 level and stenosis of the spinal canal. Less commonly, compression may be due to pathology in a higher disc or to a tumour, infection or trauma. Typical symptoms and signs of CES include leg and/or back pain, together with one or more of: bladder or bowel dysfunction; altered perianal, perineal or genital sensation; motor weakness affecting both legs; sexual dysfunction. It is a medical emergency and a missed diagnosis can have devastating consequences. In this episode, Dr Roger Henderson covers the anatomy and causes of CES, its presentation, diagnosis and treatment pathway.
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https://gpnotebook.com/en-GB/podcasts/neurology/ep-164-cauda-equina-syndrome.
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In the first of a two-episode series on chronic kidney disease (CKD), Dr Hannah Rosa is joined by Dr Will Hinchliffe, a Consultant in Renal and General Medicine working in the North East and North Cumbria. They discuss which people are at risk of CKD, how to test for it and diagnose it and, lastly, which patients require a referral to secondary care. This episode is mostly based on the NICE guideline on assessment and management of CKD and aims to help you to improve the lives of your patients by diagnosing CKD earlier and referring those who may benefit from specialist input sooner.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/renal-medicine/ep-163-chronic-kidney-disease-among-adults-in-primary-care-testing-diagnosis-and-referral.
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Ankylosing spondylitis (AS) is a chronic, immune-mediated inflammatory disorder that predominantly targets the axial skeleton, especially the spine and sacroiliac joints. This condition evolves insidiously, often beginning in young adulthood, and gradually imposes limitations on spinal mobility, eventually leading to fusion in advanced cases. Beyond its skeletal manifestations, AS can also extend its reach to various extra-articular organs, emphasising the systemic nature of the disease. In this episode, Dr Roger Henderson looks at its clinical presentation, how to diagnose it, the treatment options available and its prognosis.
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https://gpnotebook.com/en-GB/podcasts/rheumatology/ep-162-ankylosing-spondylitis.
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Post-herpetic neuralgia (PHN) is the most common complication following an episode of shingles and can affect up to one in five people. Pain is typically described as burning or like an electric shock and is often associated with allodynia and hyperalgesia. It can have significant effects on both physical and psychological well-being, with sleep disturbance and depression being frequently described. PHN is notoriously difficult to treat, with a significant number of patients achieving only a modest reduction in their symptoms despite combinations of analgesic agents. In this episode, Dr Kate Chesterman explores the treatment options available in primary care.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/neurology/ep-161-post-herpetic-neuralgia
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What if one of the most misunderstood diagnoses of the past is now one of the most manageable chronic conditions? How can GPs play a pivotal role in tackling stigma, increasing testing and improving outcomes for people living with HIV?
Dr James Waldron is joined by Dr Grace Bottoni (HIV and Hepatitis C GP Champion, Lewisham) for a series of podcasts about HIV. Together, they explore a range of topics with experts in the field. In this second episode, they talk with Dr Mel Rosenvinge (Consultant HIV Specialist, Lewisham and Greenwich NHS Trust) about what happens after a positive test result and how to help support people living with HIV. Listen to find out about the next steps in primary care.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-160-rethinking-hiv-dealing-with-a-positive-test-result.
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Baker’s cysts commonly present in primary care. In this episode, Dr Kate Chesterman discusses the pathophysiology, underlying aetiology and management options for this condition, describing possible differential diagnoses and indications for investigations. She also explains the self-care options for those with minimal symptoms and how to escalate treatment, as well as when to consider a referral.
Access episode show notes containing key references and take-home points at:
http://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-159-bakers-cyst.
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A rotator cuff injury is an event that causes pain in the shoulder. This can be due to a tear, inflammation or narrowing of the space within the shoulder joint. The rotator cuff muscles interlock to work as a unit. They help to stabilise the shoulder joint and also help with shoulder joint movement. In this episode, Dr Roger Henderson takes a specific look at tears to the rotator cuff – a problem often seen in primary care. The episode covers causes, diagnosis and treatment, including conservative approaches and surgical options.
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https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-158-rotator-cuff-tears.
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Ganglion cysts, also sometimes referred to as synovial cysts, are the most common benign soft-tissue masses of the hand and wrist. These cysts arise from the synovial lining of joints or tendon sheaths and are filled with a gelatinous, mucin-rich fluid. Despite their benign nature, ganglion cysts can cause discomfort, restrict motion and cause neurovascular compression (requiring medical intervention in some cases). In this episode, Dr Roger Henderson looks at epidemiology, pathophysiology, clinical presentation, diagnostic modalities, differential diagnoses and treatment options.
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https://gpnotebook.com/en-GB/podcasts/orthopaedics/ep-157-ganglion-cysts.
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Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, primarily affecting the median nerve at the level of the wrist. The condition results from compression of the median nerve within the carpal tunnel, leading to sensory and motor impairments in the affected hand. There are a range of causes for the condition, and treatments range from simple conservative measures to surgery. In this episode, Dr Roger Henderson looks at how to recognise the condition, some of the clinical and diagnostic tests available, when to refer to secondary care and management options including both surgical and non-surgical measures.
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https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-156-carpal-tunnel-syndrome.
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Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition that affects the large- and medium-sized arteries, primarily those in the head. It most commonly occurs in adults over 50, particularly women. The exact cause is unknown, but it is believed to be an autoimmune response that leads to inflammation and narrowing of the arteries, reducing blood flow. Symptoms include severe headaches, scalp tenderness, jaw pain when chewing and, in severe cases, sudden vision loss. Diagnosis typically involves blood tests, imaging and a temporal artery biopsy. Early detection is crucial to avoid permanent damage and blindness. In this episode, Dr Roger Henderson looks at how to diagnose this condition promptly and accurately, why urgent referral is crucial and the treatment options now available in primary care.
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https://gpnotebook.com/en-GB/podcasts/rheumatology/ep-155-temporal-arteritis.
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Febrile seizures are common in the first 5 years of life, and many factors that increase the risk of such seizures occurring have been identified. Initial evaluation should determine whether features of a complex seizure are present, as well as identifying the source of fever. In this episode, Dr Roger Henderson provides an overview of febrile seizures in childhood and also looks at risk factors, referral criteria, treatment options and prognosis.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/paediatrics/ep-154-febrile-seizures
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In this episode, Dr Hannah Rosa continues looking at the new asthma guideline from the British Thoracic Society (BTS), NICE and SIGN, which was published in 2024. This guideline, based on the latest research, contains some big changes, which will hopefully help you to improve the lives of your patients living with asthma. In the first episode in the series (episode 146), Dr Rosa covered suspected asthma, asthma diagnosis and treatment in people aged 12 and over. In this second episode, she focuses on pharmacological treatment in children aged 11 and under, as well as monitoring asthma control and self-management.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/respiratory-and-chest-medicine/ep-153-asthma-treatment-monitoring-and-self-management-whats-changed-in-the-2024-bts-nice-and-sign-guideline.
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What if one of the most misunderstood diagnoses of the past is now one of the most manageable chronic conditions? How can GPs play a pivotal role in tackling stigma, increasing testing and improving outcomes for people living with HIV?
Dr James Waldron is joined by Dr Grace Bottoni (HIV and Hepatitis C GP Champion, Lewisham) for the first episode in an insightful series that dives into the evolving landscape of HIV care. Together, they will explore a range of topics with experts in the field. In this episode, they talk with Dr Mel Rosenvinge (Consultant HIV Specialist, Lewisham and Greenwich NHS Trust) about what HIV is, how far treatments have come and the critical role of early diagnosis. From reducing stigma to understanding the life-changing impact of "U=U" (undetectable equals untransmittable). This episode sets the foundation for the series, with future parts diving into what GPs can do to improve health outcomes and address broader medical issues for people living with HIV.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-152-rethinking-hiv-from-testing-to-transformation.
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Dupuytren’s disease is a chronic, progressive condition that primarily affects the palmar and digital fascia of the hand. Over time, fibrous cords form under the skin, thickening and contracting, which can cause the fingers (most often the ring and little fingers) to curl inward. This results in Dupuytren’s contracture, limiting hand function and impacting daily activities. It often starts with the formation of painless nodules in the palm. As the disease progresses, these nodules develop into cords that restrict finger movement. While the condition is not life-threatening, it can significantly affect a person’s quality of life and is a common presentation in general practice. In this episode, Dr Roger Henderson looks at the diagnosis of Dupuytren’s, its risk factors, usual management and some of the newer treatment techniques now available.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/dermatology/ep-151-dupuytrens-disease.
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Roseola infantum is a viral infection primarily affecting infants and young children, most commonly between the ages of 6 and 12 months. It accounts for 10–45% of febrile illnesses in infants, and cases tend to peak in the spring and autumn seasons. Diagnosing roseola is almost always clinical, and for patients with the classic presentation a clinical diagnosis can be made based on physical examination findings and history alone. In this episode, Dr Roger Henderson looks at the causes and typical symptoms of roseola, along with illnesses that may mimic it, treatment options and possible complications of the illness.
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https://gpnotebook.com/en-GB/podcasts/dermatology/ep-150-roseola.
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Raynaud's phenomenon is a relatively common condition seen in primary care (especially during the autumn and winter months) that is characterised by vasospasm. This causes digits to change colour to white due to a lack of blood flow, usually brought on by cold temperatures. Affected areas subsequently turn blue due to deoxygenation and red due to reperfusion. The most common type is primary (idiopathic) Raynaud’s, affecting around 90% of people with the condition. Secondary Raynaud’s is often the initial manifestation of an associated underlying connective tissue disease. Both primary and secondary Raynaud’s can be painful, but secondary Raynaud’s can lead to complications from prolonged periods of ischaemia. In this episode, Dr Roger Henderson looks at the typical triggers for and presentation of Raynaud’s, along with lifestyle and treatment options including referral criteria.
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https://gpnotebook.com/en-GB/podcasts/dermatology/ep-149-raynauds-phenomenon.
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Sickle cell anaemia is a disease of red blood cells, caused by an autosomal recessive single gene defect in the beta-chain of haemoglobin, which results in production of sickle cell haemoglobin. Sickle cells can obstruct blood flow and break down prematurely, and they are associated with varying degrees of anaemia. A common presentation of sickle cell disease (SCD) is a painful sickle crisis, caused by obstruction of small blood capillaries. Treatment includes symptom control (including pain management) and prevention and management of complications. Until now, haematopoietic stem-cell transplantation has been the only potentially curative treatment option, but a new type of gene therapy has just been launched by NHS England. In this episode, Dr Roger Henderson gives an overview of some of the key points of SCD, with a focus on this new treatment and its availability.
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https://gpnotebook.com/en-GB/podcasts/haematology/ep-148-sickle-cell-disease.
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Paronychia is a common condition affecting the proximal and lateral nail folds of the hands or feet. In this episode, Dr Kate Chesterman discusses the differences between acute and chronic paronychia and the thinking around the causes and treatment of each. She also gives some tips that we can pass on to our patients regarding self-management and prevention.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/dermatology/ep-147-paronychia.
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In this episode, Dr Hannah Rosa discusses the new asthma guideline from the British Thoracic Society (BTS), NICE and SIGN, which was published in 2024. This guideline, based on the latest research, contains some big changes, which will hopefully help you to improve the lives of your patients living with asthma. In this first part of a two-episode series, topics covered include when to suspect asthma, how to confirm an asthma diagnosis and the pharmacological treatment pathway in people aged 12 and over. The second part of the series, which will be released later in the year, covers pharmacological treatment in children aged 11 and under, monitoring asthma control and self-management.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/respiratory-and-chest-medicine/ep-146-asthma-diagnosis-and-treatment-whats-changed-in-the-2024-bts-nice-and-sign-guideline.
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Around 0.5% of the adult population in England experience problems gambling, 3.8% are at elevated risk of gambling harms and an estimated 7% are negatively affected by someone else’s gambling. NICE has published NG248 – its first recommendations on gambling, covering the identification, assessment and treatment of people over the age of 18 who are experiencing gambling-related harms. The recommendations are also for people of any age affected by someone close to them who is experiencing gambling that harms. In this episode, Dr Roger Henderson looks at some of the key points in the guideline as well as the pharmacological options that are recommended if required.
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https://gpnotebook.com/en-GB/podcasts/general-information/ep-145-gambling-related-harms.
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The National Osteoporosis Guideline Group (NOGG) clinical guideline for osteoporosis was updated in December 2024. In this episode, Dr Hannah Rosa shares 10 things she learnt from the updated guideline about how to prevent and treat osteoporosis.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-144-osteoporosis-key-learnings-from-the-nogg-2024-clinical-guideline.
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Irritable bowel syndrome (IBS) is a chronic condition characterised by abdominal pain associated with bowel dysfunction and is one of the most common gastroenterology presentations in primary care. The pain is often relieved by defecation and is sometimes accompanied by abdominal bloating, with no structural abnormalities to explain the pain. IBS occurs in up to 20% of the adult population, and its aetiology is multi-factorial. In this episode, Dr Roger Henderson looks at the diagnosis of IBS along with lifestyle options and newer medications now available for its management.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-143-irritable-bowel-syndrome.
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Colorectal cancer (CRC) is the fourth most common malignancy in the UK and a major cause of morbidity and mortality. It refers to malignancies that arise from the caecum to the rectum and can be detected on screening, on imaging or endoscopy, or following presentation with change in bowel habit, iron deficiency anaemia or bowel obstruction. Its management depends on the stage of the disease and patient factors, with treatment options including surgical resection, chemotherapy and radiotherapy. In this episode, Dr Roger Henderson gives an overview of CRC and looks at how to achieve early diagnosis, which is essential for effective treatment and the greatest chance of survival.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-142-colorectal-cancer.
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Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that typically affects areas of pilosebaceous gland-containing skin. In HS, patients often suffer recurrent attacks of discharging and painful lesions that can require multiple courses of antibiotics or surgical drainage. The condition causes significant morbidity, distress and sometimes long-term scarring. In this episode, Dr Roger Henderson looks at the disease process, classification and classical features of HS as well as conservative, medical and surgical treatment options.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/dermatology/ep-141-hidradenitis-suppurativa.
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Seasonal affective disorder (SAD) is a form of depression that occurs at specific times of the year, most commonly during the autumn and winter months when daylight hours are shorter. Characterised by symptoms such as persistent sadness, fatigue and changes in appetite or sleep patterns, SAD is more than just the "winter blues." It is a clinically recognised but often underdiagnosed condition that can significantly impact an individual's quality of life. In this episode, Dr Roger Henderson looks at how to diagnose SAD as well as the causes, symptoms and treatment options in primary care.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/mental-health/ep-140-seasonal-affective-disorder.
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Perinatal mental health (PNMH) problems affect one in five women and one in ten men. They can present in several ways, including depression and anxiety, but also post-traumatic stress disorder, adjustment disorder, obsessive-compulsive disorder and psychosis. In the third episode of the perinatal mental health series, Dr James Waldron and Dr Jenny Barnes (GP and Perinatal Mental Health Champion, Warwickshire) discuss what to do in clinical practice when PNMH issues are suspected. Prevention is better than cure, so it is worth taking steps to identify people at risk and offering support and treatment where necessary.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/mental-health/ep-139-identification-and-treatment-of-perinatal-mental-health-problems.
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Morton’s neuroma is a common condition that results in forefoot pain. It is a condition that can often be diagnosed in primary care and managed with simple changes in footwear and over-the-counter treatments. In this episode, Dr Kate Chesterman discusses the classic presentation of Morton’s neuroma, considers the need for any investigations, and updates us on appropriate self-care advice that can be given to patients.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/orthopaedics/ep-138-mortons-neuroma.
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The 6–8-week postnatal check is a chance to better support mental health in new parents. In this second episode in a series on perinatal mental health, Dr James Waldron speaks with Dr Jenny Barnes – a GP in Warwickshire and perinatal mental health champion – about making the most of this critical opportunity. This episode discusses addressing mental health in both mothers and partners, the hidden toll of social media and understanding associated conditions such as obsessive-compulsive disorder and psychosis. It also offers practical insights for healthcare professionals to expand their approach and improve care for the whole family.
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/mental-health/ep-137-beyond-baby-blues-supporting-mental-health-in-parents-and-partners.
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In this episode, Dr Hannah Rosa invites you to join her in the first ever GPnotebook quiz of the year. The GPnotebook education team have been reflecting upon all that they have learnt over the past 12 months, in both their day-to-day clinical work and through delivering GPnotebook Study Group events. The quiz is based on the facts that the team have found most useful, interesting and sometimes surprising. So, have a pen and a piece of paper ready, and give it a go!
Access episode show notes containing key references and take-home points at:
https://gpnotebook.com/en-GB/podcasts/general-information/ep-136-quiz-of-the-year-2024.
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Tinnitus can be frustrating for both patients and clinicians as there is some misinformation and misunderstanding about its aetiology and treatment options. For some people with tinnitus there is significant distress and a reduced quality of life that may not always be appreciated by healthcare professionals. Fortunately, most cases of tinnitus can be treated successfully, and there are a number of management techniques that can reduce its impact, including sound therapy, stress reduction and treatment of any underlying causes. In this episode, Dr Roger Henderson gives an overview of this common problem, with a reminder of how to evaluate it and when to refer a patient to secondary care.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/ear-nose-and-throat/ep-135-tinnitus.
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One in six UK males will be diagnosed with prostate cancer in their lifetime. In the UK prostate cancer is the most common male cancer, with over 55,000 new cases diagnosed every year. There has been much discussion in the media recently regarding whether men under the age of 50 should have access to prostate-specific antigen (PSA) testing, particularly if they have a strong family history of prostate cancer. In this episode, Dr Roger Henderson takes a look at prostate cancer, including guidance on screening, investigations and treatment.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/oncology/ep-134-prostate-cancer.
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Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Known for its varied symptoms and potential to progress through multiple stages, syphilis can have serious health consequences if left untreated, affecting organs like the heart, brain and nerves. The infection spreads primarily through direct contact with syphilitic sores, which typically occur on the genital, anal or oral areas. Though syphilis was once thought to be largely under control, its prevalence has resurged in recent years, prompting renewed focus on prevention, early diagnosis and effective treatment. In this episode, Dr Roger Henderson discusses new syphilis guidelines issued by the British Association for Sexual Health and HIV and how these impact treatment in primary care.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-133-syphilis.
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In this episode, Dr Hannah Rosa reflects upon the changing relationship between young people and alcohol. She examines the latest statistics before discussing the Chief Medical Officer for England’s guideline on alcohol consumption for children and young people. The focus then moves on to the harms that we now know that alcohol can cause to young people, especially to the developing brain, before finishing with emphasising the role that professionals in primary care play in supporting these young people and their families.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-practice/ep-132-young-people-and-alcohol
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Perinatal mental health (PNMH) issues refer to the period from the point of conception to a child’s first birthday. It encompasses several different mental health conditions and components far beyond the traditional understanding of post-natal depression and has an important impact on families and society. In part, the huge burden and associated cost is driven by how common PNMH problems are for both men and women. PNMH issues are more common than any physical health problem in pregnancy, so there is a need for GPs to look for and manage them to ensure the best outcomes for families and children. In this episode, Dr James Waldron welcomes Dr Jenny Barnes (GP, Warwickshire) to discuss PNMH problems and help raise awareness of the risks and impact, as well as simple ideas to support families in clinical practice.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-131-perinatal-mental-health-awareness-risks-and-impacts.
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Croup is a respiratory condition typically affecting children, characterised by a distinctive barking cough, hoarseness and difficulty breathing. Caused primarily by viral infections, especially the parainfluenza virus, it inflames the larynx, trachea and bronchi, leading to swelling and obstruction in the airway. Croup symptoms often worsen at night and can be triggered by environmental factors such as cold air. Treatment ranges from home remedies like humidified air and hydration to medical interventions, such as corticosteroids or nebulised epinephrine, depending on the severity of the condition. While most cases resolve within a few days, severe instances can lead to hospitalisation. In this episode, Dr Roger Henderson looks at how best to diagnose it, whether scoring systems are useful, and principles of effective management – including when to consider hospital referral.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/respiratory-and-chest-medicine/ep-130-croup.
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Acute appendicitis is a medical emergency characterised by the sudden onset of inflammation in the appendix. As one of the leading causes of abdominal pain that necessitates surgical intervention, appendicitis can occur at any age, though it is most common in adolescents and young adults. The condition is primarily caused by a blockage in the appendix, which leads to bacterial infection, swelling and increased pressure. If left untreated, acute appendicitis can progress to life-threatening complications such as perforation, peritonitis and sepsis. Due to the non-specific symptoms, particularly in the early stages, diagnosing appendicitis can be challenging. Prompt recognition and treatment, typically through surgical removal of the appendix, are critical to preventing complications and ensuring a swift recovery. In this episode, Dr Roger Henderson looks at the clinical presentation, diagnosis and management of acute appendicitis, highlighting its significance as a common yet potentially dangerous medical condition.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-129-acute-appendicitis.
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Breast pain affects around 70% of women at some point in their lives and is a common reason for referral to breast clinics. It is often a cause of anxiety for women who may be concerned that their pain might be associated with breast cancer. In this episode, Dr Kate Chesterman discusses the assessment of the patient presenting with breast pain and explains the lack of association between breast cancer and breast pain in those with a normal clinical examination. She considers cyclical, non-cyclical and extra-mammary pain and discusses the causes and management options for these, as well as considering when referral to secondary care would be appropriate.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/gynaecology/ep-128-mastalgia-breast-pain.
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Fibromyalgia is a condition characterised by chronic widespread pain together with multiple muscular tender points or associated fatigue, sleep disturbance or cognitive dysfunction in the absence of a well-defined underlying organic disease. The majority of patients present with both tender points and associated symptoms, although the exact aetiology of fibromyalgia is unknown. In this episode, Dr Roger Henderson takes a look at possible triggers, diagnostic approaches, possible treatments (including non-pharmacological methods) and the prognosis for patients with this often poorly understood and underdiagnosed condition.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/neurology/ep-127-fibromyalgia
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In this episode, Dr Hannah Rosa reflects upon the poor lung cancer survival rates in the UK. She asks whether we are doing enough chest X-rays in primary care and whether we could be detecting lung cancers earlier. She delves further into this by exploring why diagnosing lung cancer is challenging, reviewing the guidelines and latest research and then discussing when we should continue to investigate for lung cancer even if the patient has had a normal chest X-ray. She finishes by reviewing the targeted lung health check programme that is currently being rolled out across England.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/oncology/ep-126-are-we-doing-enough-chest-x-rays-in-primary-care.
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Generalised anxiety disorder (GAD) is a common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment, and is hard to control. It is in part a diagnosis of exclusion: physical examination and laboratory studies are generally normal if no co-existing physical or mental health conditions or substance misuse issues exist. Treatment is primarily with psychotherapy (usually cognitive behavioural therapy), serotonergic antidepressants or a combination of these approaches. In this episode, Dr Roger Henderson looks at how best to diagnose GAD, what treatment options should be considered, possible differential diagnoses and the long-term outlook for patients.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-125-generalised-anxiety-disorder.
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Ovarian cancer is a common female malignancy. Patients often present with vague, non-specific symptoms such as abdominal bloating, early satiety and dyspepsia (suggestive of upper abdominal disease). Other symptoms are more suggestive of pelvic disease, such as pelvic pain, abdominal or pelvic pressure, low back pain and urinary urgency. Late diagnosis has a significantly adverse impact on survival rates, so prompt diagnosis and treatment is crucial. In this episode, Dr Roger Henderson looks at the key symptoms of ovarian cancer to be aware of in clinical practice, the NICE guidance on diagnostic tests, treatments and survival rates.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/oncology/ep-124-ovarian-cancer.
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In episode 121, care and consultations for children with additional needs, and how to help these children and their families, were discussed. In this episode, Dr James Waldron is again joined by Dr Naomi Fox. Here, they look at harnessing the power of proprioception to improve behaviour and sleep and reduce stress in children.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/paediatrics/ep-123-proprioception-and-sleep-for-children-with-additional-needs.
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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 different levels of dryness and skin conditions. Regular use of the right emollient can help maintain the skin's moisture balance, provide relief from irritation and support overall skin health. In this episode, Dr Roger Henderson looks at the different types of emollients available, which ones to choose for your patient, and how they should be used for the best results.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/dermatology/ep-122-emollients-an-overview.
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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/paediatrics/ep-121-improving-consultations-for-children-with-additional-needs.
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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 interventional procedures. However, there can be confusion surrounding when to appropriately refer a patient from primary care. In this episode, Dr Roger Henderson looks at various conditions and when to consider the use of echo scans for them.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-120-echocardiography.
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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 swallowing or breathing. Untreated goitre can lead to complications and thyroid dysfunction. The prevalence of goitre in the UK is lower than in many developing countries due to adequate dietary iodine intake, but it may still be seen in primary care. In this episode, Dr Roger Henderson looks at the diagnosis of goitre and the treatment options available, including observation, medication, radioactive iodine treatment and surgery.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/diabetes-and-endocrinology/ep-119-goitre.
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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 relevant medications and counselling. In this episode, they consider the role of medics travelling with groups at high altitude – ideal information for those interested in becoming an expedition doctor.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-information/ep-118-altitude-medicine-the-role-of-the-expedition-doctor.
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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 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 Lead for Diabetes MCN, Glasgow) and Dr Sarah Davies (GP with a Special Interest in Diabetes, Cardiff) discuss what we can do to improve earlier diagnosis of type 2 diabetes in our undiagnosed population.
More information on Chronic Conditions Month can be found here.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/diabetes-and-endocrinology/ep-117-improving-early-diagnosis-of-type-2-diabetes-addressing-the-challenge-of-undiagnosed-cases.
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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 epilepsy. She gives guidance on referral criteria and signposts useful resources that help assess fitness to drive and provide important safety information for patients.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-information/ep-116-transient-loss-of-consciousness.
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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 associated with complications that may arise from it, including insulin resistance, metabolic syndrome, fatty liver disease and an increased risk of developing type 2 diabetes. The main aims of treatment are directed at reducing hyperandrogenism or inducing fertility. In this episode, Dr Roger Henderson looks at these in more detail as well as what to remember when dealing with patients with PCOS in primary care.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/diabetes-and-endocrinology/ep-115-polycystic-ovary-syndrome.
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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, along with guidance on referral and follow up.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/urology/ep-114-erectile-dysfunction.
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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 nicotine, but various strategies and treatments are available to help support patients who are trying to stop smoking. Benefits are immediate, both in the short- and long-term, and it is never too late to stop smoking. The rise in e-cigarette use has contributed to increased numbers of smokers quitting their tobacco, but e-cigarette use in younger people has caused significant concerns. In this episode, which is an update to episode 51, Dr Roger Henderson provides an overview of vaping, and the pros and cons of e-cigarette use.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/respiratory-and-chest-medicine/ep-113-vaping-update.
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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
- The new MHRA guideline on isotretinoin.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/dermatology/ep-112-acne-getting-the-management-spot-on.
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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 torsion, the surgical approach should take precedence over other diagnostic tests. In this episode, Dr Roger Henderson discusses what to look for when diagnosing this condition, the importance of prompt treatment and the options available in primary care.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/urology/ep-111-testicular-torsion.
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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 Development Officer at Nottingham Trent University) to explore the consultation in detail. This episode discusses how to respond to a disclosure and the importance of “listen, believe, validate” when supporting a patient. They outline the concept (and myth) of the “perfect victim”, the importance of the language we use and how to help guide someone who has made a disclosure.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-information/ep-110-sexual-violence-part-2.
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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 autoimmune diseases, thyroid surgery, radiation therapy, certain medications and iodine deficiency, which is the leading cause globally. Treatment typically involves hormone replacement therapy, and with proper treatment and monitoring most people with hypothyroidism can lead normal, healthy lives. In this episode, Dr Roger Henderson provides an overview of hypothyroidism and considers differential diagnoses, testing, referral criteria, thyroxine replacement principles and prognosis.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/diabetes-and-endocrinology/ep-109-hypothyroidism.
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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 experience it. In this episode, Dr Kate Chesterman discusses the diagnosis and investigation of this distressing condition along with three principles that will help to guide its management.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/neurology/ep-108-restless-leg-syndrome.
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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. Treatment options vary depending on symptom severity and can include no treatment, medication, minimally invasive procedures or surgery. In this episode, Dr Roger Henderson looks at the key things to remember when assessing a patient with BPH and covers the newer treatments now available as well as more traditional conventional options.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/urology/ep-107-benign-prostatic-hyperplasia.
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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 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 Violence Development Officer at Nottingham Trent University) about the spectrum of problems related to sexual violence and the critical importance of understanding this topic and responding well from the outset.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-information/ep-106-sexual-violence-part-1.
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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 increasing empathy in our clinical practice can bring, and how can we all develop this vital skill?
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-105-empathy-who-cares-exploring-empathy-in-health-care.
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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 the management pathway for patients with the condition.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/rheumatology/ep-104-rheumatoid-arthritis.
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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 factors now included in the updated calculator) and the strengths and limitations of QRISK3 in understanding a person’s cardiovascular risk.
More information on Chronic Conditions month can be found here.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/cardiovascular-medicine/ep-103-primary-prevention-of-cardiovascular-disease-what-has-changed-in-qrisk3-and-why.
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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, Dr Roger Henderson takes an overview look at the symptoms and management of these as well as their prognosis and prevention.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-102-diverticular-disease.
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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 absorption of nutrients from food, leading to various symptoms and potentially serious complications. In this episode, Dr Roger Henderson looks at the diagnosis, testing and management of CD, along with the importance of longer-term follow-up in people with it.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-101-coeliac-disease.
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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 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-latest-research-on-alcohol.
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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 hormonal factors have a role in obesity, lifestyle choices (such as diet and physical activity level) and environmental factors also significantly contribute to its development. In recent years, the prevalence of obesity has been on the rise globally, leading to serious health concerns such as increased risks of heart disease, type 2 diabetes, certain types of cancer and other health problems. In this episode, Dr Roger Henderson provides an overview of the rise of obesity, the management options we have in general practice and the impact of newer injectable drugs for weight loss that many patients are now requesting.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/obesity/ep-99-assessment-and-management-of-obesity.
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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 episode, Dr Kate Chesterman discusses the risk factors for recurrence and considers appropriate investigations. She looks at options for management, including lifestyle changes and induction and maintenance regimens.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/gynaecology/ep-98-recurrent-vulvovaginal-candidiasis.
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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 of peptic ulcer disease can vary but may include burning stomach pain, nausea and vomiting, bloating or belching and loss of appetite. Treatment typically involves a combination of lifestyle changes and medication to reduce stomach acid production, eradicate H. pylori infection (if present) and protect the lining of the stomach and small intestine. In this episode, Dr Roger Henderson provides a thorough overview of peptic ulcer disease and talks about the latest advice on diagnosis, investigations and treatment.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-97-peptic-ulcer-disease.
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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 pneumonia if not properly managed. The treatment for dysphagia depends on the underlying cause and may include dietary modifications, swallowing therapy, medication or surgery. In this episode, Dr Roger Henderson takes an overview look at the causes, assessment, investigations and treatments of dysphagia, along with a reminder of oesophageal cancer, its treatment and prognosis.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/ear-nose-and-throat/ep-96-dysphagia.
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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 person's quality of life. The exact cause of trigeminal neuralgia is often unknown and treatment options include carbamazepine or gabapentin, as well as surgical procedures that relieve pressure on the trigeminal nerve or disrupt the pain signals in some cases. In this episode, Dr Roger Henderson looks at what GPs need to know when patients present in surgery with trigeminal neuralgia, when to refer them to secondary care and the prognosis for these patients.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/neurology/ep-95-trigeminal-neuralgia.
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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 bowel movements. This may include dietary changes, fibre supplements, topical medications, or in some cases, surgery. In this episode – which has been suggested as a topic by one of our listeners – Dr Roger Henderson looks at these in more detail as well as when to refer, and the options available for treatment in secondary care.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/gastroenterology/ep-94-anal-fissures.
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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 haemorrhoids, careful evaluation is always very important. Fortunately, most cases are simple to treat and often resolve very quickly, although up to 10% of sufferers may require surgery to fully alleviate their symptoms. In this episode, Dr Roger Henderson looks at the classification of haemorrhoids, their predisposing factors, symptoms — including red flag symptoms — and treatments.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-information/ep-93-haemorrhoids.
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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 series on digital wellbeing, Dr James Waldron interviews Dr Alex Lai of the WorkWell Doctors about the patient perspective. It explores how we can: 1) help patients understand the impacts of social media use on their wellbeing during clinical consultations; and 2) suggest strategies to promote healthy use of digital tools.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-92-digital-wellbeing-for-patients.
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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 assessing a patient with lateral hip pain. She then delves deeper into the diagnosis of greater trochanteric pain syndrome (GTPS), exploring the reasons why it is no longer referred to as trochanteric bursitis, initial management options, the value of corticosteroid injections and indications for onward referral.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-91-lateral-hip-pain.
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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 have on our concentration and mental health? All will be explored in this episode.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-90-digital-wellbeing-for-clinicians.
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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 (epidermis) and is considered a form of non-invasive skin cancer. Bowen's disease most commonly occurs on sun-exposed areas of the skin, such as the face, neck, head, hands and forearms. However, it can also occur in areas not exposed to the sun. In this episode, Dr Roger Henderson looks at how best to diagnose and manage Bowen’s disease, as well as looking at its prognosis and prevention.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/dermatology/ep-89-bowens-disease.
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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, perpetuating the need for repetition. OCD manifests in diverse forms, such as checking, counting or washing rituals, and its severity can range from mild to debilitating. Despite widespread misconceptions, OCD extends beyond a mere desire for order and cleanliness, impacting various aspects of daily life. Genetic, neurological, and environmental factors contribute to its development, and it often emerges in adolescence or early adulthood. In this episode, Dr Roger Henderson provides an overview of OCD, what we should be looking for to help identify patients with this condition, along with guidelines on effective treatments including cognitive behavioural therapy (CBT) and medication.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-88-obsessive-compulsive-disorder.
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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 care, along with services providing psychological therapies that update and replace the 2009 guideline. Among the topics covered are treatments for first depressive episodes, advice on preventing relapse and withdrawing from antidepressant treatment.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-87-depression-in-adults.
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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 giving some information as to a patient’s inflammatory response in certain conditions, their lack of specificity means that they are not perfect tests and interpretation is not always straightforward. In this podcast, Dr Roger Henderson looks at how inflammatory markers work, what may or may not constitute a normal reading and what to do with abnormal results.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/immunology/ep-86-inflammatory-marker-testing.
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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. Primary hyperhidrosis can affect people at any age, but often starts in early life. The diagnosis of hyperhidrosis is typically made initially on the clinical history, and this can also determine between primary or secondary hyperhidrosis. It is usually diagnosed where there is visible sweating, which interferes with daily activities and which has lasted for at least 6 months. In this podcast, Dr Roger Henderson discusses what to look for when making the diagnosis, what investigations to undertake and the range of treatments currently available.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/dermatology/ep-85-hyperhidrosis.
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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 infection (with increased all-cause mortality), along with significant implications in the areas of mental health and relationships. In this podcast, Dr Roger Henderson provides a reminder of how to diagnose TD — including from the patient’s history as well as clinical findings — and current guidelines on its management.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/diabetes-and-endocrinology/ep-84-testosterone-deficiency.
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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 challenging to easily recognise – a fact highlighted by hospital admissions linked to eczema being up to six times more likely in people of colour than in people with light skin.
In this podcast, Dr Roger Henderson looks at the reasons for this, what impact skin of colour can have on both diagnosing and managing dry skin conditions and how best to manage dry skin in people with skin of colour.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/dermatology/ep-83-the-management-of-dry-skin-conditions-in-skin-of-colour.
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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 also be mistaken for other scalp conditions such as scalp psoriasis, seborrheic dermatitis or atopic eczema. In this podcast Dr Roger Henderson looks at how to distinguish dandruff from these conditions as well as how to effectively treat dandruff to stop patients from needing repeated consultations.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/dermatology/ep-82-pityriasis-capitis-dandruff.
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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 migrans is or is not present. He also looks at diagnostic difficulties and whether acute or convalescent serological testing is helpful. Treatment with antibiotics is also discussed along with prognostic indicators.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/infectious-disease/ep-81-lyme-disease.
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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 the risks of high altitude? What medication might be needed? And why might beer taste funny at high altitude? In this episode, Dr James Waldron asks Dr Rashbal Ghattaora about his experiences working at high altitude in Tibet. They discuss how to approach a travel consultation, relevant medications, counselling and much more.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/general-information/ep-80-altitude-medicine-heightening-understanding-of-travel-consultations.
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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 role that parents and caregivers play in supporting young people through emotional turmoil and discuss the educational sessions that Dave has run for the families of young people with mental health issues. Dave discusses some of the pitfalls and traps that caregivers can fall into when trying to support their young people and shares his top tips for parents and professionals to help manage an emotional crisis.
Access episode show notes containing key references and take-home points at: https://gpnotebook.com/en-GB/podcasts/mental-health/ep-79-child-mental-health.
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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, if picked up early, can make a huge difference to the future health of a child.
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, cranberry products, D-mannose and methenamine hippurate.
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 and initial investigations in primary care, and consider available options for the management of menopause-related loss of libido, including topical and systemic hormone replacement therapy (HRT) and testosterone.
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 Rebecca's 3-month voyage with the marine conservation charity Sea Shepherd. As the boat's medic, she tended to crew members' daily illnesses, performed infection control during a COVID outbreak, and provided emotional support.
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), including: its different types, how to differentiate it from other causes of unsettled infant behaviour and the importance of de-challenging and rechallenging to make the diagnosis. Furthermore, they offer practical advice for breastfeeding mothers, as well as covering the indications for the different formula milks. They highlight the importance of maintaining balanced nutritional intake for infants and breast-feeding mums and avoiding unnecessary exclusion diets. They finish by discussing the current evidence and advice regarding early introduction of potentially allergenic foods in infants at risk of food allergies.
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 concerns that need to be addressed and the role of the sexual assault referral centre in the care of abused children and their families. Finally, they discuss agencies that can offer ongoing psychological support to children, families and healthcare practitioners who have been affected by cases of abuse.
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 disease, which is becoming increasingly prevalent as the population ages. But which patients should be auscultated and what specifically should clinicians be listening for? Dr Javaid answers these questions with reference to audio examples of heart sounds and murmurs, and it is highly recommended to listen to this episode using good-quality headphones.
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 expedition medicine, finding inspiration and opportunities, preparing oneself and getting started on the journey. Rebecca recently returned from a 3-month voyage with the marine conservation charity Sea Shepherd. As the boat's medic, she tended to crew members' daily illnesses, performed infection control during a COVID outbreak, and provided emotional support. In their conversation, James and Rebecca consider how such expeditions provide an opportunity for career diversification for primary care professionals.
In this episode, Dr Roger Henderson discusses an approach to the assessment of epicondylitis. Elbow epicondylitis is more common than is often thought and can cause significant pain and movement restriction. There can also be a number of possible differential diagnoses that need to be considered. This podcast episode looks at how to diagnose both tennis elbow and golfer’s elbow, what clinical tests to use, the best management and when to consider referral to secondary care.
In this episode, Dr Hannah Rosa looks in detail at the maternal side of the postnatal 6-week check. NICE’s quality standard on postnatal care is explored and topics, such as contraception after childbirth, are delved into in further detail. Thereafter, there is an exploration of conditions that can arise during or after pregnancy which require management postpartum, such as gestational diabetes, hypertensive disorders in pregnancy and postpartum thyroiditis.
Vitamin D is a fat-soluble vitamin that is essential for human health. It regulates calcium and phosphate homeostasis and is therefore vital for musculoskeletal functioning. In the UK, up to 50% of the adult population may be vitamin D insufficient following the winter months, with one in six being severely deficient. In this podcast, Dr Roger Henderson looks at who is most at risk of vitamin D deficiency, how it should be diagnosed, what treatment options are available and why unlicensed vitamin D preparations should not be recommended.
Actinic keratosis (AK) – also commonly known as solar keratosis – is a very common dermatological presentation in primary care, affecting large numbers of older people. It has the capacity to transform into a malignant lesion if untreated. In this podcast, Dr Roger Henderson looks at who is most at risk of AK, how it should be diagnosed, what treatment options are available, and when to consider referral to secondary care.
In this podcast, Dr Kate Chesterman discusses constipation in children. She takes us through the clinical features associated with idiopathic constipation and red flags that would cause concern. She discusses disimpaction regimes and when these should be used, as well as talking about the importance of ongoing maintenance regimes. She provides some tips on encouraging children to take laxatives and also highlights some useful patient and professional resources.
Obstructive sleep apnoea (OSA) is a very common problem affecting around one and a half million adults in the UK, most of whom are undiagnosed and untreated. OSA has significant health consequences, including heart disease and an increased risk of fatal car crashes. In this episode, Dr Roger Henderson looks at who is most at risk of OSA, how it should be diagnosed, how to refer to secondary care and what treatment options are currently available to help people with the condition.
In this episode, Dr James Waldron and Dr Thuva Amuthan (GP with an Extended Role in Dermatology) explore dermatological presentations, treatments and complications in skin of colour. The topics that they cover include: inequalities faced in certain patient groups; the psychological impact of pigmentation, depigmentation and scarring; eczema and acne in skin of colour; melasma and vitiligo; traction alopecia; and folliculitis and its potential severe consequences.
Oxygen is essential for our survival and is a powerful medical drug. Treatment with oxygen increases blood oxygen levels and helps to reduce cardiovascular workload. In this podcast, Dr Roger Henderson looks at how oxygen can be given in a home environment, the reasons it may be required and the different types of delivery systems available. He also looks at practical issues such as flying when requiring oxygen, smoking near oxygen supplies, how to arrange an emergency supply of oxygen for home use and which types of masks and nasal cannulae to use.
In this podcast, Dr Kate Chesterman discusses cluster headaches. She talks through the clinical features that would lead to a diagnosis, the initial investigations in primary care and indications for a referral to a headache specialist. She considers the management of acute attacks, including considerations around prescribing oxygen, as well as the options for preventative treatment.
In this episode Dr Hannah Rosa and Dr Nicky Mulgrew discuss autism and the role we play within general practice. They focus on when we should refer children and adults to specialists to get a possible diagnosis of autism and also explore how we can adapt our workplaces and our communication styles to make our surgeries more comfortable places for autistic people to visit.
Chronic spontaneous urticaria (CSU) is a common problem, often affecting younger people. It refers to chronic urticaria that has no obvious cause or trigger and which causes weals to occur on the skin most days for 6 weeks or more. It can be a deeply distressing and frustrating condition for sufferers that can greatly affect their quality of life. In this episode, Dr Roger Henderson looks at the possible triggers of CSU, how to approach the treatment of people with the condition and what drug therapies may be helpful.
Dermatology is a vast subject and accounts for a significant proportion of the workload in general practice. Managing dermatological conditions can be a challenge and staying up-to-date is equally so. In this episode, Dr James Waldron and Dr Thuva Amuthan (GP with an Extended Role in Dermatology) discuss topics such as: getting into dermatology as a specialist interest; improving patient engagement and adherence; improving eczema care; acne; psoriasis and the impact of dermatology on mental health.
After smoking and diet, hypertension is the biggest risk factor in the UK for premature death and disability. One in four people have hypertension in the UK, with around one in three treated to target. In this episode, Dr Roger Henderson gives an overview of the management of hypertension, covering its definition, risk factors, lifestyle management, investigations and medical treatments, including those recommended in the latest NICE guidelines.
Malnutrition can have significant adverse effects for patients with chronic obstructive pulmonary disease (COPD). In this podcast, Dr Kate Chesterman discusses how to identify and categorise those at risk of malnutrition. She also discusses how to treat malnutrition, including the appropriate use of oral nutritional supplements (ONS).
Dry skin conditions are one of the commonest skin problems that present to primary care physicians, but their psychological impact and psychiatric comorbidities are often underestimated. In this podcast episode, Dr Roger Henderson looks at dry skin, its impact on mental well-being and how it should be assessed and treated. He also gives useful consultation hints and tips about both the dermatological and psycho-dermatological aspects of dry skin problems.
Dry skin conditions are one of the commonest skin problems that present to primary care physicians, but their psychological impact and psychiatric comorbidities are often underestimated. In this podcast episode, Dr Roger Henderson looks at dry skin, its impact on mental well-being and how it should be assessed and treated. He also gives useful consultation hints and tips about both the dermatological and psycho-dermatological aspects of dry skin problems.
In 2019, vaccine hesitancy was listed as one the top ten threats to global health by the World Health Organization. In this episode, Dr Hannah Rosa explores vaccine hesitancy further, thinking about how we can make a difference in primary care.
Back in 2009, the conclusion of the first Lancet Climate Change Commission was that “Climate change is the biggest global health threat of the 21st Century.” In response to this, in October 2020, the NHS became the world’s first health service to commit to reaching carbon net zero, and in July 2022 it published its plan for delivery. So, what does all this mean for general practice? In this podcast episode, Dr Hannah Rosa shares her 10 practical sustainability tips for how we in primary care can make a difference.
In this episode, Dr Roger Henderson discusses the common problem of insomnia. He looks at what it is, how it is assessed, what causes it and ways of treating it. He also discusses simple tips patients can do at home that can cure one in three cases of insomnia without the need for any medication and mentions some famous people who suffered from insomnia along the way!
Menopause and hormone replacement therapy (HRT) can be a source of anxiety for both patients and clinicians. Menopause is frequently in the media and is at the forefront of many consultations. It’s on our minds and on our patients’ too. In the first in a series of episodes on menopause, Dr James Waldron explores its background, its coverage in the media, the changing attitudes towards it, the impact of menopause on patients and the true risks of HRT. Future episodes in the coming weeks will explore prescribing and other treatments.
Using electronic cigarettes (e-cigarettes), or ‘vaping’, has become the most popular form of nicotine replacement therapy in the UK. In this podcast episode, Dr Roger Henderson looks at why this is, the benefits to smokers, and whether we should be recommending such products to our patients who smoke. He also talks about current concerns over their increasing popularity in adolescents and what their potential long-term risks may be.
In this podcast, Dr Kate Chesterman discusses post-sepsis syndrome. She talks about the long-term implications for physical and mental health following sepsis and highlights the considerations for primary care clinicians in managing this cohort of individuals. She also discusses the role of the wider multidisciplinary team, including input from voluntary organisations.
Heat-related illnesses are increasing as a result of climate change. In this episode, Dr Roger Henderson looks at various aspects of heat exhaustion and heatstroke, including why they are different conditions and how to recognise them. He also talks about how they are treated and when hospital admission should be considered.
In this episode, Dr Roger Henderson discusses the treatment pathway for people suffering from hay fever. This comprises options ranging from simple measures for allergen avoidance to the treatments to consider for specific symptoms and when to refer for specialist advice and consideration of immunotherapy.
In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Glos CCG) and Dr Rob Hampton (Portfolio GP, Leicestershire) discuss the prescribing of medicines associated with dependence and approaches to their withdrawal. Is there a link between deprivation and long-term use of pain medications? What is the role of "sensitisation" in primary pain conditions? What are the particular challenges associated with benzodiazepine withdrawal? What alternatives should we be considering?
In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Rob Hampton (Portfolio GP, Leicestershire) and Dr Yassir Javaid (Cardiovascular and Diabetes Lead, Northamptonshire CCG) discuss the "neglected chronic condition" that is heart valve disease and the new NICE guideline covering its investigation and management in adults. Why can we expect an increase in cases over the coming years? What is the importance of timely diagnosis and referral? In which patients is a murmur more likely to represent a valve lesion? When should an electrocardiogram be recommended? How effective are current management options? What is best practice for follow-up?
In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Steve Holmes (GP, Shepton Mallet and Clinical Respiratory Lead, NHS England South West and NHS Somerset) and Dr Sarah Davies (GPwSI in Diabetes, Cardiff) discuss non-alcoholic fatty liver disease (NAFLD) in the context of diabetes. How is NAFLD best detected, diagnosed and managed in high-risk populations? How can primary care professionals identify those who are at risk of fibrosis?
In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Yassir Javaid (Cardiovascular and Diabetes Lead, Northamptonshire CCG) and Dr Patrick Holmes (GP, Darlington) examine the latest developments in renal medicine, with a focus on assessing and managing chronic kidney disease (CKD). What role do sodium–glucose cotransporter 2 inhibitors have in the management of the condition, both in people with diabetes and those without diabetes?
In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Anthony Cunliffe (Macmillan National Clinical Adviser for Primary Care) and Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Glos CCG) discuss the exacerbation of health inequalities related to the COVID-19 pandemic, with a specific focus on cancer services. Which common avoidable cancers and their risk factors might be related to health inequalities? What can primary care professionals do to address the issue?
In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Yassir Javaid (Cardiovascular and Diabetes Lead, Northamptonshire CCG) and Dr Steve Holmes (GP, Shepton Mallet and Clinical Respiratory Lead, NHS England South West and NHS Somerset) discuss the "heart–lung connection" – specifically, the overlap between chronic obstructive pulmonary disease (COPD) and heart failure. What are the challenges in distinguishing between these conditions when they present in general practice, and how can they be addressed? After diagnosing a patient with either COPD or heart failure, how important is it to also look for the condition?
In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Sarah Davies (GPwSI in Diabetes, Cardiff) and Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) discuss the interplay between mental health and conditions such as diabetes, dementia and heart disease. What role do lifestyle factors such as diet and physical activity have in modulating such relationships? Most importantly, what can we do to help patients who may be stuck in a vicious cycle whereby physical ailments adversely impact mental health, which can, in turn, make positive lifestyle changes more difficult to achieve.
In this episode, Dr Kate Chesterman discusses binge-eating disorder. She explores the defining characteristics of the condition and highlights the importance of referring to eating disorder services for treatment.
In this episode, Dr Kevin Fernando and Dr Jim McMorran discuss the ongoing NHS-Galleri trial. The study, which is being conducted among 140,000 asymptomatic patients in England, will assess whether the new Galleri blood test can assist in detecting cancer early when used alongside existing screening measures in the NHS. Kevin and Jim consider the sensitivity, specificity and positive predictive value of the test, reflect on how the test compares with other investigative measures for cancer and contemplate the key practical aspects primary care professionals should be aware of.
In this episode, Dr Kate Chesterman discusses the finding of an undescended testicle at the 6-week baby check. She considers the possible diagnoses and associated risks. Kate also takes us through the primary care assessment and clarifies the important question of when to refer.
In this episode, Dr Kevin Fernando considers the case of Juliana, a 43-year-old journalist who requests a cholesterol check because her father experienced a heart attack in his early 50s. She has no past medical history of note. Her lipid profile returns as follows: total cholesterol (TC), 7.5 mmol/L; HDL-cholesterol, 1.4 mmol/L; triglycerides, 2.2 mmol/L; LDL-cholesterol, 2.9 mmol/L. What should we do next, and what do current guidelines recommend regarding the detection and management of familial hypercholesterolaemia (FH)?
In this episode, Dr Kate Chesterman discusses the role of the primary care practitioner in the long-term follow-up of people who have undergone bariatric surgery. She highlights the current variability in monitoring and makes listeners aware of where to access the current guidance on postoperative biochemical monitoring and micronutrient replacement.
In this episode, Dr Kevin Fernando discusses diagnostic and management tips – as well as pitfalls to avoid – related to subclinical hyperthyroidism. Fatima is a 71-year-old woman who presents in primary care with non-specific malaise and a past medical history of atrial fibrillation, ischaemic heart disease and osteoporosis. On examination, there is no evidence of thyroid swelling. Her blood tests reveal a suppressed thyroid-stimulating hormone (TSH), but normal free thyroxine (FT4) and free triiodothyronine (FT3). Given Fatima's comorbidities, what should we do next?
In this episode, Dr Kate Chesterman discusses the case of Lauren, a 32-year-old lady who is 30 weeks pregnant. Lauren presents with dysuria and increased frequency. Kate talks us through the current guidance on urinary symptoms in pregnancy and considers who to investigate, when to treat and what to treat with. She highlights physiological changes in pregnancy, important obstetric and non-obstetric causes for urinary symptoms as well as relevant red flags.
In this episode, Kevin considers the diagnosis and management of superficial venous thrombosis. Lesley is a 64-year-old woman who presents to us with a sore, itchy right leg and no past medical history of note. On examination, she has a tender, hard, erythematous varicose vein extending from her thigh to ankle. What should we do next? Should we be worried about underlying deep vein thrombosis?
In this episode, Kate discusses gynaecomastia and its investigation and management in primary care. She talks us through an infographic produced by The Association of Breast Surgery called Guidance on Gynaecomastia and considers the following important questions: “who do I need to be worried about?”, “what investigations should I consider?” and “when should I make a referral?”.
In this episode, Kevin discusses the case of Louise, a 19-year-old who has been living with type 1 diabetes for the last 12 years and hypothyroidism for the last 8 years. She presents to us in primary care with a history of recurring unexplained hypoglycaemic episodes despite proactive adjustments to her insulin regimen. In addition to her insulin, she is taking levothyroxine 150 μg/day. She has not recently made significant changes to her diet or daily physical activity. Louise has also been experiencing light-headedness when rising from a sitting position. She has a BMI of 19 kg/m2, and a recent HbA1c value was 63 mmol/mol (7.9%). You record her sitting blood pressure as 119/67 mmHg and her standing value as 99/72 mmHg. You notice some patches of vitiligo on her face. What should we do next?
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Rob Hampton (Portfolio GP, Leicester) explore the use of opioids for musculoskeletal pain and examine alternative approaches to treatment. Do opioids have a role in managing musculoskeletal pain? How are guidelines in this area evolving? In what ways is our understanding of psychosomatic contributors improving? What should GPs be looking at in consultations, especially when time is limited?
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Yassir Javaid (Cardiovascular and Diabetes Clinical Lead, Nene CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the detection of chronic kidney disease in primary care. What do the different tests tell us? What are the most up-to-date guidelines on investigations for CKD, and what do they recommend we do? How often should we be conducting tests for renal function and albuminuria?
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) explore the impact that COVID-19 has had on mental health, including among people who have not been infected. How has self-isolation and shielding affected different people? What is the particular impact on children and younger people? What has the toll been on carers? Which people may struggle with "returning to normal"? How can we support people with "long COVID"? What is the potential role for talking therapies in this area?
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Anthony Cunliffe (National Lead GP Adviser at Macmillan Cancer Support) discuss cancer as a long-term condition from a primary care perspective. How is the landscape of cancer care changing, with respect to the role of primary care clinicians? Why is accurate coding so important? In what ways can clinicians better individualise care in this area? What resources are available to support difficult conversations?
In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the interplay between diabetes and severe mental illness (SMI). What exactly is meant by SMI? How prevalent is mental illness in people with diabetes? What is the role of the gut–brain axis? What signs should clinicians be looking out for in spotting depression?
In this epsiode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Yassir Javaid (Cardiovascular and Diabetes Clinical Lead, Nene CCG) discuss the management of palpitations in primary care. How can we identify those patients with palpitations who have a significant cardiac abnormality or are at risk of an adverse outcome? What are the main causes of palpitations – including those that might have a psychological basis? What are the roles of history-taking and investigations? Finally, what red flags do we need to look out for?
Steroids are prescribed for a range of health conditions. In this podcast, which has been recorded for Chronic Conditions Month 2021, Dr Steve Holmes (Clinical Respiratory Lead for NHS Somserset) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the factors that primary care clinicians need to be aware of when prescribing these drugs. What are the most common side effects with steroid use? What do clinicians need to do to minimise the risk of adrenal crisis when withdrawing steroids? What should sick-day guidance look like for people on long-term steroid treatment? How vigilant do clinicians need to be for steroid-induced diabetes?
In her first podcast for GPnotebook, Dr Kate Chesterman discusses new evidence on the management of children with non-blanching rashes with Dr Edward Snelson. Dr Snelson is a Consultant Emergency Paediatrician at Sheffield Children’s Hospital and is the author of the blog GPpaedstips. Should we be treating every non-blanching rash as meningococcal disease, and if not, why not? What important differentials do we want to consider in children with a fever and a non-blanching rash? Can GPs safely decide which children require emergency treatment?
In this episode, Kevin discusses the case of Lyndsey: a 44-year-old lady who presents to us in primary care with recurrent dizzy episodes over the last month. Lyndsey feels like her head is spinning. She feels nauseated with these episodes, but there is no history of vomiting. Lyndsey can walk unaided but feels very unsteady on her feet during these episodes. The dizziness can last for hours before resolving. There is no clear precipitant to these episodes, and there is no history of headache. Lyndsey denies any hearing loss or tinnitus. What should we do next?
In this episode, Kevin discusses thrombocytosis in the context of suspected cancer. How should an unexplained high platelet count be interpreted and managed in primary care? Which cancers are most commonly associated with thrombocytosis? Aside from underlying malignancy, what are the other possible causes? What further investigations and referrals should we consider, and when?
In this episode, Kevin looks at common questions around non-visible haematuria (NVH) – the condition formerly known as microscopic haematuria. Should we be screening for NVH? What follow-up investigations should we do for people with asymptomatic NVH? Should we change our approach for patients taking aspirin, warfarin or direct-acting oral anticoagulants (DOACs)? Finally, who should we refer and how urgently?
In this episode, Kevin examines some common questions regarding vitamin B12 deficiency. In whom should we suspect it? What investigations should be carried out in primary care? How is it associated with folate deficiency? Once a deficiency in vitamin B12 is detected, how should it be managed? Finally, what approach should be taken during the current COVID-19 pandemic, when intramuscular administration of hydroxocobalamin may be challenging?
In the first episode in a new season of the podcast, Kevin discusses helpful guidance on the corrected QT interval in the context of primary care prescribing. Why should we be concerned about prolongation of the QT interval? Which medications can affect QT interval? What other risk factors for QT prolongation should be considered? And for which patients should we recommend electrocardiogram monitoring?
Kevin is joined by Drs Patrick Holmes, Amrit Lamba and Amar Puttanna to discuss the key take-home points from last week’s American Diabetes Association Virtual Scientific Sessions congress.
Kevin discusses the findings of NHS research on COVID-19 in people with diabetes with study author Professor Partha Kar, National Specialty Advisor – Diabetes with NHS England.
Kevin discusses what to do with each of the commonly used classes of diabetes drugs during intercurrent illness – a topic of particular relevance during the COVID-19 pandemic. Are these medications safe to continue? If so, is dose titration required? Which of these drugs be temporarily be stopped?
Kevin discusses some helpful and important clinical guidance on the prevention of adrenal crisis during the pandemic. Notably, this includes not only those patients with primary adrenal insufficiency but also all of those patients on long-term steroid treatment.
Kevin summarises recommendations from the Faculty of Sexual and Reproductive Healthcare to help support women with contraceptive requirements as primary care cuts back on non-essential face-to-face contact to reduce viral transmission.
Kevin covers recently updated guidance from the British Society for Haematology on managing vitamin B12 supplementation in primary care within the context of the pandemic.
Kevin covers helpful BSR guidance including a risk stratification and scoring grid for those with rheumatological conditions who are receiving immunosuppressive therapies, and considers which patients should be advised to practice shielding.
Kevin discusses evidence-based practical advice to potentially reduce transmission of coronavirus, in the form of nasal irrigation and gargling with saline solution.
Kevin considers the challenges related to managing osteoporosis in the context of conflicting clinical guidelines, including who to assess for fracture risk, who to treat (and with what agent) and how long to treat individuals for.
Dr Kevin Fernando explains why the thinking around gout needs to change, along with common questions in relation to its management in primary care. What lifestyle advice should be given? When should urate-lowering therapy be offered, and what options are available? For those with a history of gout, how can future episodes be avoided?
Dr Kevin Fernando provides a practical overview of the utility of sodium–glucose cotransporter 2 inhibitors, focusing on dosing, cardiovascular and renal safety and the management of adverse events, including dehydration and genital infections.
Have your notebooks at the ready as Dr Kevin Fernando rounds off 2019 with tips on topical oestrogen, mirtazapine prescribing, symptoms associated with withdrawal of varenicline, valvular atrial fibrillation and gout, among others.
Dr Kevin Fernando considers the optimal use of these tests: can we reduce unecessary testing, unecessary referrals and primary care workload?
Dr Kevin Fernando summarises the key points for primary care from the NICE guideline update.
Dr Kevin Fernando discusses detection and management of the condition in primary care, including how presentation in children differs from that in adults.
Dr Kevin Fernando takes us through brief case scenarios to illustrate diagnostic tips and pitfalls in primary care.
Kevin discusses interpretation and management of mildly abnormal liver blood tests in primary care. What are the possible causes? And what should the next step be?