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The importance of coding Long Covid in electronic medical records

As the world continues to grapple with the aftermath of the COVID-19 pandemic, Long Covid has emerged as a significant public health challenge. Characterised by persistent symptoms like fatigue, brain fog, shortness of breath, and joint pain lasting weeks, months or even years after an infection, Long Covid affects millions globally. Yet, one major hurdle in understanding and addressing this condition is its under-recording in electronic medical records (EMRs). Accurate coding of Long Covid in EMRs is essential for studying its epidemiology, improving patient care, and managing its impact on healthcare systems and on societies. Electronic medical records are at the core of modern health systems and have largely replaced the more traditional paper-based records used by healthcare providers for many decades. Electronic medical records are used to track patient diagnoses, treatments, and clinical outcomes. When Long Covid is not properly coded, it becomes difficult to use this data to c...
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Empowering medical students to manage polypharmacy

Polypharmacy, commonly defined as the concurrent use of five or more medications, is a growing challenge in modern healthcare, especially among older adults with multiple long-term conditions. While advances in medicine have improved disease management, they have also led to an unintended consequence: a rising medication burden that can harm patient well-being.  Our recent study published in Clinical Practice explores how reframing polypharmacy as a chronic condition can empower future doctors to manage it more effectively. For example, polypharmacy substantially increases the risk of adverse drug reactions (ADRs). This underscores the urgent need for a shift in how we approach medication management.  Traditional medical education focuses on treating individual diseases, often leading to prescribing cascades where one drug’s side effect triggers another prescription. This cycle complicates care and worsens outcomes. We designed a three-phase educational intervention for final-...

What makes a good doctor – and who gets to decide?

What Makes a Good Doctor? This is the question that Waseem Jerjes and I explore in the Journal of the Royal Society of Medicine . It is a key question that underpins the architecture of medical education, clinical practice, regulation, and professional identity. It cannot be answered by regulators, educators, or employers in isolation. It must be answered together – by doctors and patients – revisited throughout a career, and adapted as society and the profession change. Without that shared reflection, the danger is not simply disillusionment, but the erosion of the moral foundations of clinical work. As we enter an era when diagnosis will increasingly involve artificial intelligence and when performance metrics reward volume over value, reclaiming this question as a professional one is imperative. The integrity of our institutions – and of the practitioners within them – depends on reimagining excellence in inclusive, relational terms. A good doctor is not a flawless technician or a f...

Talking to Patients About Weight-Loss Drugs

The use of weight-loss drugs such as GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) has increased rapidly in recent years. These drugs can help some people achieve significant weight reduction, but they are not suitable for everyone and require careful counselling before starting treatment. By discussing benefits, risks, practicalities, and  uncertainties, clinicians can help patients make informed, realistic decisions about their treatment. Key points to discuss with patients 1. Indications and eligibility These drugs are usually licensed for adults with a specific BMI. They should be used alongside lifestyle interventions such as dietary change, increased physical activity, and behaviour modification. 2. Potential side effects – some can be serious Common adverse effects include nausea, vomiting, diarrhoea, and abdominal discomfort. Less common but more serious risks include gallstones, pancreatitis and visual problems. Patients should know what to watch for a...

The NHS Emergency Care Plan underestimates the role of general practice

I welcome the Government’s commitment to expanding urgent care provision in community settings. This approach has the potential to ease pressure on emergency departments and enable ambulance services to focus more effectively on patients who require rapid assessment and conveyance. However, as I discuss in the BMJ , the current Emergency Care Plan underestimates the central role that NHS general practice can and should play. Primary care is often the first point of contact for patients with urgent needs, and with appropriate support, it can manage many conditions effectively without referral to other parts of the system. There is also a risk that investing in a wide array of separate interventions—such as urgent treatment centres, community response teams, and virtual wards—without clear coordination could further fragment care. This may reduce continuity, lead to duplication, and ultimately result in less efficient use of NHS resources. Direct investment in NHS general practice—partic...

Balancing Patient Safety and Human Rights: Implementing the Special Allocation Scheme in Primary Care

The Special Allocation Scheme (SAS) aims to protect NHS staff and other patients from individuals who are violent, aggressive, or pose a serious threat, while at the same time ensuring that these patients continue to receive essential primary care services in a secure environment. The decision to refer a patient to the Special Allocation Scheme is a significant one and rightly requires careful clinical and ethical consideration. However, in practice, such decisions often need to be made rapidly and under stressful or unpredictable circumstances, such as following a serious verbal or physical assault on a member of staff. Updated guidance from NHS England and the additional requirements introduced by some Integrated Care Boards (ICBs), including the need for written confirmation that all alternative approaches have been considered, are well-intentioned. These measures are designed to ensure that referrals to the Special Allocation Scheme are proportionate, lawful, and respectful of pat...

Reclaiming the primary care consultation for patients and clinicians: is AI-enabled ambient voice technology the answer?

 Our recent article in the Journal of the Royal Society of Medicine discusses the potential role of AI-enabled ambient voice technology in healthcare and the implications for doctors and patients. While interest in ambient voice technology , particularly in primary care, continues to grow, evidence regarding its feasibility, acceptability and real-world impact in primary care remains limited. This includes data on cost, staff training and implementation (including integration with current electronic medical record systems).  Questions also remain about how ambient voice technology  handles complex consultations, including with non-native English speakers, and its broader integration into routine practice. As ambient voice technology  develops, further research is needed to assess its usability, acceptability, feasibility, cost-effectiveness and unintended effects on clinical interactions and decision-making. If demonstrated to be effective, ambient voice technology...