Medical Centre

 A second medical opinion is a medical decision-making tool for patients, physicians, hospitals and insurers. For patients, it is a way to gain an additional opinion on a diagnosis, treatment or prognosis from another physician. Physicians seeking another colleague’s opinion may refer a patient to another consultant to gain further advice. Many health insurers mandate second opinion programmes to reduce medical costs and eliminate ineffective or suboptimal treatments. Hospitals may also require second reviews as part of routine pathology, radiology reviews or for legal purposes. consultant to consultant referrals. Patients in primary care may also request an opinion from a second specialist when unhappy with the opinion from the first specialist. We carried out a systematic review to summarise evidence on (1) the characteristics and motivating factors of patients who initiate second opinions; (2) the impact of patient-initiated second opinions on diagnosis, treatment, prognosis and...

That rhetorical questions like the recent one posed by  some in the media  are even asked shows how deeply ill-informed and distorted the discourse on healthcare has become in the UK. Any dispassionate observer would know that GPs are the bedrock of the NHS; and without GPs the NHS will collapse. Here are just a few home truths: GPs in England manage a wide array of acute and chronic health conditions through over 300 million patient consultations each year compared to 23 million A&E visits. [ 1]  GPs issue about one billion prescriptions annually  and have delivered  two thirds  of phase 1 covid-19 vaccinations. [2] The public already know how hard their family doctors are working to care for them. Despite the challenges of the pandemic, soaring demand, a shrinking GP workforce and a workload that has often become unmanageable, GPs have one of the highest public satisfaction ratings of any public service in the UK. In a survey in July 2021, an overwhel...

The UK’s MPs and journalists repeatedly say they want “GPs to get back to work”. But instead of asking this, they need to speak to staff in their local general practices to understand what the issues are that are causing problems for patients in gaining access primary care services, whether via a face to face appointment or by telephone. The number of GPs per person in England has declined in recent years. At the same time, the volume and complexity of care has increased steadily year-on-year. These problems have been compounded by the rebound in primary care activity following an initial fall at the start of the Covid-19 pandemic. Many GPs report that they and their teams are now dealing with a record level of work. In this context, asking GPs to “get back to work” is insulting for them and their teams. GPs made major changes in the way they work at the start of the Covid-19 pandemic to protect patients – with little additional support from NHS England – and are now struggling with lo...

Now that covid-19 vaccination of children in the UK is starting, it is essential that the legal basis of consent for a medical intervention in this group are well understood A  Court of Appeal ruling on 17 September 2021  overturned a previous High Court ruling, and decided that parental consent is not needed for children under 16 to take puberty blockers. This reaffirms, again, that the responsibility to consent to treatment depends on the ability of medical staff to decide on the capacity of under 16 year olds to consent to medical treatment. The timing is auspicious. Just a few days before, the four UK Chief Medical Officers recommended that all healthy children aged 12-15 should be “offered” a single covid-19 vaccine, with a booster likely in the Spring 2022. Until now, the only children in this age group offered a vaccine  have been those with certain medical condition s, or those living in a household with a clinically vulnerable adult. With a mass vaccine campaign ...

A recent article in the  Daily Telegraph  article asked “ If the GPs went on strike, would anybody notice? ”  The  article claimed that no one would notice if GPs went on strike and the author suggested that making all GPs salaried, forcing them to work longer hours, would help improve general practice for patients. The author quoted “a  now retired GP in his 90s from Bristol who continued doing locum work until five years ago,” who apparently said, “Many GPs are using covid-19 as an excuse for not providing good clinical services. Being able to opt out of night/weekend cover and only working two or three days a week have caused the demise of general practice to the detriment of patients.” As GPs we have worked throughout this pandemic often face-to-face in the most basic of personal protective equipment (PPE), and we were disheartened to read this piece. GPs and their teams have played an essential role throughout the pandemic.  GP teams in England alone d...

 Covid-19 case numbers remain high in the UK. In this article, I discuss why this is and why vaccines are working as expected, and protecting us from serious illness and death. What is a breakthrough infection? No vaccine is 100% effective against preventing infection. An infection in a fully vaccinated person is sometimes described as a breakthrough infection because the infective agent has “broken through” the protection from infection provided by the vaccine. How common is Covid-19 infection in fully vaccinated people? Data from Public Health England show that the Covid-19 vaccines used in the UK reduce the risk of   infection by about 70-90% in people who are fully vaccinated, so vaccines prevent the majority of people who are vaccinated from becoming infected. However, some people who are fully vaccinated will still become infected. Over time, as the number of people in the population who are vaccinated increases, a greater proportion of infections will occur in va...

Why doctors and dogs should not mix on house visits to patients. This might seem a strange topic to discuss but it is important to health professionals and is something they don’t teach you about in medical school. Bottom line: always ensure the dog is in a separate room when you do a house call. It’s very common when you arrive at a house to be do a home visit to be greeted by the sound of barking dogs. The owners will always try to reassure you that the dogs are "just being friendly" and are "harmless". Ignore them and insist the dogs are put in another room before you enter. This sometimes causes resentment with the patient who often views the dog as a much-loved, close family member that is perfectly entitled to be present in the room while the patient has their consultation with the doctor. Do not give in to this pressure. It is very difficult to carry out a clinical consultation while you have a dog (sometimes several dogs) jumping all over you, distracting yo...

Early in the Covid-19 pandemic, the elderly and people who were clinically extremely vulnerable were asked to shield to reduce their risks of Covid-19 infection and its complications. We evaluated the effectiveness of shielding in a study published recently in the journal BJGP Open .  We found that Covid-19 rates were much higher in the shielded group compared with non-shielded group (6.5% vs 1.8%). The increase in risk of infection in the shielded group persisted after adjustment for a wide range of factors in a Cox proportional hazards regression model. We also found that Covid-19 rates were seven times higher in people living in care homes; and were also higher among people from ethnic minorities, those living in poorer areas, and in people with long-term medical conditions such as respiratory disease. Our results suggest that shielding alone is not enough to protect clinically vulnerable people and that vaccination, along with suppressing community infection rates, remains the ...

Depression is common in people with multiple sclerosis (MS), and a new study from our research group shows that people with both conditions are more likely to die over the next decade than people with just one or neither condition. The study was published in the September 2021, online issue of   Neurology , the medical journal of the American Academy of Neurology. The study also found that people with MS and depression have an increased risk of developing vascular disease such as heart attack and stroke. "These findings underscore the importance of identifying depression in people with MS as well as monitoring for other risk factors for heart disease and stroke," said lead author Raffaele Palladino, MD, PhD, of Imperial College of London in the United Kingdom. "Future studies need to be conducted to look at whether treating depression in people with MS could reduce the risk of vascular disease as well as death over time." The study involved 12,251 people with MS and...