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Clinical clanger: 'I'm worried about this infant's asymmetric skin creases' ... rated statistically’. 6 A few studies have demurred (eg, Ömeroğlu et al)7 but the overall consensus is strong enough to drop skin asymmetry as a sign we should take note of. Avoiding a clangerIt is always difficult to go against colleagues’ advice, particularly when faced with an anxious parent. We should do so in a way that avoids criticism of a fellow healthcare professional and explai ... Date: 27-02-2024 Categories: • Musculoskeletal, rheumatology and sports medicine • Paediatrics
Clinical Clanger: 'Can I have some more prochlorperazine for my dizziness?’ ... of much greater importance than medication. The evidenceNICE has guidance on the management of peripheral vertigo, including BPPV, Ménière's disease, and vestibular neuritis.1 Avoiding a clangerIn vestibular neuritis, prochlorperazine can be used to settle the initial acute symptoms, but thereafter the patient’s vestibular system must be given a chance to recover. The most important a ... Date: 27-10-2023 Categories: • Ear nose and throat and ophthamology • Neurology
Clinical clangers: ‘This patient’s ulcer swab was positive. Can you issue an antibiotic prescription?’ ... in ulcer area, wound breakdown, delayed or non-healing, erythema and increase in local temperature. Pain is the most reliable symptom. Blokhuis-Arkes et al came to the same conclusion.5 Avoiding a clanger If this is an issue in your practice, consider a consensus approach among the GPs. Agree not to respond to lab results with automatic antibiotic prescriptions. You might arrange an educational ... Date: 06-07-2023 Categories: • Bacterial infection • Dermatology and wound care
Clinical clanger: ‘Your blood pressure’s too high so we need to increase your medication’ ... ctionally illiterate and many are reluctant to admit this. A review showed depression negatively impacts adherence and longer-term drug regimes are also associated with lower adherence. Avoiding a clangerSince I started asking about adherence in a non-judgmental way (often referencing my own difficulty in remembering my steroid inhaler), I’m learning about how my patients actually take their tablets ... Date: 09-06-2023 Categories: • Cardiovascular
Clinical clangers: ‘My baby has conjunctivitis again, could you prescribe some eye drops?’ ... f the risk of more serious infection at that point. But figures we do have include an estimated annual incidence of 1.35% in the US and 1.3% in the UK among people of all ages.6,7 Avoiding a clangerTaking a thorough history, listening to the parent, examining and formulating a sensible differential diagnosis will help you avoid overtreatment, as well as not missing a serious cause. In an othe ... Date: 01-12-2022 Categories: • Ear nose and throat and ophthamology • Paediatrics
Clinical clangers: ‘Her dipstick test shows a water infection, can you prescribe antibiotics?’ ... teriuria is not harmful. It can cause a urine dipstick to show a positive result, but the evidence suggests that antibiotics in these cases are not beneficial and may cause harm.2 Avoiding a clanger Each patient should be fully assessed by taking a complete, focused history and asking specifically about urinary symptoms such as dysuria, urination frequency and nocturia, and changes in a ... Date: 11-11-2022 Categories: • Elderly care • Infectious diseases, immunology and allergy • Renal medicine, urology and men's health
Clinical clangers: 'My headaches are getting worse, doctor – it must be my blood pressure’ ... in BP (leading to the well-known phenomenon of ‘white coat hypertension’). As a consequence, patients with anxiety may also make a false connection between a headache and raised BP. Avoiding a clangerA patient who calls you with a concern about headache and hypertension can often be dealt with on the phone. If there are no red flags, and the headache sounds like something benign (for example, a te ... Date: 13-10-2022 Categories: • Cardiovascular • Mental health, pain and addiction • Neurology
Clinical clanger: ‘My ankles are really swollen, doctor – can you give me some of those water tablets?’ ... is is often without a clear indication, and with significant risk of harm.The adverse effects of these drugs are often overlooked, and investigation for other causes is often not done.4 Avoiding a clangerBasic investigations are measurement of BNP, FBC, and renal and liver function. If swelling is unilateral, the differential diagnosis alters: it is important to exclude a DVT, and I have seen it as a ... Date: 01-09-2022 Categories: • Cardiovascular • Elderly care • Gastroenterology and obesity • Renal medicine, urology and men's health
Clinical clangers: ‘My ear infection is back again, can I get something to clear it up properly?’ ... dysfunction). Various authors of research and review papers state the same, claiming that it is frequently misdiagnosed or overlooked, although none offers any solid evidence for this. Avoiding a clangerSimply being alert to how common TMJ pain is, especially as a cause of earache when the ear canal and tympanic membrane look normal, should help aid correct diagnosis. It’s also important not to be ... Date: 28-07-2022 Categories: • Ear nose and throat and ophthamology • Mental health, pain and addiction • Neurology
Clinical clangers: ‘Her diarrhoea is no better, doctor, she needs some stronger medication’ ... rove to be faecal impaction. This scenario is also seen in children, though the diagnosis is less likely to be overlooked as the history is clearer and there are fewer differentials. Avoiding a clangerA careful history may give a significant clue by revealing a tendency to constipation, possibly with a deterioration just before the onset of diarrhoea. In addition, patients may volunteer that they f ... Date: 27-06-2022 Categories: • Gastroenterology and obesity
Clinical clangers: 'Your small red blood cells indicate you're anaemic, so I'm prescribing iron tablets' ... number affected is likely to be higher. Around 1,000 pregnancies per year are affected by sickle cell disease.4 Globally, 1.5% of the world’s population are ß-thalassaemia carriers.5 Avoiding a clanger Bear in mind this blood picture can have other causes than iron deficiency. The MCV may be around 70 or lower in haemoglobinopathy traits, although this is by no means universal. MCH is also oft ... Date: 20-05-2022 Categories: • Haematology
Clinical clangers: ‘My test results say I’ve got thrush – can I get a prescription, doctor?’ Dr Toni Hazell outlines how to advise a patient with an incidental finding of Candida, and why a prescription is not always necessary A 25-year-old woman presents with intermenstrual bleeding ... Date: 04-03-2022 Categories: • Long-term conditions and prescribing • Sexual health • Women's health, gynaecology and obstetrics
Clinical clangers: ‘She needs an antipsychotic, doctor – she’s started seeing and hearing things’ ... ut to control behaviour (a ‘chemical cosh’). Nursing homes are under huge pressure, but interventions that attempt to alleviate the causes are a much better way to tackle the issue. Avoiding a clangerWe can sometimes feel pressured by nursing homes to prescribe anxiolytics, sedatives or antipsychotics to help them manage their residents. Much better is to make use of local resources, such as Admir ... Date: 03-02-2022 Categories: • Elderly care • Mental health, pain and addiction • Neurology
Clinical clangers: 'It must be the gallstones causing my abdominal pain' ... re more likely. 6 Even in those felt to have biliary colic, pain is only relieved in 82% of those having a cholecystectomy, implying that some have pain from another cause.7 Avoiding a clangerThe incidental finding of abnormalities on increasingly sophisticated imaging can pose a major dilemma for GPs. As asymptomatic gallstones are common, particularly in older people, it would be unwise ... Date: 19-01-2022 Categories: • Gastroenterology and obesity
Clinical clangers: ‘I need antibiotics for this infected insect bite’ ... hcare workers create inter-referrals and, possibly, a pressure for antibiotics. But it could offer no conclusions or guidance, as there simply isn’t enough evidence on which to base any. Avoiding a clanger In the absence of evidence, GPs will have to rely on what they are very good at – pragmatism and common sense. The exact pathophysiology varies depending on the insect, but what is clear is that a ... Date: 10-10-2019 Categories: • Long-term conditions and prescribing
Book review: Staying Alive, by Dr Phil Hammond ... acticalities of our current NHS - author Phil Hammond talks of patient self awareness and the responsibility of us all to stay well and ensure the adequacy of our own NHS care. Touching on screening, clangerS (advance warning, Hammond does like his acronyms!) and everyday health tips for better physical and mental health he looks at ways to maximise the system we have got. Full of fascinating facts and s ... Date: 03-08-2015 Categories: • NHS structures • Politics
GPs need to move with the times on pharmacy Pill access ... protocol or guideline. Dare I say that they are probably more thorough than a GP in a hurry? I made a strategic telephone call to our local pharmacist to check on some details and avoid making any clangers on Radio 4. I discovered that she already had extremely thorough safety nets in place for any girls under 16 who ask for emergency contraception, and that issues of child protection and safeguarding ... Date: 04-05-2012 Categories: • Long-term conditions and prescribing • Politics • Practice and personal finance • Sexual health • Women's health, gynaecology and obstetrics

Clinical clanger: 'I'm worried about this infant's asymmetric skin creases' ... rated statistically’. 6 A few studies have demurred (eg, Ömeroğlu et al)7 but the overall consensus is strong enough to drop skin asymmetry as a sign we should take note of. Avoiding a clangerIt is always difficult to go against colleagues’ advice, particularly when faced with an anxious parent. We should do so in a way that avoids criticism of a fellow healthcare professional and explai ... Date: 27-02-2024 Categories: • Musculoskeletal, rheumatology and sports medicine • Paediatrics

Clinical Clanger: 'Can I have some more prochlorperazine for my dizziness?’ ... of much greater importance than medication. The evidenceNICE has guidance on the management of peripheral vertigo, including BPPV, Ménière's disease, and vestibular neuritis.1 Avoiding a clangerIn vestibular neuritis, prochlorperazine can be used to settle the initial acute symptoms, but thereafter the patient’s vestibular system must be given a chance to recover. The most important a ... Date: 27-10-2023 Categories: • Ear nose and throat and ophthamology • Neurology

Clinical clangers: ‘This patient’s ulcer swab was positive. Can you issue an antibiotic prescription?’ ... in ulcer area, wound breakdown, delayed or non-healing, erythema and increase in local temperature. Pain is the most reliable symptom. Blokhuis-Arkes et al came to the same conclusion.5 Avoiding a clanger If this is an issue in your practice, consider a consensus approach among the GPs. Agree not to respond to lab results with automatic antibiotic prescriptions. You might arrange an educational ... Date: 06-07-2023 Categories: • Bacterial infection • Dermatology and wound care

Clinical clanger: ‘Your blood pressure’s too high so we need to increase your medication’ ... ctionally illiterate and many are reluctant to admit this. A review showed depression negatively impacts adherence and longer-term drug regimes are also associated with lower adherence. Avoiding a clangerSince I started asking about adherence in a non-judgmental way (often referencing my own difficulty in remembering my steroid inhaler), I’m learning about how my patients actually take their tablets ... Date: 09-06-2023 Categories: • Cardiovascular

Clinical clangers: ‘My baby has conjunctivitis again, could you prescribe some eye drops?’ ... f the risk of more serious infection at that point. But figures we do have include an estimated annual incidence of 1.35% in the US and 1.3% in the UK among people of all ages.6,7 Avoiding a clangerTaking a thorough history, listening to the parent, examining and formulating a sensible differential diagnosis will help you avoid overtreatment, as well as not missing a serious cause. In an othe ... Date: 01-12-2022 Categories: • Ear nose and throat and ophthamology • Paediatrics

Clinical clangers: ‘Her dipstick test shows a water infection, can you prescribe antibiotics?’ ... teriuria is not harmful. It can cause a urine dipstick to show a positive result, but the evidence suggests that antibiotics in these cases are not beneficial and may cause harm.2 Avoiding a clanger Each patient should be fully assessed by taking a complete, focused history and asking specifically about urinary symptoms such as dysuria, urination frequency and nocturia, and changes in a ... Date: 11-11-2022 Categories: • Elderly care • Infectious diseases, immunology and allergy • Renal medicine, urology and men's health

Clinical clangers: 'My headaches are getting worse, doctor – it must be my blood pressure’ ... in BP (leading to the well-known phenomenon of ‘white coat hypertension’). As a consequence, patients with anxiety may also make a false connection between a headache and raised BP. Avoiding a clangerA patient who calls you with a concern about headache and hypertension can often be dealt with on the phone. If there are no red flags, and the headache sounds like something benign (for example, a te ... Date: 13-10-2022 Categories: • Cardiovascular • Mental health, pain and addiction • Neurology

Clinical clanger: ‘My ankles are really swollen, doctor – can you give me some of those water tablets?’ ... is is often without a clear indication, and with significant risk of harm.The adverse effects of these drugs are often overlooked, and investigation for other causes is often not done.4 Avoiding a clangerBasic investigations are measurement of BNP, FBC, and renal and liver function. If swelling is unilateral, the differential diagnosis alters: it is important to exclude a DVT, and I have seen it as a ... Date: 01-09-2022 Categories: • Cardiovascular • Elderly care • Gastroenterology and obesity • Renal medicine, urology and men's health

Clinical clangers: ‘My ear infection is back again, can I get something to clear it up properly?’ ... dysfunction). Various authors of research and review papers state the same, claiming that it is frequently misdiagnosed or overlooked, although none offers any solid evidence for this. Avoiding a clangerSimply being alert to how common TMJ pain is, especially as a cause of earache when the ear canal and tympanic membrane look normal, should help aid correct diagnosis. It’s also important not to be ... Date: 28-07-2022 Categories: • Ear nose and throat and ophthamology • Mental health, pain and addiction • Neurology

Clinical clangers: ‘Her diarrhoea is no better, doctor, she needs some stronger medication’ ... rove to be faecal impaction. This scenario is also seen in children, though the diagnosis is less likely to be overlooked as the history is clearer and there are fewer differentials. Avoiding a clangerA careful history may give a significant clue by revealing a tendency to constipation, possibly with a deterioration just before the onset of diarrhoea. In addition, patients may volunteer that they f ... Date: 27-06-2022 Categories: • Gastroenterology and obesity

Clinical clangers: 'Your small red blood cells indicate you're anaemic, so I'm prescribing iron tablets' ... number affected is likely to be higher. Around 1,000 pregnancies per year are affected by sickle cell disease.4 Globally, 1.5% of the world’s population are ß-thalassaemia carriers.5 Avoiding a clanger Bear in mind this blood picture can have other causes than iron deficiency. The MCV may be around 70 or lower in haemoglobinopathy traits, although this is by no means universal. MCH is also oft ... Date: 20-05-2022 Categories: • Haematology

Clinical clangers: ‘My test results say I’ve got thrush – can I get a prescription, doctor?’ Dr Toni Hazell outlines how to advise a patient with an incidental finding of Candida, and why a prescription is not always necessary A 25-year-old woman presents with intermenstrual bleeding ... Date: 04-03-2022 Categories: • Long-term conditions and prescribing • Sexual health • Women's health, gynaecology and obstetrics

Clinical clangers: ‘She needs an antipsychotic, doctor – she’s started seeing and hearing things’ ... ut to control behaviour (a ‘chemical cosh’). Nursing homes are under huge pressure, but interventions that attempt to alleviate the causes are a much better way to tackle the issue. Avoiding a clangerWe can sometimes feel pressured by nursing homes to prescribe anxiolytics, sedatives or antipsychotics to help them manage their residents. Much better is to make use of local resources, such as Admir ... Date: 03-02-2022 Categories: • Elderly care • Mental health, pain and addiction • Neurology

Clinical clangers: 'It must be the gallstones causing my abdominal pain' ... re more likely. 6 Even in those felt to have biliary colic, pain is only relieved in 82% of those having a cholecystectomy, implying that some have pain from another cause.7 Avoiding a clangerThe incidental finding of abnormalities on increasingly sophisticated imaging can pose a major dilemma for GPs. As asymptomatic gallstones are common, particularly in older people, it would be unwise ... Date: 19-01-2022 Categories: • Gastroenterology and obesity

Clinical clangers: ‘I need antibiotics for this infected insect bite’ ... hcare workers create inter-referrals and, possibly, a pressure for antibiotics. But it could offer no conclusions or guidance, as there simply isn’t enough evidence on which to base any. Avoiding a clanger In the absence of evidence, GPs will have to rely on what they are very good at – pragmatism and common sense. The exact pathophysiology varies depending on the insect, but what is clear is that a ... Date: 10-10-2019 Categories: • Long-term conditions and prescribing

Book review: Staying Alive, by Dr Phil Hammond ... acticalities of our current NHS - author Phil Hammond talks of patient self awareness and the responsibility of us all to stay well and ensure the adequacy of our own NHS care. Touching on screening, clangerS (advance warning, Hammond does like his acronyms!) and everyday health tips for better physical and mental health he looks at ways to maximise the system we have got. Full of fascinating facts and s ... Date: 03-08-2015 Categories: • NHS structures • Politics

GPs need to move with the times on pharmacy Pill access ... protocol or guideline. Dare I say that they are probably more thorough than a GP in a hurry? I made a strategic telephone call to our local pharmacist to check on some details and avoid making any clangers on Radio 4. I discovered that she already had extremely thorough safety nets in place for any girls under 16 who ask for emergency contraception, and that issues of child protection and safeguarding ... Date: 04-05-2012 Categories: • Long-term conditions and prescribing • Politics • Practice and personal finance • Sexual health • Women's health, gynaecology and obstetrics

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