Legacy of grief and COVID-19

Iona Heath, Former President of the RCGP, writes of the many unexpected kinds of grief from COVID-19. She states: ‘It will be very important to resist the temptation to pathologise, label, or precipitately refer on the sequelae of grief’. She emphasises we must acknowledge that some communities, particularly those subject to the structural violence of poverty and racism, have been significantly more exposed to loss of parents, life partners, children, and dear friends. She describes the power of relationship-building as an investment that has the potential to make future care easier for both patient and GP.

GPs' gut feelings in cancer diagnosis

A systematic review suggests GPs' gut feelings may have a role in cancer diagnosis. The studies, which used varied conceptualisations of 'gut feelings', showed associations with patients initially being unwell rather than with a suspicion of cancer. Pooled odds of a cancer diagnosis were four times higher when gut feelings were recorded, and became more predictive of cancer as clinical experience and familiarity with the patient increased. This may encourage GPs to acknowledge the diagnostic value of gut feelings and have more confidence in including them in their clinical assessment. Claire Friedemann Smith explains the findings in a video interview.

Continuity of care is linked to mortality

A systematic review links reduced mortality rates to continuity of care, and examines causative mechanisms. In this primary-care focused study, authors from the University of Leicester, Imperial College London, and McGill University in Montreal, found a statistically significant protective effect of greater care continuity in 9 of 12 studies that measured the effect of all-cause mortality. Improved clinical responsibility, physician knowledge, and patient trust were suggested as causative mechanisms. This review adds reduced mortality to the demonstrated benefits of better continuity in primary care for patients. Some patients may benefit more than others. Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policy makers and practitioners to counter this. Also online first in the BJGP is research on what patients with ongoing problems want from relational continuity of care. This study from the University of Bristol found that patients want a GP who listens to them, who takes time with them, who cares, who takes responsibility and action, and who trusts and respects them. 

Racism and health​​

Dr Carter Singh is a full time GP partner at Willowbrook Medical Practice, Nottinghamshire. An 'expert-by-lived-experience' in racial inequality, it is this passion that motivates him to challenge discrimination, inequality, and marginalisation in the NHS. The August issue of the BJGP publishes Dr Singh’s letter on Asking questions along with an Editorial on Racism and Health by Paramjit Gill and Virinder Kalra, and an Editor’s briefing on Prejudice Plus Power = Racism. Life & Times looks at BAME excess deaths and chronic stress by Sarah Evans, Conversations about race and abuse in the NHS by Tariq Hussain, COVID-19 and equity by Gemma Ashwell et al, and indigenous health in the COVID-19 torch by Tim Senior. View the full contents of the August BJGP.