In this episode, we look back at the last season of the BJGP podcast and reflect on some of the work we’ve discussed.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.560 - 00:11:08.620

Hi, and welcome to the BJGP podcast. I'm Nada Khan, one of the associate editors of the Journal.

And we've reached the end of another podcast season, and before we take a short break for the summer, we thought we'd look back at some of the papers we've covered and pick out a few highlights and common threads between them.

And looking back at the different podcasts over this this past season, it seemed that although each conversation started with a completely different research question, by the end we all seemed to be talking about the same thing, and that was, how can general practice work better for patients in today's increasingly complex healthcare system?

And although we talked about a wide range of different topics, we covered cancer diagnosis, dementia, women's health, medical education, and we even talked to Garth Funston about artificial intelligence. They all came back to this same underlying challenge.

And we know that general practice has always dealt with complexity, and that's not really anything new, but the kind of complexity we're dealing with now feels different. Patients are living longer with multiple conditions. Care is spread even more so across increasing numbers of services than ever before.

Technology is changing the way that we work, and somehow, amongst all that, we're still trying to preserve those relationships that have always sat at the heart of general practice. And I think another thing that really struck me was that very few of the papers and researchers were talking about making dramatic changes.

And instead we had a lot of discussions about how we could make systems we already have, just work a little bit better. So making it easier to navigate, getting people more connected, more equitable, and more human as well.

So one of the first interviews we recorded was with Katharina Savolkul about why medical students choose or don't choose a career in general practice. And on the surface, it's comes across a bit like workforce paper.

We know that we need more gps, and understanding career choice is clearly important, but I think we talked about something a little bit bigger, which is, what kind of profession are we asking people to join? And this review highlighted positive GP placements, so good role models and the hidden curriculum as well.

And although we often focus on recruitment targets, Katharina reminded us that students choose career because of the experiences they have and the values that they see lived out.

And interestingly, continuity of care remains one of the biggest reasons people are still drawn towards becoming GPs, even though many of us worry that that's becoming harder to achieve in practice. And I think that continuity became one of those defining threads that ran through a lot of the interviews that followed.

And we had Ewan Lawson join the podcast to speak to Charlotte Morris about dementia care. And what they talked about was that participants weren't really asking for more investigations or different medications.

What they wanted to feel was to be known and to have someone who understood who they were before their diagnosis recognize those changes over time and stayed alongside them as their condition progressed.

And I guess listening to that interview made me realize that it's not just about seeing the same gp, but it's about patients feeling that someone is carrying the thread of their story over time. And I had a really similar feeling talking to Dr. Tory Ford about recurrent vulvovaginal thrush.

And these were two qualitative papers about diagnosis and healthcare experiences. But I think by the end of the interview, we were talking about something much broader.

And as clinicians, we think sometimes about those bite sized consultations, but patients don't at all. At least this was the experience that I think that we drew out from Tori's work.

And in this work, I think Tori highlighted that people experience illness as a continuous journey. And although in a system where continuity of care might be challenged, clinicians might see episodes of care, but patients live their whole story.

And I think that's why sometimes recurrent conditions can feel so frustrating for patients, not because, particularly those individual episodes of care consultations are poor, but because if there's discontinuity, no one's joining those consultations together.

And I think the more interviews we recorded, I pulled out another pattern, and that's that whether we're talking about dementia, recurrent thrush, pediatric safety or postnatal care, patients and families were doing a lot of work.

So an extraordinary amount of invisible work, they were chasing referrals, following up on test results, explaining the same story repeatedly to different professionals.

And although these papers weren't a criticism of general practice, and oftentimes many of the patients talked about how much they valued their GP teams. But I think that it almost made it feel as though patients and families were bridging these gaps together between increasingly fragmented services.

And I think that Tom Purchase's work on pediatric patient safety really captured this beautifully. So rather than seeing patients just as recipients of health care, his study showed that they're active contributors to safer care.

So they're already preventing harm. Patients and their families are identifying problems and improving systems.

And I think he challenged us to think about patients as partners in care, rather than just recipients of care. Another theme that kept surfacing was inequality.

And I spoke to Eliza Hutchinson about her work in inflammatory skin disease in People with skin of color.

And her participants talked about delayed diagnosis, underrepresentation in medical education, and that impact of dyspigmentation as well in practice.

And I think, again, what stayed with me wasn't just the clinical message, which was really helpful, and I'd encourage gps to go back to listen to that, but it's how often people really just wanted their experiences to be recognized.

And similarly, I think that Claire MacDonald's work on postnatal care reminded us that women with the greatest social needs are often face the biggest barriers to access and care after birth. And ironically or sadly, this is just as services begin to step back.

And I guess these two papers were asking a much broader question was how do we design healthcare systems that work equally well for everyone?

And I think one of the papers that I really enjoyed, or one of the people I really enjoyed talking to, was Garth Funston and his work using large language models to analyze free text consultation records, aiming to pick up earlier signals for ovarian cancer. And I think that, you know, we.

We talk a lot about artificial intelligence, but actually what we ended up talking about was how we record things in consultations.

And as gps, we write huge amounts that really never get coded as read codes in the system or snowbed codes, you know, symptoms, concerns, uncertainty, those details that really make up the richness of a consultation. And I think that what Garth's work showed us was that AI might help us make better use of the information we've already recorded.

But I think that actually, you know, it's worth thinking about how we're actually using technology to help recover the stories we've already written in the free text as well.

And the last thing that we talked about in this season was something that probably every GP understands instinctively, but few of us have actually been explicitly taught, and that's prioritisation. And we spoke to Andrew McClary about the rapid decisions we make every day. So which patient do we call first? What referral can wait?

And crucially, what do we do first? Do we tackle the difficult task or go for the quick wins?

And I think that I liked the title of his work, because I suspect every GP probably immediately recognized them themselves somewhere between these two approaches. And I think we also touched upon that prioritisation isn't simply about managing workload, but it's also about managing uncertainty.

And I think that if there's one thing I'll take away from this entire season and the different people that we've talked to and the great work that we've listened to, I think it's that general practice has always been about managing complexity. But these conversations reminded me that complexity isn't something we can just eliminate or fix.

It's something that it's worth delving into to try to understand a little bit better.

And I think, you know, whether we're talking about continuity, inequalities, patient safety, or the workforce force, another common thread I thought that ran through these, these conversations was that connection.

So connecting services together, connecting research with everyday practice, and staying connected to patients and the stories that they bring with them through time, really.

And I guess for me, really, every interview this season left me thinking a little bit differently about how I, how I consult and practice and about that patient that's going to be sitting in front of me. And I think that's probably a mark of how strong this research was that we covered in this season as well.

So I guess on that note, I just want to say a big thank you to all of the authors who joined us this season to share their work and to all of you for listening.

We'll be taking a short break for the podcast over the summer, but we'll be back in September with another season of conversations about the latest research published here in the bjgp, and importantly, what it means for everyday general practice. So, yeah, until then, thanks again for listening and we'll see you in September.

Hi, and welcome to the BJGP podcast.

I'm Nada Khan, one of the associate editors of the Journal.

And we've reached the end of another podcast season, and before we take a short break for the summer, we thought we'd look back at some of the papers we've covered and pick out a few highlights and common threads between them.

And looking back at the different podcasts over this this past season, it seemed that although each conversation started with a completely different research question, by the end we all seemed to be talking about the same thing, and that was, how can general practice work better for patients in today's increasingly complex healthcare system?

And although we talked about a wide range of different topics, we covered cancer diagnosis, dementia, women's health, medical education, and we even talked to Garth Funston about artificial intelligence.

They all came back to this same underlying challenge.

And we know that general practice has always dealt with complexity, and that's not really anything new, but the kind of complexity we're dealing with now feels different.

Patients are living longer with multiple conditions.

Care is spread even more so across increasing numbers of services than ever before.

Technology is changing the way that we work, and somehow, amongst all that, we're still trying to preserve those relationships that have always sat at the heart of general practice.

And I think another thing that really struck me was that very few of the papers and researchers were talking about making dramatic changes.

And instead we had a lot of discussions about how we could make systems we already have, just work a little bit better.

So making it easier to navigate, getting people more connected, more equitable, and more human as well.

So one of the first interviews we recorded was with Katharina Savolkul about why medical students choose or don't choose a career in general practice.

And on the surface, it's comes across a bit like workforce paper.

We know that we need more gps, and understanding career choice is clearly important, but I think we talked about something a little bit bigger, which is, what kind of profession are we asking people to join?

And this review highlighted positive GP placements, so good role models and the hidden curriculum as well.

And although we often focus on recruitment targets, Katharina reminded us that students choose career because of the experiences they have and the values that they see lived out.

And interestingly, continuity of care remains one of the biggest reasons people are still drawn towards becoming GPs, even though many of us worry that that's becoming harder to achieve in practice.

And I think that continuity became one of those defining threads that ran through a lot of the interviews that followed.

And we had Ewan Lawson join the podcast to speak to Charlotte Morris about dementia care.

And what they talked about was that participants weren't really asking for more investigations or different medications.

What they wanted to feel was to be known and to have someone who understood who they were before their diagnosis recognize those changes over time and stayed alongside them as their condition progressed.

And I guess listening to that interview made me realize that it's not just about seeing the same gp, but it's about patients feeling that someone is carrying the thread of their story over time.

And I had a really similar feeling talking to Dr. Tory Ford about recurrent vulvovaginal thrush.

And these were two qualitative papers about diagnosis and healthcare experiences.

But I think by the end of the interview, we were talking about something much broader.

And as clinicians, we think sometimes about those bite sized consultations, but patients don't at all.

At least this was the experience that I think that we drew out from Tori's work.

And in this work, I think Tori highlighted that people experience illness as a continuous journey.

And although in a system where continuity of care might be challenged, clinicians might see episodes of care, but patients live their whole story.

And I think that's why sometimes recurrent conditions can feel so frustrating for patients, not because, particularly those individual episodes of care consultations are poor, but because if there's discontinuity, no one's joining those consultations together.

And I think the more interviews we recorded, I pulled out another pattern, and that's that whether we're talking about dementia, recurrent thrush, pediatric safety or postnatal care, patients and families were doing a lot of work.

So an extraordinary amount of invisible work, they were chasing referrals, following up on test results, explaining the same story repeatedly to different professionals.

And although these papers weren't a criticism of general practice, and oftentimes many of the patients talked about how much they valued their GP teams.

But I think that it almost made it feel as though patients and families were bridging these gaps together between increasingly fragmented services.

And I think that Tom Purchase's work on pediatric patient safety really captured this beautifully.

So rather than seeing patients just as recipients of health care, his study showed that they're active contributors to safer care.

So they're already preventing harm.

Patients and their families are identifying problems and improving systems.

And I think he challenged us to think about patients as partners in care, rather than just recipients of care.

Another theme that kept surfacing was inequality.

And I spoke to Eliza Hutchinson about her work in inflammatory skin disease in People with skin of color.

And her participants talked about delayed diagnosis, underrepresentation in medical education, and that impact of dyspigmentation as well in practice.

And I think, again, what stayed with me wasn't just the clinical message, which was really helpful, and I'd encourage gps to go back to listen to that, but it's how often people really just wanted their experiences to be recognized.

And similarly, I think that Claire MacDonald's work on postnatal care reminded us that women with the greatest social needs are often face the biggest barriers to access and care after birth.

And ironically or sadly, this is just as services begin to step back.

And I guess these two papers were asking a much broader question was how do we design healthcare systems that work equally well for everyone?

And I think one of the papers that I really enjoyed, or one of the people I really enjoyed talking to, was Garth Funston and his work using large language models to analyze free text consultation records, aiming to pick up earlier signals for ovarian cancer.

And I think that, you know, we.

We talk a lot about artificial intelligence, but actually what we ended up talking about was how we record things in consultations.

And as gps, we write huge amounts that really never get coded as read codes in the system or snowbed codes, you know, symptoms, concerns, uncertainty, those details that really make up the richness of a consultation.

And I think that what Garth's work showed us was that AI might help us make better use of the information we've already recorded.

But I think that actually, you know, it's worth thinking about how we're actually using technology to help recover the stories we've already written in the free text as well.

And the last thing that we talked about in this season was something that probably every GP understands instinctively, but few of us have actually been explicitly taught, and that's prioritisation.

And we spoke to Andrew McClary about the rapid decisions we make every day.

So which patient do we call first?

What referral can wait?

And crucially, what do we do first?

Do we tackle the difficult task or go for the quick wins?

And I think that I liked the title of his work, because I suspect every GP probably immediately recognized them themselves somewhere between these two approaches.

And I think we also touched upon that prioritisation isn't simply about managing workload, but it's also about managing uncertainty.

And I think that if there's one thing I'll take away from this entire season and the different people that we've talked to and the great work that we've listened to, I think it's that general practice has always been about managing complexity.

But these conversations reminded me that complexity isn't something we can just eliminate or fix.

It's something that it's worth delving into to try to understand a little bit better.

And I think, you know, whether we're talking about continuity, inequalities, patient safety, or the workforce force, another common thread I thought that ran through these, these conversations was that connection.

So connecting services together, connecting research with everyday practice, and staying connected to patients and the stories that they bring with them through time, really.

And I guess for me, really, every interview this season left me thinking a little bit differently about how I, how I consult and practice and about that patient that's going to be sitting in front of me.

And I think that's probably a mark of how strong this research was that we covered in this season as well.

So I guess on that note, I just want to say a big thank you to all of the authors who joined us this season to share their work and to all of you for listening.

We'll be taking a short break for the podcast over the summer, but we'll be back in September with another season of conversations about the latest research published here in the bjgp, and importantly, what it means for everyday general practice.

So, yeah, until then, thanks again for listening and we'll see you in September.