GP

Lisa and Sara are joined by GPs Dr Viren Mehta and Dr Joanna Bircher who summarise new guidelines and evidence relevant in primary care this week.
Covered this episode:
Clinically recognised natural courses of COVID-19 infection
Remotely assessing and risk stratifying COVID-19 patients
Learning points from the updated standard operating procedures from NHS England
Salient points from the new NICE guidelines on managing pneumonia in adults in the community
Briefly touch on the updated PHE guidance on PPE
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Useful resources: 
NICE COVID-19 rapid guideline managing suspected or confirmed pneumonia in adults in the community:https://www.nice.org.uk/guidance/ng165/resources/covid19-rapid-guideline-managing-suspected-or-confirmed-pneumonia-in-adults-in-the-community-pdf-66141902429125
Primary care pathways website: https://primarycarepathways.co.uk/
Centre for evidence based medicine: https://www.cebm.net/covid-19/
PHE what level of PPE, recommended PPE for primary, OP and community care:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877599/T2_Recommended_PPE_for_primary_outpatient_and_community_care_by_setting_poster.pdf
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We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In this, our second of the COVID-19 specific episodes, GPs Lisa and Sara are joined electronically by Dr Dan Bunstone (GP and Clinical Director of Warrington CCG and Chief Medical Officer at Push Doctor) and Dr Joanna Bircher (GP partner, clinical director for GPExcellence and Pandemic Lead for her PCN).
We discuss:
Advantages of telephone and video consultations including how to use the golden minute, picking up cues on video consults and when they might be most useful.
Safety points around confirming patient identity and others that may be in the room. 
The need for excellent documentation for non face to face consultations. 
Tips for good safety netting. 
Logistics of picking up prescriptions and how to protect shielded groups. 
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Useful resources 
Faculty of Sexual and Reproductive Health Covid-19 specific guidelines: https://www.fsrh.org/fsrh-and-covid-19-resources-and-information-for-srh/
Trisha Greenhalgh's excellent BMJ article: Covid-19: a remote assessment in primary care:https://www.bmj.com/content/368/bmj.m1182
eGP learning great telephone consultations tipshttps://egplearning.co.uk/quick-telephone-consultation-tips-for-primary-care/
Red Whale Emotional and Psychological Survival Guide: https://www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/PEARL-Emotional-and-Psychological-wellbeing%5B2%5D-EDITED.pdf
Website collating useful COVID-19 links: https://primarycarepathways.co.uk/covid19
 ____
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

We have decided to take a break from our normal release schedule to do a special, weekly series about the COVID-19 situation which is unfolding. Our hope is that we can provide some useful and practical information for everyone within primary care during this difficult time. 
In this first episode we talk to Dr Joanna Bircher (GP partner, clinical director for GPExcellence and Pandemic Lead for her PCN) and Dr Viren Mehta (GP partner, clinical director of his PCN and clinical director for Stockport CCG). 
We summarise some of the Standard Operating Procedure from 19th March with practical tips on how to implement this.
We think about ways that surgeries can reduce their footfall and protect staff and patients from exposure.
We also touch on which normal general practice services should continue during this time and where to look for guidance.
We talk about some ways to look after your staff, and speak specifically about home visits.
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Useful resources: 
NHS England Standard Operating Procedure for General Practice (19th March 2020): https://www.england.nhs.uk/coronavirus/primary-care/general-practice/standard-operating-procedures/
RCGP Guidance on workload prioritisation during COVID-19 (23rd March 2020): https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2020/covid19/RCGP%20guidance/202003233RCGPGuidanceprioritisationroutineworkduringCovidFINAL
PPE video for UK primary care: https://www.youtube.com/watch?v=Zpg64grevO0
Website collating useful COVID-19 links: https://primarycarepathways.co.uk/covid19
 ____
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Bronchiectasis can sometimes be overlooked amongst the other, more common lung conditions such as COPD. Because of this, it can be difficult for primary care clinicians to be fully aware of how to comprehensively diagnose and manage patients who have this condition. 
Lisa and Sara talk to respiratory consultant Dr Ashish about bronchiectasis. We learn exactly what this condition is, what the risk factors are for developing it, and when we should be suspicious of it as a cause. We also talk through important differentials to think about, what to look for on examination and which investigations to do (and the reliability of these). We finish by hearing about the role of sputum samples and what we can be doing in Primary Care to manage patients with bronchiectasis alongside Secondary Care.
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Useful resources: 
Table showing targeted antibiotic choices in bronchiectasis on NICE CKS: https://cks.nice.org.uk/bronchiectasis#!scenario:1 
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Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Worldwide, sepsis kills more people than cancer (https://www.bbc.co.uk/news/health-51138859). In 2050 it is predicted antibiotic resistance will kill more than cancer (http://bsac.org.uk/securing-new-drugs-for-future-generations/). What a difficult balance!
Lisa and Sara opportunistically talk to Trafford GP Dr Anya Leaver about antibiotic prescribing in Greater Manchester. We discuss the issues, recent changes in local guidelines, helpful tips to improve prescribing practice, great resources and ideas for practice audits. 
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Useful resources: 
Trafford’s two page CCG Antibiotic guidelines. Not online but may be available on request from: [email protected]
Other Greater Manchester CCG Medicine Management Teams available from link: http://psnc.org.uk/greater-manchester-lpc/service-information/medicines-management-and-guidance/
GMMMG Antimicrobial Guidelines: http://gmmmg.nhs.uk/html/cgp.php
TARGET leaflets for patients from RCGP (including 'Treating your infection UTI'): https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/amr/target-antibiotics-toolkit.aspx
'When should I worry?' leaflets and online resources including e-learning: http://www.whenshouldiworry.com/
Fever Pain score for sore throats: https://ctu1.phc.ox.ac.uk/feverpain/index.php
Why the guidelines were changed for treating Chlamydia: https://www.bashhguidelines.org/current-guidelines/urethritis-and-cervicitis/chlamydia-2015/
ESPAUR report (national data on antibiotic prescribing and resistance): https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report
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Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to several different primary care professionals about portfolio working.
Dr Anya Leaver, Dr Hussain Gandhi, Practice Nurse Alyson Rimmer, Dr Nikesh Vallabh, and Dr Saira Zaman share with us their journey into Primary Care, how they got involved in their different roles outside of clinical work, what it means to them and advice for those out there wanting to explore adding variety to their working week.  
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Useful resources: 
eGP Learning (made by Dr Gandhi): https://egplearning.co.uk/
PED Course with Health Education North West: https://www.nwpgmd.nhs.uk/ped-2019-study-day-one
Post-CCT Fellowships with Health Education North West: https://www.nwpgmd.nhs.uk/post-cct-gp-fellowship-programme-hee-nw-20192020
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Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GPwSI, Dr Rachel Hilton about Generalised Itching.
She talks us through how to approach a patient presenting with generalised itching, the common and important causes, useful investigations and the management that we can try in primary care for these patients. 
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Useful resources: 
BATHE Study, BMJ 2018: https://www.bmj.com/content/361/bmj.k1332
Skin Support Website (pruritus page): http://skinsupport.org.uk/conditions-details/pruritus
British Association of Dermatologists (pruritus leaflet): http://www.bad.org.uk/for-the-public/patient-information-leaflets/pruritus
NICE CKS Widespread Itching Causes: https://cks.nice.org.uk/itch-widespread#!backgroundSub:1
 ____
Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Dr Rebecca Baron from Health Education England about Resilience.This is part two of a two-part series about Resilience. In this episode we continue the theme of exploring resources available to healthcare professionals around resilience; books and research that have advanced the field. Rebecca gives us her learning points from these. ____
Resources mentioned in the episode:
• When “resilience” becomes a dirty word - BMJ article by David Oliver July 2017https://www.bmj.com/content/358/bmj.j3604
• 'eGPLearning PodBlast' podcast - episode about Wellbeing with Dr Helen Garr: https://www.podbean.com/eu/pb-w2jut-c480f4
• 'You are not a frog' podcast by Dr Rachel Morris all about Resilience: https://shapesfordoctors.com/podcasts/
• NHS Practitioner Health Programmehttps://php.nhs.uk/ or call 020 3049 4505
• Positivity book by Barbara Fredricksonhttps://amzn.to/2OFrOcw
• Rainy Brain, Sunny Brain book by Elaine Foxhttps://amzn.to/2DfE6D2
• Building Physician Resilience Canadian Family Physician May 2008https://www.nwpgmd.nhs.uk/resources/building-physician-resilience
• Foundation for Positive Mental Healthhttp://www.foundationforpositivementalhealth.com/
• Thinking, Fast and Slow book by Daniel Kahnemanhttps://amzn.to/2XO3Pfo
• The New Leaders book by Daniel Golemanhttps://amzn.to/2KP8Miy
• The 7 Habits of Highly Effective People book by Stephen R. Coveyhttps://amzn.to/34jcOHM
• Health Education North West Resilience resources: https://www.nwpgmd.nhs.uk/taxonomy/term/6
• Why We Sleep book by Matthew Walkerhttps://amzn.to/35ugNkW
• The Business of Sleep book by Vicki Culpinhttps://amzn.to/37AINoV
• The Body Keeps a Score book by Bessel van der Kolkhttps://amzn.to/2XIuVEw
• Eat that Frog book by Brian Tracyhttps://amzn.to/33jNaBc
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We would love your feedback & suggestions…Let us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
____
This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Dr Rebecca Baron from Health Education England about Resilience.
This is part one of a two part series about Resilience. In this episode we talk about what Resilience is and how it started as a concept in general and in healthcare. We also hear about the neuroscience behind Resilience and Rebecca goes through some resources that she has found particularly helpful herself.
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Resources mentioned in the episode: 
BMJ article by David Oliver - When “resilience” becomes a dirty word: https://www.bmj.com/content/358/bmj.j3604
'eGPLearning PodBlast' podcast - episode about Wellbeing with Dr Helen Garr: https://www.podbean.com/eu/pb-w2jut-c480f4
'You are not a frog' podcast by Dr Rachel Morris all about Resilience: https://shapesfordoctors.com/podcasts/
NHS Practitioner Health Programmehttps://php.nhs.uk/ or call 020 3049 4505
The Body Keeps the Score book by Bessel van der Kolk:https://amzn.to/34wKpxp 
The Chimp Paradox book by Professor Steve Peters:https://amzn.to/2JKIlKm 
Blink: The Power of Thinking Without Thinking book by Malcolm Gladwell:https://amzn.to/2C7Dizl 
Flourish book by Martin Seligman:https://amzn.to/2NGJvrH 
Health Education North West Resilience resources: https://www.nwpgmd.nhs.uk/taxonomy/term/6
 ____
Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to Consultant Haematologist Dr Chris Gregory about Immunoglobulins.
The subject is approached from the point of view of primary care clinicians ordering immunoglobulin blood tests. We get Dr Gregory's opinion on when it is useful to order an immunoglobulins blood test and go through the possible meaning of all the different types of results. We discuss raised immunoglobulin tests and the difference between monoclonal and polyclonal rises. We discuss the diagnosis of MGUS (monoclonal gammopathy of undetermined significance) and myeloma. 
 ____
Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C
 ____
This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. 
The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.