Flag-waving and learning to dance

Do you ever feel swamped during consultations? There can be a lot to keep track of: the patient’s clinical problem, along with the, ‘Couple of other things while I’m here, doctor’; their ideas, concerns, and expectations; the vaguely-remembered back-story in the notes; Quality and Outcomes Framework alerts; and an awareness of how late you’re running and how long it is since you had anything to eat.

Red flags are familiar as indicators of potentially serious disease. The sight of a non-blanching rash in a hot child, or cachexia in the patient not seen for a while triggers a familiar set of autonomic responses, including heightened alertness, a focus on action, and a knotted feeling in the stomach. There are yellow flags too,1 psychosocial predictors of prolonged illness, originally in relation to new presentations of low back pain, but also …

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