Nothing illustrates the abasement of primary care in the UK better than the saga of chronic kidney disease and the estimation of glomerular filtration rate. On the flimsiest clinical evidence we were ordered to tell all our patients with an eGFR under 60 that their kidneys might pack up, and collect a few pence for doing it. Fortunately our local renal physicians persuaded our Primary Care Trust that this was nonsense, using the arguments laid out in this article. What we do need, however, is a good primary care study using cystatin C, a much better marker of renal dysfunction in older people.
Bipedalism is a strange adaptation, but it encourages walking. I guess that the big dinosaurs were great walkers (“I say, Rex, why don’t we take a stroll through Primeval Forest, and eat most of it on the way?”); and birds without predators often give up flying and waddle about instead. For human beings, walking may no longer be the normal way of travelling distances, but it is undoubtedly the form of exercise we are best designed for. In one of his funniest pieces, “On Taking a Walk”, Max Beerbohm mocks the habit, but by modern standards, spry little Max was quite a walker. And so should we be, and so should our patients: this systematic review gives a few clues as to how we might encourage it.
Herpes zoster is a condition seen and treated almost entirely in primary care, and it’s really quite interesting – we see a lot of it in children, we often come across people with suggestive symptoms but no rash, and much of it doesn’t need treatment. But this clinical review from tertiary care reads like one of the duller sections of the Oxford Textbook of Medicine.