Makindo Medical Notes

🩺 Wellbeing checks in general practice are a cornerstone of proactive primary care. They allow GPs to spot early warning signs of chronic illness, screen for hidden mental health issues, and empower patients to make positive lifestyle changes. 💡 Particularly valuable for older adults, those with multiple medications, and vulnerable groups (e.g., carers, people with learning disabilities, those with poor access to healthcare).

🔑 Key Components of Wellbeing Checks

• ❤️ Physical Health Assessment: Vitals (BP, pulse, RR, SpO₂), BMI, waist circumference, routine bloods (HbA1c, lipids, renal/liver function).
• 🧠 Mental Health Screening: Mood, sleep, anxiety, depression screening (PHQ-9, GAD-7). Ask about loneliness and social support.
• 💊 Medication Review: Assess polypharmacy, side effects, drug–drug interactions. Essential in elderly and those with multiple conditions.
• 📈 Chronic Disease Monitoring: Regular checks for patients with HTN, diabetes, COPD, asthma, or CVD. Review targets and adherence.
• 🍎 Lifestyle Review: Diet, activity, alcohol, smoking, recreational drugs, sleep hygiene.
• 🎗️ Preventive Care: Vaccination updates, cancer screening (bowel, breast, cervical), opportunistic screening (BP, cholesterol, HbA1c).
• 👨‍👩‍👧 Social & Safeguarding: Assess for carer strain, domestic abuse, housing, and financial concerns.

📋 Common Wellbeing Checks & Suggested Frequency

• 🩸 Blood Pressure: Every 1–2 years if normal; every 3–6 months if hypertensive or high risk.
• 🧪 Cholesterol: Every 5 years (more often if risk factors: diabetes, FHx, CVD).
• 🍬 HbA1c / Diabetes Screening: Every 1–3 years in at-risk groups (BMI >25, FHx, PCOS, gestational diabetes).
• 🧠 Mental Health Review: Annually; opportunistically at any contact in those with chronic conditions.
• ⚖️ BMI & Weight: Annually; more often if overweight, frail, or eating disorder suspected.
• 🎗️ Cancer Screening: – Cervical smear every 3–5 years (age/risk dependent). – Mammogram every 3 years (50–70 yrs). – Bowel cancer screening (FIT/colonoscopy) from age 60 in UK.
• 💉 Vaccination Review: Annual flu, COVID boosters, shingles at 65–70 yrs, pneumococcal at 65 yrs, tetanus every 10 yrs if not up to date.

🌍 Special Considerations

• 👵 Elderly/Frailty: Falls risk, bone health (DEXA, Vit D), cognitive screening (MoCA/AMTS), continence, polypharmacy review.
• 🧒 Children/Adolescents: Growth charts, immunisations, school performance, safeguarding, screen time, mental health.
• 🤰 Women’s Health: Preconception counselling, contraception, menopause review, HRT monitoring.
• 🧑‍🦽 Learning Disabilities/Autism: Annual health check, tailored communication, reasonable adjustments.
• 🌍 At-risk groups: Migrants, homeless patients, those with substance use disorders — screen for TB, HIV, hepatitis, and social needs.

🛠️ Management of Identified Issues

• 📤 Specialist Referral: Cardiology, endocrinology, psychiatry, physiotherapy, or dietetics as appropriate.
• 🚭 Behavioural Interventions: Smoking cessation, alcohol reduction, weight loss programmes, exercise referral schemes.
• 📚 Patient Education: Written info, online resources, self-management apps (e.g., NHS apps for diabetes, asthma).
• 📅 Follow-ups: Chronic disease clinics, nurse reviews, recall systems for vaccines and screening.
• 💊 Medication Optimisation: Adjust doses, deprescribe when safe, reinforce adherence.

📝 Clinical Pearls

• 💡 “Every consultation is an opportunity” — don’t miss a chance for a mini wellbeing check.
• ⚠️ Always consider safeguarding when wellbeing concerns don’t match clinical findings.
• 👂 Active listening is key — patients often disclose hidden problems during routine reviews.
• 🧭 Use wellbeing checks to promote anticipatory care and patient self-management.

✅ Takeaway: Wellbeing checks in general practice go beyond box-ticking. They combine prevention, early detection, lifestyle support, and holistic care, improving long-term outcomes and quality of life for patients of all ages. 🌟