In this episode of the RCP Medicine Podcast, Consultant Respiratory Physician Milind Sovani joins Respiratory Registrar Daniella Draicchio and Foundation Doctor Masooma Ali to explore a compelling case of progressive breathlessness in a 45-year-old woman. What begins as a seemingly routine presentation unfolds into a diagnostic journey.

Together, the team discusses the challenges of diagnosing chronic type 2 respiratory failure, the importance of recognising paradoxical breathing, and the role of non-invasive ventilation and surgical intervention. This episode is a masterclass in clinical reasoning, multidisciplinary collaboration, and the value of thorough bedside examination.

We would like to acknowledge Dr Patience Ehilawa, Consultant Respiratory Physician at Nottingham University Hospitals , for her contribution to the content design and planning of this podcast.

References

• A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis ERJ Open Research 2021 00953-2020; DOI: https://doi.org/10.1183/23120541.00953-2020 
• Diagnosis and management of nontraumatic unilateral diaphragmatic paralysis (complete or partial) in adults - UpToDate
• Treatment of diaphragmatic paralysis using an expanded surgical protocol: review of the largest worldwide experience  European Respiratory Journal 2018 52 (suppl 62): PA806; DOI: https://doi.org/10.1183/13993003.congress-2018.PA806 
• Diaphragm dysfunction: how to diagnose and how to treat? Breathe 2025 21(1): 240218; DOI: https://doi.org/10.1183/20734735.0218-2024 

This podcast has been made with an educational grant from Bristol-Myers Squibb Pharmaceuticals Limited (“BMS”). BMS has had no input or involvement in the design, development or content of the podcast whatsoever.

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Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas

In this RCP Medicine podcast and BSR Talking Rheumatology podcast collaboration Dr Pip Watson and Dr Rik Patel discuss an interesting case of a patient presenting with headache to the acute take. Topics include tips on history and examination, an update on treatment including the use of tocilizumab and the role of fast-track pathways.  Pip is a Rheumatology Consultant in Manchester,  BSR Digital Learning Editor, and Talking Rheumatology host, Rick is a Rheumatology and Acute Medicine consultant in Manchester, working at one of the specialist centres for vasculitis.

If you liked this check out related Talking Rheumatology spotlight episodes 

• Episode 6 giant cell arteritis
• Episode 14 polymyalgia rheumatica
• Bonus case non GCA headache 

 Resources

NICE GCA guideline https://cks.nice.org.uk/topics/giant-cell-arteritis/

BSR GCA guideline https://academic.oup.com/rheumatology/article-abstract/59/3/e1/5714024?redirectedFrom=fulltext

GCAPS paper https://ard.bmj.com/content/83/Suppl_1/1100.2

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Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas

In this episode of the RCP Medicine podcast, Professor Mark Harber, nephrologist, and RCP sustainability advisor, is joined by Chris Gormley, Chief Sustainability Officer at NHS England, to explore the NHS’s groundbreaking journey toward net zero.

Together, they discuss the origins of the NHS’s green strategy, the global health implications of climate change, and the ambitious targets set for 2040 and 2045. Chris shares insights into the NHS’s leadership on sustainability, the economic and health drivers behind the movement, and the practical steps being taken - from decarbonising the supply chain to rolling out solar energy across NHS estates.

Listeners will gain a deeper understanding of the challenges and opportunities in embedding sustainability into clinical practice, the importance of international collaboration, and how clinicians and staff can get involved through green plans and toolkits.

Resources

• Greener NHS plan website - https://www.england.nhs.uk/greenernhs/
• Greener NHS – case studies https://www.england.nhs.uk/greenernhs/whats-already-happening/
• 12 things we can do as individuals to become greener
• RCP view on healthcare sustainability and climate change
• CSH Courses Courses | Centre for Sustainable Healthcare
• e-learning for Health – Environmentally Sustainable Healthcare Environmentally Sustainable Healthcare - elearning for healthcare (e-lfh.org.uk)
• SusQI.org (step by step guide) Step-by-step guide | Centre for Sustainab (susqi.org)
• Greener NHS Greener NHS (england.nhs.uk)
  CSH Resource Library Resource library | Sustainable Healthcare Networks Hub
• CSH Networks Networks | Sustainable Healthcare Networks Hub

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In this episode of the RCP Medicine podcast, Dr Helen Banks, Consultant in Rehabilitation Medicine and Training Programme Director for Rehabilitation Northwest/Mersey, talks to Dr Ganesh Bavikatte, Consultant and Clinical Lead for Rehabilitation Medicine at The Walton Centre in Liverpool. They discuss disability after stroke and the role of specialist rehabilitation to help patients optimise their activity and independence. Their discussion describes the rehabilitation pathway, from acute and through to the community, and highlights medical issues that may arise along the way. 

Dr Ganesh Bavikatte has been a consultant and clinical lead at The Walton Centre NHS Trust and Cheshire and Merseyside Rehabilitation Network since 2012. The Walton Centre is a Neuroscience Specialist NHS Trust, and the Cheshire and Mersey rehabilitation network has a pathway from hyperacute to community care for patients following severe injury, illness, and injuries, including those with stroke. 

Resources

• Spasticity in adults: management using botulinum toxin | National Guidelines
• Spasticity in adults: management using botulinum toxin | RCP
• Cheshire and Mersey rehabilitation network https://www.cmrehabnetwork.nhs.uk/

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In this episode of the RCP Medicine Podcast, Dr Neil Stone, consultant in infectious diseases and microbiology at University College London Hospitals and associate professor at UCL, joins host Dr Rohan Mehra to explore the often overlooked and increasingly important field of clinical mycology.

The conversation covers a wide spectrum of fungal infections—from diagnosing and managing invasive candidiasis to understanding the global emergence of Candida auris, and the clinical complexities of Cryptococcus and Aspergillus infections. Dr Stone also sheds light on dimorphic fungi, discussing their unique biology, geographical distribution, and the diagnostic challenges they present. Beyond individual pathogens, the episode emphasizes the broader environmental and global health implications of fungal disease, highlighting the need for a One Health approach.

Whether you're a clinician, student, or simply curious about the fungal kingdom, this episode is rich with clinical insights, diagnostic tips, and global perspectives on one of medicine’s most challenging and evolving frontiers.

Resources

WHO Antifungals Report 2025 Antifungal agents in clinical and preclinical development: overview and analysis

WHO Antifungal diagnostics report 2025 Landscape analysis of commercially available and pipeline in vitro diagnostics for fungal priority pathogens

WHO Priority Fungal Pathogens list https://www.who.int/publications/i/item/9789240060241

IDSA Aspergillosis Guidelines 2016 https://www.idsociety.org/practice-guideline/aspergillosis/

Global Guideline for Candiasis 2025 Lancet 2025 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00749-7/fulltext

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In this episode of RCP Medicine Podcast, Dr Dale Seviar a Consultant Haematologist at Guy's and St Thomas' NHS Foundation Trust is welcomed by Dr Rebecca Kuruvilla, a previous RCP clinical education fellow and an ST7 Clinical Pharmacology and GIM registrar. Together, they discuss the management of sickle cell disease using a hypothetical case study, providing valuable insights and practical tips for medical professionals. 

Sickle cell disease is one of the fastest growing genetic conditions that there is, and it's likely that many of you will be exposed to people living with sickle cell. This episode aims to provide a comprehensive understanding of the condition, acute complications and management strategies.

Funding

This episode was funded by Vertex Pharmaceuticals (Europe) Limited. Vertex had the opportunity to suggest the topic of this episode only, with no further involvement in its creation and elaboration, and all views and opinions expressed by the presenter and guests are solely their own.

Resources 

Sickle Cell Disease - RCEMLearning

RCEM_BPG_Sickle-Cell-Disease_v3.2.pdf

Inherited anaemias: sickle cell and thalassaemia - ScienceDirect 

Overview | Sickle cell disease: managing acute painful episodes in hospital | Guidance | NICE

Management of Acute Chest Syndrome in Sickle Cell Disease

Hemolytic transfusion reactions in sickle cell disease: underappreciated and potentially fatal - PMC

Sickle cell disease (SCD) and stem cell transplant | Anthony Nolan

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In this episode RCP Medicine Podcast, we are joined by Dr John Dean, Clinical Vice President at the Royal College of Physicians and a physician in East Lancashire, and Dr John Ford, an academic public health doctor and Senior Clinical Lecturer at Queen Mary University. Together. They explore the multifaceted nature of health inequalities and discuss actionable steps physicians can take to address these disparities. Both share their personal experiences and professional insights into health inequalities and how it shaped their understanding of social and economic disadvantages. They discuss the structural factors within society that lead to health inequalities and emphasise the importance of creating a fairer, more inclusive society. The conversation focusses on the role of clinicians in addressing health care inequalities and the need for continuous improvement in healthcare design and delivery.

Resources

Bridging the gap: a guide to making health inequalities a strategic priority for NHS leaders

A snapshot of UK doctors: experiences of health inequalities

Supporting clinicians to address health inequalities in practice

RCP view on health inequalities: a call to action for a cross-government strategy

Funding

This episode was funded by Vertex Pharmaceuticals (Europe) Limited. Vertex had no involvement in the creation and elaboration of this episode and all views and opinions expressed by the presenter and guests are solely their own.

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In this episode of the RCP Medicine podcast, Professor Ailsa Hart and Dr Eathar Shakweh discuss how to approach managing Inflammatory Bowel Disease (IBD) in the acute medical setting. This is the second episode of a 2-part series, with a focus on Crohn's disease. 

IBD is a common condition, affecting 1 in 123 people in the UK. The 2024 State of the IBD Care in the UK report highlighted the urgent need to shorten time to diagnosis and initiate early treatment to minimise the risk of IBD-related complications. Acute and general medicine physicians have an important role to play in diagnosing and managing IBD. This podcast will equip medics at all stages of training with the necessary knowledge to approach this heterogenous and complex condition. 

Professor Hart is Director of IBD Research at St Mark’s Hospital, London, United Kingdom and a world-leading expert in IBD. Eathar is an IBD Clinical Research Fellow at St Mark’s and Imperial, with a special interest in perianal fistulising Crohn’s disease. 

Crohn's & Colitis UK (CCUK) Website

https://crohnsandcolitis.org.uk/

This is a valuable resource for patients and healthcare professionals alike, containing a wealth of information on IBD investigation and management.

British Society of Gastroenterology (BSG) guidelines on Inflammatory Bowel Disease (IBD) - 2019

Lamb, Christopher Andrew et al. “British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.” Gut vol. 68,Suppl 3 (2019): s1-s106. doi:10.1136/gutjnl-2019-318484

https://pubmed.ncbi.nlm.nih.gov/31562236/

For interested listeners, these are the national guidelines for IBD diagnosis and management. Please note, the new guidelines for 2025 are pending release.

ECCO Guidelines on Therapeutics in Crohn's disease: Medical Treatment

Torres, Joana et al. “ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment.” Journal of Crohn's & colitis vol. 14,1 (2020): 4-22. doi:10.1093/ecco-jcc/jjz180

https://pubmed.ncbi.nlm.nih.gov/38877997/

ECCO Guidelines on Surgery in Crohn's disease: Surgical Treatment

Adamina, Michel et al. “ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment.” Journal of Crohn's & colitis vol. 18,10 (2024): 1556-1582. doi:10.1093/ecco-jcc/jjae089

https://pubmed.ncbi.nlm.nih.gov/38878002/

These are the European Crohn's and Colitis Organisation (ECCO) guidelines on therapeutics in Crohn's disease, divided into medical and surgical treatment.

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Music:

Episode 50 onward - Bensound.com

Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas

In this episode of the RCP Medicine podcast, Professor Ailsa Hart and Dr Eathar Shakweh discuss how to approach managing Inflammatory Bowel Disease (IBD) in the acute medical setting. This is the first episode of a 2-part series, with a focus on ulcerative colitis.  

IBD is a common condition, affecting 1 in 123 people in the UK. The 2024 State of the IBD Care in the UK report highlighted the urgent need to shorten time to diagnosis and initiate early treatment to minimise the risk of IBD-related complications. Acute and general medicine physicians have an important role to play in diagnosing and managing IBD. This podcast will equip medics at all stages of training with the necessary knowledge to approach this heterogenous and complex condition. 

Professor Hart is Director of IBD Research at St Mark’s Hospital, London, United Kingdom and a world-leading expert in IBD. Eathar is an IBD Clinical Research Fellow at St Mark’s and Imperial, with a special interest in perianal fistulising Crohn’s disease. 

Crohn's & Colitis UK (CCUK) Website

https://crohnsandcolitis.org.uk/

This is a valuable resource for patients and healthcare professionals alike, containing a wealth of information on IBD investigation and management.

British Society of Gastroenterology (BSG) guidelines on Inflammatory Bowel Disease (IBD) - 2019

Lamb, Christopher Andrew et al. “British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.” Gut vol. 68,Suppl 3 (2019): s1-s106. doi:10.1136/gutjnl-2019-318484

https://pubmed.ncbi.nlm.nih.gov/31562236/

For interested listeners, these are the national guidelines for IBD diagnosis and management. Please note, the new guidelines for 2025 are pending release.

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In this episode of RCP Medicine podcasts Dr Racheal Cheek and Dr Ben Chadwick discuss a common presentation to Acute Medicine. We use this as a springboard to discuss the differences that near patient testing can make in assisting rapid diagnosis and management on the Acute Medicine Unit, and how this can influence length of stay.

Dr Ben Chadwick is an Acute Medicine Consultant at Southampton General Hospital. He has a specialist interest in Medical Education and has previously been Training Programme Director for Acute Internal Medicine in Wessex and has chaired the Acute Internal Medicine Specialist Advisory Committee. He has recently been appointed to the Deputy Registrar role at the Royal College of Physicians.

Dr Racheal Cheek is an Acute Internal Medicine Registrar training in Wessex. She has been Chief Resident at University Hospitals Dorset, leading projects focused on improving patient safety. She is embracing new adventures whilst currently on maternity leave.   

Resources

Clinical impact of syndromic molecular point-of-care testing for gastrointestinal pathogens in adults hospitalised with suspected gastroenteritis (GastroPOC): a pragmatic, open-label, randomised controlled trial. Brendish, Nathan J et al. The Lancet Infectious Diseases, Volume 23, Issue 8, 945 - 955

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Episode 50 onward - Bensound.com

Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas