How do we navigate our way to focusing on sickness, suffering, and symptoms when the zones are flooded?

To borrow a phrase from American football, Donald Trump is flooding the zone. The NHS is flooding the zone. Even medical journals are flooding the zone. Pity the citizen, health professional, or reader left bewildered by a barrage of executive orders, bureaucratic healthcare edicts, and journal articles. What to do? How do you fill the unforgiving 27 hours (the time required each day for a US physician to follow guideline recommendations) with 97 200 seconds of worthwhile work?

About half of those 27 hours are needed to provide preventive services—an untenable situation with which primary care doctors in any country will empathise. Minna Johansson and colleagues argue perceptively that the premise of primary care is now fundamentally flawed in that the focus has shifted “to prevent disease in lower risk populations” (doi:10.1136/bmj-2024-080811),1 leading to the collapse of primary care. Primary disease prevention should return to being the responsibility of an adequately funded public health service, supported by appropriate national level interventions. Primary care can then “focus on people who are sick, suffering, and symptomatic.”

The UK government’s proposed shift towards prevention is sensible but complicated. If the burden falls more heavily on GPs it’s doomed to fail. Helen Salisbury points out the mismatch between prevention rhetoric and a 5% cut in public health grants to run prevention services (doi:10.1136/bmj.r232).2 Work related to screening and immunisation already defaults to general practices when it might be provided otherwise, especially given the misinformation that has beset vaccination policies (doi:10.1136/bmj.r199).3 At the same time, since the return on investment in prevention is long term, current service provision continues to be compromised by the challenges of hospital overcrowding (doi:10.1136/bmj.r171)4 and the workforce issues that the Leng review of physician associates hopes to help resolve (doi:10.1136/bmj.r145).5

Work demands are furthered by NHS leadership deficiencies (doi:10.1136/bmj.r227),6 poor obesity services (doi:10.1136/bmj.r229),7 and the emerging risks of GLP-1 agonists (doi:10.1136/bmj.r205)8 as we discover more evidence of irregular financial relations with the companies promoting these drugs (doi:10.1136/bmj.r178).9 You might be better advised to seek clinical solace and wisdom in our updates on HIV in primary care (doi:10.1136/bmj.r129),10 post-traumatic stress disorder (doi:10.1136/bmj-2024-079458),11 and endometriosis (doi:10.1136/bmj.q2782).12 If you’re seeking guidance on deploying artificial intelligence in healthcare—the topic of the moment—we can help with that too (doi:10.1136/bmj-2024-081554).13

In the contexts of clinical practice and health policy, the provenance of information to support decision making is central. Would you trust evidence submitted by McDonald’s to support a planning permission application for a fast food restaurant near a school (doi:10.1136/bmj.r163 doi:10.1136/bmj.r198)?1415 How do you judge the verdict of a team of experts assembled by Lucy Letby’s lawyers (doi:10.1136/bmj.r250)?16 What do you make of Trump fuelling a regional trade war on the pretext of cross border fentanyl smuggling, when US health experts argue that a response driven by law enforcement will “fail all US communities” (doi:10.1136/bmj.r225)?17 When every zone is flooded, from politics to clinical practice, where do you start? After your 27 hours of relentlessly following clinical guidelines, how do you clear your head enough to focus on what matters?