General medicine: what a consultant physician does, conditions seen and how referral works

General medicine looks after adults when the problem is not neatly confined to one organ. A patient with weight loss, breathlessness and anaemia, or with tiredness, joint pains and abnormal blood tests, may need a physician to pull the threads together before deciding which specialist, if any, is needed. It also covers the care of people living with several long-term conditions at once, such as high blood pressure, diabetes and kidney disease, where the treatments interact.

In hospitals the specialty usually includes acute medical care for people admitted as emergencies. In the outpatient setting, a consultant physician sees referred patients with undiagnosed symptoms, abnormal results and complex health problems. Most consultants combine general medicine with a subspecialty such as diabetes, respiratory, cardiology, gastroenterology, rheumatology or care of older people.

High blood pressure usually causes no symptoms, according to the NHS, which says the only way to know is to have it checked. It lists risk factors including age, family history, Black African, Black Caribbean or South Asian background, a high-salt diet, being overweight, smoking and heavy drinking. Untreated, it raises the risk of heart attack, stroke, heart failure, kidney disease and vascular dementia, and lowering it even a small amount helps.

Type 2 diabetes causes tiredness, passing more urine, constant thirst and weight loss, though not everyone has symptoms. The NHS says it is diagnosed with a blood test of glucose levels, and people at higher risk include those who are overweight and inactive, have a close relative with diabetes or have high blood pressure. Prediabetes means glucose is raised but not enough for a diagnosis.

Tiredness and persistent cough are two of the most frequent unexplained symptoms. For fatigue the NHS lists poor sleep, stress, depression, hormonal change, illnesses such as glandular fever and COVID-19, sleep apnoea, anaemia, diabetes, an overactive thyroid and ME/CFS among the possible explanations. For cough, the NHS says most are caused by colds or flu, but smoking, acid reflux, allergies, bronchitis and mucus dripping down the throat can also be responsible, and it adds that a cough is rarely a sign of something serious such as lung cancer.

The NHS says that when a GP assesses a cough they might listen to the chest, test a mucus sample, order an X-ray, allergy test or lung function test, and rarely refer to a hospital specialist. A physician typically goes further by combining these with a full history, examination and a review of medicines.

The NHS Health Check is a free check of heart and blood vessel health for people aged 40 to 74 without existing conditions such as heart disease, diabetes or high blood pressure, offered every 5 years. It usually takes 20 to 30 minutes and includes height, weight, waist, blood pressure, cholesterol and possibly a blood sugar test, and gives a 10-year cardiovascular risk score.

Private health assessments and longevity-style panels are marketed alongside general medicine. They can find treatable problems, but a broad panel also raises the chance of borderline results that lead to more tests. It is worth asking what each test is for, which results would change management, and who will explain and follow up the findings.

• Endocrinology and diabetes for thyroid, hormone and complex diabetes problems.

• Cardiology for chest pain, rhythm problems and difficult high blood pressure.

• Respiratory medicine for persistent cough, asthma, COPD and breathlessness.

• Gastroenterology and hepatology for digestive symptoms and abnormal liver tests.

• Rheumatology for joint, muscle and autoimmune conditions.

• Nephrology for kidney disease and persistent protein or blood in the urine.

• Care of older people for frailty, falls and multiple medicines.

On the NHS, a GP is the usual gateway. The NHS says you cannot generally refer yourself to a hospital specialist, that your GP may first suggest tests or treatments to see if things improve, and that a specialist will only see you with a letter of referral. For non-urgent referrals the NHS Constitution gives a right to start consultant-led treatment within 18 weeks, with exceptions such as clinical reasons for waiting. In England, you may have the right to choose your hospital and consultant-led team for the first outpatient appointment.

If you want to see a private specialist, the NHS advises still getting a letter of referral from your GP, and notes your GP is not obliged to accept the specialist recommendations. Insurers usually require a GP referral and approve tests in advance. Costs depend on consultation length, tests ordered, scans, and follow-up appointments, so ask for the likely range and what is included before starting.

Call 999 for sudden chest pain that does not go away, pain spreading to the arm, neck, jaw or back, or chest pain with sweating, sickness, light-headedness or breathlessness. These can be a heart attack, as the NHS notes. Use NHS 111 or an urgent GP appointment for frequent headaches or blurred vision with high blood pressure, a cough that is very bad or quickly worsening, coughing up blood, or breathing difficulty. Unexplained weight loss or a cough lasting more than 3 weeks should be seen by a GP rather than left.