October 19, 2021 by Gogodoc Editor 0 Comments


Have you ever wondered how the ‘pill’ works?

The pill is a birth control method that is designed to stop the egg from joining with sperm. It also stops ovulation, which means there is no egg for the sperm to fertilise, therefore the probability of pregnancy is reduced. It’s 99.9% effective when taken correctly.

A few side effects to birth control include:

– Headaches and Migraine

– Vaginal discharge

– Mood changes

– Nausea

For more information please do not hesitate to book a telephone or video consultation with our GP today: https://gogodoc.com

October 19, 2021 by Gogodoc Editor 0 Comments


Are you getting enough sleep but still feeling tired?

This may be a sign of anemia. Anemia is characterised by a decrease in the number of red blood cells generated, or in the amount of haemoglobin in the blood. A few signs and symptoms include:

– Fatigue

– Headaches

– Pale Skin

– Sore mouth/tongue

At Gogodoc, we offer private blood tests you can perform at home. Find out more here: https://gogodoc.com/bloodtest/ or book a telephone/video consultation to get expert advice.

July 13, 2021 by Gogodoc Editor 0 Comments

Cardiovascular Disease

The 5 Major Risk Factors for Cardiovascular Disease & How You Can Reduce Your Risk.

Cardiovascular disease (CVD) is an umbrella term for a prevalent group of conditions affecting the blood vessels and heart. These include conditions such as coronary heart disease, strokes, aortic disease and peripheral arterial disease. The good news is that many risk factors for CVD are modifiable. This article lists the five leading risk factors and briefly outlines active measures you can take today to reduce your risk of developing CVD.

1- High blood pressure (hypertension)

High blood pressure can silently lead to the thickening and hardening of your arteries, increasing the risk of complications such as heart attacks, strokes, and aneurysms. An ideal blood pressure reading is between 90/60mmHg and 120/80mmHg, whereas pressures consistently above 140/90mmHg are classified as hypertension.

2- Abnormal blood cholesterol levels

Cholesterol is a substance produced by our livers that maintains cell integrity and acts as a precursor for steroid hormones, vitamin D and bile acids. However, high cholesterol levels due to dietary habits can increase the risk of plaques forming on arterial walls and lead to subsequent narrowing and reduced blood flow.

There are two types of cholesterol known as LDL (low-density lipoprotein) – the “bad” cholesterol, which contributes to the build-up of arterial plaques, and HDL (high-density lipoprotein) cholesterol – the “good” cholesterol, which has a protective role in the cardiovascular system. Too much LDL cholesterol and too little HDL cholesterol can increase cardiovascular risk.

3- Obesity

Excess body fat can lead to abnormal blood cholesterol levels and hypertension, as described above. Furthermore, obesity increases the risk of developing diabetes, which increases the risk of heart disease by two to four times.

4- Smoking

Smoking or tobacco use harms the cardiovascular system in many ways, from impairing the oxygen-carrying capacity of the blood to raising blood pressure and damaging the arterial walls. Consequently, there is a greater risk of heart attacks. Second-hand smoke exposure can still carry the same effects as above.

5- Sedentary Lifestyle

A lack of exercise can contribute to the first three major risk factors mentioned above. Regular exercise not only improves your circulatory system and makes the heart more robust, but it also improves muscle function and the body’s ability to use oxygen.

Tips on how you can reduce your risk of cardiovascular disease.

  • Eat a balanced diet that is low in saturated fat, low in salt (less than 6g a day) and sugar. Try to eat 5 portions of fruits, berries and vegetables each day.  
  • Be active and try to achieve at least 30 minutes of modest activity such as walking for at least five days per week.
  • Maintain a healthy body weight.
  • Drink less caffeine and avoid or reduce your alcohol intake.
  • Stop smoking and avoid exposure to second-hand smoke. 
  • Control your blood pressure by following the guidance from your doctor. 

To find out more about cardiovascular disease, what treatment options are available to you and how you can better manage your symptoms, please feel free to book an appointment with one of our GPs by either visiting our website or call us on 0203 371 0995.

April 21, 2021 by Gogodoc Editor 0 Comments


What is osteoarthritis? 

Osteoarthritis (OA) is a degenerative joint disorder characterised by gradual deterioration of the cartilage that cushions the bones, which results in joint pain and stiffness that worsens on physical activity.1 OA is the most common form of arthritis in the UK, typically affecting the knee, hip, hands and lower and upper spine.

OA can be a debilitating condition and can impact your day-to-day activities. Fortunately, by undertaking certain lifestyle modifications and self-help measures, you can reduce the symptom burden. So here are three key areas where you can start managing your symptoms right now.

  • Exercise & Weight Management

It may seem counterintuitive to increase physical activity if exercise triggers joint pain and stiffness. However, research has shown that low-impact exercises such as walking can significantly improve your symptoms in the long term by strengthening the muscles that support the joint, reducing overall body weight and improving your mood at the same time. Exercise can reduce osteoarthritis symptoms for 2-6 months even after stopping exercise and helps reduce the risk of developing other chronic diseases such as diabetes.2 

It is also crucial to manage your weight and stick to a healthy diet, as excess weight can increase the strain placed on your joints, particularly the knee and hip joints.

You may find it helpful to discuss any weight management and exercise plans with your GP or physiotherapist and dietician to identify the most suitable exercises and dietary goals.

  • Pain Management

If you have been diagnosed with OA, your doctor would have discussed potential pain medications with you. Typical medications include capsaicin cream, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDS) and steroids. You should aim to take pain medication as instructed by the doctor to help alleviate any discomfort. Hot and cold packs such as using a hot-water bottle and assistive devices such as footwear with special insoles can help reduce pain further. 

It would be helpful to discuss your current pain management and experience with your GP so that further medication and therapies can be explored if none of the above is working for you. 

  • Relaxing & Sleeping Well

Relaxation therapies such as meditation and breathing techniques that get you to focus on breathing or a particular sound can help manage stress and pain. You can learn these techniques using online resources or by attending classes. If you would like to explore alternative therapies, please speak to your GP for further information. 

Poor sleep can exacerbate the pain you experience, which can affect your sleep further. Try to establish a routine where you go to bed and wake up at roughly the same time each day. Try also to avoid drinks containing caffeine or looking at digital screens before bedtime.

If you would like to find out more about osteoarthritis, what treatment options are available to you and how you can better manage your symptoms, please feel free to book an appointment with one of our GPs by either visiting our website or call us on 0203 371 0995.


1. VersusArthritis. Osteoarthritis (OA) | Causes, symptoms, treatments [Internet]. 2021 [cited 2021 Apr 20]. Available from: https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/

2. Fransen M, McConnell S, Harmer AR, van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: A Cochrane systematic review [Internet]. Vol. 49, British Journal of Sports Medicine. BMJ Publishing Group; 2015 [cited 2021 Apr 20]. p. 1554–7. Available from: http://dx.doi.org/10.1136/bjsports-2015-095424

April 7, 2021 by Gogodoc Editor 0 Comments


Whistle-stop tour of acne

What is it?

Acne is caused by glands under the skin producing too much oil (sebum). This can block the pores, which become infected with bacteria. Your body’s natural response to an infection is inflammation – visually, this is when the skin becomes red, the spots become larger and filled with pus. 

Through this process, the spot will eventually heal but it can reoccur and cause scarring.

Who gets it?

It’s most common in adolescents (85% of 16-18 year olds) and young adults (up to age 25) due to a change in hormone levels, but it can really occur at any age for a variety of reasons [1]. 

What causes it?

A variety of factors contribute to the development of acne and the exact mechanisms are poorly understood. The most common causes of acne are:

  • Hormones – most notably during puberty, in young people. The hormones can cause the pores to enlarge and produce more sebum, leading to greasy acne-prone skin [2].
  • Bacterial colonisation – it is unclear whether these are intrinsic to skin type or from the environment.
  • Genetics – there is a strong link with family history. If your parents have or had acne when they were younger you are more likely to develop acne in general.
  • Stress – when you’re stressed, your body produces more cortisol which may contribute to the development of acne.

Other conditions can lead to a flare up of acne [3]:

  • Polycystic ovarian syndrome (PCOS) – linked with an increase in certain hormones called androgens that are strongly associated with acne.
  • Medications – such as steroids (topical/oral/injected), isoniazid, hormonal treatment, certain antiepileptics and lithium.
  • Mechanical trauma – such as tight clothing causing abrasion.
  • Makeup/Cosmetics

Contrary to popular belief, there’s actually no strong link between eating fatty foods or chocolate and acne.

What can be done about it?

There are some treatments you can use over-the-counter (OTC) and some that require a doctor to prescribe them. It’s different if you’re pregnant and you need to speak to the doctor for a specific treatment. 

For mild acne [4]

The treatment with the best evidence are topical retinoids which you can buy OTC but some versions require a prescription. They help by unblocking the skin pores but like all treatments for acne, they take at least several weeks before you see results. Similarly, some people will have side-effects such as sunburn but these will settle down after a few weeks.

If you have acne with inflammation then a doctor may prescribe a combination of:

  • Topical retinoid cream
  • An antibiotic (either a cream or tablet) AND/OR benzoyl peroxide cream

For more severe or resistant acne

This is if you have a large number of spots with severe inflammation, pus and blocked pores. The best treatment for this is isotretinoin and can be associated with a range of side-effects so it will need to be prescribed by a dermatologist under specialist supervision.


Having acne can not only feel uncomfortable but it can really impact your mental health. If you are worried always consult your doctor for clarification. For more information and advice please feel free to book an appointment with one of our GPs by either visiting our website or call us on 0203 371 0995. This article is not intended to be medical advice!


[1] https://www.dermnetnz.org/topics/acne 

[2] Gollnick HP, Zouboulis CC, Akamatsu H. Pathogenesis and pathogenesis related treatment ofacne. J Dermatol. 1991 Sep;18(9):489-99.

[3] https://www.nhs.uk/conditions/acne/causes/ 

[4] https://www.nhs.uk/conditions/acne/treatment/

March 19, 2021 by Gogodoc Editor 0 Comments

Fever in a child

My child has a fever – should I be worried?

Caring for an ill child can be a very daunting experience for parents and carers, especially if you are not from a medical background. Hopefully, by the end of this post, you should be better informed and have a clearer idea of what to look out for in a child over 6 months old (signs can be very different in younger children). 

First of all, a fever (temperature above 38℃) is a healthy response to help fight infections so a fever alone is not concerning and will not harm your child. However, there are certain features that can help guide some diagnoses. 

It’s also important to note that MOST children with fever will get better within 5 days and will not get better with antibiotics, as they are caused by viruses. 

In cases that seem out of the ordinary there are ways to figure out how serious it could be…

A system that doctors use for assessing how serious a fever can be is the Traffic light system (NICE clinical guidelines, 2019). It looks complicated but will seem like common sense and become easier to read if we think about the first column first:

  • Colour – risk increases as the lips or tongue change colour (white/grey/blue)
  • Activity – risk increases if the child moves less than usual (this might be very clear if your child is usually very energetic)
  • Respiration (breathing) – risk increases if they are struggling to breathe (using their body or muscles to breathe in/out) or breathing faster than usual (‘tachypnoea’)

NOTE: The number of breaths to be worried for will depend on the age and is best assessed by your doctor.

Circulation and hydration – risk increases if their heart rate is a lot faster than usual, if they’re mouth is dry, if they are feeding 50% less than usual (infants: less than 1 year old), if their nappy is drier than usual or if they are peeing less than usual.

NOTE: Again…The heart rate, ‘CRT’ (Capillary Refill Time) and Urine output will depend on the age and is best assessed by your doctor.

OTHERS (‘Red flags’):

  • Duration of fever – you should call the doctor immediately if the fever has been going on for 5 days or more. This can be a sign of a more serious infection. 
  • In infants (less than 12 months) a worrying temperature depends:
    • Aged 3-6 months → temperature ≥ 39℃ 
    • Aged less than 3 months → temperature ≥ 38℃ (i.e. ANY fever in a child less than 3 months is worrying).
  • ANY of these signs need medical attention:
    • Swelling of the arms/legs/joints
    • ‘Non-blanching rash’ (see below)
    • Neck stiffness 
    • Seizures (shaking uncontrollably)
    • Difficulty in moving or feeling a part of their body
    • If they’re unconscious 
    • Bulging fontanelle (the open part of the head in infants)

What is a ‘non-blanching rash’ and what does it mean?

Meningitis is a serious and potentially life-threatening condition. 

A tell-tale sign of this serious infection is a ‘non-blanching rash’ accompanied by a fever and/or neck stiffness. 

The doctor will want to rule this out and an easy way to do this is through the ‘glass test’: rolling a transparent glass over the rash (see image; right). If the rash doesn’t disappear then it is ‘non-blanching’, and will need an admission to A&E as soon as possible.

Thankfully, meningitis is rarer now because of the routine vaccinations that your child will receive over the next few months and years [3]


Taking care of a child with fever is a scary experience for any parent or carer but there are some clear signs for you to look out for. It should be reassuring to know that the vast majority of fever in children are normal, treated best conservatively (e.g. Paracetamol and/or Ibuprofen, a healthy diet and plenty of water). If you are worried always consult your doctor for clarification. For more information and advice please feel free to book an appointment with one of our GPs by either visiting our website or call us on 0203 371 0995. This article is not intended to be medical advice!


[1] https://www.nice.org.uk/guidance/ng143/resources/support-for-education-and-learning-educational-resource-traffic-light-table-pdf-6960664333 

[2] https://journals.sagepub.com/doi/abs/10.1093/innovait/inq070?journalCode=inoa (rash image)

[3] https://www.nhs.uk/conditions/meningitis/

March 18, 2021 by Gogodoc Editor 0 Comments

Irritable Bowel Syndrome

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a long-term condition characterised by recurrent abdominal pain or discomfort associated with changes in the stool’s form and frequency. The abdominal pain is typically accompanied by bloating and is relieved through defecation.

The central management plan for IBS is through dietary and lifestyle modifications. While the general IBS diet may effectively control symptoms in some patients, the use of probiotics and a low FODMAP diet are experiencing a rise in popularity due to recent studies identifying increasing evidence of their effectiveness. Hence, this article aims to provide a brief overview of the two dietary modifications that may help you control your IBS symptoms. 


Probiotics are beneficial live bacteria that are commonly added to certain foods and supplements such as yoghurt. The most effective and preferred probiotic for IBS contains the bacterium Bifidobacterium infantis (or other B infantis strains), which has shown in several studies to reduce some patients’ symptoms. When taking probiotics, it is recommended you take them regularly for four weeks to see how they affect your symptoms. If you do not see any changes, it might be worth trying a different strain probiotic. You should, however, discontinue taking a probiotic product if your symptoms worsen.

A low FODMAP diet

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, a group of short-chain carbohydrates that are poorly absorbed in the small intestine. As a result, they are readily fermented by colonic bacteria and cause water movement into your gut which can cause bloating, passing of gas, pain and diarrhoea. Recent evidence suggests that a low FODMAP diet can significantly decrease IBS symptoms compared to a high-FODMAP diet.1

To follow a low FODMAP diet, you should aim to eat fewer foods containing lactose (found in Cow’s milk, yoghurt, cheese), fructose (in sweeteners and fruits such as apples and pears), fructans (found in vegetables such as broccoli and garlic, wheat and rye), oligosaccharides (in chickpeas, kidney beans) and polyols (found in sweeteners, fruits and vegetables such as cauliflower and mushrooms).2

On the other hand, there are also foods you should increase your intake of; these include cucumber, bean sprouts and lettuce; fruits such as bananas and blueberries; protein through beef, chicken and fish; and grains such as rice and quinoa.

To find a more extensive list of foods you should avoid and foods you should eat more of, visit https://www.ibsdiets.org/fodmap-diet/fodmap-food-list/.

However, it is essential to note that a low FODMAP diet’s fundamental aim is to reduce only problematic foods. You may find you can tolerate certain foods better than others, and some do have health benefits. More importantly, while a low FODMAP diet is better than a high FODMAP diet, there is little evidence of its effectiveness compared to the conventional IBS diet. 

If you have any concerns about IBS or would like to discuss dietary and lifestyle changes further with a GP, please feel free to book an appointment with one of our GPs by either visiting our website or call us on 0203 371 0995.


1.         Altobelli E, del Negro V, Angeletti PM, Latella G. Low-FODMAP diet improves irritable bowel syndrome symptoms: A meta-analysis [Internet]. Vol. 9, Nutrients. MDPI AG; 2017 [cited 2021 Mar 17]. Available from: /pmc/articles/PMC5622700/

2.         Try a FODMAPs diet to manage irritable bowel syndrome – Harvard Health [Internet]. [cited 2021 Mar 17]. Available from: https://www.health.harvard.edu/diet-and-weight-loss/a-new-diet-to-manage-irritable-bowel-syndrome

March 15, 2021 by Gogodoc Editor 0 Comments

Day in the life of a Doctor in private healthcare

Have you ever thought what a typical day in the life of a Doctor is? 

Have you ever wondered how a Doctor in private healthcare goes about his day? 

If the answer is yes to either of these questions (I hope it is) then today I will be breaking this down for you so you can get an insight into my day. 

So first let me tell you a little about myself first. My name is Ashish Srivastava and I am a qualified GP. I have been working with Gogodoc now for three years as a GP, and more recently as a Medical Director also.  

So my usual day involves me waking up around 7am. A glass of hot water with a slice of lemon is how I always start my day, followed by heading out for a 30 minute jog. This jog really clears my head and helps me feel motivated for the day ahead.  

I log myself online onto my Doctors app around 8AM. This is where I can see all my pre-booked appointments which are often a mixture of telephone calls, video calls and home visits. I will call patients for both telephone calls and video consultations via either my app or my laptop depending on how the patient has booked. 

Most of my day however, revolves around home visits. These again can be pre-booked or booked at any time during my shift. My hours on call are 8am to 11pm so as you can imagine, I have to always be alert and close to my phone! 

When calling a patient (for a home visit), I confirm the patient’s identity and then proceed to take a brief history. Based on this, I am trying to get an idea of what I may be dealing with so I can anticipate this on my visit, but most importantly I am assessing for any red flags, i.e. any signs or symptoms that would make me concerned that the patient may be in immediate serious risk to his or her health. 

Once I have taken the telephone history and ruled out any red flags, I make sure to confirm the address with the patient. It is important to do this to again confirm I have the right patient and that I am heading to the correct address. 

I always let the administrator know where I am headed so they are aware of my visit. This is good from a personal safety aspect but also so we can plan to co-ordinate other visits and calls following the visit. 

When I get to my patients house, I once again confirm the patient’s name, and show my ID badge to reassure the patient whom I am before I enter their house. I proceed with the consultation by taking a more detailed history. I prefer to make my notes as I talk to the patient to ensure I don’t forget anything later on. Following this, I will proceed to examine the patient, and together we will make a shared management plan. Usually this may involve me giving advice, and issuing the patient with a script. However, we also regularly arrange for patients to have referrals to a specialist done, provide medications to be delivered to the patient’s door, or a blood test pack sent. 

Once this is over and done with I will again be in contact with the admin and inform them that the consultation has been completed.  My admin team will then tell me what the schedule for the rest of the day is.  

Personally, I find this job great and what I love most about the job is the flexibility. I am able to do day to day tasks and admin while working. It’s a bit different to the usual 9 to 5. I also like the job as it provides a variety to my working week, as two days a week I also work in a clinic for an NHS surgery.  

I hope this insight into my day has been helpful, and I look forward to sharing more blogs with you in the future.  

Dr Ashish Srivastava MBChB MRCGP 

GP and Medical Director at Gogodoc.

March 3, 2021 by Gogodoc Editor 0 Comments

Top tips on how to stay well with asthma during cold and hot weather

As we all know, winter is the most prominent seasonal culprit for worsening asthma symptoms. However, hot and humid weather can also cause asthma symptoms to flare up. And with British weather being unpredictable as ever and our cold and hot days seemingly becoming more extreme, we thought we would cover some general and weather-specific tips on how you can keep your asthma under control this year.

General Tips (for both cold and hot days):

Continue taking your preventer inhaler to reduce the likelihood you will get symptoms and prevent asthma attacks.

Make sure your reliever inhaler is always with you so you can react if symptoms do appear.

Have a written asthma action plan so you know what to do if your symptoms exacerbate. Ensure your plan is kept visible (e.g., posting it on your fridge), share the plan with others, and check it once a month to keep it fresh in your memory. If you do not have an action plan, you can either ask your asthma doctor or nurse for one or print one out from Asthma UK’s website and take it to discuss at your next asthma appointment.

Attend your regular asthma reviews to check you are on the right medication and that you are taking the inhalers appropriately to get the best control over your symptoms.

Do not smoke, as smoking can increase the frequency and severity of symptoms.

Cold Weather Tips:

Wear warm clothing such as gloves, a hat and a scarf and stay dry if out in the cold. You could try loosely covering your nose and mouth with a scarf which prevents a gulp of cold air from triggering symptoms by warming the air you breathe.

Try breathing in through your nose instead of your mouth; again, this helps warm the air you breathe in.

Hot Weather Tips:

Check pollen forecasts as pollen is a common trigger of asthma symptoms. You can also use antihistamines to control your hay fever which will then benefit your asthma.

Plan outdoor activities such as exercise for earlier in the day as the air quality is much better then.

– Keep inhalers in a cool and dry place to ensure they continue to work. Place inhalers in a cool bag when travelling. 

Experiencing asthma flare-ups during cold and hot days can be troublesome and negatively impact your day-to-day activities. However, if you follow the above tips and keep attending your regular asthma reviews, you will be more than well-equipped to manage your asthma symptoms.

If you would like to find out more about asthma, please do not hesitate to book an appointment with one of our GPs here

March 3, 2021 by Gogodoc Editor 0 Comments

What is back pain?

Musculoskeletal (MSK) problems are very common, widely range from over 200 different conditions and represent 30% of all GP consultations. Among these, the number one complaint is ‘back pain’ [1]. 

Following this, most forms of back pain are focused in the lower back, or the ‘lumbar spine’. 

For the vast majority of cases, the cause of lower back pain is unknown (also known as “non-specific”), is usually self-limiting (lasting up to 4 weeks) and can be managed by [2]: 

  • Staying active – doing specific exercises that help the back. Swimming is a great way to do this without putting pressure on the spine.
  • Medication – Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and naproxen, but also paracetamol
  • Heat – some people find using a heated pad helps to relieve the pain
  • Acupuncture 
  • Massage 

If none of these help, there are more options that the doctor can offer or advise you on.

Back pain: when should I be worried?

As mentioned, the sinister causes of back pain are reassuringly rare – around 85% are non-specific and therefore do not have a worrying cause such as cancer (which is even rarer, at 0.7%, and has tell-tale signs that will be picked up by a professional) [3]. 

The main objective of the doctor is to rule out the more alarming causes of back pain. These are the red flags [4]:

  • Cauda equina syndrome – this is when the lowest part of the spine is so compressed that it encroaches on the nerves exiting the spine. Signs are loss of bowel or bladder control, numbness/tingling sensation of the groin area and weakness or paralysis of the lower limbs.
  • Fracture of the spine – usually preceded by a history of trauma (e.g. car accident or fall from great height). Signs include a history of regular corticosteroid use, sudden onset of severe central spinal pain which is relieved by lying down, spinal deformity and tenderness over one particular bone (‘vertebra’) of the spine. 
  • Cancer – more common if you have a past history of cancer, particularly breast, kidney, prostate, thyroid and lung cancer. Signs include unintentional weight loss, age 50 years or older, gradual onset, thoracic pain (portion of the back connected to the ribs, see image) and constant severe pain that disrupts sleep and is worse on straining (e.g. on the toilet). 

Infection – usually accompanied by the regular symptoms of infection. Signs include fever, recent tuberculosis infection, history of IV drug use, diabetes or being immunocompromised or immunodeficient (e.g. HIV, use of immunosuppressants, chronic corticosteroid use or a pre-existing condition of the immune system).


MSK issues are one of the most common presentations to the GP in the UK and amongst the 200+ conditions, back pain is the most common. In turn, most causes of back pain are “non-specific” in that there is no alarming cause and it is self-limiting. There are a wide range of ways to treat this type of back pain and it should be noted that back pain goes away within a few weeks. 

If your back pain persists, it’s a good idea to call the doctor and seek referral for a physiotherapist. 

Sinister causes of back pain are reassuringly rare but should be picked up by a medical professional. For more information and advice please book a consultation with one of our GPs today: Gogodoc


[1] https://www.england.nhs.uk/ourwork/clinical-policy/ltc/our-work-on-long-term-conditions/musculoskeletal/ 

[2] https://www.acpjournals.org/doi/10.7326/0003-4819-160-11-201406030-01006?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed& 

[3] https://www.nejm.org/doi/10.1056/NEJM200102013440508?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed 

[4] https://cks.nice.org.uk/topics/back-pain-low-without-radiculopathy/diagnosis/red-flag-symptoms-signs/ 

Reference for image (wiki open source):