5 weeks of coughing in the night, a bit of weight off the belt, and colleagues who have started to comment. A persistent cough is not a cold that forgot to leave, and they already know that, which is why they are still awake. The question is not whether coughs happen in winter. It is which ones need a chest x ray, and which ones need 999 tonight.
Smoking history, breathlessness, blood, and weight loss change the next step. Sometimes it is inhalers. Sometimes it is a chest x ray. The exam decides. Severe breathing difficulty is 999, not a next day slot. Be seen at Clinique Alpa if it has gone on longer than you like.
Chest pain, signs of a stroke, severe breathlessness, heavy bleeding, a severe allergic reaction or symptoms of sepsis need 999 or A&E immediately. A clinic appointment is the wrong door for those.
When does a persistent cough need a GP?
The short version is this. A cough that is still here at 3 weeks is no longer an ordinary cold. NICE suspected cancer guidance treats an unexplained cough at 3 weeks, particularly in people over 40 and in people who smoke, as a reason to look, often starting with a chest x ray. That is routing, not a diagnosis.
People wait because it is January, or because they had a virus in the house, or because a pharmacy linctus took the edge off at 4pm. The pattern matters more than the single reading of “it is just a cough”. Night coughing that wakes you. Breath that has shortened on the stairs. A voice that has gone hoarse and stayed hoarse. Blood. Those change the next step.
If you cannot get a sentence out, if the lips are blue, or if the chest is heaving at rest, that is 999. Do not book us. Do not wait for morning.
What does the examination actually involve?
What I look at in clinic is duration, character, and the company it keeps. Dry or productive. Day, night, or both. Whether it followed a cold and never left, or started on its own. Whether you smoke now, used to, or never have. Whether you work in dust, fumes, or a classroom of winter viruses. Whether a blood pressure tablet was started in the last few months, because some of those are a tidy cause and the tidy move is to review the tablet with the clinician who started it, not to add a second problem.
Then the second layer. Weight. Appetite. Sweats at night. Reflux that comes up at 2am. A wheeze that is new. Hay fever that has become a year round drip. Heart failure that shows as a cough when you lie down, with swollen ankles by evening. Low mood and a cough that is keeping a household awake, because nobody sleeps when one person coughs every 20 minutes.
Examination is the chest, the throat, the nodes in the neck, the calves if I am thinking about clots, the ankles if I am thinking about fluid, oxygen saturation if we have it, and the simple act of watching you walk in and talk. I listen. I do not pretend that a clear chest ends the matter when the story is 6 weeks and a bit of weight loss. A clear chest is information. It is not a verdict.
The piece most people miss is that not every lingering cough is an infection, and not every infection wants antibiotics. Most lingering ones after a virus are inflamed airways that take time. Some are asthma that has not been named. Some are reflux. Some are the tablet. Some need a chest x ray this week because the story has blood, weight loss, or a smoking history that makes waiting a poor idea. I will say which of those I think we are in, and I will say when I do not know yet.
Bloods have a place when the story is systemic: the draw is £20 plus the specific test. A referral is £50 where a chest clinic or an urgent pathway is the honest next step after assessment. Inhalers, if the picture is wheeze and variability, are ordinary. Antibiotics, if the picture is bacterial, are ordinary. Neither is a prize for coming in, and neither is withheld as a personality test.
I cannot promise the cough will stop this fortnight. I cannot promise the x ray will be normal. I cannot promise a specialist will see you next week. You get an examination and a plan. You do not get a guaranteed outcome.
When should I come in sooner?
Some of this is 999. Some of it is the same day clinic. Have the list somewhere you can read it at 11pm.
- Severe difficulty breathing, lips that look blue, or being too breathless to speak: 999.
- Chest pain with the cough, coughing blood, or feeling faint.
- A cough with a fever, confusion, or you are so unwell you cannot get to the kitchen: that may be 999 or A&E rather than us.
- Unexplained weight loss, night sweats, or a cough lasting past 3 weeks, especially if you smoke or used to.
- A hoarse voice lasting past 3 weeks, or swollen glands that are not going.
- A child who is working hard to breathe, is floppy, or has a cough with a rash that does not fade: 999.
When this comes up in consultation I would rather arrange the x ray once too often than watch another month go by because everyone agreed it was winter.
How do we see this at Clinique Alpa?
Face to face at 466 Green Lanes, Palmers Green, or at home if you are too unwell to travel and this is not 999. A 30 minute GP appointment is £100. A home visit is £250 in the day and £450 at night, each up to an hour. Same day is subject to the diary. If we cannot see you and you are getting worse, A&E is the plan.
Read the same day private GP page if you need the next slot, or the home visiting GP page if the house is the safer room. Fees sit in full on the appointments and fees page. With your consent we send a short summary to your NHS GP so this does not become a private conversation the rest of your care cannot see.
If it has gone on longer than you like, be seen. If you cannot breathe, call 999.
Get a cough that has lasted weeks examined, not guessed. Read our fees page, or call 020 8882 8088. Home visits £250 day, £450 night, published in full. In an emergency call 999. Subject to availability.
Written by Dr Mitesh Parmar, MBBS MRCGP, GP and founder of Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.