Andrew Papanikitas

Andrew Papanikitas
University of Oxford | OX · Department of Primary Care Health Sciences

BSc (Hons), MA, MBBS, PhD

About

103
Publications
10,683
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254
Citations
Additional affiliations
July 2018 - July 2019
University of Oxford
Position
  • Researcher

Publications

Publications (103)
Article
Full-text available
In the UK, genomic health data is being generated in three major contexts: the healthcare system (based on clinical indication), in large scale research programmes, and for purchasers of direct-to-consumer genetic tests. The recently delivered hybrid clinical/research programme, 100,000 Genomes Project set the scene for a new Genomic Medicine Servi...
Article
The technical advances of genomic medicine have been well described in recent years, in the medical as well as public media. The social aspects of these advances have significant implications for primary care. GPs have previously ‘done genomics’ simply by the act of taking a family history from a patient and interpreting that history as part of ord...
Technical Report
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In partnership with two academics from Oxford University, The UK Parliamentary Office of Science and Technology participated in a series of teleconference meetings with a range of stakeholders in healthcare, academia, commercial genomics and the 3rd sector. We held a total of five meetings between May and July 2020, each attended by up to nine stak...
Article
Full-text available
Background: Placebo or sham controls are the standard against which the benefits and harms of many active interventions are measured. Whilst the components and the method of their delivery have been shown to affect study outcomes, placebo and sham controls are rarely reported and often not matched to those of the active comparator. This can influe...
Article
Background Clinical commissioning involves ethically challenging decisions about health resource allocation. However, commissioners come from a range of professional backgrounds with varying levels of training and expertise in ethical decision-making. Hence, they may lack the relevant training and resources to feel fully prepared for this increasin...
Article
Background: Poorly described placebo/sham controls inhibit appraisal of active intervention benefits and harms. The 12-item Template for Intervention Description and Replication (TIDieR) checklist was developed to improve the reporting of active intervention components. The extent to which TIDieR is used to guide description of placebo or sham con...
Article
Full-text available
Background: People's social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients' socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients' socioe...
Article
The House of God is a seminal work of medical satire based on the gruelling internship experiences of Samuel Shem at the Beth Israel Hospital. Thirteen ‘Laws’ were offered to rationalise the seemingly chaotic patient management and flow. There have been large shifts in the healthcare landscape and practice since, so we consider whether these medica...
Article
A commitment to safeguarding confidentiality is essential in ensuring patients’ trust. With increasingly complex models of healthcare, changing uses of personal patient data, and sharing of patient information between services, confidentiality can be difficult to maintain in the day-to-day practice of primary care. This article summarises the ethic...
Article
Full-text available
This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation conc...
Article
Full-text available
ABSTRACT This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisa...
Article
Full-text available
The RCGP conference, like other annual healthcare conferences offers a protected space for reflection on ethical aspects of practice. This paper presents a summary and discussion of a fringe session led by the RCGP Committee On Medical Ethics at the 2017 RCGP annual conference in Liverpool. Well thought-out rules offer a potential solution to the b...
Chapter
Jani and Papanikitas examine defensive medicine as a markets-related phenomenon that has increasing prevalence across healthcare systems globally. They divide defensive medicine into two broad categories: Positive defensive medicine, or assurance behaviour, occurs when unnecessary services are provided to patients to reduce the chance of patients t...
Poster
Full-text available
A collaboration of five clinical commissioning groups (CCGs) was surveyed to assess ethical training received and what commissioners perceived as ethics educational needs.
Article
GPs in the UK have been involved in commissioning healthcare for years; well before the Health and Social Care Act of 2012. In this article, we discuss the ethics of commissioning and resource allocation as an essential skill for all GPs. Limitations in resources for healthcare, need and expectations result in difficult decisions, which need to be...
Article
Professionalism is a key component of good general practice, and self-awareness is a key component of professionalism. Being self-aware means understanding your own fitness to practice as a GP. It is a critical skill for ePortfolio reflections and appraisals, as it is a critical skill for good practice. In this article I will offer an approach to p...
Article
Everyday clinical dilemmas in general practice may not always be recognised as involving ethical challenges. Such cases will typically make the GP feel a bit uncomfortable and uncertain. Ethics is often seen as relevant to abstruse and complicated cases, such as cases concerning genetic testing for Huntingdon’s chorea or the reckless patient with a...
Article
Full-text available
An ethically problematic clinical case is used to illustrate the potential importance of understanding clinical ethics in an interdisciplinary context. Whilst much has been written on ethics education for multidisciplinary and interdisciplinary teams, we argue that it is important that both healthcare professions and healthcare teams are able to lo...
Article
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In this paper I discuss the ways in which the conference stream ethics and values manifested at the 2015 RCGP Annual Conference in Glasgow, and the ways in which it is planned for the 2016 RCGP Annual Conference in Harrogate. The 2015 RCGP had plenaries, oral presentations, breakout symposia, a debate, and a poster stream. I briefly discuss each in...
Poster
Full-text available
Research problem: We discuss a notional field of primary care ethics and ways that it may be usefully defined within the bioethics literature. We will discuss: Whom does it concern? What disciplinary approaches might inform the field? And what might such a field offer? Findings: Primary care ethics has predominantly been a guise of general practice...
Poster
Full-text available
The purpose of this paper is to explore what inter professional ethics in the primary care context ought to be like. Inter professional care is the process in which different professional groups work together to improve the delivery of health care, its underpinning premise being to promote the well being of the patient. Inter professional working t...
Article
Full-text available
In advance of a medical conference on the duty of candour for medical ethics educators, this paper discusses the duty of candour as a significant development in the culture of medicine. Those who teach medical ethics need to assess its implications for their own practice. It is also a duty that needs to be critically examined in light of both patie...
Article
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We comment on a paper published in the same issue of the London Journal of Primary Care. We applaud Bow's engagement with the ethical issues in a previous LJPC paper but argue that further work is needed to establish the everyday moral concerns of health care workers in primary care. We also suggest that the ethical distinction between advice and m...
Conference Paper
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This short paper is the annotated version of a three minute 'elevator pitch' which was presented at the NIHR collaboration for leadership in applied health research and care (CLAHRC) Oxford stakeholder symposium on 11 th December 2014 at St Anne's College Oxford Translational approaches to medical research aim to improve links between science and a...
Conference Paper
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Moral outrage at abuses in the name of medical research have led to a complex array of research ethics procedures. In this talk we outline some of the history and rational for medical research ethics as well as point out some special features of the primary care setting.
Conference Paper
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Background: We suggest there is a field of enquiry within medical ethics which is referable to, and growing out of, primary care, which draws attention to the ‘ordinary’ ethical dilemmas faced by family doctors in their daily practices. In the UK, as 95% of doctor patient interactions occur in the primary care setting, this has important implicati...
Article
Full-text available
Primary care ethics is a field of study that has recently found new life, with calls to establish the relevance of ethical discussion in general practice, to gather a body of literature and to carve out an intellectual space for primary care on the academic landscape of bioethics. In this report, we reflect on the key strands of the 4th primary car...
Article
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The development of shared electronic records has been galvanised by initiatives to improve the information technology infrastructure of healthcare and by fragmentation of healthcare provision. This report uses a public discussion by the RCGP Ethics Committee, Patient Participation Group and the Informatics Group to review key issues relating to sha...
Conference Paper
Full-text available
Family medicine educators who are asked to teach internationally will face numerous challenges as they work to adapt their knowledge and expertise to fit local needs. • Information, training and support for doctors migrating to the UK give little emphasis to professional and ethical standards • Local cultural nuances may require additional training...
Article
Full-text available
In a previous issue of the BJGP , Papanikitas and Toon use a fictional narrative to illustrate the ethical components of an ordinary consultation.1 We discussed the narrative as a class as well as the questions posed by the authors, and would like to showcase our discussion as a way to decrypt some of the moral decisions and value judgements in thi...
Article
The development of shared electronic records has been galvanised by initiatives to improve the information technology infrastructure of healthcare and by fragmentation of healthcare provision. This report uses a public discussion by the RCGP Ethics Committee, Patient Participation Group and the Informatics Group to review key issues relating to sha...
Article
Full-text available
We present reflections on a conversation by two general practitioners about ethics in primary care. Our aim was to see if we could learn anything by exploring the differences in the framing and enactment of issues seen as 'ethical' between our respective geographies of practice. One of us is a GP in the first five years of practice, who is writing...
Article
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We report key themes arising from a postgraduate workshop organized by the King's Interdisciplinary Discussion Society (KIDS) held in April 2011. KIDS believe that health is a phenomenon that transcends disciplinary boundaries, and therefore issues relating to health care and medical ethics are best addressed with an interdisciplinary approach. The...
Article
This paper discusses confidentiality as a routine issue of concern to British general practitioners participating in a qualitative study as well as in contemporaneous practice literature. While keen to reflect on routine issues, such as confidentiality, participants who professed a lack of expertise in medical ethics also perceived reluctance or in...
Article
Full-text available
E thics has long been recognized as an integral element of primary health care 1. Despite the ubiquity of ethical challenges and dilem-mas in primary care, it remains a neglected domain in the world of bioethics. Accordingly, there have been calls to explore the ethical di-mensions of primary healthcare 2,3 On February 15 th 2011, the Royal Soci-et...
Article
The International Surgical Congress of the Association of Surgeons of Great Britain and Ireland takes place this year in Bournemouth, UK (11–13 May 2011). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Article
‘Primary care ethics has acquired a definitive place on the “bioethics map”’.1 Ethics has long been recognized as an important aspect of primary healthcare.2 But what are the ethical issues in primary care? How do GPs and other members of the primary healthcare team make moral decisions? How should they decide which actions are good, or right in a...
Article
Full-text available
‘Just a quick one doctor,’ The last patient on Friday afternoon gave Mike a big smile as he beckoned her into his room. He gave a sigh of relief and returned the smile as she sat down. It was 20 past 5, and catching the train to London to meet an old friend seemed a realistic prospect. The afternoon had run to time: one person with complex emotiona...
Article
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A 'for example' requiring more information During a 10 minute appointment for a sore throat, a 13 (nearly 14) year old girl divulges to her GP that she has just met her first 'proper' boyfriend. She asks for advice about contraceptives. When asked, she states that her parent are unaware of her relationship and she plans to tell them when she is old...
Article
A recent article in the March 2009 edition of Clinical Ethics stated that, ‘In the Summa Theologica, Thomas Aquinas discusses how murder may be justified in self defence’, provided that killing is not intended. This statement is open to challenge on historical and semantic grounds, with respect to the writings of the 13th Century Roman Catholic phi...
Article
The authors use a composite case based on their experiences to illustrate the ethics of inter-professional conflict. An HDU team receive two telephone calls. One is from the patient's cardiologist, who states that a patient must be anti-coagulated without delay. The other is from the surgeon responsible for the patient's current admission, who stat...
Article
‘No one takes statins in Scandinavia.’ Neville, a well-meaning GP registrar, had offered to treat the smartly suited Mr James for his alarmingly high blood cholesterol. The retaliative pronouncement seemed to be a secondhand truth, questionable both in its veracity and its relevance: ‘My herbalist says that no one in Scandinavia takes statins, beca...
Article
The Doctrine of Double Effect has been described as often used in medicine and surgery but is seldom described outside the palliative medicine context. This paper presents a possible clinically focussed illustration of the doctrine of double effect used in an acute urological setting. The authors describe the case of an elderly patient with signifi...
Article
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Article
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The end of the 20th century has seen the endorsement of patient-centeredness as a core component of any clinical consultation. Doctors working within or contracted to the NHS are increasingly seen less as autonomous professionals and more as civil servants, answering to a number of masters. In the post-millennial NHS where do the boundaries of pers...
Article
There are times when inter-departmental politics or indifference may sometimes spill onto service provision and threaten to affect patient care. There can be no doubt that an emergency section cannot be delayed indefinitely. An unstable child who requires NICU or transfer can potentially occupy both Paediatric SHO and Registrar for hours. This arti...
Article
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Article
In the past decade, the teaching of surgery in the undergraduate curriculum has undergone considerable changes in quantity, mode and method of delivery. This is a result of the radical reforms of higher education, the health service and the undergraduate medical curriculum. These reforms are often interrelated and are occurring in conjunction with...
Article
In the past decade, the teaching of surgery in the undergraduate curriculum has undergone considerable changes in quantity, mode and method of delivery. This is a result of the radical reforms of higher education, the health service and the undergraduate medical curriculum. The changes are complex and require us to ask the questions: how important...

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Projects (3)
Project
Genetic testing can increasingly provide risk information which might predict future disease development and guide medical or lifestyle planning. While genetic risk prediction might offer potential benefits to healthcare services and society, and to individuals who can buy or access testing, there may also be costs and harms. A number of commercial providers and UK Government programmes are, or expect to generate personal genetic risk information and people might reasonably expect the NHS to advise and manage their risk, for example by having regular screening. However for many kinds of genetic risk information, interpretation is at present unclear, and it is not known how risk should be managed. The partnership, between researchers in clinical genomics/ethics and the Parliamentary Office of Science and Technology, will organise a stakeholder meeting bringing together relevant professional bodies, researchers and policy makers to identify evidence required to inform policy and a future funding application. The partnership will encourage mutual policy and research communication, influencing research design, delivery, dissemination and contribution to policy. Genetic testing to understand causes of disease has traditionally been performed in the NHS with a clear rationale for testing, informed by professional guidelines and evidence. To promote equity of access, accuracy and utility, genetic tests are offered to appropriate patients and performed and interpreted by accredited laboratories. NHS genetic counselling educates about the implications of possible results, directs medical screening, informing of relatives, and provides psychosocial support. Understanding how and why the public are interacting with genomic information outside traditional healthcare models, and how receipt of this information meshes with the NHS, is needed to ensure development of a policy position that prioritises benefits to individuals and publicly-funded healthcare systems.