One of the most fascinating aspects of running clinical Q&A services is seeing what questions clinicians actually ask. Looking back at questions submitted to the UK primary care Q&A services – ATTRACT in Wales and the NLH Q&A Service in England (both ended by early 2010s)- and comparing them with questions submitted to AskTrip (from 2025 onwards) gives us a rare opportunity to see how frontline clinical uncertainty has evolved over two decades.

There’s an important distinction: ATTRACT and NLH Q&A were exclusively used by primary care clinicians, while AskTrip has always had a broader, less clearly defined user base. This makes the comparison even more interesting: we’re contrasting the firmly primary care questions of the 2000s with a more mixed set of modern-day queries.

For this analysis, we focused on four common clinical areas: asthma, hypertension, depression, and diabetes. We identified relevant questions from AskTrip, then selected a matching set of questions from the historical ATTRACT/NLH archives. To give balance, we used the same number of questions for each condition across both sources. This approach doesn’t capture every question ever asked, but it provides a structured way to compare themes and see how the nature of clinical uncertainty has shifted over time.

Asthma: Same Worries, New Tools

  • Then (ATTRACT & NLH Q&A): Questions often focused on inhalers and safety: Should LABAs always be combined with steroids? Does tiotropium help in asthma? Is chlorine in swimming pools a trigger for atopic kids? These were very patient-specific, case-driven questions.
  • Now (AskTrip): Questions reflect newer therapies and broader patient groups: When should biologics be started? What’s the role of immunotherapy? How do you manage asthma in pregnancy or elite athletes?

The safety theme is consistent, but modern queries also ask about biologics, prevention, and life stages – reflecting advances in care and broader evidence.

Hypertension: From Protocols to Personalisation

  • Then: Practical queries dominated: How often should hypertensives have bloods checked? Which drugs are safe in pregnancy? These questions often referenced NICE guidelines or practical case scenarios.
  • Now: Broader and more diverse: What’s the best treatment for hypertension? Is renal denervation worth considering? What’s the malpractice risk of hypertension?

We’ve moved from nuts-and-bolts case management to personalised medicine (pharmacogenetics), lifestyle interventions, digital tools, and even system-level concerns.

Depression: Beyond Antidepressants

  • Then: Most questions were about drugs and safety: long-term use of dosulepin, SSRI interactions, depression risk from antihypertensives, safe prescribing in pregnancy, and whether statins cause low mood.
  • Now: The scope has widened: How effective is CBT vs medication? What about ketamine or esketamine for resistant depression? Does partner involvement help postnatal depression? Is St John’s Wort useful?

Clinicians still worry about safety, but there’s now far greater interest in therapy modalities, novel treatments, and patient-centred care.

Diabetes: Core Concerns, Expanding Horizons

  • Then: Focused on early prevention debates and older drugs: Is aspirin useful for primary prevention? Metformin vs sulfonylurea first-line? How much does each drug lower HbA1c? When to stop metformin in renal impairment?
  • Now: Questions reflect a complex therapeutic landscape: What’s the role of GLP-1s, SGLT2s, tirzepatide? How effective are lifestyle interventions in preventing diabetes? Is AI ready for diabetic retinopathy screening? Should podiatrists be embedded in primary care teams?

The fundamentals (glycaemic control, complication prevention) remain, but questions now incorporate new drug classes, technology, prevention strategies, and system-level solutions.

Cross-Cutting Themes

Looking across all four areas, some common threads emerge:

  1. “What’s the best treatment?” never goes away. Whether in 2005 or 2025, clinicians want to know the most effective, safest option.
  2. Safety is a constant. Every era has questions about drug harms, interactions, and risks in special populations.
  3. Shifts in framing. The early services captured questions often phrased as case vignettes; AskTrip includes both detailed scenarios and broad, almost textbook-like questions.
  4. Lifestyle and holistic care. Far more visible in modern questions – from mindfulness to diet, fasting, exercise, and patient communication.
  5. Technology and innovation. Biologics, pharmacogenetics, AI, apps, and new drug classes appear only in the newer questions.
  6. From patient to system. Modern queries also touch on malpractice, prevalence in specific countries, and team-based care.

Conclusion

Comparing two decades of clinical questions is like holding up a mirror to how medicine itself has changed. The essence of what clinicians want – safe, effective treatments backed by evidence – has never shifted. But the tools, therapies, and perspectives have expanded dramatically.

ATTRACT and the NLH Q&A Service captured the day-to-day dilemmas of UK primary care in the 2000s, while AskTrip reflects a wider, global audience with questions ranging from basic management to cutting-edge therapies and system-level challenges.

In 2005, a GP in Wales might have been asking whether to taper clonidine slowly; in 2025, someone on AskTrip is asking whether AI is ready to screen for diabetic retinopathy. The questions evolve, but the clinician’s need for trustworthy, evidence-based answers remains constant.