Clinical CPD · Long COVID
Long COVID in Clinic
How to think when the tests come back normal
More than how to treat Long COVID. This is a framework for recognising it — and for knowing which direction the tests and referrals need to take from the moment the patient is in front of you.
Explore the courseReleased section by section. Early access is open now.
Exclusion is where it starts, not where it ends
A normal work-up tells you what the illness is not. It does not tell you what is driving it, which system to look at first, or where the next test and the next referral should point.
That gap is where clinicians are left stranded — and where patients are told their results are reassuring while they are plainly unwell. This course sets out a way to reason past it: how to recognise the pattern early, what to exclude first, and how to read the likely trajectory of a case so that investigations and onward referrals are chosen with direction rather than by trial and error.
It is a framework to think with, not a protocol to follow. Used well, it changes the first consultation as much as the tenth.
What the pattern looks like — in people living with it
The work is already under way
Alongside the course, people living with Long COVID have been completing a structured symptom questionnaire built around the four domains. This is not a formal study. It is a self-selected, self-reported sample with no control group and no outcome data. But it lets us see, in real people, the patterns the framework describes.
From 277 responses to the McMillan Long COVID phenotype questionnaire (self-reported; 15 January – 27 June 2026; corrected scoring).
What this is, and what it is not
These responses illustrate patterns; they do not prove them. The sample is self-selected and self-reported, the questionnaire is unvalidated, and there are no outcomes and no non-COVID comparison group.
What the data is consistent with: the four domains overlap heavily, gut–immune involvement travels with high scores elsewhere, and post-exertional worsening tracks a multi-domain burden. What it does not establish: four discrete phenotypes, that addressing the gut first improves recovery, or that the scores measure the anatomical sites they are named after. The four-domain map and its sequencing remain a Framework; the macrophage-centred mechanism remains a Hypothesis.
What the course covers
The framework is built step by step, each piece of evidence graded as it is introduced.
- The consensus, fairly statedWhat the field agrees on, at its strongest, and where it falls short.
- Why one-size trials disappointA heterogeneous condition tested with homogeneous trials, and what that means for how you read the evidence.
- Two different problemsStructural damage after severe illness, and immune dysregulation that may persist after a milder infection — and why they need different work-ups.
- The macrophage hypothesisBuilt piece by piece, with each claim graded: established, supported, framework, novel, or contested.
- A four-domain phenotype mapAutonomic and vagal, gut–immune, brainstem, and vascular–endothelial. Why severity is not the same as priority.
- Diagnostic safety and directionRed flags, the look-alikes to exclude first, when not to apply the framework at all, and how it steers the next test and referral.
How the course works
On-demand and online, worked through section by section. Each section pairs a recorded teaching module with a clinical case library and a short review, so the reasoning is applied to the kinds of patient you actually see.
It is being released and refined over the coming weeks. Early access is open now, and the price rises as each new section is added, so the earlier you join, the less you pay — and new sections arrive at the price you joined.
Every claim labelled
- Established
- Supported hypothesis
- Framework
- Novel
- Contested
Where a proposal is my own, it is labelled as mine. The four-domain map is a reasoning framework and has not yet been tested against patient outcomes.
Designed to the standard of structured CPD. Accreditation is being pursued and is not yet held. Clinicians can log the learning as reflective CPD, in line with their college's or regulator's requirements.
Who it's for
Written for clinicians: GPs and hospital physicians, nurses and advanced clinical practitioners, physiotherapists, occupational therapists and allied health professionals, and occupational health clinicians — anyone who meets these patients and has to decide what to do next.
Anyone else is welcome, including people living with Long COVID and those who support them. The teaching is pitched at a clinical level and uses medical terminology. It is educational, and it cannot advise on anyone's individual health. Please take questions about your own care to your own clinician.
Your presenter
Dr Philip McMillan is a physician and researcher. With Professor Anthony Turner and Professor Bruce Uhal, he is an author of "The Central Role of Macrophages in Long COVID Pathophysiology", published in the International Journal of Molecular Sciences in 2026.
See the full course
If you have sat across from a patient whose tests all came back normal, this framework is for you. See how it is built, and work the first section for yourself.
- Released in sections — new material added over the coming weeks
- Price rises as it grows — join early and lock in today's rate for the whole course
- Yours as it's built — every new section included at the price you joined