A patient I’ll call Margaret came to see me a few weeks ago. She’s 68, sensible, and not one to make a fuss. She’d come for her usual appointment but as we chatted she mentioned she’d been battling what she thought was a nasty cold for over a fortnight.

Something had changed, though. She was breathless walking to her kitchen. Her temperature kept spiking then settling, only to spike again. Most tellingly, she told me she felt ‘different’ to how she’d felt with colds before. ‘I just know something isn’t right,’ she said.

I was concerned enough to call her GP surgery while she was still with me. They fitted her in that afternoon. Margaret’s instincts were spot on. She had pneumonia. I share her story because, with those in hospital with flu hitting record levels for this time of year, many of you will be asking the same question.

Margaret was asking herself: when does a winter bug become something more serious?

The figures are stark. Last week, an average of 1,717 patients were in hospital beds across England with flu, more than 50 per cent higher than the same week last year.

Experts are warning there is no peak in sight yet, and with flu season having started a month earlier than usual, we’re in for a challenging winter.

At the same time, the NHS is under enormous strain. Thousands of A&E attendances last winter were for minor complaints that could have been handled elsewhere.

So how do you know when to seek help and when to stay at home with a hot water bottle and some paracetamol?

First, it’s important to understand what flu actually feels like. Unlike a cold, which tends to creep up on you gradually, flu usually hits like a freight train. One moment you’re fine; the next you’re flat on your back with a high temperature, aching muscles, and a headache that feels like someone is tightening a vice around your skull.

You’ll feel exhausted in a way that you won’t with a simple cold. Most people will recover from flu within a week or two with rest, fluids, and over-the-counter remedies.

But here are the warning signs that suggest something more serious is developing.

1) Breathlessness is the big one. If you find yourself short of breath doing things that wouldn’t normally trouble you, or if you’re breathing rapidly even at rest, this needs attention.

2)Chest pain, particularly if it’s sharp or worse when you breathe in, is another red flag.

3) A cough that’s getting worse not better, especially if you have thick, discoloured or blood-stained phlegm, requires a call to your GP.

4) Pay attention to the pattern of your illness too. With a straightforward viral infection, you’ll generally feel gradually better over seven to ten days. If you seem to be improving and then suddenly deteriorate, this ‘double-dip’ pattern can indicate a secondary bacterial infection such as pneumonia has set in.

5) Confusion or drowsiness in an older person should always be taken seriously. In the elderly, pneumonia doesn’t always present with the classic symptoms. Sometimes the only sign is that someone becomes muddled or unusually sleepy.

Very young children, pregnant women, and anyone with a chronic health condition such as diabetes, heart disease, or lung problems should have a lower threshold for seeking help. These groups are at higher risk of complications and shouldn’t wait if they’re worried.

When you do contact your doctor, be specific. Don’t just say you have flu. Explain that you’ve been unwell for a certain number of days, that your symptoms changed on a particular day, and describe exactly what’s worrying you. If you’re breathless, say so. If your temperature has been persistently high despite paracetamol, mention that. Doctors rely on these details to triage appropriately.

Prevention, of course, is better than cure. If you’re eligible for a flu jab and haven’t had one yet, it’s not too late. The NHS has already delivered nearly 17 million flu vaccinations this autumn. Good hand hygiene remains your best defence against picking up viruses in the first place. Wash your hands regularly, avoid touching your face, and keep your distance from people who are clearly unwell. And if you do fall ill, stay home.

I know this sounds obvious, but every winter I see patients who’ve struggled into work and infected half their colleagues.

As for when to call 999 or go to A&E, the threshold is high: severe difficulty breathing, lips turning blue, chest pain that isn’t going away, or collapse. These require emergency care. Other situations can be handled by calling 111, speaking to your GP or a pharmacy.

Margaret, incidentally, is doing well. A course of antibiotics and some rest sorted her out. But I’m pleased she mentioned her symptoms to me when she did, and that she saw her GP swiftly. Had she left it much longer, she too might have needed a hospital admission.

Sometimes our bodies know before we do that something is not right. This winter, listen to yours.

Time for Meghan to see her dad

The news that Thomas Markle is fighting for his life in hospital having had his leg amputated will have prompted many to reflect on their own fractured family relationships.

He is 81 years old. He has been estranged from his daughter Meghan since her wedding in 2018. Whatever the rights and wrongs of their falling out, there is something unbearably sad about an elderly man lying in a hospital bed, separated from his daughter by more than just miles. A spokesperson has said that Meghan has ‘reached out’ to her father, though Mr Markle claims he has not heard from his daughter ‘but would love to speak to her’.

I’m not here to apportion blame. Family rifts are rarely straightforward but studies show estrangement increases the risk of depression, anxiety and even physical illness. What troubles me most is when that window of opportunity closes forever.

I’ve sat with sobbing patients after a parent died before they could make amends. They torture themselves with ‘what ifs’ and ‘if onlys’. If you’re estranged from someone you once loved, I ask you this uncomfortable question: why wait until the worst has happened?

Many people think of dermal fillers as being no more risky than a facial. What could possibly go wrong? Quite a lot, it turns out. New research reveals a serious complication: vascular occlusion. This occurs when filler is injected into or too close to a blood vessel, blocking blood flow. Tissue deprived of blood begins to die, leading to skin loss and permanent facial deformity. How many of the people jabbing filler into faces have the training and equipment to do it safely? Fillers are a medical intervention, not a beauty treatment.

Dr Max prescribes... a phone-lock box

Last Christmas I bought myself a KSafe, a timed lock-box for my phone, and it has been invaluable. You pop your device inside, set the timer, and that’s it: no scrolling, no notifications, until it unlocks. The enforced separation has transformed my evenings and weekends. If someone you love complains they spend too much time glued to their screen, this makes a good gift. Temptation is gone (thekitchensafe.com, from £45).