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Jeanne Lenzer: The Backstory—When is patient consent needed?

12 Feb, 16 | by BMJ

jeanne_lenzerWhile I was reporting on a study for The BMJ, I suddenly felt as if I’d walked through Alice’s Looking Glass.  You’ve possibly heard about the study by now: researchers found that patients treated by sleep-deprived resident doctors were no more likely to die or suffer serious complications than patients under the care of doctors working limited hours.

Of course the study seems a bit strange given what we know about doctors’ performance and sleep deprivation.  And while sleepy truckers are well-known to be deadly on the nation’s highways (as are pilots and others entrusted with the public welfare) it appears that some doctors want to believe they are immune to the biologic limits of other humans. more…

Richard Smith: Putting the H back into the NHS

12 Feb, 16 | by BMJ

richard_smith_2014The H in NHS stands not for hospital or healthcare but health, and the NHS needs to do better at promoting health, said Simon Stevens, chief executive of NHS England, this week at a meeting organised by the University of Southampton. If England can’t do better at prevention then the NHS will be overwhelmed, said Stevens. Premature deaths from heart attacks have come down by 40% in the past decade: imagine, he said, the pressure on the NHS if that hadn’t happened. But what can the NHS do to counter the “new smoking” of obesity and the 20 year gap in healthy life expectancy between the richest and poorest?

Stevens sees five approaches. more…

Jeffrey Aronson: When I use a word . . . A penicillin anniversary

12 Feb, 16 | by BMJ

Today, 12 February, is the 75th anniversary of the first clinical use of penicillin in Oxford in 1941 (picture).

aronson_penicillin

Image: A plaque commemorating the first administration of purified penicillin to a patient in the Radcliffe Infirmary on 12 February 1941 by Dr Charles Fletcher; the word “systematic” is not necessarily an error; the word has occasionally, albeit rarely, been used to mean systemic, the word that we would now use, and the OED lists examples from the 19th, 20th, and even the 21st centuries. more…

Miriam Saey Al-Rifai: Midwestern adventures into the mind

12 Feb, 16 | by BMJ

miriamMy induction was interrupted by a loud siren bellowing out across County Buchannan. My supervisor, consultant forensic psychiatrist, Dr Reynolds, ran me out of the hospital into the courtyard shouting “Tornado!” I stared up at the fast moving grey clouds and, as I set off to dive into the nearest bush, I heard my supervisor laugh. It was just the monthly tornado drill.

And so began my medical elective, at Northwest Missouri Psychiatric Rehabilitation Centre. It was so full of humour, as I navigated my way through American Midwestern culture, and so full of fear and uncertainties, as I, alone, explored the role of a psychiatrist in a secure forensic psychiatric facility in a state that still practises the death penalty and prides itself in its ghost stories. more…

Saurabh Jha: Britain’s junior doctors are not apprentices

12 Feb, 16 | by BMJ

Saurabh_JhaIt was Boxing Day weekend. The consultant surgeon summoned the on-call team. “We face a calamity,” he said. The house officer had called in sick. The locum wasn’t going to arrive for another 12 hours. This meant that I, the senior house officer, would have to be the house officer. The registrar would take my place. The consultant, looking tense, would have to be the registrar—i.e. a junior doctor again.

“Junior doctor” is a misnomer because it implies a master and an apprentice. Running the National Health Service (NHS) are apprentices who become Jedis very quickly, and without a Ben Kenobi showing them the ropes. more…

Martin Marshall: Confused about general practice?

11 Feb, 16 | by BMJ

martin_marshallWhen I first became a GP, general practice was organised in a way that was so easy to describe to people. We had practices serving defined local communities and we had family practitioner committees (FPCs), which provided a bit of light touch administration. And that was that.

Compare this blissful simplicity with the plethora of primary care organisations that now provide and commission care. The other day I tried to explain the current structures to a medical student but I could tell from her face that I wasn’t making much sense.

Practices remain, I’m glad to say, albeit a bit bigger and a bit less relaxed than they used to be. more…

Desmond O’Neill: Combating bar stool gerontology

11 Feb, 16 | by BMJ

Des O Neill 2015One of the greatest challenges for us as we age is “bar stool gerontology.” For most complex subjects—nuclear physics, molecular biology, or philosophy—most of us recognise that some learning and education are required to grasp their fundamentals.

Yet despite the fact that we are at our most complex in later life, it remains acceptable in many walks of life to ignore advances in research on ageing—presumably on the basis of, “Sure, we all know what ageing is.”

A staggering example of this gerontological illiteracy was the recent pronouncement by the head of acute care for NHS England that loneliness was driving older people into emergency departments. more…

Richard Smith: Doctors using safety and evidence for political ends

10 Feb, 16 | by BMJ

richard_smith_2014In my 40 years of messing around with medical journals I’ve tried to contribute to promoting patient safety and the use of evidence. Generally things seem better from a time when patient safety was largely ignored and evidence used haphazardly rather than systematically, but I fret now that doctors are using both safety and evidence for their own selfish ends.

The BMA is smart enough to know that simply asking for more money and better conditions for junior doctors and general practitioners is a poor strategy, and so it emphasises risks to patient safety. more…

What, if anything, does the EuroHealth Consumer Index actually tell us?

9 Feb, 16 | by BMJ

Since 2005, the Health Consumer Powerhouse has produced its annual EuroHealth Consumer Index, ranking European health systems according to their performance on a host of indicators around (i) patient rights and information, (ii) accessibility, (iii) outcomes, (iv) range and reach of services, (v) prevention and (vi) pharmaceuticals. In its most recent iteration, the United Kingdom ranked only 14th of 35 countries studied. This is in stark contrast to the assessment by the Commonwealth Fund just a year before, in which the UK was rated as the best performing health system among a set of high-income countries in 2014. more…

Hoong-Wei Gan: Strike on, strike off: why junior doctors are fighting for their patients

9 Feb, 16 | by BMJ

Striking is not integral to any doctor’s identity. As others have pointed out over the last few months, a doctor pledges, before anything to else, to “first do no harm.”

However, as doctors we no longer have to decide between amputating a gangrenous limb or leaving a patient to die. Our decision-making is becoming an ever more subtle balancing act of benefit versus risk—my neurosurgical colleagues for instance regularly have to choose between resecting as much brain tumour as possible to prevent recurrences and cutting out so much as to leave the patient severely disabled. more…

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