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Lesley Henderson and Simon Carter: What can we learn from the doctors of Star Trek in its 50th anniversary year?

21 Oct, 16 | by BMJ


Star Trek‘s Leonard
“Bones” McCoy

You don’t need to be a “Trekkie” to have noticed that 2016 marks the 50th anniversary of Star Trek. Events around the world have been organised to celebrate the enduring success of this popular TV and film series. We think that doctors should be particularly interested in Star Trek, not least because doctors have always featured prominently in every reincarnation of the franchise.

Indeed, the President of the American Medical Association, Dr Robert Wah, named Star Trek’s iconic physician Leonard “Bones” McCoy as his favourite fictional character because he represents the perfect combination of scientific knowledge and human compassion. But what else can we learn from Star Trek? more…

Paul Buchanan: Words can also hurt me

21 Oct, 16 | by BMJ

peb-photo-jpgWords. As we look ahead to an increasingly connected and interconnected world, how do we, as clinicians and patients, account for the words we use? How do we record the words we use to create a narrative and a context for ongoing treatment, as an archive of data that could help with research, with therapy development, and with better outcomes for patients?

Whose words do we record? If the data, and therefore the words, belong to the patient where is the balance between accurate recording and the possibility of doing harm or undermining therapy by noting everything? Where is the balance of disclosure and access if the words noted could be accessed by a patient with a history of mental health issues and which when read without support could set back or exacerbate an individual’s condition? Should I as a patient have the right to have full access to all notes, all results, all data held about me, if it might cause me harm? How does “do no harm” apply if I have the right to all of my data? more…

Jeffrey Aronson: When I use a word . . . Empathy—fact and fiction

21 Oct, 16 | by BMJ

jeffrey_aronsonThe English suffix -pathy comes from the Greek
-παθεια. Vary the prefix, vary the feeling:

ἀντιπάθεια – suffering instead, contrary affection, aversion (ἀντί = opposite, against);
εὐπάθεια – ease, sensitivity to impressions; in the plural, luxuries (εὐ = well, thoroughly);
περιπάθεια – violent passion, indignation (περί = around, near, concerning, beyond);
προπάθεια –anticipation; in the plural, forebodings of suffering (πρό = before, instead);
συμπάθεια – fellow feeling, affinity, (in grammar) analogy (σύν = with, together);
ἐμπάθεια – physical affection, passion, partiality (ἐν = in, into, on, for).

The nuances of the differences in meanings between these last two derivatives, the Greek originals of our words sympathy and empathy, carry over into English. more…

Andrew Furber: Should local government run the NHS?

21 Oct, 16 | by BMJ

andrew_furberA white paper published by the Conservative government in 1944 proposed that a new National Health Service should be managed by local authorities. [1] The Labour Party was split on the matter, but after their general election victory in 1945 Bevan proposed a plan favouring nationalisation of all hospitals. And so the NHS was born.

Nearly 70 years later the role of local government in the NHS is once again being debated. The integration of services delivered through local authorities and the NHS is underway in every part of the UK. In England there are now several NHS Clinical Commissioning Groups being led by local government officers. So should the NHS be run by local authorities, and would it be better? more…

Tom Jefferson: The EMA’s policy 0070 is live

21 Oct, 16 | by BMJ

Yesterday the European Medicines Agency’s (EMA’s) long awaited policy 0070 went live. I have previously described the policy, its aims, advantages, possible limitations, and potential impact on everyone here and here and here. Briefly, the first phase of the policy sees the release of fundamental components of clinical study reports (CSRs) of randomised controlled trials and other pharmaceutical studies. These complex documents provide a wealth of detail and a chance to minimise the effects of reporting bias, which plagues large swathes of contemporary pharmaceutical trial literature. more…

Richard Smith: What should a patient ask before entering a clinical trial?

21 Oct, 16 | by BMJ

richard_smith_2014“What,” a Finnish journalist asks me, “should a patient ask before entering a clinical trial?” That’s a good question, I think, as on my feet I try to answer the question. So here’s an attempt at an answer.

She asked me the question because I’d been saying that much that is published in medical journals is wrong, many trials are never published, and many trials are more for the benefit of drug companies than patients. more…

Sharon Roman: I am the girl next door

21 Oct, 16 | by BMJ

sharon_romanI flatter myself that the wedding ring on my finger does not stop the opposite sex from finding me attractive and noticing me. On good days, I am able to appear to be just as attractive and “normal” as everyone else does, if you do not look too closely. My apparent normalcy does however hinder and frustrate me at times, much as I strive for it.

At the grocery store, the elderly woman in front of me is granted patience and helped to her car with her bags. If there is no seat available on the subway, no one steps up to offer me his or hers. When using the handicapped washroom I am eyed with suspicion. Once I had to use the Men’s to avoid a messy embarrassment, for which I was loudly jeered. Confronted in a parking lot, I have been accused of using my parents’ handicapped parking permit. I’ve been accused of not really needing my cane, and shunned because it was assumed that I had been drinking. These types of incidents are too exhaustive to numerate here. Unfortunately for everyone involved, whether they know they are or not, ignorance is not bliss. No one, neither others nor I benefit from narrow mindedness or their inability to conceive of necessities and challenges that are not visibly forthcoming. more…

Claire McDaniel and Daniel Marchalik: Physicians and their pasts

20 Oct, 16 | by BMJ

The Doctor’s Book Club
Richard Flanagan The Narrow Road to the Deep North 

So we beat on, boats against the current, borne back ceaselessly into the past.

-F. Scott Fitzgerald, The Great Gatsby

It is estimated that almost 13,000 Allied prisoners died building the Burma Railway during the Second World War. Richard Flanagan’s The Narrow Road to the Deep North weaves together the stories of these men and women, Allied and Japanese, whose lives were forever changed by the experience of working on this 415-kilometer stretch in the deep jungle of Southeast Asia known as the “Death Railway.” more…

Hitesh Bansal: When the worlds of medical student and medical patient collide

20 Oct, 16 | by BMJ

hitesh_bansalA 20 year old male presented to A&E with abdominal pain. The pain was sharp, constant, severe, located in the epigastric region, radiating through to the back, and had been present since waking that morning. It was associated with profuse vomiting, no hematemesis, no change in bowel habit, no history of unfamiliar food, or travel abroad. He was a student, did not smoke, and drank roughly 15 units a week. He was otherwise healthy.

The diagnosis? Pancreatitis. The patient? Me. That diagnosis of pancreatitis, four years ago, would change my life. For better and for worse. more…

Rosanna O’ Keeffe on Direct Provision: Is this really the best we can do for those seeking asylum?

19 Oct, 16 | by BMJ

rosannaIn 2000 the Direct Provision scheme was officially introduced by the Irish government. The scheme requires asylum seekers to live in designated accommodation centres while they await decisions on their application for refugee or humanitarian leave to remain in Ireland. Initially, it was expected that the maximum time spent in Direct Provision would be six months. Unfortunately, the average stay is currently estimated to be four years.

According to the Reception and Integration Agency, 2015 was marked by an increase in the number of people housed in Direct Provision, from 4364 in 2014 to 4696 in 2015. Almost a quarter (1172) of these people were underage residents in 2015.

The people waiting to hear their fate under this scheme (tired, perhaps grieving those left behind, and often battling post traumatic stress) will probably be housed more…

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