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Henry Murphy: The Moderate Doctor

25 Nov, 15 | by BMJ

Jeremy Hunt recently told Twitter that “Moderate doctors must defeat the militants,” quoting the title of a Times article about the current war between the Department of Health and the BMA. My first response was to sit back and enjoy a flurry of hilarious responses (the reason I look at the @Jeremy_Hunt Twitter page so often). Comments included “Moderate doctors must defeat Jeremy Hunt,” ”If your definition of militant is standing up to protect the NHS against tyrants like you…,” and “So where are all these ‘moderate doctors’… I don’t know anyone who doesn’t think you are wrong and doesn’t support junior drs.” more…

Alisha Patel: Why sustainability should be important to medical students

25 Nov, 15 | by BMJ

Alisha-Patel_picMedical school can feel like a production line of future doctors, equipping us with the skills to diagnose and manage patients with a vast number of illnesses. But if we are not engaging in issues related to sustainability along the way, then will we really be able to fully fulfil our duty as health professionals?

The concept of sustainable healthcare was briefly introduced to me in my first year of medical school. I was surprised to realise the extent to which the NHS is affected by environmental change, and that it is also contributing to it too as the largest public sector emitter of carbon emissions. more…

Richard Smith: The NHS—a terrible thought

25 Nov, 15 | by BMJ

richard_smith_2014There is great reluctance in Britain to consider any other kind of funding for the NHS apart from taxation, but we are surely close to a time when we will have to consider it. This morning I awoke with the thought, which felt terrible, that funding through taxation is a straitjacket that is causing increasing pain. more…

Meena P: A lack of resources for community health nursing in India

25 Nov, 15 | by BMJ

meena_pWith a shortage of doctors, it is the nurses and other allied health professionals who run the show in many of the primary healthcare settings in India. Nurses make up a major proportion of the health workforce. In this context we need more and more nurses who are capable of addressing the diverse healthcare needs of society. There is a shift from hospital based curative care to community based preventive and rehabilitative care, and a greater focus on giving people control over their health. Therefore, we need nurses who are equipped with specialized knowledge and skills in public health to work in community healthcare settings. more…

Peter Killwick: Risks associated with conflicts of interest at CCGs

24 Nov, 15 | by BMJ

peter_killwickConflicts of interest are an inevitable part of the commissioning environment. There are obvious advantages to having local GPs at the heart of commissioning and in many areas they have made a very positive contribution. But the governance challenges associated with commissioning are enormous. In recent months, we have been working with a number of CCGs who have found those challenges difficult. At times they have fallen short of delivering in line with expected practice. From a number of recent investigations we have identified some key conflict of interest themes which contributed to the failure and are likely to be common issues for other CCGs. more…

Anita Charlesworth: The impact on health of the comprehensive spending review

23 Nov, 15 | by BMJ

anita_charlesworthOn the 25 November the Chancellor of the Exchequer will stand up in Parliament and make a statement that will shape much of the political landscape for the rest of this decade. More substantively these spending review decisions will impact every household in the UK. Given its importance it’s not surprising that, by all accounts, negotiations have been tough. Perhaps more surprising is that health is proving to be one of the most problematic areas of public spending to settle. Health was one of the clear commitments for the new government—the NHS would get the annual increases rising to £8bn over and above inflation in return for delivering £22bn savings based on Simon Steven’s Five Year Forward View. more…

Richard Lehman’s journal review—23 November 2015

23 Nov, 15 | by BMJ

richard_lehmanNEJM 19 Nov 2015 Vol 373
Spooky RSV trial
2048 There’s a hint of Porton Down about this phase 1 study of an oral treatment for respiratory syncytial virus (RSV). The 62 volunteers trooped in and the steel doors shut behind them. Two days later, masked personnel in white coats proceeded to inoculate them intranasally with four log10 plaque-forming-units of the RSV-A Memphis 37b challenge virus. They spent another two days in quarantine and were then monitored twice daily for signs of incipient RSV infection. As soon as these appeared, nasal samples were sent off for a polymerase chain reaction test to confirm that it was indeed RSV, and they were then given the mystery agent ALS-008176, or a placebo. At this point Sherlock broke in to the secret chamber, the lights went out, klaxons sounded, and the experiment had to be aborted. Ah no, that was just for the television: in real life the subjects continued to languish in durance vile until two weeks had elapsed. more…

Samir Dawlatly: Capacity insurance—not being missold

23 Nov, 15 | by BMJ

My wife and I have just booked a near extortionate holiday in the UK for the next major school holidays. As usual we were offered “cancellation insurance,” just in case something were to happen with either of us or our children that meant we couldn’t enjoy our rain drizzled fun in the Peak District. We didn’t take the holiday company up on the offer. In fact we rarely take out insurance or extend warranties on anything, apart from the washing machine, which we simply can’t do without as a consequence of having three children. more…

Jeffrey Aronson: When I use a word . . . Terrorism

20 Nov, 15 | by BMJ

jeffrey_aronsonThe Latin word “terror,” from the hypothetical Indo-European root TER, implying trembling, meant “the fact or quality of inspiring terror” (Oxford Latin Dictionary) and a person or thing that causes terror. Territare meant to constrain by fear, to try to scare, or, as we would now say, to terrorize. From “terror” we get such words as terrible, deterrent, and perhaps turmoil. “Terrific” originally meant terrifying or terrible; it now means the opposite.

In Greek τέρας meant a monster, something that might make you tremble, like Cerberus, the Chimera, the Gorgons, the Hydra, the Sphinx (pictures below.) more…

John Middleton: Why is there acute hunger in the UK and what is to be done about it?

19 Nov, 15 | by BMJ

john_middleton_2015Every day family doctors face the struggle of being custodians of entitlement to food bank help and backstops for the failures of the welfare system, while at the same time wanting to do their best for their patients, which in extreme cases means getting them something to eat.

This same uncomfortable tension is played out in food banks across the country: how to respect and celebrate the humanity and hard work of food bank volunteers, yet at the same time say this is not a service we should expect to operate in one of the richest countries in the world, which, until now, had a tradition of safety net welfare provision. more…

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