There is no doubt that Hong Kong is going through an identity crisis. Those who have had teenage children will appreciate the mood swings and the irrational emotionality of the conflicted child; anxious to grow up but reluctant to face the reality of adulthood. I came to Hong Kong two years after the handover/return of the territory to mainland China. Economically things were not so bright, but politically Hong Kong residents were still delighted with their new freedom from British colonial rule. Now we are in 2012 and the fateful 2047 seems not so distant anymore. As the territory moves inexorably towards full reunification with mainland China, the days of British rule are increasingly being referred to in nostalgic terms. more…

Oh, behave. I got some grief for saying on a previous blog that some of the criticism of health reform was a bit “hysterical.” I felt a little chastened. I now feel utterly justified.

I just did a Google search for “NHS Arab Spring” which gave me almost 1,000,000 results. I saw the phrase used in the Health Service Journal a few months back but turned a blind eye. The actual Arab Spring was in the news at the time. It was an easy analogy. No harm done. But now the analogy is everywhere.  And it’s mostly referring to a summit of Royal Colleges and the BMA this week to trash talk the health bill. more…

The captain made a mistake. We don’t know why; misjudgement, show boating, foolishness. After hitting the rocks, he seemed to ignore the consequences, delaying action, almost pretending it didn’t happen, and leaving people fend for themselves. Master of a recently built vessel of such scale, he was clearly at the top of his profession having risen through the ranks. But, no one is immune to weakness; the frailty of human behaviour, self preservation, or failure to do the right thing. Only, this time the ship was the size of a small hospital and he had absolute responsibility for the well being of his passengers and crew. The effect was catastrophic. 

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There can be a lot of disagreement when it comes to healthcare management and leadership. There are competing views about how far all doctors can be trained to be leaders, and how much impact leadership training can have on clinical outcomes.

There are some studies and reports which suggest that organisations with a higher degree of medical engagement with leadership and improvement have better outcomes, and better ratings from regulators. More recently the question was posed about what doctors getting involved in leadership training are motivated by—is it for improving patient care, or is it for their CV? more…

“We have nothing as bad as America’s worst, and nothing as good as America’s best,” wise words said to me by someone many years ago, and this principle has stood the test of time. There are certainly many dreadful things in American healthcare, but there are also wonderful services and excellent innovation with a rigorous evaluation for each of them. In my collection of ten classic articles on better value healthcare, eight come from the United States. This is a paradox. Although they have no finite budget and do not have full population coverage, the thinking and the innovation within healthcare organisations such as Kaiser, or universities such as Harvard or Dartmouth, is streets ahead of the debate in the United Kingdom. But let’s not feel too bad as we have nothing as bad as the worst, for example, the Republican views on healthcare, and the millions who are uninsured. more…

27 October 2010—sitting in a plane taking off from Paris, flicking through the Lonely Planet to Guadeloupe that I had just bought at the airport, I cast my mind over the events of the last year leading me to this departure for a six month post in the French Caribbean…

Keen to build on a background of dual nationality, I was interested in the possibility of spending part of my training as a junior doctor in France. After a bit of research it seemed unlikely that I would be able to do a direct swap of placements. I decided to take advantage of the offer of a year “time out of foundation programme” from my deanery in the UK, with the comfort of near guarantee of an F2 post on my return. My initial idea had been to try to apply for a locum post in France.  These are few and far between and not easily planned in advance; furthermore I wanted to be in a training position, given my junior status. I was advised by English and French colleagues to get a post as a French “interne” i.e. junior doctor in training, so my only option was to sit the “Examen Classant National” (ECN)—the much dreaded national ranking exam—a bit like a foundation and speciality application all rolled into one nightmare… more…

Clinical commissioning team of the year: embracing change to deliver patient care

Should it become law later this year, the proposed Health and Social Care Bill will result in significant changes to the way the majority of healthcare services are commissioned in England.  Although controversial in nature the bill does represent an opportunity for general practitioners and other healthcare clinicians to shape the way healthcare is provided in their local area, using their unique insight into local healthcare needs to set future service priorities. more…

One of the experiences that has made me think the most in the past week was having my shoes shined in Queretaro, Mexico. It was the lavish care, almost love, that the shoeshiner put into his task that made me think.

I was seated in a high, metal chair in bright sunshine in one of the main squares in Queretaro, a Mexican city that has become a World Heritage Site because of its beautiful colonial centre. A series of squares are filled with fountains, statues, trees, and flowers. Many of the trees are pruned to be  striking green cylinders. In the centre of the square where I’m sitting there is a bandstand, and on Sunday night we watched a brass band play while many couples, most of them elderly, danced gracefully. (At the time I thought how our bandstand in Clapham, my home in London, rarely has a band and never has anybody dancing.) more…

JAMA  18 Jan 2012  Vol 307
265     Cangrelor is one of a number of reversible thienopyridine platelet inhibitors competing to replace clopidogrel. This could be an enormous market, but the BRIDGE study, funded by The Medicines Company, begins with a small niche: patients who discontinue antiplatelet treatment before elective coronary artery bypass grafting. The problem that this study is alleged to address is the risk of rebound coronary events in such patients, unless some kind of platelet inhibition is maintained up to near the time of surgery (using IV cangrelor, of course); but in fact a coronary end-point appears nowhere in the trial. Instead, the primary end points are bleeding during surgery and laboratory platelet function tests. These lab tests are the weakest of surrogates, and I am unconvinced that there is a problem here that cannot be addressed in a simpler way. This study really doesn’t belong in a leading medical journal. more…

The award-winning experiential health website, healthtalkonline.org, launched a new section devoted to carers of people with a terminal illness on Wednesday. The website’s real life stories are proving a valuable resource not only to patients but also to health professionals.

healthtalkonline already hosts thousands of videos of people talking about their experiences of different medical conditions, from autism to pregnancy. The new section features 240 video clips taken from interviews with 40 men and women who have cared for a dying loved one. They cover the hidden aspects of caring, from dealing with financial issues to coping with conflicting emotions following the death. more…