It’s easy to dismiss Twitter, a network that links people using messages of 140 characters or less, but it fills a genuine social gap. If Facebook is an archipelago of islands held together by social ties, Twitter is the shifting current that bathes them. Where Facebook is faithful, Twitter is promiscuous.

Teaching thinking skills to young researchers is hard, especially when their brains are busy multitasking with Twitter, Facebook, and their lab book all at the same time, and when they demand information in tiny bites, not lengthy academic excursion. more…

From le paradoxe français to a tiny tavern off a narrow alley in Kilkenny. An unlikely journey. But not, perhaps, if the barman is a cardiologist. Red wine has much more than cardiovascular benefits and it was such a pleasure to enjoy a glass with friends in the company of Michael Conway, with jaunty hat and easy manner, the owner, sommelier, and much more besides. A consultant cardiologist in Kilkenny Hospital, his “Hole in the Wall” wine bar is a museum, a link with the past, and a project born out of his love of history. more…

The e-petition calling on the government to drop its Health and Social Care Bill has now reached 153 000 signatures to become the second most popular campaign on Number 10’s official petition site. It already qualified for a debate in the House of Commons, when it passed the 100 000 signatures milestone. Some 90% of general practitioners, celebrities including Stephen Fry, Rio Ferdinand, and Jamie Oliver, three Cabinet ministers, and a good part of David Cameron’s own party (see Tim Montgomery’s blog) don’t want the bill. Rarely have doctors, nurses, and the public been so united on a political question. Sadly, David Cameron is closing his eyes and ears. more…

The Prime Minister’s summit on implementing the NHS reforms has provided a new focus for debate about what the reforms will mean in practice. The government’s critics maintain that competition will undermine the core values of the NHS to the detriment of patient care. Some of these critics go further to claim that competition will result in the privatisation of much healthcare provision and the end of the NHS as we know it.

History suggests the need to treat these claims with caution, if not scepticism. Ever since the Conservative government introduced the internal market reforms in the early 1990s, opponents of choice and competition have warned that the future of the NHS is under threat, and yet it is performing better today than ever before. And as Nick Timmins showed in a recent analysis for the Financial Times, the private sector’s share of the market for elective care for NHS patients has remained stable,  giving the lie to the argument that widespread privatisation of provision is inevitable. more…

I have to admit that after working for the NHS for 19 years I felt the need for a different challenge. I was four years into my appointment as a consultant dermatologist in East Kent, and although I enjoyed the clinical work, I was finding the fluctuations in health service politics somewhat exhausting. My sons, Zac and Josh, aged 7 and 6, were very happy in our local village school, and my husband Aaron was planning his PhD. more…

It was not of course in relation to the NHS that Tony Blair famously said “I only know what I believe.” His assertion was in defence of military action in Iraq despite the millions on the streets saying “Not in my name.” It is however a convenient method of ignoring the troublesome masses who disagree and it has a hint of direct communication with higher powers as an infallible guide to action. more…

JAMA  15 Feb 2012  Vol 306
669    This week’s star Viewpoint piece is about The Unintended Consequences of Conflict of Interest Disclosure. It seems to me that twenty-first century medicine operates on roughly the same principle as the court of the Grand Vizier of the Ottoman Empire – prestige is judged by the number of bribes you are offered. Far from being a source of shame and reluctance to publish, these are routinely flaunted at the end of most interventional trials in the leading medical journals. I once counted 63 for a single individual; and perhaps he would argue that once you enter double figures, they begin to cancel each other out. How did we reach a state where the default setting of our medical culture is conspicuous corruption? As the authors here point out, this cannot go on: “Conflicts of interest, including fee-for-service arrangements, are at the heart of the astronomical increases in healthcare costs in the United States, and transparency is no substitute for more substantive reform.” And just as the US health system thinks of ways to get out of this hole, our British political masters are determined to push us into it.
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“I’m afraid I’m currently out of the office right now on the never-ending mission to restore world health—I am very interested in your message and will endeavour to reply to it as soon as I am back.” This rather immodest response to my request to sign up to a new soon-to-be launched on-line game (http://www.syrum-game.com) was signed by the lead character, Professor Syrum. Syrum will be a social game on Facebook which will allow participants to take control of their own pharmaceutical company. The aim is to equip and use a laboratory to discover new drugs, bringing them to market to improve global health, or as the learned professor puts it—“the health of the world is at stake and you are the only one that can save us.”

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When I first met Andrew Wilner, an American physician, a few years ago, it was the first time I had heard of the word “neurohospitalist.” I obviously knew what a neurologist or a neurosurgeon are, but a neurohospitalist was an absolute novelty, and I have a feeling it is not a well known role in Europe, if it exists at all.

But Dr Wilner works as a neurohospitalist in the New England area of the United States. So, some time ago, I had a chat with him to learn the ropes of the job (and he gave me permission to reproduce some of his comments). According to him, “a neurohospitalist is a neurologist who sees patients exclusively in the hospital.” Meschia defines a neurohospitalist as a doctor providing care “to patients with neurological abnormalities that either lead to hospitalisation or complicate their stay in hospital.” more…

I became interested in commissioning through Fundholding. Like the majority of GP practices that got involved we did so because we wanted to improve the experience and the services our patients received. We used the influence which holding a budget gave us to address quality.  For example, we improved the safety of anticoagulation management, we accessed investigations without having to send people to hospital so we could deliver more effective care, and we reduced waiting times for planned care. Fundholding made me realise that getting involved, as a doctor, in how the system was managed could improve quality for patients. The advent of PCTs drew me into the more complex and difficult agenda of large-scale change and whole-system improvement. I realised that if I didn’t want to disadvantage my own practice, because of the obvious conflict of interest I had in being able to influence funding flows across the whole system, then I needed to leave general practice and commit to commissioning. more…