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The BMJ Today: If you hear hoof beats in Texas think of horses, not zebras

8 Apr, 14 | by BMJ

As Saurabh Jha writes, “The likelihood that someone with cerebral aneurysm hit by a bat develops subarachnoid hemorrhage (near certainty) is not the same as the likelihood that someone who develops subarachnoid hemorrhage after high impact trauma has an aneurysm, hitherto undisclosed (very low).” But would you order tests so you could absolutely rule it out? Would you perhaps order further tests to rule out bleeding brain metastases from lung cancer? Jha asks us to stop “hunting for zebras in Texas” and put an end the “rule-out” culture that pervades medicine.

A dermatology clinic nurse asked a patient with HIV how she became infected. The patient had no idea her HIV status would be disclosed in her GP’s referral letter, and felt stigmatised by the nurse’s question. This incident, described at a National AIDS Trust event, prompts GP Kate Adams to examine the public interest justification in General Medical Council guidance on patient confidentiality. Are doctors sharing too much sensitive information about patients, she asks. And more importantly, are patients being made aware that their data will ordinarily be shared for clinical purposes?

Obsessive-compulsive disorder is in the WHO’s list of the top 10 most handicapping conditions by lost income and decreased quality of life, and it’s the fourth most common mental disorder. Research shows that people can spend 10 years or more struggling with OCD before they get the appropriate help. Veale and Roberts’s clinical review summarises the evidence on how to recognise, assess, and manage people with OCD.

Our new weekly column by the Glasgow GP Margaret McCartney had a great start. Her criticisms of UK tabloid The Sun‘s attempts to rehabilitate Page 3 with a breast cancer awareness campaign went viral on Twitter and hundreds of news outlets, including The Sun, reported her stance. Now she’s turned her attention to the bureaucracy that she says has taken the joy out of medicine.

Jett Aislabie is an assistant editor on bmj.com.

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