The BMJ Today: Beyond doing no harm, helping can get tough

kristina_fisterMedicine can do great things, but at today’s thebmj.com things look rather bleak. Nine out of 10 people who are transferred to hospital with cardiac arrest don’t survive to discharge. Some argue that most of these ambulance transfers should not happen at all; others disagree. It’s not about the cost, as Americans have calculated the savings would be less than 0.1% of what the health system loses owing to fraud. But transfer might harm. Do join the discussion, as did Robert H Trenkamp, who tells us better hospital care is possible for these patients and that not so many need to die.

Harm can also come from not including patients in medical decision making. When asked to single out one thing that has made the most difference in her field in her lifetime, Angela Coulter opts for the development of evidence based, patient decision aids.

Still, it seems that including patients does not always reap as much benefit as one would hope. A trial across 18 primary care practices tested a patient oriented decision aid for prioritising treatment goals in diabetes. Little effect on patient empowerment was seen, prompting editorialists Hargraves and Montori to write: “A decision aid, patient power, medical skills, and scientific evidence do not simply result in good decisions by being in a room together.” Can the key lie in studying the logic of clinical conversations, with the help of patients?

In children with cerebral palsy, communication can be so difficult that lasting pain may elude doctors. Yet if pain is controlled, children with cerebral palsy can have a quality of life close to that of their healthier peers. Doctors should ask about pain, and possibly use pain diaries and scoring tools. The causes vary—from spasticity, gastrointestinal or skeletal problems, to dental reasons, or even physiotherapy—as do recommended procedures for exploration and treatment. Read more on this and what else medicine can do for children with cerebral palsy in this clinical review.

Kristina Fišter is an associate editor for The BMJ.

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