My son, a chef, is part of a “pop up think tank” of people under 35 working on happiness. They are gathering evidence through a questionnaire, and I thought that some BMJ readers might be interested in both the questions and my answers. You might like to try answering the questions yourself. more…

Change may be the new constant, but it is always important to understand who embraces change most readily, and where. Doctors in general are traditionally conservative, as those outside the profession will be only too happy to confirm. We like to think we pioneer change both via behaviour (witness the change in smoking prevalence amongst doctors in the UK that preceded the change in prevalence in the wider population) and via technology (transplants, genetic research, new drugs). The resistance many doctors are showing to the current NHS reforms in England, suggests we are less engaged with that third pillar of large scale change: governance; the rules, regulations, laws, and incentives that determine how the system runs. more…

On 17 October, I was fortunate to attend a daylong seminar at BMA House on “the health and security perspectives of climate change.” Uniquely, this programme pulled together medical and military professionals along with climatologists, zoologists, and politicians. The morning focused on threats to global climate, health, and security whereas the afternoon sessions focused on the way forward.

The health risks from climate change might seem more obvious than the security risks, but what I learnt is that situations in Darfur and Somalia are the perfect storm examples of the intersection of climate change, health and security. In Bangladesh, if we project forward to a world without improvement and with increased violent weather and rising sea levels, we will encounter a situation in which some 75 million Bangladeshi people (half of the population) are at risk of displacement along with the stability of the nation despite long term excellence in disaster planning and management. more…

Once again the RCGP’s Annual conference last week in Liverpool produced a wealth of stimulating and topical debates – from the ethics of whether doctors should take a lead in commissioning (why do we always feel the need to “take the lead?”), to what constitutes sustainable general practice. The groups considering the latter issue, chaired by Tim Ballard and Trevor Thompson, concluded that when done well general practice and primary care is, by its very nature, sustainable: keeping people healthy, independent, empowered, and out of hospital. However, these worthy aspirations don’t always inspire and direct individuals to more specific action. Of course, there is the usual list of ways in which we can do the day job in a more environmentally sensitive way: declutter, go even more paperless, measure and reduce energy consumption, more teleconsultations (did I hear correctly that one Cornish practice has exceeded 50% here?), better procurement, fewer and more integrated collection of specimens, visits on foot, by bike, on a (electric) scooter. more…

“We know what we need to do to avoid severe climate change. We know how to get it done. We have the technology, and we can afford it. But we don’t have the political will.” That’s the message I remember most clearly from the BMJ’s conference on climate change, and sadly as a human being with all the evolutionary defects of our species I see our failure inside myself. This is not a comfortable state.

The speaker who gave the message may have exaggerated a little. It seems that if we want to keep global temperature rise to no more than 2°C then we need to see global carbon emissions fall within about three years. Ultimately we need to reduce carbon emissions from 768 units per unit of global gross domestic product to 8. (I may not have got this entirely right, but it doesn’t matter too much: the point is that we need a very substantial reduction, much larger than most of us begin to grasp.) more…

I am still proud to be a doctor. This used to be because I looked up to inspirational mentors, tutors, and role models. I still do, although my inspiration is increasingly derived from younger doctors and medical students (a cohort effect). We have a young inspirational medical student working with us currently doing research in his elective period. He is asking a sample of medical leaders in the UK how appropriately we are training the next generation of medical leaders – to address the forthcoming challenges we face (to add to the plenty we already have). This presupposes that formal training in this area actually works. I suspect it does and we should certainly support Peter Lees and colleagues in establishing the Faculty of Medical and Management. It is what every profession and professional should do – although I wince every time I use the word professional – we should be training people for competence in tasks, not for memberships of professions. What’s your definition of a professional? I think mine is probably someone who is alert to the likelihood that they will one day be rumbled. If you sympathise, you’re probably fine. If it irritates you, you may want to ask yourself why. more…

Last week the bmj.com poll asked “Should it be compulsory for adult cyclists to wear helmets?” 68% of respondents voted no, out of a total 1,439 votes cast. The question triggered an interesting debate. Below are a selection of the comments posted in response to the poll.

Sven Felsby: The idea of forcing cyclists to wear helmets may appear relevant, but it is ridden with pitfalls:
1. Many cyclists wear their helmets inappropriately, often tilted backwards, exposing the forehead completely. Should these people be fined?
2. Even riding a bike without helmet probably confers a health benefit compared to driving. By over-regulating, we risk driving potential cyclists back in the cars.
3. Brute force is not an effective way of changing behaviour. Use a carrot instead of a stick: exempt helmets from VAT. Encourage dealers to sell more helmets.

p.s. I ride my bike 5 miles to work every day of the year, always with a helmet. more…

When good people do too little, bad things happen. Or: beware death by omission as much as death by commission. Prizes avaliable if you know the heritage of the original quotations. more…

Much has been hypothesised, debated, and advocated about NHS reform. Specialists in a range of areas have looked at the impacts on their particular area of work, yet little has been remarked about the impacts of the transition on one of the NHS’s core duties – sustainability. Rising natural resource costs, climate change, and legal obligations make this a critical area of risk for public health and health care delivery. more…

Chris Ham’s article in last week’s Observer newspaper (“Politicians have ducked hard decisions on the NHS for far too long” Sunday 19 June 2011), and a news story in this week’s BMJ (BMJ 2011;342:d3921), claim that up to 20 hospitals, around 10% of the total in England, may not be financially sustainable. 
 
This is highly probable on the current evidence of what is happening, even in well led hospitals like Leicester. Later in the article Chris Ham extends the issue of sustainability into the second of its three dimensions in healthcare: clinical sustainability. With better IT, more empowered patients, more need for collaboration with other agencies such as social care and primary care, and with good evidence of better specialist care in fewer, higher quality tertiary centres, business as usual is not an option for our traditional district general hospital (DGHs). 

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