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Guest bloggers

Samir Dawlatly: Will general practice survive?

28 Jul, 15 | by BMJ Group

Just before I completed my training as a GP the 2012 Health and Social Care Act was passed. I had a sinking feeling that general practice wasn’t quite going to be what I thought it was. Up until that time I had been concentrating on passing my exams and assessments and not really taken much of an interest in medico-politics. At times I felt like there was little hope of stability and security in primary care.


Lalitha Bhagavatheeswaran and Joseph Fitchett: That Sugar Film

27 Jul, 15 | by BMJ

TSFAustralian actor, writer and director Damon Gameau was about to become a father. With a little one on the way and the aim of teaching his future child how to lead a healthy lifestyle, Damon embarked on a 60-day experiment to unravel the truth about sugar. However unlike other films on sugar, which have focused on obvious high sugar content items such as soda and desserts, That Sugar Film focuses on foods that are perceived to be healthy. These include for example smoothies, low fat yogurts, cereals and granola bars. more…

Neel Sharma: Medical certification—too many tests?

24 Jul, 15 | by BMJ

In May this year, Paul Teirstein and Eric Topol authored a viewpoint on the role of maintenance of certification (MOC) in the States. Their article highlighted the shift from a ten yearly to two yearly MOC approach pointing towards concerns of the value of such frequent retesting. These included the lack of evidence for such a shift, the fact that a written test can never truly translate to what is done in actual practice (“clinical decisions are often not black and white, yet test questions must have one best answer”), the limitation of the test itself in an environment of super specialisation (“adult anesthesiologists who never treat children must take a test that includes questions about pediatric anesthesiology. General surgeons must review trauma surgery for the recertification examination even though they do not treat patients who sustain trauma. A cardiologist who spends four days per week in a basic science laboratory and one day caring for patients in a clinic is tested on reading cardiac echocardiograms and exercise stress tests, yet never performs these services”) as well as the significant costs involved. In keeping with the first point, they detailed that evidence supporting physician certification and MOC was written by ABIM employees. more…

Paul Lord: Too many “tick box” exercises

21 Jul, 15 | by BMJ

paul_lord“L’enfer, c’est les autres”—Hell is others

As I progress from trainee to GP, I have taken time to reflect on the process I have been through and I think this saying sums it up. No, I’m not an antisocial existentialist (nor did Sartre intend that the line be interpreted that way), but I have found my existence reduced to the sum of the judgements of others. more…

Defining child poverty

10 Jul, 15 | by BMJ

The government’s plan to repeal the 2010 Child Poverty Act, which committed it to eradicating child poverty in the UK by 2020, and dispense with the current definition of child poverty is highly concerning. Especially when you consider this plan in the context of a recent report by the four UK children’s commissioners, which stated that levels of child poverty in the UK were “unacceptably high” and expected to rise.

Iain Duncan Smith has indicated that the standard definition of relative child poverty (a household income below 60% of contemporary median) will be replaced with measures of “worklessness:” family breakdown, addiction, debt, and educational attainment. Details of how this “new” definition of child poverty will be formulated, and what the targets are, have not been outlined. This is concerning because an unvalidated and unclear measure of child poverty may be open to political manipulation. more…

Anna Mead-Robson: Welfare cuts and suicide risk

8 Jul, 15 | by BMJ

anna1Pity the politician tasked with addressing over a thousand psychiatrists on the state of mental health services. At last week’s International Congress of the Royal College of Psychiatrists, such a fate befell the Rt Hon Alistair Burt, minister of state for community and social care.

Braving his audience, Burt acknowledged the current weaknesses within our services and the large body of work needed to address the mental health of the nation. He also added that the new Conservative government is committed to reducing the number of suicides in the UK. A worthy goal, but is this really compatible with impending cuts to the welfare budget? more…

Nicola Bedlington: Patient involvement in medical devices—an opportunity we may be missing

2 Jul, 15 | by BMJ

nicola_bedlingtonPatient involvement in health and social care is a fundamental right, and an operating principle of European healthcare systems. In the area of medicines patients are recognised as experts and are participating in many aspects of access, innovation, safety, and transparency, thanks, not least, to the commitment to patient involvement of the European Medicines Agency. However, in the area of medical devices a change of mind-set is needed. more…

Marika Davies: Standing up to disrespectful doctors

2 Jul, 15 | by BMJ

marika_daviesMedia reports that chip away at the confidence the public has in doctors occur regrettably often. A recent case in Virginia, USA, in which a patient recorded offensive comments made about him by the medical team during a colonoscopy, will make depressing reading for all those who work hard to earn and maintain the trust of patients. more…

Michael Soljak: Data access for research—Kafka writes again

29 Jun, 15 | by BMJ

Data are the lifeblood of health research, and the UK government is claiming that data collected in the course of NHS clinical care are available to reputable researchers for the purposes of improving health and healthcare. However, the reality is rather different, and it is becoming increasingly difficult to obtain research data.

Anonymised patient level Hospital Episode Statistics (HES) data on inpatient admissions have been available for research and other secondary uses for many years, and their use has led to major improvements in quality, from identifying higher mortality at weekends to sounding the alarm about institutional failures such as those at Mid Staffordshire Foundation Trust. This was achieved with reasonable information security standards and a proportionate approach to the risks and benefits by the Information Centre for Health and Social Care, as it was called then. more…

Martin Marshall: The travesty of the 10 minute consultation

29 Jun, 15 | by BMJ

martin_marshall“Perfunctory work by perfunctory men.” That’s how an eminent physician once described general practice. “A ridiculous claim” cried GPs, rising to the defence of their discipline, “specialists just don’t understand the nature of general practice. They don’t value our ability to make quick decisions based on a deep understanding of our patients and their context, our exceptional skill at managing risk and uncertainty, of using serial consultations to optimise the effectiveness of our diagnostic and therapeutic interventions.” more…

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