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Guest bloggers

David Oliver: How real life stories can help us understand the challenges of care for older people

16 Apr, 14 | by BMJ

david_oliverOn television we can often tell more from peoples’ words or reactions than from any scripted voiceover. In “Protecting our Parents”—a three part BBC 2 documentary, due to be screened on 17 April, this holds very true.

Our society is often afraid to face up to the realities of old age, and a youth fixated broadcast media compounds this. Yet here, we have a moving, thought provoking, and beautifully constructed series, courageous enough to highlight the dilemmas faced by those at the extremes of age and frailty, and when confronted with life changing decisions at the interfaces between remaining at home, being in hospital, or requiring long term care and support. The light touch used by the programme’s makers allows us to draw our own conclusions rather than be steered, and to appreciate that these dilemmas come in many shades of grey and have no perfect solution or neat resolution. The cases are entirely typical of the work many of us do day in day out in frontline services. more…

Nick Harvey: There’s now a cure for hepatitis C… but the poor can’t afford it

15 Apr, 14 | by BMJ

nick_harveyPicture the scenario: a disease is destroying your liver and there’s a chance you will die. There’s a cure, but you can’t have it as it costs more than you earn. There are tens of millions more of people like you. Hundreds of thousands of them die every year.

It sounds like some sci-fi dystopia, but this is the situation that the 150 million people who have hepatitis C virus (HCV) find themselves in today. HCV is spread through blood-to-blood contact, mostly through shared needles. Around 350,000 people die of HCV related liver complaints each year, but new drugs have been developed within the last six months with cure rates higher than 90 per cent. more…

Jen Gunter: The Tamiflu talisman

14 Apr, 14 | by BMJ

jengunterOseltamivir (Tamiflu) has been prescribed for my son, Oliver, multiple times. It’s possible he has taken this drug more than anyone.

Oliver was born at 26 weeks gestation and was left with significant bronchopulmonary dysplasia. He also has a complex congenital heart disease, now partially repaired, but he is left with moderate pulmonary valve regurgitation and right ventricular hypertrophy. This one-two pulmonary-cardiac punch has left him medically fragile. more…

Neal Maskrey: Medical maths

9 Apr, 14 | by BMJ

neil_maskreyMost of us end up with a handful of people who remember us. Teachers have thousands of people who remember them for the rest of their lives. I’ve been lucky to have had dozens of memorable teachers, and one of the first was Miss Molineux. Miss Molineux was young, enthusiastic, and kind. We were not just the seven year olds she taught, but her devoted fan club. She drilled us in multiplication, encouraged our developing reading, and stayed late to play cricket with us after school. To this day if I have to multiply 8 by 7, a whiff of Miss Molineux’s perfume and 56 are simultaneous events.   more…

Jonathon Tomlinson: Moral luck, agent regret and the doctor as drug

3 Apr, 14 | by BMJ

jonathon_tomlinson“You saved my life, doctor. I can’t thank you enough.” Letter from Tom 2011

“Our mother is dead … because of you.” Bereaved daughter. Poplar coroner’s court 2010

“What is the drug you use with patients all the time?” “The doctor is the drug.” M Balint 1952 [1]

Professional identity is particularly strong in doctors and medical students, and perhaps more than our non-medical peers we assimilate this into our personal identity. [2,3] With this, comes a sense of moral responsibility; we cannot avoid thinking that what happens to our patients is not just down to what we do, but the kind of people we are. How much we internalise our identity and feel morally responsible varies considerably, at one, perhaps narcissistic, extreme it’s all about us and at another, perhaps psychopathic, extreme, it’s anyone or anything other than us. more…

Ryan Irwin: What healthcare can learn from football—10 key lessons

31 Mar, 14 | by BMJ

ryan_irwinFootball, the world’s most played sport, provides an excellent laboratory for understanding the nature of organisations and has some useful lessons for members of the healthcare economy. Here, 10 lessons are explored.

1. Culture is king
Culture is the product of values, beliefs, and behaviours. Football clubs are synonymous with their own cultures, which when expressed positively, bring a sense of shared pride, celebrate ethnonationality, and encourage positive personal expression. However, when expressed negatively, it can lead to hooliganism and extremism. [1] Healthcare leaders and organisations should understand and influence their own organisational culture, to ensure a culture of quality, safety, and learning, or fall victim to cultures which create harm. more…

Sue Macdonald: A parent’s view of cerebral palsy—20 years on

25 Mar, 14 | by BMJ

sue_macdonaldThe other day I came across a personal view that I wrote 20 years ago just after learning that my baby son, Dominic, had been diagnosed with cerebral palsy. The article made me cringe a bit, in the way that something written by your younger self invariably does. But the emotions I was trying to express came back to me all too vividly. I remember the questions about the future racing through my mind. I remember feeling exhausted by the endless hospital visits, crushed by my sadness, and daunted by the responsibilities that lay ahead. And yet, through all the grief and trepidation, I remember daring to hope that the future wouldn’t be so bad. However, the one thing I never imagined was that 20 years later I would be writing another personal view with just the same feelings of trepidation and uncertainty. more…

Daniel Marchalik: Rethinking medical education—in defense of fiction

24 Mar, 14 | by BMJ

daniel_marchalik2In the past decade, medicine has quickly entered a new era in which morning rounds take place in front of a computerized set of lab values and histories are taken from electronic medical records. As verbal exchanges and eye contact become increasingly rare, the patient, as described by Madeline Drexler, morphs into an “oddly invisible prop: part artist’s model, part one-night stand, heard but not seen…exposed, invisible, dehumanized.” [1] As a consequence, medical schools, subject to the pressures to produce not only skilled but also compassionate physicians, have almost ubiquitously adopted “empathy” as a core competency required for graduation. The combination of these forces has created a difficult predicament: how do we approach a task as complex and elusive as “teaching” empathy in a time where face-to-face interactions have evolved into a charming antiquated gesture. more…

Neal Maskrey: Where is the evidence for evidence based medicine?

19 Mar, 14 | by BMJ

neil_maskreyThe internet was 25 years old last week. When Tim Berners-Lee was asked what has surprised him most about the internet’s use he replied “kittens.” With respect, I disagree. The most surprising aspect of the internet is how easy it is to genuinely interact with people around the world. My e-friends might not come to sit at my sick bed and in time share my “dark, tender moments,” but I have e-friends with whom, thanks to Sir Tim, I freely share sadness, joy, laughter, tears……and lots of ideas.

Last week I hope I made a new e-friend. She asked where was the evidence that using evidence to practice medicine is actually beneficial. “So many medical societies have got into the guideline business.” Does adherence to these guidelines really have a positive impact on healthcare? more…

Seye Abimbola and Aku Kwamie: Posting and transfer in the health sector

19 Mar, 14 | by BMJ

seye_abimbolaaku_kwamie

 

 

 

 

 

 

The things we don’t talk about in global health escape our attention perhaps because they don’t have a name—the unnamed subject being, in effect, a non-issue. From 3 to 7 February, a group of 19 researchers, decision-makers, and policy advocates from 12 countries gathered for a meeting at the Rockefeller Foundation Bellagio Centre in Italy to give one such issue a name and place it firmly on the global health agenda. Organised by the Health Governance Hub of the Public Health Foundation of India, and the Averting Maternal Death and Disability programme at the Columbia University Mailman School of Public Health, the meeting deliberated on the problem of posting and transfer of the health workforce (frontline staff and managers), especially in the public sector of low and middle income countries. The importance of posting and transfer cannot be overstated. more…

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