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Daniel Whitney: Mental health has still not achieved “parity of esteem”—even among some medical professionals

1 Dec, 16 | by BMJ

daniel_whitney

It’s late morning; little piles of lists and notes from assessments carried out in the past 24 hours are littered between me and the PC. The assorted paraphernalia that seems to accumulate around me after a night on-call clutters my surroundings: a dictaphone, the British National Formulary, Maudsley guidelines, and the semi-completed audit I glance at guiltily every time I find something more urgent to do.

The medical students enter. I welcome them and realise that I had agreed one could present a history they had taken. I had felt guilty earlier; they had been struggling to find patients who met their tick box quota of “cases,” more…

Lorraine Atkinson: Preventing prison suicides

30 Nov, 16 | by BMJ

prison_cell2016 will be remembered for many reasons. I will remember it as the worst year on record for the number of prisoners who have taken their own lives in prisons in England and Wales.

More than 100 people have died by suicide in prison since the beginning of 2016. There are five weeks remaining yet already this is the highest death toll since current recording practices began in 1978. more…

Valentina Lichtner: Incorrect patient record selection

28 Nov, 16 | by BMJ

valentina_lichtnerRecently the Wall Street Journal alerted its readers to a report by the ECRI Institute in the US on the common problem of patient misidentification. [1,2] The study found 7613 “wrong patient” incidents reported across 181 organizations in the period January 2013 to July 2015. Selecting the wrong electronic record was one example of this type of incident.

The consequences of record mis-selection can be serious and include patients receiving the wrong medications, incorrect results, diagnosis, and history of illness. The incidents always involve an error of commission (e.g. giving treatment that should not have been given) and one of omissions (e.g. not giving the treatment as intended), and two patients: the patient whose wrong record has been selected, and the patient who was the intended recipient. more…

Jamie Murdoch: Nurse or non-clinician in the delivery of telephone triage?

24 Nov, 16 | by BMJ

The question of who should triage patients over the phone is critical to delivering safe and effective care and has become a contentious issue for healthcare systems. Belgium is currently undergoing important changes in how it provides healthcare to patients in this respect.

belgium_outofhours

Maggie De Block at the opening of the new
out-of-hours care centre in Bruges hospital

On 21 October 2016, Maggie De Block, the Belgian minister for health, opened a new out-of-hours healthcare centre in Bruges, one of the first in Belgium to be located in the same place as a hospital emergency department. On the same day, a study led by the University of Antwerp began testing telephone triage in Belgium for the first time. In doing so they will be using professional call takers with no clinical training. more…

Trevor Plunkett: Dementia is not a disease

24 Nov, 16 | by BMJ

Recently I read in at least three daily newspapers that dementia is now the leading cause of death in the UK. It appears that such statements arise from figures supplied by the Office of National Statistics (ONS), which wrote, “Dementia and Alzheimer’s (sic) has replaced ischaemic heart disease as the leading cause of death in England and Wales.”

The inference from these articles is that dementia itself is a death causing disease. I make the point pedantically, because I wish to be clear when I say, I wholeheartedly disagree with these statements. Newspaper journalists and editors seem unable to differentiate between disease and symptom, and the ONS is not helping. more…

Sara Hamilton: Pioneering open heart surgery

24 Nov, 16 | by BMJ

sara_hamiltonMy brother died in 1964 at Guy’s Hospital. He was 15, I was 12. He had a congenital heart problem which I believe was a ventricular septal defect. He was under the care of Lord Brock, a leading British chest and heart surgeon and one of the pioneers of modern open heart surgery. He had his first major operation when he was 12 in 1961, but was told that it had not been successful, and he would need further surgery. Second time around, he died in the operating theatre. At twelve, I had not appreciated how serious the operation was—it was even with some pride that I had told my school friends that my brother was having “open heart surgery.” I went back to school the very next day. My parents had never spoken to me about the possibility of his death and we never discussed how much they had themselves been told. They were aware that Lord Brock was foremost in his field and they knew that Jonty had the best possible treatment at the time.  more…

Thushara Matthias: Caring for older patients

22 Nov, 16 | by BMJ

I’m a postgraduate trainee from a developing country and have completed my local training in internal and general medicine to be a consultant physician. The rest of my training involves mandatory “foreign training” in an overseas country of our choice for one year. In most cases, doctors from my region choose either the United Kingdom or Australia due to the ties we have with these countries’ medical systems.

When I arrived in the UK to work as a clinical fellow in acute medicine two months ago,  I was eager to start work on the medical short stay wards. As time has passed, I have learnt that each passing day we retain a few patients who are not going home despite being medically fit. more…

Juliet Cohen: Proving torture–home office mistreatment of expert medical evidence

21 Nov, 16 | by BMJ

juliet_cohenThe encounter that changed my medical career was in 1990, with an interpreter working in a Red Cross clinic overseas. We had become friends over the weeks that I worked there and one day he showed me his application to be considered a refugee. He detailed the events leading to him having to flee his country, but gave hardly any detail about what he had actually suffered. I asked why and he explained that he did not like to revisit those memories or to be pitied. He wished his case to be considered on his words and deeds.  more…

Neel Sharma: Sayre’s law—any hope for change in academia?

17 Nov, 16 | by BMJ

neel_sharma“In any dispute the intensity of feeling is inversely proportional to the value of the issues at stake . . . that is why academic politics are so bitter.”
Wallace Stanley Sayre

Although I am just starting out, I have gained some experience in the world of academia. I was always drawn towards understanding why the patients we treat are treated the way they are, and where the reasoning for certain diagnostics and management strategies originates from. That was my trigger for entering academia.

Months later, and having been exposed to academic communities both East and West, I am drawn to another issue: academic politics. more…

Richard Lehman: Pre-diabetes: can prevention come too soon?

17 Nov, 16 | by BMJ

richard_lehmanIn the last fifty years, most people across the world have had more food to eat and less physical work to do. On the plus side, we are living longer—often much longer—than our immediate ancestors. On the minus side we are running higher levels of blood glucose. Overall, there is much to rejoice about. But at the same time public health physicians, whose job is not to rejoice, tell us that we are facing a global epidemic of diabetes. And they are right. more…

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