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Abraar Karan: The success trap of academic medicine and the need for change

20 Jan, 17 | by BMJ

abraarThe career options available to physicians today are more diversified than they have ever been. Physicians are making their presence known in areas that are not fully clinical, including policy, management and leadership, the arts, communications, consulting, and more. Dual degrees have also been on the rise, with many more students pursuing the MD/MPH, MD/MPP, MD/MBA, and, less commonly, Master of Arts and JDs.

However, the criteria for being hired or promoted at the most prestigious medical centers in the US and UK, most of which are also prominent research institutes, primarily focus on academic output, such as papers, abstracts, and academic presentations. This has been noted as a problem for clinicians within these institutions, since they have to juggle providing the best clinical care with the demands of academic publishing. more…

Bernard Merkel: Should patients really be at the centre of healthcare?

20 Jan, 17 | by BMJ

bernard_merkelI attended the recent Organization for Economic Co-operation and Development (OECD) policy forum on the Future of Health, “People at the Centre,” with mixed feelings. [1] On the one hand, the conference had an exciting theme and would give me the opportunity to hear about some new ideas and international developments, as well as to catch up with old colleagues and friends. On the other, I noticed that the agenda was going to be dominated by presentations by various American health policy academics—Michael Porter (keynote speech), David Blumenthal (keynote speech), Don Berwick, and Chris Murray. more…

Neel Sharma: Fired up, ready to go!

20 Jan, 17 | by BMJ

neel_sharmaAlthough I’m not usually political by a long shot, the presidential transition in the US today has made me reflect on Barack Obama’s legacy and his mantra of: “Fired up, ready to go!”

I transplanted these words temporarily and thought back to where I currently stand as a junior doctor. When I left medical school I was naïve. I assume most of us were. We eventually realise when we begin to practice medicine, that the system that we work in is not always so conducive to effective working practice. I’m sure readers are avidly digesting the state of the NHS this winter. I also realised that as juniors we focus on safe and effective patient care, but our focus can be distracted by our worries of what those above us think. more…

David Shaw: The implications of conflicts of interest for informed consent

18 Jan, 17 | by BMJ

david_shawThe General Medical Council (GMC) has detailed guidelines on handling conflicts of interest. These state that “You must not allow any interests you have to affect the way you prescribe for, treat, refer, or commission services for patients.” [1] But in many cases, doctors who fail to disclose a conflict of interest are not only breaching rules governing conflicts of interest; they are also breaching guidelines on consent.

When seeking consent from a patient, doctors must ensure that three criteria are met: the patient must be adequately informed and be competent to make a decision, and that decision must be voluntary. The GMC guidelines on consent state that “you must…share with patients the information they want or need in order to make decisions [and] maximise patients’ opportunities, and their ability, to make decisions for themselves” (principle 2). In addition, principle 3 states “For a relationship between doctor and patient to be effective, it should be a partnership based on openness, trust and good communication.” [2] more…

Miranda Wolpert: We must set realistic expectations for outcomes in child mental health

17 Jan, 17 | by BMJ

The secretary of state for health, Jeremy Hunt, identified Child and Young People’s Mental Health Services as “the biggest single area of weakness in NHS provision at the moment.” Hardly a day goes by when there is not another story in the press about children and young people failing to get access to or needing to travel huge distances for treatment. Professionals and lobby groups call for more funding and greater access.

I want to be clear that I absolutely endorse the need for more funding and the calls for better access. However, I am concerned that, because of the strength and urgency of the focus on funding and access, consideration and discussion of the limits of treatment is being lost. The fact that not all provision is helpful is rarely discussed; perhaps partly out of concern that, if it were raised, what limited resources are already available would be cut further. I have argued elsewhere that this silence on the limits of treatment has potential negative consequences; in particular it can leave therapists and patients alike feeling bewildered and blamed for a lack of progress and can limit any motivation to genuinely review outcome rates and make improvements in the light of that review.   more…

Seth Berkley: The new priority in Syria is preventing epidemics

17 Jan, 17 | by BMJ

Regardless of how the current ceasefire agreement in Syria came about, it has—to a large extent—brought a welcome halt to hostilities in many parts of the country. But as one humanitarian crisis is suspended, another potentially hangs in the balance—the growing threat of epidemics. With no way of knowing how long the ceasefire will last, there is an urgent need to get vaccines into Syria before this much-needed opportunity slips away and before the suffering of people in Syria is made even worse by the growing threat of deadly infectious disease.


Samir Dawlatly: The perfect storm to distract us from a crisis

17 Jan, 17 | by BMJ

All over social media recently there has been wailing and gnashing of teeth by GPs, such as myself, at suggestions that the opening hours of general practice are in some way to blame for the crisis in hospitals up and down the country. A single paper initially led with the story that the Prime Minister was going tell GPs that they had to be open from 8 until 8, 7 days a week, according to local need. This is nothing new. This is old news. This is the part of the plan set out in the GP Forward View, with the finer details being laid out in NHS operational planning guidance (see page 53). more…

Florence Wilcock: Maternity voices partnerships—“No hierarchy, just people”

16 Jan, 17 | by BMJ

florence_wilcock“No decision about me without me” has been a key element of NHS rhetoric since 2012. It’s a great idea, however, the current reality is that as a universal principle this remains far from true.

Why is there still such a struggle to make this happen? In healthcare there is an increasing acceptance of the need to have patient engagement strategies and patient representatives at meetings, however, this attempt can be tokenistic and fall short as a genuine endeavour to find out what service users want, and to design improvements and implement changes together. more…

Lindsay-Ann Coyle and Sarah Atkinson: Living with multimorbidity

12 Jan, 17 | by BMJ

“I sometimes refer to myself as having OCD and sometimes refer to myself as having an eating disorder.”

Living with multimorbidity may constitute one of the biggest challenges to how contemporary medicine is practised. The number of people living with multimorbidity is predicted to double in one decade—that is from 1.9m to 2.9m between 2008 and 2018. [1,2]

At the same time, there is a growing awareness of the need to address the problems multimorbidity presents to current medical practice more…

Arnie Purushotham: Multidisciplinary team meetings in cancer care need to change

11 Jan, 17 | by BMJ

arnie_purushothamMultidisciplinary team (MDT) working is one of the cornerstones of our cancer services. MDT meetings are vital for exemplary patient care but it is becoming increasingly clear that they need to be refreshed.

Despite the rising incidence of cancer, an ageing population and huge improvements to cancer services and treatment regimens, the format of MDT meetings has not changed since their introduction over 20 years ago. We now see more patients, with more co-morbidities, and far more treatment options to discuss. more…

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