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Guest bloggers

John Davies: The Olympic Games opening ceremony in an occupied city

8 Aug, 16 | by BMJ

Rio_Olympic_GamesOver the weekend, downtown Rio was like an occupied city. Traffic was diverted from whole streets so that military lorries could park en echelon, guarded at each end by squads of soldiers, while the nonchalant Cariocas, Rio’s residents, walked by. The biggest street of all, the Avenida President Vargas, normally four carriageways with a total of twelve lanes, was blocked off in one direction. Brazil is determined that these Games shall be safe and as peaceful as they should be. more…

Clifford Mann: My biggest career failure

29 Jul, 16 | by BMJ

I had spent five years as a senior house officer in the late 1980s and early 1990s trying to decide on a specialty, sitting exams, and changing my mind several times. Eventually, having taken an accident and emergency post—largely to pay the mortgage—I finally found a subject that was sufficiently broad to gain my interest. Obtaining a registrar post, however, was quite another matter.

I was interviewed and rejected by Leeds, York, Leicester, Lincoln, St Mary’s, and the Central Middlesex. I learnt quite a bit from these interviews, including the lesson that one should never cancel a holiday to the Algarve in an attempt to get a job in Yorkshire. more…

John Davies: Getting ready for Rio

28 Jul, 16 | by BMJ

As the Olympic Games approach, I’m beginning to make preparations. I’m going there!

I got the bug at London 2012. They asked the public to volunteer because no games can happen unless thousands of people give their time and expertise. Staff are appointed in all trades and professions that are needed for such a mega event and paid, but the games could not happen unless people did the grunt work for nothing. Less than nothing really, because the games do not pay volunteers’ expenses (except for daily travel for their shift and a meal while on shift) and do not provide accommodation. Thousands of the 75 000 London “Gamesmakers” slept on the floors and sofas of friends of friends, stayed with remote family relations, and camped on sports grounds all around the city. more…

Sarah Mitchell: It’s time to change end of life conversations for better care

27 Jul, 16 | by BMJ

brumyodo_1What can we do to improve care for people who are dying? Someone dies every minute in the UK. In healthcare we know we need to improve what we are doing, but the messages in guidelines and strategies have changed little over recent years.

Public health agendas in palliative and end of life care are increasingly promoted to empower people to have conversations about the end of life, death, and dying, with the philosophy that “care for one another at times of crisis and loss is not simply a task for health and social care services, but is everyone’s responsibility.”

GPs are considered to be embedded in their communities and should therefore be in a prime position to engage in these public health agendas. As a GP in busy Birmingham more…

Collette Isabel Stadler: How poor provision of mental health services adds to the risk burden for children in care

26 Jul, 16 | by BMJ

If you are a 65 year old male smoker with hypertension, hyperlipidaemia, and a family history of cardiovascular disease, the QRISK calculator informs a physician that your chances of having a heart attack in the next 10 years are 47%. Health professionals leap into risk modification and disease prevention mode; you are referred to smoking cessation programmes, offered dietary and lifestyle help, and prescribed statins and antihypertensives. The approach is aggressive and holistic. I am proud of the UK’s approach to physical illness prevention on all levels.

If you are a 13 year old child in state care, your chance of having a significant mental health problem during adolescence is 49%, yet this is not always a catalyst for action.  more…

Ilora Finlay et al: Doctors should be wary of assisted dying

22 Jul, 16 | by BMJ

This blog was commissioned following a debate on assisted dying at the BMA ARM. It is part of a collection of blogs on the topic. Jacky Davis argues that the BMA should move to a neutral position on assisted dying. Sheila Hollins et al argue that the BMA is right to reject a neutral position. In this piece Ilora Finlay et al say that doctors should be wary of assisted dying. 

Why should doctors be wary of what is being called “assisted dying.” Well, let’s pass over the obvious problem—that giving patients the means to kill themselves cuts right across the “do no harm principle” in medicine. Let’s look at some of the practical issues.

After nearly 20 years of legalised physician-assisted suicide in Oregon, only one in three doctors there is prepared to undertake this in practice. [1] So it’s not surprising that there is “doctor shopping,” in which patients whose doctors refuse to assist their suicides seek out or are “introduced to” a minority of willing ones who have never met them before and know nothing about them beyond the referral letter or notes. In 2015 one Oregon doctor handed out no less than 27 prescriptions for lethal drugs. [2] more…

Basil Porter: Deadly silence

22 Jul, 16 | by BMJ

basil_porter.jpgI recently returned from a fiftieth anniversary reunion of our Witwatersrand Medical School graduating class in Johannesburg, South Africa. Many had spent their careers outside of South Africa, most in the USA, Canada, Israel and the UK. During formal sessions, people were asked to talk about our student days and their subsequent lives.

A few recalled the short, surly mortician in his white coat next to the prostate corpse, who would with a flourish unknown to today’s medical students, most of whom probably have not even seen an autopsy, make a long vertical incision from sternum to pubis. All the internal organs would be laid out followed by an electric saw removing the upper half of the skull, allowing the brain to be removed and join the fellow organs. The pathologist would then enter and select a student to join him in continuing the autopsy. more…

Adrian James: Why mental health treatment should only ever be “patient-first”

19 Jul, 16 | by BMJ

adrian_james2Earlier this month I spoke at a conference on Psychological Therapies for Severe and Prolonged Mental Illness in London. I was one of only two psychiatrists on the bill, among many psychologists putting forward a “therapies first” approach to the treatment of severe mental health problems.

As I said at the conference, I have a problem with this insistence on indicating a preference. And that’s not a matter of me protecting my own ground; it’s a matter of protecting patients. I’ve argued the need for more psychological therapies on many occasions. I have no interest in turf-wars. I have an interest in providing patients with the most appropriate treatment, in the most appropriate way. more…

Oliver Minton: Cancer survivorship—where to next

14 Jul, 16 | by BMJ

ollie_mintonI was invited to attend the inaugural cancer survivorship conference in Brussels—at the time our interests aligned (and indeed still do). The conference felt different with patient groups, bankers, actuaries and even royalty alongside all the usual suspects. I left feeling hugely positive about what could be achieved with governmental and organisational backing. However this was in 2014 and as we all realise the world is now a different place.

The cancer strategic direction has turned more to personalised medicine and potentially a focus on immuno-oncology. Blockbuster drugs and science will always make good headlines, but for many patients are diagnosed, treated, and cured of their disease and have to live with the sequelae of treatment. This goes beyond follow up appointments and blood tests, fear of recurrence, and into resuming normal life with work, family etc. more…

Lara Fairall: Serendipity and scaling up towards universal primary care

14 Jul, 16 | by BMJ

lara_fairallA Brazilian adaptation of our PACK training programme for primary care doctors and nurses went live last week in the Southern city of Florianὸpolis, or Floripa as it is known to locals, amid great excitement including a clip on local television. We’ve spent 15 years in South Africa developing, researching, and fine tuning our programme. PACK, or the Practical Approach to Care Kit, combines a clinical decision support guide with onsite, interactive, team-based training sessions to familiarise health workers with its content and support scalable implementation. It covers an approach to the most commonly seen symptoms and conditions amongst adults attending primary care services, integrating content on communicable diseases, NCDs, mental disorders and women’s health. We’ve demonstrated positive impacts on quality of care in a series of pragmatic trials mainly in the area of communicable diseases. The programme has been scaled up in South Africa reaching more than 20 000 nurses and doctors across more than 2000 clinics. Last year we partnered with the BMJ’s Evidence Centre to keep the guide up to date with the latest evidence, and to respond to the many requests we’ve had to adapt and implement the programme in other countries. You can read more about our journey over the past 15 years in an article published last year. more…

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