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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…

Barbara Harpham: CCGs are not adopting new technologies quickly enough

26 Jun, 15 | by BMJ

barbara_harphamIn December 2011, the NHS identified six ways technology could help patients and, ultimately, save money. A freedom of information request was sent to 211 clinical commissioning groups (CCGs) across England in October 2014 looking for a progress update; 189 (90%) responded.

How did they do? Well, it’s a mixed bag, with CCGs naturally opting to cherry-pick where to focus their efforts. But overall the picture is not healthy. more…

Richard Graham: Is it time to unplug?

26 Jun, 15 | by BMJ

Richard_Graham_Portrait

As we approach the first UK National Unplugging Day, one might well ask why there is a need to have a day promoting gadget free time for families. After all, we can switch off our smartphones and tablets any day or at any time, and thus feel reassuringly conscious of and in command of our use of them. Or can we?

Our use of digital devices is now extensive, with Ofcom’s recent “Adults’ media use and attitudes report” indicating that online time for most adults has doubled over the last decade. For young adults, communication and accessing media (predominantly videos now) will take up more than nine hours of each day. For medical practitioners, is this just an issue of lifestyle and choice, or are there consequences of using devices, if only through the disruption of sleep, that we should attend to? Should we consider this use high, problematic, or even a sign of “addiction?” more…

Michelle Webb on the need to improve sepsis recognition and treatment

25 Jun, 15 | by BMJ

Over 100,000 people a year have an episode of sepsis at a cost of around 35,000 lives, more than bowel and breast cancer combined. Sepsis is the third highest cause of death in hospitals and one of the commonest causes of death in pregnancy.

As a result of advances in medicine we are living longer. However, the medicines that we are using more and more to treat cancer, arthritis, and to allow us to perform transplants are also reducing our patients’ ability to fight infection—thereby increasing the risk of sepsis. Over the past 10 years the incidence of sepsis has increased by 8-13%. more…

Iris van der Heide: We need policies to target integrated care for people with multimorbidities in Europe

25 Jun, 15 | by BMJ

PrintThe ICARE4EU project wants to improve the care of people suffering from multiple chronic conditions. It will describe, analyze, and identify innovative integrated care programmes for people with multimorbidity in 31 European countries, and aims to contribute to more effective implementation of such programmes. During the project (from 2013 to mid 2016), members of the ICARE4EU consortium will keep readers of The BMJ informed about project developments.

more…

Natika H Halil on providing emergency contraception to under 16s

24 Jun, 15 | by BMJ

natika_hallRecently the UK’s press went into overdrive reporting on the recent change in emergency contraceptive pill ellaOne’s product licence—now available to buy over the counter for women of “all reproductive ages,” and therefore including under 16s.

Of course levonorgestrel was already available to under 16s in pharmacies in many areas through patient group directions. In these instances, it has been given outside of product licences, but in line with all guidelines relating to contraception and young people, and with pharmacists working within Gillick competency and Fraser guidelines. more…

Anne Gulland: Mental health problems—a gender divide

19 Jun, 15 | by BMJ

Anne_GullandFeckless, hysterical, neurotic, sluttish: these are just some of the adjectives used to describe female patients suffering from psychological illness in the book Good General Practice, an investigation into general practice published in the mid 1950s. [1] The author was Stephen Taylor, an eminent GP and civil servant whose views were typical of an age when it was still thought that women were biologically more prone to mental ill health than men. more…

Athene Donald: Learning lessons from Tim Hunt

17 Jun, 15 | by BMJ

athene_donald_2015Many years after his Nobel Prize winning discoveries in cell cycle regulation, Tim Hunt made some inappropriate and indefensible comments. It seems like the whole world wants to discuss those comments. Or rather, it’s as if they want to demonise the man and forget the totality of his life.

Scientists are supposed to like evidence. We are not supposed to cherry pick data to fit a model that ties in with our beliefs, and I fear that some of the more extreme extrapolations that have been made—based on one data point of some off the cuff remarks, however offensive people have found them—do not stand up to scrutiny. If any good is to come out of this whole sorry episode, I hope it will be that people scrutinise their own behaviour in the light of the issues regarding the ongoing barriers, explicit and implicit, that women in medicine and science face. more…

Sioned Gwyn on sexism and women in medicine

17 Jun, 15 | by BMJ

sioned_gwynSir Tim Hunt, British biochemist and Nobel Laureate, had until recently enjoyed relative anonymity outside of scientific fields. Recently, at an international conference of science journalists in Seoul, he was invited to speak at a meeting for women in science and delivered as part of his speech an extraordinarily ill judged few sentences which have come to haunt him: “Let me tell you about my trouble with girls. Three things happen when they are in the lab. You fall in love with them, they fall in love with you, and when you criticise them, they cry.

more…

Karsten Juhl Jørgensen: Why do five recent reports on breast screening reach conflicting conclusions?

17 Jun, 15 | by BMJ

karsten_juhl_jørgensenSince 2012, five collaborative efforts to quantify the benefits and harms of breast screening have been published. These are the UK Independent Review, the EUROSCREEN Working Group series (both 2012), the Swiss Medical Board report (2014), the updated IARC/WHO Handbook, and a report from the Research Council of Norway (both 2015). The approach to put together panel members to review the evidence, and the methods to do this, has varied considerably. So have estimates and recommendations. The Swiss report found that harms outweighed benefits and recommended clearly against the intervention, whereas the EUROSCREEN Working Group and the IARC/WHO panel found the opposite. The UK and Norwegian reports were somewhere in between, estimating that three and five women, respectively, are overdiagnosed for each woman who has her life extended. They recommended screening, but also recognized that the balance is delicate and the need for informed decisions.  more…

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