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Guest bloggers

Mary Higgins: Remembering

25 Oct, 16 | by BMJ

IMG_0701Recently we held our annual service of remembrance—the 20th time we have formally celebrated the brief lives of babies that died. This is an important part of our care of women, reflecting that for many their pregnancies do not always have a happy outcome.

There are many words that could be used to describe this service. Some may choose to call it a very sad occasion. So many people drawn together on a Sunday afternoon in October, all bound together by a common experience of loss and grief. more…

Hitesh Bansal: When the worlds of medical student and medical patient collide

20 Oct, 16 | by BMJ

hitesh_bansalA 20 year old male presented to A&E with abdominal pain. The pain was sharp, constant, severe, located in the epigastric region, radiating through to the back, and had been present since waking that morning. It was associated with profuse vomiting, no hematemesis, no change in bowel habit, no history of unfamiliar food, or travel abroad. He was a student, did not smoke, and drank roughly 15 units a week. He was otherwise healthy.

The diagnosis? Pancreatitis. The patient? Me. That diagnosis of pancreatitis, four years ago, would change my life. For better and for worse. more…

Rosanna O’ Keeffe on Direct Provision: Is this really the best we can do for those seeking asylum?

19 Oct, 16 | by BMJ

rosannaIn 2000 the Direct Provision scheme was officially introduced by the Irish government. The scheme requires asylum seekers to live in designated accommodation centres while they await decisions on their application for refugee or humanitarian leave to remain in Ireland. Initially, it was expected that the maximum time spent in Direct Provision would be six months. Unfortunately, the average stay is currently estimated to be four years.

According to the Reception and Integration Agency, 2015 was marked by an increase in the number of people housed in Direct Provision, from 4364 in 2014 to 4696 in 2015. Almost a quarter (1172) of these people were underage residents in 2015.

The people waiting to hear their fate under this scheme (tired, perhaps grieving those left behind, and often battling post traumatic stress) will probably be housed more…

Chris van Stolk and Joanna Hofman: Helping people with mental health problems to stay in work

19 Oct, 16 | by BMJ








Reducing mental ill health in the UK remains a significant policy challenge for government. Just over 6 million working age people have mental health problems, with 39 per cent of those seeking help and 24 per cent receiving treatment. However, a recent report from the National Audit Office (NAO) indicated that access to mental health services is limited with patients having little choice over the services they receive and often enduring long waiting times.

At the same time, these services can incur significant costs to governments. In 2016, the Mental Health Task Force valued the current costs of mental health support and services across government departments in England at £34 billion a year. However, even this high number was seen by the task force as being insufficient to meet current demand. more…

Jonny Martell: Opening a dialogue in mental health

18 Oct, 16 | by BMJ

jonathan-martellI was there the first time my father saw the psychiatrist. I think it was the only time, in his study at home. I remember I was seated behind him, a bit to the side. A little out of the way. Walking down the corridor afterwards, my father still seated by the fire, the psychiatrist asked me, “Is there a shotgun in the house?”

“Yes,” I replied—my father used to farm.

“Find a new home for it please.”

She prescribed some medication and requested a head scan. A community psychiatric nurse paid him visits—described by my father, not unkindly, as “a little bully.”

The scan results came through several months later. But my father never saw them. more…

Iain Chalmers: Should the Cochrane logo be accompanied by a health warning?

18 Oct, 16 | by BMJ

Iain-ChalmersThe birth of the Cochrane logo

Twenty four summers ago I asked David Mostyn to design a logo to illustrate the objectives of the soon-to-be-opened Cochrane Centre. He did a good job: the circle reflects global objectives and international collaboration; the mirror image “Cs” stood for the Cochrane Centre (and, a year later, the Cochrane Collaboration); the horizontal and vertical lines show the results of some early randomised trials assessing the effects of prenatal corticosteroids on the likelihood of early neonatal mortality; and the diamond is a statistical summary of the information derived from the individual studies above it. As prenatal corticosteroids were not in widespread use at the time, the logo illustrated the human costs that can result from failure to prepare systematic, up-to-date reviews of controlled trials of health care. more…

Paul Aylin: Weekend Gravity Waves

13 Oct, 16 | by BMJ

On 15th September 2016, a letter appeared in The Guardian with an unlikely collection of signatories including Lords, an MP, a number of medics, a leader in evidence based medicine and the physicist Professor Stephen Hawking. [1] The letter drew attention to the “freshly disputed evidence surrounding a weekend effect”, suggesting that claims for this apparent difference in mortality rates between patients admitted at the weekend and those admitted during the week are not supported by reliable research, and that “Critically… at least 13 independent, peer-reviewed papers were available to the secretary of state that refute his definition of a weekend effect.”


Laurence Gerlis: Is private medical practice that bad?

12 Oct, 16 | by BMJ

laurence_gerlisDuring my 30 years as a private GP I have become used to being insulted by other doctors. Some see us as mercenary quacks, with little genuine interest in patients’ needs, who overprescribe and bombard NHS GPs with useless health screening reports.

NHS doctors are not volunteers, they are paid. All patients pay for NHS treatment, even the poorest who pay via taxes including VAT. The money just takes a more circuitous route than it does in our clinic. So there is no moral discrepancy. My patients pay again, mainly because they cannot get an NHS appointment soon enough and they work in Central London where I am based. My average patient is not a rich oligarch, but a 30-something working person on a slightly above average salary. I don’t see this as vicious queue jumping, just being practical. I have never had any income apart from what I can earn in fees from individual patients, whereas NHS doctors have a guaranteed patient flow and income plus pension. One NHS GP confided to me, “I wish I had the nerve to take a chance as you did, but I need to know that I have regular income.” more…

Nicholas S Hopkinson reviews “The state of medicine”

12 Oct, 16 | by BMJ

nick_hopkinson“I am furious, sad, and scared for the NHS” —Margaret McCartney’s opening words in the introduction to her latest, timely book, The State of Medicine (Pinter and Martin 2016). Understandable sentiments, as the NHS heads for £20 billion/year underfunding by 2020 and politicians can launch thinly veiled xenophobic attacks on our colleagues born overseas.

McCartney’s writing has been characterised by a consistent critique of the distorting effect and waste that follows from misconceived interventions in healthcare; the harms these can cause to the lives of those who need care and to those who provide it. The Patient Paradox (Pinter and Martin 2012) challenged the growth of screening and consumerism; how time and resources are being shifted away from people who are unwell and disadvantaged, towards those who are healthy and who themselves risk being treated for conditions that may never affect them. Living with Dying (Pinter and Martin 2014) focussed on the balance of risks and harms of interventions at the end of life and the need to prioritise human kindness over remote technology. more…

Mary Higgins: Breaking bad news in maternity care

7 Oct, 16 | by BMJ

IMG_0701There’’s one thing I really hate about my job, and that’’s a particular phone call. A midwife I respect will ring and ask can I come down straight away. A woman has presented because her baby hasn’’t moved in a couple of hours, and the midwife can’’t hear a heartbeat.

As I enter the room, there is a woman there, hopefully with someone, who looks up as I walk in. Her face tells a story—fear, hope—and what I say next will be remembered for the rest of her life. more…

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