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Jonathon Tomlinson: What are we afraid of?

25 Nov, 14 | by BMJ

Review of
Atul Gawande: Being Mortal: Medicine and What Matters in the End. Profile Books
Margaret McCartney: Living with Dying. Pinter and Martin

jonathon_tomlinsonSurgeon, professor, and best selling writer Atul Gawande confesses halfway through his new book, Being Mortal, “I felt foolish to still be learning how to talk to people at this stage in my career.” Like every conscientious, solution focused surgeon he has found an answer by way of a simple, honest phrase to share with his patients, “I’m worried.” “They were such simple words,” he says, “but it wasn’t hard to see how much they communicated.”

The patient might very well respond: “But I’m the sick one, what the hell are you worried about?” This is an excellent question. Among the things doctors worry about is their own mortality and their inability to cope when they cannot cure. more…

David Zigmond: Payments for diagnosing dementia—what are the hidden costs?

21 Nov, 14 | by BMJ

david_zigmond2Payment by results in matters of complex welfare can easily subtract from, rather than add to, our greater good. The recent and mooted NHS initiative for payment by results—to pay GPs £55 for each new dementia diagnosis—matches any folly in our contemporary gallery of well intentioned welfare misconceptions.

This fresh folly draws from these simplistic assumptions: that dementia is an illness that is underdiagnosed and undertreated; that doctors are undermotivated to address these problems; and that financial incentives will substantially change our burdens from dementia. more…

Paul Laboi: Making dialysis care more person centred

21 Nov, 14 | by BMJ

PaulLaboiIt’s increasingly recognised that empowering people to take a greater role in managing their healthcare is beneficial for both patients and healthcare professionals, especially for those living with long term conditions. Evidence shows that many people enjoy taking an active role in their treatment, and that doing so can lead to better outcomes and improved quality of life.

Take the example of people living with kidney disease, 20 000 of whom receive dialysis in the UK each year. Kidney dialysis is an essential but demanding procedure, which removes waste and excess fluid from the blood. It usually takes three to four hours at a time, three times a week. more…

Billy Boland: Final thoughts on the NHS Leadership Academy

19 Nov, 14 | by BMJ

billy_bolandHaving made my final submission for the NHS Leadership Academy, and after being told I’ve passed the course by my learning set, the programme should be in the bag. That is unless there are any last minute surprises from the validating board coming up.

I’ve always enjoyed the space between handing in coursework and getting my results. Given that I don’t yet officially know my fate, I thought now would be the right time to give my reflections on the programme as a whole. Here are some things to think about (Dos and Don’ts) if you’re considering applying yourself: more…

Samir Dawlatly: Open letter to the Department of Health and NHS England

17 Nov, 14 | by BMJ

Dear Department of Health and NHS England

It seems clear that you, the medical fraternity, as well as the mass media agree that there is a recruitment and retention crisis in general practice in England. What is also clear is that we have differing opinions on the reasons this crisis has arisen.

While doctors and some of the organisations that represent us are open about working conditions in the hope that they can be improved, it appears that you are intent on sticking to the same, seemingly rehearsed, lines. Whether the audience is a room full of GPs, medical students, or a national newspaper, the message seems to be: “The reason for the GP recruitment crisis is that GPs complain so loudly about their conditions, putting off medical students and junior doctors—if they didn’t complain so much we could recruit more GPs.” I paraphrase, of course. more…

Tamasin Cave: NHS England needs to come clean on its spending

14 Nov, 14 | by BMJ

P4A_ERGOTransparency is a much used word in the new NHS. It is the key to safer care, says Jeremy Hunt, and the most important innovation in health, according to NHS England director for patients and information, Tim Kelsey. His boss, Simon Stevens, claims that NHS England has “set new standards for openness and transparency in all of its operations.”

For these words to be meaningful, NHS England needs to get the basics right. At the moment it is not. more…

Amlan Basu: Behind the scenes of Broadmoor

12 Nov, 14 | by BMJ

Amlan BasuThe landmark documentary Broadmoor aired on ITV on Wednesday 5 and 12 November. For the first time, the NHS allowed a camera crew into a high secure psychiatric hospital to film the lives of patients and staff.

One of the biggest challenges of being clinical director of Broadmoor Hospital is changing the public perception of severe mental illness and improving understanding of its causes, treatment, and outcomes. more…

David Oliver: The media narrative on quality in healthcare—helpful or harmful?

11 Nov, 14 | by BMJ

david_oliverOn 28 October, I was part of a Health Foundation and Nuffield Trust “Quality Watch” panel, speaking on the media representation of quality in healthcare. Truth be told, I had been on call for four straight days, then that morning my ward doctor had gone off sick, and it had been touch and go as to whether I could get into London at all. I felt guilty that my preparation consisted of hastily scribbled notes on the train; although, as my wife pointed out, this is a subject I have spent much time thinking and speaking about.

As well as writing my own various columns and blogs, I confess to being a news media junkie. I have BBC Radio 5 and 4 and TV news on non-stop, and tend to read two or three newspapers every day. I also keep an eye on local TV and newspaper reports and the “trade” press, such as The BMJ and Health Service Journal. Stories about health and social care, policy, and related ethical and legal dilemmas always pique my interest—and there are a lot of them. more…

Chris Ham: The NHS Five Year Forward View—the man matters more than the plan

6 Nov, 14 | by BMJ

Something very important happened on 23 October and it wasn’t the publication of the NHS Five Year Forward View.

Far more important was the passion and confidence with which Simon Stevens launched the plan and challenged politicians to provide the funding needed to deliver it. His performance stood in stark contrast to the bickering over the despatch box on the same day, when Labour and the Conservatives sought to claim the plan as their own. more…

Mary E Black: Inside the mind of a Member of Parliament

31 Oct, 14 | by BMJ

maryeblack copy

I had the opportunity to listen to a number of MPs explain how they think during the excellent Westminster experience  organized by Cumberlege Eden & Partners as part of my NHS Executive Fast Track Programme. I took notes from the MPs—current and recent—whom we met. The session was targeted at senior people in the NHS, but it could be generally applicable to other organizations.

Here are 10 examples of what might be running through their minds as you approach them for a long-awaited meeting.

more…

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