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Jeffrey Aronson: Happy 50th birthday, Yellow Cards

8 Dec, 14 | by BMJ

jeffrey_aronsonTo London, to celebrate 50 years of the Yellow Card scheme. The scheme, which was started by the erstwhile Committee on Safety of Drugs (CSD), and is now run by the Medicines and Healthcare products Regulatory Agency (MHRA), allows health professionals and patients to report suspected adverse drug reactions to medicines, either manually, on a yellow coloured card, or online. more…

Ben Gibbison: “Well, it’s the NHS . . . what do you expect?”

5 Dec, 14 | by BMJ

ben_gibbisonA few years ago, I was climbing in the Indian Himalaya. After driving to the road head, we walked for four days to our base camp. There, one of our group suffered with high altitude cerebral oedema. We carried her back down the valley for 12 hours until we reached the road head and found a car to take us to the nearest hospital.

Once inside the hospital, I asked, “Have you got any oxygen?”

“I don’t know Sir, I’ll go and see,” came the reply from the nurse.

He appeared with a rusty oxygen concentrator, which he wheeled along the ground. We couldn’t start it and so, while I made attempts to fix the concentrator, the nurse wiped down the yellowing pair of nasal speculae with a rag. more…

Nancy Devlin, John Appleby, David Parkin: Why has the PROMs programme stalled?

3 Dec, 14 | by BMJ Group

In 2009, the English NHS introduced a world leading initiative in the pursuit of quality healthcare: the measurement of patients’ views about their own health became a routine part of the delivery of NHS funded services. In an initiative led by the Department of Health, robust and reliable condition specific and generic (EQ-5D) patient reported outcome measures (PROMs) are now completed by patients both before and after four elective surgical procedures. more…

Zosia Kmietowicz: Why don’t hospitals share test results?

3 Dec, 14 | by BMJ Group

zosiakMy sister nearly died of pneumonia earlier this year. Exceptional NHS care saved her life. But I have been left flummoxed by the lack of communication during her illness and in the subsequent months of her recovery between the hospitals involved in her treatment and rehabilitation.

My sister has diabetes and rheumatoid arthritis, and doctors think that the pneumonia was brought on—or certainly made worse—by the drugs she was taking for her rheumatoid arthritis when she fell ill. These were stopped as soon as the seriousness of her condition was evident. But now, six months after the bout of pneumonia and her discharge back to her local hospital, the only drugs she is getting for her painful rheumatoid arthritis are simple painkillers, which provide little relief from her symptoms. more…

Sanna W Khawaja: An NHS full of secret agents

2 Dec, 14 | by BMJ

sanna_khawajaWhile I enjoy the occasional spy movie, I always find myself irritated at the protagonist, who very often spends the film focused on a mission with little or no knowledge of the “bigger picture.” Quite often he or she knows little about the organisation they work for, and, at times, they even accidentally end up in a gun fight with their own colleagues.

I was mid-rant about these “secret agents” when it recently dawned on me that I too have been trained like a secret agent (albeit without the martial arts). more…

Gill Morgan: NHS Providers’ programme for the next parliament

1 Dec, 14 | by BMJ

Gill MorganIt’s rare for the NHS to be out of the headlines. From immediate winter pressures to the longer term challenges of promoting wellness and preventing illness, there is a continuous national conversation about the NHS. Like the weather, everyone has a strong opinion on our prized national institution.

The NHS is, as Professor Don Berwick astutely described, a “world leading example of commitment to health and healthcare as a human right.” People are as protective of it as they are critical. They want the best from the public service they turn to when they are in pain, vulnerable, and worried—they want to trust it and they want it to give them hope. more…

Samir Dawlatly: Is NHS privatisation inevitable?

27 Nov, 14 | by BMJ

“So what difference would it make if the NHS was privatised?” asked a medical student this week. We had just been discussing my pet conspiracy theory: that the bad press GPs and other parts of the NHS receive is actually an orchestrated attempt to destabilise the faith of the population in it. The modus operandi for privatising any public service seems to be to restrict the budget, drive up demand, and use the media to tell everyone how appalling the service is. The end result is to create a climate where privatisation would seem like a good thing.

I hadn’t expected such an incisive question from the students, forgetting that they were, of course, among the educational elite of their generation. So I paused. more…

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…

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