They’ve done it again!

While prescription charges were abolished in Wales in 2007, Northern Ireland in 2010, and Scotland in 2011, the Department of Health in England increased them from £7.40 to £7.65 from 1 April this year. To put that into more graphic context, anyone required to pay the charges would have to find an eye-watering £22.95 if they were to have just three prescriptions fulfilled. The charge raises an annual total of £450m for the Exchequer—a relatively paltry sum in terms of national revenue but a very painful increase for NHS patients, and one which seriously risks denying them access to the treatments they need. more…

Hippocrates (c.460 BC–370 BC) is often described as “the father of modern medicine.” Wise and knowledgeable though he was, he was, in truth, a late-comer.

The medicine of the ancient Egyptians dates from the beginnings of the civilization in about the 3rd century BC to the Persian invasion of 525 BC and was remarkably sophisticated for its time. Ancient Egyptian doctors undertook simple surgery, were able to set bones, gave careful attention to safety in childbirth, and developed a comprehensive pharmacopoeia, based largely on herbal and other natural treatments—in truth, some of them inherently dangerous. They also understood the importance of personal hygiene and diet. They enjoyed an excellent international reputation, and rulers of other empires would ask Egyptian pharaohs to send them their best physicians to treat themselves, family members, or favoured friends. more…

Were I to develop motor neurone disease, or some comparably progressive, incurable, and terminal condition, I would wish to be informed of the diagnosis, perhaps to have the opportunity of a second opinion, to be given a carefully considered and evidence-based prognosis with timelines, however approximate, and then, having put my affairs in order and at a time of my choosing, to be allowed to depart this life at home and as quickly, quietly, and painlessly as possible. more…

Hraztan Jebejian is an Armenian doctor, and a very good one. He studied hard, keeps his CPD up-to-date, ensuring that he is fully abreast of developments in his speciality, is utterly reliable, and much in demand. He works very hard and makes a good living. more…

It seems clear that the determined campaign to prevent healthcare-acquired MRSA within the NHS is paying substantial dividends. The financial year from April 2010 to March 2011 saw a reduction of 22% in reported cases of MRSA bacteraemia, and a 50% reduction against those reported for the year 2008/9.

That “determined campaign” has included pre-op assessments for elective patients and isolation for emergency admissions until their MRSA test results have been seen; improved cleaning of floors, toilets, and beds; requiring health professionals to wear short sleeves and no ties; to wash carefully before and after examining or treating patients, before and after touching potentially contaminated equipment or dressings, after bed-making and before handling food; frequent use of fast-acting antiseptic solutions such as hand wipes or gels; wearing disposable gloves for any contact with open wounds, handling needles, or inserting drips; and isolating patients known to be or suspected of MRSA infection. more…

Surveys regularly show that whereas (approximately) 80% of people who have not used the NHS in the previous five years believe it to be dreadful, 80% of those who have used it praise it highly. The reason for so extraordinary a disparity is clear. Non users believe the popular media’s stories about the NHS, and the popular media have a far greater appetite for horror stories than for good news ones. So, those who do not actually use the NHS see it through a veil of ghastly stories of old ladies being left unfed and unwashed, of clinical errors by foreign locums and even occasionally of rogue clinicians doing wicked things. Those who do use it rarely fail to be impressed by the dedication, professionalism, and kindness of the staff who look after them. more…

It seems unlikely that many of the BMJ’s readers are able to listen to Radio 4 between 8.30 and 9.00 am on a weekday, and even less likely that they could find time to read a 96 page paper by the Institute for Government, signposted on the Today programme a week or so ago, although its accompanying “Practical Guide” is at least as useful and rather more digestible, as is its paper “Using social influence to reduce DNA rates in healthcare settings.” Being semi-retired, I am fortunate in being able to listen to the radio over breakfast, and the signposting in question was sufficiently intriguing to encourage me to read all three papers. more…

Now that I no longer have an axe to grind (recovery from the revision surgery on last year’s failed whole hip replacement appears to be going well), I would be interested in doctors’ reactions to the argument for the introduction of temporary disabled badges.

During the six months I waited for surgery, I was in considerable pain and had increasing difficulty in both standing and walking. Many people wait longer for hip replacements and with greater disabilities. more…

The past week spent as an in-patient in the Charing Cross Hospital in West London served mainly to reinforce my respect and admiration for the staff there. Once again (this was revision surgery for a whole hip replacement done last year) there was not the slightest sign of any of the unpleasantness one reads of in the popular press. The doctors, nurses, physiotherapists, catering staff, and cleaners could not have been more attentive, caring, kind or professional. It may seem churlish to pick on the one thing that irritated my fellow patients and me to distraction, but it is a matter that concerns clinical and support staff scarcely at all, and it is one which could be put right with so little thought and at so little cost but which has presumably been embedded in the system for years. more…

Over the past fifty years or so, science and medicine have been remarkably successful in extending people’s lives. But health professionals, focused on curing illness, or preventing or delaying death, have been far less successful in respecting people’s wishes with regard to the nature of their deaths – where they wish to die and the medical interventions they may or may not wish to receive as they approach death. At a time when patients are increasingly supposed to be participants in decisions about their care, that is doubly troubling, and it is why a seminar held by the charity Compassion in Dying at the end of March this year was so welcome and worthwhile. more…