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Richard Smith

Richard Smith: Dumfries and Galloway NHS 2—Recruitment is the number one problem

24 Jan, 17 | by BMJ

richard_smith_2014Richard Smith visited and wrote about the NHS in Dumfries and Galloway in 1980, 1990, and 1999, and this series of blogs describes what he found in 2016. A feature article provides a summary.

The thing that currently pleases Angus Cameron, the medical director of the Dumfries and Galloway Health Board, is that the board did extremely well in the GMC survey of trainees. They “hate coming here,” he says, but they have a very good experience when they do—and they do well in their exams. They hate coming because they don’t want to leave their partners and flats in Glasgow, and—despite the good experience as trainees—they don’t want to come back when fully trained. more…

Richard Smith: Dumfries and Galloway NHS I—The three priorities of the chief executive

23 Jan, 17 | by BMJ

richard_smith_2014Richard Smith visited and wrote about the NHS in Dumfries and Galloway in 1980, 1990, and 1999, and this series of blogs describes what he found in 2016. A feature article provides a summary

England has an urban health system with some rural areas, whereas Scotland has a rural system with some urban areas, observes Jeff Ace, the chief executive of Dumfries and Galloway Health Board. The observation on Scotland may not be true in population terms, as most of the population lives in urban areas, but it’s certainly true in geographical terms: nowhere in England is 73 miles from a district general hospital as is the case for Stranraer. Other places in the Highlands and Western Isles are even further from hospitals. more…

Richard Smith on supply-led demand—more doctors, more hospitals, more cost but not more value

19 Jan, 17 | by BMJ

richard_smith_2014I squirm every time I hear that “increasing patient demand” is driving up costs in the NHS. I squirm because demand, although a standard technical word of economists, sounds so pejorative and blaming. “Those bloody patients. If they’d only stop demanding so much the NHS would be fine.” It’s crucial to understand (but is not widely understood) that the main driver of costs in health care systems is the rising cost of medical interventions—the fact that much more can be done. This gives rise to what economists call “supply-led demand.” As one senior NHS leader once said to me, the main driver of costs in the American health system is the National Institutes of Health, the biggest funder of medical research in the US (and the world) because it keeps inventing stuff. more…

Richard Smith: The brutality of demography

10 Jan, 17 | by BMJ

richard_smith_2014Many of us elite liberals like to think of ourselves as rational creatures trying to get by in a crazy world, but we know that we are prey to all sorts of cognitive and emotional malfunctions. What we don’t perhaps recognise so well is the power that demography exerts on us, just as it does on rats in a cage. I knew much of what David Willetts described in his BBC broadcast It’s the Demography, Stupid, but the excellent broadcast demonstrated well the brutal power of demography.

The seven billion people on the plant are distributed with one billion in each of Africa, the Americas, and Europe and four million in Asia. more…

Richard Smith: Tales of sustainability I—transforming mental health services in Lambeth

5 Jan, 17 | by BMJ

richard_smith_2014In 2010 adult mental health services in Lambeth in South London were at breaking point, with most acute wards running at over 100% capacity (possible because of overspill into the expensive private sector). There was a collective view amongst partners that resources were not being spent effectively, going on small numbers of people, often with little benefit. Something had to change.

I was told the story of how services in Lambeth are being transformed by Denis O’Rourke, who is assistant director for integrated commissioning in mental health for NHS Lambeth Clinical Commissioning Group. He’s the opposite of the stereotyped bureaucrat; a Celtic supporter, he’s both passionate and pragmatic about working with everybody and anybody to improve the lives of people who use mental health services. more…

Richard Smith: What if all the works of Democritus had survived and those of Aristotle been lost

29 Dec, 16 | by BMJ

richard_smith_2014Richard Feynman, the great physicist, conducted a thought experiment in which he asked what one statement would he save if all of scientific knowledge was lost. His answer: “All things are made of atoms–little particles that move around in perpetual motion, attracting each other when they are a little distance apart, but repelling upon being squeezed into one another.” He added: “In that one sentence you will see an enormous amount of information about the world, if just a little imagination and thinking are applied.”

The idea that the world is made of atoms is 2500 years old and originates with Democritus, a Greek from Abdera. He was of the school of Miletus which believed that the world should be understood through observation and reason not through “fantasy, ancient myths or religion.” (The quote is from Carlo Rovelli’s Reality is Not What It Seems: The Journey To Quantum Gravity, a marvellous book. Indeed, everything I write here comes from that book.) more…

Richard Smith: The dead journalist and social care

15 Dec, 16 | by BMJ

richard_smith_2014The juxtaposition of an article by a dying (indeed, dead) journalist bemoaning the NHS denying him an expensive cancer drug and a spate of articles illustrating the “crisis in social care” shows well the conundrum facing the British people.

I may be the only member of Britain’s “elite” who hadn’t heard of A A Gill, the journalist who has been described as embodying the heart and soul of the Sunday Times. (I’ve stayed away from the Sunday Times for 25 years and am confused by A N Wilson, A S Byatt, and all the others who opt for initials rather than first names.) Gill was famous for his acerbity, wit, dissolute lifestyle, dyslexia, ex-wives, and pet hates, which included “truffle oil, fat people, dinner parties, Christmas dinner, coulis, gastropubs, Tex-Mex, warm salads, nutritionists, seasonal eating, and vegetarians.” His first wife left him in the middle of a dinner party, and his wit, but not his acerbity failed him when he described the classicist Mary Beard, who has long grey hair, as too ugly for television. more…

Richard Smith: Rethinking the publication of surgical innovations

8 Dec, 16 | by BMJ

richard_smith_2014A scandal in cardiothoracic research has led Martin Elliott, a cardiothoracic surgeon at Great Ormond Street, to conclude that current methods of publishing surgical innovations are not only inadequate but also shameful. In a Gresham lecture in London recently he presented proposals for improving the sharing of surgical innovations.

The scandal

The scandal, which is now known across the globe, concerns Paolo Macchiarini, a brilliant and charismatic but ultimately flawed cardiothoracic surgeon. Macchiarini has replaced diseased tracheas in a series of patients with plastic tracheas that are supposedly covered in the patients’ stem cells. Most of the patients have died, and a Belgian cardiothoracic surgeon has said that he’d rather face a firing squad than undergo Macchiarini’s operation—because it would be a quicker and less painful form of execution. more…

Richard Smith: Working to make cholera a disease of the past

23 Nov, 16 | by BMJ

richard_smith_2014Until last year the Cholera Hospital in Dhaka, Bangladesh, could have a thousand admissions a day before and after the monsoon. On a calm day now it still has hundreds. Not all the patients, many of them children, have cholera but many do. Many of the children also have malnutrition, sometimes severe. In order to cope the doctors used to have to erect a tent in the car park and fill it with cholera cots that were inches apart. A cholera cot has a hole in the middle to help management of the profuse diarrhoea that is the hallmark of cholera. As the tent was dark my immediate thought on entering the tent was of pictures of the Crimea with Florence Nightingale, the lady with the lamp, attending the dying soldiers. But few die in the Dhaka Cholera Hospital as the nurses and doctors are so adept at treating the disease, and tremendous improvements in the hospital mean that the tent hasn’t been needed in 2016.


Richard Smith: Why is the Mona Lisa the most famous painting in the world, and why are Facebook and Harry Potter so popular?

21 Nov, 16 | by BMJ

richard_smith_2014When you enter the room in the Louvre that contains the Mona Lisa you find people crowded around the bullet-proof case that contains the Mona Lisa and largely ignoring the other paintings in the room, which include other masterpieces by Leonardo da Vinci. Four-fifths of the people who visit the Louvre do so to visit the Mona Lisa, and its insurance value is £700m, way ahead of any other painting. Why is it the most famous painting in the world? And why are Facebook, Harry Potter novels, Shakespeare, and Katy Perry so popular? more…

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