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Richard Smith

Richard Smith: Rediscovering a BMJ gem

7 Apr, 14 | by BMJ

Richard SmithAfter a class I taught recently one of the students came up to me and said, “My mother was fond of you. Her name was Clare Vaughan.” I remembered. I met Clare only once, shortly before she died in July 1996 in her early 40s. My memory of the meeting is hazy: I remember beauty, kindness, stillness, a lovely smile. But what I remembered clearly and have now reread many times is the piece Clare wrote for the BMJ as she was dying. It’s a gem that deserves a special place in the profusion of medical writing, most of it unprecious. more…

Richard Smith: What will robots do when they take us over?

27 Feb, 14 | by BMJ

Richard SmithLord Rees, the Astronomer Royal and former president of the Royal Society, believes that robots might replace human beings within 50-60 years. Looking at writings from him on the web, I’m not sure that’s exactly what he believes, but an audience at the London School of Economics was told he did by his friend Lord (Melvyn) Bragg, the broadcaster and author. The idea seems to me plausible and got me wondering what the robots would do once they took over. more…

Richard Smith: The history of surgery—my contribution

26 Feb, 14 | by BMJ

Richard SmithIn his book “Adolf Hitler: my part in his downfall,” Spike Milligan modestly suggested that his part had been small. My contribution to the history of surgery is even smaller and much more ignominious, but I’m prompted to tell the tale by the Royal College of Surgeons of Edinburgh deciding to make me a fellow. Goodness knows why this ancient and venerable college decided to do such a thing, but the motivation cannot have been my surgical prowess. Readers will, I’m sure, agree if they ever get to the end of this sad story. more…

Richard Smith: Should all GPs have 3000 patients?

18 Feb, 14 | by BMJ

Richard Smith
Perhaps 20, possibly 25 or even 30, years ago I had breakfast (or was it lunch?) with Geoffrey Marsh, a GP from Teesside, and he told me that all GPs should have 3000 patients. I think he was right, but since that time average list sizes have steadily shrunk until they are now under 1600. more…

Richard Smith: Nourishing the world

17 Feb, 14 | by BMJ

Richard Smith

About a billion people end the day hungry, another billion are obese, and food prices are steadily rising. Clearly something is very wrong with the world’s food system, and the Economist last week held a conference on Feeding the World. As several people pointed out, it might better have been called Nourishing the World as it’s not just a matter of filling bellies. Some 165 million children are stunted because of malnutrition, and two billion people are deficient in vitamins and minerals. more…

Richard Smith: Teaching medical students online consultation with patients

14 Feb, 14 | by BMJ

Richard SmithA first year medical student of today may well still be practising in 2070. We can’t know how medicine will look then, but we can see some clear trends. The relationship between doctors and patients will surely be much more equal; indeed, health will be the business primarily of patients, with doctors as advisers, guides, and facilitators. Much of medical practice will be conducted online, with online consultations routine. Indeed, in some parts of medicine online consultations are routine now, reminding us that the future is already here but not evenly distributed. Recognising these trends, Leicester Medical School has introduced medical students to online interaction with patients at the very beginning of their course. I went to Leicester to meet with patients, students, and teachers who are participating in the programme. more…

Richard Smith: Will digitisation transform the NHS as it has much else?

10 Feb, 14 | by BMJ

Richard SmithDigitisation of the NHS will both save and improve it believe Jeremy Hunt, secretary of state for health, and Tim Kelsey, national director for patients and information at NHS England. Both were youthful, bubbly, and even charming as they did a double act last week at the Cambridge Health Network, although Kelsey had to perform alone for an hour while Hunt was stuck in traffic courtesy of the tube strike.

When he finally arrived Hunt began by saying, “This has been a tough year for the NHS.” Increasing transparency is surfacing problems in the NHS. What he found most disturbing about the patient abuse at Mid Staffs was that “people in the system” had known that something was wrong for about five years before action was finally taken.

Fresh from university in 1991 Hunt started a business exporting marmalade to Japan. It was not a success: he managed to export only half a container load. If it had been a success, he joked, I wouldn’t be here now. He evoked 1991 because it was just the beginning of the internet revolution, and we had no idea how it would change our lives—how, for example, we would be able to email anybody, anywhere, at any time, and how we could do free video calls to anywhere in the world. He and Kelsey believe that the NHS still has to experience the same revolution, but that it will come. more…

Richard Smith: Medical research—still a scandal

31 Jan, 14 | by BMJ

Richard SmithTwenty years ago this week the statistician Doug Altman published an editorial in the BMJ arguing that much medical research was of poor quality and misleading. In his editorial entitled, “The Scandal of Poor Medical Research,” Altman wrote that much research was “seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation.” Twenty years later I fear that things are not better but worse.

Most editorials like most of everything, including people, disappear into obscurity very fast, but Altman’s editorial is one that has lasted. I was the editor of the BMJ when we published the editorial, and I have cited Altman’s editorial many times, including recently. The editorial was published in the dawn of evidence based medicine as an increasing number of people realised how much of medical practice lacked evidence of effectiveness and how much research was poor. Altman’s editorial with its concise argument and blunt, provocative title crystallised the scandal. more…

Richard Smith: Doctors and the Hollande affair

20 Jan, 14 | by BMJ

Richard SmithIt’s hard not to be fascinated by Francois Hollande’s alleged (why do we keep bothering with this word?) affair with an actress with stories of two Parisian love nests, bags of croissants being delivered by security men for breakfast, and the president travelling by scooter for their assignations. But the bit of the story that fascinates me most is the role of doctors. Are they, I wonder, being used?

Anonymous doctors first entered the story when Hollande’s “official partner”—Valerie Trierweiler, “the First Girlfriend,”—was admitted to hospital with a coup de blues. It seems she admitted herself for tests, but did any doctor have to agree? We are led to think that this was her reaction to being told about her partner’s affair, but it’s hard to believe that she didn’t know about her partner’s escapades discretes, when they seem to have been going on for two years and were talked about all over Paris. more…

Richard Smith: Taboo over the private sector limits health development

17 Jan, 14 | by BMJ

Richard SmithIn most low and middle income countries the private sector accounts for 60-80% of outpatient care and 40-60% of inpatient care. Yet aid agencies have largely ignored the private sector, severely limiting their impact. This week a small meeting organised by the Centre for Global Development in Europe discussed how attitudes might be changed. Some of those at the meeting (which was held under Chatham House rules) had been running a three day course on the private sector for 30 people from the Department of International Development, showing that attitudes are beginning to change.

The words “private sector” immediately create antibodies, particularly in countries like Britain where health is largely in the public sector, but it’s important to understand what is meant by the private sector. Mostly it’s not big for profit providers but rather a whole variety of informal, small scale providers together with NGOs, faith organisations, pharmacies, distributors, and others. Because of this wide range many have preferred the term the “non-state sector,” but, as was pointed out at the meeting, it is mostly a market—and the words “private sector” help people to remember that. more…

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