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Bernard Merkel: U-turn on the European Commission’s health portfolio still leaves unfinished business

29 Oct, 14 | by BMJ

bernard_merkelIt is not often that an issue about how the European Commission is organised in relation to a specific part of its work on health comes to the top of the political agenda. Yet that is exactly what has happened in the past month.

On 10 September, the president elect of the European Commission, Jean-Claude Juncker, announced his new team of commissioners and their job portfolios. Among the raft of proposals he made, one change stood out for the Brussels health community: responsibility for pharmaceuticals and medical technology would be transferred from the incoming health commissioner (Vytenis Andriukaitis, an ex-health minister of Lithuania) to the new Polish commissioner responsible for the single market, industry, and enterprise (Elżbieta Bieńkowska). more…

David Zigmond: NHS stewardship—the missing personal factor

28 Oct, 14 | by BMJ

david_zigmond2In healthcare our systems of governance are increasingly developed and vaunted. Yet these are very different from our capacities for stewardship.

Inevitably and predictably, the recent party political conferences each designated the NHS as a crucial battleground: each claimed the better vision, ethos, and competence. Yet there is something recurrently missed by politicians, planners, and orbiting think tanks. It is the crux of personal attitudes, relationships, and investments: the human conductors of our best personal continuity of care. more…

Philip van der Wees: Patient preferences to distinguish between good and bad practice variation

28 Oct, 14 | by BMJ

Philip van der Wees“Keeping good practice variation and reducing bad practice variation is a main driver for quality improvement in healthcare.” With this key message, Albert Mulley, professor at the Dartmouth Center for Health Care Delivery Science in the United States, summarized his keynote presentation at the fourth conference of the Scientific Institute for Quality of Healthcare at Radboud University Medical Center. His message revealed an essential dilemma, in assessing the quality of patient centered healthcare at the individual patient level, versus quality assessment at the healthcare system level. more…

Julie Browne: Why do some clinical supervisors become bullies?

28 Oct, 14 | by BMJ

Julie BrowneThe literature on bullying in the medical workplace makes disturbing reading. In the General Medical Council’s 2013 national training survey, 13.2% of respondents said that they had been victims of bullying and harassment in their posts, nearly one in five had seen someone else being bullied or harassed, and over a quarter had experienced “undermining” (unfair or belittling treatment). more…

Richard Smith: Leapfrogging to universal health coverage

28 Oct, 14 | by BMJ

richard_smith_2014Low and middle income countries have the chance to create health systems that will perform much better than those in high income countries. Copying health systems that look increasingly unsustainable would not be wise. Instead, low and middle income countries can “leapfrog” to something better, and the World Economic Forum has a project to make that happen. I heard about it in New York last week.

A plot of health adjusted life expectancy against the health expenditure of individual countries shows a plateau in the late 1960s at an expenditure of about US$500 per head adjusted for purchasing power. Yet most high income countries are spending more than US$2500, with the US spending US$8000. To be blunt, these high expenditures don’t look like “value for money.” more…

Tara Lamont: On biography, cancer, and Richard Doll

27 Oct, 14 | by BMJ

Tara_Lamont_3I’m a sucker for the lives of great men (and, occasionally, women) in medicine. This is particularly the case when it comes to those who lived in the 20th century, whose lives are punctuated with big moments: from the great depression, to active service overseas in the second world war, to the formation of the NHS shortly after. Their lives are marked by quiet heroism and lives well lived—before you even come to their impact on health and science. There seems to be that much more space for these individuals to make their mark on history. more…

Richard Lehman’s journal review—27 October 2014

27 Oct, 14 | by BMJ

richard_lehmanNEJM 22 October 2014 Vol 371
1577 The whole point about tuberculosis is that it is slow. The discoverer of its causative organism, Robert Koch, called it the fungus-germ, or Mycobacterium. It takes 20 times longer to divide than most other bacteria. It is only after years of division that it can do terrible things. The old Welsh chest physicians I once worked for called this “galloping” TB, and recalled how it had carried off some friends of their youth. But even this word, when pronounced as “gahl-lopin” in a soft south Welsh accent, had a mournful slowness about it. Three trials in this week’s NEJM show that it does not pay to take shortcuts with this slouchy beast. Several new fluoroquinolone drugs kill off Mycobacterium tuberculosis quite rapidly in the laboratory and in animal models and were thought to offer the promise of a faster cure than standard rifampicin based regimens. In the first trial, moxifloxacin was tested in a randomised trial cunningly designed by academics based in the tiny windswept town of St Andrews in the Scottish kingdom of Fife. They spread their net across four continents, but they have shown that in uncomplicated, smear positive pulmonary TB, four months of a moxifloxacin based regimen is not dependably curative. more…

The BMJ Today: The joys and snags of being a GP

27 Oct, 14 | by BMJ

tiago_villanuevaAs a GP who didn’t train in the UK and who has never worked in the country as a GP, I follow the situation of general practice in the UK with great interest, but from a certain distance that characterises an outsider such as myself. I am well aware that general practice in the UK is going through difficult times, with a recruitment crisis, many GPs facing increasing workloads and on the verge of burnout, and some even leaving the country behind to work further afield.

The recruitment of GPs has always been a problem all around the world, for many different reasons. Despite everything, GPs in the UK remain among the best paid GPs in the world, which means we must look way beyond pay as an argument to attract more GPs to the trade. more…

Margaret Cooter: Colour me unusual—a MRSA quilt and a TB dress

24 Oct, 14 | by BMJ

Margaret_Coote2On learning about the source of the colour of Anna Dumitriu’s quilt, some people feel distinctly uncomfortable, and a few have even said, “But that’s irresponsible! That’s dangerous!”

The blue doesn’t come from indigo or from a new type of powder—and the way it’s used is definitely not irresponsible or dangerous. Although the colour comes from MRSA bacteria (“superbugs”), the colouring process was carried out in a laboratory, under optimal safety conditions. more…

Samir Dawlatly: A GP on why I still go to work

24 Oct, 14 | by BMJ

Recently Lord Howe warned GPs to stop complaining about their work conditions, so that they did not cause a workforce crisis. Similar noises were heard from NHS England at the recent Royal College of General Practitioners Annual Conference, where politicians and leaders were questioned about the state of primary care and, in particular, general practice, by delegates who seemed close to breaking point.

As a GP, I have every sympathy with those raising issues about excessive, unreasonable patient demand; arbitrary health and safety checks (including the state of paintwork in the cleaner’s cupboard); and the morale sapping nature of being the current political football of choice. And yet I still go to work. As do most GPs. more…

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