You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Elizabeth Wortley: And strike I did

27 Apr, 16 | by BMJ

Yesterday I did not cross a picket line. I don’t yet know the figures for how many junior doctors did choose to work, aside from those who were unable to strike, but I would not blame anyone who chose to. I almost did.

I woke up at 5am and my heart was racing with moral indecision. This ultimate question of where my ethical and public service role as a doctor lies; with the individuals today, or the systems of the future, has had me on edge for days.

After the deliberation that went into my blog “should I strike” I realised yesterday morning that the question I was really battling was, “Do I need to answer this question for every junior doctor, or just for me, in my own context?” more…

Richard Smith: The deeper causes of the doctors’ strike—a thought experiment

27 Apr, 16 | by BMJ

richard_smith_2014I’m on my way to walk among bluebells, but my mind is on junior doctors engaging in a total strike, not providing even emergency care, for the first time in the 68 year history of the NHS. How did it come to this? I feel that as “a sort of Doctor” for 40 years and somebody who has written probably a million words on healthcare I ought to know, but I don’t. But let me try. This is a thought experiment.

Immediate causes

The immediate cause is the Secretary of State for Health imposing a new contract on junior doctors. He effectively says, “Sod you. I’m fed up with this. We’ve talked for two years and got nowhere. The government has a democratic mandate to introduce a seven day contract, and you, a bunch of overprivileged brats, have no right to deny the will of the people.” I can feel some sympathy for his position, but imposing the contract is an aggressive act. Good people stand up to bullies, and the junior doctors are mostly good people. more…

Michelle Sinclair on the GP forward view

26 Apr, 16 | by BMJ

pounds_healthIt’s not about the money sings Jesse J.

Well yes, actually, it is.

The release this week of the General Practice Forward View sounds good, doesn’t it?

£2.4bn recurrent investment in general practice, £500m sustainability and transformation package to include a practice resilience programme, redesigning of services and support for collaborative work, a reduction in workload and bureaucracy, an expanded workforce, and a commitment to reduce the regulatory burden of CQC.

Sounds great in theory, except that as ever, the devil is in the detail. more…

Taryn Youngstein: “No doctor wants to strike”

26 Apr, 16 | by BMJ



Ethical dilemmas are the essences of medicine. As doctors, we frequently have to act in our patient’s best interests; when they are confused, demented, or suicidal for example. We have to act fast, and make decisions they can’t, for their own good. At medical school great lengths are taken to prepare us for these situations and GMC guidance and the law are both very clear on this issue. This is our job, it is what we do and its preservation is what we are fighting for.


Richard Smith: The NHS is a fiction, but what’s the story?

26 Apr, 16 | by BMJ

richard_smith_2014Ask somebody “What is the NHS?” and they are likely to answer to “The people who work in it, the buildings they work in, and the tools they use to do their work.” But it clearly isn’t that. The people who work in the NHS come and go, and none were working in the NHS when it began. Buildings too come and go, and the tools are constantly changing. The NHS is not a thing but a fiction, and none the worse for that. Indeed, if we recognise the NHS as a fiction we are more likely to be able to keep it alive. more…

Elizabeth Wortley: Should I strike?

26 Apr, 16 | by BMJ

junior_doctors_contractI am in a moral quandary, I am in a personal quandary, and I am in a professional quandary. I cannot answer the question “Should I strike?”

As a doctor, I’m very used to questioning, reviewing evidence, and coming to a conclusion. One of my favourite topics for discussion is bias and avoiding it every day. With regards to this contract, I don’t know what’s bias or not, I’m tired of thinking about it and I’m scared of getting the answer wrong. And I’m not alone. more…

Alice Gerth: Taking sides in the junior doctors’ strike

25 Apr, 16 | by BMJ

junior_doc_strike_April2016As a full walk out is planned for this week, juniors need to ensure that they have carefully considered which side of the picket line they will stand on. Full disclosure, I have not been participating in strike action and my reasons can be found in a previous blog post: Strike action is not the answer.

I continue to engage with my colleagues on their plans for this week and I have noticed the mood shifting. They are disheartened and deeply concerned for two reasons. Firstly, the strikes have been going on for a long time with little evidence of progress; secondly, the prospect of withdrawing all junior doctor care is daunting.


Junior doctors’ strike 26 – 27 April 2016: Live blog

25 Apr, 16 | by BMJ Group

Demotix 28/09/2015This week, junior doctors in England will be undertaking a full withdrawal of labour between the hours of 8am and 5pm on Tuesday 26 and Wednesday 27 April, as the ongoing industrial dispute between the BMA and the government shows no sign of ending peacefully. This latest action marks an escalation from previous strikes this year as junior doctors will not be providing emergency cover. It is also a historic moment; the first time an all out strike has been called by junior doctors in the history of the NHS.  If you have any news, pictures, thoughts, or tweets to offer us for the blog, please send them to Gareth Iacobucci at


Richard Lehman’s journal review—25 April 2016

25 Apr, 16 | by BMJ

richard_lehmanNEJM 21 April 2016 Vol 374

Aliskiren in Cardioland

1521 What does the R in the RAA pathway stand for? I used to pose this question in lectures several times a year, believing all that I had been told about the importance of the renin-angiotensin-aldosterone pathway in heart failure. I’d explain that we had drugs which blocked the AA but not the R. Then, a few years ago, along came aliskiren, a direct renin inhibitor. But early trials raised fears that poor Alice had come too late to the party. And this trial in people with chronic heart failure and reduced ejection fraction really pushes her down the rabbit hole. “In patients with chronic heart failure, the addition of aliskiren to enalapril led to more adverse events without an increase in benefit. Noninferiority was not shown for aliskiren as compared with enalapril. (Funded by Novartis; ATMOSPHERE)” shouted the Queen of Hearts. “Not non-inferior, not non-inferior” squawked the Mad Hatter. Alice went to look for her friend the Walrus, because she couldn’t stand the atmosphere any longer. more…

Jeffrey Aronson: When I use a word . . . A contract or a contra-act?

22 Apr, 16 | by BMJ

jeffrey_aronsonSo, the junior hospital doctors’ “contract” has been published, and the secretary of state for health, described in BMA documents as “SoSH”, which is also an obsolete word meaning a dull, heavy sound or a thud, has called it a “draft final version”—a contradiction in terms.

The word “draft” comes from an Indo-European root meaning to draw, DHERAGH, which gives us words such as drag and dredge. A droshky is a low four wheeled open carriage used in Russia, dragged along. As a dray is. The nasalised form of the root gives us drink and drown. more…

BMJ blogs homepage


Helping doctors make better decisions. Visit site

Creative Comms logo

Latest from The BMJ

Latest from The BMJ

Latest from BMJ podcasts

Latest from BMJ podcasts

Blogs linking here

Blogs linking here