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Richard Lehman’s journal review—16 January 2017

16 Jan, 17 | by BMJ

richard_lehmanNEJM  12 Jan 2017  Vol 376

I first went to the Proms in 1966. I enjoyed the queuing, the atmosphere, and the music: young Barenboim playing Beethoven with Boulez, Kertesz conducting Dvorak, Heather Harper singing something English and so forth. So long ago. Now the word prom seems to mean a passing-out ritual (in both senses of the word) by school-leaving teenagers, or Patient Reported Outcome Measures. The Americans prefer PRO for the latter, but that is equally confusing. PROMS/PROs have become something of an industry over the last ten years or so. The title of this Viewpoint says it all—”Patient-Reported Outcomes—Harnessing Patients’ Voices to Improve Clinical Care.” They are a way of harnessing patient voices. Once harnessed, these can be converted into metrics and tick-boxes and studied quantitatively at a distance. All this is well-described in this article, which ends by saying that “There is sufficient scientific rationale and understanding of implementation methods to expand collection of PRO data in clinical care. Doing so could turn the rhetoric regarding ‘patient-centered care’ into a reality.” But there is a much better, quicker way of doing that. It consists of  unharnessing patients’ voices and actually listening to them. This is called Experience-Based Co-Design and it works in real-time cycles where patients have the power to change things. No wonder it hasn’t caught on. more…

Jeffrey Aronson: When I use a word . . . Apoptosis

13 Jan, 17 | by BMJ

In their landmark paper in the British Journal of Cancer 45 years ago, Kerr, Wyllie, and Currie reported a phenomenon that they described as “controlled cell deletion”. They proposed calling it “apoptosis” and explained the term in a footnote, as follows:

The word “apoptosis” (ἁπόπτωσισ) is used in Greek to describe the “dropping off” or “falling off” of petals from flowers, or leaves from trees. To show the derivation clearly, we propose that the stress should be on the penultimate syllable, the second half of the word being pronounced like “ptosis” (with the “p” silent), which comes from the same root “to fall” and is already used to describe drooping of the upper eyelid. more…

Keith Pearson: “I hear and share doctors concerns about revalidation”

13 Jan, 17 | by BMJ

When the General Medical Council (GMC) commissioned me to carry out a review—Taking Revalidation Forward—I considered revalidation’s primary function was to assure patients about the quality and safety of doctors.

I still believe that, but I have also gained a greater appreciation of the benefits revalidation brings to healthcare organisations and to doctors themselves. People have told me how revalidation underpins and evidences the professional standing of a doctor. more…

Martin McKee: A Shared Society? Interpreting Theresa May’s revolutionary vision

13 Jan, 17 | by BMJ


Theresa May is an unlikely revolutionary. Yet, on the day she entered 10 Downing Street, this was how she defined herself. She spoke of the need to tackle shorter life expectancy of those born poor, the harsher treatment of black people in the criminal justice system, and low educational attainment among white working class boys. Six months later, in a speech entitled The Shared Society, she restated this commitment. [1] The British public had, we were told, voted in the EU referendum for a “quiet revolution” that would “change the way our country works.” There is, of course, the minor detail that this was not the question on the ballot paper so how could she know what type of change voters wanted? But, even if she could know, it’s far from clear how she would address these issues. more…

Andrew S Al-Rais: How to avoid handover hostility

13 Jan, 17 | by BMJ

Arriving in resus the tension was palpable. A familiar interplay was evolving in the Paediatric bay. The “Handover Standoff.” On one side stood a fatigued transfer team accompanying an intubated toddler with intracranial pathology. The last couple of hours had been spent performing complex tasks in a stressful environment whilst simultaneously organising beds, personnel, and transport. The critical care transfer ballet that is so frequently staged in a district hospital. From my viewpoint the transfer team appeared to have done an excellent job and were now well placed to receive our plaudits. Perhaps even a cup of tea. Instead they faced a wall of various healthcare professionals. Stern questions were being fired at the transfer team—staccato clippings barely disguising the receiving team’s apparent annoyance. The transfer team swiftly adopted a back foot stance, aggrieved at the apparent insinuation that they had not performed to the highest possible standards. “Who told you come to resus?”, “We were told the child was three, not two.” “You’ll just have to wait—this isn’t what normally happens.”


Lindsay-Ann Coyle and Sarah Atkinson: Living with multimorbidity

12 Jan, 17 | by BMJ

“I sometimes refer to myself as having OCD and sometimes refer to myself as having an eating disorder.”

Living with multimorbidity may constitute one of the biggest challenges to how contemporary medicine is practised. The number of people living with multimorbidity is predicted to double in one decade—that is from 1.9m to 2.9m between 2008 and 2018. [1,2]

At the same time, there is a growing awareness of the need to address the problems multimorbidity presents to current medical practice more…

Paul Buchanan: How not to annoy your doctor

12 Jan, 17 | by BMJ

peb-photo-jpgWhat do we, patients, really want when we phone up to book that appointment? What do we really need? Why do we feel like the only answer is to take a half day off work to go and see the doctor?

Is it that we are genuinely ill, have developed symptoms of something inexplicable, feel so utterly sick that we have to call the doctor? Or is it that we need to feel like someone out there is actually listening to us, and so a trip to the doctor, especially at this time of year, is explicable and almost expected? more…

Daoxin Yin: Will the universal two-child policy in China exacerbate gender discrimination in the medical job market?

12 Jan, 17 | by BMJ

daoxin_yinWinter is the new doctor recruiting season for Chinese hospitals. Between the end of November and February, government-owned hospitals, who are major employers, interview job candidates. Most of these candidates are medical students who are about to graduate in June or July. As well as the traditionally male-dominated surgical sector and other departments doing interventional therapy such as cardiology and intervention, a preference for male doctors exists universally and is applied to hospital employment. Sometimes, the preference for a male doctor is clearly written in job posts, and more often than not, it tacitly plays a role in the decision-making process.  more…

Helen Tuckwood: Living with vitiligo

12 Jan, 17 | by BMJ

I first noticed two patches of white skin about 10 years ago, when I was 47 years old. The patches were on the inside top of my thighs, symmetrical to each other. I had just returned from a holiday abroad and the white patches stood out. At first they didn’t really bother me because the patches were hidden, but after a time, when they started to spread, I decided to investigate the cause.

I read about the possible causes on the internet and concluded that it might be vitiligo. I later visited my doctor who confirmed that this diagnosis was correct.  more…

David Lock: Have NHS leaders failed to “speak truth unto power”?

11 Jan, 17 | by BMJ

This is blog is not a rant—well not too much of a rant. It is an expression of serious frustration about the way the NHS is run and about the willingness of some senior NHS managers to become complicit in something near to dishonesty.

Everyone at the frontline knows the NHS is running on empty. The more perceptive know that more money for the NHS alone will not improve services for patients. But—and this is perhaps the unpopular “but”—NHS senior managers ought to accept their share of the responsibility for the present crisis because they have colluded in pretending the NHS can deliver the impossible. Does anyone believe that NHS managers have “spoken truth unto power” about limits of NHS productivity? more…

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