Reading the Francis Report for many of us is like looking in a mirror. The mirror is at an angle, magnifying the perversities in the picture, but it is all recognisable. We see our NHS reflected back at us, the NHS in England in the early years of the 21st Century.

As the weeks since it was launched pass and the Francis Report fades rather too rapidly from the news headlines, there is little cause for cheer and much to dishearten. True, the concept of compassionate care is being bandied around in evangelical fashion and squeezed into every document possible. But frankly, there is an Orwellian touch to the way the word is being used and a real danger that the concept will be rendered trite and meaningless. Over the last few weeks, I have listened to an operating department assistant describe how he was dragged away from looking after a patient three times by an anxious manager wanting him to amend a form ticking boxes saying he was providing compassionate care to the patient; I have heard someone from the workforce planning department moaning about how busy he was having to amend job descriptions to include the word compassionate; and I have been approached by someone in medical education asking me to invent some exam questions that tested for compassion! more…

The smell of formaldehyde will never leave me. On my first day as a medical student, in anatomy class, six of us crowded around a dead body, scalpels in hands, waiting to make the first cut. On my university entry form, like everyone else I had proudly stated that I wanted to “help people.” However idealistic my goals, I had assumed that these “people” would at least give me a sporting chance to help by being alive. On that day, it was not to be, and for three more years I consigned myself to seeing bodies in parts. more…

Doctors first started to speak out about the health impact of nuclear weapons way back in 1980; the BMA published The Medical Effects of Nuclear weapons in 1983 and it was in 1985 that International Physicians for the Prevention of Nuclear War (IPPNW) was awarded the Nobel Peace Prize for its work in publicising what nuclear weapons do to people. Now here we are 30 years later with more countries possessing these “aweful” weapons than ever before – nine at least, including Israel, and several more on the want-to-be list. more…

I cannot have pot plants in the house. The overwhelming smell of pot plants and stale urine is my lasting memory of visiting residential and nursing homes many years ago as a GP trainee in Devon. Rows of pot plants arranged in the hallway and rows of elderly people in front of the television. This memory is, perhaps unfairly, coloured by my lack of experience and feelings of powerlessness at the time—as an inexperienced trainee I hadn’t seen many older people in the community and I wasn’t sure what to do. These homes were often in adapted older buildings which, despite modification, were probably unsuited for purpose and staffed by nurses displaced from mainstream nursing or washed up in a career cul de sac. I didn’t enjoy it. more…

I have already been invited twice this year to give a talk about emigration of doctors out of Portugal. I find this a sign of the difficult times we’re going through in Portugal. Doctors, like every citizen, have been subject to relentless austerity measures and to progressive impoverishment. But we’re not currently seeing doctors leaving the country in droves. Nurses, however, are a completely different story. Portugal is currently the second country (after Spain) to have the most nurses registered in the UK’s Nursing and Midwifery Council and the number of Portuguese nurses in the UK has grown over 40 fold in the last six years. more…

Patient charges have featured in the British press in recent weeks after Malcolm Grant, the head of NHS England, raised their spectre last month.

Until recently I was undecided about patient charging. There’s mixed evidence and obvious downsides, but health spending is a bottomless pit, and £5 judiciously applied here or there seems like a good way of partially filling that pit and discouraging every no-show or vexatious and petty query of the worried well. more…

It is now more than a month since the BMA first blew the whistle on the gathering failures bedevilling the government’s flagship NHS 111 service—and regrettably the problems show no sign of abating. In many areas of the country, such as Greater Manchester, NHS 111 was overwhelmed by call demand during its pilot phase before Easter to such an extent that it was suspended before it had even been launched. Similar problems hit the service in South London and in other regions, forcing suspensions or part suspensions of NHS 111 as Easter came and went. Where it was operational NHS 111 limped towards the May bank holiday with little sign of improvement. more…

For very many years making a medical diagnosis was based loosely on the application of the principle of Occam’s Razor otherwise known as diagnostic parsimony—look for the fewest possible causes to explain a patient’s symptoms. However, with the increase in longevity of the background population, Occam’s Razor was eventually superseded by the Hickam’s Dictum which states that “patients can have as many diseases as they damn well please.” Here the idea is to consider that multiple symptoms are more likely explained by a collection of common diseases rather than a single rare one. more…

The movement towards open science is gathering pace, driven by scientific and ethical imperatives—not simply by the technological possibilities. In medicine such openness has real potential to benefit patients and society. Indeed, the arguments for open registration and publication of studies’ protocols, methods, and main results are underpinned by ethical arguments that are focused on patients and the public. The Ottawa Statement on trial registration is a prime example. more…

JAMA  1 May 2013  Vol 309
This week’s JAMA is devoted to child health. This was a mistake, because although children are generally interesting, health generally is not. A study from Quebec tries out various doses of vitamin D in babies and finds you can only get to a reliably high value by using doses which might cause hypercalcaemia. I’m not sure how many generalist readers need to know this. Likewise it’s faintly interesting that two doses of human papillomavirus vaccine given between the ages of 9 and 13 may give the same immunogenicity as three given between 16 and 26, but as we don’t definitely know how long this lasts from the trial, nobody is going to change practice. But among the skim-and-flick-past articles there is one important one, which brings good news for the parents of very premature babies.

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