If you want to refresh your memory of the comings and goings in Geroge Eliot’s classic, Middlemarch, then look no further than Professor Rosin’s analysis in the June 2009 issue of Medical Humanities.

http://mh.bmj.com/cgi/content/short/35/1/43?q=w_mh_current_tab

If you want to follow a contemporary equivalent of medical marketplace machinations then you need look no further than what is currently happening to general practice in England and Wales. And specifically to the Orwellian world in which carers and cared for find themselves. A world where government announcements to the national news media of the universal introduction of Cognitive Behavioural Therapy are followed by the systematic reduction of mental health care services in primary care. In my own practice, in the past 6 months, first the PCT provided mental health care worker was removed and more recently the practice counsellor of 17 years standing was ‘let go’. But hey ho, never mind, NICE guidance has after all told us what to do: if a patient is suitable for CBT and it isn’t available (!) we can (and should) tell them to ‘hang on’. more…

http://www.munch.museum.no/content.aspx?id=15

This week a leading national paper in the UK broke news  of what has been rightly called a medical scandal. They revealed the existence of a report into the systemic inadequacies of management systems at Birmingham Children’s Hospital. The impact of these failings on the standard of care provided by the hospital are now the subject of a further report, deemed necessary once the contents of the first report were made public.

http://www.guardian.co.uk/society/2008/nov/09/royal-college-surgeons-birmingham-childrens-hospital-scandal-report

The report was commissioned by the local Primary Care Trust (PCT) for whose patients the hospital provides care. Rather than being commissioned because  of identified negative impacts in terms of increased patient morbidity and mortality, the report is, instead, the result of the PCT’s response to a collective and anguished cry for help from the world class doctors at Birmingham Children’s Hospital and other local hospitals. No longer able or willing to stand by whilst their reasoned arguments about patient safety, duty of care, and the ethical imperatives inherent in their role as both care givers and patient advocates fell on deaf and ignorant ears, they looked elsewhere in the hope that reason and integrity would prevail.  more…

This week there was good news for patients in England with an age-related eye condition that leads to blindness. This week, long after a new and effective drug treatment for a relatively common condition called wet macular degeneration became commercially available, the National Institute for Health and Clinical Excellence (NICE) ruled that it should be made available to NHS patients in England.

It’s easy to have the impression that most recent rulings from NICE have been negative, in the sense of declaring a new treatment insufficiently cost-effective to merit provision by the tax-funded National Health Service. So this positive ruling- allowing access to effective drugs- is to be welcomed. Nevertheless I found something rather disturbing in the tone of the media coverage of this news story and therein lies a medical humanities perspective. more…

To say that it is sometimes appropriate, even obligatory, for guidelines to be ignored will not make me any friends  amongst those campaigning for more equitable access to NHS funded IVF treatment. Nevertheless, and in spite of my discomfort with the inequitable access to IVF treatment experienced by people in different parts of the UK, I’d like to tell you why I think guidelines are made to be broken. more…

Today has been- to use popular management speak- challenging. Today was one of those days when, in spite of twenty-two years as a doctor, I find myself distressed at the suffering that I’ve encountered. And I’m left wondering how to find the right balance between being useful, of use to my patients, and still being able and willing to keep within sight of the blood. more…

The title of this posting refers to a funding controversy causing outrage amongst patients, doctors, and other health care professionals in the United Kingdom: namely the decision by the government to deny free National Health Service (NHS) treatment to any patient, in England or Wales, who decides to pay for life-prolonging cancer treatment that the NHS does not provide on the grounds of cost. more…