This study of self-monitoring in type 2 diabetes calls into question a widely-used and expensive intervention and has drawn a stream of responses ever since it was first posted on the BMJ website some weeks ago. I must declare two kinds of bias: firstly in favour of the researchers, some of whom I know personally, and secondly against books of daily test results brought to me by patients who are not on insulin. About these I have never found anything intelligent to say, except to suggest they do fewer. Perhaps there is a small subset of badly controlled patients (who would have failed the entry criteria for this trial) for whom such exercises are motivational: but for most, it is just a waste of NHS money and digital pain.
A confession: I have never really used risk scores much. Does anybody? I used to try in the days of the Sheffield tables, whose greens and reds adorned my wall until quite recently, but damn it, if you smoke you need to stop, if you don’t drink wine you need to start, if your systolic BP is above 150 it needs to be lower and if your cholesterol is over 6 and you’re male, you need a statin. If you’re diabetic or you’ve got bad coronaries you need the whole works. But if you need some kind of quantification for an untreated patient, then QRISK probably beats the old Framingham score.
Many people seem to regard talking treatments as intrinsically (and indeed morally) superior to drug treatments for depression. It does seem true that cognitive behavioural therapy can produce lasting benefit for some aspects of depression, such as insomnia and agoraphobia; but this study of major depression in adolescents showed no advantage in combining a serotonin reuptake inhibitor with CBT over giving the drug alone.
Here’s a short article which you need to keep in a safe place: how to assess capacity to make a will. Every now and again you will be asked to decide this, and this piece tries tells you how, though half of it is taken up by legal waffle. Be sure to recover it before calling the patient in, because they may not be impressed to find you rummaging about and appearing more forgetful than they are. Do not compound your error by quoting awfully funny lawyerly jokes from the paper about leaving your money to President Putin.