At home we’re watching old episodes of Cardiac Arrest, a series written 13 years ago by an ex-junior-doctor which depicts hospital medicine through a fog of anger and sleep deprivation. The only dignity seen in the series is in the behaviour of ethnic-minority relatives of patients killed by the system. A caricature? Yes, but an uncomfortably realistic one: we now teach medical students a lot about communication skills but we should also be teaching them the ABCD of dignity conserving care. Hang on, did I say medical students? Sorry, I meant to say – as a priority – hospital administrative staff, nurses, and bed managers. And why stop there: how about everyone in the Department of Health, including our elected Secretary of State?
The sorting out of children who wheeze has defied logic for almost the whole time I have been a GP: millions have been urged to keep puffing in steroids which do them no good, and may do harm, while every year a couple of dozen children die from acute asthma. GPs take their advice from “experts” who study studies and see a completely unrepresentative selection of wheezy children: their guidelines sometimes stand the evidence on its head, as with the British Thoracic Society and allergen avoidance. One thing we do know is that a lot of allergens in early life protect against atopy, the main cause of true chronic asthma, and that allergen avoidance later makes no difference. Most other kids suffer from episodic viral wheeze, and need only intermittent bronchodilators. Although written by experts, this clinical review contains much sense.