How would you raise concerns if you felt that clinical practice was below standard in your hospital or surgery and patient safety was being compromised? Do you and your teams have clearly defined ways to report any concerns? The BMJ news reports on a whistleblower who has finally been acquitted of unfair dismissal in a complicated and lengthy case which included an original concern around overcrowding and a patient death on a ward.

And another dilemma—what would you do if a patient discloses to you that they smoke cannabis for medical reasons? An uncertainties article by an Australian group entitled “Should doctors prescribe cannabinoids” pulls together systematic reviews and randomised controlled trials to help answer queries around this controversial area of practice. Californian doctors can recommend cannabis for any medical use if they believe the patient may benefit, which unsurprisingly the paper says has created “clinical conundrums” for US doctors.

In the UK, a cannabis based medical extract, nabiximols is approved for use in alleviating chronic neuropathic pain and muscle spasticity in patients with multiple sclerosis. Other approved uses in the US are for the control of nausea and vomiting in cancer therapy as well as stimulating appetite in patients with AIDS related wasting. Read more here.

BMJ Confidential this week features the deputy medical director of NHS England, Mike Bewick, who says that medicine is a “great career for someone who likes people and problem solving.” He says that his personal ambition is to “reform medical training” saying that we need to attract more people from “ordinary backgrounds so that our communities see that it is possible for someone to represent them in all professions.” He made the leap from working as a clinician at the coal face to experiencing life as a medical manager, which he says can be incredibly challenging, but he has learnt some important lessons along the way such as the value of teams and how they can support leadership particularly in challenging situations. In looking to the future he predicts that further advances in IT and genetics will completely change how we practice.

And continuing on the subject of challenging situations and how good teamwork can help resolve them, a summary of the NICE guidance sets out the evidence around the prevention and management of pressure ulcers covering areas such as how to assess patients, repositioning, as well as guidance to help decide which patients need wound debridement.

The guidelines advise a multidisciplinary approach which may be a factor in reducing distress and waste of substantial healthcare resources for a common condition that the authors say can be devastating, but avoidable with effective training and management.

Cath McDermott is Head of Education, The BMJ.