The BMJ Today: The good and the bad news for doctors and patients

Tiago_VillanuevaWhen it comes to interacting with patients, most doctors’ working days, regardless of the setting, include a combination of breaking both good and bad news. It is extremely rewarding when, for instance, we can tell patients in hospital wards that they have fully recovered and will be going home soon or, on the other hand, when we can reassure a patient in primary care that the initial suspicions of a serious disease turned out to be unfounded.

There was indeed some good news in The BMJ this week. According to a news story, which reported an analysis of population and death certification data for all cancers in 27 European countries published in an oncology journal, the proportion of deaths due to cancer of any sort is expected to decrease in Europe in 2014. The study predicted rates of 138.1 deaths per 100 000 in men and 84.7 per 100 000 of the population in women, which corresponds to a reduction of 7% in deaths in men and 5% in women compared to 2009. But there’s the reverse side of the coin too. The study also tells us that this year more people in Europe will be told by their doctors that they have pancreatic cancer compared to 2000-2004. Less than 5% of patients diagnosed with pancreatic cancer live for more than five years after diagnosis. The age standardised rates are expected to rise from 7.6 deaths per 100 000 of the population in men and 5.0 deaths per 100 000 in women in 2000-2004, to 8.0 and 5.6 deaths, respectively, per 100 000 of the population in 2014.

But breaking either good or bad news implies having a certain degree of certainty. Doctors also often spend a great deal of time dealing with uncertainty and trying to make sense of unclear clinical scenarios. For example, diagnosing an inflammatory abdominal aortic aneurysm may not be straightforward. Despite having similar risk factors and commonly affecting similar locations in the abdominal aorta as the conventional atherosclerotic abdominal aortic aneurysm, an inflammatory abdominal aortic aneurysm usually affects younger patients and triggers symptoms like abdominal or back pain, accompanied by systemic symptoms such as weight loss, malaise, and fever. To make it even more confusing for clinicians, inflammatory aneurysms may be palpable but not always pulsatile, due to encasement by fibrous tissue. Inflammatory abdominal aortic aneurysms comprise about 5% of all abdominal aortic aneurysms, and are featured in the most recent endgames picture quiz.

Doctors themselves also often receive their fair share of both good and bad news. According to Sean Roche, a psychiatrist in North London, psychiatrists are increasingly spending more time collecting and entering data, which is consequently reducing the time they have available to attend to their patients. This is the kind of testimonial we’ve traditionally been hearing for many years from GP’s around the world, but it is disappointing to see it is affecting hospital doctors as well. In his blog, Roche called this phenomenon “fetishization of data”, which he feels may ultimately be unethical.

Victor Montori puts some recently published evidence surrounding the safety of incretin based drugs (glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors or gliptins) into context, in an editorial published this week. With low to moderate confidence, incretin based drugs don’t seem to significantly increase the risk of acute pancreatitis, unlike previously reported. This is good news in the sense that this new information may be potentially useful to help both doctors and patients decide together what will be the best second line therapy for diabetes.

I want to finish off with some good news for readers of The BMJ print issue. It’s that time of the week when you receive it in the post and get to relax while you read The BMJ over a cup of tea…

Tiago Villanueva is The BMJ editorial registrar.