Two years ago, GP Michael Frank Harris discovered a right inguinal swelling while looking in his bathroom mirror. He writes about what happened next in the return of our Patient’s Journey series. Harris surprised his haematologist with an alternative diagnosis and together they took a leap of faith—deciding on treatment for stage I follicular lymphoma, rather than stage IV. They will only know if they made the right decision after many years of follow up.
Richard Lehman’s History Lesson highlights surprising parallels between the Reformation and the evidence based medicine revolution. Obviously (hopefully?) debate about EBM won’t lead to a century and a half of bloody wars but, to avoid a similarly long and messy resolution, medical reformers “must all work together towards the common goal of dependable, real time, patient relevant evidence, which is brought to bear through effective shared decision making.”
Thyroid cancer is one of the fastest growing diagnoses; more cases of thyroid cancer are found every year than all leukemias and cancers of the liver, pancreas, and stomach. In our State of the Art Review of low risk papillary thyroid cancer, Juan P Brito and colleagues look at treatment options, epidemiology, and future questions for research. Thanks probably to advances in imaging technology, clinicians are seeing more patients with low risk thyroid cancers. Lack of clarity about diagnosis, however, has lead many of them to receive treatment that is more appropriate for aggressive cancers.
In 2006, Angela Coulter and colleagues embarked on a quest to track down evidence on the effects of patient focused interventions and make it easier to find. Clinical commissioning groups and NHS trusts often cite a lack of evidence that person centred care works as a reason to avoid change. Now the latest version has been published there are no excuses.
Jett Aislabie is an assistant editor on bmj.com.