{"id":258,"date":"2007-06-17T18:26:35","date_gmt":"2007-06-17T17:26:35","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2007\/06\/17\/bmj-16-jun-2007-vol-334\/"},"modified":"2007-06-17T18:26:35","modified_gmt":"2007-06-17T17:26:35","slug":"bmj-16-jun-2007-vol-334","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2007\/06\/17\/bmj-16-jun-2007-vol-334\/","title":{"rendered":"BMJ  16 Jun 2007  Vol 334"},"content":{"rendered":"<p>Diagnostic studies are abundant, but I continue to be amazed that senior researchers often write about things like \u201cspecificity\u201d and \u201csensitivity\u201d as if they are not context-dependent.<!--more-->There is a world of difference between me in primary care ruling out peripheral vascular disease because I can\u2019t feel the foot pulses in a woman who gets calf pain while walking around town, and a vascular surgeon wanting to know where the lesion lies in an old smoker who can\u2019t go fifty metres. <a href=\"http:\/\/www.bmj.com\/cgi\/content\/abstract\/334\/7606\/1257\">This systematic review<\/a> identified 107 studies and my conclusion is that ultrasound is probably good enough for most purposes I require, while the vascular surgeon should opt for magnetic resonance angiography.<\/p>\n<p>Does \u201cprimary care medicine\u201d mean the same thing in all developed countries? Obviously the strict answer has to be no, but <a href=\"http:\/\/www.bmj.com\/cgi\/content\/abstract\/334\/7606\/1261\">this study<\/a> of diagnostic clustering in three countries \u2013 the USA, Australia, and New Zealand \u2013 shows remarkable similarities. The paper is followed by a nice little filler describing the enriching effect of a GP exchange between England and Canada. Sabbaticals and swaps remain the best way to combat primary care fatigue.<\/p>\n<p>Thirty years ago, GPs saw a lot of acute coronary syndromes and often tried to manage them at home, knowing that patients sent to hospital generally fared worse. Now both the incidence and the mortality of these syndromes has fallen dramatically, and GPs are happy to be by-passed in the interests of rapid diagnosis and intervention. But ACS without ST-elevation remains a dilemma. It is easy to detect the cases with myocardial damage ten hours later, when the troponins have risen, but in the meantime the window for treatment has gone. Here is a <a href=\"http:\/\/www.bmj.com\/cgi\/content\/extract\/334\/7606\/1265\">good clear review<\/a> of the problem.<\/p>\n<p>When he was eight years old, little Mieczys\u0142aw Horszowski was acclaimed as the greatest living player of Chopin, and so he remained for the next 90 years. For several of these decades he taught in America, where his pupils were frustrated by his refusal to explain fingering and his gentle insistence on demonstrating passages as real music. One of them finally gave up and splashed out an approximate imitation of the master. \u201cGood,\u201d smiled Horszowski, \u201cbut we should also try to <em>play the notes<\/em>.\u201d  In this <a href=\"http:\/\/www.bmj.com\/cgi\/content\/extract\/334\/7606\/1274\">Personal View piece about a man dying from heart failure<\/a>, Communication is seen as the \u201cforgotten palliative care emergency\u201d, and I would entirely agree. But the authors also ensured his good death by managing to deactivate his implanted defibrillator. We should also try to <em>find the magnet<\/em>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Diagnostic studies are abundant, but I continue to be amazed that senior researchers often write about things like \u201cspecificity\u201d and \u201csensitivity\u201d as if they are not context-dependent. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2007\/06\/17\/bmj-16-jun-2007-vol-334\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-258","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>BMJ 16 Jun 2007 Vol 334 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2007\/06\/17\/bmj-16-jun-2007-vol-334\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"BMJ 16 Jun 2007 Vol 334 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Diagnostic studies are abundant, but I continue to be amazed that senior researchers often write about things like \u201cspecificity\u201d and \u201csensitivity\u201d as if they are not context-dependent. 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