We did something a bit different today as an executive team. We used the “goldfish bowl” technique to explore how to support the transition from PCT-led to Consortia-based commissioning. I apologise if you already know what this technique entails. For those of you who don’t; we put four chairs in the middle of a circle […]
Category: Columnists
Sandra Lako on the importance of prevention
A few weeks ago a child came to the hospital with classic signs of tetanus: a locked jaw, rigidity of the muscles, and jerking of the body. The diagnosis was obvious. The doctors and nurses tried to cure the child, but in reality they had little to offer. The children’s hospital is not set up […]
Richard Smith: The pain of prioritisation
With almost every endeavour participants have many more ideas on what might be done that than there are resources to get them done. Prioritisation is thus essential, but, my goodness, it’s hard. Many groups will slide back to making almost everything a priority, which means, of course, that nothing is a priority. I reflected on […]
James Raftery: NICE changes its position on Alzheimer’s disease drugs
The provisional guidance from NICE on drugs for Alzheimers’ disease – donepezil, galantamine, rivastigmine, and memantine – marks a dramatic shift from restricting access to those with moderate disease to recommending these drugs as options for all patients with the disease. What has changed? No new compelling evidence has emerged. For each of the drugs […]
Richard Smith: Important study points towards a different future
In what I think is a very important BMJ paper, John Ioannidis and Fotini Karassa have shown that systematic reviews, the highest level of evidence, may be highly deceptive. We did, I suppose, know this in a way, but they illustrate the case beautifully. What disappoints me is that nobody has responded to their paper. […]
Richard Smith: Medical schools to close?
Until now medical schools have had it easy. They have lots of high quality applicants, most students graduate, and all of them can find jobs. Suddenly, as for many others in Britain, the world looks more hostile. I hang around medical schools, and many people think it likely that one or two medical schools may […]
Julian Sheather: When patients become the enemy
I was out with a friend recently, a GP. He works in an inner-city practice. By all accounts he is a good GP. As a mate I know him to be passionate, hard working, and committed. He is bright, with interests that range way beyond medicine. I got to know him when he was a […]
Desmond O’Neill: Social networking, telemedicine, and stroke
Some medical technologies creep up on you, some arrive with a bang. In internal medicine much of the change – electronic laboratory reporting, digital imaging – is gradualist and steered by other disciplines, and physicians are grateful if relatively passive users. On the other hand, telemedicine for stroke thrombolysis was a radical step for both […]
Martin McShane: Yes Minister
I used to love Yes Minister. The civil service is full of very clever and erudite people who are hugely creative. Their brilliance shines through in the guidance just issued to PCTs and clinical commissioning groups on strategies to achieve cost-effective prescribing. As it says in the widely circulated Chief Executive’s Bulletin, “This guidance reflects […]
Sandra Lako on a night check at the hospital
It’s 1:00 am. My colleague and I have just returned from a surprise visit to the hospital. Three times a month we do spot checks on the wards; periodically we check during the early or late shifts and occasionally during the night and weekend shifts. The reason for these checks is that the Welbodi Partnership […]