My patient Pat damaged a knee skiing abroad, had it fixed locally, and limped home. “Should I keep on taking these tablets they gave me, Doc? They’re to help me sleep.” I suggested not. They’d given Pat one of the so called “z drugs”—zaleplon, zolpidem, or zopiclone, I forget which. Not for long enough, I […]
Category: Columnists
The BMJ Today: Thinking about common and not so common conditions
• Pityriasis versicolor is a superficial fungal infection of the skin that is commonly seen in general practice. The latest practice pointer looks at its diagnosis, differential diagnosis, management, and prevention. One particular aspect about its management is that first line treatment comprises shampoo containing either ketoconazole, selenium sulphide, or zinc pyrithione. • Iron deficiency […]
Jeffrey Aronson: When I use a word . . . Phonemes shmonemes
I referred my patient Pat for a specialist opinion. The consultation was not a success. “That specialist registrar you referred me to was totally useless,” said Pat. “What an insolent shmuck! Doc, don’t ever become a registrar.” I don’t know which surprised me more, the insult or the advice. I certainly don’t expect to hear […]
Paul Glasziou: Six proposals for evidence based medicine’s future
This blog is part of a series of blogs linked with BMJ Clinical Evidence, a database of systematic overviews of the best available evidence on the effectiveness of commonly used interventions. Gordon Guyatt coined the term “Evidence based medicine” (EBM) over 20 years ago, and it has had a remarkable global influence. But EBM is […]
Tiago Villanueva: Returning to medical school 10 years later
A few weeks ago, I returned to the Faculty of Medicine at the University of Lisbon—the medical school from where I graduated ten years ago. The reason was to participate at the AIMS meeting, an international conference for medical students as both a member of the jury of the oral presentations and as a speaker. […]
William Cayley: About what are we being precise?
I’ve been too swamped with the day to day realities of teaching, patient care, and just plain real life lately to be very reflective, but Zackary Berger and Dave deBronkart finally spurred me on to put fingers to keyboard, and put words to my thoughts on the nascent move towards “precision medicine.” From the first, when […]
Richard Smith: “Flat of the curve” healthcare
Alain Enthoven, an economist and inventor of the internal market, described “flat of the curve” healthcare where increased expenditure on healthcare produces no further benefit. Are we at that point in many health systems in high income countries, including Britain? Enthoven’s graph is best thought of as theoretical insofar as it’s not easy to measure […]
Jeffrey Aronson: When I use a word . . . Rough breathing
Exploring the English phonemes, I have reached the unvoiced labiodental fricative f. When consonantal shift changes p, the unvoiced bilabial plosive, into f, a breath becomes a sneeze, even though it is the p that is plosive. Let’s start with orthopnoea, the symptom of breathlessness—or worsening breathlessness—on lying flat. But “orthopnoea” does not mean breathlessness […]
Billy Boland: Psychiatry is full of story
I had a minor revelation at the weekend whilst talking about why I became a psychiatrist. It’s one of the careers that never fails to excite further questions when you’re getting to know people. I feel like I’ve told my story a thousand times. That’s why it felt so strange to get a new personal […]
Richard Smith: Will health become more like education or education more like health in the UK?
Uwe Reinhardt, the world’s funniest health economist, says that eventually all health systems will be the same: whatever they want for the rich; an insurance based system for the majority; and a rump service for the poor. “Never in Britain,” say Reinhardt’s British friends, but I wondered if he might be right as I read […]