The first case of Ebola in the United States, a cluster of cases of “acute neurologic illness with focal limb weakness of unknown etiology in children,” and ongoing concern over enterovirus D68 in the US. As if economic uncertainty and ongoing conflicts around the globe were not enough to put one on edge, there is now […]
Category: Columnists
Richard Smith: Using data to improve care and reduce waste in health systems
Annual expenditure on healthcare in the United States is currently $2.8 trillion, and about a third of it is wasted, says the Institute of Medicine. The sum wasted is about five times the GDP of Bangladesh, a country of 160 million people. This is waste on a spectacular scale, and reducing it while improving the […]
Neal Maskrey: When paradigms shift
When paradigms shift it’s always disconcerting. Thomas Samuel Kuhn published The Structure of Scientific Revolutions in 1962 and it’s become a decisive text on the nature of science. He used the term “paradigm” to describe the belief system that underpins puzzle solving in science. Far from discovering any absolute “truth,” normal science progresses routinely within […]
David Lock: Avastin and Lucentis—It’s time for NHS commissioners to act rationally by limiting the choices for wet AMD patients
The news that a Cochrane Review has concluded that Avastin (bevacizumab) is as safe as Lucentis (ranibizumab) to treat patients with wet age related macular degeneration (“wet AMD”), along with other studies that have shown the two drugs have broadly the same level of clinical effectiveness, comes as no surprise to those of us who have been […]
Richard Smith: Patients harmed by misdiagnosed preferences
Linda is 58 and has been diagnosed with breast cancer. She would have preferred not to have surgery but was convinced by her surgeon that it would be the best option. After her operation, the hospital contacted her to apologise as she had not had breast cancer. She’d been misdiagnosed. An inquiry, legal action, and […]
Desmond O’Neill: Ageing, astronauts, and organists in Rotterdam
“Le frime” is an almost untranslatable French word for doing something that seems superfluous for the fun of it. It is as good a term as any for the opening ceremonies of our European Union Geriatric Medicine Society conferences. These reflect how individual nations put their best foot forward for guests. While the content may at […]
The BMJ Today: The complexity of medical jargon
Up to this day, I’m still often asked by friends when I am going to become a specialist, considering I am “just” a GP. It remains difficult for lay people to understand and acknowledge that GPs master a trade of their own, just like hospital specialists, and are not just doctors who didn’t pursue any […]
Richard Smith: Is it time to stop using the word poverty in Britain?
Is poverty yet another word that is so misunderstood we should stop using it—at least in Britain? John Lanchester, a friend of mine, argued so in the Observer. Can he possibly be right? Lanchester doesn’t seem to be arguing that we should stop using the word poverty when we mean “absolute poverty.” When the Millennium Development […]
William Cayley: My Chief Complaint
My chief complaint . . . is with the chief complaint. One of the hallowed concepts in medical history taking and documentation is the “chief complaint.” Supposedly a way to set the agenda for a medical visit, in current practice it often gets both distorted and treated as a boundary setter. Ideally, in medicine, we […]
David Oliver: Tails of the unexpected—could the NHS learn from vets?
As I sit at my keyboard, I am looking at my calm and contented 3 year old calico cat, Tilly. Apart from the shaved area on her flank, you wouldn’t know anything had ever been different. Yet last week, she came close to dying from acute kidney injury. I had come home after a long day […]