I’m petrified. I’ve been invited to participate in the Institute of Medicine‘s Roundtable on value and science driven healthcare. The focus of the all-day meeting is “continuous learning and the digital infrastructure for informed clinical decisions,” and the bit that I’m expected to speak about are the “functional needs for digital information at the point […]
Richard Lehman’s journal review – 9 July 2012
Arch Intern Med 25 June 2012 Vol 172 909 The Archives are about to mutate into JAMA Internal Medicine, but I generally find them a better read than JAMA proper. One reason is the abundance of lively comment—and in the case of this paper on sex differences in the protective effect of statins, I find […]
Domhnall MacAuley: The final answer to the breast screening dilemma at WONCA Europe.
Communicating risk is about numbers. If you think of any serious disease, the potential to reduce risk by 50% sounds fantastic. If the incidence is 2/10 and you reduce the risk by 50% you save one life in 10. If the incidence is 2/100 you save one life in 100. If the incidence is 2/1000 […]
Tiago Villanueva: Portugal’s health system in intensive care
Austerity is already asphyxiating Portugal’s health system, and recent developments may soon put it in the intensive care unit. The current state of affairs is so serious that for the first time ever, Portugal’s two medical unions and the Portuguese Medical Association have joined forces to bring forward the first national industrial action supported by […]
Emma Rourke: Junior doctors don’t put patients’ lives at risk
It’s coming up to that time of year once again, where—for newly qualified doctors across the country—the jubilation associated with passing finals gives way to the incipient dread of the first day in a new job, and the knowledge that very soon patients’ lives really will be in their hands. It’s well known that if […]
Pritpal S Tamber: Err, so what are we talking about again?
Orbiting around the hallowed nucleus of the doctor-patient relationship is an entire healthcare industry that occasionally—although not often enough—impacts on clinical practice. Having spent five years in this orbit one of the things I’ve concluded is that no one really knows what anyone else is saying. That may seem like an inflammatory remark so let […]
Richard Smith: Medical journals: a gaggle of golden geese
I used to be part of running a course for editors of medical journals, and on each course we’d encounter editors, usually distinguished professors, who worked evenings and weekends on journals for free. They did so as a contribution to their specialty and for a dollop of honour. In their naivety they imagined that the […]
Julian Sheather: Vulnerable adults, coercion, and the inherent jurisdiction of the High Court
In law, the capacity to make a specific decision has a binary quality. Somewhat like a light it is either on or off, you either have it or you don’t and there are no intermediate states. Yes capacity can fluctuate, the bulb can wink on and off, but at any one time we either have […]
David Kerr: The dangers of going to hospital
Hospitals can be dangerous places. Two things happen to everyone admitted to hospital for more than a few hours—they are put to bed and are fed. Over half a century ago Richard Asher highlighted the obsession hospitals have with beds and the dangers of being confined to bed (BMJ 1947; doi: 10.1136/bmj.2.4536.967). Asher’s description of […]
Richard Lehman’s journal review – 2 July 2012
JAMA 27 June 2012 Vol 307 2595 Of all the things that made me glad to retire from general practice two years ago, pay for performance must top the list. Here’s a Viewpoint piece from the USA which explains why: “Focusing on specific outcomes does not reward skills or result in managing complexity, solving problems, […]