joannalyall50@gmail.com Maurice King said he was not ambitious to be a professor or head of department, rather he wanted “to make the world turn better.” He understood his efforts might not be received in the spirit they were made, however, quoting Molière’s maxim, “It is a madness like no other to want to interfere in correcting the world.” “He loved people and wanted to improve healthcare but didn’t always choose the best way of expressing his ideas,” said his son Ben. In 1990 a Guardian news story interpreted his Lancet paper, Health is a sustainable state ,1 as a call for sick children in the developing world to be left to die. “Reduced childhood mortality must no longer be promoted as a necessary and sufficient condition for reduced mortality,” he wrote. He argued that oral rehydration should not be introduced at a population level if there were no “complementary ecological sustaining measures” such as family planning, as this would “increase the man years of human misery.” “However, the individual doctor must rehydrate his patient,” he said. It was a nuanced argument and the Guardian article provoked angry letters from Unicef and …
{"title":"Maurice King: physician who proposed a one child policy to combat overpopulation","authors":"Joanna Lyall","doi":"10.1136/bmj.q2603","DOIUrl":"https://doi.org/10.1136/bmj.q2603","url":null,"abstract":"joannalyall50@gmail.com Maurice King said he was not ambitious to be a professor or head of department, rather he wanted “to make the world turn better.” He understood his efforts might not be received in the spirit they were made, however, quoting Molière’s maxim, “It is a madness like no other to want to interfere in correcting the world.” “He loved people and wanted to improve healthcare but didn’t always choose the best way of expressing his ideas,” said his son Ben. In 1990 a Guardian news story interpreted his Lancet paper, Health is a sustainable state ,1 as a call for sick children in the developing world to be left to die. “Reduced childhood mortality must no longer be promoted as a necessary and sufficient condition for reduced mortality,” he wrote. He argued that oral rehydration should not be introduced at a population level if there were no “complementary ecological sustaining measures” such as family planning, as this would “increase the man years of human misery.” “However, the individual doctor must rehydrate his patient,” he said. It was a nuanced argument and the Guardian article provoked angry letters from Unicef and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We thank Eddy and colleagues for their article on medical leadership,1 recognised as essential in postgraduate medical training.2 We have two important additions. Firstly, the Healthcare Leadership Academy (HLA)’s scholars programme, founded in 2016, is a year long, funded leadership development programme mapped to the NHS leadership framework that nurtures and empowers tomorrow’s healthcare leaders.3 The programme can be undertaken in parallel to studies or work and explores the leader as communicator, manager, follower, negotiator, philosopher, and entrepreneur …
{"title":"Take the lead: additional medical leadership development opportunities and resources","authors":"Christopher J Graham, Laura (Josie) Cheetham","doi":"10.1136/bmj.q2602","DOIUrl":"https://doi.org/10.1136/bmj.q2602","url":null,"abstract":"We thank Eddy and colleagues for their article on medical leadership,1 recognised as essential in postgraduate medical training.2 We have two important additions. Firstly, the Healthcare Leadership Academy (HLA)’s scholars programme, founded in 2016, is a year long, funded leadership development programme mapped to the NHS leadership framework that nurtures and empowers tomorrow’s healthcare leaders.3 The programme can be undertaken in parallel to studies or work and explores the leader as communicator, manager, follower, negotiator, philosopher, and entrepreneur …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
One of the huge attractions of practising medicine in the UK is that we can make our treatment decisions according to our patient’s clinical need, not their ability to pay. Most of the time, I don’t need to tailor my clinical advice to what my patient can afford or whether they’re insured—although I do have to think about money, about the capacity of the NHS as a whole and its finances. This is one of the many reasons I’m proud and happy to be a GP in the NHS. I was therefore shocked to …
{"title":"Helen Salisbury: If GPs aren’t formally part of the NHS, what are we?","authors":"Helen Salisbury","doi":"10.1136/bmj.q2635","DOIUrl":"https://doi.org/10.1136/bmj.q2635","url":null,"abstract":"One of the huge attractions of practising medicine in the UK is that we can make our treatment decisions according to our patient’s clinical need, not their ability to pay. Most of the time, I don’t need to tailor my clinical advice to what my patient can afford or whether they’re insured—although I do have to think about money, about the capacity of the NHS as a whole and its finances. This is one of the many reasons I’m proud and happy to be a GP in the NHS. I was therefore shocked to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henry John Woodford, Dan McKenzie, Lucy Mary Pollock
Guideline directed medical therapy for heart failure for older people with frailty may do more harm than good, say Henry Woodford and colleagues The management of heart failure is evolving. Recent clinical trials have widened the range of effective treatments. Simultaneously, recognition is growing of the importance of frailty in populations with an increasing proportion of older people.1 Heart failure, old age, and frailty are intertwined. The prevalence of frailty increases with age.2 The average age at diagnosis of heart failure is around 77 years in developed countries,34 and mortality rises with age, reaching almost 40% in the first year after diagnosis among those over 85.4 Frailty is present in up to 45% of people with heart failure,5 and people with existing frailty are more likely to develop heart failure.6 In 2022-23 around 5300 people a month were admitted to hospitals in England and Wales because of a heart failure exacerbation, with an average age around 78.7 However, uncertainty remains about management of heart failure in patients with frailty. Some clinicians champion the wider use of evidence based therapies; others urge a more cautious approach. Who is right? The medical management of heart failure has improved substantially. Trials demonstrating benefits from concomitant use of several drug classes have been translated into guidelines to standardise management and promote best practice.891011 Typically, people who have heart failure with reduced ejection fraction (HFrEF) are recommended a combination of four or five drugs—a beta blocker, an angiotensin converting enzyme inhibitor or combined angiotensin receptor neprilysin inhibitor, a mineralocorticoid receptor antagonist, and a sodium-glucose co-transporter 2 (SGLT-2) inhibitor—plus a loop diuretic for symptom relief. For people with heart failure with preserved ejection fraction (HfpEF) guidelines recommend an SGLT-2 inhibitor alone, alongside a loop …
{"title":"Appropriate management of heart failure in older people with frailty","authors":"Henry John Woodford, Dan McKenzie, Lucy Mary Pollock","doi":"10.1136/bmj-2023-078188","DOIUrl":"https://doi.org/10.1136/bmj-2023-078188","url":null,"abstract":"Guideline directed medical therapy for heart failure for older people with frailty may do more harm than good, say Henry Woodford and colleagues The management of heart failure is evolving. Recent clinical trials have widened the range of effective treatments. Simultaneously, recognition is growing of the importance of frailty in populations with an increasing proportion of older people.1 Heart failure, old age, and frailty are intertwined. The prevalence of frailty increases with age.2 The average age at diagnosis of heart failure is around 77 years in developed countries,34 and mortality rises with age, reaching almost 40% in the first year after diagnosis among those over 85.4 Frailty is present in up to 45% of people with heart failure,5 and people with existing frailty are more likely to develop heart failure.6 In 2022-23 around 5300 people a month were admitted to hospitals in England and Wales because of a heart failure exacerbation, with an average age around 78.7 However, uncertainty remains about management of heart failure in patients with frailty. Some clinicians champion the wider use of evidence based therapies; others urge a more cautious approach. Who is right? The medical management of heart failure has improved substantially. Trials demonstrating benefits from concomitant use of several drug classes have been translated into guidelines to standardise management and promote best practice.891011 Typically, people who have heart failure with reduced ejection fraction (HFrEF) are recommended a combination of four or five drugs—a beta blocker, an angiotensin converting enzyme inhibitor or combined angiotensin receptor neprilysin inhibitor, a mineralocorticoid receptor antagonist, and a sodium-glucose co-transporter 2 (SGLT-2) inhibitor—plus a loop diuretic for symptom relief. For people with heart failure with preserved ejection fraction (HfpEF) guidelines recommend an SGLT-2 inhibitor alone, alongside a loop …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Finally, we’re here. After months of heated debates, social media uproar, royal colleges in turmoil, and the reputation of many national organisations being questioned, the worm has turned. The health and social care secretary, Wes Streeting, has called for a review of how physician and anaesthesia associates are deployed in the NHS.1 The chair of the review, Gillian Leng, has a strong reputation and is well placed to conduct it. Since the stipulation is to look at data and views neutrally and to reach a decision about whether these roles are a cost effective use of taxpayers’ money, the former chief of the National Institute for Health and Care Excellence is as good as it gets. So, what next? One thing is to allow open communication from all parties and ensure that there’s a genuine desire to investigate this thoroughly. This issue won’t just go away. …
{"title":"Partha Kar: Leng’s review of physician and anaesthesia associates is welcome—with guarded optimism","authors":"Partha Kar","doi":"10.1136/bmj.q2608","DOIUrl":"https://doi.org/10.1136/bmj.q2608","url":null,"abstract":"Finally, we’re here. After months of heated debates, social media uproar, royal colleges in turmoil, and the reputation of many national organisations being questioned, the worm has turned. The health and social care secretary, Wes Streeting, has called for a review of how physician and anaesthesia associates are deployed in the NHS.1 The chair of the review, Gillian Leng, has a strong reputation and is well placed to conduct it. Since the stipulation is to look at data and views neutrally and to reach a decision about whether these roles are a cost effective use of taxpayers’ money, the former chief of the National Institute for Health and Care Excellence is as good as it gets. So, what next? One thing is to allow open communication from all parties and ensure that there’s a genuine desire to investigate this thoroughly. This issue won’t just go away. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eddy’s article is an excellent resource for resident doctors to encourage leadership experience.1 Leadership is a key skill for all doctors. The General Medical Council states that, whatever their role, …
Eddy 的文章是住院医生鼓励积累领导经验的绝佳资源1 。医学总会规定，无论医生的角色如何，...
{"title":"Leadership skills and failures","authors":"Alice McGalliard","doi":"10.1136/bmj.q2596","DOIUrl":"https://doi.org/10.1136/bmj.q2596","url":null,"abstract":"Eddy’s article is an excellent resource for resident doctors to encourage leadership experience.1 Leadership is a key skill for all doctors. The General Medical Council states that, whatever their role, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculosis is a preventable and curable disease that continues to devastate the most vulnerable, including migrant and refugee communities in the shadows of global crises According to the World Health Organization’s global tuberculosis report, TB is one of the world’s deadliest infectious killers, claiming 1.25 million lives (including 161 000 deaths among people with HIV) and causing 10.8 million people to become ill in 2023.1 Refugees, migrants, and other displaced people are disproportionately vulnerable to tuberculosis, facing compounded risks such as inadequate healthcare, unsafe living conditions, and legal and social barriers.2 Only through unified and decisive action can we prevent further ill health and loss of life from TB. Globally, around a billion people—equivalent to one in every eight people—have experienced migration or forced displacement.345 Although not all refugees and migrants are vulnerable, the scale of the vulnerable population is staggering. For example, in the first half of 2024, over 120 million people had been forcibly displaced because of persecution, conflict, violence, or human rights violations and other disruptive events. This includes 46 million refugees and other people in need …
{"title":"Unified response is needed to tackle tuberculosis among refugees and migrants","authors":"Tereza Kasaeva, Hannah Monica Dias, Farai Mavhunga, Kerri Viney","doi":"10.1136/bmj.q2598","DOIUrl":"https://doi.org/10.1136/bmj.q2598","url":null,"abstract":"Tuberculosis is a preventable and curable disease that continues to devastate the most vulnerable, including migrant and refugee communities in the shadows of global crises According to the World Health Organization’s global tuberculosis report, TB is one of the world’s deadliest infectious killers, claiming 1.25 million lives (including 161 000 deaths among people with HIV) and causing 10.8 million people to become ill in 2023.1 Refugees, migrants, and other displaced people are disproportionately vulnerable to tuberculosis, facing compounded risks such as inadequate healthcare, unsafe living conditions, and legal and social barriers.2 Only through unified and decisive action can we prevent further ill health and loss of life from TB. Globally, around a billion people—equivalent to one in every eight people—have experienced migration or forced displacement.345 Although not all refugees and migrants are vulnerable, the scale of the vulnerable population is staggering. For example, in the first half of 2024, over 120 million people had been forcibly displaced because of persecution, conflict, violence, or human rights violations and other disruptive events. This includes 46 million refugees and other people in need …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In September 2024, deaths from drug overdose in the US fell for the first time since the opioid epidemic.1 But in England and Wales, drug related deaths increased in 2023 to the highest level since 1993,2 with just under half involving an opioid.3 In England, we have seen a sharp rise in deaths involving nitazenes, a group of potent synthetic opioids. These compounds are being found in street heroin and cocaine, seized powders, counterfeit …
{"title":"Deadly nitazenes: a 2024 update","authors":"Limon K Nahar, Rebecca Andrews, Sue Paterson","doi":"10.1136/bmj.q2614","DOIUrl":"https://doi.org/10.1136/bmj.q2614","url":null,"abstract":"In September 2024, deaths from drug overdose in the US fell for the first time since the opioid epidemic.1 But in England and Wales, drug related deaths increased in 2023 to the highest level since 1993,2 with just under half involving an opioid.3 In England, we have seen a sharp rise in deaths involving nitazenes, a group of potent synthetic opioids. These compounds are being found in street heroin and cocaine, seized powders, counterfeit …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"119 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is a stark mismatch between the current wonders of medical science and the relentless erosion of humanity of care in our healthcare services. It is time to put compassion back into healthcare. What is compassion? It’s not only putting yourself in the shoes of others, but also doing something about it. It is an active concept by contrast to empathy which is just putting yourself in the shoes of others. Compassion can be taught, measured, and audited. There is compelling evidence that this is needed. The family support organisation Congenital Hyperinsulinism International (CHI) has worked with over 600 participants examining the “journeys” that families experience when their child is found to have this devastating illness which causes severe hypoglycaemia.1 If it is not recognised and treated promptly, it causes life-long brain damage. The research by CHI found that families remembered individual doctors and nurses who showed them compassion, but it was not embedded in the organisational cultures of the hospitals in which their children received care. For example, compassion was not always present …
{"title":"It’s time to put compassion back into compassionate care","authors":"Al Aynsley-Green","doi":"10.1136/bmj.q2645","DOIUrl":"https://doi.org/10.1136/bmj.q2645","url":null,"abstract":"There is a stark mismatch between the current wonders of medical science and the relentless erosion of humanity of care in our healthcare services. It is time to put compassion back into healthcare. What is compassion? It’s not only putting yourself in the shoes of others, but also doing something about it. It is an active concept by contrast to empathy which is just putting yourself in the shoes of others. Compassion can be taught, measured, and audited. There is compelling evidence that this is needed. The family support organisation Congenital Hyperinsulinism International (CHI) has worked with over 600 participants examining the “journeys” that families experience when their child is found to have this devastating illness which causes severe hypoglycaemia.1 If it is not recognised and treated promptly, it causes life-long brain damage. The research by CHI found that families remembered individual doctors and nurses who showed them compassion, but it was not embedded in the organisational cultures of the hospitals in which their children received care. For example, compassion was not always present …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alok Godse, Yincent Tse, Abosede Kokumo, Christian Harkensee
### What you need to know A 12 year old boy presented with a history of recurrent frank haematuria. He reported three or four episodes in the past three months, with each episode quickly fading after a couple of days. On detailed questioning, he revealed that, during each episode, he experienced transient mild dysuria, urinary frequency, urgency, and central abdominal discomfort. Abdominal examination revealed no tenderness, his foreskin was retractable, and no meatal inflammation or excoriation was visible. In clinic his urine looked clear yellow with no visible blood. Urine dipstick revealed 3+of blood. Visible haematuria (macroscopic) is visible bloody discoloration of urine. With easy availability of urine dipstick tests, the incidental discovery of persistent (defined as more than 6 months) non-visible haematuria (microscopic haematuria or NVH) may also occur. Visible haematuria is rare, and its incidence is unknown, whereas non-visible haematuria has been found in up to 5% of school children on mass screening in Asian schools,12 with up to 0.5% persisting three to six months later. Unlike in adults, underlying malignancy as a cause of haematuria in children is extremely rare (<0.1%).345 Although the underlying cause cannot be determined by whether the haematuria is visible or non-visible, isolated non-visible haematuria is most commonly idiopathic, whereas visible haematuria may stem from the kidney (such as IgA nephropathy or autoimmune disease) or the urinary tract (such as posterior urethritis, urinary tract stones, balanitis, or urinary tract infection46). It would, …
{"title":"Haematuria in children","authors":"Alok Godse, Yincent Tse, Abosede Kokumo, Christian Harkensee","doi":"10.1136/bmj-2022-072501","DOIUrl":"https://doi.org/10.1136/bmj-2022-072501","url":null,"abstract":"### What you need to know A 12 year old boy presented with a history of recurrent frank haematuria. He reported three or four episodes in the past three months, with each episode quickly fading after a couple of days. On detailed questioning, he revealed that, during each episode, he experienced transient mild dysuria, urinary frequency, urgency, and central abdominal discomfort. Abdominal examination revealed no tenderness, his foreskin was retractable, and no meatal inflammation or excoriation was visible. In clinic his urine looked clear yellow with no visible blood. Urine dipstick revealed 3+of blood. Visible haematuria (macroscopic) is visible bloody discoloration of urine. With easy availability of urine dipstick tests, the incidental discovery of persistent (defined as more than 6 months) non-visible haematuria (microscopic haematuria or NVH) may also occur. Visible haematuria is rare, and its incidence is unknown, whereas non-visible haematuria has been found in up to 5% of school children on mass screening in Asian schools,12 with up to 0.5% persisting three to six months later. Unlike in adults, underlying malignancy as a cause of haematuria in children is extremely rare (<0.1%).345 Although the underlying cause cannot be determined by whether the haematuria is visible or non-visible, isolated non-visible haematuria is most commonly idiopathic, whereas visible haematuria may stem from the kidney (such as IgA nephropathy or autoimmune disease) or the urinary tract (such as posterior urethritis, urinary tract stones, balanitis, or urinary tract infection46). It would, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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