Dawn P Richards challenges some of the common objections to patient engagement in research I have been in a lot of spaces over the years where people were not convinced about patient engagement in research. They often feel that they already have enough to do, or that this is “yet another” hoop that funding agencies are requiring them to jump through. I am writing this for you. I am not entirely sure that I will change your mind, but hopefully I can get you to think about some of your objections and why patient engagement in research is generally a good thing. ### Patients are vulnerable in most systems Firstly, I would ask you to consider that patients are pretty much at the bottom of the pecking order in most situations or settings. In healthcare, they are beholden to healthcare providers and are obliged to behave like a “good patient.”` A good patient asks questions gently or strategically (or not at all!), avoids being too “difficult,” and does not challenge the professionals. Never mind that patients live 24/7 with their chronic condition or the health consequences of an acute illness, and that they manage as best …
{"title":"Dear sceptics of patient engagement in research","authors":"Dawn P Richards","doi":"10.1136/bmj.r133","DOIUrl":"https://doi.org/10.1136/bmj.r133","url":null,"abstract":"Dawn P Richards challenges some of the common objections to patient engagement in research I have been in a lot of spaces over the years where people were not convinced about patient engagement in research. They often feel that they already have enough to do, or that this is “yet another” hoop that funding agencies are requiring them to jump through. I am writing this for you. I am not entirely sure that I will change your mind, but hopefully I can get you to think about some of your objections and why patient engagement in research is generally a good thing. ### Patients are vulnerable in most systems Firstly, I would ask you to consider that patients are pretty much at the bottom of the pecking order in most situations or settings. In healthcare, they are beholden to healthcare providers and are obliged to behave like a “good patient.”` A good patient asks questions gently or strategically (or not at all!), avoids being too “difficult,” and does not challenge the professionals. Never mind that patients live 24/7 with their chronic condition or the health consequences of an acute illness, and that they manage as best …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992235","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 this paper by Dell-Kuster and colleagues ( BMJ 2020;370:m2917, doi:10.1136/bmj.m2917, published 25 August 2020), the author name …
{"title":"Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r117","DOIUrl":"https://doi.org/10.1136/bmj.r117","url":null,"abstract":"In this paper by Dell-Kuster and colleagues ( BMJ 2020;370:m2917, doi:10.1136/bmj.m2917, published 25 August 2020), the author name …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992237","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}
Eric was born in Dundee, first son to William and Annie Mackay and one of eight children. He was brought up in the city, attending Morgan Academy. At the tail end of the second world war Eric trained to “tattie rogue”—finding potatoes that are diseased—progressing to work as a potato inspector. He then studied medicine at St Andrews, where he found he preferred the practical side, becoming a sharp diagnostician. He was a member of the Christian Union and through its international links he met Leonard Van Valen, …
{"title":"Eric John Mackay","authors":"Catherine Meikle","doi":"10.1136/bmj.r90","DOIUrl":"https://doi.org/10.1136/bmj.r90","url":null,"abstract":"Eric was born in Dundee, first son to William and Annie Mackay and one of eight children. He was brought up in the city, attending Morgan Academy. At the tail end of the second world war Eric trained to “tattie rogue”—finding potatoes that are diseased—progressing to work as a potato inspector. He then studied medicine at St Andrews, where he found he preferred the practical side, becoming a sharp diagnostician. He was a member of the Christian Union and through its international links he met Leonard Van Valen, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992232","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}
Sanath graduated in 1997 and obtained a diploma in orthopaedics in 1999 from Manipal Academy of Higher Education, Mangaluru, India. He trained and worked at St John’s Medical College, Bangaluru, from 1999 until 2003. He married his classmate, Usha Rao, in May 2000 and they came to the UK in 2003. Sanath did further training in orthopaedics and …
{"title":"Sanath Kumar Shetty","authors":"Ravish Shetty, Nikhil Kaushik","doi":"10.1136/bmj.r97","DOIUrl":"https://doi.org/10.1136/bmj.r97","url":null,"abstract":"Sanath graduated in 1997 and obtained a diploma in orthopaedics in 1999 from Manipal Academy of Higher Education, Mangaluru, India. He trained and worked at St John’s Medical College, Bangaluru, from 1999 until 2003. He married his classmate, Usha Rao, in May 2000 and they came to the UK in 2003. Sanath did further training in orthopaedics and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992233","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}
The rise of anti-DEI legislation and rhetoric threatens representation in the medical workforce and patient outcomes, says Naeema Hopkins-Kotb I still remember receiving my first letter from Harvard Medical School—and no, it wasn’t an acceptance letter. I was a student in the thick of pre-med requirements, trying to decide on the next institution I would trust with my dream of becoming a doctor. The letter was from Harvard’s Office of Recruitment and Multicultural Affairs, with information to help students like me, who are under-represented in medicine, apply to medical school. I revisited the list of medical schools I was applying to and added Harvard. Initiatives like this one, which are aimed at promoting diversity, equity, and inclusion (DEI), made it clear that I am needed and belong in medicine as a black woman. Today, DEI is under attack—and the effects of anti-DEI rhetoric and legislation on medicine will further marginalise black women, both seeking and providing healthcare, for years to come. In June 2023, the US Supreme Court ruled that race can no longer be a factor that influences students’ admission to university, effectively ending affirmative action..1 …
{"title":"What black women in medicine stand to lose in the US’s war on diversity, equity, and inclusion","authors":"Naeema Hopkins-Kotb","doi":"10.1136/bmj.r134","DOIUrl":"https://doi.org/10.1136/bmj.r134","url":null,"abstract":"The rise of anti-DEI legislation and rhetoric threatens representation in the medical workforce and patient outcomes, says Naeema Hopkins-Kotb I still remember receiving my first letter from Harvard Medical School—and no, it wasn’t an acceptance letter. I was a student in the thick of pre-med requirements, trying to decide on the next institution I would trust with my dream of becoming a doctor. The letter was from Harvard’s Office of Recruitment and Multicultural Affairs, with information to help students like me, who are under-represented in medicine, apply to medical school. I revisited the list of medical schools I was applying to and added Harvard. Initiatives like this one, which are aimed at promoting diversity, equity, and inclusion (DEI), made it clear that I am needed and belong in medicine as a black woman. Today, DEI is under attack—and the effects of anti-DEI rhetoric and legislation on medicine will further marginalise black women, both seeking and providing healthcare, for years to come. In June 2023, the US Supreme Court ruled that race can no longer be a factor that influences students’ admission to university, effectively ending affirmative action..1 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992231","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}
It is right to highlight that NHS staff felt the “strain and trauma” of caring for patients with covid-19.1 Although the risks of this viral infection have lessened, it is still a hazard for healthcare workers and their patients. Recent advice from the Joint Committee on Vaccination and Immunisation (JCVI)2 does not make provision for healthcare workers in forthcoming rounds of covid-19 vaccination. This …
{"title":"Healthcare workers should get covid-19 vaccinations","authors":"Raymond M Agius","doi":"10.1136/bmj.r89","DOIUrl":"https://doi.org/10.1136/bmj.r89","url":null,"abstract":"It is right to highlight that NHS staff felt the “strain and trauma” of caring for patients with covid-19.1 Although the risks of this viral infection have lessened, it is still a hazard for healthcare workers and their patients. Recent advice from the Joint Committee on Vaccination and Immunisation (JCVI)2 does not make provision for healthcare workers in forthcoming rounds of covid-19 vaccination. This …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992236","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}
Boytchev and colleagues investigate the fossil fuel industry’s influence on medical research.1 We deeply appreciated The BMJ ’s bold decision in 2020 to ban advertising and research funded by companies producing fossil fuels—a ban now being extended to other BMJ Group journals.23 This principled action sets an important precedent for medical …
{"title":"Fossil fuel industry funding undermines the integrity of scientific findings","authors":"Giovanni Ghirga, Paolo Ghirga","doi":"10.1136/bmj.r107","DOIUrl":"https://doi.org/10.1136/bmj.r107","url":null,"abstract":"Boytchev and colleagues investigate the fossil fuel industry’s influence on medical research.1 We deeply appreciated The BMJ ’s bold decision in 2020 to ban advertising and research funded by companies producing fossil fuels—a ban now being extended to other BMJ Group journals.23 This principled action sets an important precedent for medical …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992238","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 December it emerged that the medical apprenticeship programme had been paused—a move that has implications for the institutions spearheading courses and for the future of medical education more broadly, Erin Dean hears For the past 18 months staff at Plymouth University’s Peninsula Medical School have been working hard to develop a medical apprenticeship programme, an alternative route into medicine beyond the current medical degree course.1 In partnership with NHS employers, the university came up with a radical four year programme that would allow apprentices to work and study mainly where they lived. The programme was aimed at graduates already in healthcare who hadn’t previously had the opportunity to become doctors, says Laura Bowater, head of the medical school (box 1). But late last year, just as the team was about to seek the first cohort of apprentices to start this September, they were told by the government to pause recruitment.2 Box 1 ### What are medical apprenticeships? Medical apprenticeships (also called medical doctor degree apprenticeships or NHS doctor apprenticeships) aimed to open an alternative route into medicine beyond the current medical degree course. “The main difference between the apprenticeship and a traditional medical degree is that apprentices will work in healthcare from the beginning of their degree while also studying the academic subjects of a medical degree,” Elizabeth Hughes, medical director for undergraduate medicine at NHS England, told The BMJ last year. The Department for Education said in a blog published in February 2024, “People who complete the medical doctor degree apprenticeship will have the same academic qualifications as those who complete their degree through medical school.”8 The apprenticeships would be delivered through a relationship between the apprentice, the employer, and the medical school, said Hughes. Apprentices would earn a salary as they trained, and they wouldn’t have to pay tuition fees.RETURN TO TEXT “We …
{"title":"Medical apprenticeships: what next now that the scheme has been paused?","authors":"Erin Dean","doi":"10.1136/bmj.r128","DOIUrl":"https://doi.org/10.1136/bmj.r128","url":null,"abstract":"In December it emerged that the medical apprenticeship programme had been paused—a move that has implications for the institutions spearheading courses and for the future of medical education more broadly, Erin Dean hears For the past 18 months staff at Plymouth University’s Peninsula Medical School have been working hard to develop a medical apprenticeship programme, an alternative route into medicine beyond the current medical degree course.1 In partnership with NHS employers, the university came up with a radical four year programme that would allow apprentices to work and study mainly where they lived. The programme was aimed at graduates already in healthcare who hadn’t previously had the opportunity to become doctors, says Laura Bowater, head of the medical school (box 1). But late last year, just as the team was about to seek the first cohort of apprentices to start this September, they were told by the government to pause recruitment.2 Box 1 ### What are medical apprenticeships? Medical apprenticeships (also called medical doctor degree apprenticeships or NHS doctor apprenticeships) aimed to open an alternative route into medicine beyond the current medical degree course. “The main difference between the apprenticeship and a traditional medical degree is that apprentices will work in healthcare from the beginning of their degree while also studying the academic subjects of a medical degree,” Elizabeth Hughes, medical director for undergraduate medicine at NHS England, told The BMJ last year. The Department for Education said in a blog published in February 2024, “People who complete the medical doctor degree apprenticeship will have the same academic qualifications as those who complete their degree through medical school.”8 The apprenticeships would be delivered through a relationship between the apprentice, the employer, and the medical school, said Hughes. Apprentices would earn a salary as they trained, and they wouldn’t have to pay tuition fees.RETURN TO TEXT “We …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992245","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}
Increasing numbers of doctors are struggling at work, while the support available to them is at risk. Emma Wilkinson investigates When Anne Noble, a GP in Sheffield, contacted NHS Practitioner Health she was feeling hopeless and couldn’t see a way out. Working as a partner in a deprived area for 10 years had taken its toll. Every consultation was complex and emotionally challenging. She was experiencing moral injury (box 1) and feeling overwhelmed at how little she could help. Box 1 ### Moral distress and moral injury The BMA defines moral distress as “where institutional and resource constraints create a sense of unease among doctors from being conflicted about the quality of care they can give.”12 Moral injury, the union says, can arise where sustained moral distress leads to impaired function or longer term psychological harm. Moral injury can produce profound guilt, shame, and in some cases a sense of betrayal, anger, and profound “moral disorientation.” It’s also been linked to severe mental health problems.RETURN TO TEXT That phone call with NHS Practitioner Health—a free, confidential NHS primary care mental health and addiction service for doctors—gave her the external validation she needed to take a break. She was signed off sick for a month. “I do feel massively lucky we have that as a resource, because there was that unique recognition of what was happening for me,” says Noble. She hadn’t felt able to speak to her own GP about it, she wasn’t interested in taking medicines, and although NHS counselling was an option, she knew that cognitive behavioural therapy wasn’t the answer either. The most recent General Medical Council (GMC) annual report into doctors’ workplace experiences, which drew on data and research from 2023, found that almost a quarter of doctors (23%) had taken a leave of absence in the past year owing to stress.1 One in …
{"title":"Trapped and overburdened—what can be done for doctors facing burnout?","authors":"Emma Wilkinson","doi":"10.1136/bmj.q2858","DOIUrl":"https://doi.org/10.1136/bmj.q2858","url":null,"abstract":"Increasing numbers of doctors are struggling at work, while the support available to them is at risk. Emma Wilkinson investigates When Anne Noble, a GP in Sheffield, contacted NHS Practitioner Health she was feeling hopeless and couldn’t see a way out. Working as a partner in a deprived area for 10 years had taken its toll. Every consultation was complex and emotionally challenging. She was experiencing moral injury (box 1) and feeling overwhelmed at how little she could help. Box 1 ### Moral distress and moral injury The BMA defines moral distress as “where institutional and resource constraints create a sense of unease among doctors from being conflicted about the quality of care they can give.”12 Moral injury, the union says, can arise where sustained moral distress leads to impaired function or longer term psychological harm. Moral injury can produce profound guilt, shame, and in some cases a sense of betrayal, anger, and profound “moral disorientation.” It’s also been linked to severe mental health problems.RETURN TO TEXT That phone call with NHS Practitioner Health—a free, confidential NHS primary care mental health and addiction service for doctors—gave her the external validation she needed to take a break. She was signed off sick for a month. “I do feel massively lucky we have that as a resource, because there was that unique recognition of what was happening for me,” says Noble. She hadn’t felt able to speak to her own GP about it, she wasn’t interested in taking medicines, and although NHS counselling was an option, she knew that cognitive behavioural therapy wasn’t the answer either. The most recent General Medical Council (GMC) annual report into doctors’ workplace experiences, which drew on data and research from 2023, found that almost a quarter of doctors (23%) had taken a leave of absence in the past year owing to stress.1 One in …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991572","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}
When I started in general practice we’d already made the switch to an electronic patient record. We still pulled the paper notes before each surgery—even though the chances of finding a relevant previous entry and being able to read the handwriting were slim—and laboratory results arrived on slips of paper to be stuck in the notes. These were soon replaced by electronic messages, which arrived more quickly and were less likely to be lost. The last element to go paperless was prescribing: even seven years ago I was still signing stacks of paper prescriptions, ready to be collected by the patient or the pharmacy. Although we can still …
{"title":"Helen Salisbury: Electronic prescribing in hospitals is well overdue","authors":"Helen Salisbury","doi":"10.1136/bmj.r122","DOIUrl":"https://doi.org/10.1136/bmj.r122","url":null,"abstract":"When I started in general practice we’d already made the switch to an electronic patient record. We still pulled the paper notes before each surgery—even though the chances of finding a relevant previous entry and being able to read the handwriting were slim—and laboratory results arrived on slips of paper to be stuck in the notes. These were soon replaced by electronic messages, which arrived more quickly and were less likely to be lost. The last element to go paperless was prescribing: even seven years ago I was still signing stacks of paper prescriptions, ready to be collected by the patient or the pharmacy. Although we can still …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991565","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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