This Week in BMJ
BMJ No 7048 Volume 313
Saturday 6 July 1996
The vegetative state has been widely debated since the declaration in 1993 that tube feeding could be withdrawn from Tony Bland, who remained vegetative after the Hillsborough football ground disaster. Since then several other similar declarations have been made. The diagnosis of the vegetative state depends on the clinical assessment that there is no meaningful response to the environment. On the basis of experience on their specialist vegetative state rehabilitation unit, Andrews et al describe their findings that 42% of patients referred to them as being vegetative were aware of the environment and could communicate using either eye pointing or a touch sensitive switch controlling a buzzer (p 13). Although some patients remained cognitively impaired, others were able to make decisions about their daily activities. The authors emphasise the limitations of diagnosing the vegetative state by clinicians on busy general wards and argue that diagnosis requires the skills of a multidisciplinary team experienced in long term disability management of severely disabled people.
Primary schoolchildren commonly report being the victim of bullying. As bullying can cause substantial grief for its victims and may cause long term harm it is a problem that is worth identifying so appropriate action can be taken. On p 17 Williams et al analyse the results of a population based semistructured interview conducted by school nurses in Newham, east London. They show a strong association between reporting of headaches, tummy aches, feeling sad, bed wetting, and not sleeping well with being the victim of bullying. Although the study could not establish a causal association, the authors recommend that health professionals ask primary schoolchildren who present with these symptoms whether they are being bullied.
It would be extraordinary good fortune if the career inclinations of medical students and the pedagogic influence of their teachers combined to give the country precisely the proportion of doctors it needs in each specialty. Without trusting to serendipity, it is important to know about doctors' career preferences. On p 19 Lambert et al report the career choices expressed by the 1993 qualifiers from medical schools in the United Kingdom a year after qualification. Compared with the 1983 qualifiers, there was a large shift away from general practice and some significant changes in choices within hospital practice. There were also striking differences between men and women in their choice of careers. The number of women wanting to be general practitioners was double that of men. Few women wanted to be surgeons. The percentage of doctors who wanted a career outside medicine altogether, though small, has increased over the past 10 years.
Depression, anxiety, and other so called neurotic disorders are among the most common chronic conditions in primary care. On p 26 Lloyd, et al report evidence of increased mortality and considerable psychiatric and physical morbidity among patients identified 11 years previously as having a neurotic disorder. The group as a whole had a high rate of consultation with general practitioners. Initial severity of neurotic disorder was associated with long term outcome and use of service independently of age, sex, and physical illness. Almost all subjects were undertreated.