Asian doctors are still being discriminated against when applying for hospital jobs, says a letter in this week's BMJ.

Five years ago Drs. Aneez Esmail and Sam Everington found that British trained doctors with Asian names were less likely to be shortlisted for posts as senior house officers. They repeated their survey in March and April 1997, sending matched pairs of applications for 50 advertised posts covering a wide range of specialties. 36% of candidates with Asian names were shortlisted, as opposed to 52% English.

The discrimination is being practised by consultants responsible for shortlists, say the authors, despite numerous public commitments by the profession's leaders and employers to deal with it. "It is an indictment of our profession that we still seem to tolerate a situation in which people's careers and livelihoods are jeopardised simply because they have the wrong name (and hence the wrong colour of skin)."

Contact:
Dr Aneez Esmail
Medical Practitioners Union

Tel: 0161 256 3015
Fax: 0161 256 1070

British doctors are less sure about practising in the UK than at any time in the past, says a paper in this week's BMJ. The authors asked doctors who qualified in 1993 whether they intended to practise in the UK, and compared their responses to those received in response to earlier surveys.

75.5% of 1993 qualifiers definitely or probably intended to practise in the UK, compared with 89.2% in 1983. The 1993 figure was lower than for any cohort previously surveyed. The large percentage who were undecided in 1993, compared with earlier cohorts, is notable, say the authors.

"Although early intentions do not invariably correspond with future careers, the doctors' responses show an increased lack of commitment to a medical career in the United Kingdom, which may be an early warning of either higher loss or higher disenchantment in the future," they conclude.

Contact:
Trevor Lambert
University of Oxford

Tel: 01865 226992/994
Fax: 01865 226993

[British doctors are not disappearing]

An accompanying editorial says that, contrary to rumour, there is no evidence that recent graduates are leaving medicine, although the reduction in applications for posts seems to indicate that some have given it up for a while. Young doctors are increasingly taking time off after graduation to travel, and many prefer to follow a flexible work pattern for the first few years.

The authors call for a regular census of all UK doctors, including their date of birth, specialty and career plans, to aid forecasting of future need.

Contact:
Prof Peter Richards
Northwick Park and St. Mark's NHS Trust

Tel: 0181 869 2020
(Thursday and Friday: 0171 290 2980/1 ask for conference office)
Fax: 0181 869 2995

Recent discoveries in genetics and new approaches to treatment may have considerable benefit in the treatment of substance abuse, says a paper in this week's BMJ.

Consumption of alcohol and other intoxicating drugs has serious public health problems relevant to a wide range of people, and recent decades have seen significant advances in their understanding and treatment. Marc Schuckit, director of the Alcohol Research Centre at the San Diego Veterans Hospital and Professor at the University of California, says that an improved understanding of genetic factors will make it possible to identify people at highest risk of substance abuse, intervene earlier, and tailor treatment to their specific needs.

New treatments for cocaine dependence may include a form of immunisation against its effects, and for alcohol problems there have recently been successful trials of acamprosate, a drug to help alcoholics remain abstinent. Although a great deal of work remains to be done on these and other new approaches, says the author, they are likely to have direct effects on the future clinical management of patients.

Contact:
Dr. Marc Schuckit
San Diego Veterans Hospital,
California
USA

Tel: 001 619 552 8585 xtn 7978
Fax: 001 619 552 7424

An out of hours visit is preferable to telephone advice, says a survey of patients in this week's BMJ.

Dr. Chris Salisbury, from Imperial College School of Medicine at St. Mary's Hospital, London, compared patients' satisfaction with out of hours care provided by a London GP cooperative and a deputising service in an overlapping area, and found that there was little difference in overall satisfaction between the two. However, a substantial majority of patients expressed dissatisfaction with some aspects of both services. Those given telephone advice and those from non-white ethnic groups were particularly likely to be dissatisfied, while white patients and those aged over 60 years were generally more satisfied.

Overall levels of patient satisfaction seem to be lower than previously reported, says the author, who calls for the involvement of consumer representatives in planning new arrangements for out of hours care, and for a more gradual introduction of changes in the delivery of care.

........while GPs prefer coops

GPs belonging to the cooperative or subscribing to the deputising service had different views from those of their patients. 92% said that they were satisfied with their arrangements for out of hours care, with cooperative members being more satisfied.

The main reasons that they chose to belong to the cooperative were the quality of care that patients received and the fact that it was run by local GPs. Many described considerable benefits to their personal and professional lives. "The provision of good quality out of hours services seems to have removed an important cause of demoralisation among general practitioners", says the author.

Contact:
Dr. Chris Salisbury

St. Mary's Hospital,
London

Tel: 0171 725 1075
Fax: 0171 706 8426

Sudden illness in flight is said to cause 1.5% of general aviation accidents worldwide. A paper in this week's BMJ reviews the findings of 1000 consecutive aviation accidents in the UK between 1956 and 1995 and found that medical or toxicological factors caused or contributed to 47 of them.

Cardiac disease in the pilot was the most common factor, say the authors, but there were also nine cases of alcohol intoxication in flight and three definite suicides. The commonest cause of incapacitation in flight not resulting in accidents is neurological disorders, and in this survey these disorders also contributed to seven deaths. The 2.4% rate of alcohol intoxication in private pilots is comparable with that reported elsewhere, say the authors.

Contact:
Dr. S.A. Cullen
RAF Department of Health and Medical Training

Tel: 01296 696023
Fax: 01296 623535 xtn 7691

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