Editor's Choice | This Week in BMJ | Press releases
BMJ No 7113 Volume 315 Press Releases Saturday 11 October 1997 Embargoed: 00.01 hrs 10 October 1997 UK time Punishing doctors won't improve services Punishing doctors won't improve services(Every system is perfectly designed to get the results it gets)In this week's BMJ, highlighting the case study of a cardiothoracic surgeon from Bristol, who will go before the General Medical Council next week for 'unacceptably poor results', O'Connor calls for the need for a comprehensive approach to providing a quality health service. He concludes that a punitive approach to quality may be occasionally necessary to protect public safety but 'big sticks' alone are not enough to improve our healthcare and that doctors need to examine and improve the whole system within which they work. See Editorial (O'Connor) p 897
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Professor of Medicine and Community and Family
Medicine Center for the Evaluative Clinical Sciences,
tel: 001 603 650 1680
Losing weight can help your heart(Effect of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study)Obese people in danger of heart attack find that this risk is reduced when they lose weight, says a report by Karason et al in this week's BMJ. In the study, obese patients were found to have higher blood pressure and structural heart abnormalities (that were not found in non-obese counterparts) which could lead to heart disease or even death. But there is good news, as patients can take action to help themselves! The report concludes that to prevent or improve abnormalities in their heart, obese people should concentrate on reducing their weight, just as much as regulating their blood pressure. See Paper (Karason et al) p 912
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tel: 00 46 31 603 759 or 00 46 31 601 000
Could more medical students train in the community?(Can students learn clinical method in general practice? A randomised crossover trial based on objective structured clinical examinations)There is currently a move in health teaching for medical students to undertake more community based education, but until now there has been little research undertaken to assess how effective this really is. In this week's BMJ, Murray et al consider the skills acquired by first year students during two halves of a 10 week teaching block in general internal medicine, half taught in general practice and half taught in hospital. The results showed that students can attain clinical skills at least as well in general practice as in hospital. The authors conclude that there is valid evidence to show that student learning could partially be redistributed from traditional locations to the community and that there is a need for further research to assess which specific skills, knowledge and attitudes are best acquired in each location. See Paper (Murray et al) p 920
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Professor of Primary Care,
tel: 0171 288 3247 Reducing the health bill in France through compulsory guidelines(Preliminary evaluation of an attempt to merge mandatory practice guidelines and cost containment in France)In the five years up to 1996, expenditure on healthcare in France increased at an average yearly rate of four to five per cent and by 1996, it amounted to about 10 per cent of the gross domestic product. In a report in this week's BMJ, Durand-Zaleski et al assess the latest of a number of cost containment programmes introduced to tackle the problem. The system, launched in 1994, combines mandatory practice guidelines on procedures and drug prescribing with a system of fines up to '2,000 for doctors who do not comply. So far 186 doctors have been investigated and 75 have been fined. Durand-Zaleski et al found that the rate of increase of expenditure on medical services has decreased since the system was introduced, but there is concern that there has been a shift in expenditure from outpatient to inpatient services, as hospitals are not covered by the guidelines. See Education and debate (Durand-Zaleski) p 943
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Assistant professor,
tel: 00 33 1 4981 3674
In a linked editorial in this week's BMJ, Dixon considers the implications of the mandatory practice guidelines for the UK. The author notes that the impact on health of the French procedure has not yet been evaluated and that such a system is likely to be extremely expensive.
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Kings' Fund Policy Institute,
tel: 0171 307 2547 or 2812 Cancer, murder or lightning - clear talking about risk(Risk language and dialects)The presentation of risks to life, such as the probability of death from cancer, murder, road accident or lightning, has never been standardised, certainly not in any form of everyday language. In a paper in this week's BMJ, Calman (the Chief Medical Officer) and Royston propose scales which provide the basis of a common language for describing a wide range of risks. The authors suggest that their proposed risk scales now need to be tested to see if and how they improve people's ability to understand and communicate risks. See Education and debate (Calman, Royston) p 939
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Head of operational research,
tel: 0113 254 5576 Embargo: 00.01 hrs Friday 10 October 1997 Please contact Public Affairs Division for the text of the paper & the authors for further comment For further information, please contact:
Jill Shepherd on 0171 383 6529
or telephone (8.30am -
6.00pm): 0171 383 6254 Or fax requests to Public Affairs Division, BMA on 0171 383 6403. If you currently receive your British Medical Journal press release by mail and you would like it faxed to you please telephone (0)171 383 6123, Fax: (0)171 554 6123 or E-mail: LRiviere@mail.bma.org.uk When dialling the UK from abroad, remember to delete the first zero from the local area code, eg, (00 44) 171... BMA on Internet page: http://www.bma.org.uk If you intend to use any article publicised in this press release, ensure you quote the British Medical Journal as source
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