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BMJ No 7116 Volume 315 Saturday 1 November 1997 This Week in BMJ | Editor's Choice | Press releases
Editorials 1105
Why some cases of retinopathy worsen when diabetic control
improves
1106
Changing incidence and mortality from cutaneous malignant
melanoma
1107
Acute excited states and sudden death
1108
Teaching medical students in general practice: respecting patients'
rights
1109
Medicine based evidence, a prerequisite for evidence based
medicine
News 1111
Secret cameras uncover parental child abuse
Papers 1117
Cutaneous malignant melanoma in Scotland: incidence, survival,
and mortality, 1979-94
1122
Effect of nutrition improvement project on morbidity from
infectious
diseases in preschool children in Vietnam: comparison with control
commune
1126
Impact of the NHS reforms on English hospital productivity: an
analysis
of the first three years
1130
Inequalities in income and long term disability in Spain: analysis
of
recent hypotheses using cross sectional study based on individual data
1136
Improving response rates among doctors: randomised trial
1137
Relation between weight and length at birth and body mass index
in
young adulthood: cohort study
1129
Correction: Risk of testicular cancer in cohort of boys with
cryptorchidism
General practice 1138
Patients' views on their discharge from follow up in outpatient
clinics: qualitative study
1142
Consent and confidentiality in teaching in general practice: survey
of
patients' views on presence of students
1141
Correction: Effects on birth weight and perinatal mortality of
maternal
dietary supplements in rural Gambia: 5 year randomised controlled trial
Clinical review
1143
Fortnightly review: A regular review of the long term follow up of
depression
1146
Lesson of the week: Delayed closure of injuries to the hand
caused by
blasts helps to preserve function
1148
ABC of palliative care: Nausea, vomiting, and intestinal
obstruction
Education and debate 1151
Confounding and indication for treatment in evaluation of drug
treatment for hypertension
1154
Women's health: Women's health is a global issue
Letters 1158
Influence of cholesterol on survival after stroke
1160
Gonorrhoea and ethnicity
1160
Improving ethnic data within surveillance must be
priority 1160
Funding of drug treatment of multiple sclerosis should not be
delayed 1161
Heterogeneity of air pollution effects is related to average
temperature
1161
Mental health assessment 1162
Aciclovir in herpes simplex gingivostomatitis
1162
Tobacco manufacturers did not orchestrate media interest in
possible
ban on tobacco sponsorship 1163
Approval of SHO posts is rarely withdrawn but is often given for
limited time
1163
Steroids should never be given until possible herpes zoster
infection
has been excluded
1163
Marfan's syndrome might have been factor in acute dissection of
aorta
in amphetamine misuser 1163
Future of international health
1164
End of life decisions
1165
Many people who disapprove of abortion nevertheless think it
should be
legal
1165
Royal Medical Benevolent Fund asks for donations for
Christmas 1165
Correction: Graded exercise in chronic fatigue
syndrome
Obituaries 1166 J Clark, T Cochrane, E N McKenzie, W L Parry-Jones
Views & reviews Soundings 1167 Public accountability
Personal view 1167
Should stroke medicine be a separate subspecialty?
Medicine and books 1169 Ante-Natal Screening and Abortion for Fetal
Abnormality Ed David Paintin
History of the Canadian Medical Association 1954-94 John S
Bennett
Minerva 1104
S2 Career Focus Classified supplement Appraising doctors and dentists in training
Editor's choicePatients' voices"I'd had chest pains for some months, Dr A treated it as indigestion, up until the heart attack that is. My heart stopped twice you know, they had to shock me." Oh dear, you think as you listen to the patient. How am I going to defend Dr A? In fact, Nick Wilson tells us in a filler (p 1121), he didn't have to. "There was no hint of anger or malice in the man's voice, but rather affection for his doctor, human and imperfect." Perhaps Dr A was better at communication than diagnosis, and perhaps that was why his patients loved him. Not all doctors do so well with communication. Yvonne Burkey and others have conducted a qualitative study of how patients who have been long term outpatients view being discharged (p 1138). About a fifth felt abandoned. Some didn't understand what was happening: "I was told that I don't need to go anymore, but not told why. Was I completely cured? Was it to cut down on their numbers, because I'm still smoking, because I'm getting old." Or: "He just said to me 'With you being so tired, rather than give you iron tablets now we'll check the blood count and see how we go from there. Okay?' And okay is a sign you can go you see ... You're sort of shoved out the door." The authors of the study conclude that patients being discharged from outpatient clinics value a clear message that they are being discharged, information about their condition and care, recognition of their views, and time to ask questions. Written information helps. None of this is surprising, but the messages seem to be often ignored. Communication is hard. Norma O'Flynn and others have been looking at the quality of consent gained from patients for medical students to be present during their consultation with general practitioners (p 1142). Between 9% and 18% had not been asked, and a still larger proportion did not think that they had a choice. Interestingly, a third disagreed with the statement "I would like to know in advance if a student might be present," while getting on for half disagreed with the statement "The student should be able to see all my medical records." The authors conclude that doctors need to give patients a real choice about whether they see a student but are unsure whether to explain to patients that students would routinely see medical records. Having discovered that many patients don't want students to see their records, the authors might find it hard to explain on live television (an acid ethical test) why they didn't think it necessary to ask them. Finally, the prize for "counterintuitive idea of the week" goes to Marshall B Kapp from Dayton, Ohio, who urges the invention of "stay ill" cards for friends with chronic diseases (p 1125). Get well cards are clearly not appropriate.
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