Editor's choice

The mysterious and the prosaic

Is medicine a mysterious activity? Of course it is, but doctors like to behave as if it isn't. They hustle, bustle, dissect, experiment, collect data, write up, catalogue, make appointments, and imagine that they are progressing towards a world that is entirely sorted. But as they do so they daily invoke the utchat, the eye of the ancient Egyptian god Horus (p 1543).

Jeff Aronson explains that the <Rx> symbol that doctors use when writing a prescription is not a shortened version of the Latin word for recipe but a corruption of the utchat. Horus had many manifestations, but originally he was Horus the Elder, the falcon headed god of the sky. He had two eyes, the sun and the moon, but Set (god of night and darkness, evil, and death) stole the sun. Aronson tells of other adventures, but the upshot was that the eye of Horus became a potent symbol of good fortune and healing and came to us via the Greeks and the Arabs. Remember this as you write prescriptions in Kentish Town, Topeka, Pune, or wherever.

Much more prosaically Brian Jarman and others have been trying to explain the wide differences in death rates in hospitals in England (p 1515). Crude death rates vary from 3.4% to 13.6% and standardised mortality ratios (with England as 100) from 53 to 137. Does that mean that if you are reading this in England and collapse with severe chest pain that you are more than twice as likely to die if taken into one hospital rather than another? It might, but, as the authors write: "Meaningful comparison of hospital death rates requires adjustment for severity of illness, length of hospital stay, age, diagnosis, and type of admission." In other words, it's tough to make comparisons, not least because many of the data are not available. The authors, however, do a good job and arrive at the interesting conclusion that an important predictor of the variation is the number of doctors per head of the population, both in hospital and general practice. More doctors means fewer deaths.

Britain has far fewer doctors per head of population than most other developed countries, yet ironically it now has 200 fully trained obstetricians facing unemployment. Medical staff planning in Britain uses the central planning beloved of Stalin and consistently gets it wrong. That's one reason why career guidance for doctors is such a mess, but it's not much better in many other countries. Recognising these failings, the BMJ three years ago started Career Focus, and today its editor, Douglas Carnall (who has done a great job), reviews the first three years (classified supplement; www.bmj.com). One message is that the range of articles has been surprisingly rich and diverse. Another is that the whole archive will soon be fully searchable on our website.

Footnotes

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