BMJ 1999;319 ( 23 October )

Editor's choice

The everyday

What's the commonest cause of a limp in a child? A stone in the shoe, taught one famous professorreminding us all that most of medicine is everyday and unglamorous. What's the commonest cause of deafness? After reading the article on recent advances in otolaryngology (p 1110) you might answer "not wearing a hearing aid." About a third of Britons have a significant hearing loss by the age of retirement, and half of those could be helped with a hearing aid. Yet less than half of those who could benefit wear an aid. They may be stopped by vanity or by the aid sometimes making the problem worse not better. Aurelia Richards and Michael Gleeson describe some new devices that are coming through.

One of the commonest health problems is elderly people in residential homes with chronic disease that is slowly destroying their quality of life. Unfortunately, argue the authors of two articles, health care tends to focus on acute problems at the expense of managing and preventing exacerbations of chronic illness. One set of authors proposes responding to the problems of those in residential homes by creating a new partnership among general practitioners, geriatricians, and social support staff (p 1119). Gerry Bennett proposes instead that multidisciplinary teams based on geriatric units could pick up the challenge (p 1122), but he worries that geriatricians have lost interest in chronically frail elderly people. True geriatrics, he thinks, might be rediscovered in residential homes.

How often do BMJ readers put their fingers into patients' mouths? Not often enough, suggest Ritu Gupta and Michael Perry (p 1113). They describe three patients who had little to see on oral examination but who had tumours that could be palpated. The lesson is to perform a digital examination of the mouth in patients with symptoms suggestive of oropharyngeal disease even if appearances are normal.

A paper and an editorial discuss how everyday drugsantidepressantsmay have the everyday side effect of upper gastrointestinal bleeding (p 1081 and 1106). Although antidepressants are not associated in most doctors' minds with this side effect, the data are convincing. Two additional editorials examine another kind of poisoning, that from carbon monoxide (p 1082 and 1083). The peak season is beginning in the Northern hemisphere as people crank up their unsafe heating systems.

Finally, Mary Black discusses that most everyday problem of dealing with tricky women (p 1114). She discusses how "an irrepressible patient," who wanted a home birth, challenged her training and professional standing, and ultimately changed her practice. The story has a twist that will repay careful reading to the end.

Footnotes

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Relevant Articles

Antidepressants and upper gastrointestinal bleeding

Alain Li Wan Po
BMJ 1999 319: 1081-1082. [Extract] [Full Text] [PDF]

Carbon monoxide poisoning

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BMJ 1999 319: 1082-1083. [Extract] [Full Text] [PDF]

Hyperbaric oxygen in carbon monoxide poisoning

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Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study

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Recent advances: Otolaryngology

Aurelia Richards and Michael Gleeson
BMJ 1999 319: 1110-1113. [Extract] [Full Text] [PDF]

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P Victoria Spencer
bmj.com, 3 Nov 1999 [Full text]