Editor's choice

Psychic wages

This week, unusually, we publish a study evaluating a diagnostic test. We also start a series about evaluating diagnostic procedures. On p 454 S J Andrews and colleagues show that ultrasonography combined with abdominal radiography performs just as well as intravenous urography in identifying abnormalities in men with urinary tract infections. Since this combination is safer than intravenous urography the authors recommend it as the initial investigation. In this study intravenous urography acted as the "gold standard," but as André Knottnerus and colleagues explain in their introduction to our new series, sometimes there simply isn't an independent standard against which to assess a new test (p 477). An example is conditions where symptoms are more important than anatomical status, as in prostatism.

Another study provides a perspective on diagnosis in practicethis time of coronary risk. Primary care physicians are confronted with a range of calculators to help them measure the risk of coronary disease in their patients and so help them in treatment decisions. One immediate problem identified by R J McManus et al in their comparision of these tools (p 459) is that most general practice records don't contain information on all the factors needed to calculate risk. Although they found that the British tables overall gave the most sensitive results for risk, in the absence of adequate information, doctors' and nurses' subjective evaluations were reasonable.

About half the articles in this week's issue have been contributed to by clinical academicsan endangered species in the UK. Recent figures show that up to 20% of clinical academic posts in UK universities are vacant, and even when posts are filled there has often been only one applicant (p 446). As Paul Stewart shows in his editorial, this situation is not new, but now that Britain wants to train more doctors and therefore needs academics to teach them the problem has become acute (p 437). Paul Stewart identifies money as the core of the problemboth directly in that clinical academics tend to earn less than their clinical counterparts and indirectly in the way that funding for research and teaching undermines the career structure for clinical academics. Nevertheless, he also shows how career structures are being improved and emphasises that the "psychic wages" of academic medicine are great: "the professional rewards are immense . . . academic clinicians have the luxury of a varied workload" and "the ability to control their destiny through excellence in research and education."

Other groups that suffer from recruitment and retention problems may not have that advantage. On p 440 Luke Birmingham discusses yet another report on doctors working in prisons that repeats familiar messages about difficult working conditions and lack of training and qualifications. And in Career Focus Stephan Larsson says that if Britain is serious about attracting overseas specialists to work in Britain the least it could do is pay applicants' travelling expenses (p s63; bmj.com/cgi/content/full/324/7335/s63).

Footnotes

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