BMJ  2006;332 (7 January), doi:10.1136/bmj.332.7532.0-f

Editor's choice

Doing things differently

The beginning of a new year is a time to think about doing things differently. The first BMJ of the new year has several suggestions.

If fear of precipitating acute glaucoma has prevented you from dilating a patient's pupils before checking for diabetic retinopathy, stop worrying and get out the mydriatic eye drops. Gerald Liew and colleagues (p 3) tell us that you are twice as likely to spot retinopathy through a dilated pupil and there is very little chance of precipitating acute angle closure glaucoma, though they do say you should warn the patient to seek medical attention if symptoms develop.

If you have been following guidelines on treating chronic cough with empirical treatments for gastro-oesophageal reflux disease, stop—A B Chang and colleagues' systematic review suggests you should first check that the patient has GORD (p 11). If you have ever thought of giving clarithromycin to patients with stable coronary heart disease, don't (p 14).

And if you have ever frowned on a mother whose baby sucks a dummy or pacifier, think again. De-Kun Li and colleagues' case-control study indicates that sleeping with a dummy/pacifier cuts the risk of sudden infant death by more than 90% (p 18). The authors acknowledge the limitations of their study and that only half of eligible women agreed to take part. They don't claim that dummies prevent sudden infant death, but it's a hypothesis worth testing.

Any day now we expect the UK government to announce its plans for reforming primary care, so we have asked some thoughtful people for their vision for primary care in 2015. Most are surprisingly utopian. Despite talking of patients being "utterly bemused," Peter Lapsely (p 43) sees out of hours work being made more attractive, linkage to the "by now excellent" NHS Direct telephone and internet advice service, and patients acknowledging that they have responsibilities as well as rights. Dougal Jeffries (p 44) sees recovering morale and an end to competition: "the ruinously costly `choose and book' fiasco is a fading memory." Providers will relearn "the simple lessons of cooperation and coordination." Like others, he sees most care happening outside hospitals and lots of patients availing themselves of alternative therapies provided within the NHS. Carol Black (p 47) and Mayur Lakhani and Maureen Baker (p 41) are aspirational: strong clinical and professional leadership and medical professionalism will ensure high levels of public trust.

Alone among our visionaries, Hamish Meldrum is underwhelmed by life in 2015 (p 46): Tesco Health has taken over the failing NHS Direct; Connecting for Health finally integrates the NHS computing systems eight years late and £25bn over budget; patients have less choice because hospitals have closed and local treatment centres offer only a limited selection of treatments, and patients are charged for non-essential services including hotel care in hospital. Why is it I find Meldrum's vision the most convincing? Note to self for 2006: try to look on the bright side.

Fiona Godlee, editor

(fgodlee{at}bmj.com)


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Relevant Articles

Fundoscopy: to dilate or not to dilate?
Gerald Liew, Paul Mitchell, Jie Jin Wang, and Tien Yin Wong
BMJ 2006 332: 3. [Extract] [Full Text] [PDF]

Good general practitioners will continue to be essential
Mayur Lakhani and Maureen Baker
BMJ 2006 332: 41-43. [Full Text] [PDF]

The magic roundabout
Peter Lapsley
BMJ 2006 332: 43-44. [Full Text] [PDF]

Return of a system based on social values
Dougal Jeffries
BMJ 2006 332: 44-45. [Full Text] [PDF]

General practice under pressure
Hamish Meldrum
BMJ 2006 332: 46-47. [Full Text] [PDF]

Still striving for utopia
Carol Black
BMJ 2006 332: 47-48. [Full Text] [PDF]

Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study
De-Kun Li, Marian Willinger, Diana B Petitti, Roxana Odouli, Liyan Liu, and Howard J Hoffman
BMJ 2006 332: 18-22. [Abstract] [Full Text] [PDF]

Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux
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