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EDITOR'S CHOICE: Fiona Godlee Cure or care? BMJ 2005; 331: 0-f [Full text]

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Trials for trialling

Neville W Goodman   (9 December 2005)

blurring of distinctions

Angshu Bhowmik   (12 December 2005)

Trials for trialling 9 December 2005
Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB Send response to journal: Re: Trials for trialling	As someone once said, 'There ain't a noun that can't be verbed.' I dislike the verb trial, but it's here to stay. Try is obviously wrong; it's too casual. There is a rule about doubling consonants: the consonant doubles if there is only one syllable; and it doubles if the last syllable of a word of two or more syllables is stressed. Thus omit becomes omitted but vomit becomes vomited. However, rules exist to be broken. Focus should be focused, but focussed is more common; benefitted seems more common than benefited. And l is a special case, doubling in British English (but not in American English) even if the last syllable is unstressed. So if we want to stress the English origin of our drug trials then we should be trialling them. Competing interests: None declared
blurring of distinctions 12 December 2005
Angshu Bhowmik, Consultant Physician Homerton University Hospital, E9 6SR Send response to journal: Re: blurring of distinctions	The raising of standards of nursing so as to make nurses become so much more than "just doctors' servants" is to be warmly welcomed. It is unfortunate that many doctors feel threatened by nurses' widening ranges of activity and increasing powers. In my opinion, we should encourage nurses to take on wider roles but also not forget and encourage them to remember that "nursing care" is also an essential part of those wider roles. If the distinctions between nurses and doctors become blurred, it will not be because of nurses taking on certain additional roles. Even after the considerable training and experience that senior nurses will have accumulated, their knowledge and outlook will still not be the same as that of doctors who have undertaken systematic and comprehensive studies of anatomy, physiology, pathology and pharmacology and the relationships between these disciplines. It is this study which differentiates doctors from nurses - not merely a "license to prescribe". Many doctors are condemning the decision to allow nurses to prescribe after a mere few weeks of training. Such training cannot be a substitute for the study and experience that doctors have to go through, they argue. Ironically, it is this very study which is being gradually phased out of medical school. New medical students are being taught that communication skills, empathy and safety are more important than a knowledge of anatomy and physiology. Junior doctors will no longer have to gain wide experience of diagnosis and treatment, but merely have to complete the required number of DOPS forms (the list of procedures required of the 1st year foundation trainee is so short as to leave me quite worried, by the way) and mini-CEXs in order to be deemed competent. Is this very different from nurses' "cannulation certificates"? It is the unwitting deterioration of standards of medical education that we should be be trying to avoid in order not to allow the distinction between doctors and nurses to be blurred. Perhaps it is those who consciously or subconsciously recognise the problems with medical training who are the most concerned that nurses will tread onto the "doctors' turf" - not because nurses are being given too much power, but because doctors' training is gradually coming to resemble that of nurses. Competing interests: None declared