Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Best friend as support at consultations
- Michael Patkin (18 May 2007)
-
One's own room
- Phillip J Colquitt (18 May 2007)
-
Real patient care
- Stephen MW Hutchison (18 May 2007)
-
Prof
- Christopher M Buttery (19 May 2007)
-
This issue is dedicated to early cancer detection
- Celine M Aranjo (19 May 2007)
-
Getting it right - timely assessment and treatment
- Derek Bell (19 May 2007)
-
Communication, communication, communication
- elizabeth m witherington (19 May 2007)
-
Availability comes first in primary care
- Gösta E Eliasson (19 May 2007)
-
Health Education
- Eluzai .A. Hakim (19 May 2007)
-
its the teamwork, stupid
- David I Ben-Tovim (20 May 2007)
-
Just ask if they smoke...
- Chris Del Mar (20 May 2007)
-
'Full presence' and compassionate intention
- Leila Kozak, PhD (20 May 2007)
-
Patients as participants in their care
- Peter M Lapsley (21 May 2007)
-
ICE, ICE, Baby......
- John A Spencer (21 May 2007)
-
An ostrich of an initiative
- GRAHAM WATT (21 May 2007)
-
CBT for depression
- Tony Kendrick, Jeannette Lynch (21 May 2007)
-
Professor C.A.B.Clemetson's Legacy
- Michael D Innis (21 May 2007)
-
Most important? Heathy living.
- Bill Cayley (21 May 2007)
-
ICE is nice, but needs to be ICES
- Joanne M Shaw (22 May 2007)
-
Look at the bigger picture. Look beyond the consulting room
- M Justin S Zaman (22 May 2007)
-
Availability
- anthony clift (22 May 2007)
-
carer's response
- Anne M Chatterley (22 May 2007)
-
Emphasize the positive
- W. Bruce Thompson (22 May 2007)
-
Focus on COPD disease management
- Erik W.M.A. Bischoff (23 May 2007)
-
Effective Communication
- Theo Schofield (23 May 2007)
-
Integrated ICT for patients and health professionals
- Tom Fahey (23 May 2007)
-
Providing information for patients: some considerations.
- Elizaveta Naumova, Professor Yury Shvarts (25 May 2007)
-
Look at why we have a problem
- Glenn Stewart (25 May 2007)
-
A fair and rapid asylum process
- Jean P Fisher (25 May 2007)
-
The metacontext needs everyone's attention.
- Steven Ford (25 May 2007)
-
Opportunistic advice
- Janet Boaler (25 May 2007)
-
consultation skills
- Elizabeth A McClure (25 May 2007)
-
The whole person
- Katherine H Checkland (25 May 2007)
-
Screening for gallstones. Saving lives and budgets.
- David Flook, Rochdale Road, Oldham, OL1 2JH (25 May 2007)
-
Addiction
- Steven A. Burr (25 May 2007)
-
Studies needed on older patients with multimorbidity: take the challenge!
- Els Licht (25 May 2007)
-
Making a difference
- Jonathan R Benger (26 May 2007)
-
IN DRIVER'S SEAT
- PRANAV KUMAR (27 May 2007)
-
Alcohol history
- Trevor G Stammers, Twickenham, TW1 4SX (28 May 2007)
-
Your Health Depends On You
- Hugh Mann (29 May 2007)
-
Holistic care at the end of life
- Wendy-Jane Walton, Shrewsbury SY2 6DL (30 May 2007)
-
End of life care in the elderly
- Alex Williamson (31 May 2007)
-
Listen
- James Hickman (31 May 2007)
-
Motivational interviewing
- Adrian H Sie (31 May 2007)
-
health care is much more than just medical care
- Melissa K Raven (31 May 2007)
-
Families
- Simon Fountain-Polley (31 May 2007)
-
Liverpool Care of the Dying Pathway
- Philip R Williams (31 May 2007)
-
Trust, Sincerity of Purpose
- Dindukurthi Sudhakar (31 May 2007)
-
Respect and communication
- Alison J Melvin (31 May 2007)
-
The Final Frontier
- Colin J Greaves (31 May 2007)
-
Occupational Health in the Consultation
- Antony S Willman (31 May 2007)
-
Poverty and diseases are overwhelmingly connected.
- Dr. Naseem A. Qureshi (31 May 2007)
-
Listen and touch
- Pedro Solberg (31 May 2007)
-
too many tests/investigations
- Vaidyanathan Gowri (31 May 2007)
-
Diagnostic errors and patient care.
- Giuseppe Lippi (31 May 2007)
-
reflection
- Joaquin Averbach (31 May 2007)
-
Solid foundations
- Brian P McNicholl (31 May 2007)
-
Better care
- Moahmed Salim Merchant (1 June 2007)
-
Talk about reproductive health
- Douwe A A Verkuyl (1 June 2007)
-
Better quality of life and appropriate treatments
- Roberto G Romanelli (1 June 2007)
-
voting for sexual health interventions
- Gerda Pohl (1 June 2007)
-
Re: Health Education
- Peter J Mansfield (1 June 2007)
-
Community based team care for the elderly
- Barry J. Goldlist (1 June 2007)
-
Helping patients follow self-administered treatments
- R Brian Haynes (1 June 2007)
-
Integrate outside the clinic
- Christopher J Burns-Cox (1 June 2007)
-
Dignity of the Patient
- Satyendra K Tyagi (1 June 2007)
-
The importance of diagnosing the transition of "living with" to "dying from"
- Clive E Bowman (1 June 2007)
-
Time, understanding and reassurance
- John A Evers (1 June 2007)
-
The patient as a resource
- William G Kernohan (1 June 2007)
-
Making a difference
- helene a brandon (1 June 2007)
-
The Cardiovascular Center of Excellence
- William H Bestermann Jr (1 June 2007)
-
Motivating Self Care and Change in Patients
- Pamela J. Lockwood (1 June 2007)
-
Recognition of neurodevelopmental disorders
- Richard J Purvis (1 June 2007)
-
Caring for somatising patients.
- Sani Abdel- Aziz Hlais (1 June 2007)
-
Build Patient Self-Care Capability
- James E. Schlosser (1 June 2007)
-
Medical basics, tobacco cessation, healthy diet, exercise, good insurance.
- Stephan D Thome (1 June 2007)
-
Re: Emphasize the positive
- B Shah (1 June 2007)
-
Patient empowerment and corporate responsibility translates to good health
- Paul R O Nyatigi (1 June 2007)
-
Stop smoking!!
- ANDREA PELUCCHI (1 June 2007)
-
Check Check and Check
- Dr Jayaraman Nambiar (1 June 2007)
-
Prevention is the thing
- ADOLFO PRECIADO SOLÍS (1 June 2007)
-
Register of adverse events
- Manuel Praena (1 June 2007)
-
Educate, advice, motivate your patient
- Prof. Enrique J. Sánchez-Delgado, M.D. (1 June 2007)
-
Pain, a problem neglected.
- William G Notcutt (1 June 2007)
-
Quality and culture
- Aureo Muzzi (1 June 2007)
-
standardization of care
- Matthew Garber (1 June 2007)
-
I wish I knew!
- Andrew N Crowther (1 June 2007)
-
Vaccination
- Inge Axelsson (1 June 2007)
-
Care and be bothered
- Ashis Banerjee (1 June 2007)
-
Targeting Overweight in Children
- Mukesh Kapoor (1 June 2007)
-
More time for Patient - Doctor Interaction!!
- Himanshu Kataria (1 June 2007)
-
Adequate time for communication
- Fotios Drakopanagiotakis (1 June 2007)
-
Promote Breastfeeding
- Prakash Manikoth (1 June 2007)
-
Youth Mental Health - An overdue opportunity to improve public health
- Patrick D. McGorry (1 June 2007)
-
Lets all work together
- Elizabeth Cottrell (1 June 2007)
-
Prevent iatrogenic infection and make procedures safe
- James D Newton (1 June 2007)
-
An ill for every pill
- Luca Mascitelli (1 June 2007)
-
Doctors' practice should be changed first
- Aung Maug (1 June 2007)
-
Think about prevention
- carolyn V Brown (1 June 2007)
-
Time - Yours, is of the essence.
- Robert O. Cannon, MD, MPH (1 June 2007)
-
Exercise!
- Stan Baltsezak (1 June 2007)
-
Jobs, Jobs, Jobs
- David Brookman (1 June 2007)
-
Health Education is the best approach
- Mohy K El Masry (1 June 2007)
-
Adverse Drug Reactions: A public health problem but nobody’s job
- Susan E Jordan (1 June 2007)
-
Physical Activity & Exercise: A service for National Health
- Mark E Batt (1 June 2007)
-
Saving the patient's backside (and your own)
- John Kennelly (1 June 2007)
-
Systems and Culture
- Rob Z Torok (1 June 2007)
-
Behavioral change is the most effective intervention
- Brian Stello (1 June 2007)
-
Patient Held Records
- Rupert Gude (1 June 2007)
-
Life beyond illness
- Rebecca Scott (1 June 2007)
-
Making a difference: now it is self improvement and techniques’ turn to explore as new health care interventions.
- Syed Abdul Mujeeb (1 June 2007)
-
Health education
- Sawsan Talib Jamal (1 June 2007)
-
Consent
- R Mohindra (2 June 2007)
-
Re: Physical Activity & Exercise: A service for National Health
- Robert D Southward (2 June 2007)
-
co ordinating with business houses
- katpadi varadarajan arulalan (2 June 2007)
-
Connect to communicate
- Woody Caan (2 June 2007)
-
suggestions
- Alessandro Calderan (2 June 2007)
-
Professional Competence, Communication skills, Follow up,easy availiblity to patient.
- Dr Rajender Singh Chauhan (2 June 2007)
-
Diet and Exercise
- Maura Murphy (2 June 2007)
-
Childhood pulmonary diseases in developing economies
- Cristan Q Cabanilla (2 June 2007)
-
Re: Integrated ICT for patients and health professionals
- Mithun Barik (2 June 2007)
-
Computers are our friends!
- Kate E. Koplan (2 June 2007)
-
Proper communication with the patient
- Chandra Sekhar Devulapalli (2 June 2007)
-
Save Your Life
- ARIE EISENMAN (2 June 2007)
-
Dont smoke use sunscreen
- Abduljabar A. Theyab (2 June 2007)
-
Nutritional Support
- Tarik Z. Nursal (2 June 2007)
-
Take care & listen.
- David D Jones, 1 Dunluce Ave Belfast BT9 7HR (3 June 2007)
-
prevention is better than cure
- Ruchika S. Nagori (3 June 2007)
-
Always listen to the patient
- Armando A. Calvo (3 June 2007)
-
Improving Medical Care
- Phillip Periman (3 June 2007)
-
'I can't hear what you're saying because your actions are SHOUTING so loudly.'
- Anwar A. Chahal (3 June 2007)
-
Transparency
- Fernando S Cavalcanti (3 June 2007)
-
MDGs!
- Dr. Naseem A. Qureshi (3 June 2007)
-
Cut Waiting Times
- Edward P GIBLIN, 12 St Neots Rd,Sandy. Beds. SG19 1LB (3 June 2007)
-
Better utilisation of technology and preventive services
- Rajat Bhatt (3 June 2007)
-
children's health
- vivek v gharpure (3 June 2007)
-
Factors affecting mortality in leptospirosis
- Dr. Jitendra V. Dave, Dr(Mrs)V.M.Bhagat, Dr R.D.Patel, and Dr Mayur Jarag (3 June 2007)
-
Primary Prevention Elementary sir!!!
- dr mohan devegowda (4 June 2007)
-
Making a difference
- benedict mccaffrey (4 June 2007)
-
Improving patient care.
- Carlos A Scarampi (4 June 2007)
-
standardisation, categorisation of practice & intensive value based education of healthcare providers
- Dr.Pramod Madhukar Kulkarni (4 June 2007)
-
More talk and less pills
- Anuruddha M Abeygunasekera (4 June 2007)
-
100 words for BMJ
- Ettore Guidi (4 June 2007)
-
Increasing the health of the nation
- David Jenkins (4 June 2007)
-
Avoiding unnecessary tests and treatments
- Soledad Marquez-Calderon (4 June 2007)
-
Making a difference
- Roger H Jones (4 June 2007)
-
Quality and safety in clinical care
- Graham Neale (4 June 2007)
-
Empathy not sympathy
- MANJEESTHA DAS (4 June 2007)
-
Integrated system improves patient care
- Sung Hyuk Choi (4 June 2007)
-
Education on medical error is essential
- Glenn W Mitchell (4 June 2007)
-
Accident prevention
- James M Hynson (4 June 2007)
-
Effective treatment
- Leslie G Scarth (4 June 2007)
-
the new approach to the patent
- Dan Botezatu (4 June 2007)
-
Life registry for continuous support
- José I Valenzuela (4 June 2007)
-
Organising hospital-infection preventing policies
- Razi Riyadh Hati (5 June 2007)
-
first, do no harm
- David J Biau (5 June 2007)
-
Making the biggest difference
- Brian R Budenholzer (5 June 2007)
-
Don't forget biopsychosocial model!
- Dr. Naseem A. Qureshi (5 June 2007)
-
Baby and the bath water
- Kim Botly (6 June 2007)
-
Educating decision makers before educating patients
- Augusto Pimazoni, Rua Borges Lagoa 908 - Apt. 123 - Sao Paulo, SP - zip 04038-002 - (6 June 2007)
-
Antenatal Care Makes a Difference
- George D. Carson (6 June 2007)
-
Continuity of Care
- Stephen C Harper (6 June 2007)
-
Bury "Think Dirty"
- Michael D Innis (6 June 2007)
-
Establish objectively best treatment for the patient in front of you
- J. Deinum (6 June 2007)
-
Interaction of different factors
- Benedetto Mangiavillano (7 June 2007)
-
Public Health
- Anthony J Morkane (7 June 2007)
-
Honesty is the best health policy
- Graham Kyle (7 June 2007)
-
Patient centered care
- Keugoung Basile (7 June 2007)
-
The role of doctors in patients' education: What can medical education do?
- Samy A. Azer (7 June 2007)
-
Evaluate delegation
- S. Michael Crawford (7 June 2007)
-
...........when doctors and patients meet one to one.......
- Dr Bimal K Agrawal (7 June 2007)
-
Palliative and end-of-life care for all: according to need not diagnosis
- Scott A Murray (8 June 2007)
-
Re: improving the health care in our developing countries
- soulaiman elias soulaiman (8 June 2007)
-
Endotheliology in Primary Care Practice
- A. O'tayo Lalude (8 June 2007)
-
Do not treat the X-Ray, treat the patient
- Kandiah Senthilnatha (8 June 2007)
-
Satisfaction with anaesthesia care – from the patients’ point of view
- Thomas Heidegger (8 June 2007)
-
Real Care plus Knowledge
- Lucianoi Tarantino (8 June 2007)
-
use the internet during consultations
- dominic j stevens (8 June 2007)
-
A humane attitude toward patients
- Takuya Watanabe (8 June 2007)
-
leave us alone?
- mark r stacey (8 June 2007)
-
Universal Health Care, Free for All
- Richard L Nelson (8 June 2007)
-
Offering choice in rehab after MI
- Hasnain M Dalal (9 June 2007)
-
Two Ways to Health
- Jan Pitha (9 June 2007)
-
Who’s going to play doctor?
- Saskia Holtslag, and Peter E Westerweel, MD; University Medical Center Utrecht, the Netherlands (9 June 2007)
-
Detection of smoking-related disease
- Finn Edler von Eyben (9 June 2007)
-
The integrated system improve patient care
- Sung Hyuk Choi (9 June 2007)
-
Changing the health trajectory of new lives
- Alan A Woodall (10 June 2007)
-
Keep it simple in Teaching the Patient
- Patricia J Peterson (12 June 2007)
-
Behavior Change
- Larry A. Green (12 June 2007)
-
What's your poison?
- Ken Checinski, Ferhal Utku (13 June 2007)
-
The origin of the word 'doctor' is to teach
- George Peat (14 June 2007)
-
A proper approach.
- Aldo Riani (14 June 2007)
-
Hypertension is the most important problem for my patients
- Frank Bender (18 June 2007)
-
Empathy and communication are priorities for your patient
- Stefano Bellentani, Stefano Bellentani, M.D., PhD (21 June 2007)
-
Clinical Practice Evidence Based and Patient Centered
- Wanderley Marques Bernardo (25 June 2007)
-
My patient and his diabetes
- Mohamad Said M. Takrouri (2 July 2007)
|
|
|||
|
Michael Patkin, retired general surgeon Royal Adelaide Hospital, South Australia 5000
Send response to journal:
|
The most simple measure to improve consultations is for the patient to have a best friend with them, to help remember the questions and the answers and to reinforce recommended treatment later on. This best friend might be spouse or other close relation, neighbour, or simply good friend. During the 1980s patients who saw me as a country general surgeon for gastric bypass surgery had the same best friend with them for each of several consultations, with them while they walked 45 minutes briskly each day before surgery, and with them to reinforce the dietary advice to get them slightly lighter and fitter. Competing interests: None declared |
|||
|
|
|||
|
Phillip J Colquitt, Technician/RN Independent Comment
Send response to journal:
|
Patients should have their own room. Hospital dormitories exude a reform school atmosphere, grading the patient as unworthy of privacy, and maximising access to the patient in favour of hospital workers in training. Drawn curtains don’t eliminate sounds and smells. It’s hard to take breakfast next to another’s toilet. Single rooms would eliminate the constant bed moves within a ward and also complaints based on mixing the patients. With constant mass observation eliminated, the predictive power of medical treatment would be tested. I daren't mention a view. Competing interests: None declared |
|||
|
|
|||
|
Stephen MW Hutchison, Consultant Physician in Palliative Medicine Highland Hospice, Inverness, IV3 5SB
Send response to journal:
|
This is a subject I think and teach a lot about, and I can best summarise my main point by quoting Dr Francis Peabody, in the mid 1920s, who concluded a seminal lecture on patient care by saying "The secret of the care of the patient is in caring for the patient". We need to learn to really care, in our hearts, for people. A briefer summary could be 'Love your patient'. If we really care in that way, we will communicate thoughtfully, and investigate and treat compasionately. Some people will be hard to love, and that takes more work! Patients expect technical expertise but it is the attitude, which they notice and which conveys either care, or carelessness. Peabody, Francis W The care of the patient JAMA 1927; 88: 877-92 Competing interests: None declared |
|||
|
|
|||
|
Christopher M Buttery, Clinical Professor Virginia Commnwealth University, USA, 23298
Send response to journal:
|
Stop talking about health care when you mean medical treatment. To improve population health focus primary care on preventing chronic disease. Focus all members of a household/family on behaviors inimical to health. The chronic diseases are driven by a combination of genetics and behaviors. We have failed to guide adolescents to select future spouses based on genes so primary care must educate potential partners to strengthen behaviors most likely to result in good health. Medical interventions only prolong disease and rarely return patients to health. Medical schools must provide better training in epidemiology and medical strategy, not tactics (medical care).
Competing interests: None declared |
|||
|
|
|||
|
Celine M Aranjo, General Practitioner New South Wales, 2208, Australia
Send response to journal:
|
Since the above is so, I'd just like to say that 'cancer' as understood by many, is not a disease entity like 'the 'flu', or SARS,or HIV/Aids. 'Cancer' when considered to be a combination of diseases and disorders, could give the true concept of the word 'cancer';this in turn, should lead us to investigate the probable diseases and disorders and try to treat these BEFORE the cancer diagnosis is evident. For example, the 10 facts about cancer as put by the WHO states that chronic conditions as in chronic infections,(e.g.chronic bilharziasis,chronic lymphatic filariasis,neurocysticercosis..)are eventual causes of cancer:- uro-genital and colo-rectal...in the former,lymphoma either NHL or HL in the filarial infections,echinococcosis in the third infection, the list goes on..and when treatment is started as soon as possible for these infections,world-wide, perhaps many 'cancers' will be eliminated before they start. Competing interests: None declared |
|||
|
|
|||
|
Derek Bell, Porfessor of Acute Medicine SW10 9NH
Send response to journal:
|
Individually all clinicians aim for the highest quality of care. However, in practice, especially in acute care outcomes for patients vary by post code, hospital environment and by time of day or week. To improve this we must develop a greater understanding of why this occurs and hence remedy the problem. Publications and critical incidents often show flawed process as significant factors in poor outcomes. What can we do differently for patients? A greater emphasis on competent first assessments including a good history combined with assessment of patient need (illness severity, dependence or patient wishes) is likely to improve outcomes. We often minimise the importance of this by looking for technological solutions and we assess these core competencies poorly and at best intermittently.Often assuming these are 'easy skills'. We need to develop better systems to train and monitor patient care assessment linked to provide prompt treatment(not when convenient for the NHS) and thus move towards abolishing post code or weekday/weekend lotteries. Competing interests: None declared |
|||
|
|
|||
|
elizabeth m witherington, clinical assistant nottingham university hospitals
Send response to journal:
|
What our patients really, really want is to know that when they are bloody ill (learning how to recognise this diagnosis needs to be reintegrated into undergraduate curricula), they will receive a decent standard of care at a hospital reasonably near their home. The single most important thing that we can do to improve patient care is to learn how to communicate medical information when we entrust our patients to another doctor. We may have delivered the highest standard of care ourselves, but unless we tell the next doctor how we have meddled with medication, we contribute to risk and potential harm. Increased fragmentation of care has led to fragmentation of thinking. The most vulnerable patients (BMJ 2007;334:1016-1017, doi:10.1136/bmj.39201.463819.2C Multimorbidity's many challenges) are at greatest risk from our failure to communicate properly at transfers of care. Safe transfers of care require information about -how ill the patient is now -how ill they have been during the most recent episode -what has changed, diagnostically -what has changed, therapeutically, and why -what monitoring is required for each of these changes, when it is required, and who is required to do it This is not a new subject, and it is not sexy, but if we communicate properly it could reduce a lot of misery, reduce risks and possibly save lives. Competing interests: topic editor, transfers of care, www.saferhealthcare.org.uk |
|||
|
|
|||
|
Gösta E Eliasson, GP Falkenberg SE-311 37 Sweden
Send response to journal:
|
Today medical care is complicated and there are many investigations done at the primary health care centre. This means allocation of resources. GPs can do many things. The question is what is most important. Patients are mostly satisfied with their care, given that they have came inside the walls of a health care centre. But to be able to see a GP becomes more and more difficult. Walk in centres and NHS direct could be a substitute, but the personal relation will suffer from these organisational fixes. Real quality improvement would be to make availability to a personal GP priority number one in health care. All other tasks should be subordered this. Competing interests: None declared |
|||
|
|
|||
|
Eluzai .A. Hakim, Consultant Physician St.Mary's Hospital,Newport, Isle of Wight,UK,PO30 5TG
Send response to journal:
|
Properly carried out,Health Education empowers the patient with information about risk factors for commom conditions.Conditions directly related to Alcohol consumption,Cigarette and recreational drug smoking, Obesity and Road traffic accidents, for example, continue to increase in our emergency Departments placing enormous strain on Health Resources. These problems may be dealt with cost effectively through appropriate strategies to educate the public and patients to minimise exposure to these factors and hence reduce morbidity, mortality and improve quality of life.Many obese patients do know that judicious exercise reduces cardiovascular risk and obesity, choosing instead to visit a Doctor for a prescription!Education is to date the most powerful weapon on our hands in Healthcare which must be distinguished from treatment.There are more people who need Healthcare than treatment.I have encountered heavy cigarette smokers who resisted outpatient clinic advice against smoking by saying,"Don't patronise me;I have smoked all my life and Iam well" More structured educational material would help in this situation. Competing interests: None declared |
|||
|
|
|||
|
David I Ben-Tovim, director, Redesigning Care and Clinical Edipemiology Units flinders Medical Centre, Bedford Park, South Australia 5042
Send response to journal:
|
The most important thing is to believe that it is true. That being admitted as a patient in a modern hospital is second only to cardiovascular disease as a source of preventable mortality and morbidity: And that this is so world wide, and that nothing that we have done so far has changed that risk. If we really, truly believed in the evidence (which of course we do not, not really) we would agree that trying to do what we do now, but doing it a bit better is not going to be enough. In fact, it is that kind of thinking that is the problem. It assumes that our basic approach is fine, we just need to work a bit harder at it. If around one in ten patients leave hospital with a patient safety event, the problem goes much deeper than any top five, ten or twenty interventions can fix. From the patient viewpoint, care in hospital or primary care is a process made up from a sequence of activities from registration through to specific treatment and exit. We have to get the right step, to the right patient, at the right time, at the right place, and get it right first time, at every point along the journey. Biomedical thinking is not about how care is actually delivered. It is about what should be delivered at a restricted number of steps. But no one ever got better from a should, only from an is. We have to learn from people who understand about improving processes and who really care about quality (in places like modern manufacturing and service industries), and understand that we are members of a team, and that its the teamwork, stupid, that will make the difference. Competing interests: None declared |
|||
|
|
|||
|
Chris Del Mar, Dean Bond University, Queensland 4229
Send response to journal:
|
There’s indirect[1] and direct[2] evidence that the NNT (treat here meaning provide anti-smoking advice) for smokers is about 10 - 17 to prevent a death from smoking-related disease. It will be much lower for smoking-related morbidity. That’s a pretty good hit-rate — and since smokers are about 30% of our general practice population, case-finding is not difficult. We have to overcome the problem is that this is undetectable in practice, unlike many clinical activities for which success provides immediate positive feedback to the clinician. Hence the need for proxy measures for primary care to target. 1 Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ 1994;309:901-910. 2 Rose G, Colwell L. Randomised controlled trial of anti-smoking advice: final (20 year) results. J Epidemiol Community Health 1992;46:75- 7. Chris Del Mar Dean, Health Sciences and Medicine, Bond University, Gold Coast Australia 4229. Competing interests: None declared |
|||
|
|
|||
|
Leila Kozak, PhD, Investigator/Senior Project Manager University of Washington, School of Medicine, Seattle, WA 98109, USA
Send response to journal:
|
I agree with Dr. Hutchinson’s statement (“Real patient care”). As he says, “we need to learn to really care, in our hearts, for people.” To accomplish this ‘real patient care’ we need to train providers beyond communication skills – we need to train them in the practice of being “fully present” and attuned with their compassionate intention. This quality of presence that the provider may bring to the interaction and the conscious projecting of a compassionate intention can make a huge difference not only on patients but in the quality of life of providers. This sense of presence and intention also has the power to transcend cultural/language barriers. Competing interests: None declared |
|||
|
|
|||
|
Peter M Lapsley, Patient editor BMJ, BMA House, Tavistock Square, London WC1H 9JR
Send response to journal:
|
Like many patients, I wish to be an active partner in my healthcare, collaborating with clinicians to achieve acceptable outcomes. That can be thwarted by doctors’ slavish adherence to evidence-based guidelines and protocols, and by poor explanation of risks and benefits. The rigid requirements of evidence-based medicine deter doctors from taking account of patients’ lifestyles and, thus, of the quality of patients’ lives. A recent survey by the Royal College of Physicians Patient & Carer Network found that risk-benefit communication was taught in only a minority of specialties. If patients’ needs are to be met, both those things must change. Competing interests: I am the BMJ's patient editor |
|||
|
|
|||
|
John A Spencer, GP & Professor of Medical Education Newcastle University (NE2 4HH) & Adelaide Medical Centre, Newcastle (NE4 8BE)
Send response to journal:
|
If GPs (nay, all doctors) consistently and systematically elicited their patients' ideas, concerns and expectations (ICE), the effect on patient satisfaction, diagnostic accuracy, inappropriate help-seeking behaviour, quality of care of, for example, long term conditions and functional illness, and concordance (to name a few outcomes), and possibly even on job satisfaction, could be momentous. Competing interests: None declared |
|||
|
|
|||
|
GRAHAM WATT, PROFESSOR OF GENERAL PRACTICE UNIVERSITY OF GLASGOW G12 9LX
Send response to journal:
|
This initiative is important but addresses only half of the problem - identifying the most effective interventions in primary care. To improve public health, we need to consider not only what is effective for individuals, but also how many people are eligible for the intervention. What needs to be compared is the product - just as supermarkets make mega- profits based on small margins for large volumes of sale, primary care improves population health by doing simple things for and with large numbers of people. The inverse care law is alive and well, 36 years after its initial formulation, as the availabilty of good medical care continues to vary inversely with the need for it in the population served. It is not so much a "law" as the result of the policy, maintained throughout the history of the NHS, of rationing medical manpower in primary care - in the war-time sense of everyone having equal access to a general practitioner. Thus general practitiioners, and resources tied to the numbers of GPs, are distributed equitably in terms of population numbers, but inequitably in relation to population health need. In England, this situation is getting worse rather than better. All this boils down to less time in the consultation for patients with higher levels of need - an endemic situation which can only be resolved by professionals and patients adapting to lower levels of expectation and aspiration. Such practices are further behind in the transition from reactive to anticipatory care. When the most effective interventions have been identified and ranked, we shall still be no further on in addressing why such interventions are less likely to be delivered in deprived areas. As Tudor Hart also said, "intellectual opposition to injustice is only the beginning of social understanding". We need fewer ostriches, and more owls, who are not only wise, but can see the whole picture. Graham Watt
Competing interests: None declared |
|||
|
|
|||
|
Tony Kendrick, Professor of Primary Medical care University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST., Jeannette Lynch
Send response to journal:
|
Depression is one of the greatest burdens facing all health economies, over and above the considerable personal costs[1]. Total economic costs are estimated to exceed £25 billion per year (2% of GDP)[2] largely due to the loss of 91 million working days[3]. The incidence seems to be increasing[4] and with it the use of antidepressant drugs: prescriptions rose by 36% between 2000 and 2005 to 7.3 million items per quarter, the 4th most expensive area of prescribing[5]. Many patients do not wish to take antidepressants however and the risk-benefit ratio is not as favourable as psychological therapy. Guidelines recommend CBT based treatments as appropriate alternatives[6], but despite this, access to such treatments remains limited[7] and should be increased as a matter of urgency. 1.World Health Organisation E. Mental health: facing the challenges, building solutions. 2005. 2.Layard R. Mental health: Britain's biggest social problem? RL414c, 1-33. 2004. 3.Layard R. The case for psychological treatment centres. RL447 (2nd update), 1-10. 2006. 4.Mental Health Foundation. Statistics on Mental Health - fact sheet. 2003. 5.Prescriptions Pricing Authority. Drugs used in Mental Health. 2005. 6.Depression: management of depression in primary and secondary care. 1- 328. 2005. National Istitute for Clinical Excellence, National Clinical Practice Guidelines. 7.Lovell, K. Richards, D. 2000. Multiple Access Points and Levels of Entry (MAPLE): Ensuring Choice, Accessibility and Equity for CBT Services. Behavioral and Cognitive Psychotherapy, 28, 379-391. Competing interests: None declared |
|||
|
|
|||
|
Michael D Innis, Director Medisets International Home 4575
Send response to journal:
|
Dr. Clemetson : "To reduce the risk of Barlow's disease,(misdiagnosed as SBS) we should consider the following: (1) Postponing inoculations for infants who are premature or ailing in any way, even with an upper respiratory infection; (2) reconsidering the wisdom of giving as many as six inoculants, all at once, to infants at eight weeks of age; (3) administering 500 mg of vitamin C powder or crystals, in fruit juice, to infants before inoculation; and (4) giving additional ascorbic acid by injection to any infant showing a severe reaction such as convulsions or a high-pitched cry." http://en.wikipedia.org/wiki/C._Alan_B._Clemetson Competing interests: None declared |
|||
|
|
|||
|
Bill Cayley, Assistant Professor, UW Health Augusta Family Medicine, University of Wisconsin 207 W Lincoln, Augusta, WI 54722 USA
Send response to journal:
|
Healthy lifestyles are the foundation of healthy lives. Several previous responses wrestle with the tension between medical treatment (with interventions, drugs, etc) and education for healthy living (exercise, smoking, etc). In the individual doctor-patient encounter, both have a place. However, the area that we need far more clinically applicable research and improvement in practice is understanding how to both assess patients' life-style risk factors, and understanding how to motivate for health-ful change in three basic areas: eating, exercise and smoking. The more we can focus on healthy living, the more we will prevent help prevent disease in the long-term, and the more we will implicitly convey to our patients that we view health as more than just pills and technology. Bill Cayley, MD bcayley@yahoo.com Competing interests: None declared |
|||
|
|
|||
|
Joanne M Shaw, Vice-Chairman, NHS Direct 207 Old Street, London, EC1V 9PS
Send response to journal:
|
I fully support Dr Spencer's contention that clinicians should follow the ICE framework. Decisions made by doctors are better when informed by patients’ Ideas, Concerns and Expectations. But treatment decisions should not be made by doctors alone - patients are also decision-makers. For example, it is the patient who decides whether, when and how to take the medicine once prescribed. And as we all know, around 50% of medicines for long term conditions are NOT taken as prescribed. Shared agreement is needed for patients to buy into and follow treatment decisions. ICE is nice but needs to become: Ideas, Concerns, Expectations and Shared decision. Which is why training doctors in shared decision-making with patients, along with the use of ICE, would make such a difference to personal health. Competing interests: None declared |
|||
|
|
|||
|
M Justin S Zaman, Research Fellow in Epidemiology/Specialist Registrar in Cardiology University College London WC1E 6BT
Send response to journal:
|
A nutrition transition has occurred amongst populations in high- income nations [and soon lower-income ones...] in which not only is energy intake per person higher but also a higher proportion of that energy is derived from added sugars and fat. (1) The obesity epidemic is comparable to the tobacco epidemic. (2) Evidence that increased tobacco consumption results from trade liberalisation (3) and global marketing (4) are potentially applicable to the obesity epidemic. Health behaviours are not “lifestyle” variables, governed largely by individual choice and therefore a matter of individual responsibility, but are socially patterned and reinforced in groups. To create an environment in which individual behavioural initiatives can succeed, major shifts in population behaviour through public health policy are necessary. Reference List (1) Drewnowski A. Fat and Sugar: An Economic Analysis. J Nutr 2003; 133(3):838S-8840. (2) Chopra M, Darnton-Hill I. Tobacco and obesity epidemics: not so different after all? BMJ 2004; 328(7455):1558-1560. (3) Bettcher D SCGE. Confronting the tobacco epidemic in an era of trade liberalization. Commission on Macroeconomics and Health, editor. WG4:8. 2001. Geneva, World Health Organization. Ref Type: Report (4) Collin J. Think global, smoke local: transnational tobacco companies and cognitive globalisation. In: Kelley L, editor. Health impacts of globalisation: towards global governance. New York: Palgrave, Macmillan, 2006: 61-86. Competing interests: None declared |
|||
|
|
|||
|
anthony clift, College Medical Adviser M24 4DZ
Send response to journal:
|
100 words BMJ General Pactice has suffered from being proactive (campaigns for immunisation, birth control, smoking cessation etc) rather than reactive to patents needs. This has led to inordinate work loads, destroying access to the GP just when its needed . Stop all remunerated targets, which seem to have dominated practice as they are major income producer. Rely on doctors to give appropriate advice when seen. GPs are becoming inaccessible, especially out of hours and visits, but many callouts are a chance to educate the patient in use of the NHS. Make small charge for all GP consultations, with appropriate relief for the elderly and chronic sick. Competing interests: None declared |
|||
|
|
|||
|
Anne M Chatterley, carer parent's home HP23 4AF
Send response to journal:
|
Doctors need to talk to each other especially when sharing the care of a patient or transfering the care to another department/hospital. It is frustrating to have tests repeated because the 'new' team cannot access the previous results or accessing them takes too long, is too difficult or, as I heard twice recently, the new team prefer to do their own tests as they know the staff who carry out/process those tests (this suggests they do not trust other colleagues work which does not fill the patient with confidence if they return to the care of that team). What you tell patients needs to reflect the fact you are aware of what your colleagues have said, this is not to say you have to agree with what they said, just be aware and if necessary explain why your conclusions differ. Competing interests: None declared |
|||
|
|
|||
|
W. Bruce Thompson, GP 28 Church Walk, Lurgan, N.Ireland. BT67 9AA
Send response to journal:
|
For many years NHS patients have had great incentive to maximise their illness behaviour. The introduction of the Disability Living Allowance (DLA) provided a paycheque for the professional patient, whilst increased waiting lists neccesitated exaggerating symptoms to get priority treatment (or any treatment at all). Getting better costs the patient money. The reduction of waiting times will allow timely intervention to those who need medical help and weed out the malingerer. Why not stop DLA payments and use these funds to encourage wellness not illness behaviour - free leisure centres, parks, cycle paths, school games facilities - the list is endless. Competing interests: None declared |
|||
|
|
|||
|
Erik W.M.A. Bischoff, GP trainee and PhD student Department of General Practice, HAG 117, Radboud University Nijmegen, The Netherlands
Send response to journal:
|
COPD prevalence and COPD-related mortality and morbidity have increased enormously during the last decades and caused an expanding burden on health care systems worldwide. International guideline committees have pronounced their concerns about the further increase in COPD prevalence. The major part of COPD-related costs can be attributed to the increase of exacerbations, which have a significant impact on patients’ health status. In my opinion, health care professionals and researchers should focus on how to improve health care or disease management for patients with COPD. How can we help patients to prevent and to react efficient on exacerbations? How can we improve the use of medication among COPD patients? How can we help them to change their lifestyle (e.g. stop smoking, exercise programme)? Although more and better research on this topic is needed, there has to be also a willingnes | |||