Education, loss, and diagnostic acumen

BMJ 1998; 316 doi: (Published 14 March 1998) Cite this as: BMJ 1998;316:0

Education, education, and education were the three main issues in last year's British election. Governments worldwide want to encourage education and lifelong learning to achieve economic advantage. Educational level correlates strongly with length of life, and education will even protect you (a little) against Alzheimer's disease. So the more the better seems to be the message. But, as always, it's more complicated than that, and education takes a beating in this week's journal.

Alison Bolam and others have conducted a randomised controlled trial of the effect of postnatal education on infant care and family planning among Nepalese mothers (p 805). They found no effects on infant care and a small increase in the uptake of family planning. These are important negative results because a review of over 500 studies of health education in the developing world showed that only 11% included evaluation and only three were rigorous studies. Many resources may be being wasted.

A second study evaluates the effects of Heartbeat Wales, a programme of public education with supportive policy and infrastructure changes (p 818). Health behaviour did improve—but no more than in a control area. Unfortunately no confident conclusions can be drawn because the sample was too small and the control area became “contaminated” with the measures introduced in Wales. The main conclusion is that better methods are needed for evaluating health promotion programmes.

Loss may account for a quarter of consultations with general practitioners—yet loss is hardly addressed in the training of doctors. We try to set that right today by beginning a 10 part series on coping with loss (p 856). The lack of attention to loss in medical training may result from thinking that loss is irreversible and untreatable. In fact much can be done to help patients cope with loss, as this series will show.

Those who pride themselves on diagnostic acumen might begin to reflect now on two strange cases described in this week's journal. Why might a hardworking man always feel too weak to go to work on Mondays and why might a patient's iris turn from blue to green? J W Fletcher describes the first case and prides himself on diagnosing familial periodic paralysis (p 871). The change in the colour of the iris in the second case was caused by siderosis secondary to a ferrous intraocular foreign body (p 872).

Finally, two great characters are ushered out on our obituary pages (p 868). Hastings Banda, the president of Malawi, turned from an affectionate, caring, and kind general practitioner to a ruthless dictator who built more prisons than hospitals. “Reggie” Murley was a surgeon and medical politician who had strong views on everything and condemned the “gas bags” of the BMA council.

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