One fear about universal healthcare systems that seem to be “free” is that they encourage less affluent patients to see doctors more often. A Canadian study refutes this. It found that most people use little health care and high cost users are a small group of very ill people drawn from all neighbourhoods and all income groups. Interestingly, low income earners used doctors' services less often than expected, despite their poorer health status (CMAJ 2004;170: 209-14).

Black humour is how some people make sense of the clinical experiences they'd rather forget. Here's an exercise designed by one woman after her first mammogram. “Open your fridge door and insert one breast between the door and the main box. Have one of your strongest friends slam the door shut and lean on the door for good measure. Hold that position for five seconds (while holding your breath). Repeat again in case first time was not effective enough.”

The most life saving opportunity frequently missed by clinicians is hand hygiene. We all know the evidence, but practice in real life remains unacceptably low. According to an article in the Mayo Clinic Proceedings (2004;79:109-16), the answer is to use alcohol-based hand rub instead of soap and water. It's quicker, less …