Good medicine

The BMJ just got an unusual review. “Boy, is that a scary publication,” said Sandi Toksvig, “I read one article about the risks of oesophageal cancer from drinking tea in northern Iran. That’s very specific indeed. I’ve decided I’m not drinking tea there again.” Ms Toksvig, comedian, writer, and presenter, isn’t a regular BMJ reader but had mugged up before compering the first ever BMJ Group awards night, held in London last week. Ten awards were presented to celebrate excellence in medicine and health care, ranging from Research Paper of the Year to Lifetime Achievement award (doi:10.1136/bmj.b1428). Judith Longstaff Mackay, senior adviser to the World Lung Foundation, won the lifetime award for her many years of effective campaigning for tobacco control in Asia and beyond. Everyday work on the clinical front line was recognised too, with many of the awards going to NHS staff throughout the United Kingdom for practising good medicine, ensuring high quality care, and showing great leadership.

There’s a lot of good medicine in the BMJ this week. Although Sandi might be even more alarmed by the reminder that one in 10 acute admissions to hospital in the UK is accompanied by an adverse event, she could be reassured by the clear advice to junior doctors on how to minimise the effect on patients (doi:10.1136/bmj.b1046). When an adverse event occurs, the competent novice doesn’t panic: he or she protects the patient from further harm, tries to reverse any damage, calls for senior help, thinks about family and staff members’ needs, and—very importantly—explains and apologises to the patient as soon as possible.

And there’s the new Rational Testing series, on the best use of diagnostic tests in the initial workup of common or important clinical presentations. The BMJ has developed this series with two experts from Hull: Stephen Atkin, professor of academic endocrinology, and Eric Kilpatrick, honorary professor of biochemistry. This week Fabian Hammer and Paul M Stewart describe a young man who went to his general practitioner with a six month history of mild but progressive headache and was found to have a blood pressure of 178/108 mm Hg (doi:10.1136/bmj.b1043). He was otherwise well, but his hypertensive father had died from a stroke in his 40s. Which tests would you do?

This series complements our Rational Imaging series, which includes 24 articles so far. The most recent is Chirag Patel and colleagues’ article on what to do when neck imaging—in their case done to stage a bronchial tumour—incidentally reveals a thyroid nodule (BMJ 2009;338:b611, doi:10.1136/bmj.b611). We would be pleased to consider contributions of up to 1000 words for both series. Each article needs a short case history, the practical details and pros and cons of two or three initial key tests or imaging techniques, and the case outcome (http://resources.bmj.com/bmj/authors/types-of-article/practice). And, when these articles are based on genuine cases, we will need the patient’s consent to publication using the BMJ’s form, which is now available in 14 languages (http://group.bmj.com/products/journals/patient-consent-forms).