Inside Stories

Polythenia gravis: the downside of evidence based medicine

BMJ 1995; 311 doi: (Published 23 December 1995) Cite this as: BMJ 1995;311:1666
  1. Down End Research Group
  1. Correspondence should not be addressed

    The impetus for this case report and study protocol was the admission to hospital of a senior physician with a fractured neck of femur. On the night of the accident the patient had got up to pass water and slipped on a pile of journals still in their plastic wrappers which were lying on the floor beside his bed. The history revealed gradually increasing nocturia compatible with age related benign prostatic hyperplasia. On direct questioning he admitted that he had recently performed a bone densitometry measurement on himself and found a slight reduction of bone density compatible with a male menopause some 10 years earlier. He also admitted that he felt an increasing sense of guilt and inadequacy associated with an inability to keep up with the journals. On the DEWLAP index 1 he scored moderately high for his age. His JASPA score (see table 2 was 5, consistent with a mound of journals kept by the bed, avalanching both under the bed and across the room. The oldest journal in the pile was nearly five years old, and the JOCA (journal cumulative age) index (total number of journals mutiplied by the age of each one) was in excess of 100.

    View this table:
    Table 1

    DEWLAP (deteriorating work levels in aging physicians)index

    View this table:
    Table 2

    JASPA (journal associated score of personal angst) score

    The patient made an uneventful recovery after surgery and returned to clinical duties in three months despite being in moderate continuous pain and receiving regular analgesia; his walking distance was only 30 yards. Follow up at this time by the orthopaedic consultant briefly recorded an “excellent result,” and the patient was discharged from clinic. Paradoxically there was a significant improvement in his DEWLAP score, perhaps because he was …

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