A theme issue for medics and an increasingly health informed public
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7371.984 (Published 02 November 2002) Cite this as: BMJ 2002;325:984
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I enjoyed the contribution from Dr Fisken. He remains a member of
the BMA but disociates himself from the Journal. Strangely, I prefer the
opposite arrangement.
Competing interests:
Unashamedly politically correct.
Competing interests: No competing interests
How will the BMJ look like in 2013 being a consumer-responsive
scholarly journal? At the very least, each article on the web should have
a patient friendly, journalistic summary attached. The BMJ already
produces press releases (which serve a similar function), so why not
adding this "lay abstract" to each article. Having the author to draft
such a lay abstract may be a useful exercise for them to think about what
their research means in lay terms.
Secondly, clinically relevant articles published in the BMJ should
facilitate shared decision making by also providing an attachment
containing "Questions you should ask your doctor", in order to facilitate
a discussion between patient and health professional to determine whether
this article contains information that is relevant for their condition.
This checklist can be downloaded and brought into the consultation, and it
also contains references for the doctor to the original article in the BMJ
and links to further information for the health professional. Thus,
patients will be catalysts for bringing - literally - evidence into the
practice.
Thirdly, as patients will be able to access their electronic health record
on the web (much as they access their bank account online today), and
(obviously) personalzed links to articles relevant for them will be
dynamically and automatically generated. The health professional can also
issue a "information prescription", adding further links to patient
education material and articles on the web.
Fourth, the BMJ website also will allow and encourage patient feedback and
serve as a research tool. For example, if a qualitative study is being
published about preferences, needs, motives or experiences of patients and
health care consumers, why not invite people to submit additional comments
into a structured questionnaire and re-analyze the database to see whether
additional themes emerge.
Competing interests:
None declared
Competing interests: No competing interests
I agree wholeheartedly with Dr Curran but I would go much further:
your latest ideas seem to me to show that you have finally gone over the
edge. Why not simply drop the word "medical" from your title and rename
yourselves the "British Sort-of-Health-Interested Journal"?
I have recently attended two high-quality postgraduate meetings and I
was struck by the provenance of the articles cited by so many of the
speakers: of those which came from general medical journals a high
percentage were from the 'Lancet' or the 'New England Journal of
Medicine'; there were precious few from the BMJ. The reason for this can
easily be seen in your dismissive remark about how many research articles
provide information about the aetiology or pathophysiology of disease but
"don't matter to patients". How can a doctor give a full and balanced
account of an illness to a patient if s/he does not understand the
aetiology, pathophysiology, etc of that condition? Your persistent
denigration of the profession and your obsession with political
correctness and with innovation for its own sake seem to have led you to a
position where you have simply forgotten that a doctor is different from a
nurse, a patient, a health administrator or a journalist.
I have written to your distribution centre asking to be taken off
your circulation list, although I remain a member of the BMA. I shall not
be reading the BMJ in future - frankly, I have better things to do with my
time.
Competing interests:
None declared
Competing interests: No competing interests
It is obviously a good idea for people to be informed
about health matters, to take more responsiblity for
their health and to realise the benefits and limits of
medicine. Whether it is a good idea to try and
accomplish this through altering the format and content
of the BMJ to acheive this is another matter.
I would suggest that the BMJ is first and foremost a
"trade paper" and its primary purpose should be to
educate and inform practioners of that trade. I would
also suggest that the reason why it is read outside of
the profession is because of the characteristics that
make it a succesful trade paper ie the quality and detail
of its articles which arise out of who they are aimed at
ie the medical profession. Changes to the content and
format to appeal to a broader readership, whether for
the reasons proposed in the editorial or simply to
increase sales, would, I think, diminish the the journal,
making it of less use to its primary readership and
ultimately unsatisfying also for the non-professionals
who choose to read it.
Let me use an analogy with another trade, which
may seem a little odd, but does I think have some
usefulness. I am interested in cinema and
occasionally read trade magazines such as "Variety". A
lot of the articles in the magazine are abstruse or
irrelevant to someone outside of the film business.
However, some are of interest and the film reviews are
excellent. The reason for this is that the reviews are
aimed at a specific audience who need to know an
unglossed assesment of the strengths and
weaknesses of a film. If the editors of "Variety" decided
to change the format to appeal to a broader audience
they would probably have to remove articles of
relevance to those in the trade to make room for more
lightweight "movie-goer" friendly articles and reviews,
and in the process become less authoritative and so of
less use to those in the trade and of less interest to
outside readers who want to know more about films
and the film business than can be found in the general
press. I suggest that the same thing would happen if
the changes of the proposed theme issue of the BMJ
were to be adopted.
If the editors at the BMJ are set to do this, by all
means and let us see the result, but it seems that
some of the suggestions for articles ( a "celebrity"
interview) do not sound very inspiring.
On a grammatical note, it is good to see that the
author of the editorial manged to slip in a couple of
hyphenated words, something which is usually
(unfairly) banned by the BMJ!
Competing interests:
None declared
Competing interests: No competing interests
I sincerely do hope that the general public does become more savvy
about their health. I have been trained and worked from the North of
Scotland in Aberdeen to the south of England on the Isle of Wight, and I
have this to say.
The more affluent people tend not to present to hospitals acutely as
they do know how to look after themselves.
More awareness should be made of depression and anxiety. Why do so
many people e.g. in Lanarkshire and Glasgow smoke and drink so much?
Smoking and drinking is not their main problem: it is stress. Also a large
reason why there are waiting list for cancer and cardiac operations is
because a lot of the public smoke and drink too much, don't eat nor
exercise properly and expect doctors to reverse decades of damage within a
ward round.
With further regards to smoking and alcohol; Why is there such a
pervading myth that "roll ups" are "healthier" cigarettes? Why is alcohol
promoted so glamourously and no mention is placed on adverts to "enjoy it
responsibly" as is the case in the US? There should be a debate as to
smoking and alcohol as gateway drugs to harder drugs because I have seen
my generation become more and more apathetic to the misery drug misuse can
cause. The Swedish model of zero tolerance backed up by treatment of
existing users should be studied and seriously considered.
Parents should be told that a child with coryza and thus having "a
virus" is not a euphemisism for their GP as "I don't have a diagnosis" but
a genuine medical problem that doesn't require a second opinion in A+E.
Also, the use of antibiotics by some GPs for viral bronchiolitis should
cease and desist, otherwise resistance will exceed efficacy and doctors as
a whole won't have some of the most useful drugs ever developed, and
patients won't insist on ineffective treatment.
Also, the general media should be less sensationalist e.g calls for a
vaccine against E.coli after the outbreak in Lanrakshire which claimed
less than 50(correct me if I'm wrong) lives(unfortunate as they were), to
protect a population of 50 million.
Once these issues are settled then I think the merits of e.g the
latest surgery can be debated. My point is this is where the starting line
is.
Competing interests:
None declared
Competing interests: No competing interests
It's an interesting point, but I would be sad to see words such as
'paternalism' banned. It has a particular meaning which I don't feel any
alternative word expresses. While I understand its origins, it has come to
stand for a particular attitude which in the past may have been adopted by
fathers, but today can be held by both sexes and in all sorts of
professions. I promise that female doctors can behave in a paternalistic
way! But actually, that is what some patients want - they want their
doctor to make decisions on their behalf, without much consultation.
As an 'outsider' working closely with the medical profession, it
seems to me that a real issue for health professionals is how to tell what
sort of patient they have in front of them - is it someone who wants full
details of all the risks to enable them to make an informed decision, or
is it a patient who would prefer to take advantage of their doctor's
training and experience? Sometimes it may be obvious, but sometimes it
just isn't, and then communication problems can arise. Perhaps that would
be an issue worth exploring in the special edition?
Competing interests:
patient
Competing interests: No competing interests
The BMJ has a policy of banning some words from it's jounal - eg
accident.
Could it consider extending the ban to "paternalism", particularly when
taken to mean or associated with "doctor knows best"? It is a sexist,
pejorative term - a female equivalent would never be used in the same way.
Can female doctors be paternalist - if so, how? If not, are they
maternalist, and is that good or bad?
Perhaps you could set the problem to Jeff Aronson.
David Baker
Competing interests:
male
Competing interests: No competing interests
Lynn Eaton chooses to focus on paternalism and partnership in her
editorial, and rightly so. The Sherpa analogy is very powerful. It is
also very apposite to the way in which some of the more interactive items
for the June edition might be constructed.
When someone sets out on a therapeutic or diagnostic journey, it is
generally for the first and only time. Guides can help; fellow travellers
can help; but perhaps a bloody good map is the best bet of all, because
everyone can use it as a reference point. And, of course, maps are only
constructed through the experience of others, so the model introduces the
broad issue of consent, and the ethical use of confidential information in
health research.
I wonder whether it would be possible, built around a branching MCQ,
to take a visitor to the site through some moderately complex models which
would inform future decisions in partnership with professionals. Taking
two examples from my areas of interest:
A route which starts off with abdominal pain, runs through an
emergency appendicectomy and ends in a decision as to whether retained
tissues might be used for a demographic study of new variant CJD without
individual consent.
A route which starts off with a routine antenatal ultrasound and
takes the visitor through to the prenatal diagnosis of a non-lethal
anomaly such as major facial cleft.
It’s easy to think of others, but whatever might be chosen should, in
my opinion, be quite complex in order to avoid the trap of “dumbing down”
for visitors as well as medics.
The is, as perhaps should be expected now from the BMJ, an exciting
project. Good luck with it.
Simon Knowles
Competing interests:
None declared
Competing interests: No competing interests
Screening for diabetes is very topical yet ignored
Dear Sir/madam
as a researcher in diabetes, i would like to draw your attention to the
rising epidemic of diabetes. Certainly not enough is being done and only
tip of the iceberg is treated. we should stress on this issue and your
theme issue next year would be wonderful opportunity to raise this issue.
certainly, research in this area would be/should be submitted and no effort
be spared to nip the devil in its bud.
Competing interests:
None declared
Competing interests: No competing interests