Personal reflective practice can lead to change

This week The BMJ provides plenty of ideas for readers to improve patient care or to create better systems. Some lessons are personal and moving. Partha Kar describes difficult experiences as an international medical graduate (doi:10.1136/bmj.o2360).1 Kindness and time to chat, play computer games, and share dinner with colleagues served to combat his loneliness in ways that even the best formal induction programmes can’t. After learning that England has the second highest income inequality in Europe, Helen Salisbury considers whether she could better allocate time to prioritise patient need over demand and tackle inequality in her practice’s service (doi:10.1136/bmj.o2375).2 Her practice will try by contacting patients with long term conditions who are rarely seen.

As more people opt for private healthcare services, Sally Howard explores some of the unintended consequences (doi:10.1136/bmj.o2115).3 People may turn to the private sector to be seen quickly when the NHS is under pressure. But private providers can mean more work for NHS primary care if patients return to the NHS partly assessed or if private test results are returned to NHS GPs for interpretation and action instead of being handled by those who arranged the test. How can the burden that private systems put on the NHS be reduced? And how can patients be better informed about whether private healthcare is right for them?

New research prompts Barbara Mintzes and Colleen Fuller to call on drug regulators to be transparent about the evidence underpinning their decisions on drugs with serious adverse effects (doi:10.1136/bmj.o2275).4 Prescription medicines are so common that even rare harms are an important public health problem. Linked research from Meera Dhodapkar and colleagues investigates how often potential drug safety signals caused regulators to change the information on drug labels or make formal announcements (doi:10.1136/bmj-2022-071752).5 It should be easier than they found it to track down the evidence—or the evidence of the decision making process that supported a label change or announcement.

Continuing to evolve is the visual summary of the living WHO guideline on drugs for covid-19, which gives an overview of new and updated recommendations for (and against) therapeutics for individuals (doi:10.1136/bmj.m3379).6 It is food for thought for prescribers and policy makers in reviewing their approach to management as covid cases rise again. The latest in The BMJ’s covid inquiry collection, from Azeem Majeed and colleagues, offers lessons from the implementation of covid vaccinations (doi:10.1136/bmj-2022-070344).7 Vaccines were a pandemic success story, yet many clinicians involved in delivering the programmes will recognise some of the challenges Majeed and colleagues outline. Decision making, transparency and communication, and capacity to support research and delivery of vaccine programmes are still needed.