Category: Medicine in the media

How should GPs be paid?

October 20, 2008 2:16 pm

The dirty semi-secret that GPs get paid per item of what they do – for example, immunisations, cervical smears, blood pressure checks – has been making me uncomfortable for years. I still do not know what the best way of paying GPs is. The Sunday papers this weekend are full of stories about GPs being paid not to send people to hospital. This is only the tip of an unpleasant iceberg. Professional medicine should be about doing the right thing for patients. And while doctors should have an eye on the cost effectiveness of potential interventions, and should not be wasting public money, there should be no personal financial gain involved.

What would be a better way? On one hand, the ‘independent contractor’ model (where GPs contract services to the NHS) at least has the chance to try and negotiate a decent professional contract. On the other hand, this hasn’t been achieved; would a standard contract actually allow professional values to flourish? Maybe a flat pounds-per-hour would be better; good practice could be audited by peer review and patient feedback. Not to mention a proper assessment of prescribing practices and referral rates.

Posted in Medical professionalism, Medicine in the media, Politics of healthcare | Permalink

The “arrogance” of hospitals

October 16, 2008 9:52 am

The Healthcare Commission have published a report today about the state of the NHS.

On Radio 4′s Today programme this morning, they had Dr Michael Dixon speaking. He is a GP and chair of the NHS Alliance, as well as being a Trustee of Prince’s Foundation for Integrated Health. Dr Dixon took issue with the charge that hospitals were not sending out discharge summaries quickly enough. He was asked why this was; he said the cause was “arrogance”.

There is no doubt that discharge summaries are important. But to accuse hospitals of “arrogance” as a cause of slow receipt of them by GPs? It is not uncommon for hospital doctors to phone GPs like me to discuss difficult cases or to flag up potential problems as a patient comes home. This is rather helpful. Not at all “arrogant”.

It is also common for patients to come to the surgery, or to deliver in, a hand written discharge summary with a note of the most important problems or changes to treatment. This isn’t “arrogant” either.

I know for a fact that many hospital doctors stay late or go back in when they are not supposedly working to get through the paperwork; I also know that hospital secretaries, who are paid appallingly, work long and hard to get discharge letters typed quickly. I also know that most secretaries could earn more money for an easier job elsewhere. Most secretaries do not just type letters but act as PAs and organisers for patients, smoothing paths and sorting problems. I have not met an “arrogant” secretary yet.

This kind of comment damages morale and does not recognise the real resources that the NHS relies on. Goodwill and vocation is what keeps the NHS afloat.

Posted in Medical professionalism, Medicine in the media, NHS | Permalink

Pain and the Virgin Mary

October 1, 2008 10:44 am

There are lots of reports that “faith in God really can relieve pain” and such in the press at the moment. These reports are based on a study published in Pain (yep, medical journals have all the most exotic titles: Gut, Brain, Breast, Lung….) and the abstract is available here.

Unsurprisingly, the research does not prove anything about a faith in God relieving pain. What does it show, then? The researchers compared 12 practising and believing Catholics with 12 nonbelievers. The researchers administered electric shocks to the subjects’ hands while asking them to study either a religious picture of the Virgin Mary or a secular image. When the groups were compared, the Catholics studying the image of the Virgin percieved that they had less pain. This correlated with specific findings on functional MRI scans which the researchers thought could play a role in brain regulation of pain in this group.

This is interesting, but it does not prove that faith in God has reduced pain. It shows that pictures of the Virgin Mary, presented to people likely to be familiar with that image, caused reductions in those people’s perceived pain. It may have been the case that any familiar image – religious or not - would have been as capable of distracting people from pain.

That is worth exploring. While distraction is a well known technique for helping with pain, more work may help sort out what kinds of visual distraction work best for what people.

Posted in Medicine in the media, Questions about healthcare, Testing treatments | Permalink

Cancer, poverty and pay-to-access journals

September 30, 2008 2:06 pm

I had intended to use this evening to read the paper published by the British Journal of Cancer about survival rates from cancer over the past 20 years. This paper has had a lot of media attention. The upshot seems to be that people are living longer after a diagnosis of cancer, but those living in affluent areas (still) do better in terms of survival compared with those living in deprived areas. I wonder if some of the reported improved mortality in some social groups relates to an increase in over diagnosis resulting from screening for some types of cancers – but cancers which were never going to affect lifespan anyway. For example, this can be true of some prostate or breast cancers (a subject touched on in a feature for this week’s FT Magazine about breast cancer here.)

Meantime, some media commentators have ascribed the differences in survival rates to all kinds of things including the quality of nutrition, smoking, exercise, alcohol, stress, and even the supposed greater ability of the middle classes to ‘nag’ one’s doctor for a diagnosis.

I would have liked to go and read the academic paper in full. However the journal is not part of my Athens subscription (the package offered to GPs in Scotland) until the paper is a year old. The individual parts of this paper cost $32 each. That adds up to quite a lot.

The British Journal of Cancer says that it is planning to allow free access to the journal – but only for papers published over a year ago. This is good but it is not good enough. On the BJC website it says that “BJC is owned by Cancer Research UK, the world’s leading independent charity dedicated to cancer research”. It also says that “its far-sighted mission was to encourage communication of the very best cancer research from laboratories and clinics in all countries”. I imagine that if the standard subscription package offered by my institution doesn’t cover access then this would also be the case in many other countries too.

I would also have hoped that Cancer Research UK would consider that allowing journalists and other interested people rapid and full access to the complete studies to be an essential part of dissemination of the published research. This would allow for properly informed discussion and debate. Otherwise the information we get about cancer will continue to be as erratic and unhelpful as it currently is.

Posted in Medicine in the media | Permalink

Congratulations from Gordon Brown

September 22, 2008 12:24 pm

Hospital acquired MRSA infections in the UK have apparently fallen by a third in the last year according to the Health Protection Agenc y. Gordon Brown is writing to all NHS staff to say well done.

I foresee problems. There have been a couple of political drives on MRSA recently which have been non-evidence based; the ‘deep clean’ of all hospitals and a ban on long sleeves for staff (even though the Department of Health itself said this was non evidence based.) In fact, the nonsense spoken by the DoH demonstrates the absurdity of how MRSA is being dealt with. On one hand the Uniforms and Workwear policy they have produced keeps saying how important it is to look professional (no untied long hair, not ‘too many’ badges) because this could ‘send the wrong messages’ to patients about ‘professional pride’. At the same time, while acknowledging there is no evidence for it, the policy bans neck ties. I know of hospitals expending considerable energy into banning cufflinks while doing precious little about their commodes being shared. There is no evidence that any of the government’s ideas have had anything to do with a decreased rate of MRSA infections. The danger is that the government believes its own hype and that its policies have made the difference.

I wrote about microbiological concern about MRSA transmission last year here. The things that do seem to make a difference to MRSA infections are antibiotic prescribing, the cleaning of all surfaces, especially the less obvious ones, and decreased bed occupancy rates. Banning neck ties is not only non evidence based but it is not the surface most able to come into contact with most patients either. What about blood pressure cuffs, stethoscopes, curtains around beds, and visitors?

Posted in Effectiveness, Medicine in the media, NHS | Permalink

Junk food, fish oils and prisons

September 17, 2008 4:47 pm

Lots of media coverage on a new study today, which is apparently going to compare the reported offences of prisoners while taking either placebo or a fish oil+multivitamin+mineral supplement. Some headlines have interpreted this as ’Prison study to investigate link between junk food and violence’. I think that’s an extrapolation too far; the quality of the food the people eat isn’t going to vary during the study (although nourishing food, and the social interactions of eating should perhaps be an area of further interest in this group of people.)

The apparent health improving qualities of fish oils have been much overhyped in recent years. However there have been previous studies done looking at the effects of fish oils in prisoners and good quality evidence on a larger scale is to be welcomed. I haven’t seen the trial protocol on the register yet, but will keep an eye on this story.

Posted in Food, Medicine in the media, Testing treatments | Permalink

Clinical trials and TV

September 17, 2008 3:08 pm

Just as I was working out how to play a Harry Potter DVD an amazing television advert came on. It’s only broadcasting in Scotland but you can see clips at Get randomised. The website doesn’t say who is funding the ads, but I am impressed at the way that fair clinical trials are being promoted as a good thing and not, as per usual, mad scientists coercing gullible victim human guinea pigs into crazed experiments.

What would be very nice would be a study to assess the impact (or not) of these adverts – fair tests for all interventions, indeed…

Posted in Medicine in the media, Testing treatments | Permalink

The Professor Peter Higgs Fan Club

September 15, 2008 12:51 pm

I don’t think that Peter Higgs has a fan club – yet. An interview with him in New Scientist this week reveals why he should have one. He is the theoretical physicist who has predicted the existence of a particle now known as the ‘Higgs boson’ which explains the origin of mass and which the CERN project in Switzerland, turned on this week, is going to investigate.

I very much like Professor Higgs for these reasons. 1) He is modest. He heard from a colleague that the name ‘Higgs’ had been attached to almost everything to do with the theories of mass generation (“I think I was first to draw attention to the particle associated with it…..I go around pointing out that nothing else in this kind of theory was mine or mine alone”). 2) He considers other people: he was concerned about the vogue for calling the Higgs particle the ‘God particle’ (“it might offend people who are religious”). But most importantly (3) he is very wary of the overselling of theories when they are still at the experimental stage and that overenthusisatic researchers can do real damage to the public at large (“He urges scientists not to repeat the mistakes of the past by overselling [the CERN experiments] as a machine destined to find the definite answers to the remaining mysteries of the universe.”)

On number 3, I suspect that there are medical researchers and press officers who could learn rather a lot.

Posted in Medicine in the media, Science | Permalink

Reality TV and mental health

September 9, 2008 1:18 pm

There is a piece in the Observer this week about the Jeremy Kyle show. The author says that people with serious mental health problems are prey to the exposure these kinds of shows bring. These shows - where aggressive confrontation and public goading are to used to provoke and taunt people about personal problems or issues – are nasty to watch. On the Jeremy Kyle show there is apparently a “qualified mental health nurse and psychotherapist” who “found no evidence of mental illness” and decided that a “contestant” was “fit to take part”.

Is there really a way to decide if someone is “fit to take part” in such an exercise? Doctors are often asked to fill in certificates claiming that one is “fit to take part” in all sorts of things from skydiving to marathon running. One can say perhaps that there is no obvious reason why one should not do certain things, but there are seldom criteria where it is possible to say that one will be capable of a task. There are a few things where there is clear demarcation of acceptable risk; for example, the criteria for fitness to drive is something the DVLA is very clear about. These kinds of shows, however, are a different thing.

The Channel 4 show Big Brother hires psychologists. These shows look for people who are going to be “good entertainment”. In this context, it usually means that the people are chosen with the belief that they will provide drama. Again, in this context, it usually means conflict with oneself or the group. Presumably the presence of psychologists provide the television company with something to arm themselves with against charges that they place people in potentially damaging situations, played out live and in the public arena. Freedom to do as one wishes is one thing. But the presence of a psychologist does not guarantee happy endings.

I do know one thing, though. The less television I watch, the happier I am.

Posted in medical ethics, Medical professionalism, Medicine in the media | Permalink

The curse of ‘wellness’

August 26, 2008 10:16 am

‘Health’ I understand. But ’wellness’ ?

‘Wellness’ appears in the dictionary. But it is a mushy, ill-defined, nebulous word that is inherently anti-science (as it has no clear meanings or parameters). I find it to be a very irritating word. ‘Wellness’ is a word which, I have noticed, seems to increase in use in proportion to the money that one is invited to spend on trying to obtain it.

But ‘wellness’ is subjective, and, as a goal, tempts people into new dimensions of worry not just about the absence of disease but also about the depth of exuberant positivity one should bodily and mentally expect to find. It also invites lavish consideration of preventative ‘health checks’, many of which are marginal in potential benefit and most of which come with a flip side of cons. There are drinks, work outs, food, shoes, bras, chairs, and, of course, health clinics, which come with the promise of ‘wellness’.

Thus, I have spent years trying to dissociate myself from the curse of ’wellness’ in healthcare, and now I have a moral dilemma. I have spent several months trying to find bathroom fittings that will fit into an awkwardly shaped room. I have found the perfect fit. However, the modest fittings are defined as a ‘wellness product’. The search goes on.

Posted in Medicine in the media | Permalink