BMJ No 7146 Volume 316

Press Releases Saturday 06 June 1998

(1) DEPRESSION MAY BE A RISK FACTOR FOR HEART DISEASE IN MEN

(2) METHODS OF ESTIMATING THE CHANCES OF SURVIVING SURGERY

(3) HOW RELIABLE ARE LEAGUE TABLES?

(4) REACTIONS TO THE GENERAL MEDICAL COUNCIL INQUIRY AT BRISTOL ROYAL INFIRMARY

(5) PUBLIC MASSIVELY OVERESTIMATES WHAT JUNIOR DOCTORS EARN

(1) DEPRESSION MAY BE A RISK FACTOR FOR HEART DISEASE IN MEN

(Depression as a risk factor for ischaemic heart disease in men:
population based case-control study)
http://www.bmj.com/cgi/content/full/316/7146/1714

Depression increases the risk of morbidity and mortality after a heart
attack, irrespective of whether patients have diabetes or hypertension,
their level of deprivation or whether or not they smoke.  In this week's
BMJ, Julia Hippisley-Cox et al from Queen's Medical Centre in Nottingham
investigate whether depression occurs before the onset of ischaemic heart
disease.  They found that men who were depressed were three times more
likely to develop ischaemic heart disease.  This association did not seem
to apply, however, to women.

Contact:
Julia Hippisley-Cox, Lecturer in General Practice, Department of General
Practice, The Medical School, Queen's Medical Centre, Nottingham
email:  julia.h-cox{at}nottingham.ac.uk (best means of contact)
 

(2) METHODS OF ESTIMATING THE CHANCES OF SURVIVING SURGERY

(Cumulative risk adjusted mortality chart for detecting chances in death
rate:  observational study of heart surgery)
http://www.bmj.com/cgi/content/full/316/7146/1697

Comparisons of death rates will give misleading results if differences in
the types of patients and illnesses are not taken into account.  In this
week's BMJ, Poloniecki et al from St George's Hospital in London explore
the chances of surviving an adult heart operation at one hospital and how
this varied over four years with the type of patients being operated on.
The authors conclude that not only surgeons but all practitioners for whom
failures can be identified should use the CRAM (Cumulative Risk Adjusted

Mortality or Morbidity) quality control scheme cited in their paper, so
that proper in-house investigations can take place if the death rate
increases.  Still more importantly, continuous surveillance of this kind
is, they argue, the only means of providing a patient with a realiststic
estimate of the chances of surviving surgery at a particular hospital.

Contact:
Dr Jan Poloniecki, Lecturer in Statistics, Public Health Sciences, St
George's Hospital Medical School, London
email:  j.poloniecki{at}sghms.ac.uk
 

(3) HOW RELIABLE ARE LEAGUE TABLES?

(Reliability of league tables of in vitro fertilisation clinics:
retrospective analysis of live birth rates)
http://www.bmj.com/cgi/content/full/316/7146/1701

League tables of schools and hospitals are increasingly common and much
attention is paid to the precise position of an institution in the table.
In this week's BMJ, Marshall and Spiegelhalter  describe a new statistical
technique that can be used to quantify the uncertainty about ranking.  They
have applied it to in vitro fertilisation clinics in the UK and found that
the rankings were not entirely meaningful and therefore it would be unwise
to take them too seriously.  Positions in ranking can alter radically year
on year, but this does not necessarily mean that a significant change in
the success rate has occured.

Contact:
Dr David Spiegelhalter, Senior Statistician, MRC Biostatics Unit, Institute
of Public Health, Cambridge
email: david.spiegelhalter{at}mrc-bsu.cam.ac.uk
 

(4) REACTIONS TO THE GENERAL MEDICAL COUNCIL INQUIRY AT
     BRISTOL ROYAL INFIRMARY

There is a cluster of articles in this week's BMJ relating to last week's
General Medical Council ruling about the heart surgery case in Bristol.

Competence, professional self regulation and the public interest
http://www.bmj.com/cgi/content/full/316/7146/1740

Professor Rudolf Klein explores some of the questions raised in the GMC
inquiry at Bristol from the perspective of a lay observer, concluding that
the case has revealed that doctors are unclear about what is involved in
their responsibility to protect patients from harm from other doctors;

doctors need training in communicating with each other;  more stringent
training requirements are needed before surgeons may operate independently
and more needs to be done to develop benchmarks against which performance
can be judged.

Contact:
Professor Rudolf Klein, Professor of Social Policy, Centre for the Analysis
of Social Policy, University of Bath, Bath
email: R.E.Klein{at}bath.ac.uk

Lessons from the Bristol case
http://www.bmj.com/cgi/content/full/316/7146/1685

In his editorial, Professor Tom Treasure writes that a major issue in the
Bristol case has been the nature of the information given to the parents  -
there may be a place for giving an optimistic outlook to a patient judged
to have no choice but to undergo high risk emergency surgery to save life,
but the circumstances where that approach is justified are limited.  There
was no justification for a rosy glow in this case...  A frank presentation
of the risks and benefits to the family should include sympathy and
compassion but this should not supplant frankness.

Treasure outlines the role that national audits for surgery can play in
monitoring performance and concludes that if the profession must now
monitor itself effectively so that a system of regulation is not imposed
upon it.

Contact:
Professor Tom Treasure, Professor of Cardiothoracic Surgery, St George's
Hospital, London

Half of all doctors are below average
http://www.bmj.com/cgi/content/full/316/7146/1734

In an Education and Debate paper, Dr Jan Poloniecki makes the observation
that even if all surgeons are equally good, half of them will have below
average results;  one will have the worst results and those reults will be
a long way below average.  He writes that it will be of little value if the
Bristol case before the GMC is resolved merely by striking off three
doctors, two of whom are already retired, without a wider lesson being
learned.  It will be of very great value if the case establishes that the
Health Service should now equip itself to provide people contemplating an
operation with a numerical estimate of the chances of failure.

Contact:
Dr Jan Poloniecki, Lecturer, Public Health Sciences, St George's Hospital
Medical School, London
email:  j.poloniecki{at}sghms.ac.uk

In response to an anonymous case history of a junior doctor aware of a high
level of deaths during surgery, four authors offer their advice on how the
situation should have been handled.

What should a junior doctor have done?
http://www.bmj.com/cgi/content/full/316/7146/1736#resp1
Contact:
Professor Miles Irving, Professor of Surgery, Department of Surgery,
Clinical Sciences Building, Hope Hospital, Salford
email:  mirving{at}fs1.ho.man.ac.uk

You cannot expect people to be heroes
http://www.bmj.com/cgi/content/full/316/7146/1736#resp2
Contact:
Dr Donald Berwick, President, Institute for Healthcare Improvement, 135
Francis Street, Boston, 02215MA, USA

Put out the fire or risk an inferno
http://www.bmj.com/cgi/content/full/316/7146/1736#resp3
Contact:
Professor Peter Ruben, Dean, Faculty of Medicine and Health Sciences,
University of Nottingham, University Hospital, Queen's Medical Centre,
Nottingham

Present system of whistleblowing is unsatisfactory
http://www.bmj.com/cgi/content/full/316/7146/1736#resp4
Contact:
Professor Tom Treasure, Professor of Cardiothoracic Surgery, St George's
Hospital, London
 

(5) PUBLIC MASSIVELY OVERESTIMATES WHAT JUNIOR DOCTORS EARN

(Pay rates for junior doctors' additional hours need to be adjusted)
http://www.bmj.com/cgi/content/full/316/7146/1748

In this week's BMJ a letter written by Dr Trevor Pickersgill, Research
Fellow in Neurology at the University of Wales shows that most members of
the public think that junior doctors are paid at least as well for their
out of hours commitment to the NHS as they are during their standard
working day.  529 patients, medical students and nurses were surveyed and
asked how much they thought a newly-qualified house officer would earn on
Christmas Day 1997, given that they earned £7.42 per hour normally.  The
correct answer is £3.71, which is 50 per cent of their standard pay.

Only 2.6 per cent of respondents correctly identified the hourly pay.  86.6
per cent were of the opinion that the doctor would be paid at least 100 per
cent of the standard rate.  Nearly thirty per cent (29.3 per cent) thought
they were paid 200 per cent or more, known as "double-time".

Contact:
Carmel Turner, Press Office, BMA House, Tavistock Square, London
 
 

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