This week in the BMJ
Volume 326, Number 7391, Issue of 29 Mar 2003Doctors deliver care, but who cares for doctors?
Doctors deliver care, but who cares for doctors?
The stress of practising medicine affects many doctors' wellbeing.
Firth-Cozens' editorial (p 670) highlights the need for a proactive
approach towards the health of NHS staff. A special issue this week of
BMJ Careers focuses on doctors' wellbeing, exploring the
difficulties of being a doctor. From her own experience, Bennett
(p s103) shares valuable advice for doctors with minor mental
disorders. Freeman and Adams (p s105) present some tips on dealing
with patients who are doctors, and Brewer (p s106) informs on GMC
health procedures for ill doctors.
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Errors found in half of intravenous drug doses
Errors occur in the preparation or administration of almost half of
intravenous drug doses. In an ethnographic study with disguised
observation, Taxis and Barber (p 684) observed drug rounds in 10 wards
in two UK hospitals. Potentially moderate errors occurred in 29% of
the intravenous drug doses, and potentially serious errors in 1%. The
most common errors were giving bolus doses too fast and poor
preparation of drugs that required several steps.
(Credit: FERMARIELLO/SPL)
Increase in blood glucose predicts myocardial infarction
An increase in blood glucose during antihypertensive treatment is an
independent risk factor for myocardial infarction. Dunder and
colleagues (p 681) studied a cohort of 1860 Swedish men who had
participated in a baseline investigation when aged 50 and who were
re-examined at age 60. A significant interaction existed between
proinsulin concentration at baseline and antihypertensive treatment on
increase in blood glucose, suggesting that the metabolic impact of
antihypertensives increases the risk of myocardial infarction in an
insulin resistant state.
NHS awards scheme may be discriminatory
Non-white and female consultants may be disadvantaged under the NHS
discretionary points award scheme, which rewards consultants beyond
their basic salaries. Esmail and colleagues (p 687) found that in
England and Wales white consultants had 1.37 times as many awards as
non-white consultants, and men had 1.25 times more than women. In
Scotland the ratios were 1.34 and 1.36, respectively. Without effective
monitoring and a transparent process, suspicion of discrimination in
the allocation of awards may persist.
(Credit: CMS/SPL)
Statins reduce lipid levels better than fibrates
Statins are better at lowering blood cholesterol concentration than
fibrates, but they vary in their ability. In a cross sectional study
Hippisley-Cox and colleagues (p 689) compared the effects of lipid
lowering drugs and found that atorvastatin and simvastatin excelled.
The survey revealed that 57% of the patients taking statins reached
the target level of serum cholesterol compared with only 26% of those
taking other lipid lowering drugs. The target value for cholesterol may
not be realistic since the initial mean values in patients in primary
care are higher than those in patients in clinical trials.
(Credit: SCOTTISH VIEWPOINT)
Online consultations improve knowledge transfer
Internet consultations between doctors and specialists capitalise on
knowledge generated at centres of excellence and reduce geographical
variability. Kedar and colleagues
(p 696) conducted a retrospective case review of the first year of
online consultations between doctors around the world and consulting
specialists at a health maintenance organisation in Boston, USA.
Analysing 79 internet based consultations, they found that new
treatment was recommended in 90% of cases and a change in diagnosis
occurred in 5% of cases. Moreover, patients had faster access to
specialist opinions than they would if waiting to see a specialist.
(Credit: ANTONIA REEVE/SPL)
Cognitive therapy works best for anxiety disorders
The clinical care of anxiety disorders varies, but trials report that
cognitive therapy is most effective. In an extract from the Best
Treatments website, Tonks (p 700) presents the treatment options for
generalised anxiety disorders. Cognitive therapy is the treatment of
choice, but other options include buspirone and antidepressants, which
are also likely to work. Bezodiazepines may do more harm by causing
dependency, and further study is needed on applied relaxation,
antipsychotic drugs, and abecarnil, trials say.
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