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Obioma Ezekobe GP - patients need to be educated about resources

Obioma Ezekobe is a GP in an urgent care centre in Central Middlesex Hospital. She believes that the public need to be educated about the use of NHS resources, and be taught when it is appropriate to seek care. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427...




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Katherine Henderson A and E consultant - lack of ward beds is hitting A and E the hardest

Katherine Henderson is the clinical lead of the emergency department at St Thomas's hospital in London. She worries that lack of ward space is having a domino effect throughout A and E and is the cause of increased waiting time for both patients and ambulances. If you would like to contribute to this collection, please email a brief audio...




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Thrombolysis in acute ischaemic stroke - time for a rethink?

In the US the licence, or marketing authorisation, for alteplase is limited to 0-3 hours after onset of stroke, but some other countries - including the UK and Australia - have extended the licence to 4.5 hours. In an analysis article on thebmj.com Brian Alper, vice president of evidence based medicine research and development at Dynamed, and...




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Health apps for well people - problematic or panacea?

Some apps have the potential to encourage healthier habits and are accessible to most people, argues Iltifat Husain, but Des Spence notes the lack of any evidence of effectiveness and the potential for encouraging unnecessary anxiety. Read more about in our head to head "Can healthy people benefit from health apps?" -...




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The health debate - the analysis

The future of health and social care looks certain to be a defining issue in the forthcoming UK general election. Social care has been subject to deep public spending cuts, raising concerns about the sustainability of services in the future. Whoever wins the next election will need to grapple with providing joined up health and social care...




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The BMJ requires data sharing on request for all trials

The movement to make data from clinical trials widely accessible has achieved enormous success, and it is now time for medical journals to play their part. From 1 July The BMJ will extend its requirements for data sharing to apply to all submitted clinical trials, not just those that test drugs or devices. The BMJ's Elizabeth Loder explains what...




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QOF, what is it good for?

Martin McShane, medical director of long term conditions at NHS England, questions the validity of the Quality and Outcomes Framework and suggests how it should change in the future. Read the related article: http://www.bmj.com/content/350/bmj.h2540




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Time to target older women for cervical cancer screening?

Cervical screening programmes in many countries stop at around the age of 65 and much of the focus is often on younger women. However, comparatively little attention has been given to older women despite the fact that they account for about a fifth of cases each year and half of deaths. In this podcast Susan Sherman, a senior lecturer in...




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GI bleeding, slow to diagnose, slow to treat

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has been examining the treatment of acute GI bleeds in England's NHS. Two of the authors, Martin Sinclair, consultant surgeon, and Simon McPherson, consultant vascular radiologist, join us to talk about their findings. Read the full...




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Tackling racism in the NHS

For decades research has shown that discrimination, harassment, and exclusion are pervasive experiences for staff from black and minority ethnic (BME) backgrounds in the National Health Service. In this podcast, the authors of a recent analysis article in The BMJ talk about the evidence for discrimination, what the NHS has done and is doing, and...




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Diagnosis and treatment of hepatic encephalopathy

Hepatic encephalopathy constitutes a spectrum of neuropsychiatric abnormalities, beginning with subtle psychomotor changes and progressing to confusion with asterixis, somnolence, and then coma, arising in patients with impaired liver function. In this podcast, Tim Cross, a consultant hepatologist from the Royal Liverpool University Hospital,...




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They drained 92L from me - diagnosis and management of pleural effusion

Pleural effusions are common, with an estimated 1-1.5 million new cases in the United States and 200 000-250 000 in the United Kingdom each year. Rahul Bhatnagar, academic clinical lecturer at the University of Bristol, describes how pleural effusions may be investigated and treated in the community and secondary care, with a particular focus on...




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How scientific are US dietary guidelines?

They have a big impact on the diet of American citizens, and those of most Western nations, so why does the expert advice underpinning US government dietary guidelines not take account of all the relevant scientific evidence asks Nina Teicholz. Read the full investigation: http://www.bmj.com/content/351/bmj.h4962




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What it's like to receive cardiac rehabilitation

With improved survival and and ageing population, the number of people living with coronary heart disease in the UK has increased to an estimated 2.3 million. There is increasing evidence that cardiac rehabilitation benefits these patients, and as such it has been included in international clinical guidelines. ​In this podcast, we're joined by...




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Why do the Scottish do fewer knee arthroscopies?

The “correct” rates of discretional interventions are difficult to define. However, David Hamilton and Colin Howie point out that discrepancies in usage of knee arthroscopy within the UK suggest the organisation of the care pathway may be an important determinant Read their full analysis: http://www.bmj.com/content/351/bmj.h4720




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Is place of death important to patients?

The current orthodoxy is that home is the best and preferred place of death for most people, but in this podcast, Kristian Pollock a sociologist from Nottingham University questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere. Read the full...




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The junior doctor protest

Thousands of NHS staff have demonstrated against the government’s threatened “imposition” of an “unsafe and unfair” contract for junior doctors. At a London rally on Saturday 17 October junior doctors and supporters noisily defended their trade union, as speakers accused England’s health secretary, Jeremy Hunt, of misleading the public about...




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Europe's impending syrup tsunami

Europe's common agricultural policy (CAP) on sugar is due to change, and Emilie Aguirre, from the UKCRC Centre for Diet and Activity Research at the University of Cambridge, argues that an influx of cheap high fructose corn syrup (HFCS, isoglucose) into the European market will have a negative effect on on the health of the continent. Read the...




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This house believes that medicine is the best career in the world.

Medicine has long been a rewarding career, but doctors say the profession needs to overcome the frustrations of working in the NHS to ensure it remains so. During the Big Debate at BMJ Live in London last week six speakers argued for and against the motion, “This house believes that medicine is the best career in the world.” After presentations...




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Unexpected findings, with uncertain implications, in research imaging

When healthy volunteers are scanned as part of a research project, unexpected findings, with uncertain implications, can be thrown up. Joanna Wardlaw, professor of applied neuroimaging and honorary consultant neuroradiologist at the University of Edinburgh, joins us to discuss how her group deals with these incidental findings, and what...




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Revisiting the bridge

In the podcast, we’ll hear from Kevin Hines the survivor of such an attempt, and Alys Cole-King, a psychiatrist who wants to break down the stigma of suicide. Originally broadcast in 2010 For more on suicide risk assessment and prevention, read our latest clinical review: http://www.bmj.com/content/351/bmj.h4978




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The evidence on doctors strikes and patient harm

Doctors considering strike action may worry about the effect on patients. David Metcalfe and colleagues examine the evidence and find that “patients do not come to serious harm during industrial action provided that provisions are made for emergency care.” Read the full analysis: http://www.bmj.com/content/351/bmj.h6231




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The diagnosis and treatment of post-traumatic stress disorder

PTSD may develop after exposure to exceptionally threatening or horrifying events. About 3% of the adult population has PTSD at any one time, and more than 50% in survivors of rape. In this podcast Jonathan Bisson, professor of psychiatry at the School of Medicine in Cardiff joins us to talk about the evidence for diagnosis and treatment, and...




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Sarah Wollaston - obesity, not a sugary drinks tax, is regressive

The UK Parliament's Health Select Committee's recent report on childhood obesity says 1 in 5 children are obese by the time they leave school. The committee calls for legislation to turn the tide by taxing sugary drinks, a pre-watershed ban on junk food advertising, and investment in public health. We joined Sarah Wollaston, conservative MP for...




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Diagnosing COPD in primary care

Francesca Conway, from the Department of Primary Care and Public Health at Imperial College London is co-author of an article on diagnosis of COPD. She joins us to discuss the major guideline recommendations, and highlights where they concur and where they differ. Read the full article: http://www.bmj.com/content/351/bmj.h6171




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The big (research) book of British teeth

Despite what hollywood says, science has proven that British teeth are actually better than American. Richard Watt, head of the Research Department of Epidemiology and Public Health at UCL explains how they came to that conclusion. Read the full research: http://www.bmj.com/cgi/doi/10.1136/bmj.h6543




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Cancer screening - does it save lives?

The claim that cancer screening saves lives is based on fewer deaths due to the target cancer. Vinay Prasad, assistant professor at Oregon Health and Science University, joins us to argue that reductions in overall mortality should be the benchmark and call for higher standards of evidence for cancer screening. Read the full...




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CKD In the elderly - disease, or disease label

Around half of people aged over 75 meet the diagnostic criteria for chronic kidney disease (CKD), but there is debate about what this means for patients as only a proportion of elderly people with CKD will have clinically important outcomes as a result. In this podcast, Dr Arif Khwaja argues that for CKD in the elderly, we should focus on...




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Exercise induced bronchoconstriction

James Smoliga, from High Point University, North Carolina, and Ken Rundell, from The Commonwealth Medical College, Pennsylvania, join us to discuss how to test for, and manage, exercise induced bronchoconstriction, and particularly how to distinguish it from other respiratory conditions. Read the full review at...




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The role of stenting in stable angina

Iqbal Malik, consultant cardiologist at Imperial College Healthcare NHS Trust in London, joins Mabel Chew to discuss the role of angioplasty and stenting in patients with stable angina. Read the full article online: http://www.bmj.com/content/352/bmj.i205




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Junior doctors second strike - from the picket line

This week, junior doctors in England have taken industrial action for the second time in as many months after failing to reach agreement with the government over their proposed new contract. Tom Moberley and Abi Rimmer, from BMJ Careers, went to the picket lines at Northwick Park Hospital, and University Hospital Lewisham to talk to the doctors,...




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What is vaginal seeding - and is it safe?

How should health professionals engage with this increasingly popular but unproved practice? Aubrey Cunnington, a consultant paediatrician from Imperial College London joins us to discuss. Read the full editorial: http://www.bmj.com/content/352/bmj.i227




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Zika virus - "it really felt like having bad sunburn, all over your body"

“Juliet”, a woman living in London, was diagnosed with a mysterious illness in November 2015, Ian Cropley, a consultant in infectious disease from The Royal Free London NHS Foundation Trust, was there to investigate. In this podcast, we find out how Zika, once a little known virus causing a rash and fever, has subsequently become a global health...




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"It's the workforce, stupid" - is the NHS workforce in crisis?

As the junior doctors in England strike, concerns for the workforce are foremost in the minds of those running the NHS. A summary is available here: http://www.bmj.com/content/352/bmj.i1510 In The BMJ roundtable, recorded at the Nuffield Trust Health Policy Summit on Friday 4 March 2016, we asked our participants if they think the NHS is in...




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"We're pulling the rug out from under the feet of [GPs]"

Gareth Iacobucci talks to Candace Imison, director of policy at The Nuffield Trust, about the problems facing GPs, and how primary care could be changed. "5 minutes with... Candace Imison": http://www.bmj.com/content/352/bmj.i1378




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"I thought I was the worst person with type I..." - Self management of diabetes

Nick Oliver, consultant diabetologist at Imperial Healthcare NHS Trust and Philippa Cooper, who has type I diabetes, join us to explain how structured education works for patients, and give tips on self management. Read the full review: http://www.bmj.com/content/352/bmj.i998




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Should doctors boycott working in Australia’s immigration detention centres?

However well intentioned, working in detention centres amounts to complicity in torture, says David Berger, a district medical officer in emergency medicine at Broome Hospital in Australia. However, Steven Miles, chair in bioethics at the University of Minnesota thinks that they play an important role in telling the world about conditions in...




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Médecins Sans Frontières's Dunkirk spirit

As France has moved in recent weeks to clear camps where migrants stay while trying to cross illegally into Britain, Médecins Sans Frontières has just opened a new one. Sophie Arie talks to Caroline Gollé, medical coordinator at the Médecins Sans Frontières​ La Linière camp​. Read more about the camp: http://www.bmj.com/content/352/bmj.i1696




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"What's the point in living, in a body I don't want" - how the NHS treats trans people

James Barrett, president of the British Association of Gender Identity Specialists, and Nina, a trans woman, join us to discuss how difficult it can be for trans people to access gender clinics, and what barriers are faced by the community after their transition has been completed. Read James Barrett's personal...




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The pattern of damage caused by Zika virus in the brains of 23 foetuses

In February World Health Organization (WHO) declared the microcephaly epidemic in South America an international public health emergency. Today, the US Centers for Disease Control and Prevention, the CDC, has confirmed that it’s is Zika virus which is causing that microcephaly.  The outbreak was originally spotted in Recife, in Brazil, and it’s...




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BMJ roundtable: How to fix out of hours care

The BMJ recently held a discussion between experts in the fields of general practice, emergency medicine, and paediatrics about the state of out of hours care in the UK, and crucially offered their vision for a better service. Are children a special case, can urgent care ‘hubs’ be a silver bullet, is NHS 111 up to the job of triaging patients,...




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Medical error—the third leading cause of death in the US

Medical error is not included on death certificates or in rankings of cause of death. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine, joins us to explain why we don't measure medical error, and why it is so important that we start. Read the full analysis: http://www.bmj.com/content/353/bmj.i2139




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The science of improvement

Or, the one where Fiona Moss and Don Berwick tells us what they think quality improvement is. Fiona Moss is dean, Royal Society of Medicine, and Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. Don's talk and the interview with Fiona were both recorded at the International Forum on Quality and Safety in...




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"The information we get can be harmfull"; Informed consent is not a panacea

Providing information to enable informed choices about healthcare sounds immediately appealing to most of us. But Minna Johansson, GP trainee and PhD student at the University of Gothenburg, argues that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may...




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Travellers' diarrhoea

Travellers’ diarrhoea is one of the most common illnesses in people who travel internationally, and depending on destination affects 20-60% of the more than 800 million travellers each year. In most cases the diarrhoea occurs in people who travel to areas with poor food and water hygiene. Mike Brown, consultant in infectious diseases and tropical...




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"Women deliver, and not only babies"

Katja Iversen, CEO of Women Deliver, joins Rebecca Coombes to explain why the UN sustainable development goals are unachievable if we don't empower women and girls to take control of their health, wellbeing, and reproductive rights. http://womendeliver.org/




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Women and the Zika Virus

Interviews from the Women deliver conference in Copenhagen. Donna McCarraher, director of reproductive, maternal, newborn and child health at FHI 360, explains why women should be at the centre of efforts to mitigate the effect of Zika Virus in Brazil.




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Abortion as a development issue

Interviews from the Women deliver conference in Copenhagen. Catrin Schulte-Hillen, co-ordinator of reproductive health and sexual violence care at Medecins Sans Frontieres, explains why the development community shouldn't conflate sexual violence and access to abortion.




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"What has convinced me is the evidence" - why mandatory treatment for drug use is a bad idea

Global evidence indicates that mandated treatment of drug dependence conflicts with drug users’ human rights and is not effective in treating addiction. Karsten Lunze, associate professor at the Boston University School of Medicine, joins us to describe the evidence, and why he is convinced seemingly counter intuitive hard reduction...




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Caring for patients with delirium at the end of their life

Delirium is common in the last weeks or days of life. It can be distressing for patients and those around them. A clinical update explains why successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the...