Category: clinical medicine

Hospitals are full of sick people and not all of them are patients. More and more staff in hospitals are turning up for work that they are unable to do. They are present, but not working at their best, due to the impact of COVID-19 on their health and well-being. Every week there is another […]

What should a clinician wear when consulting with a patient? For many years the answer was simple: a white coat. A long one, if you were qualified, and a short one if you were in training. The white coat symbolized the clinician’s authority; until authority became a non-starter for some clinicians, such as psychiatrists and […]

Does legislation really make a difference to the health of women? A quarter of a century ago, the USA legislated in the Women’s Health Equity Act to remove the inequalities between men and women in medical research. More recently, Health Canada recommended comparative studies in healthy male and/or female volunteers to minimize variability. Nonetheless, nothing has really […]

Almost one in four of us has two or more health conditions. With each additional disease, morbidity, mortality and poly pharmacy increases. Some think multiple health problems can be cured by minimizing the uncoordinated care that comes with trying to deal with a number of health problems sequentially and that the focus should be on the […]

The UK and the USA have suffered more than their fair share of clinical crises within their health care systems. In the UK, neonates and the elderly are dying in inordinate proportions in hospitals. In the US, deadly infectious diseases are now carried out of the research labs into the wards of the most prestigious hospitals. More doctors […]

Adults who have more than two health problems are likely to receive a prescription for a painkiller at least once every six months. Chronic pain is one of those heart sink problems of medicine. Nothing chronic is ever simple or curable. Originally it was thought that pain became chronic when the circumstances that initiated it […]

Is it time we let computers drive our medical care? According to the World Health Organization, there was a global shortage of 7.2 million health providers in 2013, and this figure will to increase to 12.9 million by 2035. Establishing new medical schools, which every country has adopted, isn’t a long term solution. Increasing the […]

Medicine is not just a science. It is a living practice. Translating emerging science into practice is one of the key skills of doctors. Before scientific knowledge became viral, translation was merely a matter of communication. Now, as the science of medicine reaches epidemic proportions, it is becoming more and more difficult to perform this […]

Medicine is a multinational industry no longer defined by country boundaries. Its main product is a workforce. It is time to disrupt our rigid health care so that it can bend For example, doctors now can work autonomously and remotely from their traditional locations for at least some of their work-time. Radiologists, for example, now […]

Risks are ephemeral. Once identified they are no longer risks but problems to be solved. Risks that cannot or should not be problematized need to be abandoned. In the most positive light, identifying risks should only be a first step in a long pathway of improvement. First, the risk must be linked to a behaviour […]

Under the surface, health care leadership is a stagnant pond filled with ever deepening chasms between the two rival schools – clinicians and managers.  Clinical leadership is no longer about advocating for individual patients, especially about expensive interventions and hospital stays where there is little likelihood of these clinical decisions ever being substantiated by research. […]

Seasonal change often generates a flurry of diagnosing. It should be okay to be sad about the shortening days, rather than suffering from ‘seasonal affective disorder’. In women, a runny nose and a sore throat transforms into ‘flu’ and in men it becomes ‘manflu’. Once a diagnosis is made it is indelible. Escalation of symptoms […]

Receiving a diagnosis that we have a progressively debilitating disease such as cancer or multiple sclerosis is a lifetime sentence. Initial diagnostic tests can accurately stage the disease. New imaging tools such as PET scans, MRIs, and genetic testing can detect the extent of the disease long spread before it becomes evident to clinicians and […]

Our health care systems are dying under their own weight. They are morbidly obese. They keep on eating up our resources with a voracious appetite. Like clinical obesity, it is not a single problem, but a complex growth that arises from the interaction between our genetic make up, our bodies, our communities and the environment […]

Body organs are a valuable commodity. Nearly every part of the human body has been transplanted – except of course the brain. As the Western world struggles to maintain a charitable stance on organ transplantation which results in long waiting lists, a thriving market in live transplantation exists in many less industrialized countries. Expendable organs, […]

Hospitals are full of sick people and not all of them are patients. More and more staff in our hospitals are turning up for work that they are unable to do. They are present, but not working at their best, either due to health problems or other events that are distracting them or both.  It […]

Support medicine based on individuals; not paper. Encourage responsive practice; based on divergent thinking with the ability to converge when necessary. Commit to genuine funding for health, that is, ten percent GDP for ten years from government and private sector. Ensure that hospitals remain places for treating sick people, not making those who treat them […]

Wherever I go my body always comes with me and as a doctor I am fortunate to know a little about what goes on. Anatomy showed me what I might look like inside. Microscopy led me further inside and let me understand the pathology. I learned about diseases. Unfortunately, the disease-friendly approach is now letting […]

Having more than one health problem is more common than we think and potentially deadly. Almost one in every four of us has two or more health conditions. With each additional disease morbidity, mortality and polypharmacy increases. Some think multimorbidity can be cured by focusing on the whole patient. Research shows the opposite. Multiple health […]