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International Primary Care Association

Clinical Focus Volume 7 N1

From the editor...

The proverbial really has hit the fan. The Francis report on the Mid Staffs Hospitals investigation is damning against the culture of an organisation that seemed to have lost its ethos of “Caring for Patients” as the primary objective. Rather the obsession was to hit the “targets” imposed by regional and national policy. Managers colluded with clinicians to garner favourable scores with the wilful neglect of tending to the sick and needy. How have we travelled so far back so quickly? The recent revelation of a whistleblower, who has broken his £500K payment gagging clause, that his concern over deaths in the Lincolnshire Hospitals were ignored at senior managerial level, begs the question how widespread is this lack of transparency.

This is a wakeup call for the precious NHS. For far too long we have been directed to reach and over reach targets of a meaningless nature so that politicians can measure and parade success. As clinicians we have, mostly unwittingly or under duress, acquiesced to this nonsense and lost sight of what matters. What is the first line of Good Medical Practice and the duties of a doctor, as demanded by the GMC: “Make the care of your patient your first concern”? Had healthcare professionals and for that matter, non-clinical managers adhered to this simple and altruistic axiom patients may have been saved and their relatives would have been spared the anger and sense of injustice that they feel.

How is it that the government has launched Healthcare UK, promoting the quality of the NHS abroad to attract inward medical tourism, when we have the examples cited above and maybe another 10-12 hospitals being investigated? We really have managed to do a 180 degree on priorities. Sadly, the culture of targetism and pandering to political edicts has provided us with the inevitable outcome. Disaster! I am afraid there will be many more to uncover over the next few months.

This edition is a veritable feast. Chronic kidney disease is increasing in prevalence. Stringer and Cockwell have provided an excellent overview, particularly the importance of albuminuria. The cosmetic industry is in the news but there are patients with genuine medical problems such as hirsutism who require sympathetic management. Hewapathirana and Page provide an easy to follow piece for primary care colleagues.

We also have the first of two articles on Nutrition by Katey Halliday. The one deals with what we already know, nutrition and its relationship to disease, but with some surprises in store. Nutrition and eating disorders are seen frequently in children and adolescents. This age group also suffer from anxiety disorders such as obsessive compulsive disorder, which can go largely unrecognised. Rao illustrates the salient features that can be picked up in primary care and enable many of these patients to be managed in the community.

Ayres and Anderson have put together an easy guide to the presentation and management of haematuria identified either visibly or by way of a dipstick. Haematuria need not be a heart sink symptom or sign but a patient complaining of “Sleep problems, tiredness and lack of energy” is a real challenge. Biljani makes the valid point that chronic insomnia, not appropriately managed, is a major risk factor for mood disorders. Finally, Qureshi, Lim and Ramli focus on diabetes and the importance of not just glycaemic control but also managing blood pressure and lipids, aspects that are commonly negated in our obsession for controlling the glucose levels.

As always, letters and suggestions for future features are most welcome. Please email me at the address shown. Happy educational reading.

Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: editorial, clinical focus, primary care
Read 6521 times Last modified on Tuesday, 03 May 2016 14:38

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