from the editor...
The festive season approaches and the NHS crises will mount. Black holes of underfunding, bed shortages, pressure on primary care and accident and emergency insufficiencies………
Interestingly, it is well known that a well-run and funded community healthcare based service is the most cost effective model of healthcare delivery but all the structures are dominated by the hospital based fraternity. Consider the panels that constitute the interviewers for medical school entry. Hospital consultants predominate, sometimes at the exclusion of all others, little wonder there is a problem with recruiting into general practice as consultants will tend to favour individuals in their own image!
The levers of power within the NHS are in the wrong hands. Politicians generally have little understanding of the NHS. The BMJ has a regular feature of interviews with key members of the medical fraternity and one question relates to the best and worst Health Secretaries. No prizes for that Bevan is considered almost God like for his universal healthcare vision and negotiating skills, with the worst being almost wholly individuals running the NHS over the last 20 years or so with the most ire reserved for Andrew Lansley.
Nearer to home. Hospitals are run by managers who wield power but have little or no understanding of healthcare delivery. Those that understand it, the frontline doctors and nurses and allied healthcare professionals, have little or no power. The production of statistics to prove improvements in care are generally an easy smokescreen for deficiencies, which are seen and felt by those at the interface with patients and not in board rooms and committee meetings!
This summer has been very pleasant, in fact we have had an Indian summer with temperate weather and sunshine deep into October. Nevertheless, even this is not sufficient sunlight to ensure adequate Vitamin D levels in toddlers. The role of GPs in recognising and preventing deficiency of this vitamin in young children is discussed by More and Singhal (p. 104).
The vexed question of a GP confronted by an “odd personality” is difficult. The essence seems to be able to distinguish between “personality styles” and “personality disorders”. The features seen in the latter are frequently diagnosed as formal mental illnesses such as psychosis, mania and obsessive compulsive disorder. Braithwaite (p. 114) has provided a succinct article on how primary care physicians can assist in diagnosis and joint management, noting particularly that medication is not usually the solution. Facial pain and in particular earache is a very common presenting symptom in general practice. Commonly, due to its rich innervation, the pain is referred from other sites in the head and neck e.g. teeth, tongue, tonsils. However, a frequently missed cause of referred pain is from the Temporomandibular joint. Durham and Zakrzewska (p. 124) provide an overview of this common aetiology for earache. The potential confusion of the aetiology of earache is mirrored by patients with Medically Unexplained Symptoms (MUS). The latter group constituting some 20% of patients with a somatic complaint and a frequent presentation in primary care. Hussain and Salvadori (p. 132) provide insight into addressing issues raised by such symptoms and caution against using the traditional model of having to “Make a Diagnosis”. Siriwarnasinghe and Hassanaien (p. 139) cover a subject that most mature female members of the public would have some knowledge of or know a person who has suffered, “Uterine fibroids”. This is the last issue of 2014. Let me take this opportunity to wish you the best for the Festive Season and a very happy and prosperous New Year.
Professor Ram Dhillon
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