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Trust! Defined by the OED as, “Firm belief in the reliability, truth, or ability of someone or something”. This month’s healthcare news is deluged with the “loss in trust between clinical staff and the government”. It is the words, truth and reliability, which interest me in the definition.


All meaningful relationships are built on truth and this has been eroded by a series of government initiatives, 7 day working week, altering definition of normal working hours, less reward for more duty hours, enforceable contracts to work in the NHS………… Given that politicians are in the business of improving the life of all citizens it is obvious that change needs to be supported by involved parties. It is wholly disingenuous to suggest that doctors and healthcare staff are not prepared to examine the reasons for many of the deficiencies e.g. waiting lists, increased patient morbidity/mortality at weekends…….. They are. They are key to any solution so ostracizing them at the onset is counterproductive.


The government needs to listen to grassroots staff, not always their advisors. Take note, even the Conservative party faithful are concerned, hence the warning of, “unintended consequences”, for the NHS, by Sara Wollaston MP, if the proposed junior doctors’ contract is implemented. Jeremy Hunt the Secretary of State for Health has probably realised that the figures of preventable weekend deaths, at 11,000, was never mentioned in the research paper he quotes. The recent junior doctors demonstration, of 20000 (just under 50% of junior doctors), is evidence of how passionately they feel. They are not dupes of the BMA union as Hunt continues to opine, but professionals with genuine grievances.


This issue has a key thread of children. The child with the persistent cough is a common presentation and Sunther, Rivers and Bush provide an approach to management (p.76). Most of us have some understanding of depression in adults. It is underdiagnosed in children and adolescents, being easily missed and so cause needless suffering, occasionally with severe complications. Sigalas, Barkla and McCardle (p.83) stress the atypical symptoms of depression and the variable presentations, depending on the age and pointers on what needs to be done. Down syndrome one normally envisages as a disorder of children but those surviving into adult life has increased dramatically over the last 3 decades. McCall, Taylor and Marder (p.92) highlight the key and serious medical issues that patients with Down syndrome may develop and how to identify and manage them.


Included is a very useful and succinct overview of anaemia. Alimam, Allard and Pendry (p.60) have captured the essence of the approach to this common finding in primary care. Along the blood and vascular theme, Hubbard and Vig (p.101) have given a fine summary of Peripheral Arterial Disease, particularly factors that indicate severity and potential complications. If these can be assessed reliably in primary care then some of the more severe and costly forms of treatment of amputations etc. may be avoided.


Enjoy the excellent contributions. Ideas for future topics very welcome. Please drop me an email.

Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: Clinical Focus Primary Care
  • Login: Please login to view Full Text of the article
Read 954 times Last modified on Friday, 15 April 2016 10:27

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