From Covid to the energy crisis – superb article from Kamran Abbasi, BMJ Editor’s Choice, 4 September 2022

‘After covid, politicians are failing us again over the energy crisis’ –

and

‘It may be worth remembering how August 2022 feels, because a politician or a commentator may tell you in a year or two that the NHS and energy crises were figments of our imaginations, that the public or experts panicked and foisted disastrous policies on politicians’ …so writes Kamran Abbasi with links to many articles around the issues, including children and schools.

A must-read for anyone interested in the truth about covid, ‘following the science’, government policy/ the public enquiry, and, similarly, the energy crisis.

https://emails.bmj.com/q/11oNf2DhwGmpsk48Lnezhrf/wv

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breast screening – bmj podcast on overdiagnosis

I just came across this bmj podcast for medical students and doctors – highlights subjects not taught in medical school:

https://www.google.com/search?client=firefox-b-d&q=bmj+shapscratch

or https://www.bmj.com/sharpscratch

It’s a podcast for med students and docs – the red one with pic of sticking plaster is about overdiagnosis.

Posted in Breast Cancer, breast screening, Campaigns, cancer, citizen safety, clinical trials, Compassion in healthcare, Critical thinking, DCIS, diagnoses, ethics, evidence-based medicine, harms, healthcare modernisation, high quality health information, information, informed consent, mastectomy, medicine's flaws, openness, Over-medicalisation, overdiagnosis, overtreatment, personal autonomy, Screening, Screening Mammography, transparency, unsolicited appointments | Tagged , , , , , | Leave a comment

Breast cancer screening: important new research information for women and policy makers

Breast cancer screening: important new research information for women and policy makers

The ‘Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study – explores the awareness of women who identified themselves as having a possible breast cancer overdiagnosis’.

This is a particularly important study because women need to be properly informed of the risks of overdiagnosis and overtreatment before they choose to accept or decline a breast cancer screening invitation. The study provides rare insight into the ‘profound negative impact of finding out about overdiagnosis after a diagnosis of breast cancer’.

Study participants’ own ‘Suggestions for Other Women’ are summarised in a linked supplemental online file.

Implications for clinicians and policy makers

 ‘…it is important that policymakers and clinicians improve current practice by considering these findings and suggestions made by our study participants. There is a need to adequately inform women considering breast screening of the risks of overdiagnosis and overtreatment.’

Pickles K, Hersch J, Nickel B, et al

Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study

BMJ Open 2022;12:e061211. doi: 10.1136/bmjopen-2022-061211

https://bmjopen.bmj.com/content/12/6/e061211

Posted in citizen safety, DCIS, patient/public involvement, personal autonomy, psychological harm, Public safety, research | Tagged , , , , , , , , , | Leave a comment

Breast cancer screening aid

Informing Women About Overdetection in Breast Cancer Screening:
Two-Year Outcomes From a Randomized Trial
Jolyn Hersch , Alexandra Barratt, Kevin McGeechan, Jesse Jansen et al.
JNCI Natl Cancer Inst (2021) 113(11): djab083 First published April 19, 2021.

Brief decision aid brings lasting improvement to women’s understanding of potential consequences of breast cancer screening without changing participation rates.

‘Abstract
Background: Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effects on screening knowledge and participation over 2 years.’

‘Conclusions: A brief decision aid produced lasting improvement in women’s understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening.’

The updated Intervention Decision Aid is freely available online: https://ses.library.usyd.edu.au/bitstream/handle/2123/16658/2017%20updated%20breast%20screening%20DA%20%28Hersch%20et%20al%29.pdf?sequence=1&isAllowed=y

Posted in Breast Cancer, breast screening, Campaigns, cancer, citizen safety, Compassion in healthcare, Critical thinking, diagnoses, evidence-based medicine, harms, healthcare modernisation, high quality health information, information, mastectomy, openness, Over-medicalisation, overdiagnosis, overtreatment, patient safety, personal autonomy, Public safety, research, Screening Mammography, transparency | Tagged | Leave a comment

NEJM widens public access via new partnership

The New England Journal of Medicine is broadening public access to high quality information by sharing short video summaries through their channel on You Tube which will include summaries of article findings and their implications using interviews, animations and more.

How the New England Journal of Medicine is broadening access to high-quality health information

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Breast cancer screening – financial incentives

An informative BMJ article by Dr Theodore Bartholomew and colleagues this week discusses the pros and cons of breast cancer screening (the latter includes overdiagnosis) together with potential consequences of financial incentives:

Financial Incentives for Breast Cancer Screening undermine informed choice. BMJ 2022;376:e065726

https://www.bmj.com/content/376/bmj-2021-065726

They argue that the focus should be on decision making not uptake when the balance of benefit and harm is subjective. The article includes a useful icon array from the Harding Centre for Risk Literacy as an example of a breast cancer screening decision aid. (- If only women invited to breast cancer screening were offered this decision aid their understanding re screening would be enhanced, their decision better informed.)

Posted in Breast Cancer, breast screening, citizen safety, ethics, evidence-based medicine, harms, healthcare modernisation, medicine's flaws, overdiagnosis, overtreatment, Screening, Screening Mammography | Tagged , , , , , , , | Leave a comment

Inadvertent Patient Harm: doctors, managers, medical education, patients, public, policy makers

Patients’ Emancipation: Towards Equality. Charlotte Williamson. Please see flyer, review etc two pages back. Details and review also on Amazon. Clear, well-structured information and suggestions for healthcare modernisation to benefit providers and patients.

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Overdiagnosis and climate change

“Tackling overdiagnosis takes on a new urgency in the context of climate change.

At the extreme end of low value care is no value care—otherwise known as overdiagnosis. Overdiagnosis is the detection of harmless conditions that could be safely left undiagnosed and untreated.23 Once diagnosed, however, a cascade of tests and treatment usually follows, which will not benefit patients who were not unwell to start with…”

Overdiagnosis is increasing the carbon footprint of healthcare. Alexandra Barratt, professor of public health, Forbes McGain, associate professor. https://doi.org/10.1136/bmj.n2407 (Published 04 October 2021).

BMJ 2021;375:n2407

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Book review: Patients’ Emancipation: Towards Equality by Charlotte Williamson

This remarkable book had an immediate impact on me.

As a patient activist aiming to improve health services, useful information had often been too difficult to obtain. I had felt like a lone voice pushing against brick walls, as controlled and disenfranchised as women from an earlier age who sought voting rights.. Sometimes there seemed to be a deliberate ‘Them and Us’ policy which kept patients in their place to prevent upsetting the status quo. Genuine patient centred care seemed an unobtainable goal.

Over the following years, although official policy directed healthcare providers towards patient-centredness and doctor-patient groups brought joint working, even small improvements came slowly and often melted away as personnel changed roles.

However, increasing numbers of patient representatives worked alongside health professionals at national level which fostered understanding, mutual respect and trust. Sadly, this was not the case countrywide.Despite apparent acknowledgement of the need for change, there were often plenty of words, but no deeds; tantalising improvements dissipated like scorched summer mist, while patients’ poor experiences of healthcare illustrated that patient harm, even if inadvertent, continued to occur. Why?

As I turned the pages of this important work, I realised why it felt like the final missing piece of a jigsaw puzzle. It was precisely what had been needed for so long, and the key to achieving patient centred healthcare modernisation.

This brave book not only discusses how unintentional patient harm can be caused by doctors, and even managers, but dares to suggest how improvement and change can be achieved.  

The well-structured, rich content explains the author’s theory of the need for patients’ emancipation, while clarity of thought and reasoned argument backed by a wealth of examples and detailed information all lead in planned sequence to the final chapter, Chapter 7. This includes stress that doctors experience as well as steps that ‘interest holders’ such as patients, doctors and managers can take to help patients’ emancipation. 

                                                                   …………………..

We are all potential patients, so this remarkable book could be useful for everyone. It would not be an over-statement to say this superb work not only deserves to be an essential part of medical education, but also recognised as an important foundation for modernising patient-centred care.

Mitzi Blennerhassett

You can download the promotional flyer here.

Or read ‘The Radius’ review here.

Buy direct from the publisher by emailing design@quacks.info or by calling 01904 635967

Or buy from Amazon.co.uk here.

………………………………………………………………………………………………………………………………………………….

Patients’ Emancipation:

Towards Equality

Charlotte Williamson
Published 2021 ISBN 978-1-912728-36-7
Softback: 170 pages printed on 100gsm bookwove, chosen for its sustainabilty.

“An engaging and interesting argument around the thought that patients are subject to a subtle form of oppression that they haven’t actually realised is in existence. The narrative will undoubtedly intrigue a wide audience. The work is well-structured, allowing the story to build progressively into a multi-layered scenario of relatable events and circumstances, leaving the reader hungry to continue reading.”

Jessica Kingsley, Publishers.

“It provides both an academic and an experiential insight.”

Professor Rob Baggott, Professor of Public Policy at De Montfort University.

Bafflingly, in spite of their good intentions, doctors and managers can sometimes harm patients. This harm ranges from major instances of bodily damage, like those reported in the Cumberlege Review of 2020 and the many ‘hospital scandals’ before it, to minor instances of inconsiderate or patronising behaviour. But neither doctors nor patients are usually aware of what lies beneath these distressing actions. What can explain this? The author’s emancipation theory, drawing on social, structural, andpersonal factors, can.  This book develops that theory, illustrating it with everyday examples. It offers patients themselves, doctors and managers ways to work towards emancipating patients from oppressive attitudes and unjust restrictions.

Preface and Acknowledgements

Chapter 1     Introduction to patients’ emancipation

Chapter 2     Patients take action :  ideas and principles

Chapter 3     Patients specialise : roles and relationships

Chapter 4     Doctors respond

Chapter 5     Enter managers

Chapter 6     The political trio: patients, doctors, and managers

Chapter 7     Concluding thoughts : a new model?  

Postscript    The corona-19 pandemic

References

Index

Patients’ Emancipation: Towards Equality

£15.00 includes p&p   ISBN 978-1-912728-36-7

obtainable direct from the publisher Quacks Books:

Quacks Books, 7 Grape Lane, Petergate, York YO1 7HU

E: design@quacks.info    T: 01904 635967    or visit:

http://radiusonline.info/patients-emancipation-towards-equality/

through your local bookseller, or via Amazon.co.uk:
https://www.amazon.co.uk/Patients-Emancipation-Equality-Charlotte-Williamson/dp/1912728362/ref=sr_1_1

Softback: 170 pages printed on 100gsm bookwove, chosen for its sustainabilty.

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Covid-19 vaccinations – British Medical Journal article

‘Primary Care can do it, but needs extra support to do it fast, safely and effectively’ say Professor Azeem Majeed and Mariam Molokhia writing in the bmj 30 November 2020.

For anyone wanting to know more about the Covid-19 vaccine being offered to the UK public, the Rapid Responses to this article (currently numbering 29 and, like the article, all with free access to the public) offer interesting information and flag up several concerns, not least openness, patient/person safety and informed consent.

Vaccinating the UK against Covid-19. Majeed A, Molokhia M. BMJ 2020;371:m4654

Posted in covid19, Critical thinking, death, ethics, harms, informed consent, patient safety, personal autonomy, Public safety, vaccination programmes, vaccines | Tagged | Leave a comment