Tessa Richards

Let the patient revolution begin

Patients can improve healthcare: it’s time to take partnership seriously

Too much medicine; too little care

Time to wind back the harms of overdiagnosis and overtreatment

Time to deliver patient centred care

We must harness the energy, insight and expertise of patients, carers, and the communities that support them to help drive change

Continuing medical education: Needs to be more effective, accountable, and responsive to all stakeholders in health

Medical education is unfit for the millennium. Professional conservatism, inertia, and poor leadership have left it struggling to cope with rapidly changing health care systems. Those universities that have adopted new educational programmes may dispute this, but globally they are in a minority and their experiences have mostly not been evaluated or well disseminated. Too many education programmes at all levels continue to churn out “time honoured” material, present it boringly, and assess its absorption predominantly by written tests. Too few train doctors, both new and established, to acquire the skills that the new trends in health care demand. Adult learning theory holds that a key element of good teaching is the ability to stimulate self learning. This message has been accepted at medical undergraduate level, where many universities have introduced variations on problem based learning curriculums. Continuing medical education has, however, lagged behind. More emphasis has been placed on quantity than quality, despite the fact that ever more credence is being given to the role of continuing medical education in maintaining professional standards. In …

Running out of time

The deadline for implementing European legislation on doctors’ working hours is looming, but it remains unclear what the rules will be or the effect they will have on staff and patients, Tessa Richards reports

The BMJ's own patient journey.

Seeks to promote patient partnership by walking the talk

Listen to patients first

High death rates galvanised quality improvement and innovative change in one of the Netherland’s largest hospitals, transforming it into a model for patient participation, reports Tessa Richards

Meeting the challenge of genetic advance: Requires rigorous navigation between laboratory, clinic, and society

See p 618 Advances in molecular genetics over the past decade have been remarkable. Soon the entire human genome will have been sequenced and most of the genetic loci associated with human disease identified. These advances have greatly enhanced understanding of disease mechanisms and begun to explain why the clinical course of common disorders such as diabetes, asthma, and rheumatoid arthritis is so variable, as Bell discusses in the first of four articles on the broader implications of the new genetics (p 618).1 In future presymptomatic population based genetic testing for common late onset disorders such as Alzheimers disease2 and colon cancer may become widespread and bring important health benefits. Genotyping may become part of routine investigations to help clinicians tailor drug treatment effectively. But in what has been dubbed the “post-genome” era, increasing attention is now being paid to the limitations as well as the potential of DNA based genetic tests. The ability to detect genes …

Patients’ roles and rights in research

Full partnership with patients is essential to any modern research enterprise

Disillusioned doctors: Need a better balance between service commitment and education.

The exodus of young doctors from the NHS has been exaggerated,1 but British medicine has nothing to be complacent about. Disillusionment and discontent among doctors seems widespread and, as shown in this weeks journal, is by no means confined to the juniors. Growing concern about the services inability to care adequately for patients is causing frustration and even despair among senior doctors. This is perhaps reflected in early retirement, which is becoming common among both hospital consultants (especially those without merit awards) and general practitioners. Surveys of junior doctors who have left or are contemplating leaving medicine now rank the unattractive lifestyle of consultants as a major factor in their decision. In general practice the same concern about lifestyle is adversely affecting recruitment to general practitioner training schemes. Objective measurement of the misery index may be lacking and anecdote more evident than hard data, but recent discussions at the Royal Society of Medicine made it clear that there is an iceberg of discontent that cannot be ignored. Over the past year there have been 3300 calls to the BMAs helpline, mostly from doctors between the ages of 21 and 25 years, and although less than 100 have left their jobs many were experiencing difficulties. The causes of discontent are familiar. Despite the New Deal, long …