Clin Med
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This opinion paper briefly considers the credibility of the announced rationale behind the current extensive reform of the NHS in light of recent research evidence about performance of the system. The paper outlines the authors' views of the history of the reform, which originates in a set of documents, produced in the late 1980s by the Centre for Policy Studies, which aimed to introduce private sector involvement throughout the NHS, and a brief report by a consultant for a health maintenance organisation in the USA. Tracking of the pro-private sector changes in the NHS demonstrates that the bill is a major step in the implementation of NHS privatisation and also delineates a roadmap for coming developments, which have been explained to corporate providers and investors seeking new profit opportunities but have not yet been debated openly with the electorate in the UK.
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The National Plan for Liver Services in 2009 called for a review of current liver services across the UK to identify areas of good and poor provision. We present the results of a national questionnaire survey of liver services, which focussed on staffing and training, access to key facilities and clinical management of liver disease. ⋯ Wide variation in the clinical management of serious liver diseases supports the need for managed clinical networks. These results will help to guide the development of standards of care for liver services across the UK.
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Numbers of National Clinical Assessment Service referrals concerning practitioners' performance are much higher for the over-50s, especially in GPs. In 20% of cases there are concerns with diagnosis that are unlikely to be recognised by revalidation. ⋯ We need to assess pratictioners' competencies in diagnosis throughout their careers. Plans to extend working life may require changes to the clinical responsibilities of older doctors.
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Biography Historical Article
Revalidating Sherlock Holmes for a role in medical education.
Sir Arthur Conan Doyle endowed Sherlock Holmes with extraordinary skills that Dr Watson and others found incomprehensible until Holmes gave explanations, often in the form of memorable maxims and short monologues. Intentionally or not, Doyle left us crime-solving precepts that still inform aspects of medical practice. ⋯ Doctors still invoke Holmes's methods in clinical contexts, but the validity of some of the parallels has been challenged and quoting the more popular sayings has been equated with conceit. This paper examines how the use of selected maxims and monologues can help to link abstract principles and live context in a credible way in order to make aspects of clinical reasoning and professional behaviour more accessible and memorable.