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  • “Start private, end private”—a principle that could help protect the NHS from subsidising private care
    by Alastair D Hay on 24/05/2024 at 9:06 AM

    With public satisfaction with the NHS at its lowest,1 the increasing use of private healthcare is concerning.2 The number of UK adults estimated to have health insurance doubled between 2021 and 2022.3 A YouGov survey conducted in April 2023 found that one in eight people in the UK reported using private healthcare, and one in four considered using private healthcare in the previous year.4 Of those using it, a third said that it was for the first time.4The relationship between the NHS and private healthcare sector in the UK is complex. Arguments in support of private provision emphasise taking pressure off the NHS and promoting choice for those who have the means to pay for healthcare.As an NHS GP, I am not convinced. The state pays a premium to train staff and provide a 24 hour, 365 day healthcare service. This means that anyone can access the care they need,...

  • Gender medicine in the US: how the Cass review failed to land
    by Jennifer Block on 23/05/2024 at 10:31 PM

    The newly released Cass review on transgender care for under 18s has had a seismic effect across the United Kingdom and Europe.1 Scotland and Wales promptly followed the NHS in England in ceasing the prescription of puberty “blocking” drugs outside of research protocols. The UN special rapporteur on violence against women and girls, Reem Alsalem, called the independent inquiry’s findings and recommendations “seminal” and stated that policies on gender treatments have “breached fundamental principles” of children’s human rights, with “devastating consequences.” Some charities and clinicians are disappointed with last month’s final review report. But the tone of major print and broadcast media in the UK has shifted: outlets that have previously reported criticism of gender services as transphobic now note how, as the Guardian reported, “the lack of high quality research, highlighted by Cass, has been a subject of growing unease among doctors.”The review by Hilary Cass, paediatrician and former...

  • SAS and locally employed doctors deserve more support and respect
    by Partha Kar, Robert James Fleming, Somaditya Bandyopadhyay on 23/05/2024 at 12:06 PM

    The medical workforce contains many doctors who are not consultants and who are not part of a recognised training programme. Specialist, associate specialist, and specialty doctors (SAS) and locally employed doctors (LED) are the fastest growing sections of the workforce and make up 24% of all licensed doctors.1 They play a vital role in delivering NHS services.SAS doctors are employed on a nationally negotiated contract. The current national SAS contracts are the less senior “specialty doctor” and the senior, experienced, and independent “specialist.” Additionally, there are doctors employed on trust-derived contracts called “locally employed doctors” (LED) who can have multiple titles including “clinical fellow,” "trust grade,” and “trust doctor.” Medical training initiative doctors (MTI) are also commonly employed as LEDs and therefore form part of the group.These doctors deserve, but often do not receive, parity with other doctors in educational and career support and in opportunities.2 They are a potentially...

  • The untold health toll of voting
    by Charu Bahri on 23/05/2024 at 10:59 AM

    Supriyanto, 54, passed out in the polling booth he was managing in West Java, Indonesia, on 14 February 2024. He was rushed to a nearby health facility where he was pronounced dead. Supriyanto had had breathing difficulties before he passed out, and his family said he had a history of asthma.Supriyanto was one of 181 election officials who died on polling day in Indonesia’s election. Another 4770 officials are recorded as being ill in the fortnight after. Most deaths were from heart attacks, road traffic accidents, septic shock, acute respiratory distress syndrome, and hypertension.In the six month run up to the 2020 US presidential election, participants in a study reported an increase in moderate to severe anxiety and depression, an increase in visits to mental health clinics, and increased prescription drug use—and a decline after the election.1 Another group of researchers reported that 68% of adults they surveyed said that...

  • A rare cardiac mass
    by Hassan Ali, Osama Gasimmalla on 23/05/2024 at 10:01 AM

    A new systolic heart murmur was identified in a woman in her mid-60s during a preoperative assessment (fig 1). She had completed a course of radiotherapy and chemotherapy for rectal cancer (stage T4b N1b M0), followed by uncomplicated elective robotic low anterior resection and laparoscopic ileostomy. Elective reversal surgery of her ileostomy had been scheduled. The heart murmur was investigated with echocardiography and computed tomography, the latter showing a large mass in the right ventricle measuring 5.0×4.5×5.7 cm.bmj;385/may23_7/e078072/F1F1f1Fig 1The patient was discussed at a multidisciplinary team meeting. Differential diagnoses for cardiac mass include a thrombus, metastatic rectal cancer, and primary cardiac sarcoma. Owing to the absence of pericarditis or a substantial pericardial effusion, sarcoma was less likely. The patient underwent cardiac magnetic resonance imaging, and a biopsy sample was taken of the endomyocardium, which showed an adenocarcinoma that had metastasised from the bowel to the atrioventricular groove and right ventricle....

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