“We may not have GPs in ten years’ time; healthcare will have changed that much. What we do, who does it and where… all up for grabs.” Roy Lilley has some harsh and sympathetic words to say about UK general practice. I am not convinced by the detective metaphors but he is surely right to focus on the mismatch between what many are projecting primary care is about, and the realities. It is this divergence that students and young doctors are picking up on. I do not think the problem is that young doctors need more ‘education’ about primary care. By contrast, primary care is being demolished by our political masters. The idea of a personal physician is something to value, it is just that modern primary care can’t deliver this at the same time as doing all the others jobs that government has dumped on it. [link to this post]

Access to skincancer909 Well, when was the exam?

 

Students please repeat after me: “Attention is so central to our ability to think”. The ever sensible Daniel Willingham in an article in the NYT. He goes on to say, ‘People’s performance on basic laboratory tests of attention gets worse if a cellphone is merely visible nearby’. [link to this post]

Worth a view if you want to know a little bit more about where the UK may be going.

https://www.youtube.com/watch?v=ofuhlR4LAgQ

The Soul of the Research University, by Nicholas Lemann. This is one of the best (brief) histories of the modern research university and the conflicts that arise between teaching and research, and between the Ivory Tower, and training for that little bit of the world that is outside Higher Education. Nice summaries of Newman, Flexner, Clark Kerr etc. The author is a professor of journalism, and a former Dean at Columbia. It shows.

Pharma:We need to talk about Kevin…. oops I mean Pharma [link]. Depressing and dismal, if not shameful.

More dismal reading: The major scientific discoveries of the 20th Century would not have happened under today’s rules, they would not get funding now. [link]

Why good people leave science [link]

Rescuing US biomedical research from its systemic flaws. Bruce Alberts et al.here and a comment from an economic perspective (Malthus all over again). As the author says ‘Get it? It’s as if the Pope and three leading cardinals held a press conference predicting the collapse of the Catholic church. These people know what they are talking about and we need to listen.’

The Heart of research is Sick, by Peter Lawrence, and The mismeasurement of science, by Peter Lawrence in which he recalls the classic Leo Szilard parable about how to kill genuine discovery. Can you imagine Szilard in the academy?

It’s that time of year isn’t it?

Students are the coin of the realm.

David Patterson.

There is a moving and well written Perspective in this week’s NEJM, written by an Australian physician, Ranjana Srivastava. It is about the premature death of a close colleague. It contains an interesting account of a conversation with a medical student. The student tells the author how deeply she misses the deceased colleague. 

“The other students are saying I must get over it or I’ll never become a real doctor. They say real doctors don’t cry. This has forced me to think about what specialty I might pursue where I don’t have to deal with loss.” I stare at her incredulously. Fighting back tears, she ventures, “Do you think I should see a psychiatrist?”

“What for?”

“To learn how to experience loss properly. I really want to be a good doctor,” she says. “I want to be strong to help others.”

My incredulity is replaced by alarm that we impart such pernicious messages to impressionable future doctors.

Amen. [link for this post]

‘A Better Way Out’, Marcia Angell’s spirited review of Atul Gawande’s ‘Being Mortal’. Essential reading for all med students and doctors, and an indictment of much modern medicine and medical education. It will happen to you, and me— possibly sooner for the latter.

The MOOC Misstep and the Open Education Infrastructure, David Wiley (via Stephen Downes).

Occupy Your Brain: On Power, Knowledge, and the Re-Occupation
of Common Sense. Carol Black. A terrific read, aimed largely at school rather than universities.

Why lectures are dead (or soon will be) By Tony Bates. In talking about attempts to improve lectures he uses the phrase : ‘Nevertheless, all this is just lipstick on a pig.’ A new one on me, but I like it.

‘Health policy is in tatters. Markets haven’t worked, inspection hasn’t worked, demand management has failed, morale at an all-time low and workforce planning botched. The sky is dark with chickens coming home to roost. The NHS is now all about muddling through’. Roy Lilley calls it right. But what is a young graduate or student to do? [link for this post]

So, let me get this right. The NHS wants to stop buying certain drugs from pharma, because they think the benefits do not merit the expense. Now, I regularly buy goods from Waitrose. On review, and after discussing the benefits of the various items with my family, I decide to stop buying the goods. (I had never entered into any long term contract). They just don’t seem worth it anymore. Waitose are not impressed, and say that they spent a lot of money stocking their shelves with said items, together with the 40% of their costs they spend on advertising and wining and dining doctors. They want a judicial review to force me to keep buying their goods. More of Galbraith’s ‘Welfare for the rich’, with tax payers subsidising businesses that can’t innovate in the marketplace. FT report here