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Astra arts award
240
General-practitioner prescribing
Astra arts award
The Royal College of General Practitioners’ attempts to improve prescribing habits has included the establishment of prescribing fellowships. J. D. Gilleghan, the prescribing fellow for their
Any improvement in a patient’s quality of life in hospital is an important adjunct to clinical care. Arts projects are good at making the hospital environment more congenial for patients, their families, and staff. Patients in mental health institutions especially benefit (see Lancet Dec 7, p 1452). So, it is perhaps appropriate that entries for the Astra arts award (now in its second year) for 1991 were confined to projects from any mental health institution in the National Health Service. The first prize of 2000 and a set of limited edition prints by the American artist Jim Dine were awarded to the Florence Street Day Hospital, Glasgow, whose exhibition, with contributions from patients and their families and artists, was regarded as an important contribution towards debunking the myth of the "mad house". This year, a second prize was awarded: [1000 went to Earls House Hospital, Durham, for its programme of workshops for residents, banners for the hospital grounds, and an exhibition of painting in Durham Light Infantry
Scottish branch from 1986 to 1989, offers several numerous recommendations with his review1 of prescribing. "Realistic" prescribing, which is based not only on pharmacological principles but also on insight into the social and psychological complexities of the patient, differs somewhat from "rational" prescribing, which is what is taught in medical school. Thus one suggestion is that thought be given to increased use of general practitioners to teach prescribing to medical students and junior hospital doctors. Gilleghan also thinks that training in psychotherapeutic skills and in the use of placebo ought to be increased. His suggestion for helping GPs (and others) derive the maximum benefit from sales representatives is to give them advice on how to assess the information given by these representatives: the West Lothian Drugs and Therapeutic Committee’s Hitchhiker’s Guide to Promotional Literature is cited as an example of how such advice can be given. The arrival of the single market for pharmaceutical products in the European Community could bring with it new problems. The message that Gilleghan has for the UK Government is to impose import restraints on the highly inappropriate combinations of drugs that have already been licensed in some European countries. 1.
Gilleghan JD. Prescribing m general practice. London: Royal College Practitioners. 1991. Pp 36. £7.50 (incl postage). ISBN 0-850841623.
of General
Prolific writers A medical research-worker from overseas, finding himself alone in London on Christmas Day, was pleased to be invited to the festive table of his project supervisor. With the plum pudding sitting uneasily on stomach linings unused to such things he was horrified to hear "Come on then, there’s time to dash off another paper before tea and cake". Writers of such devotion surely deserve their own prizes, and the database at the Institute of Scientific Information in Philadelphia has come up with a bizarre competition that looks tailor-made. Heading the world’s most prolific researchers (writers) is Moscow crystallographer Yury Struchkov with a paper out every 4 days on average in 1981-90. S. R. Bloom snaps at Struchkov’s heels with a paper every 5 days-indeed, medicine is well represented in this list, with more than half the entries. T. J. Peters scrapes into the top twenty at a miserable 32 a year. Some medical fraudsters have been noted, with hindsight, to have been suspiciously prolific, and medical journal editors are tightening up on definitions of authorship. Understandably, therefore, those in the top twenty interviewed for N ature1 tended to the defensive. Julia Polak, coming in eighth with 436, declares adherence to current criteria; so does David ("I do the work with my own two hands") Greenblatt at 383; while Anthony Fauci at no 17 has heen taking his name off papers "more than ever". 1. Anderson C. Writer’s cramp. Nature
1992; 355: 101.
Help for sick doctors A rising prevalence of disease is not, in general, good news, but Dr Sidney Brandon sees the slow but steady rise in the number of referrals to the National Counselling Service for Sick Doctors as an indication that more doctors-but still too few-are aware that help is at hand if they need it. In its first year, 1985-86, the service had 133 referrals; in 1990-91 it had 204. Dr Brandon, who recently took over from Prof Kenneth Rawnsley as chairman of the service, thinks that many sick doctors, especially those who are dependent on alcohol or drugs, are still reluctant to seek help locally and may not know where else to turn. The counselling service offers confidential advice informally, without coercion, and from outside the doctor’s home area. Any doctor who is worried about a sick colleague or about his own health may approach the service at 3rd Floor, 26 Park Crescent, London WIN 3PB (telephone 071-580 3160).
Museum. For more information about arts projects in hospitals contact Malcolm Miles, British Health Care Arts Centre, Duncan of Jordanstone College of Art, 13 Perth Road, Dundee DDI4HT, UK.
In
England Now
I have a slightly eccentric but entertaining acquaintance with whom I have maintained contact since I left Norfolk many years ago. A year or so ago he mentioned that he had fallen from his roof and injured his shoulder, and in succeeding letters he described a slow but painful improvement. Despite my exhortations he refused to see a doctor. Fifteen months after the incident I found myself not far from his remote cottage after a day’s birdwatching beneath those vast Broadland skies. I called on him, and he was delighted to see me. We talked for an hour or two, of birds and beasts and Broadland characters, many now gone but still fresh in our minds. His shoulder injury did not seem to inconvenience him, and he was able to shake hands without pain, but as I was about to leave he asked me if I would look at his arm. I did not have time to refuse: in a few seconds he was stripped to the waist, so I figured there was not much wrong. But examination revealed a great deal wrong. There was gross wasting of his deltoid, so the shoulder had no round contour. Passive movements were almost full, but active movements were limited to raising his arm to the horizontal. If I lifted it above that it immediately fell down. Furthermore abduction of the arm was accomplished without any movement of the head of the humerus, which could be palpated in its proper place. I concluded that he had sustained a fracture of the neck of the humerus, possibly with injury to the axillary nerve, and he now had a pseudoarthrosis. He is seventy, very independent, and prefers to avoid doctors except for itinerant birdwatching physicians who call unexpectedly. There could be no worse surgical patient. He is relatively free of pain now, has a functional arm (he is even using his gun and described how he had despatched an injured fox he had found dragging itself down the road), and is not greatly incapacitated. An X-ray would have been nice to confirm the diagnosis; but that would have meant seeing a doctor, and I told him to keep well away in case someone would be tempted to interfere and might make
things worse. But, if one is looking for clinical cases for the final FRCS, Norfolk is a good source of the sort of pathology which one might think only occurs in textbooks. And a trip to London, with expenses paid, would be reward enough for these Norfolk characters, some of whom still don’t normally venture even as far as Norwich, except once a year for the Norfolk Show. *
*
*
The case report before the meeting contained the statement: "Her bowels had been open one and a half times during that day with liquid stools". While the physicians debated the possible causes of the diarrhoea, it was as usual left to our epidemiologist to question the statistics.
General-practitioner prescribing
Astra arts award
The Royal College of General Practitioners’ attempts to improve prescribing habits has included the establishment of prescribing fellowships. J. D. Gilleghan, the prescribing fellow for their
Any improvement in a patient’s quality of life in hospital is an important adjunct to clinical care. Arts projects are good at making the hospital environment more congenial for patients, their families, and staff. Patients in mental health institutions especially benefit (see Lancet Dec 7, p 1452). So, it is perhaps appropriate that entries for the Astra arts award (now in its second year) for 1991 were confined to projects from any mental health institution in the National Health Service. The first prize of 2000 and a set of limited edition prints by the American artist Jim Dine were awarded to the Florence Street Day Hospital, Glasgow, whose exhibition, with contributions from patients and their families and artists, was regarded as an important contribution towards debunking the myth of the "mad house". This year, a second prize was awarded: [1000 went to Earls House Hospital, Durham, for its programme of workshops for residents, banners for the hospital grounds, and an exhibition of painting in Durham Light Infantry
Scottish branch from 1986 to 1989, offers several numerous recommendations with his review1 of prescribing. "Realistic" prescribing, which is based not only on pharmacological principles but also on insight into the social and psychological complexities of the patient, differs somewhat from "rational" prescribing, which is what is taught in medical school. Thus one suggestion is that thought be given to increased use of general practitioners to teach prescribing to medical students and junior hospital doctors. Gilleghan also thinks that training in psychotherapeutic skills and in the use of placebo ought to be increased. His suggestion for helping GPs (and others) derive the maximum benefit from sales representatives is to give them advice on how to assess the information given by these representatives: the West Lothian Drugs and Therapeutic Committee’s Hitchhiker’s Guide to Promotional Literature is cited as an example of how such advice can be given. The arrival of the single market for pharmaceutical products in the European Community could bring with it new problems. The message that Gilleghan has for the UK Government is to impose import restraints on the highly inappropriate combinations of drugs that have already been licensed in some European countries. 1.
Gilleghan JD. Prescribing m general practice. London: Royal College Practitioners. 1991. Pp 36. £7.50 (incl postage). ISBN 0-850841623.
of General
Prolific writers A medical research-worker from overseas, finding himself alone in London on Christmas Day, was pleased to be invited to the festive table of his project supervisor. With the plum pudding sitting uneasily on stomach linings unused to such things he was horrified to hear "Come on then, there’s time to dash off another paper before tea and cake". Writers of such devotion surely deserve their own prizes, and the database at the Institute of Scientific Information in Philadelphia has come up with a bizarre competition that looks tailor-made. Heading the world’s most prolific researchers (writers) is Moscow crystallographer Yury Struchkov with a paper out every 4 days on average in 1981-90. S. R. Bloom snaps at Struchkov’s heels with a paper every 5 days-indeed, medicine is well represented in this list, with more than half the entries. T. J. Peters scrapes into the top twenty at a miserable 32 a year. Some medical fraudsters have been noted, with hindsight, to have been suspiciously prolific, and medical journal editors are tightening up on definitions of authorship. Understandably, therefore, those in the top twenty interviewed for N ature1 tended to the defensive. Julia Polak, coming in eighth with 436, declares adherence to current criteria; so does David ("I do the work with my own two hands") Greenblatt at 383; while Anthony Fauci at no 17 has heen taking his name off papers "more than ever". 1. Anderson C. Writer’s cramp. Nature
1992; 355: 101.
Help for sick doctors A rising prevalence of disease is not, in general, good news, but Dr Sidney Brandon sees the slow but steady rise in the number of referrals to the National Counselling Service for Sick Doctors as an indication that more doctors-but still too few-are aware that help is at hand if they need it. In its first year, 1985-86, the service had 133 referrals; in 1990-91 it had 204. Dr Brandon, who recently took over from Prof Kenneth Rawnsley as chairman of the service, thinks that many sick doctors, especially those who are dependent on alcohol or drugs, are still reluctant to seek help locally and may not know where else to turn. The counselling service offers confidential advice informally, without coercion, and from outside the doctor’s home area. Any doctor who is worried about a sick colleague or about his own health may approach the service at 3rd Floor, 26 Park Crescent, London WIN 3PB (telephone 071-580 3160).
Museum. For more information about arts projects in hospitals contact Malcolm Miles, British Health Care Arts Centre, Duncan of Jordanstone College of Art, 13 Perth Road, Dundee DDI4HT, UK.
In
England Now
I have a slightly eccentric but entertaining acquaintance with whom I have maintained contact since I left Norfolk many years ago. A year or so ago he mentioned that he had fallen from his roof and injured his shoulder, and in succeeding letters he described a slow but painful improvement. Despite my exhortations he refused to see a doctor. Fifteen months after the incident I found myself not far from his remote cottage after a day’s birdwatching beneath those vast Broadland skies. I called on him, and he was delighted to see me. We talked for an hour or two, of birds and beasts and Broadland characters, many now gone but still fresh in our minds. His shoulder injury did not seem to inconvenience him, and he was able to shake hands without pain, but as I was about to leave he asked me if I would look at his arm. I did not have time to refuse: in a few seconds he was stripped to the waist, so I figured there was not much wrong. But examination revealed a great deal wrong. There was gross wasting of his deltoid, so the shoulder had no round contour. Passive movements were almost full, but active movements were limited to raising his arm to the horizontal. If I lifted it above that it immediately fell down. Furthermore abduction of the arm was accomplished without any movement of the head of the humerus, which could be palpated in its proper place. I concluded that he had sustained a fracture of the neck of the humerus, possibly with injury to the axillary nerve, and he now had a pseudoarthrosis. He is seventy, very independent, and prefers to avoid doctors except for itinerant birdwatching physicians who call unexpectedly. There could be no worse surgical patient. He is relatively free of pain now, has a functional arm (he is even using his gun and described how he had despatched an injured fox he had found dragging itself down the road), and is not greatly incapacitated. An X-ray would have been nice to confirm the diagnosis; but that would have meant seeing a doctor, and I told him to keep well away in case someone would be tempted to interfere and might make
things worse. But, if one is looking for clinical cases for the final FRCS, Norfolk is a good source of the sort of pathology which one might think only occurs in textbooks. And a trip to London, with expenses paid, would be reward enough for these Norfolk characters, some of whom still don’t normally venture even as far as Norwich, except once a year for the Norfolk Show. *
*
*
The case report before the meeting contained the statement: "Her bowels had been open one and a half times during that day with liquid stools". While the physicians debated the possible causes of the diarrhoea, it was as usual left to our epidemiologist to question the statistics.