Medicine and Science from The BMJ

In the previous episodes of Doctor Informed, we've heard why it's so important to talk about patient safety concerns, and some of the mechanisms that allow hospital staff to raise them, but knowing why and how doesn't always make it easier to speak out. In this episode we're exploring the concept of a voiceable concern – identifying what counts as a concern, and what counts as an occasion for voice by an individual, is not a straightforward matter of applying objective criteria- for example how do you tell if you're witnessing poor practice, or just something that lies outside your area of understanding? Or how do you know if the common practice in this particular ward is actually an outlier when looking at other hospitals? Our guests this week; Mary Dixon-Woods is director of THIS Institute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients. Zoe Fritz is a consultant in acute medicine at Cambridge University Hospitals NHS Foundation Trust, she is also a Wellcome Fellow in society and ethics at THIS Institute, investigating how we communicate and record uncertainty around diagnosis. Reading: https://pubmed.ncbi.nlm.nih.gov/34978470/ www.bmj.com/podcasts/doctorinformed/ https://www.thisinstitute.cam.ac.uk/podcast/

Rachel Levine Trained as a paediatrician, before becoming firstly the state of Pennsylvania's Physician General, then its Health Secretary. During president Joe Biden's administration, she was nominated to become the U.S.'s assistant secretary of health. That lead to her becoming a four-star admiral in the U.S. Public Health Service Commissioned Corps, and thus the first openly transgender four-star officer in the US. In this podcast, we discussed the pandemic - but also wider problems affecting Americans' health, notably climate change, inequality and the opioid crisis. We also discuss the health and care of LGBT+ people, in the U.S, and around the world. This interview was recorded on the 16th of December 2021.

The BMJ has special criteria for considering Christmas research: first it should make you laugh, and then it should make you think. In this festive episode of the Talk Evidence podcast, our regular panel of Helen Macdonald and Joe Ross are again joined by Juan Franco, editor in chief of BMJ Evidence Based Medicine. They’ll give you a peek into what makes for good Christmas research, and why what may seem silly on the surface has a deeper meaning.

As clinicians, we're all taught that patient safety is everyone's responsibility - but on the ground it can be hard to know how to most effectively report concerns, especially if you're not sure how those concerns will be received. In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore, and they ask "who is actually responsible for patient safety?" To answer that we're joined by 2 guests Bill Kirkup, independent investigator who has worked on the reports into failings in Mid-Staffordshire, and Gosport. Henrietta Hughes - GP, and the NHS's first guardian, Henrietta championed the creation of freedom-to-speak-up guardians in the English NHS, to ensure that clinicians are able to freely speak out.

Fiona Godlee is stepping down as Editor-in-Chief of The BMJ after 16 years in the position. She was the first female editor of the journal, and over her tenure has seen a lot of changes - both to the publication she's run, and to the wider world of medicine. To mark her departure, Helen Macdonald sat down with Fiona to ask her a bit about those early days at the journal, on her view of women taking leadership roles in medicine, on her thoughts about some of the big issues facing science, and what is coming next. Note from the editor; apologies for the audio quality in the first half.

In this second podcast focussing on the covid response in South Asia, we’re focussing on the intersection of conflict and covid in the region. The pandemic has highlighted the underlying weaknesses in many health systems - but could it also be used as a catalyst for change, and be a step towards easing tensions? To discuss this, Kamran Abbasi, executive editor of The BMJ, is joined by Zulfiqar Bhutta, head of the Institute for Global Health and Development, Aga Khan University, and Arun Mitra senior vice president of Indian Doctors for Peace & Development. To read more; Conflict, extremism, resilience and peace in South Asia; can covid-19 provide a bridge for peace and rapprochement? https://www.bmj.com/content/375/BMJ-2021-067384

In this episode of Doctor Informed, Clara Munro is joined by Ayisha Ashmore - and they're getting to grips with being a compassionate colleague. While the topic might seem warm and fuzzy, there's some good hard science to suggest that compassionate leadership at every level of healthcare can make a huge difference to staff, and improve patient outcomes. Most people innately have the skills need to be compassionate colleagues - but often the pressures of the job can make it the lowest of priorities in our everyday interactions. Our two guests this week think that's wrong though - and say that compassionate leadership is one of the most important things to get right. Joining us are, Michael West, senior fellow at The King's Fund and professor of Work and Organisational Psychology at Lancaster, and Bob Klaber, consultant general paediatrician and director of strategy, research and innovation at Imperial College Healthcare NHS Trust Michael has written the book on compassionate leadership in health and social care - https://tinyurl.com/vh55mker. You can read more about Bob's work in his blog - https://www.imperial.nhs.uk/about-us/blog/how-acts-of-kindness-can-improve-care-and-strengthen-teams Ayisha has written about putting some of this all into practice in a maternity setting - https://bmjleader.bmj.com/content/early/2021/11/25/leader-2021-000449

In the wellbeing podcast, the dread topic of phone usage has come up again - how social media, and an "always on" culture can affect our wellbeing. But knowing that, and changing our behaviour are two different things - so to give some advice on reducing our reliance on phones, Abi and Cat are joined by Nidhi Gupta, assistant professor of pediatrics at Vanderbilt University Medical Center, who's been using techniques from behavioural addiction to help with device usage. For more from Nidhi, visit https://phreedom.net/ Some of the research that Nidhi mentions https://publications.aap.org/pediatrics/article/138/5/e20162591/60503/Media-and-Young-Minds A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children https://pubmed.ncbi.nlm.nih.gov/18316661/ Distraction: an assessment of smartphone usage in health care work settings https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/ Treatment Considerations in Internet and Video Game Addiction https://pubmed.ncbi.nlm.nih.gov/29502754/ The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083558

When you hear the reports from a major patient safety issue, it will be shocking to hear how they have played out - but the patterns in behaviour, of people and institutions which have gone disastrously wrong, can be seen throughout healthcare. As this first series of Doctor Informed unfolds, we'll be exploring these patterns, and bring you evidence and expertise on tackling them - Doctor Informed is about going beyond medical knowledge to make you the best doctor you can be. In this first episode we're talking to experts who have seen these patterns firsthand, and whose work is all about tackling them; Bill Kirkup is a clinician turned investigator - he's led investigations into failings at a maternity and neonatal unit in Morcambe Bay, into the Oxford paediatric cardiac surgery unit and into Jimmy Savile’s involvement with Broadmoor Hospital. He was also a member of the Hillsborough Independent Panel Mary Dixon-Woods is director of THIS Insitute, and a Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Her work is concerned with generating a high quality evidence-base to support the organisation, quality and safety of care delivered to patients.

In this month’s Talk evidence, we’re going back to our roots and avoiding covid - so sit back and listen to Helen Macdonald and Joe Ross discuss a new nutrition study to prevent fractures in older adults by eating dairy, and a meta-analysis which helps you choose pain relief medications for management of osteoarthritis. We’ll hear from Steven Woloshin about the virtual Overdiagnosis conference, and why he’s so excited about a new category in the National Library of Medicine. Finally, we have a study on urinary retention and risk of cancer that has been over 25 years in the making. Reading list; Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care https://www.bmj.com/content/375/bmj.n2364 Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis https://www.bmj.com/content/375/bmj.n2321 To access the webinars Steven was talking about. https://www.preventingoverdiagnosis.net/ Acute urinary retention and risk of cancer https://www.bmj.com/content/375/bmj.n2305 Podcast listener survey. Please let us know how we could improve the podcasts for you, and your specialty - https://linktr.ee/BMJsurvey