Medicine and Science from The BMJ

Non-medical interventions are increasingly being proposed to address wider determinants of health and to help patients improve health behaviours and better manage their conditions - this is known as social prescribing. In England, the NHS Long Term Plan states that nearly one million people will qualify for referral to social prescribing schemes by 2024. In this podcast, Chris Drinkwater, emeritus professor of primary care and Louise Cook, a link worker, both at Newcastle University's Ways to Wellness - who provide social prescribing support. They describe the evidence base for the service, how they work with patients to coordinate their non-medical interventions, and how they measure success. Read the full clinical update: https://www.bmj.com/content/364/bmj.l1285

Change requires the application of power - the way in which individuals can accrue power has shifted in our digitally connected world. Traditional ways of influencing change in healthcare (getting the chief executive on side, having a quiet chat with the medical director) are not the only way to build a momentum. Henry Timms - author of “New Power” the internationally best selling book joins us to talk about about how much of his thinking on these power structures has come from healthcare. https://thisisnewpower.com/ https://twitter.com/hashtag/newpower Henry Timms onstage at the International Forum on Quality and Safety in Healthcare https://livestream.com/IFQSH/Glasgow2019/videos/189271449

Helen Macdonald and Carl Heneghan are back again talking about what's happened in the world of evidence this month. They start by talking about shoulders - what does the evidence say about treating subacromial pain, and why the potential for a subgroup effect shouldn't change our views about stop surgery (for now, more research needed). (16.00) Statins - more uncertainty about statins, this is now looking at older people. Age is a big risk factor for cardiovascular disease - at what point does that risk overwhelm any potential benefit from taking statins? (20.30)Carl explains his rule-of-thumb for turning relative risks into absolute risks, in a way can help doctors talk to patients about new evidence. (25.46)What's the evidence for doctors messes? Carl's rant of the week focuses on the calls (including the BMJ's campaign) to have spaces for doctors to relax in hospitals. He asks, is that better than putting in a gym? What's the evidence for that. Reading list: Subacromial decompression surgery for adults with shoulder pain https://www.bmj.com/content/364/bmj.l294 Efficacy and safety of statin therapy in older people https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext The future of doctor's messes https://www.bmj.com/content/364/bmj.k5367.abstract

As England’s presumed consent law for 2020 clears parliament, Veronica English, head of medical ethics and human rights at the BMA, say that evidence from Wales and other countries shows that it could increase transplantation rates. But Blair L Sadler, physician and senior adviser to California State University, consider such legal changes a distraction lacking strong evidence: they say that public education and trained staff would have a proven impact. We also hear from Erin Walker, the recipient of 2 liver transplants, about her concerns on families over-ruling donor's wishes. Read the full debate, and Erin's commentary: https://www.bmj.com/content/364/bmj.l967

It can be difficult to know what to do when a person in severe psychological distress presents to a general practice or community clinic, particularly if they are behaving aggressively, or if they are refusing help. Most patients who are acutely disturbed present no danger to others, however situations can evolve rapidly. Frontline staff need to know how to call for help, how to assess and manage physical risk, and how to de-escalate such situations. In this podcast Aileen O’Brien, reader in psychiatry and education at St George’s University of London joins us to give some advice on what to do in that situation - why deescalation is useful, and who else to involve. We also hear from someone who lives with bipolar disorder, and has had experiences of being acutely unwell in a public places, which have lead to police and psychiatric intervention. Read the full practice article: https://www.bmj.com/content/364/bmj.l578

In every generation there are a few that know the secret; the counterintuitive effects of loop diuretics. In this podcast Steven Anisman, cardiologist at the Dartmouth Hitchcock Department of Cardiovascular Medicine, joins us to explain about the threshold effects of these drugs, and why that might change the way in which you think about prescribing them. Read the full article on treatment of oedema with loop diuretics, and contribute to the discussion: https://www.bmj.com/content/364/bmj.l359

Renza Scibilia and Chris Aldred have diabetes, and their introduction to the idea of complications arising from the condition were terrifying. Because of this early experience, and Chris's later development of complications, they have campaigned to make doctors really think about the way in which they talk about complications with patients. Challenging the use of "non-compliant" and other stigmatising language. Chris has also documented his experience of developing an ulcer, and having it successfully treated, on social media, to open up the conversation and make us all #talkaboutcomplications. Chris Aldred is @grumpy_pumper on twitter, and blogs at http://www.the-grumpy-pumper.com. Renza Scibilia is @RenzaS on twitter and blogs at https://diabetogenic.wordpress.com/

In 2014, Oliver Johnson was a 28 year old British doctor, working on health policy in Sierre Leone after finishing medical school. Also working in Freetown was Sinead Walsh, then the Irish Ambassador to the country. Then the biggest outbreak of Ebola on record happened in West Africa, starting in Guinea and quickly spreading to Liberia, Sierre Leone and Nigeria. Oliver and Sinead have co-authored a book about the change that wrought on their lives, how they stepped into roles coordinating the international response to the disease and running a treatment centre. They join us today to talk about their experiences there. For more information about Ebola, including the current outbreak in the Democratic Republic of Congo visit https://www.bmj.com/ebola. For Sinead and Oliver's book - Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline is available now. https://www.amazon.co.uk/dp/B07DFLFF9P/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

If you've been keeping up to day with The BMJ - online on in print, you might have noticed that we've got a new type of article - NIHR Signals - and they are here to give busy clinicians a quick overview of practice changing research that has come out of the UK's National Institute for Health Research. Tara Lamont, director of the NIHR dissemination centre, joins us to talk a bit more about the research underpinning these articles. You can find the full list of articles: https://www.bmj.com/NIHR-signals

More doctors are choosing to retire early, doctors who take career breaks find it hard to return to practice, and doctors at all stages of their careers are frustrated by the lack of support given to training and development in today’s NHS. Each year the BMJ holds a roundtable discussion at the Nuffield Summit - where health leaders come together to talk about the NHS. We wanted to know what more the NHS can do to provide fulfilling careers for staff and to improve support for doctors who want to keep working and those seeking to return to practice. Taking part in the discussion were: Tom Moberly - UK editor for The BMJ Rahkee Shah - paediatric registrar Ronny Cheung - consultant general paedatrician Claire Lemer - consultant paediatrician Candace Imison - Director of Workforce Strategy at the Nuffield Trust James Morrow - GP partner