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‘More than half of my paycheck goes to rent’: young US doctors push to unionise

Young doctors just out of medical school working as resident physicians, fellows and interns at major US hospitals are organising unions at an increasing rate, citing long-running problems highlighted by the Covid-19 pandemic and a need to rethink the struggles young doctors face in the profession.

The Committee of Interns and Residents, an affiliate of SEIU, added five unionised sites in 2022 compared with about one a year before the pandemic and the surge has continued in 2023 with multiple union election filings. It currently represents over 25,000 residents, fellows and interns across the US, comprising about 15% of all resident and fellow physicians.

Hospital management has opposed the unionisation effort, declining to voluntarily recognise the union, encouraging residents not to sign union authorisation cards ahead of the election filing and writing local op-eds in opposition to unionisation.

Since going public with their union plans, staff have been sent emails and been invited to meetings to try to dissuade residents from unionising, “often counting on myths around what unionizing would mean”, said Dr Sascha Murillo, a third-year internal medicine resident at Massachusetts general hospital.

The unionising campaign took off after vulnerabilities in the healthcare system were exposed by the Covid-19 pandemic, she said, with residents working on the frontlines and bearing the brunt of staffing shortages, an influx of Covid-19 patients, and patients who deferred medical care.

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Source: The Guardian, 27 April 2023

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‘Misogyny’ and ‘medical patriarchy’ widespread at major trust, reports find

A major teaching trust is dominated by a “medical patriarchy”, while “misogynistic behaviour” is a regular occurrence, two investigations have discovered. 

Two reports into University Hospitals Birmingham Foundation Trust  have been published. They are the outcome of an investigation into the trust’s leadership carried out by NHS England, and an oversight review by former NHSE deputy medical director Mike Bewick.

They follow major concerns being raised over recent months about safety, culture, and leadership at the trust.

The NHSE review said the trust “could do more to balance the medical patriarchy that dominates” the organisation. It noted consultants are invited to observe a chief executive’s advisory group meeting, but nursing, midwifery and allied health professional leaders are not.”

On culture, NHSE said the trust should take steps to ensure staff can work in psychologically safe environments where “poor behaviours are consistently addressed” and to “eradicate bullying and cronyism at all levels of the organisation”. Staff had described “inequity and cronyism” being a feature of recruitment processes at all levels.

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‘Misleading’ A&E figures in England hiding poor performance

NHS bosses are using misleading figures to hide dangerously poor performance by A&E units in England against the four-hour treatment target, emergency department doctors claim.

Some A&Es treat and admit, transfer or discharge as few as one in three patients within four hours, although the NHS constitution says they should deal with 95% of arrivals within that timeframe.

How well or poorly A&Es are doing in meeting the 95% target is not in the public domain because the data that NHS England publishes is for NHS trusts overall, not individual hospitals.

That means official figures are an aggregate of performance at sometimes two A&Es run by the same trust or include data for any walk-in centres, minor injuries units or urgent treatment centres that a trust also operates. Forty-eight trusts have two A&Es and many also run at least one of the latter.

The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, wants that system scrapped. It is urging NHS England to start publishing data that shows the true performance of every individual emergency department against the 95% standard.

“The current data is misleading,” Dr Adrian Boyle, the college’s president, told the Guardian. “It’s a good example of a lack of transparency and also of performance incentives. Being open about the long delays in some A&Es would shine a light in some dark places.”

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Source: The Guardian. 28 October 2023

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‘Menu of neglect’: preventative care hits cliff as US health resources diverted to fight Covid

Health resources diverted to fight the COVID-19 pandemic have caused a major drop in critical preventative care in the US, including childhood vaccinations and lead screenings, sexually transmitted disease testing and substance abuse services.

In short, many of the routine measures meant to keep Americans healthy – and keep American health from slipping further behind that of other developed, peer nations – have hit a worrying cliff.

As attention has focused on the immediate crisis of the pandemic and the hundreds of thousands of lives lost in America, this other hidden crisis represents another layer of disaster that also has profound implications.

“This is either the second or first worst pandemic in modern human history,” said Dr Howard Markel, a pandemic historian and pediatrician at the University of Michigan. “We knew there would be repercussions and unintended consequences.”

Now, there is a “whole menu of neglect” to address as a national vaccine campaign allows people to slowly emerge from a year of lockdowns and social distancing. “There is no historical precedent for this,” added Markel.

In the first few months of the pandemic alone, at least 400,000 children missed screenings for lead, a toxic heavy metal. Doctors and nurses ordered 3m fewer vaccines for children and 400,000 fewer for measles specifically.

For the first time, clinics were forced to ration lab tests for sexually transmitted diseases as lab capacity and supplies were diverted to test for COVID-19. Contact tracers were also re-deployed from tracking chlamydia, gonorrhea and syphilis cases to finding people in contact with COVID-19 patients.

Data from one large commercial lab showed 669,000 fewer HIV tests were processed. Compared to 2019, the lab diagnosed nearly 5,000 fewer cases of HIV. Delayed diagnosis can lead to people unwittingly transmitting the virus.

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Source: The Guardian, 26 April 2021

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‘Medically fit’ patients caught covid while waiting for discharge, trust admits

A hospital trust has admitted that ‘medically fit’ patients caught covid on its wards while waiting to be discharged, with some of the cases under investigation.

Bedfordshire Hospitals FT board papers said that a “number” of medically fit patients “acquired [covid] infection while awaiting appropriate and safe discharge”.

Trusts nationwide have struggled to discharge patients as quickly as they wanted, the reasons including a Department of Health and Social Care mandate to only allow designated care homes to accept covid patients; the resumption of NHS Continuing Healthcare tests; shortages of community beds; and capacity in the care sector.

The trust, formed in April by the merger of Luton and Dunstable University Hospital FT and Bedford Hospital FT, said a “significant proportion of [its covid] cases [were] due to acquisition in the hospital”.

It continued: “A significant additional factor was the length of stay for many patients who were medically fit for discharge but were unable to return to their place of residence. Case reviews have shown that a number of these patients acquired infection while waiting appropriate and safe discharge.”

The board papers said its covid serious incident reviews covered “some deaths on both sites… and the majority [were] patients with very severe co-morbidity”. It said six out of 15 serious incidents being investigated at its Bedford hospital site were “of potentially avoidable nosocomial covid infection (hospital acquired)”.

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Source: HSJ, 4 Februrary 2021

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‘Massively reduced’ length of stay emerging at much criticised new hospital, says CEO

The CEO of a troubled trust has said evidence is emerging of ‘massively reduced’ length of stay in a new hospital criticised for being too small.

Emergency staff have raised concerns about a lack of space and bed capacity at the new Royal Liverpool Hospital, which opened in October, as services have come under severe pressure this winter. The new building, on a next-door site to the old hospital, has fewer beds, although more have opened elsewhere in the city.

In an interview with HSJ, Liverpool University Hospitals Foundation Trust chief executive officer James Sumner acknowledged aspects of the new building have created difficulties, including in relation to accident and emergency configuration and capacity, but added the move’s benefits are beginning to be seen.

He said a new care model and single rooms throughout the whole hospital are helping to reduce length of stay, as well as eliminating bed closures due to infection outbreaks.

He said: “We’ve got really good evidence of massively reduced length of stay in this new building, [with] about 70 fewer people every day waiting over seven, 14 and 21 days in hospital.

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Source: HSJ, 1 February 2023

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‘Many, many’ Australian doctors advertising as general physicians without required qualifications

Some doctors in Australia are using the title “specialist general physician” despite not having completed the training required by law, potentially misleading patients with complex and chronic health conditions that require specialised care, physicians say.

After completing a medical degree and postgraduate work experience, graduates can apply to the Royal Australasian College of Physicians (RACP) fellowship training program. All RACP trainees complete similar foundational training before choosing areas of advanced training to specialise in such as geriatrics, cardiology, general medicine or other areas.

General physicians are different from general practitioners (also known as GPs). General physicians care for patients with unusual or complex conditions and see patients either in hospital or those who are referred to them, usually by the patient’s GP.

Medical practitioners can only use titles such as “specialist general physician”, “specialist geriatrician” or “specialist cardiologist” if they have completed the advanced specialist RACP training in the corresponding field of practice and have registered with the Australian Health Practitioner Regulation Agency (Ahpra).

But Dr Jenna Paterson, a specialist general physician working in Victoria and South Australia, said there are “many, many” doctors who advertise their services to patients as a “general physician” without the qualifications to do so.

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Source: The Guardian, 13 June 2023

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‘Low priority’ community cases to be deferred as staff redeployed

NHS England has told local systems to defer ‘low priority’ cases across 11 community services, because of the pressures created by the omicron wave. 

NHSE has issued guidance for the prioritisation of the community health workforce “given the increasing pressures on the health system due to the omicron wave of COVID-19 this winter and the need to provide booster jabs as quickly as possible”.

It is hoped the guidance will encourage the redeployment of community staff to help reduce the strain on acute services.

Staff working in musculoskeletal services are being asked to deprioritise some low priority rehabilitation work, with patients enabled to self-manage at home.

It adds: “Where possible, provide capacity to support other community resources focused on rehabilitation and recovery for those discharged from acute care and those whose functioning is deteriorating at home, and/or the administration of vaccines.”

A host of other services have been advised to continue, but with “prioritised” waiting lists and a deferral of provision considered for “low priority cases” to “free up workforce capacity”, including children’s therapy interventions, children’s community paediatric services and audiology services for older adults.

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Source: HSJ, 11 January 2022

 

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‘Longest ever strike’ announced by junior doctors for next month

Junior doctors will take part in what is “thought to be the longest single period of industrial action in the history of the health service” for five days next month.

The British Medical Association junior doctor committee announced this morning there would be a walkout from 7am on Thursday 13 July and 7am on Tuesday 18 July in its ongoing pay dispute with government.

It comes amid growing expectation that a Royal College of Nursing ballot on further strike action over the Agenda for Change pay award, which ends this week, is likely to fail to secure a mandate.

But junior doctors’ strikes are continuing to hit elective recovery, and strain relationships, with workload on other groups increased as they are asked to provide cover. 

Junior doctors have allowed no “derogations” (exemptions) from the action, as they say other staff groups can cover emergency care, and one move to call them in to a busy hospital in the south west, in an earlier round, was abandoned. 

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Source: HSJ, 23 June 2023

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‘Long-COVID’ in our community – new call for research proposals

Up to £20 million is available for new research projects which aim to understand and address the longer-term physical and mental health effects of COVID-19 in non-hospitalised individuals. 

Increasing medical evidence and patient testimony has shown that some people who contract and survive COVID-19 may develop longer-lasting symptoms.

Symptoms can range from breathlessness, chronic fatigue, ‘brain fog’, anxiety and stress and can last for months after initially falling ill. 

These ongoing problems, commonly termed ‘Long-COVID’, may be experienced by patients regardless of how severe their COVID-19 infection was and irrespective of whether they were hospitalised.

UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR) are launching a call to fund two or three ambitious and comprehensive proposals and a small number of study extensions that will address ‘Long-COVID’ in the community. 

This work will complement other major studies already funded by UKRI and NIHR which focus on long covid in hospitalised patients. Projects are expected to start early in the new year and may be funded for up to three years in the first instance.

The call will open on 12 November and close on 9 December 2020.

Further information

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‘Long flu’: study finds flu patients at higher risk of longer-term illness

People who have been hospitalised with flu are at an increased risk of longer-term health problems, similar to those with long Covid, data suggests.

While the symptoms associated with such “long flu” appear to be more focused on the lungs than ongoing Covid symptoms, in both cases the risk of death and disability was greater in the months after infection than in the first 30 days.

“It is very clear that long flu is worse than the flu, and Long Covid is worse than Covid,” said Dr Ziyad Al-Aly, a clinical epidemiologist at Washington University in St Louis, Missouri, who led the research.

He was motivated to study the phenomenon after observing the scale of long-term illness experienced by people who have recovered from Covid.

“Five years ago, it wouldn’t have occurred to me to examine the possibility of a ‘long flu.’ But one of the major lessons we learned from this pandemic is that a virus we all initially thought could only cause acute disease is leaving millions of people with long Covid, he said. “We wondered whether this could be happening with other things. Could this be happening with the flu, for example?”

The research, published in the Lancet Infectious Diseases, found that while Covid patients faced a greater risk of death or hospital readmission in the following 18 months, both infections carried a significant risk of ongoing disability and disease.

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Source: The Guardian, 14 December 2023

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‘Long covid’ clinics still not operating despite Hancock claim

The government and NHS England appear unable to identify units set up to treat ‘long covid’, contrary to a claim by Matt Hancock in Parliament that the NHS had ‘set up clinics and announced them in July’. 

There are growing calls for wider services to support people who have had COVID-19 and continue to suffer serious follow-up illness for weeks or months. Hospitals run follow-up clinics for those who were previously admitted with the virus, but these are not generally open to those who were never admitted.

Earlier this month the health secretary told the Commons health committee: “The NHS set up long covid clinics and announced them in July and I am concerned by reports from Royal College of General Practitioners that not all GPs know how to get into those services.”

Asked by HSJ for details, DHSC and NHS England declined to comment on how many clinics had been set up to date, where they were located, how they were funded or how many more clinics were expected to be “rolled out”.

However, two charities and support groups — Patient Safety Learning and the Long Covid Support Group — told HSJ they were not aware of dedicated long covid clinics for community patients. An enquiry from Patient Safety Learning to NHS England has not been answered.

The number of people affected by long covid is unclear due to a lack of research but there are suggestions it could be half a million or more. Symptoms can include fatigue, sleeplessness, night-time hypoxia, “brain fog” and cardiac problems. It appears to affect more people who were not hospitalised with coronavirus than those who were were. There is some evidence that small clinics have been set up locally on a piecemeal basis, without national funding.

HSJ has only been able to identify only one genuine “long covid clinics” open to those who have never been in hospital with covid. 

Trisha Greenhalgh, an Oxford University professor of primary care health sciences who has interviewed around 100 long covid sufferers, told HSJ: “Nobody I have interviewed had been seen in a long covid clinic but there is an awful lot of people who would like to be referred and who sound like the need to be but they haven’t.”

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Source: HSJ, 23 September 2020

Read the letter Patient Safety Learning sent to NHS England

hub Community thread - Long Covid: Where are these clinics?

 

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‘Long covid’ – The under-the-radar coronavirus cases exhausting thousands

We’re swiftly learning the symptoms of Covid-19 may last longer than previously thought. One in 10 people are reporting a longer tail of symptoms, which exceeds the suggested two-week recovery time.

It’s thought around 30,000 people in the UK could be impacted by a prolonged version of the illness – what some are calling ‘long covid’. These people are months into their recovery from the virus and still fighting a range of persistent symptoms. In some cases, the symptoms disappear for a while before coming back. In others, they’re gradually improving over time.

Research from the Covid-19 Symptom Study in the UK, led by Professor Tim Spector of King’s College London, shows after three weeks of first reporting symptoms, a group of people continue to experience fatigue, headaches, coughs, loss of smell, sore throats, delirium and chest pain.

People with mild cases of the disease are more likely to have a wide range of symptoms that come and go over an extended period, Prof Spector found. And these people are often flying under the radar because they’re not in hospital.

Those who believe they’ve had ‘long covid’ are now calling on the government to recognise their plight, invest in research and put support in place.

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Source: Huffpost, 2 July 2020

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‘Living with Covid plan’ will hamper NHS patient care, doctors warn as restrictions lift

Senior doctors say the government’s “Living with Covid” plan will hamper the ability of the NHS to provide care.

Michelle Drage, chief executive of the Londonwide Local Medical Committee, which represents the majority of practices in the city, has said the government’s changes may discourage vulnerable patients to seek care when they need it, while David Nicholl, a neurologist and spokesperson for Doctors’ Association UK, said it could exacerbate health inequalities.

It comes as the legal requirement to isolate after testing positive is lifted from Thursday, while free Covid testing ends on 1 April.

NHS England sent a letter to all healthcare providers confirming workers would have to continue with current rules and not come into work after testing positive.

Staff were told they should continue to carrying out regular testing, and access this through national routes until 31 March, but were not given guidance on testing requirements beyond this.

Dr Drage said the changes in isolation and testing rules could put off vulnerable patients.

“We may well see people not being able to access the services they need to because they’re afraid to attend,” she said.

“Then to make people pay for those tests for what looks like a fiver a pop, when the people that can least afford it and the people who can least afford to take time off... suggests to me we’re increasing the risk of inappropriate transmission.”

“It’s a perfect storm that could be brewing that will have a further impact on the ability of patients to be properly cared for… It feels like, yet again, the government gambling with people’s health to sustain the economy.”

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Source: The Independent, 25 February 2022

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‘Lives at risk’ in Britain’s crumbling hospitals

Patients’ lives are at risk because NHS hospitals have been allowed to crumble into disrepair, with ceilings collapsing and power cuts disrupting surgery.

The number of clinical incidents linked to the failure to repair old buildings and faulty equipment has tripled in the past five years, an investigation by The Times found.

Hundreds of vital NHS operations and appointments are being cancelled as a result of outdated infrastructure, undermining attempts by doctors to tackle record waiting lists.

Recent incidents include an unconscious patient on a ventilator being trapped in a broken lift for 35 minutes and power running out as a patient lay in an operating theatre.

On Saturday, April 23, a five-hour power cut at the Royal London Hospital in east London led to the cancellation of operations including two lifesaving kidney transplants, and meant women giving birth had to be transferred to different maternity units in the backs of taxis.

Hospitals have also recorded hundreds of rat and pest infestations, and some rooms containing patients have been left “overflowing with raw sewage”.

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Source: The Times, 2 May 2022

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‘Little evidence’ whether or not most antidepressants work for chronic pain

Antidepressants commonly used to treat chronic pain lack evidence as to whether or not they work, researchers have said, declaring the situation a global public health concern.

Chronic pain, typically defined as pain lasting three months or more, is a widespread problem affecting up to one in three people, with conditions ranging from osteoarthritis to fibromyalgia.

While exercise is often recommended, this is difficult for some patients, while there are concerns that opioids and other painkillers such as aspirin and paracetamol could do more harm than good.

Increasing numbers of patients are prescribed antidepressants to treat their pain, with hundreds of thousands in the UK estimated to be taking amitriptyline. Antidepressants affect chemicals known as neurotransmitters, which is how they are thought to relieve pain.

But a new Cochrane review, led by Prof Tamar Pincus, professor in health psychology at the University of Southampton, has revealed there is little evidence whether or not amitriptyline and many other common antidepressants work when it comes to tackling chronic pain.

“The fact that we don’t find evidence whether it works or not, is not the same as finding evidence that it doesn’t work,” she said. “We don’t know. The studies simply are not good enough.”

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Source: The Guardian, 10 May 2023

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‘Life threatening’ risk to clinically vulnerable after firms disconnect energy supply, warns NHS chief

A senior NHS leader has warned of a “life-threatening” situation in which clinically vulnerable people are being admitted to hospital after having their energy supplies disconnected.

Sam Allen, chief executive of North East and North Cumbria Integrated Care Board (ICB), has written to Ofgem today to raise “serious concerns” that vulnerable people have seen their electricity or gas services disconnected as a result of non-payment.

In the letter, which the ICB has published on its website, Ms Allen said the impact of energy supplies being cut off “will be life threatening for some people” and place additional demand on already stretched health and social care services.

She wrote: “It has come to light that we are starting to see examples where clinically vulnerable people have been disconnected from their home energy supply which has then led to a hospital admission.

“This is impacting on people who live independently at home, with the support from our community health services team and are reliant on using electric devices for survival.

“An example of this is oxygen; and there will be many other examples. There is also a similar concern for clinically vulnerable people with mental health needs who may find themselves without energy supply.

“Put simply, the impact of having their energy supply terminated will be life threatening for some people as well as placing additional demands on already stretched health and social care services.”

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Source: HSJ, 5 September 2022

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‘Legally wrong’ to make pregnant women with Covid give birth alone

NHS guidance which often forces pregnant women who test positive with coronavirus to give birth alone is legally wrong, lawyers warned.

Official guidance drawn up by NHS England states that if a woman tests positive for Covid, their husband or partner must self-isolate at home and is not allowed to support them during childbirth.

But campaigners and lawyers told The Independent their guidance for visitor restrictions in maternity services during the pandemic is legally inaccurate as people have the “right to private and family life” under Article Eight of the Human Rights Act.

Maria Booker, of Birthrights, a leading maternity care charity, said: “The NHS oversimplifies the government’s self-isolating Covid regulations and tells partners they have to stay at home. But this hasn’t taken into account the legal nuance that government rules state people can leave home if they have a reasonable excuse."

“A woman being anxious about giving birth alone, which most people will be, is likely to legally constitute as a reasonable excuse."

“It is completely inhumane for a woman to give birth without a partner or supporter. It is even scarier giving birth alone you are Covid positive. It is terrifying. Nobody should give birth alone and that includes Covid positive women.”

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Source: The Independent, 13 February 2021

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‘Lack of respect’ for children at ‘inadequate’ hospital

Staff failed to provide kind and compassionate care and did not treat children with respect at a private hospital downgraded from ‘good’ to ‘inadequate’, a report by health inspectors has revealed.

Huntercombe Hospital Stafford was placed in special measures in 2016, but was rated “good” by the Care Quality Commission two years later.

Now, its first inspection under provider Huntercombe Young People Ltd in October 2021 has exposed a raft of safety concerns and instances of poor care. Huntercombe Young People Ltd took over the service in February 2021. 

Heavy reliance on agency staff, workers spotted with their “eyes closed” on observations, and staff not respecting young people’s pronouns were among concerns inspectors flagged.

Staff observation of patients was also found to be “undermined” by a blind spot where people could self-harm unseen, the CQC report, published today, said.

Children also told the CQC they felt staff did not always understand their mental health condition or know how to support them, particularly those on the psychiatric intensive care ward with eating disorders or autism.

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Source: HSJ, 10 March 2022

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‘Know, Check, Ask’ before you take medication urges Northern Ireland's Minister

Both patients and healthcare staff have a central role to play in ensuring the safe use of medicines, Health Minister Robin Swann has said.

Minister for Health Robin Swann was speaking at an event to mark the roll out of the ‘Know, Check, Ask’ Campaign across all healthcare sectors in Northern Ireland. The aim of the campaign is to increase awareness and understanding about the importance of using medicine safely.

The call for action of the campaign is for:

Patients to Know Check Ask – Before you take it:

  • KNOW your medicines and keep an up-to-date list.
  • CHECK that you are using your medicines in the right way.
  • ASK your healthcare professional if you’re not sure.

Health Care staff to Know Check Ask – Before you give it:

  • KNOW your medications.
  • CHECK you have the right: patient, medicine, route, dose and time.
  • ASK your patient if they understand and ask your colleagues when you are unsure.

Minister Swann added “I want to encourage and help patients to be more curious about their medication, know what medication they are using, how to use it safely and feel able to ask their health care professionals questions about their medicines.  Patients should also feel able and confident to report problems with their medication early and so help reduce avoidable harm.”

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Source: Department of Health, 30 September 2022

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‘It’s terrifying’: parents’ struggle to get help for children with long Covid

On Christmas Day, Gail Jackson’s 16-year-old daughter said she was in so much pain she thought she would die. Liliana had been briefly admitted to hospital with Covid in September. Her symptoms never went away and, as time went on, new ones had emerged.

“For months she had a relentless, agonising headache, nausea, tinnitus, fatigue and insomnia, but the worst thing was the agonising nerve pain,” said Jackson. “I couldn’t even touch her without her screaming in pain.”

On Christmas morning, Jackson drove to hospital with her daughter vomiting from pain in the passenger seat. When they got to the hospital, however, the A&E doctor said there was no such thing as long Covid in children. “He said she just needed to go home and get on with her life,” Jackson said. “It was jaw-dropping.”

It is extremely rare for children and young people to contract severe Covid, but recent research has shown that even mild or asymptomatic infection can lead to long Covid in children. A study at UCL is investigating long Covid in 11- to 17-year-olds who were not hospitalised with the disease.

The National Institute for Health and Care Excellence (NICE) has recommended more research to produce guidance on how children and young people are affected and how they can be treated. However, there is no case definition of long Covid in children and young people in the way there is in adults.

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Source: The Independent, 3 May 2021

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‘It’s soul destroying’: why so many NHS staff are off sick with burnout

“Frustration with the system was why I went off in the end,” said Conor Calby, 26, a paramedic and Unison rep in southwest England, who was recently off work for a month with burnout. “I felt like I couldn’t do my job and was letting patients down. After a difficult few years it was challenging.”

While he usually manages to keep a distinct divide between work and home life, burnout eroded that line. He also lost his sleep pattern and appetite.

The final straw came when what should have been a 15-minute call resulted in three hours on the phone trying to persuade the services that were supposed to help a suicidal patient to come out. “I was on a knife edge. That was due to the system being broken. That’s the trigger.”

Doctors and nurses are struggling under the strain too. After her third time with burnout - the last resulting in her taking six months off work – Amy Attwater, an A&E doctor, considered leaving the profession altogether.

Attwater, 36, said in the Covid crisis, during which a colleague killed himself, she started having suicidal thoughts and doubting her own abilities. She twice reported that she was being bullied but said no action was taken.

“The only thing I was left with was to take time off work. I ended up having therapy, seeing a psychiatrist and being on two antidepressants,” said Attwater, the Midlands-based committee member for Doctors’ Association UK.

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Source: The Guardian, 5 February 2023

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‘It’s really only the beginning’: are we on the cusp of a breakthrough in endometriosis?

After generations of inaction and very few novel ideas, researchers and activists are hopeful a new path is being charted in understanding and treating the crippling chronic condition

“There’s an excitement at the moment,” says Andrew Horne. After decades of inaction, something is happening in endometriosis.

Now, says the professor of gynaecology and reproductive sciences at the University of Edinburgh, “I do think things are changing. There are more people working on it, so it’s bringing in people from different disciplines with new ideas.”

In the space of a few months, from gatherings in Edinburgh and Washington DC, labs in Sydney and Japan, there is a sense that new ideas are bubbling to the surface, including a fundamental rethinking of endometriosis not as a disease of the pelvis, but rather, says Horne, “a whole-body disease”.

It’s hard to pinpoint the exact moment when despair turned to hope in the research and patient community. There was no single breakthrough. No one person responsible.

In March, the largest ever study on the genetics of endometriosis was published in Nature Genetics, which found genetic links to 11 other pain conditions as well as other inflammatory conditions. The study, involving DNA from more than 760,000 women, found ovarian endometriosis is genetically distinct from other types and indicated there may be a genetic predisposition to excessive inflammation in people with the condition. One of the researchers, Dr Nilufer Rahmioglu from the University of Oxford, described the data as a “treasure trove of new information”.

Weeks later on the other side of the world, researchers from Sydney’s Royal Hospital for Women attracted international attention after they grew tissue from different types of endometriosis and compared how each responded differently to treatments. Jason Abbott, professor of obstetrics and gynaecology at the hospital, likened the development to those made in the treatment of breast cancer three decades ago.

Two weeks on from the Australian discovery, Japanese researchers found a common form of bacteria may be contributing to the growth of endometriosis via inflammation.

The frisson was, by then, hard to miss.

Read the full article here: https://www.theguardian.com/society/2023/aug/10/its-really-only-the-beginning-are-we-on-the-cusp-of-a-breakthrough-in-endometriosis 

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‘It’s not medical tourism, it’s desperation’: rising number of Britons resort to treatment abroad

Cathy Rice had been in all-consuming pain for 18 months when she decided to fly to Lithuania. “I was going up the stairs on my hands and knees. I couldn’t get to the shop. I had no quality of life,” she says.

Rice, 68, who has four grandchildren, had been told she needed a knee replacement for an injury caused by osteoarthritis but – like millions of NHS patients – faced a gruelling wait.

At a clinic in Kaunas, Lithuania’s second largest city, the operation was arranged within weeks and cost €6,800 (£5,967) – around half the cost in the UK. The price included a pre-travel consultation, return flights, airport transfers, two nights in an en suite hospital room, pre-surgery check-ups and post operative physio.

“I thought, ‘Just look at your choices. You can stay here and be in this kind of pain for another couple of years or you can take a decision’,” Rice says.

The former health sector worker, from Glasgow, is one of a growing number of Britons going abroad for routine medical care. She had never gone private before and never had a desire to. But last week, a year after the first surgery, she returned to Lithuania to have the same procedure on her other knee. This time, she says the wait she faced on the NHS was three years.

She explains tearfully that to cover the costs of the surgeries in Lithuania, she sold her house. “People think that if you’re doing this you’ve got a wonderful pension or you’re very well off. But the driver here is that people are in pain,” she says. “This is not medical tourism; it’s medical desperation.”

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Source: The Guardian, 21 January 2023

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‘It’s not just about dying’: Uganda’s pioneers of palliative care undaunted by huge challenges

 

Morphine was first introduced in Uganda 30 years ago, but as the burden of cancer increases, thousands of people still lack access to even basic treatment or pain relief.

About 70% of the 2,000 patients on Hospice Africa Uganda (HAU)’s programme have cancer, and some are HIV positive, too. Few can afford tests or treatment for their conditions and, even when they can, it is not uncommon for doctors to misdiagnose or fail to prescribe adequate pain relief. Often, by the time a patient is referred to HAU, their condition is incurable, much to the frustration of the team, whose goal is to offer palliative care from the moment a person is diagnosed with a life-limiting condition.

“One of our biggest challenges is to remove the stigma [around palliative care]. Some people think it is about dying, but it is for anyone with a chronic illness that is not going away,” says Antonia Kamate Tukundane, programmes manager at HAU’s Mbarara site in south-west Uganda. “Palliative care focuses on holistic care: How are you? How is your family? What other things are affecting your illness? We provide something the doctors and nurses have no time for.

Dr Anne Merriman at home in Kampala. She founded Hospice Africa Uganda in 1993, with a vision to introduce “palliative care for all in need in Africa”

“Sometimes the patient comes to us very ill and passes on, but if we had known the patient earlier we could have explained what was happening to their body; agreed on realistic goals; all this is so helpful for the patient. Those who find us are glad they did.”

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Source: The Guardian, 6 March 2023

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