Category: Opinion

The Citadel by A. J. Cronin: A symbolic title

The Citadel, a 1937 novel by A. J. Cronin, explores the themes of social and health inequalities, drawing from his personal experiences working as a doctor in Britain’s pre-NHS era. The protagonist, newly qualified and virtuous Dr Andrew Manson, begins his medical career in a small Welsh mining town and observes first-hand the close marriage between social inequalities and health inequalities.

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The view from the ferris wheel

Who would have wanted to be a lead clinician in Public Health England at the start of the pandemic? Judith Dawson finds that trying to balance the population losses against individual and economic loss is an impossible job. But in a typical government response to unpalatable results we find ourselves being reorganised at the worst possible moment.

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A short course in racism

David Misselbrook discusses how two books, To Kill a Mockingbird and Sacred Hunger, have helped him understand more about why Black Lives Matter matters and have given him his own refresher course in racism.

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Does place-based care matter to primary care in the post-COVID-19 digital age?

General practice is well-positioned to identify and intervene in the wider determinants of health. Many of the ingredients are already in place: registered patient lists, extensive data, and the ability to engage both proactively and opportunistically with patients. But primary care’s responsibilities lie with their registered patients, rather than a geographical area.

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The problem of prescribing for pain

Judith Dawson reflects on the draft NICE guidelines for the management of chronic primary pain. There is widespread use of ineffective and addictive pain medication of questionable benefit. However, implementing any change will depend on a cohesive approach across primary and secondary care clinicians of all levels and a re-education of public expectations.

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Is this really doctoring?

The opportunities to treat more and more patients in less and less time is the unspoken aim of the improving of technology. But as we move into this future, we must continue to courageously ask both ourselves and our employers; is this really doctoring and who is really benefitting?

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Cumberlege: Responding to those who suffer medical complications

The Cumberledge report puts forward the case for radical reform. Dealing with those who have by our actions sustained loss and pain, even as a recognised complication of a necessary procedure, can be exceptionally challenging. It is important to be able to identify and recognise the feelings that we experience in response to this scenario in order to be able to cope with them and avoid transference to the patient.

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