'The Hard Thing and The Right Thing are Often The Same'

 

Doctors and Patients

 

By the end of my first year as a doctor, I was ready to kill myself

An Anonymous junior doctor in The Guardian


On my morning drives to the hospital, the tears fell like rain. The prospect of the next 14 hours – 8am to 10pm with not a second’s respite from the nurses’ bleeps, or the overwhelming needs of too many sick patients – was almost too much to bear. But on the late-night trips back home, I’d feel nothing at all. Deadbeat, punch-drunk, it was utter indifference that nearly killed me. Every night, on an empty dual carriageway, I had to fight with myself to keep my hands on the steering wheel. The temptation to let go – of the wheel, the patients, my miserable life – was almost irresistible. Then I’d never have to haul myself through another unfeasible day at the hospital.


By the time I neared the end of my first year as a doctor, I’d chosen the spot where I intended to kill myself. I’d bought everything I needed to do it. All my youthful enthusiasm for healing, big dreams of saving lives and of making a difference, had soured and I felt an astronomic emptiness. Made monumentally selfish by depression, I’d ceased even to care what my husband would think of me, or that my little boy would grow up without his mother.


Doctor suicide is the medical profession’s grubby little secret. Female doctors aretwice as likely as the general population to take our own lives. A US study shows our suicide rate appears higher than that of other professional groups, with young doctors at the beginning of their training being particularly vulnerable. As I wrestled silently with the urge to kill myself, another house officer in my trust went right on and did it. To me, that monstrous waste of young life seemed entirely logical. The constant, haunting fear of hurting my patients, coupled with relentless rotas at work, had rendered me incapable of reason.


Though we know large numbers of doctors kill themselves, what is less clear are the reasons why, when dedicated to preserving human life, some doctors silently plot their own deaths. A 2006 study at the University of Pennsylvania identified that during their first year as doctors, young physicians experienced skyrocketing rates of burnout, with symptoms of emotional exhaustion, depersonalisation, and reduced sense of personal accomplishment soaring from 4% to 55%.


For me, the explanation ran deeper. I was entrenched in a hospital system that brutalised young doctors. Working on my hospital’s surgical emergency unit, there were simply too few of us to cope with the daily onslaught of patients. Officially eight or 10-hour days ran routinely into 13, 14 or 15 hours as we house officers worked at fever pitch to provide what was, at best, a mediocre service for our patients. Run ragged, we fought to keep our patients safe, but their numbers outstripped ours 20 or 30 to one, and the efforts this took were superhuman. The nurses knew, the consultants knew, even the hospital management knew, yet no one seemed to give a damn.

It wasn’t just exhaustion that drove me into depression. Plenty of jobs are busy. But there is something uniquely traumatic about being responsible for patients’ lives, while being crushed under a workload so punitive it gives neither the time nor space for safe assessment of those patients. Days were bad enough, but nights on call were terrifying. I remember running from the bed of one patient, still haemorrhaging blood from her surgical wound, to another whose heart rate had plummeted to 20, perilously close to a cardiac arrest. Two stricken patients, but only one doctor, wracked with the knowledge that if something went wrong, the guilt would be hers alone.


I was lucky. I was pushed by the colleague in whom I finally confided into seeking professional help. It took anti-depressants, therapy and a narrowly-avoided psychiatric inpatient admission to bring me back to the land of the living.




 Now, on the cusp of junior doctors’ first national strike in 40 years, I’m astounded the health secretary persists in ignoring unanimous condemnation of his new contract from juniors and medical leaders alike. If he gets his way, Jeremy Hunt will make it easier for hospitals to abuse their juniors, by stripping away the safeguards that stop hospitals overworking us, fining those that do. Under his new contract, our hours will become even longer, even more antisocial – at a time when we simply have nothing more to give. And as we are pushed to treat more and more patients, faster and faster, fatigue and psychological distress will dull our competence: your lives will be less safe in our hands. And our own? Take it from someone who’s been there. Watch the suicide rate climb.

Why all medicine men should watch Munnabhai M.B.B.S

Shuvendu Sen in The Times of India

It does not have the somber ambiance of The Doctor, where a brash MD himself succumbs to throat cancer and is hushed to humility. It does not carry the macabre interaction of a supposedly psychologically disturbed man and a tyrannical nurse as seen in One Flew Over the Cuckoo’s Nest. Neither does it inspire an awakening as Philadelphia did through a gay lawyer fighting AIDS.

Munnabhai MBBS is anything but the tempting medical plot hashing out tears, tension and hope. It walks clear of such obvious seductions. Truth be told, the movie is as loud as it can get, carries all the ingredients of Bollywood absurdity and harps on emotions, raw and running. But take a moment to peer beneath the rubble and you would smell a treasure. A rare treasure’s takes on a mission that has degenerated into a profession soaked with cynicism and slit throat parlance. And I am no film reviewer.

Let us take an earthly stand. When was the last time, we physicians have put our right hands up and taken the oath that we would take care of patients over and above vested interests? When was the last time, save glorious exceptions, we have crossed the borders of our financial gains and taken a bow for the penniless sufferer? When was the last time we thanked the hospital sweeper for his services to patient care? For that matter, when was the last time a medical book was written to highlight the absolute necessity to reach out to a stage four cancer patient other than through mindless chemotherapy and pain medications? Fact remains that medicine, like none other profession has become the yardstick of a cultivated upper lip vocation, to pursue and prevail. In our pursuit for perfection we have lost the imperfect patient.

And the fact that Munna bhai, despite all his convivial and genteel mindset, was a full blown quack, a rank outsider, drenched in liquor, roadside patois and all that was coarse and callous, made the white coat adorned messiahs look even more like bloodless bodies. Harsh words, but if anything had been flushed down the drain in the practice of medicine, it had to be empathy and emotions. Formless jottings have replaced tender words. Machines have superseded probing minds. An impatient doctor sits across the floor, rummaging the symptoms, inaccessible to the sufferer.

But of course, Munnabhai M.B.B.S has its own share of absolute lunacy. The frequent fist fights, the semi clad on-campus dance and the lugubrious antics are a far cry from the austere charm and book like precision of its western counterparts. But there’s a reason why British Medical Journal took a note of this movie. One suspects the makers of this movie played the human mind well.

Sometimes the finest sustains longer when drowned under the gross. The fine trickle beneath the plunging waves has always made its presence felt. Cure has always been the visible highpoint of medicine. It is the unseen, unspoken care that needs visibility. Munna bhai was all about that care.

On the NHS frontline: 'being a doctor in A&E is like being a medic in a war zone'

Doctor explains why she decided to make a film depicting the real-life drama of targets and staff pushed to the limit

• 
• • Saleyha Ahsan
  • The Guardian, Wednesday 5 March 2014

The start of a shift and I brace myself as I walk into the waiting area. A huge number of people are already there, waiting to be called. I try to avoid eye contact. It's like entering an arena but I feel more like the sacrificial lamb than a gladiator. Entering the main area of the emergency department, a scene of chaos. All available space to see patients is occupied. Staff shout instructions to each other above the noise. I hear a patient vomiting, another is crying out in pain and an elderly woman's voice cuts through, confused and repeating that she wants to go home. "So do I," I whisper to myself.

Colleagues run between cubicles with clean sheets, urine pots and trays for taking blood. Ambulance sirens heard above the noise signal that more patients are coming. A cardiac arrest case is sped into the resuscitation room with paramedics pumping the chest of a patient as the rest of the crash team run through. The atmosphere is explosive and adrenaline charged.

A senior doctor in the middle of the storm tries to bring order in a place that refuses to be controlled. Junior doctors are flushed, red in the face, eyes wide with a hint of panic. I find a tearful one at the computer. She is new and hating every second of it. There isn't time or even space to console her with a pep talk. Give her a few more weeks and the hard outer shell will develop like body armour.

My first patient of the shift needs a full neurological exam. I hunt around for a pen torch to shine into her eyes. "Make sure you have your weapons before you go to war," says a fellow registrar, wryly, handing over the torch. I smile. This is not Palestine, Libya or Syria. This is a hospital on the eastern outskirts of London.

 The A&E department at Queen's hospital in Romford deals with 400 patients a day.

Being a doctor in accident and emergency has at times resembled being a medic in a war zone. I have worked as a doctor in various conflicts and yet some of my most stressful moments, facing a tidal wave of pressure, have happened closer to home, in Queen's hospital, Romford.

The UK's A&E departments have been described by the College of Emergency Medicine (CEM) as facing a crisis. The term was specifically chosen to describe the situation that everyone from the most senior consultant to the most junior nurse is experiencing. Last year Dr Cliff Mann, the CEM president, wrote in a press release: "A lack of a plan for resolution [is] an existential threat to emergency medicine."

There are recurrent themes causing the crisis: more people are coming to A&E; a falling number of doctors want to work there because of the pressures involved and the poor work/life balance; and hospitals are increasingly full – resulting in bottlenecks that back up into the emergency department.

Over the past four progressively worse winters I came to a tipping point. Nothing in the media was reflecting the daily realities of being a doctor on the shop floor. Last April, when the CEM's press release hit the headlines, I took my cue.

I divide my time as an A&E doctor and film-maker. I wanted to make something honest and reflective of the reality.

After a year's worth of access negotiation, I began filming with the Guardian this winter in two hospitals – Queen's where I work as a middle-grade locum, and Musgrove Park, in Taunton, Somerset, where Cliff Mann also works.

"For a long time we were like John the Baptist, crying into the wilderness and no one was listening," Mann said to me, while on shift at Musgrove Park. The most senior consultant within emergency medicine leads from the front, including a Friday shift that runs from 3pm to midnight. "No one goes into emergency medicine thinking it's going to be easy and calm – that would be bizarre. But if you push the individual with persistently increasing intensity levels they will start to fade."

The TV stories of George Clooney and the ER cast don't come close to reality. My research into the speciality obviously went beyond watching medical dramas but nothing prepared me for what it was actually like.

Attending conferences in emergency medicine becomes almost therapeutic in its sharing of experiences. At an emergency medicine conference, Expanding Scientific Horizons, held in Twickenham, south-west London, last year, it was telling that the sessions entitled Creating Satisfaction and Maintaining Wellbeing in Emergency Medicine were standing room only.

One of the speakers, Susie Hewitt, a consultant from Derby, spoke about her battle with depression during the time she was appointed head of service for the introduction of the four-hour target – the government's instruction that 95% of patients should be seen within four hours of arriving at A&E.

The culmination of work and personal pressures resulted in what Hewitt describes as being "hit with what felt like a big freight train".

Many of us recognised ourselves in that. At the conference leaflets for well-being support and therapies were being distributed widely. We are clearly not a very healthy bunch right now.

The CEM warned the government three years ago that there was a problem with falling numbers of staff, but no concrete solutions emerged. I began to see my own consultants and middle-grade colleagues make plans to fly to the other side of the world.

 Medics with a patient at Queen's hospital. The hospital was built for 90,000 patients a year but receives 140,000.

Queen's A&E, part of the Barking, Havering and Redbridge University Trust, sees about 400 patients a day and its sister hospital, King George's, sees 200. The trust serves a population of 750,000 and is one of the UK's largest. It also has one of the highest elderly populations in London. Following a report by the Care Quality Commission (CQC) that its A&E was "at times unsafe because of the lack of full-time consultants and middle-grade doctors", Queen's became the 14th hospital to be put into special measures last December. Filming with the Guardian inside its A&E began the next day.

The hospital was built for 90,000 patients a year but receives 140,000. Ironically, King George's A&E, which performs better against targets, is scheduled for closure in 2015, after a unanimous vote by local primary care trusts. Queen's is expected to absorb the extra numbers. Queen's is understaffed, with only eight full-time consultants where it requires 21 in order to provide 24-hour cover, seven days a week. Four consultants left last year.

One of them, Dr Rosie Furse, described the pressure of targets. Battles with certain specialities to accept patients on to their wards are also a common complaint. She left for a post on the island of Mustique before being recruited to a hospital in Bath.

David Prior, chairman of the CQC, was reported in the Guardian in May 2013 as saying too many patients were arriving at hospital as emergency cases, and improved earlier care in the community was needed. He suggested more acute beds should be closed. "Emergency admissions through accident and emergency are out of control in large parts of the country," he said.

That prompted memories of a recent bed-blocked day in Queen's. Matron Mary Feeney rushed into A&E having secured a bed on the intensive therapy unit for an unwell patient in an A&E cubicle.

"They say bring him in half an hour – half an hour we have not got," and with that the patient was out of the door on the way with matron off to negotiate access at the hallowed gates of ITU.

A significant contributor to breaches of the four-hour target is the quest to find a bed for someone who is clearly not well enough to go home. Over Christmas one woman was brought in with diarrhoea and a ruptured bowel requiring a surgical side room. She waited in A&E for 17 hours until a room became available. Another woman was brought in with high blood sugars and needed an acute medical bed. I saw her when she arrived in the evening and then met her the next morning when I came back to work. That's when A&E becomes a ward.

On the first day of filming we had four intubated, unconscious patients in the resuscitation room at the same time, all of them requiring critical beds. The rest of the room was full of acutely unwell patients being redistributed around A&E as more room was needed with each new ambulance arrival.

Finding alternatives to A&E through improved care in the community is essential but if more acute beds close the A&E waits will get longer for sick patients requiring admission.

 Staff at work at Queen's hospital. The hospital has only eight full-time consultants.

I went through a period of having palpitations during a stretch of extremely challenging shifts last winter. It was when I had a palpitation and nearly passed out while driving that I decided to step down my intensity of work. I had further investigations but the remedy was obvious. I reduced my shifts and the palpitations have stopped.

Over the past three years I have worked harder than in my previous life in the army. I went through the Sandhurst commissioning course, renowned for its tough schedule, but in accident and emergency medicine at its peak, the intensity is tougher.

The CEM published an aptly named report – Stretched to the limit – in October last year. It described a consultant workforce under pressure. As a middle grade I wonder if actually I can physically do the job of a consultant.

The report said: "Evidence confirms that burnout among physicians in emergency medicine occurs at the highest rate of all medical specialities. There is also a very worrying trend developing of consultants seeking to move abroad after having been trained in the NHS."

The report details 21 consultants having left the UK in 2013 with an overall exodus of 78 since 2008.

Within the report details of a survey reveal that consultants on average plan to retire at 60 with the current job not compatible with advancing age. "Doing four nights in a row when you are 50 or 55 is physically impossible," said Dr Antoine Azzi, a specialist registrar working at Queen's at the very end of his training and soon to be a consultant.

He hopes for a less intense workload as a consultant, but it appears that is not going to be the case. The report said that 40% of the consultant workforce were on call one night in every six. The average age of emergency medicine consultants is 43 and the survey showed most plan to retire at 60.

The things that make a difference include access to training, which provides juniors with skills they need and reduces a layer of stress.

Before she left, Furse, like many other consultants, was dedicated to improving the working lives of her trainees and colleagues.

On one occasion I placed a chest drain into a patient with a spontaneous pneumothorax – a collection of air between the lung and the chest wall. If I failed, he could go into respiratory arrest, which could lead to death.

Furse stood by, calm and instructive. "Get it in quick, Saleyha," was all she said. I urged the drain's tube into his chest and the moment I saw the swinging bubble of the drain, signalling a successful placement I allowed myself to breathe and the patient was stabilised.

Moments like that are what makes being a doctor count but opportunities for training are few as workload grows.

The constant turnover of new junior doctors hits the department, too. Most junior doctors who spend six months in A&E leave at the end of their assignment with a lot of experience, but they are relieved to be going and they won't be coming back.

Mann says: "They come and do their six-month attachment and at the end say, "Thank you very much, it was interesting but I am moving on because it nearly killed me.'"

There is a quote from Hippocrates that says: "Where there is a love of medicine, there is a love of humanity." I see this every day to some degree in A&E. Before she left Furse reminded us during a teaching session: "Patients are key to everything we do and if you stop caring about them – well you should not be here any more."

Looking back on diary entries related to shifts I did last year during the spell when I was having palpitations I was reminded why I put myself through it. It's what makes us go back the next day no matter how awful the shift has been.

I wrote: "It was hard, I am tired and I was pushed but I feel alive. Today counted. I cared for patients and they remained the main focus of my day. Nothing else. Patients arrive here to be seen on possibly the worst days of their lives and through them we learn so much about our art. They teach us how to be doctors. As I walked into work today I was hit by reflection of all the patients who have left their mark – the ones that didn't make it.

"They stay with you, like companions. I shared the last few hours of their lives with them … forming a bond that transcends into something almost spiritual even for those that don't believe. Above all else, that is what counts and it remains a privilege."

Is this the loneliest generation?

The Government is trying to quantify social isolation amid health fears

Brian Brady

Sunday, 13 January 2013

Government officials have been ordered to find out exactly how lonely Britain's population is, amid concerns that "the most isolated generation ever" will overwhelm the NHS.

The Department of Health is attempting to measure the extent of "social isolation" in the UK, after warnings that it has sparked spiralling levels of illnesses including heart disease, high blood pressure, dementia and depression.

Research has revealed that loneliness is a growing problem in the UK – particularly among the elderly – with one in three admitting that they sometimes feel lonely. Among older people, more than half live alone, 17 per cent are in contact with family, friends and neighbours less than once a week, and almost five million say the television is their main form of company.

However, the trend is expected to worsen in the coming years. The Office for National Statistics disclosed last year that the number of Britons living alone has risen to a record 7.6 million – one million more than in 1996 and amounting to almost one in three households.

But beyond the personal problems the "loneliness epidemic" presents, ministers have been put on alert over its wider impact – and financial costs. Loneliness is blamed for piling more pressure on to health and social care services, because it can increase the risk of complaints including heart disease and blood clots. Experts also believe it encourages people to exercise less and drink more – and ultimately go to hospital more often and move into residential care at an earlier stage.

The Government's attempts to measure social isolation among people using health and social care will increase the pressure on the NHS and councils to tackle the problem now – to slash millions from their spending on the effects of loneliness in the future.

The care and support minister, Norman Lamb, said: "For the first time, we will be aiming to define the extent of the problem by introducing a national measure for loneliness. We will be encouraging local authorities, NHS organisations and others to get better at measuring the issue in their communities. Once they have this information, they can then come up with the right solutions to address loneliness and isolation."

It is the latest in a number of attempts to gauge, and change, the national mood: Tony Blair appointed the LSE academic Lord Layard as his "happiness tsar", while David Cameron has previously tried to measure people's well-being. In each case, the driving aim was to cut health and social welfare costs by making people feel better about their lot.

An official guide on combating isolation, issued to local authorities by the organisation Campaign to End Loneliness, says: "Tackling loneliness will reduce the demand for costly health care and, by reconnecting individuals to their communities, it will give renewed access to older people's economic and social capital." The guide points out that a scheme in Essex where lonely people were "befriended" by volunteers cost £80 per person but produced annual savings of £300 per person. Another project directing older people to local services cost £480 but realised savings of £900 per person.

Anne Hayden, a Dorset GP, saved more than £80,000 in costs for six patients who were "high users of NHS services" with a befriending scheme to boost their emotional well-being. David McCullough, chief executive of the WRVS (formerly the Women's Royal Voluntary Service), said: "It's to the benefit of not only the patient, but also the NHS as a whole, that GPs spot the early warning signs of isolation and refer patients to services such as befriending or community centres."

Case study

Win Noble was a nurse who had to give up work to care for her husband after he had a stroke and heart attack.

"It's not until you're on your own that you feel miserable. My husband died in 2001. I had nursed him for 20 years.

"In 2005, my next-to-oldest daughter died and then so did my youngest daughter. I was on my own because the rest of the family don't live in the area and I'm partially disabled, so I can't really socialise. One of my other daughters is housebound, one lives in Rhyl and one in Skegness and my only son is in Sleaford. I hadn't seen my son for five years but he rings me and came down this week.
"I don't see the others. I used to read a lot of books, from the mobile library, and I do a lot of puzzles just to keep occupied.

"Age Concern contacted me and suggested a craft class. After a few weeks they started to get a group together to play games like Scrabble and have quizzes. I got really involved and really enjoyed it. I became a volunteer and people needed me again."

Rachael Bentham

Parkinson's sufferer wins six figure payout from GlaxoSmithKline over drug that turned him into a 'gay sex and gambling addict'

A French appeals court has upheld a ruling ordering GlaxoSmithKline to pay €197,000 (£159,000) to a man who claimed a drug given to him to treat Parkinson's turned him into a 'gay sex addict'.

Didier Jambart, 52, was prescribed the drug Requip in 2003 to treat his illness.

Within two years of beginning to take the drug the married father-of-two says he developed an uncontrollable passion for gay sex and gambling - at one point even selling his children's toys to fund his addiction.

He was awarded £160,000 in damages after a court in Rennes, France, upheld his claims.

The ruling, which is considered ground-breaking, was made yesterday by the appeal court, which awarded damages to Mr Jambart.

Following the decision Mr Jambart appeared outside the court with his wife Christine beside him.

Jambart broke down in tears as judges upheld his claim that his life had become 'hell' after he started taking Requip, a drug made by GSK.

Mr Jambart began taking the drug for Parkinson's in 2003, he had formerly worked as a well-respected bank manager and local councillor, and is a father of two.

After beginning to take the drug he claimed he attempted to commit suicide eight times.

In total Mr Jambert said he gambled away 82,000 euros, mostly through internet betting on horse races. He also said he engaged in frantic searches for gay sex.

He started exhibiting himself on websites and arranging encounters, one of which he claimed resulted in him being raped. 

He said his family had not understood what was going on at first.

Mr Jambert said he realised the drug was responsible when he stumbled across a website that made a connection between the drug and addictions in 2005. When he stopped the drug he claims his behaviour returned to normal.

"It's a great day," he said. "It's been a seven-year battle with our limited means for recognition of the fact that GSK lied to us and shattered our lives."

He added: 'I am happy that justice has been done. I am happy for my wife and my children. I am at last going to be able to sleep at night and profit from life. '

He added that the money awarded would, 'never replace the years of pain.'

The court heard that Requip's side-effects had been made public in 2006, but had reportedly been known for years.

Mr Jambert said that GSK patients should have been informed earlier.

Closed drug trials leave patients at risk and doctors in the dark

 

Drug companies can hide information about their drugs from doctors and patients, perfectly legally, with the help of regulators. We need proper legislation

We need muscular legislation to ensure that all information about all trials on all currently used drugs is made available to doctors Photo: Alamy

By Ben Goldacre

8:13PM BST 25 Oct 2012

34 Comments

This week, Daily Telegraph readers have been astonished by revelations about the incompetent regulation of implantable medical devices. This paper has clearly demonstrated that patients are put at risk, because of flawed and absent legislation. But many of these issues apply even more widely, to the regulation of all medicines, and at the core is a scandal that has been shamefully ignored by politicians.
 

The story is simple: drug companies can hide information about their drugs from doctors and patients, perfectly legally, with the help of regulators. While industry and politicians deny the existence of this problem, it is widely recognised within medical academia, and meticulously well-documented. The current best estimate is that half of all drug trials never get published.
 

The Government has spent an estimated £500 million stockpiling Tamiflu to help prevent pneumonia and death in case of an avian flu epidemic. But the manufacturer, Roche, continues to withhold vitally important information on trials of this drug from the universally respected Cochrane Library, which produces gold-standard summaries on medicines for doctors and patients. Nobody in the Department of Health or any regulator has raised a whisper about this, though Roche says it has made “full clinical study data available to health authorities around the world”.
 

In fact, while regulators should be helping to inform doctors, and protect patients, in reality they have conspired with companies to withhold information about trials. The European Medicines Agency, which now approves drugs for use in Britain, spent more than three years refusing to hand over information to Cochrane on Orlistat and Rimonabant, two widely used weight loss drugs. The agency’s excuses were so poor that the European Ombudsman made a finding of maladministration.
 

Even Nice, the National Institute for Health and Clinical Excellence, plays along with this game. Sometimes chunks of its summary documents on the benefits and risks of drugs are redacted, because data has only been shared by companies under unethical “confidentiality agreements”. The numbers are blacked out in the tables, to prevent doctors seeing the benefits from a drug in each trial; and even the names of the trials are blacked out, as if they were code names for Russian agents during the Cold War.
 

This is a perverse and bizarre situation to have arisen in medicine, where decisions are supposed to be based on evidence, and where lack of transparency can cost lives. Our weak regulations have been ignored, and if we don’t act quickly, the situation will soon get much worse. The European Medicines Agency’s sudden pledges of a new era of transparency are no use: it has a track record of breaking such promises. We need proper legislation, but the new Clinical Trials Directive, currently passing through the European Parliament, does nothing to improve things.

Are you glazing over at the mention of European directives? This is where it all went wrong. Sunlight is the best disinfectant, but these issues have been protected from public scrutiny by a wall of red tape, while the people we trust to manage these complex problems have failed us. Regulators have lacked ambition. Politicians have ignored the issue. Journalists have been scared off by lobbyists. Worst of all, the doctors in medical membership bodies, the Royal Colleges and the Societies, even the patient groups – many of them funded by industry – have let us all down.

This must change. We need muscular legislation to ensure that all information about all trials on all currently used drugs is made available to doctors. We need the members of patient groups and medical bodies to force their leaders to act. And we need EU medicines regulators to be held to public account, for the harm they have inflicted on us.

Ben Goldacre is a doctor and author of 'Bad Pharma’ (4th Estate 2012)

VISUALISATION

Wayne Rooney reveals visualisation forms important part of preparation

• Manchester United striker: 'I visualise scoring wonder goals'
• Says Finland forward Jari Litmanen was an inspiration

• Jamie Jackson
• guardian.co.uk, Thursday 17 May 2012 15.30 BST

Wayne Rooney say he lies in bed 'the night before the game and visualise myself scoring goals or doing well'. Photograph: Michael Regan/Getty Images

 

Wayne Rooney has revealed how since being a very young player he visualises game patterns and goalscoring situations to enhance his performance.

The Manchester United and England striker told ESPN: "Part of my preparation is I go and ask the kit man what colour we're wearing – if it's red top, white shorts, white socks or black socks. Then I lie in bed the night before the game and visualise myself scoring goals or doing well. You're trying to put yourself in that moment and trying to prepare yourself, to have a 'memory' before the game. I don't know if you'd call it visualising or dreaming, but I've always done it, my whole life.

"When I was younger, I used to visualise myself scoring wonder goals, stuff like that. From 30 yards out, dribbling through teams. You used to visualise yourself doing all that, and when you're playing professionally, you realise it's important for your preparation."

Asked about his abilities as a developing player with regard to his peers Rooney added: "You're a bit more advanced than the kids your age, so there are times on the pitch where you can see different things, but they can't obviously see it. So then you get annoyed – they can't calculate.

"It's like when you play snooker, you're always thinking three or four shots down the line. With football, it's like that. You've got to think three or four passes where the ball is going to come to down the line. And the very best footballers, they're able to see that before – much quicker than a lot of other footballers."

Jari Litmanen, the former Ajax and Liverpool No10, provided one source of inspiration for Rooney. "I enjoyed how he moved and got into space," he said. "And he was patient. If you looked at him, he always never looked like he was rushed doing anything. He always used to take his time. Then, when the opportunity came, he found the space to get the ball in the net.

"The more you do it, the more it works. You need to know where everyone is on the pitch. You need to see everything."

Medical Errors - Eighth Leading Cause of Death in the US

According to the Institute of Medicine, between 690,000 and 748,000 patients are affected by medical errors in the US every year and between 44,000 and 98,000 die from them. Even this low ball estimate makes medical mistakes the eighth leading cause of death worse than breast cancer, AIDS and motor vehicles accidents. It also makes medicine far more error prone than high-risk fields. For commercial aviation to take the same toll in the US as medical errors do, a full-up 747 would have to crash every three days, killing everyone on board.

More troubling is the medical profession's traditional response to these disturbing statistics, which has largely involved evasion, obfuscation, minimisation, defensiveness and denial....

"Observing more senior physicians, students learn that their mentors and supervisors believe in, practice and reward the concealment of errors. They learn to talk about unanticipated outcomes until a mistake morphs into a complication. Above all they learn not to tell the patient anything."  - Nancy Berlinger in After Harm.

Extracted from Being Wrong by Kathryn Schulz