Experiences of death and other stories . . .
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2855 (Published 25 May 2016) Cite this as: BMJ 2016;353:i2855
Empathy in health professionals
Watching people die used to be part of growing up until the last century. But few medical students witness death until they work on hospital wards, and in semi-structured interviews 53 medical students described the experience to researchers (BMC Med Educ doi: 10.1186/s12909-016-0631-3). Most felt emotionally diminished, experienced a decrease in empathy to cope with the emotional pain, and sought the comfort of colleagues. This rite of passage also introduced them to the ordinariness of death and their professional role in dealing with its practicalities. Shifts of empathy are also explored in a New Scientist article (http://bit.ly/1s1CG7b). “Empathic distress” is a common cause of burnout in health professionals and can lead to aggressiveness and a desire to escape. However, compassion training methods are being developed to help people learn to strike a balance between empathy and personal coping mechanisms (Soc Cogn Affect Neurosci doi: 10.1093/scan/nst060).
CRP and antibiotic prescribing
If doctors could distinguish between bacterial and viral infections, perhaps they would prescribe fewer antibiotics, runs a familiar refrain. One method is to measure C reactive protein (CRP), an inflammatory mediator that was discovered at about the same time as penicillin. But a randomised trial of preconsultation CRP measurement in febrile children presenting to primary care in Norway shows no difference in the rate of antibiotic prescribing or referral to hospital (BMJ Open doi:10.1136/bmjopen-2016-011231) compared with a group who could order CRP after the consultation only.
Malaria, bacteria, or both?
In reality, there is a strong impulse to give treatment on a “just in case” basis to febrile children, and in many countries where malaria is endemic this can lead to prescription of malarial drugs as well as antibiotics. A study using quantitative polymerase chain reaction testing of blood samples from afebrile and febrile children in Gabon finds that although malaria is common in the febrile group (78.8%), bacterial DNA is also detected in 4.6% of malaria positive febrile children (Am J Trop Med Hyg doi:10.4269/ajtmh.15-0751).
Non-financial COIs
As a virgin goddess, Minerva is aware of her conflicts of interest with other less chaste deities (that hussy Venus, for example). Surveying humanity, she sees the same thing everywhere. People who have developed their own psychological therapies love to reference them in flattering ways when performing systematic reviews, a survey finds (BMJ Open doi:10.1136/bmjopen-2015-010606). “Non-financial conflicts of interest . . . need more transparency and better management,” the authors conclude.
Venus and reproductive health
Speaking of Venus, I hear that she will be starting a column of her own in imitation of mine in Journal of Family Planning and Reproductive Health Care. Thank you my dear. I shall take it as a compliment.
Sleep-wake disorders after TBI
To determine the effect of brain trauma on sleep, a Swiss group performed detailed sleep assessment in 31 participants 18 months after a first traumatic brain injury (TBI) and compared the results with those from healthy people without previous TBI matched for age, sex, and sleep satiation (Neurology doi:10.1212/WNL.0000000000002697). Sleep need was consistently about an hour longer in the patient group than in controls (8.1 h (standard deviation 0.5) v 7.1 h (0.7)).
Oscar the cat
In the Steere House Nursing and Rehabilitation Center in Providence, Rhode Island nine years ago, Oscar the cat would do his rounds and snuggle up to patients until they died a few hours later. Oscar’s prognostic powers far exceeded those of the medical and nursing staff. He has inspired an article in the New England Journal of Medicine, a book called “Making Rounds with Oscar: the Extraordinary Gift of an Ordinary Cat,” and most recently an excellent article about uncertainty at the end of life by Piotr Szawarski, an intensive care consultant at Wexham Park (J Intensive Care Soc doi:10.1177/1751143716646123).