The only place to start this month is on page 220 with the review of Simon Winchester's biography of Joseph Needham. The account of this astonishing polymath's life is something to wonder at, and is a reminder of China's extraordinary inventiveness. Writing with a 21st century perspective, Iain Bamforth writes ‘Needham would hardly be surprised at the dynamic explosion of wealth and creativity in China …’, but he also reproduces the Needham question: ‘If the Chinese had been so technologically inventive why did they not come up with modern science?’ We may be criticised for publishing something that has little, if any, relevance for primary care, but I challenge anyone to read this and not feel uplifted.
This month there are a clutch of papers that study children and young adults from different perspectives. The tribulations of parenthood figure twice. On page 173, the study from the Netherlands describes how parents assess their children as they become sick and make decisions when to summon professional help, with findings that will echo the experience of many readers as both parents and doctors. The accounts are of parents trying to make sense of what they observe and wanting to avoid any possible risk. Like adults dealing with their own illnesses, almost all of them had some kind of idea of a diagnosis when they got to the point of calling a doctor, a reminder of the importance for doctors of exploring their ideas. The study on page 180 is an unusual reminder of the contribution of fathers to the health of families. There have been numerous reports of links between the health of mothers and children, but fewer concerning fathers. The authors come up with the rather curious finding that depression among fathers is associated with an increase in consulting among the children for speech and language problems, and for behavioural problems.
Drug taking among adolescent patients is a permanent source of worry. At the time of writing this, the UK government has been so bothered by the political consequences, that they have decided to ignore the recommendations of their own expert committee on the classification of ‘ecstasy’. Cannabis poses similar problems for governments. It seems to occupy a position close to alcohol: it is widely used and is harmless for many users, but can cause harm for some users (page 157). The article on page 166 is a report from one team developing an intervention to deal with excessive cannabis use. Among adolescents we also worry about mental health problems. The editorial on page 156 is a reminder of how common mood problems are among those consulting their GPs, but the authors caution against applying formal psychiatric labels too readily. The study on page 159 confirms how common low mood is among those consulting, and there was congruence between the patients' and their doctors' assessment of mental health difficulties. Intriguingly, better continuity of care tended to lead to over diagnosis.
Another odd finding is reported on page 198. Patients reporting chest pain where the initial diagnosis was not cardiac pain were more likely than control patients to receive a first diagnosis of ischaemic heart disease in the year following. It's not at all clear what is going on with such patients, or how clinicians should respond to the findings, except that it is likely to make us all even more nervous of missing things than we are already.
David Orlans is inviting readers to ‘Share your learning points’. He is hoping to produce a compilation of distilled wisdom from different authors. It's based on the concept that we are all reflective learners, and over our working lives we assemble collections of insights that may never get communicated to others. We're publishing some of his ideas on page 218, in the hope that many readers will be encouraged to send in their own ideas. Gathering the collective wisdom of the BJGP's readers into a book sounds like a fantastic idea, and we hope lots of you will respond enthusiastically.
- © British Journal of General Practice, 2009.
