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    Official figures issued this summer highlighted the increasing rates of Type 2 diabetes in the UK, and the growing share of the NHS budget which it consumes. And since the poorest people are twice as likely to suffer Type 2 diabetes and its complications, this is also an issue which should concern all of us. The figures, I’d like to suggest, are just the latest warning sign of a continuing public health disaster which began in 1984. This was the year in which the Department of Health issued the first-ever governmental dietary guidelines for the population at large (not counting […]
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    Training some patients with chronic illnesses to become ‘expert patients’ can significantly reduce the need for outpatient and general practice consultations and give the patients a much appreciated high degree of self-management.  Patients already, through experience, have highly relevant expertise including knowledge of their body and symptoms, of their lifestyles, and of treatment preferences. This short article uses the example of self-care by diabetic patients to illustrate the scope of potential change and it goes on to describe what expert patients could achieve in a major part of mental healthcare – that of bipolar affective disorder. Diabetic patients typically self-manage […]
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    Within the Osier paradigm, doctors have generally accepted accountability in two directions; to their professional colleagues collectively, and to their patients individually. In each case, accountability has been at two levels: a formal level of official complaint, disciplinary action or litigation; and an informal level of custom and expectations. Because in Osier’s time doctors had so little influence on the outcome of illness, accountability for outcome was not possible. Even the traditional Hippocratic rule ‘primum non nocere’ (above all, don’t harm) was not enforceable; desperate fear condoned desperate remedies; so doctors were encouraged to add substantial risks from treatment to […]
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