CONTENTS FROM THE EDITOR
THE problem of increasing demand at a time of constrained resources will be familiar
to everyone working within the NHS. New approaches aimed at tackling this are welcome, and in this issue, Professor Jason Leitch, the Scottish Government’s national clinical director, discusses his role in planning greater integration between health and social care, and more patient-centred care (p. 10). Sepsis is a relatively common, life-threatening condition affecting 150,000 people per year in the UK, resulting in 44,000 deaths. On page 16, Dr Ron Daniels, chief executive of the UK Sepsis Trust, highlights recent NICE guidelines aimed at reducing misdiagnosis and delays in treatment. On page 14, Jim Killgore talks to consultant Dr Stephen Hearns about his innovative and at times dramatic work with the Scottish Emergency Medical Retrieval Service (EMRS). Rigid
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protocols are key to reducing the cognitive overload that comes with high-stress emergency situations. Medical innovation and scientific advances are discussed in a
different context by Deborah Bowman on page 9, highlighting the ethical importance of interpretation by clinicians when applying new discoveries to patient care. On page 8, Alan Frame discusses health literacy and its importance in shared decision making and informed consent. Douglas Hamilton discusses the challenges faced by dentists in adhering to good practice when prescribing antibiotics (p. 18). Doctors accustomed to acting as patient advocates may find themselves in the uncomfortable position of having to act against a patient’s wishes and breach confidentiality if someone deemed medically unfit refuses to stop driving. GMC guidance on reporting concerns to the DVLA is reviewed on page 12.
Dr Barry Parker
AN INTEGRATED APPROACH New MDDUS Board member
Professor Jason Leitch talks to Summons about ongoing reform in Scottish public health and his role
UNFIT TO DRIVE Barry Parker looks at the
factors to consider when a medical condition may compromise a patient’s fitness to drive
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Cover image: Winter Tree, Mary Paton. Oil on board, 1970. Born in Ayrshire in
1920, Paton studied at Edinburgh College of Art under McTaggart and Gillies. She spent most of her later life in Aberdeenshire, and was inspired by the surrounding landscape. She died in 1990.
Art in Healthcare (formerly Paintings in Hospitals Scotland) works with hospitals and healthcare communities across Scotland to encourage patients, visitors and staff to enjoy and engage with the visual arts. For more information visit
www.artinhealthcare.org.uk Scottish Charity No SC 036222.
WINTER 2016
MEDICINE ON THE EDGE Stephen Hearns discusses
cognitive overload and other challenges with the Scottish EMRS
CLINICAL RISK REDUCTION: SEPSIS ALERT
Dr Ron Daniels of the UK Sepsis Trust highlights the importance of improved diagnosis and management in this oft-missed condition
Editor:
Dr Barry Parker Managing editor: Jim Killgore Associate editor: Joanne Curran Editorial departments: MEDICAL Dr Richard Brittain DENTAL Mr Aubrey Craig LEGAL Simon Dinnick
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RESISTANCE IS FUTILE Doug Hamilton considers
the dilemma faced by dentists in prescribing antibiotic treatment
REGULARS 4 Notice Board
6 News Digest 8 Risk: Health literacy on the information superhighway 9 Ethics: Ethics as interpretation 20 Case studies: Pressure to prescribe, No prophylactic antibiotics, Abdominal lump 22 Addenda: Object obscura: Goa stone, Book choice: Being Mortal: Illness, Medicine and What Matters in the End, Crossword and Vignette – Frank Pantridge, cardiologist and inventor of the portable defibrillator
Please address correspondence to:
Summons Editor MDDUS Mackintosh House 120 Blythswood Street Glasgow G2 4EA
jkillgore@mddus.com
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Summons is published quarterly by The Medical and Dental Defence Union of Scotland, registered in Scotland No 5093 at Mackintosh House, 120 Blythswood Street, Glasgow G2 4EA. • Tel: 0333 043 4444 • Fax: 0141 228 1208
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The opinions, beliefs and viewpoints expressed by the various authors in Summons are those of the authors alone and do not necessarily reflect the opinions or policies of The Medical and Dental Defence Union of Scotland.
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