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Where do all the forms go that we so industriously complete for audits, investigations and management exercises? I recently stated that I had removed an Akrapovic exhaust silencer from a uterus and gave the procedure a fanciful number – silence was the not inappropriate response. So where does all the paperwork go and who reads it (and where and why)? Yet, my patients still can't park their cars on site and make it to the clinic within 13 weeks of entering the hospital campus – something, I understand, to do with a private finance initiative for car parking. At least it's not our fault that patients are defaulting on their part in meeting our waiting list targets.
And what about Modernising Medical Careers – was short listing and interviewing ever so much fun? Then we read that medical school applicants are now cribbing internet solutions to their application forms and an alarmingly high percentage of them have shown leadership in dealing with their grandmother's corns – but did they find somewhere to park when they took her for her hospital appointment? Some may, in error, even find themselves short listed and appointed to specialty training without even attending medical school, such is their compassion in dealing with their antecedent's podiatry crisis.
So, for those of you already in the system and entitled to read this journal, what is in store? A great deal: Khalid Khan's team take us on the first part of an odyssey into the arena of health technology assessment and enlightens us as to how new technologies are adopted into our health care system (and not one mention of that ultimate of all barriers to progress – the business case). Elizabeth Ball and Kim Hinshaw look at vaginal birth after previous caesarean delivery and how to predict the appropriateness and likely success. As Norman McLeod wrote: ‘Courage, brother! do not stumble’ – sorry, I'm informed that's not acceptable – ‘Courage, sibling! do not stumble’. Haritha Sagili and Mike Divers take us through the modern management of miscarriage (no relationship to ‘justice’ and appointing junior doctors). Then we have a fascinating comparison between obstetric haemorrhage as managed in Gimbie, Ethiopia and Queen Charlotte's and Chelsea Hospital, London. Julian Woolfson provides a most apt commentary on this fascinating and thought-provoking exercise.
Having only yesterday removed a rugby ball from a uterus, which was not there 2 years ago, Vanessa Harry's thought-provoking article on uterine leiomyosarcomas had me call the oncologists to theatre for a second opinion. Then, to be truly ashamed, read about the obstetric management of female genital mutilation. As the father of three daughters I am speechless that this is still a problem in the Western world and that there are apologists for this savagery. In the best periodical tradition we have part 2 of the series on cardiac disease in pregnancy, this time dealing with acquired disease. This is an outstanding piece of source material for all involved in the care of these women – and for those taking professional exams (though not much use in completing a job application form for a training post...mental note to commission an article on corns and grannies). And, of course ‘And finally...’ takes us to Ireland, with an exposition on Irish hospitality: all Dublin-based, for some reason – so that's the last time James Drife gets a bed in our house.
Enjoy this bumper value edition: our next one will be the last before the new trainees arrive. But it's great to know that there'll be someone on the team who is a natural at grief and anger management.
Neil McClure, Editor-in-Chief
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