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\"In the woods outside the town of Willnot, the remains of several people have suddenly been discovered, unnerving the community and unsettling Hale, the town's all-purpose general practitioner, surgeon, and town conscience. At the same time, Bobby Lowndes--his military records disappeared, being followed by the FBI--mysteriously reappears in his hometown, at Hale's door. Over the ensuing months, the daily dramas Hale faces as he tends to his town and to his partner, Richard, collide with the inexplicable vagaries of life in Willnot. And when a gunshot aimed at Lowndes critically wounds Richard, Hale's world is truly upended.\"--Front jacket flap.

Back pain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). We compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice (control). 1573 adults (aged ≥18 years) with back pain (with or without radiculopathy) consultations at ten general practices in England responded to invitations to attend an assessment clinic. Eligible participants were randomly assigned by use of computer-generated stratified blocks with a 2:1 ratio to intervention or control group. Primary outcome was the effect of treatment on the Roland Morris Disability Questionnaire (RMDQ) score at 12 months. In the economic evaluation, we focused on estimating incremental quality-adjusted life years (QALYs) and health-care costs related to back pain. Analysis was by intention to treat. This study is registered, number ISRCTN37113406. 851 patients were assigned to the intervention (n=568) and control groups (n=283). Overall, adjusted mean changes in RMDQ scores were significantly higher in the intervention group than in the control group at 4 months (4·7 [SD 5·9] vs 3·0 [5·9], between-group difference 1·81 [95% CI 1·06–2·57]) and at 12 months (4·3 [6·4] vs 3·3 [6·2], 1·06 [0·25–1·86]), equating to effect sizes of 0·32 (0·19–0·45) and 0·19 (0·04–0·33), respectively. At 12 months, stratified care was associated with a mean increase in generic health benefit (0·039 additional QALYs) and cost savings (£240·01 vs £274·40) compared with the control group. The results show that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care. Arthritis Research UK.

\"Growing up as the daughter of a dedicated surgeon, Elizabeth L. Silver felt an unquestioned faith in medicine. When her six-week-old daughter, Abby, was rushed to the Neonatal Intensive Care Unit with sudden seizures, and scans revealed a serious brain bleed, her relationship to medicine began to change. The Tincture of Time is Silver's gorgeous and haunting chronicle of Abby's first year. It's a year of unending tests, doctors' opinions, sleepless nights, promising signs and steps backward, and above all, uncertainty : The mysterious circumstances of Abby's hospitalization attract dozens of specialists, none of whom can offer a conclusive answer about what went wrong or what the future holds. As Silver explores what it means to cope with uncertainty as a patient and parent and seeks peace in the reality that Abby's injury may never be fully understood, she looks beyond her own story for comfort, probing literature and religion, examining the practice of medicine throughout history, and reporting the experiences of doctors, patients, and fellow caretakers. The result is a brilliant blend of personal narrative and cultural analysis, at once a poignant snapshot of a parent's struggle and a wise meditation on the reality of uncertainty, in and out of medicine, and the hard-won truth that time is often its only cure. Heart-wrenching, unflinchingly honest, and beautifully written, The Tincture of Time is a powerful story of parenthood, an astute investigation of the boundaries of medicine, and an inspiring reminder of life's precariousness\"-- Provided by publisher.

High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.

\"One doctor's passionate and profound memoir of his experience grappling with race, bias, and the unique health problems of black AmericansWhen Damon Tweedy begins medical school,he envisions a bright future where his segregated, working-class background will become largely irrelevant. Instead, he finds that he has joined a new world where race is front and center. The recipient of a scholarship designed to increase black student enrollment, Tweedy soon meets a professor who bluntly questions whether he belongs in medical school, a moment that crystallizes the challenges he will face throughout his career. Making matters worse, in lecture after lecture the common refrain for numerous diseases resounds, \"More common in blacks than whites.\" Black Man in a White Coat examines the complex ways in which both black doctors and patients must navigate the difficult and often contradictory terrain of race and medicine. As Tweedy transforms from student to practicing physician, he discovers how often race influences his encounters with patients. Through their stories, he illustrates the complex social, cultural, and economic factors at the root of most health problems in the black community. These issues take on greater meaning when Tweedy is himself diagnosed with a chronic disease far more common among black people. In this powerful, moving, and deeply empathic book, Tweedy explores the challenges confronting black doctors, and the disproportionate health burdens faced by black patients, ultimately seeking a way forward to better treatment and more compassionate care\"-- Provided by publisher.

Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections. We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing. The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guideline-based prescribing were sustained at 5 months after the intervention. A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. ClinicalTrials.gov, no. NCT01913860

\"Greta Helsing inherited the family's highly specialized, and highly peculiar, medical practice. In her consulting rooms, Dr. Helsing treats the undead for a host of ills--vocal strain in banshees, arthritis in barrow-wights, and entropy in mummies. Although barely making ends meet, this is just the quiet, supernatural-adjacent life Greta's been groomed for since childhood--until a sect of murderous monks emerges, killing human and undead Londoners alike. As terror takes hold of the city, Greta must use her unusual skills to stop the cult if she hopes to save her practice and her life\"-- Provided by publisher.

Geva Greenfield and colleagues ask whether it is time to reconsider the role of the GP as gatekeeper to specialist services, and call for more evidence to guide future policy

'What is a Doctor?' is a vital contribution to the ongoing debate about how we maintain an NHS that is both fit for purpose and free. Using stories and case studies from across his thirty-year career as a GP, Phil Whitaker offers insight into the medical movements, political interference and societal changes that have transformed the role of doctor over the past three decades. Much has altered for the better but, even when based on good intentions, an equal or greater amount has been damaging and threatens the sustainability of the NHS. In examining what it means to be a doctor today this book also answers an accompanying question 'what is a patient?' - and how we can all take a more active role in our healthcare. And looking forward Dr Whitaker describes what might yet be done to restore the NHS and its capacity for properly patient-centred care.

Objective To evaluate the effectiveness and costs of a multifaceted flexible educational programme aimed at reducing antibiotic dispensing at the practice level in primary care.Design Randomised controlled trial with general practices as the unit of randomisation and analysis. Clinicians and researchers were blinded to group allocation until after randomisation.Setting 68 general practices with about 480 000 patients in Wales, United Kingdom.Participants 34 practices were randomised to receive the educational programme and 34 practices to be controls. 139 clinicians from the intervention practices and 124 from control practices had agreed to participate before randomisation. Practice level data covering all the clinicians in the 68 practices were analysed.Interventions Intervention practices followed the Stemming the Tide of Antibiotic Resistance (STAR) educational programme, which included a practice based seminar reflecting on the practices’ own dispensing and resistance data, online educational elements, and practising consulting skills in routine care. Control practices provided usual care.Main outcome measures Total numbers of oral antibiotic items dispensed for all causes per 1000 practice patients in the year after the intervention, adjusted for the previous year’s dispensing. Secondary outcomes included reconsultations, admissions to hospital for selected causes, and costs.Results The rate of oral antibiotic dispensing (items per 1000 registered patients) decreased by 14.1 in the intervention group but increased by 12.1 in the control group, a net difference of 26.1. After adjustment for baseline dispensing rate, this amounted to a 4.2% (95% confidence interval 0.6% to 7.7%) reduction in total oral antibiotic dispensing for the year in the intervention group relative to the control group (P=0.02). Reductions were found for all classes of antibiotics other than penicillinase-resistant penicillins but were largest and significant individually for phenoxymethylpenicillins (penicillin V) (7.3%, 0.4% to 13.7%) and macrolides (7.7%, 1.1% to 13.8%). There were no significant differences between intervention and control practices in the number of admissions to hospital or in reconsultations for a respiratory tract infection within seven days of an index consultation. The mean cost of the programme was £2923 (€3491, $4572) per practice (SD £1187). There was a 5.5% reduction in the cost of dispensed antibiotics in the intervention group compared with the control group (−0.4% to 11.4%), equivalent to a reduction of about £830 a year for an average intervention practice.Conclusion The STAR educational programme led to reductions in all cause oral antibiotic dispensing over the subsequent year with no significant change in admissions to hospital, reconsultations, or costs.Trial registration ISRCT No 63355948.