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Miles and Jo Weatherall were married 62 years and died within a few months of each other. Their obituaries tell of their many medical and academic achievements, but it's the glimpses into the lives they lived outside work that touched me more as a reader (doi: 10.1136/bmj.39241.578160.BE doi: 10.1136/bmj.39241.530116.BE). Another obituary records a much shorter and all too different life: that of a young academic in Iraq. Khalid Tariq Al Naib, a medical microbiologist, was kidnapped and murdered in Baghdad on 30 March, on the day he returned from a sabbatical in Australia (doi: 10.1136/bmj.39234.632002.BE). One reason for his trip was to learn how to improve scientific training and development in Iraq.
“Nothing is static, nothing is absolute, nothing remains the same for ever, least of all the thought and life of a human being,” Richard Lehman observes in his weekly journal blog on bmj.com (http://blogs.bmj.com/category/comment/medical-journals-review). He is talking about an article by Alan Wasserstein in the Annals of Internal Medicine of 5 June on Michel de Montaigne, essayist of the French renaissance. Montaigne's experiences of renal colic, it seems, mellowed him into the compassionate humanist who described mankind with clarity and honesty.
Emma Wicks tells a story that everyone expected to be short: her autobiography as a person with cystic fibrosis (doi: 10.1136/bmj.39188.741944.47). “It is difficult to plan for the time that my parents were told I would not have. It is hard to think about getting a mortgage, or starting a pension when you're not sure you'll live long enough to have a retirement.” Rather than arranging her funeral, though, she's planning her wedding and feeling optimistic. We publish such patient's journeys to help doctors understand how it feels to face a difficult diagnosis, live with a condition, cope with the effects on carers, and make the best of available health care. Emma's tale includes practical suggestions: she would love, for instance, to take her intravenous antibiotics at home rather than sitting in hospital for two weeks with an acute infection.
Would you expect a systematic review on imaging technologies for diagnosis of lower limb arterial stenosis to give you some patients' insights? I wouldn't, so I was pleasantly surprised to see that Ros Collins and colleagues reviewed, as well as evidence on diagnostic accuracy and associated harms, some data on patients' comfort during these investigations and on their preferences (doi: 10.1136/bmj.39217.473275.55). Contrast enhanced magnetic resonance angiography came out best for sensitivity and specificity for stenosis of more than 50% in a lower limb vessel, and patients found it tolerable. But, in an accompanying editorial, Andrew Bradbury and Donald Adam remind us that these findings have limited relevance to most patients (doi: 10.1136/bmj.39244.344664.80). A fifth of people over 60 in developed countries have absent pulses or a reduced ankle-brachial pressure index, a quarter of them have symptoms (mainly intermittent claudication), and for most of these patients this is managed in primary care. Of the few referred to specialists, most are managed conservatively. This isn't because of rationing. In real clinical life few people need such high tech diagnostic imaging: careful history taking and examination is often enough.