On being a patient

Those who practise medicine should remember that we are all patients at some time, most likely at the beginning and end of our lives. Therefore, this textbook begins with an account of encounters with the medical and nursing professions, written by an outstanding doctor, medical historian, and leading clinical scientist. After a highly distinguished and eventful career which spanned the introduction of the British National Health Service in 1948, Christopher Booth died in 2012, aged 87 years. Latterly, he experienced the protracted misery of illness punctuated by repeated surgery; but to the end he retained his intellect and penetrating wit. His piquant observations are a challenge to us all as we try to provide care for our patients, as is his parting shot: ‘If you are a physician, no matter how important you may think that you are, you should, so far as your own illnesses are concerned, consider yourself a layman.’

Why Is Exercise Underutilized in Clinical Practice Despite Evidence It Is Effective? Lessons in Pragmatism From the Inclusion of Exercise in Guidelines for the Treatment of Depression in the British National Health Service

Exercise remains greatly underutilized in clinical practice for reasons that are only partly understood. This critical review situates the problem within the broader political and economic context. It focuses on depression, the leading cause of disability worldwide, and the processes that followed the inclusion of exercise as a treatment option in clinical practice guidelines in the British National Health Service. The review highlights previously unaddressed phenomena, including antiexercise lobbying by primary care physicians and efforts to present the evidence for the antidepressant effects of exercise as weak, nonexistent, or methodologically flawed. Notably, the field of kinesiology remained silent while these processes unfolded. This information suggests that the path from research evidence to implementation in clinical settings remains dependent on factors beyond the amount and quality of research evidence. The review underscores the need to vigilantly monitor, critically appraise, and actively participate in the clinical research literature and the development of guidelines.

The lost worlds of royal commissions in the NHS: The unaccountable in pursuit of the unanswerable?

There have been recent calls for a royal commission (RC) on the British National Health Service (NHS). This article focuses on the impact of RCs and similar advisory bodies, particularly on finance recommendations, of three inquiries with broad remits across the whole of the NHS from very different periods: Guillebaud (1956); Royal Commission on the National Health Service (1979); and House of Lords Select Committee on the Long-term Sustainability of the NHS (2017). These inquiries appear to have had rather limited impacts, especially on NHS funding. First, there appears to be some hesitancy in suggesting precise figures for NHS expenditure. Second, the reports are advisory, and governments can ignore their conclusions. Third, governments have ignored their conclusions. In the 1950s and the 1980s, contrary to the recommendations of the inquiries, NHS expenditure subsequently grew only slowly, and charges were increased. In short, asking an independent RC to provide answers on NHS expenditure is perhaps the unaccountable in pursuit of the unanswerable.