Stress and emotional exhaustion linked

Emotional exhaustion is the key precursor of stress according to a longitudinal study of UK doctors published in The Lancet. High levels of personal accomplishment increased stress, but by contrast depersonalisation - treating patients as objects rather than as people - lowered stress levels. Might this explain the Psalmists observation that 'the wicked have no struggles and are free from the burdens common to man'? (Psalm 73:3-5) The current emphasis on encouraging doctors to care more about patients as individuals and to reach higher personal achievements, without time and support, was adding to stress and burnout in doctors according to one of the research team, Professor McManus of University College, London. (Lancet 2002;359:2089-90; British Medical Journal 2002;324:1475, 22 June)

Coma case coming

A Scottish GP is taking her NHS Trust to court for seeking to withdraw life support when she was in a coma. Fiona Smith was injured in a car accident in Tours France in July 1995; in which her husband Jim, also a doctor, died. She was later allegedly diagnosed as being in a persistent vegetative state by doctors at Dundee Royal Infirmary, who she claims then discussed ending life support. Dr Smith, who woke up six months after the crash, is currently preparing a £100,000 lawsuit against Tayside University Hospitals Trust, and hopes her case will help to challenge Scotland's Adults With Incapacity Act and win a European Court ruling. A Trust-appointed review panel says she received 'good and proper care' in 2000. (Doctor 2002;19, 19 September)

Warnock advocates mercy killings

The courts should be able to sanction mercy killings for patients suffering terminal illnesses according to Baroness Warnock, former chair of the Committee of Inquiry into Human Fertilisation and Embryology. Writing in Counsel, the official magazine for barristers in England and Wales, she argues that if the law permits abortion for fetal abnormality, it should also allow euthanasia. In July Warnock backed the cloning of babies to treat infertile couples, saying there were no serious ethical obstacles providing the technique could be shown to be safe. (The Independent 2002;6 August)

Relativising gender

The public perception of transsexuals is likely to change further if government plans seeking new legal rights for the group go ahead. The Lord Chancellor's Department has convened a new working group to look at key issues affecting Britain's 5,000 transsexuals including rights to marry, adopt, inherit family titles and property and receive revised birth certificates. (The Times 2002;22 June)

Spiritual beliefs and bereavement

People who profess stronger spiritual beliefs seem to resolve their grief more rapidly and completely after the death of a close person than do people with no spiritual beliefs, a Marie Curie centre study has concluded. Although the study did not discriminate between different religious traditions, and was cautious to distance itself from suggesting that 'an intervention concerning spiritual matters is appropriate for people with no professed beliefs', it did however recommend more accurately identifying people who would have difficulty adjusting to loss. (British Medical Journal 2002;324:1551-4, 29 June)

The global neighbourhood

The Johannesburg Earth Summit could have gone much further in its recommendations to ensure justice for the poor and dispossessed, but progress here will always be limited by how we, as a global community, answer the question 'Who is my neighbour? Jesus' definition of neighbour included anyone in need who crosses our path, regardless of ethnicity, religion or social background (Luke 10:25-37). In tackling the issues raised by globalisation we can make a good start by remembering the words of Martin Luther King: 'We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one directly, affects all indirectly'. (British Medical Journal 2002;325:97,13 July)

Armageddon

A quarter of all Americans believe that Jesus will return in their lifetime and nearly two thirds believe Revelation's apocalyptic prophecies to be broadly accurate. In July this year a new thriller title The Remnant went straight to number 1 in the New York Times best seller list, the tenth such book in a series called Left Behind written by authors Tim LaHaye and Jerry Jenkins. Their 9th book Desecration: Antichrist takes the throne eclipsed John Grisham to become the best-selling American Novel of 2001. The series popularises the dispensational premillenialist view of the end times involving belief in a literal rapture, seven-year tribulation and millennium - albeit with variations on some of the finer details. (The Times (2) 2002;20 September)

Working too hard?

Overwork may be fatal according to a case control study showing that weekly working times were related to likelihood of myocardial infarction. Those working more than 60 hours per week have twice the risk of those working less than 40 (Occupational and Environmental Medicine 2002; 59:447-51). Jesus worked hard but did not go on responding to need when exhausted despite the fact that 'crowds of people came to hear him and be healed of their sicknesses'. Rather he 'often withdrew to lonely places and prayed'. (Luke 5:15-16)

Negligence claims

The total annual cost to the NHS of negligence claims rose seven-fold between 1995 and 2000, such that the cost of outstanding claims is now £2.6bn with a further £1.3bn predicted to arise from incidents not yet reported. Cases of cerebral palsy and brain damaged babies accounted for 80% of outstanding claims by value and 26% by number. (British Medical Journal 2002;324:1411, 15 June)

Spiritual care

More than half of the medical schools in the United States now have courses on religion and medicine that introduce medical students to spiritual issues in medical illness, according to a recent review in the Journal of the American Medical Association. Over 60 studies have examined the role of religion in medical conditions with the majority finding high rates of 'religious coping' (receiving comfort and support from religious beliefs). The author states, 'Even in Europe where religious involvement is low, studies find that those who are less religious experience more depression and recover more slowly from depression'. Readers are encouraged to take a spiritual history and be supportive of their patients' beliefs. (JAMA 2002;288:(4):487-493)