Out with the old and in with the new

Looking forward to the New Year and back at the old one, like Janus the two-faced Roman god of doorways and transitions (if Roman doctors had the NHS to work in, they would always be at his shrine), January is the perfect time to reflect on time and its passing. At such moments (with very big topics), I tend to seek help from reliable sources. Who may you ask? Einstein, Stephen Hawking, Brian Cox - No. Doctor Who. He knew a lot about the human race, and generally thought we were a bit daft but loveable. With the experience of his 800-odd years of existence, he felt that the cycle of events in human lives reassured us. He's probably right (he usually is) but it can also be frightening and a little intimidating.

I recently read 'The Ghost of Thomas Kempe' by Penelope Lively with my sons. This is a book for children which raises some big questions. The hero is haunted by a sixteenth century sorcerer who is upset with all things modern that encroach on his former role, including the local doctor. The boy discovers a diary by a boy from 150 years ago who encountered the same ghost, who later becomes his school's benefactor. He knew him as a boy through the diary, but sees him as an elderly man, through his portrait at school. He begins to think of the future, when he will be an old man. The 'relentless march' of time. Reassuring but also frightening. No matter what we do, it never stops.

Primarily in my role for patient.info but also as a clinician, I am always striving to stay on top of the latest changes in medicine, but this seems like a reasonable time to take a step back from the micro and look wider. Over the last 20 years medically, there have been several large-scale shifts in organisation and they will always roll on regardless. For all clinicians there have been several seismic shifts; the acceptance of guidelines and evidence-based medicine and the introduction of appraisal and revalidation stand out for me. For GPs there has been the increase in conditions that are managed in the community and the computerisation of our surgeries with the subsequent demise of the 'Lloyd George' paper notes. Where will we be in a further 20 years, I wonder? Will we still have an NHS or general practitioners (either, in a recognisable form, from that of today)?

Meanwhile, we will continue our efforts to keep you informed of the latest changes in evidence-based medicine and guidelines. To this end we have updated our hypertension in pregnancy and pre-eclampsia articles this month, based on new guidance from the Guidelines and Audit Implementation Network (GAIN).

Find them at:

Pre-eclampsia (patient page)

Pre-eclampsia and Eclampsia (professional page)

Pregnancy and High Blood Pressure (patient page)

Hypertension in Pregnancy (professional page)

We have also updated the following articles:

Acute Otitis Media In Children (professional page)

Otitis Media with Effusion in Children (patient page)

Benign Paroxysmal Positional Vertigo (professional page)

Benign Paroxysmal Positional Vertigo (patient page)

Vertigo (professional page)

Dizziness, Giddiness and Feeling Faint (professional page)

Congenital Primary Glaucoma (professional page)

Ebstein's Anomaly (professional page)

Gastrointestinal Infections in Pregnancy (professional page)

Hepatomegaly (professional page)

Hereditary Haemochromatosis (professional page)

Hyperthyroidism (professional page)

Hyperthyroidism (patient page)

Hyperthyroidism in Pregnancy (professional page)

Thyroid Eye Disease (professional page)

Thyroid Eye Disease (patient page)

Thyroid Function Tests (professional page)

Thyroid Function Tests (patient page)

Intracranial Abscesses (professional page)

Pericardial Effusion (professional page)

Peripheral Blood Film (professional page)

Full Blood Count (professional page)

Full Blood Count and Blood Smear (patient page)

Platelet Function Disorders (Thrombocytopathy) (professional page)

Thrombocytopenia (professional page)

Polyuria (professional page)

Post-term Pregnancy (Prolonged Pregnancy) (professional page)

Reye's Syndrome (professional page)

Vertebrobasilar Occlusion and Vertebral Artery Syndrome (professional page)