BMJ - British Medical Journal

New testimony gathered by the BMA details instances of physician associates (PAs) and anaesthesia associates (AAs) making incorrect clinical decisions, dangerously prescribing medication, introducing themselves as doctors, and taking part in surgical procedures for which they were not qualified.1The BMA said that the scale of the evidence it had gathered through an online reporting portal between November 2023 and February 2025 showed that the NHS had failed in its duty to ensure patient safety. The 600 reports of serious concerns gathered by the BMA have been submitted as evidence to the government commissioned Leng review.23 But the BMA said that the NHS must introduce urgent interim measures while the review is ongoing, including an immediate halt to recruitment of PAs and AAs, implementation of the BMA’s safe scope of practice and supervision guidance,4 and an immediate investigation into PAs and AAs being placed on doctor rotas.The BMA has now published...

This man in his early 70s presented with a two year history of an itchy rash on his lower limbs. He had initially had a diagnosis of psoriasis and was treated with topical clobetasol propionate. Although the itch improved with this treatment, the rash persisted and worsened. On examination, there was clearly demarcated erythema on both feet and lower legs, and thickening, deformation, and discoloration of the toenails (fig 1). Fungal cultures of the skin identified Trichophyton rubrum, and the diagnosis was revised to tinea incognito with onychomycosis.bmj;389/apr03_7/e082105/F1F1f1Fig 1Tinea incognito refers to a superficial dermatophyte infection that has been inappropriately treated with topical steroids, leading to an atypical clinical appearance.1 This patient was treated with itraconazole (200 mg twice a day for seven days each month) orally for six months, and topical antifungal cream twice a day for one month, with substantial clinical improvement. This case highlights that tinea incognito...

The studyKhalaf Z, Bush A, Saglani S, et al. Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma. Thorax 2024;79:112-119.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/schoolchildren-with-asthma-face-different-risks-at-different-ages/

Countries across Africa are facing more frequent and concurrent infectious disease outbreaks, straining pandemic surveillance and control systems amid cuts to aid. These challenges warrant empowered leadership from the Africa Centres for Disease Control and Prevention (Africa CDC), rapid capacity building, and new financing initiatives.The Africa CDC recently recommended maintaining mpox as a public health emergency of continental security owing to intense spread and the emergence of a new highly transmissible clade Ia variant.1 Mpox remains uncontrolled in 22 countries, with weekly cases tripling between August 2024 and February 2025.1 Vaccine supplies, surveillance systems, and health services are insufficient, exacerbating the risks to public health.Concurrent outbreaks of Ebola, Marburg, measles, cholera, and other diseases add further strain to fragile health systems. In January 2025, Tanzania reported a Marburg outbreak with 100% case fatality rate.2 Also in January a new disease outbreak in the Democratic Republic of the Congo (DRC) affected...

A child was found to have noticeably decreased vision in his left eye during a routine optometry examination after showing normal vision six months previously. He did not self-report any eye symptoms (such as redness, pain, or tearing), headache, or dizziness, and had no personal or family history of eye diseases or other medical conditions. His parents reported that a green laser pointer (wavelength 532 ±10 nm, maximum output power <50mW, Class III) had been purchased six months previously and the patient had been playing with it frequently. The patient reported looking directly at the laser pointer light on several occasions. He did not report that anyone else had shone the laser into his eyes. There was no history of trauma to either eye.On examination, his best corrected visual acuity was 20/32 in the left eye and 20/20 in the right eye. Fundus colour photography showed multifocal, yellowish, faceted lesions...

Mortality in surgeryMore than 10 years ago, a survey in The BMJ drew attention to higher mortality in people who had elective surgical procedures carried out on Friday or over the weekend compared with Monday (BMJ doi:10.1136/bmj.f2424). A study in Ontario, Canada finds something similar. Among 400 000 patients undergoing 25 common surgical procedures, adverse postoperative outcomes, including death, re-admission, and long and short term complications, were 5% commoner in patients who underwent surgery on Fridays (JAMA Netw Open doi:10.1001/jamanetworkopen.2024.58794).Pandemic anniversary photographsThe New York Times marks the 5th anniversary of the covid-19 pandemic with a collection of photographs that capture some of the weirdness and tragedy of the period (https://www.nytimes.com/2025/03/10/world/asia/covid-anniversary-photos.html). Another piece in the same newspaper reminds us that, although we still don’t know how the pandemic started, inquiry and debate about its possible origins have been stifled rather than encouraged (https://www.nytimes.com/2025/03/16/opinion/covid-pandemic-lab-leak.html). Minerva was alarmed to learn that experiments with...

The General Medical Council is appealing to the High Court against a decision by a medical practitioners tribunal to suspend a consultant for 12 months for a “one-off” rape of a young woman instead of striking him off the register.1Aloaye Foy-Yamah was a consultant in acute medicine at Blackpool Victoria Hospital but was dismissed after the tribunal handed down its determinations on the facts last November. The woman, who was a friend, reported the assault, which happened in 2018, to the police, who investigated but did not prosecute Foy-Yamah. But the tribunal decided on the balance of probabilities that the rape, which he denied, had taken place while the woman was staying at his home.The GMC’s lawyer had asked the tribunal to erase Foy-Yamah from the register. The tribunal decided, however, that his “misconduct came right up to the line of erasure but fell just short of crossing it.” The...

The UK government’s tepid response to the House of Lords Food, Diet, and Obesity Committee report on the obesity crisis is concerning,1 particularly its refusal to exclude food companies from policy discussions in the face of such clear conflicts of interest. The rising burden of obesity related cardiovascular disease is especially concerning in light of The BMJ’s recent investigation into McDonald’s systematic efforts to circumvent local authorities’ health based planning decisions.2The similarity to previous tobacco industry interference is strong and well documented. The Obesity Health Alliance’s 2024 report shows the extent to which unhealthy food industries use strategies identical to those used by the tobacco industries in the past to resist public health action.3 In the same manner that tobacco industries have said that their products can be part of a healthy lifestyle, McDonald’s says that its drive-throughs promote physical activity and healthy eating. This commercial influence is particularly concerning...

The General Medical Council (GMC) plans to appeal against a tribunal’s finding that a consultant obstetrician and gynaecologist’s fitness to practise is not currently impaired, although six years ago he removed two patients’ ovaries without consent and on multiple occasions examined patients without a chaperone.In February a medical practitioner tribunal decided1 that Ali Shokouh-Amiri was guilty of misconduct over the incidents, which happened in 2017 and 2018. At the time he was employed by the Medical Specialist Group in Guernsey, becoming a partner in 2017, and was head of gynaecological oncology at the Princess Elizabeth Hospital. But the tribunal “considered that Dr Shokouh-Amiri has shown good insight into his failures which has developed over the last six years and that he has put in place procedures and actions to address his failings and to ensure they do not happen again,” said the legally qualified chair, Stephen Gowland.Shokouh-Amiri faced a catalogue...

General practitioners will be able to prescribe the weight loss injection tirzepatide (Mounjaro) to “prioritised patient cohorts” from 23 June, NHS England has said.New interim commissioning guidance instructs integrated care boards (ICBs) to meet the funding costs of tirzepatide and sets out a phased implementation plan for the next three years.1Last June the National Institute for Health and Care Excellence (NICE) published draft guidance recommending tirzepatide for use in primary care settings and specialist weight management services.2 NICE estimated that the total population eligible for tirzepatide was 3.4 million people.NHS England called for a phased rollout of the treatment to avoid overwhelming the NHS.3 NICE accepted this request in its final guidance published in December and asked NHS England to develop a detailed plan of who would be eligible in the first pilot phases, on the basis of clinical need rather than just body mass index (BMI).4NHS England’s guidance sets...

The BMA’s Resident Doctors Committee (RDC) has reached an agreement with the government over how exception reporting in England will be reformed, officially ending the union’s dispute with the government over the issue.Exception reporting is the process through which doctors can report differences in their total hours worked when compared with their set schedule—times when they were unable to take their contractual rest breaks or when educational or training opportunities were missed—and the levels of support available to them.The BMA has said that the current system is “not fit for purpose” because inaccessible systems, time consuming processes, and the fear of repercussions are deterring doctors from reporting such instances. “This not only means doctors don’t get the pay and training opportunities they deserve but also means that NHS hospitals are missing out on crucial information about how they are functioning,” the BMA said.The RDC voted to go into dispute with...

This editorial by McCartney et al(BMJ 2025;388:r593; doi:10.1136/bmj.r593, 25 March) has been amended to clarify that the benefits review described in the sixth paragraph applied to recipients of employment and support allowance.

The need for shared decision making and informed consent in gynaecology is not new.1 When the Supreme Court enshrined it in law in Montgomery v Lanarkshire Health Board,2 it was not doing anything revolutionary; these concepts were already part of General Medical Council guidance.3 But practical implementation was, and is, problematic.Good communication with a sympathetic and empathic listener is crucial for patients to feel safe. Safety is so fundamental to compassionate healthcare that it beggars belief that women frequently leave their gynaecology appointments feeling distressed, violated, or traumatised. Once a woman feels unsafe, once trust is lost, she is unlikely to return.Despite concerns about invasive gynaecological procedures being expressed over many years, progress is glacially slow, a fact emphasised by the recent report of the House of Commons Women and Equalities Committee4 and the UK government’s response.5 The gaslighting of women in gynaecological settings is commonplace; severely painful, invasive procedures,...

My husband lives with a spinal cord injury. Hospital admission can be traumatic when I’m excluded despite being his carer.1 I’m privy to information about his care that can’t be gleaned in a single handover with clinicians. I’ve felt unwelcome during the admission process, and healthcare staff haven’t treated me as an expert partner in care. Transitions involve patients and families moving between different clinical contexts—but too often their experiences and expertise are lost or undermined in the process.Problems with admissions and transition are seen across care settings and patient groups. Al Aynsley-Green, the first national clinical director for children in government, has expressed his concerns about patients receiving chaotic care and scant communication, which is often inappropriate for their age group or condition. He tells of a young woman with a complex health condition being cared for in a cramped overflow hospital bay alongside older people with dementia and...

The United Nations has called for “justice and answers” after the bodies of eight Palestinian medics, six first responders, and one UN staff member—still in their uniforms and gloves—were recovered from a mass grave in southern Gaza after an attack by Israeli forces.1The UN said that the “clearly identified” humanitarian workers had been dispatched to collect injured people on 23 March in the Rafah area and had been travelling in five ambulances, a fire truck, and a clearly marked UN vehicle. They then “came under fire from Israeli forces who were advancing in the area,” after which their teams lost contact with them.On 31 March the UN’s emergency relief coordinator, Tom Fletcher, posted on the social media platform X,2 “15 emergency and aid workers in Gaza were found buried by their wrecked and well-marked vehicles . . . They were killed by Israeli forces while trying to save lives.”The Israel...

bmj;389/apr02_1/r631/FAF1faChristian Ip-Yam was born in Mauritius, the eldest of four sons. He attended Royal College Port Louis, a prestigious state grammar school in the island’s capital. Being academically gifted and diligent, he was awarded the Mauritian state scholarship in 1979 and applied successfully for medicine at Manchester Medical School where he was a friendly, easy going, and hardworking student who seemed to sail through his undergraduate exams. He qualified with honours in 1984 and opted for a career in anaesthesia.He trained at Northwick Park, Charing Cross, and Harefield hospitals in London and undertook lectureships in cardiothoracic anaesthesia at the University of Liverpool. He published at least 20 research papers in highly respected academic journals.In 1994 he took a sabbatical in Singapore, where he met his future wife, Georgia, a doctor in aesthetics. He settled permanently in Singapore in 1995 and he and Georgia were married in 1996. He quickly established...

The death toll continues to rise in central Myanmar after a 7.7 magnitude earthquake hit South East Asia on 28 March. Over 2700 people have died so far, with another 4521 injured and 441 reported missing.1The disaster prompted Myanmar’s ruling military junta, the State Administration Council (SAC), to make a rare call for humanitarian aid on 29 March, despite the ongoing civil war. On 1 April, however, aid agencies reported that the junta was preventing humanitarian assistance from reaching earthquake survivors.2 SAC resumed airstrikes in rebel areas barely three hours after the earthquake struck.3A UN assessment found that many health facilities in Myanmar have been damaged by the earthquake and warned that a “severe shortage” of medical supplies, including trauma kits, blood bags, anaesthetics, and assistive devices, was hampering response efforts. According to the World Health Organization4 three hospitals were severely damaged, with 22 sustaining partial damage.In a 30 March...

When hurricane Helene flooded a North Carolina plant that made 60% of the US’s intravenous fluids in October 20241 it was a grimly familiar situation. The damage worsened a shortage that had lingered since hurricane Maria hit the same company’s production in Puerto Rico in 2017.Medical procedures had to be altered to reduce the use of IV products. Fluids were rationed and surgeries postponed, and some patients had to get by with sports drinks.2 It took three months to bring the crisis under control.A broader, more intractable crisis has replaced it. Trump’s aggressive reconfiguration of US trade relations and a pledge to make all of the country’s essential drugs and their inputs at home is threatening the stability of medical supply chains that have only just recovered from covid.Additionally, tariffs targeting both traditional US allies and rivals are likely to hamper progress already made on relocating some medical sourcing from...

In this feature by Sally Howard (BMJ 2025;388:r305, doi:10.1136/bmj.r305, published 6 March 2025) we have removed a sentence stating that more than 1000 women a year die each year from unsafe abortion in Malawi—a statistic that has been disputed, including in the paper originally referenced in our article (Miller C. Maternal mortality from induced abortion in Malawi: what does the latest evidence suggest? Int J Environ Res Public Health 2021;18:10506. doi:10.3390/ijerph181910506. https://pmc.ncbi.nlm.nih.gov/articles/PMC8507663/).

The World Health Organization will slash its budget for 2026-27 by more than a fifth after the US withdrew, and other nations reduced, its funding.WHO plans to cut back the scale of its projects and its workforce to tackle a funding gap of nearly $600m (£464m; €555m) this year, Reuters reported after seeing an internal memo from 28 March. WHO proposes cutting its 2026-27 budget by 21%, from $5.3bn to $4.2bn. It had initially proposed a more modest cut, reducing spending to $4.9bn.“Despite our best efforts, we are now at the point where we have no choice but to reduce the scale of our work and workforce,” the memo reportedly said. Staff numbers will be cut by the end of April.In an earlier memo dated 10 March, WHO announced a one year limit on staff contracts and was working to alleviate the funding shortfall with more contributions from countries, private...