I was interested to read Dr Phil Hammond’s column ‘Rooting out incompetence – time for a new approach?’ (Guidelines in Practice, February 2005, p. 48). Many healthcare professionals have come across colleagues who are unfit to practise. However, it takes a great deal of courage to blow the whistle. How many of us have thought about taking this step but decided against it for fear of the consequences? For those with family and financial commitments it is a difficult decision to take the fear is that the whistleblower may be the one who is ostracised and eased out of his or her job. As for Dr Hammond’s suggestion of a doctor-led inspectorate to investigate complaints, I feel that such a body made up entirely of doctors would attract suspicion. It would be far better to involve patients, too.
June Hitchcock, travel health
consultant, Sevenoaks, Kent
Cardiovascular risk in rheumatoid arthritis
Clinic- and community-based studies have provided evidence of an increased rate of cardiovascular mortality in patients with rheumatoid arthritis (RA). The degree of risk is similar to that in diabetes mellitus. GP colleagues need to be aware of the increased cardiovascular risk in RA patients and that risk prediction charts may underestimate their 10-year cardiovascular risk. GPs should target these patients for blood pressure monitoring and consider applying a lower threshold for intervention with drug therapy. Further research is needed to guide practice in this area.
Dr Neil McKay, specialist registrar,
rheumatology, Northern Deanery,
Newcastle upon Tyne