We have to declare our conflicts of interest: both of us were strong devotees of the wisdom of Dr. Richard Lehman, a GP for 35 years and a leading advocate for shared medical decision-making. He was also a Professor of the Shared Understanding of Medicine at the University of Birmingham.
Very few physicians have enough time to read the headlines of the week’s major medical journals, and stay on top of all the advances in terms of drugs, procedures and diseases, yet lucky for us, we had Dr. Richard Lehman to do this for us. And he made many of our lives so much easier.
You’d have to look very hard to find a better, more entertaining and solid conveyor of medical wisdom than Richard Lehman, speaking both to general practitioners and the general public in his weekly column in the BMJ. He authored that column for 12 years, and what an immense accomplishment, often recapping and delivering bite-sized morsels of wisdom on the major medical news headlines of the week.
Going further than most medical columnists, he didn’t hold back when excoriating the problems of overdiagnosis, the self-congratulatory medical-industrial research complex, and the often-gross mismatch between what the research world was offering and what patients actually needed.
Richard was frequently laugh-out-loud funny, employing dry British wit wrapped in the eloquence of William Blake. He often wrote most trenchantly about the problem of medical waste, the over-intrusiveness of medicine and the overuse of medical care that often did more harm than good for most patients. In his last column in July 2018 he dissected a JAMA article on the use of the echocardiogram. No need to actually read the article because he sums it up so cleverly:
Although I recently had an echocardiogram, I have no idea what the nice lady was looking for, or indeed why. In the US it seems that Medicare spends nearly a billion dollars annually on echocardiography—most of which involves a complete report on both ventricles. This article suggests that some of the cost could be reduced by making fewer measurements. I’m not sure. Once the clinic has bought the machine, hired the nice lady, and she has squeezed all the jelly on, I think she might as well have a good look round while describing her holiday plans. Plop, whoosh,Corsica. It’s all very interesting for us old folk to listen to.
Richard was much more than a blogger. He was one of the clearest and most influential voices in modern evidence-based medicine. He helped normalize skepticism toward overdiagnosis and low-value care long before those conversations became mainstream.
We both met and had dinner with Richard and his wife Sue in Barcelona in2016 at the Preventing Overdiagnosis conference. In person he was entirely without pretence, kind and courteous as well as being whip-smart and intellectually fearless. He was the sort that could be absolutely ruthless when confronting medicalization, weak evidence, and self-serving medical dogma. He had that rare ability to dismantle an entire field with two calm paragraphs and one perfectly placed sentence.
Richard weighed into all areas of medicine, including orthopaedic surgery. He wrote about the work of FICEBO several times in his BMJ weekly review. The opening line to his blog about the original FIDELITY sham-surgery trial in NEJM (2013) didn’t put any sugar coating on that one: “Arthroscopic partial meniscectomy is useless.”
Similarly in 2016, he covered our mechanical symptoms paper with the classic: “Trimming menisci: mostly a sham.” He later added: "What, no more arthroscopic wash-outs and trims to extract gold from knees? How else will these poor folk support their families?” One line from that piece has really stayed with us:
“Knee arthroscopic procedures were the first to fail the criteria of evidence based medicine. Now it’s the turn of the shoulder.”
Amen to that. That sentence captured an entire era of orthopaedics.
Richard was always at the vanguard of patient involvement and this was remembered by Johanna Trimble, a patient advocate from Canada. She wrote to say that "I just heard to my sorrow that Dr. Richard Lehman has died. I loved to read his BMJ articles and will miss his wonderful humour."
She pointed out one of his most memorable articles called the Ten Commandments for Patient-Centred Health. The first commandment is classic Richard Lehman: Thou shalt have no aim except to help patients, according to the goals they wish to achieve.
That dry, humane, deeply intelligent voice is now gone--and I think many of us feel the loss.
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