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I’ve read a few spy novels in my time. I don’t think I’d cause much controversy if I put forward the view that John le Carré is perhaps the finest author in the genre. There are very many interesting things that happen in his riveting, multi-layered stories, but there’s one I want to focus on here. This is what happens when somebody defects—changes side. There’s a complex, rigorous and sometimes harrowing process where the defector is questioned in immense depth to extract the maximum possible information from them. There’s a similar process after one of their own spies returns from fieldwork, or after some major event. The word used to describe this process is ‘debrief’. Isn’t it very odd that we use the same word to describe what we put people through after a major event in healthcare?
In this issue, Sian Cooper, Mark Winton and Joanna Farrington-Exley do that lovely thing where they put a name to something which, once named, is completely intuitive ( see page 270 ). I’d not heard of toxic debrief before, but as soon as Bob Phillips recommended to me that I ask them to write about it, those two words made perfect sense to me. I’ve undergone toxic debrief, and I’ve witnessed toxic debrief. I’ve watched as conversations after a major event have spiralled into a litany of all of the other events experienced by the noisiest member of the conversation—with graphic detail and escalation. This can only leave the more vulnerable feeling that their own experience was not only relatively trivial, but that there is worse to come. I sincerely hope that I have not delivered toxic debrief—but I do hope that now that it has a name, I’m more protected from any involvement in it. They use a model called ‘Time Out’ which, despite the association in my mind with the naughty step, is a helpful way of delivering the support needed in a timely fashion. Their model is formally taught at their workplace, and so this paper won’t give you everything you need to practice time out. But it does give some really interesting ideas worth reflecting on, in case you need to support people after an event. For this reason, I’m making this paper my editor’s choice.
Also in this issue there are an excellent series of articles about General Data Protection Regulation ( see pages 294, 296, 298 and 302 ). You doubtless heard a lot about this around May 2018 as it came into force across the EU. You would not be alone if you remember the main impact being everyone who wanted to continue to send you spam emails sending increasingly begging emails to be allowed to carry on. However, there are a variety of perspectives we should all be aware of, and in these articles we’ve asked authors to look at them. Here’s a pair of questions I’d suggest you ask yourself when reading them: Do I really understand what a Data Controller is, and have I become one, either deliberately or by accident?
There are, as ever, lots of great papers in this issue. For example, you can find out if N-terminal pro-brain natriuretic peptide is a useful test ( see page 282 ) in determining severity of bronchiolitis (spoiler: not quite yet, but keep watching). You can read some great Epilogues, and some really good summaries of recent clinical evidence—for example, if you’ve not caught up with the phenytoin vs levetiracetam story yet, you can find a summary here ( see page 319 ). I hope you enjoy the issue, and do keep getting in touch.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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