Mental health problems at work.

organising the randomised trials that are needed to evaluate the numerous interventions that have been suggested and are in current use. Finally, venous thromboembolism. Deep vein thrombosis and pulmonary embolism are avoidable and treatable risks for all ill patients. Yet few hospitals provide a coherent and informed preventive service, or a good treatment service, of the sort that has been pioneered at McMaster University Medical School in Ontario. There is surely a gap here which medical angiologists could fill, because both prevention and treatment are almost entirely medical rather than surgical, much is known. and can be done, and certainly more research is needed. There is therefore a good argument to develop medical services for patients with peripheral vascular disease in collaboration with vascular surgeons and services for venous thromboembolism. Physicians with an interest in such disorders-medical angiologists-might also take on Raynaud's disease and other vasospastic disorders, perhaps contribute to vascular prevention clinics, and possibly plug gaps in services for coronary heart disease and stroke. But they cannot spread themselves too thinly because to cover all vascular disorders would require training and competence in general medicine, cardiology, neurology, and haematology-which would be completely unrealistic. At present there are perhaps five physicians in Britain who would admit to being medical angiologists, though I suspect that they are counted as general physicians. The European working group's proposal for one or two per 100 000 population is so unrealistic that it undermines the group's case. It would mean as many as 1000 medical angiologists in Britain. To start with it would be best to train and appoint some general physicians with an interest in angiology in a few teaching hospitals and large district general hospitals. Eventually, however, medical angiologists would have to convince purchasers to buy their services-so someone somewhere needs to show that the outcome for patients with peripheral vascular disease would be improved and that the incidence and ravages of venous thromboembolism could be reduced. Here, then, is the challenge to medical angiolo-gists: prove that we need you. 1 European Working Group on Medical Angiology. The case for the speciality of medical angiology. Cause thirty times as many lost days as industrial disputes The amount of time lost from work through mental health problems is enormous-in England and Wales it amounts to 80 million working days a year, cosfing employers C3 7 billion, according to the then secretary of state for …