What do you think?

Latest posts

The most recent posts from the doc2doc forums

Re: Pros and cons of doc2doc

Posted in doc2doc feedback at Sun, 30 Aug 2015 16:19:51

DrS

Posts: 1531
Joined: 25 Jan 2009

A few rambling thoughts here. I don't use the BMJ journal website much, I like the paper journal as I can scribble & highlight on it more easily. Some of these features may already exist on there, apologies if they do. I personally like to have everything all in one place so Id prefer if the BMJ commeng came into d2d rather than them having their own seperately site (I like only having to keep an eye on one website)

 

My concern of moving to an exclusive comments on stories in the BMJ style is that it would restrict our topics to those covered in the journal. Many of the discussions on D2D (esp those I tend to engage more with) are based on news articles, items from other journals, new guidelines, clinical problems & life / career advice. Tying D2D more strongly into the BMJ website would cut out much of this. 

I don't mind suggestions on what I've previously liked or commented on (not just read as i often open a page, read a few lines to get the gist then realise it's not for me). As you can only see the 10 most recent posts sometimes you miss out on a topic oh might be interested in if you've been away for a day.

It would be nice to unfollow a topic to stop it appearing in the recent discussions widget. For example... There might be a few popular discussions about an adult topics which are all active & so taking up several of the spaces in the recent discussions. Can I click that I'm not interested in that and it then disappears (& doesn't return) from the widget so I can see new things I might like (like when you leave a discussion in Facebook to stop getting all the notifications about it)

The doc2doc search has always been unreliable. Perhaps a keywords system where people can nominate upto 5 keywords would help simple searching. I might tag my recent returning to work discussion with "maternity, return to work, advice, career, family", whereas a "hardcore" clinical paper could use the article MESH keywords. Visitors could then be offered a "popular discussions" word cloud to see hot topics on search for particular terms. 

If people are discussing an article from BMJ group (not just BMJ but ADC etc) perhaps an option to auto link the abstract into the opening post with link to the journal (I read an article online, want to discuss, click "discuss" and the widardry takes me to an open discussion if there is one, or using a template starts one with the abstract already in which then appears on D2D). You can then have 2 recent discussion widgets: "from the journals" and "freelance" (or whatever catchy name suits those that aren't discussing articles).

 

for those articles from journals, the ability to link those articles & your participation into your BMJ learning portfolio (or even better my NHS eportfolio) so I can quickly & easily link "I've read this & actively discussed it" for my portfolio

and finically can we PLEASE get the mobile site fixed so I can view it with my phone portrait, Its the only site I have to view & use landscape as its not resizeable and the discussion column doesn't fit in portrait!

hope that's some ideas to be getting on with! (Happy to expand on /clarify any if my ramblings don't make sense)

Re: Extra Interesting ECG

Posted in General clinical at Sun, 30 Aug 2015 11:15:38

Dr.Chid

Posts: 735
Joined: 21 Feb 2012

Prolonged Qtc,Sicksinus syndrome.Does not look like Hypokaelemia.

Re: Retirement/part time

Posted in General at Sun, 30 Aug 2015 11:02:18

Maxim

Posts: 484
Joined: 14 Dec 2010

Kirked

It sounds as if you are starting from a position of strength.  If I've read this right, you have several good prognostic factors:

1) You seem to be contemplating this on your own terms and in your own time.

2) You're not considering stopping your professional career abruptly but being able to choose the type and pace of work to suit your circumstances.

3) You are young enough and in good enough health (I hope) to put plenty of energy into new projects and to cope with the other changes imposed frequently on any profession.

One tip would be (you may already have done this) to draw up a fairly strict balance sheet of pros and cons to what you would be leaving and what you would be taking on.  One important factor is if you are would be giving up the cameraderie of a large friendly legal team to work mainly alone.

As others have said, it's important to keep learning new skills at any stage of life and not to put things off until the mythical 'one day...' 

Finally, involve any partner or spouse closely in discussion and planning.

Good luck!

Re: Restarting work after maternity - what are your tips?

Posted in Medical mums at Sun, 30 Aug 2015 09:52:26

nilu

Posts: 1
Joined: 03 Feb 2009

Go part time and sort out childcare

 

Re: Nurse or Doctor?

Posted in General clinical at Sat, 29 Aug 2015 12:15:15

DuaneF

Posts: 1595
Joined: 09 Dec 2011

Kirked and JohnD,

 

As a matter of interest,  in the USA, we have Doctors, Nurse Practicioners, and Physician Assistants.  I will outline the details briefly to conserve Bandwidth!  Doctors, are Well you know Medical Doctors,  fully licensed to practice medicine after their med school, and post graduate residency.  Nurse Practicioners are Nurses who after going through an advanced educational curriculum and practicum can practice alongside Doctors, or as a practicioner by themselves.   Physician Assistants normally practice in a Doctors clinical setting, and can prescribe everything a Doctor can, but they normally seek advice from Doctor in the clinical setting, but do operate independently while in the setting.  There is a Sociological stigma for Doctors, almost as if they prefer Physician Assistants since they are more "On the Leash"  So to say, or under the control of the Doctor.  Nurse practciioners tend to be viewed as competitors and a Threat to Doctor Soverignty.   This is not with all Doctors, but it is a sociological fact none the less,  I read a book in this very topic a number of years back.  As a Paramedic in the military I was able to have full abilities on scene for care in trauma care, but in hospital I would act on advice of staff Doctor, and of course would do so in trauma care on scene when I needed advanced Drug advise, or care for multiple traumas, and clinical problems IE - Poisoning etc.

    I will avoid posting links, any questions shoot.

DuaneF

Re: Clinical question of the week: should RBBB be an indication for primary PCI?

Posted in Cardiology at Fri, 28 Aug 2015 22:50:01

gben5

Posts: 2
Joined: 18 Feb 2014

I thought RBBB is indicative of RV strain from RCA disease,PE,Chronic Lung disease,.Reperfussion would be necessary in the setting of ACS .

Re: #rsjc journal club: Incidental findings on chest CT imaging (Thorax)

Posted in Respiratory medicine at Fri, 28 Aug 2015 22:35:14

@thelungdr

Posts: 2
Joined: 24 Aug 2015

See our discussion from last nights journal club. If you have any further comments add them to twitter including our hashtag #rsjc (For @respandsleepjc)

 

Storify link: https://storify.com/respandsleepjc/twitter-journal-club-respandsleepjc-reviews-thorax

 

Symplur stats:

http://www.symplur.com/healthcare-hashtags/rsjc/analytics/?hashtag=rsjc&fdate=08%2F26%2F2015&shour=09&smin=00&tdate=08%2F28%2F2015&thour=17&tmin=00

Re: Aphantasia: a real disorder or a fantasy?

Posted in Psychiatry at Fri, 28 Aug 2015 17:11:06

DuaneF

Posts: 1595
Joined: 09 Dec 2011

Sure John,

 

I will not cut and Paste any more Information,   Especially Scientific in Nature.

DuaneF

Children bearing children

Posted in Public health at Fri, 28 Aug 2015 16:51:04

John D

Posts: 3693
Joined: 01 Feb 2010

We had a thread recently, on the sad case of a girl in a South American country, not even a teenager, who was pregnant by her abusive father, in a state where the Law forbade abortion.  A sad, even pitiful case, if there were only one, but there is more, much more of this.

http://www.pressreader.com/uk/the-guardian/20150828/282024736016781/TextView

This article from today's Guardian, writes of the 5100 girls less than 15 years old who became pregnant in Guatemala last year alone.   It tells the stories of girls who were 12 or 11, who became pregnant after having only one menstruation in their lives, because they were already being abused, frequently, by the men of their families.   

The United Nations Population Fund report, "Motherhood in Childhood"  http://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP2013.pdf concentrated as UNFPA does on pregnancy in 15-19 year olds, showing the deprivation of education as well as deprivation as poverty that such early pregnancy imposes.  But it also found that Latin America and the Caribbean is the only region in the world where births to girls under age 15 is rising (Page 5).  But Guatemala is not even listed in the UNFPA report, "Adolescent Pregnancy" as a country the highest prevalence of adolescent pregnancy (Niger, Chad, Mali, Guinea, Mozambique )  http://www.unfpa.org/sites/default/files/pub-pdf/ADOLESCENT%20PREGNANCY_UNFPA.pdf

In the world of 2013, there were 7.2 million births to girls under 18, and 2 million of those mothers were less than 15 years old.   This is not an isolated case, or a  single country where young girls, pre-adolescent girls are abused so badly.  It is a powerful force in the world that perpetuates poverty, ignorance, morbidity and death.

John

Re: Fears of the Spread of new Viruses

Posted in General at Fri, 28 Aug 2015 14:33:31

Mukhtar Ali

Posts: 1008
Joined: 14 Nov 2010

Saudi Arabia sees Mers deaths surge

Saudi Arabia has announced four more deaths from Middle East Respiratory Syndrome (Mers), bringing the number of deaths in the past week to 17.
 

BMJ Open journal club: are GP-led walk-in centres effective?

Posted in General clinical at Fri, 28 Aug 2015 10:38:22

Emma Gray

Posts: 2
Joined: 25 Aug 2015

A paper recently published in BMJ Open, by Arain et al, takes a look at the perceptions of healthcare professionals regarding the effectiveness of GP-led walk-in centres in the UK, and the impact that these centres may have on other urgent care services.

Despite health services in the UK being overstretched, the authors found that the presence of the walk-in centre did not have an effect on the demand on emergency department services. Many participants interviewed for the study felt that the centre was just duplicating already existing healthcare services. This may be due to a lack of public awareness of the service; inappropriate use of the centre; or public confusion as to the function of the service.

What do you think can be done to increase the effectiveness of GP-led walk-in centres? Are they a useful part of the urgent care system?

----------------------------------------------------------------------------------------------------------

More information about this article:

Abstract

Objectives This study aimed to identify the perceptions of healthcare professionals regarding the effectiveness and the impact of a new general practitioner-led (GP-led) walk-in centre in the UK.

Setting This qualitative study was conducted in a large city in the North of England. In the past few years, there has been particular concern about an increase in the use of emergency department (ED) services provided by the National Health Service and part of the rationale for introducing the new GP-led walk-in centres has been to stem this increase. The five institutes included in the study were EDs, a minor injuries unit, a primary care trust, a GP-led walk-in centre and GP surgeries.

Participants Semistructured interviews were conducted with healthcare providers at an adult ED, an ED at a children's hospital, a minor injuries unit, a GP-led walk-in centre, GPs from surrounding surgeries and GPs.

Results 11 healthcare professionals and managers were interviewed. Seven key themes were identified within the data: the clinical model of the GP-led walk-in centre; public awareness of the services; appropriate use of the centre; the impact of the centre on other services; demand for healthcare services; choice and confusion and mixed views (positive and negative) of the walk-in services. There were discrepancies between the managers and healthcare professionals regarding the usefulness of the GP-led walk-in centre in the current urgent care system.

Conclusions Participants did not notice declines in the demand for EDs after the GP-led walk-in centre. Most of the healthcare professionals believed that the GP-led walk-in centre duplicated existing healthcare services. There is a need to have a better communication system between the GP-led walk-in centres and other healthcare providers to have an integrated system of urgent care delivery.

Link to the full text article: http://bmjopen.bmj.com/content/5/8/e008286.full

Re: Interesting ECG

Posted in Cardiology at Fri, 28 Aug 2015 06:30:36

Dr.Chid

Posts: 735
Joined: 21 Feb 2012

In Response to Re: Interesting ECG:[QUOTE]

Correct :- Atrial Flutter with 2 : 1 block , the 15th beat is  premature atrial complex


Posted by alaminium[/QUOTE]

Sir,

Thank you.

Dr.Chid

 

Re: Where do you stand on e-cigarettes?

Posted in Public health at Thu, 27 Aug 2015 18:17:22

Sidhom

Posts: 581
Joined: 23 Aug 2013

Today, I had training in Fire Awareness. The instructor spoke about the risk of fire by e-cigs. It can happen if they receive a higher charge ie 1 amp instead of 0.5 ampere, or overheating. My experience with a few colleagues of mine was fairly negative. One smoked it in between cigarettes, one smoked it all day long as it is 'safe', and one reverted to cigarettes after a while, non-smokers tried it, liked the taste and eventually two became smokers.

We had to add new signs of no e-cigarette smoking is allowed in closed premises, as one was trying to smoke everywhere because it is 'safe'.

On the other hand, if one considers smoking an addiction, I wonder theoretically what would be the difference between e-cigarettes and methadone.

Re: Gun technology - what is acceptable to the American people?

Posted in News & media at Thu, 27 Aug 2015 13:29:03

DuaneF

Posts: 1595
Joined: 09 Dec 2011

Hi John, Sken, and Kirked,

 

Clearly as the murder rate in both the USA and UK is up, there are not sufficient controls of  of various types to stop this.    Although I admire your fortitude John, and in theory I applaud sensible Gun control,  I admonish anyone who immediately jumps to conslusions and goes after law abiding gun owners.  In reality this criminal who was killer, sought to terrorize through social media the masses.   Mental Illness is the cuplrit here, in America we have absolutely no form of Mental Illness control,  Aha, there is the rub!   Lock up, and quarantine the vicious evil killers, and keep safe the productive nice people.  Wkat a concept.   Maybe kirked could provide somew insight here,  QUESTION: -  Why, is it that the person who makes threats on social media, rants about killing, purchases Guns, and spews evil words all over twitter and facebook cannot be locked up as a danger to himself and society, - IN AMERICA??  I am at a loss as to why we keep passing more Gun laws if we fail to enforce the existing ones.   As a courtesy to all involved, I would ask that no one spout off more sensless Rhetoric about gun control,   and instead seek to find a solution to the mental health crisis.   I have friends who lost their lives to people weilding axes and knives, so since I am not ranting about confiscating knives, lets look for real solutions.   I ask this, and since John D is a moderator I implore him to enforce this in a fair way.   People have died, this is not a time for going after inaminate objects, IE Guns!  Lets stop the criminals and Mentaly ill from Killing, and maiming, this is the Goal.   Is this possible, The following posts will tell.

 

DuaneF

 

London Low Emissions Zone fails.

Posted in Public health at Thu, 27 Aug 2015 11:03:26

John D

Posts: 3693
Joined: 01 Feb 2010

The London LEZ was supposed to improve atmospheric conditions and the health of the people by excluding potentially polluting vehicles from Greater London - approximately within the M62.   But it hasn't, among school children anyway.

Effects of Air Pollution and the Introduction of the London Low Emission Zone on the Prevalence of Respiratory and Allergic Symptoms in Schoolchildren in East London: A Sequential Cross-Sectional Study.   Wood HE,Marlin N,Mudway IS et al  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109121

The study confirmed the association of  vehicle pollutants with respiratory morbidity in schoolkids, but found no reduction in the pollution levels in the three years since the LEZ was started.

John

 

Re: The forthcoming paradigm of psychiatry

Posted in Psychiatry at Thu, 27 Aug 2015 07:58:34

kirked

Posts: 1871
Joined: 08 Oct 2010

It’s quite telling when one looks back at terminology used where Mental Healthcare and legislation meet and has evolved:

There is much talk of madhouses, imbeciles and lunatics. People needing hospitalisation for an attack of the spleen and the vapours. Patients living in  bedlam following the wild beast test or because they are simple or feeble minded. The Lunacy Commission is created to care for general paralysis of the insane. In one famous case a widow comments ‘my son is of weak mind however there is nothing like a flogging to cure him’.

kirked

ACC/AHA Cholesterol Guidelines Found Efficient and Cost-Effective

Posted in Diabetes at Wed, 26 Aug 2015 19:34:15

diabetesMD

Posts: 757
Joined: 15 Apr 2011

Physician's First Watch

July 15, 2015

By Cara Adler

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The 2013 American College of Cardiology/American Heart Association cholesterol guidelines improve detection of individuals at increased risk for cardiovascular disease, a JAMA study finds. Moreover, the guideline's 10-year CVD risk threshold for primary statin treatment is cost-effective — and could even be lower — another JAMA study suggests.

Among more than 2400 adults not on statins at the start of a community-based cohort study, 39% were eligible for statins using the ACC/AHA criteria, compared with 14% using criteria from the 2004 ATP III guidelines. During roughly 9 years' follow-up, the risk for incident CVD in patients eligible for statins versus noneligible patients was significantly higher when applying the ACC/AHA criteria (hazard ratio, 6.8) than with the ATP III criteria (HR, 3.1).

In a separate simulation study, researchers found the ACC/AHA guideline's 7.5% 10-year CVD risk threshold for initiating statins had an "acceptable" incremental cost-effectiveness ratio of $37,000 per quality adjusted life-year (QALY) compared with a cutpoint of 10%. (Commonly used cost-effectiveness values are $50,000–$150,000 per QALY.) However, if the cost-effectiveness ratio were $100,000 per QALY, a 4% cutpoint would be optimal.

Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "These studies further support the wisdom of transitioning the guidelines from a focus on cholesterol levels to the level of the patient's risk. It is also important to remember that the guidelines are broad recommendations and each decision depends on the preferences of each individual patient."

Link(s):

JAMA article on cost effectiveness (Free abstract)

JAMA article on statin eligibility and incident CVD (Free abstract)

JAMA editorial (Subscription required)

ACC/AHA CV Risk Calculator (Free)

COMMENT: We have had a number of posts on the subject of the value of the new guidelines and the cost-effectiveness of increasing the number of people who should be put of statins.  The two papers discussed in this post add significant data both to the preventative value of using the new risk-based guidelines versus the old LDL-based guidelines.  Taken together these papers provide strong evidence that  the new guidelines provide a cost-effective means for preventing future events

That e-petition, asking for a no confidence debate on Health Sec. Hunt

Posted in News & media at Wed, 26 Aug 2015 17:03:39

John D

Posts: 3693
Joined: 01 Feb 2010

You may recall the e-petition asking for a no confidence debate in Parliament on Secretary of State for Health Hunt.  And that the 'tariff' for such petitions is that 10,000 signatures will "get a response from the Government" and 100,000 "will be considered for a debate in Parliament".   The "No Confidence in Hunt" petition got over 200,000, and this ws the response:

The Government has responded to the petition you signed – “To debate a vote of no confidence in Health Secretary the Right Hon Jeremy Hunt”.

Government responded to all who signed the petition this:

The Government is committed to delivering seven day services to make sure that patients get the same high quality, safe care on a Saturday and Sunday as they do on a week day.

Many people do not realise that if you are admitted to hospital on a weekend, you have a 16% greater chance of dying. The Government wants to change this so that everyone can be confident that they will receive the same level of care whatever day of the week they are admitted to an NHS hospital. 

NHS consultants already provide an outstanding service and show great dedication to ensuring patients get the best outcomes. But the Government has a duty to make sure the system is set up in a way which makes it as easy as possible for hospitals to organise their resources to maximise patient safety across every day of the week.

To understand more about the possible issues for staff contracts, last year the government asked the independent pay review bodies for NHS staff - The Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB) for their observations and recommendations about how the reform of employment contracts could help support the delivery of seven day services in England.

The reports were published this month. They identified that a major barrier to seven day services is a decade old contractual right in the consultants’ contract negotiated by their union representatives in 2003 that allows senior doctors to refuse to work non-emergency work in the evenings, at nights and at weekends. No junior doctor, nurse or other clinical group has any such right. Other senior public sector professionals who work in services required to keep the public safe, such as police officers, firemen and prison governors, do not have this opt out either.

Whilst the vast majority of consultants work tirelessly for their patients, the opt out allows individuals to charge employers hugely expensive payments which are much higher than national contract rates (up to £200 an hour). The average earnings for a hospital consultant are already in the top 2% in the country at £118,000, and these inflated payments can make it difficult for hospitals to provide the weekend cover they know patients need. 

The report endorsed the removal of the opt out, as well as broadly supporting other changes to the consultant contract that would ensure the right level of cover is available every day of the week; not just Monday to Friday.

Under the new plans, doctors will still continue to receive a significantly higher rate for working unsocial hours and there will be a contractual limit (not an expectation) of working a maximum of 13 weekends a year.

By the end of the Parliament, the Government hopes that the majority of consultants, in line with existing practice for nurses, midwives and junior doctors, will be on reformed contracts, working across seven days, to deliver a better service to patients. Hospitals like Salford Royal and Northumbria that have instituted seven day services have already seen improvements in patient care and staff morale.

These new plans will mean that doctors working in some of the toughest areas in the NHS, such as A&E and obstetrics, will at last be properly rewarded and there will be faster pay progression for all consultants early on in their career. Under the new proposals, the highest performing consultants could be able to receive up to £30,000 a year in bonus payments, on top of their base salary.

Of course, improving weekend care requires more than just ensuring greater consultant presence. That's why the government is also addressing issues such as access to weekend diagnostic services, provision of out of hospital care to facilitate weekend discharges, and adequate staffing cover amongst other clinical groups,. But NHS leaders and the independent pay review bodies are clear that increasing the presence of senior clinical decision makers at weekends is vital, and that the consultant opt out remains a barrier to organising broader support services and staff rotas.

The Government feels it is under an obligation to the public to do all it can to make NHS care at the weekend as safe as during the week through the delivery of seven day services this Parliament and that is what it will continue to do.

Click this link to view the response online: https://petition.parliament.uk/petitions/104334

Thanks,
The Petitions team
UK Government and Parliament

A disappointing response, I have to say, and not just because they refused, but because of the manner of it - a mere re-statement of Hunt's statistical distortions.

But!   My MP happens to be of the other persuasion, and although I emailed them because they are my MP, to register my concern at this brush-off, not to garner solidarity, they have emailed me thus:

Thank you for your email regarding a no confidence debate on the Health Secretary. As this petition has well over 100,000 signatures it will be considered for a debate by the backbench business committee. I will monitor developments very closely. 

I am deeply concerned at the lack of confidence which the medical profession seems to have in Mr Hunt and hope he either takes drastic action to improve the situation by listening to their concerns and acting upon them or considers his position. 

If you feel I can be of any further assistance on this or any other matter please do not hesitate to get in touch. 

So may I ask all members of D2D who did sign the petition, to contact their own MP, of any persuasion, and ask them about it?  The BackBench Business Committtee is important, as it choses the subjects for debate in "backbench time".    Even if the majority there follows the Tory Party Line and rejects it, it will generate more publicity about Hunt's Plan, and doctors fears about it in repsct of patient care.

John

 

 

Re: Am I Mad? Considering quitting Core Medical Training

Posted in General at Wed, 26 Aug 2015 13:55:37

b.ahmed

Posts: 1
Joined: 06 Feb 2011

Hello, I just wanted to say that if you haven't done it already there is a great burnout questionnaire available from the BMA, with relevant resources at the end depending on your score to help.

http://www.bma.org.uk/burnoutquestionnaire

Re: Body cams for Doctors

Posted in Medicolegal at Wed, 26 Aug 2015 11:24:07

Poltor

Posts: 299
Joined: 29 May 2013

Someone is bound to say that one cannot wear a body camera when dealing with patients as it would interfere with their human rights to privacy!

Re: Are UK junior doctors right not to re-enter contract negotiations with the government?

Posted in Careers at Wed, 26 Aug 2015 11:03:54

RosieCain

Posts: 9
Joined: 10 Jun 2015

To help junior doctors see how they may be affected by any contract changes, as proposed by NHS Employers, we have designed a pay ready reckoner.

This model is only illustrative as the NHS Employers' proposals are incomplete and the calculations are based on the data provided by them.

This is our best guest estimate of what pay will look like under the new proposals, although this is unlikely to be wholly accurate for a number of reasons:

The model relies on the user inputting their current hours into the new definitions of day (7am-10pm), night (10pm-7am) and Sunday (7am-10pm) hours working. It then calculates how pay might change if these working patterns were to stay the same. However given Government announcements about service redesign such as the introduction of 'seven day services' however they are defined, it seems unlikely that working patterns will stay the same.
 

The model relies on NHS Employers' definitions of unsocial hours and unsocial hours pay rates, endorsed by the DDRB, we do not know whether these would translate to reality.
 

Crucially, the model only looks at comparative earnings at a snapshot in time. What is important is the entire training pathway of a junior doctor, as it may be acceptable say for one placement or grade to receive relatively lower earnings if over the full training programme there is a net gain. Whilst it is likely that pay progression will change under the proposed model, there is currently not sufficient information available to model this change, although it is likely to reduce earnings over the course of training.
 

This modeller only works for full-time (as opposed to less-than-full-time) and full shift (as opposed to non-resident) rotas and thus those training less-than-full-time or on non-resident rotas should not use this tool for comparison.
 

Finally, the scenario with most support from DDRB and NHS Employers (C+ a model with provisions for RRPs) is impossible to currently model accurately. The main issue with Scenario C+ is how to quantify the level of any RRP and then to decide which specialties to apply them to. We do not know what level RRPs will be set at, or which specialties they will apply to. The NHSE proposals do make a suggestion for 4 specialties (which have been incorproated into this model) but this appears purely illustrative.

Re: Corridor consultations/advising friends

Posted in General at Wed, 26 Aug 2015 10:54:51

sken

Posts: 1072
Joined: 13 Oct 2009

Yes we have discussed but I think mostly in relation to going a step further and treating.. Depends on the problem - in retirement particularly  I find some just what a person with whom they can "talk through" a health issue or have a moan. But there are occasions when would prefer non-involvement. Bereavent and isolation issues can be tricky.

kirked - relating to your other post about retirement : you will find that ailments of one sort or another are statistically more likely and if living in some sort of "close relationship" ailments can have a very clear effect on those close by . Some dialogue becomes essential.

The internet is invaluable , but the depth of discussion and on-going support that is needed for some going through a bad time is way beyond what many GPs could offer - so who else but family/friends (and Google) is there for advice?

DOI Experience as a giver and a receiver.

Re: Would judicial consent for assisted dying protect vulnerable people?

Posted in BMJ at Wed, 26 Aug 2015 09:44:43

sken

Posts: 1072
Joined: 13 Oct 2009

I hope that most have us have glanced at the BMJ this week . There is a lengthy (approx 1,000 words)  and somewhat alarming rapid response from a past president of the Islamic Medical Association which is contradictory in places but perhaps explains why judicial review may be needed in some circumstances. (Earlier opiinion expressed by this group has been that it is better to risk prison than abide by an advance decision that might lead to shortening of life). 

The problem - and it is one I find a bit frightening - is that if in the future one is cared for by someone whose religion will not allow even the refusal of certain treatments aimed at prolonging life or that suffering hardship may be beneficial in taking away sin , just how should one proceed? Am I entitled to refuse care offered because of the religious views of the provider - going through the courts during the last weeks of life could be "tiresome" , particularly if I in turn make myself liable to a charge of religious discrimination in , say , preferring a Hindu doctor or a humanist or "traditional" Christian etc...? I can also envisage that there are times when I might have a preference for an older (or younger)  , or male (or female) doctor. I can't think of an instance where I might have a colour preference.

This is not meant to be a "religious post" but one exploring a general principle which has been touched on previously. In the future in the UK , I foresee a time when we may need "faith wards" much as we have "faith schools" - and to some extent most hospices could perhaps be seen in this light - but in the interim there could be problems?

Male Doctors more likely to be sued or struck off than female Doctors

Posted in General at Wed, 26 Aug 2015 07:52:33

kirked

Posts: 1871
Joined: 08 Oct 2010

Emily Unwin of the UCL Medical School has just published a paper in BCE Journal (Biomed Central) that demonstrates, she says that male doctors are two and a half times more likely to be sued for negligence or be struck off than female doctors. ."This effect was demonstrated over a number of years, across a range of study designs, across different countries, and with a wide definition of outcome types, and therefore seems robust”. The team analysed 40,246 cases of medico-legal action that represented a global population of 4,054,551 people. They discovered no matter where in the world the studies came from, male doctors were still being sued two and a half times more than their female collegues. What is more the difference between men and women had been consistent for the past 15 years. She says this finding suggests the idea male doctors are more likely than female doctors to experience medico-legal action as there are more practicing male doctors is false. If this had been the case, the difference between male and female doctors would have reduced over time as the number of female doctors increased. Between 2010 and 2013 there was a 64 per cent increase in the number of complaints made to the UK medical regulator and a 42 per cent increase in the number of doctors struck off or suspended from the UK medical register. Similarly, in the United States, the number of state board disciplinary actions increased between 2008 and 2012, with a 17 per cent increase in the number of medical licenses that were revoked, denied, or suspended.

"Investigating complaints about doctors' fitness to practice not only places an enormous level of stress on the doctor being investigated, but also places a resource strain on regulators and may lead to patient concerns about the quality of care they receive. More research is needed to understand the reasons for why male doctors are more likely to experience a medico-legal action. The causes are likely to be complex and multi-factorial. The medical profession, along with medical regulators, and medical educationalists, now need to work together to identify and understand the underlying causal factors resulting in a sex difference in the experience of medico-legal action".

(I did not have access to the original paper so this is a report of a report)

kirked

Re: Should blazing courage be celebrated quickly or at leisure?

Posted in News & media at Tue, 25 Aug 2015 19:09:45

DuaneF

Posts: 1595
Joined: 09 Dec 2011

John,

 

My Friend,  you misunderstand me,  I am proud of them, and All people doing their jobs with distinction.  I refused a medal in the Service, where I was extricating a lady from a burning car, and got 2nd degree burns to my face and hands,  all healed thank the fates.   In any event most Military people are humble, and always say it is their job.    I say the real heroes are the spouses of these soldiers,  I always said my wife was more a hero than me, running the house whilst I was training in some jungle somewhere!  I also believe the Doctors of primary medicine and all branches are heroes,  fighting to keep us all healthy. 

 

DuaneF