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Re: Reimbursing patients for financial loss

Posted in News & media at Sat, 28 Nov 2015 23:07:00


Posts: 27
Joined: 04 May 2015

My view as a retired GP would be that it would be reasonable for the Doctor to pay.

Re: SPRINT trial Should we lower systolic targets.

Posted in Psychiatry at Sat, 28 Nov 2015 23:04:59


Posts: 27
Joined: 04 May 2015

One difference in the articles is that the BMJ Evidence Update says that total mortality is not improved by lowering systolic target from 140 to 120. But the NEJM article says that it did reduce total mortality. 

Re: Nuremberg legacy 70 years on

Posted in News & media at Sat, 28 Nov 2015 15:00:49


Posts: 1178
Joined: 13 Oct 2009

Kathleen Taylor's book "Cruelty" is well worth a read in trying to understand what is a very complex aspect of human behaviour (she is a neurophysiologist) with chapters on what is cruelty , why does it exist etc... and concluding with one on can we stop being cruel. 

At various points she raises several points relevant to the Nuremburg trials. In particular the way in which we tend to focus on the Holocaust. IT is of course only one of many events some of which in many ways were far worse which have occurred throughout history and have continued to happen - in some ways the Holocaust has not been the worst of these events. 

A second point is to distinguish those features of the holocaust which were due to cruelty as opposed to aiming for efficient extermination. It was perhps the callous approach to extermination that appalled us so much and the extent of "otherisation".  Soldiers who stole from corpses might be shot and those who indulged in cruelty for its own sake were looked down on as betraying the ideals of the Reich. 

Interestingly this month has also seen the removal of the USA statue of the general who tried to promots the extermination of native Americans using smallpox. The Armenians still seek recognition for their genocide. Other countries in Africa and the East have their own horror stories from the not so distant past. 

We need try to understand these events and how we might also slip into these obscene aspects of human behaviour . That is one of the reasons these are important anniversaries. A few years ago there were comments that we should not even try to understand suicide bombers and that there was something wrong with those folk who could even envisage that any form of "understanding"  could be possible, Active social prejudice is not far beneath the surface in the UK although I suspect less now than during my childhood. 

Another brilliant book I have been reading consists of a series of essays on death in English history and how our attitudes change. One bit points out how doctors in the post war years until the mid1960s felt that aiming for cure was an overriding purpose of medicine with little grasp of palliative care. This still persists in some quarters . Perhaps when we look at the suffering which we have caused in pushing forward with research and treatments which by their nature may involve undue suffering , then we should also look to our own attitudes. As kirked says we should ponder over these anniversaries and see their relevance for each of us as individuals. 

Re: Cardiology Quiz

Posted in Cardiology at Fri, 27 Nov 2015 23:23:30


Posts: 475
Joined: 29 Jul 2010

You could have hit the correct answer Patlush for diagnosing Wellens`Syndrome, in fact Wellens`Syndrome comes right  in the differential diagnosis, the only thing is that there is prolonged QT interval in the ECG, the corrected QTc here is 550 ms ( QTc is prolonged if it is > 440 ms in men and > 460 ms in women ) ; the prolongation of QTc is in favor of Subarachnoid Hemorrhage , moreover the symptom of headache supports intracranial bleeding

Raised intracranial pressure due to bleeding produces the same ECG changes, but Iam not sure whether other causes such as brain tumors or abcess produces the same ECG changes

The ECG below is taken from 69 years old male with   Wellens`warningWellens' Syndrome.png

Re: why digital is not working

Posted in General clinical at Fri, 27 Nov 2015 10:18:02


Posts: 1178
Joined: 13 Oct 2009

Perhaps the problem  is simply the amount of unplanned work the NHS has to do within the resources available. These problems are long-standing. In the 1970s some surgeons tried right stay surgery - planned admissions based around the needs of the individual but that requires designated beds. So come a flu outbreak etc... choices have to be made. Move on 20-30 years and all out-patients had to be given a designated slot ... so a stark choice between telling urgents that no appointment , cancelling someone else and breaking the system in some way. Equally those days when 20% of OP time might be spent trying to find fairly randomly filed results in several volumes of notes should be a thing of the past.

 I recall one colonoscopy list - a bit overbooked as usual - where one patient had multiple pretty significant polyps and another was kept waiting unduly. And complained. So I was given a very strong warning from the manager that it must never happen again. Thereafter we took 1-2 patients off every list ..... I am not sure that most patients with significant rectal bleeding prefer to wait an extra month or 2 for a test where the computer dictates the appointment. 

There is a constant clash throughout the NHS between running smoothly and offering a patient sensitive service. My own GP group now provides a telephone based consultation service rather than appointments and is already swamped. 

 We need to see the "digital" as a tool not an overriding system. If we want the system to run better the first step might be for the public to take some responsibility for their own health. As with John D I think the NHS provides a world-class service but because we have to have a certain amout of working on an ad hoc basis. We will need to see what the new systems of health care will do when the NHS finally flounders . I bet they will not be as good overall - and the public will have themselves to blame in large part.

 I have a long -standing grouse where "digital" is concerned and have always been disappointed how generations of doctors still continue to think in terms of black and white where numbers are concerned. Ask the result of a test and get told the result is "normal" can be infuriating : just why can't doctors cope with numbers ? This approach totally ignores trends in results (someone whose BMI falls from 30 to 20 should not be dismissed as having a result in the normal range ) and what is normal for that patient , the timing of the sample etc..? And a "normal" blood pressure is often a feature of a particular doctor's way of thinking..... 

Re: Aphantasia: a real disorder or a fantasy?

Posted in Psychiatry at Thu, 26 Nov 2015 08:16:33


Posts: 1
Joined: 26 Nov 2015
I was referred to here from another person with aphantasia. I can't explain to you how our minds work, because I don't know. But it is my belief that this is very real, for me and for many others.

universal screening for hypercholesterolemia in children,

Posted in Careers at Wed, 25 Nov 2015 23:38:47


Posts: 475
Joined: 29 Jul 2010

Abstract :-

During the last 50 years, it has become evident that atherosclerosis originates in childhood. Although cardiovascular disease (CVD) events are rare in children, autopsy data and imaging studies have documented subclinical disease in association with measurable risk factors during childhood. When present at a young age, risk factors track into adulthood and have been associated with a moderate to high risk of future CVD. As such, the ability to identify this vulnerable population creates the opportunity to prevent the development of risk factors and future CVD events with effective management of genetic and acquired risk factors. In 2011, the National Heart, Lung, and Blood Institute Expert Panel published comprehensive guidelines summarizing the current evidence and providing developmentally appropriate recommendations for screening, treatment, and follow-up ofchildren and adults younger than 21 years at risk for premature CVDs such as myocardial infarction and stroke. In addition to screening individuals with a family history of hypercholesterolemia and/or premature CVD, the Expert Panel recommended universal screening of all children between 9 and 11 years of age and then again between 17 and 21 years of age. Although the recommendation for universal screening, regardless of general health or the presence/absence of risk factors of CVD, is not without controversy, this review serves to create awareness among healthcare providers, elected officials, and the lay public about the burden of CVD, the opportunity for prevention, and the benefits of early and effective therapeutic intervention with lifestyle changes and lipid-lowering medications.

  Ref:-       2015 Jan;108(1):7-14. doi: 10.14423/SMJ.0000000000000219.

According to my searches openions are controversial, some authers found that both screening and early intervention in the pediatric population will identify individuals not previously recognized at risk of premature  coronary artery disease and stroke and reduce the incidence of later morbidity and mortality

Opponents of universal screening believe that there is no adequate evidence to show that interventions based on abnormal lipid screening results in youth will be more effacious than interventions later in the disease process

Coke’s Chief Scientist, Who Orchestrated Obesity Research, Is Leaving

Posted in Diabetes at Wed, 25 Nov 2015 20:08:17


Posts: 792
Joined: 15 Apr 2011


Coca-Cola’s top scientist is stepping down after revelations that the beverage giant initiated a strategy of funding scientific research that played down the role of Coke products in the spread of obesity.

Rhona S. Applebaum, Coke’s chief science and health officer, helped orchestrate the establishment of a nonprofit group known as the Global Energy Balance Network. The group’s members were university scientists who encouraged the public to focus on exercise and worry less about how calories from food and beverages contribute to obesity.

Coca-Cola spent $1.5 million last year to support the group, including a $1 million grant to the University of Colorado medical school, where the nonprofit group’s president, James O. Hill, a prominent obesity researcher, is a professor.

Coke’s financial ties to the group were first reported in an article in The New York Times in August, which prompted criticism that the soft drink giant was trying to influence scientific research on sugary drinks.

The university returned the money to Coca-Cola this month after public health experts raised concerns.

Dr. Applebaum, a food scientist with a Ph.D. in microbiology, had been Coke’s chief scientific and regulatory officer since 2004. In that role she helped lead the company’s efforts to work with scientists as a way to counter criticism about sugary drinks.

At one food industry conference in 2012, Dr. Applebaum gave a talk outlining Coca-Cola’s strategy of “cultivating relationships” with top scientists as a way to “balance the debate” about soft drinks.

A spokeswoman for Coca-Cola said on Tuesday that Dr. Applebaum, 61, had made the decision to retire in October and that her retirement “has been accepted and the transition is underway.” The company declined a request for an interview with Dr. Applebaum.

Coca-Cola has said that while it offered financial support for the Global Energy Balance Network, the company had no influence on the group or the scientific research it produced. But reports show that Dr. Applebaum and other executives at Coke helped pick the group’s leaders, create its mission statement and design its website, findings first reported this week by The Associated Press.

The A.P. also published a series of emails between Dr. Hill of the University of Colorado and Coke executives that revealed the initial strategy of the Global Energy Balance Network. Before the G.E.B.N. was created, Dr. Hill proposed publishing research that would help the company fend off criticism about its products by shifting the blame for obesity to physical inactivity

COMMENT: It’s a start.



Re: MCS - Court ruling allows withdrawal of treatment

Posted in News & media at Wed, 25 Nov 2015 17:39:41


Posts: 1659
Joined: 09 Dec 2011

Yes John,

I think your right,  investigative journalism seems to be the effect, and the rooting out of said corruption.  I like your painting of the red line thing,  I too am a fan of history,  and this seems to keep me busy,  and spending more money on history books!



Re: Blunt trauma abdomen with pancreatic laceration

Posted in General clinical at Wed, 25 Nov 2015 13:23:49


Posts: 554
Joined: 04 Jul 2010

Hi JohnD,

The diaphragm appeared normal during exploration. There was no obvious injury.

Re: Fructose consumption and metabolic syndrome

Posted in Diabetes at Wed, 25 Nov 2015 11:39:20


Posts: 792
Joined: 15 Apr 2011

Fructose in fruits is not the same because the fiber (pulp) in fruit slows its absorbtion.  On the other hand, pulp free fruit drinks are metobolically similar to sugared beverages.

Re: ECG Question

Posted in Cardiology at Tue, 24 Nov 2015 22:13:28


Posts: 475
Joined: 29 Jul 2010

Progressive shortening of the  PP interval and , or , the RR interval

Re: Confidentiality vs Information Disclosure

Posted in Medicolegal at Tue, 24 Nov 2015 10:43:37


Posts: 528
Joined: 14 Dec 2010


Can you give some more information on a couple of points that might have a bearing on any answer to this interesting question.  I don't know much about the details of this procedure.

1)  What would the best chance of success be in this procedure and is the 10% primarily because of the HIV infection and any treatment being given for it?  Does treatment carry risk to the foetus?

2) I presume that egg harvesting has a small risk to the donor and I wonder if you can tell us that risk.

I doubt that the donor has any general right to know her sister's HIV status but her altruism might have limits if the risk to herself wasn't seen to be justified by the very low chance ot successful pregnancy for her sister.  In that case she might have a claim to know that, for reasons undisclosed, the chance of success was very low.

You mention, in passing, that the sisters 'worship at the same church'.    Were you hinting that the donor's religious beliefs might have a bearing on her decision to donate if she was aware of all the facts.

In summary, I wouldn't think the donor has an absolute right to information about the recipient's health details and that eggs should probably be freely given (eg like blood) without other knowledge unless this affected the donor's judgement of the level of personal risk that would be acceptable to her.  This judgement might well be different according to whether the recipient is a sibling or someone unknown.



Confidentiality vs Information Disclosure

Posted in Medical ethics at Mon, 23 Nov 2015 22:06:18

Tom Axon

Posts: 2
Joined: 12 May 2014

Mr and Mrs A, have been married for 5 years and in their late 30's. Mrs A is sub-fertile due to fibroids. Superoverulation was attempted but no ova were collected. Mrs A is also HIV +, but is stable. Her husband, who has tested negative, knows her status, but apart from the HCPs caring for her, no one else knows

She is advised by the Fertility clinic to seek an egg donor. Her younger sister, who has two children of her own, is prepared to donate an egg to her. Mrs A is close to her sister and they worship at the same church, so see each other reguarly.

The clinicians caring for her at the Fertility Centre are divided on the question of whether or not Mrs A's siter has a righ to know her sister's HIV status? Mrs A is admant that her sister is not told, particualry as she recognises that the IVF treatment proposed has probably only a 10% chance of success in her case.

Discuss the ethical and legal issues

How should we determine the relative weight of patient factors in determining glycemic goals?

Posted in Diabetes at Mon, 23 Nov 2015 18:46:15


Posts: 792
Joined: 15 Apr 2011

Clinical Assessment of Individualized Glycemic Goals in Patients With Type 2 Diabetes: Formulation of an Algorithm Based on a Survey Among Leading Worldwide Diabetologists

Diabetes Care October 30, 2015


OBJECTIVE Over the past few years diabetes glycemic guidelines increasingly have stressed the need to adjust glycemic targets based on parameters pertaining to individual patient characteristics and comorbidities. However, the weight and value given to each parameter will clearly vary depending on the experience of the provider, the characteristics of the patient, and the specific clinical situation.

RESEARCH DESIGN AND METHODS To determine if there is current consensus on a global level, we conducted a survey among 244 key worldwide opinion-leading diabetologists. Initially, the physicians were to rank the factors they take into consideration when setting their patients' glycemic target according to their relative importance. Subsequently, six clinical vignettes were presented, and the experts were requested to suggest an appropriate glycemic target. The survey results were used to formulate an algorithm according to which an estimate of the patient's glycemic target based on individualized parameters can be computed. Three additional clinical cases were submitted to a new set of experts for validation of the algorithm.

RESULTS A total of 151 (61.9%) experts responded to the survey. The parameters “life expectancy” and “risk of hypoglycemia from treatment” were considered to be the most important. “Resources” and “disease duration” ranked the lowest. An algorithm was constructed based on survey results. Presenting three new cases to 57 leading diabetologists who suggested glycemic targets that were similar to those calculated by the algorithm validated it.

CONCLUSIONS The resultant suggested algorithm is an additional decision-making tool offered to the clinician to supplement clinical decision-making when considering a glycemic target for the individual patient with diabetes.

COMMENT: An interesting exercise that may be useful in helping clinicians weigh various clinical factors in determining the glycemic goals for individual patients.


Re: Between 1969 and 2013, the age-standardized death rate per 100 000 decreased from 1278.8 to 729.8 for all causes (42.9% reduction)

Posted in Diabetes at Mon, 23 Nov 2015 13:57:45

John D

Posts: 3844
Joined: 01 Feb 2010

Thank you, DM MD!

Yes, medicine has a lot to proud of, but sometimes we take credit where it is not due!

The defeat of epidemics, endemic in the 19th century, was due to public health measures, such as the removal of the handle from the pump in Broad Street by Dr.John Snow  during the cholera epidemic in London of 1854, but it was civil engineers like Joseph Bazelgette whose enormous sewerage works in the 1860s that stopped them for good.

And the decline of puerperal sepsis in the UK occurred in the 1930s, after being a constant risk despite the acknowledgement by doctors that bacteria and cross infection were to blame.    This is sometimes hailed as due to the first antibiotics, but sulphonomide didn't reach clinical practice until 1937, and the last peak in puerperal sepsis deaths was in 1934.  After that, the death rates fell precipitously from 1.5/1000 live births to less than a tenth of that ten years later.   Of course, during that time penicillen was introduced, but during WW2 very little was available foir the civilian population.


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Did obstetricians and midwives finally get the message?    Were better designed  obstetric departments built, like the old Southmead Hospital Bristol unit, divided into pavilions so that fewer women were exposed when an infection occurred?   The pavilion plan, specificly to mitigate infection, was one that was used in the 18th century!   Although based on the Miasma Theory, which totally misled doctors, British Naval Hospitals such as the Stonehouse at Plymouth were so successful that the design was copied  by M.le Chirugien J-R Tenon for the new Hotel Diuex of Paris, to replace the original, insanitary, 16th Century hospital.


The latest CDC data on e-cigarette use in the US.

Posted in Diabetes at Sun, 22 Nov 2015 23:45:00


Posts: 792
Joined: 15 Apr 2011


 Electronic Cigarette Use Among Adults: United States, 2014

Key findings

Data from the National Health Interview Survey

In 2014, 12.6% of adults had ever tried an e-cigarette even one time, with use differing by sex, age, and race and Hispanic or Latino origin. About 3.7% of adults currently used e-cigarettes, with use differing by age and race and Hispanic or Latino origin. Current cigarette smokers and former smokers who quit smoking within the past year were more likely to use e-cigarettes than former smokers who quit smoking more than 1 year ago and those who had never smoked. Among current cigarette smokers who had tried to quit smoking in the past year, more than one-half had ever tried an e-cigarette and 20.3% were current e-cigarette users. Among adults who had never smoked cigarettes, 3.2% had ever tried an e-cigarette. Ever having used an e-cigarette was highest among never smokers aged 18–24 (9.7%) and declined with age.

COMMENT:  Even though a UK committee recently concluded that e-cigarettes were safer than smoking tobacco cigarettes and may be useful for smoking sensation, I find the data on young non-smokers troublesome.  We need to monitor their use carefully. 

Re: It is time to break the silence on physician suicide.

Posted in News & media at Sun, 22 Nov 2015 09:45:10


Posts: 1178
Joined: 13 Oct 2009

I think times have changed dramatically in recent years and am far from sure that there is any "silence" about physician (are we excluding surgeons and anaesthetists for some reason?) suicide. Along with alcohol it was certainly put aside in years gone by but now it seen that stresses and there consequences are much more permissible and there are a variety of agencies in place to offer help.

Where I think problems arise is that - as with other caged animals - there is less freedom where many of the stresses are concerned. I am not sure that 12+ hours a day initself does great harm and they have been a feature of life for many years. What makes them stressful is working these hours because one is told to and not having the same control over them. Increasingly this a feature of professional life and combined with pressure not to put traditional medical values as the maindriving factor.Secondly there are the social pressures to lead a "normal" life as well. Thirdly , we have I think in many ways a less understanding clientelle (to cover patients AND families). Fourthly , there are internal stresses for many doctors - having been selected on a basis of academic excellence there may be increased resistance to being treated in a less than respectful way.

I was disappointed recently when I read the RCP recommendations on sleep hygiene for doctors working shift systems or undue hours. I suspect that those dreaming up some of these ideas have never experienced a difficulty in this direction. There is of course mention of the bit about if (in the unlikely event) that there is any difficulty in "switching off" after a particularly stressful 12-14 hours then get up until in a more relaxed frame of mind.... The difficulty being that by then it may be nearly time to return to work.

Past studies may not be relevant for the present re-emerging problems particularly on incidence. Probable suicides should be recognised as such and looked at on a case by case analysis , but seeing suicide as an iceberg tip what we really need to focus on are the stresses that may be contributing to this outcome for the relatively few.

Were cardiovascular deaths related to insulin dose in the ACCORD trial?

Posted in Diabetes at Sat, 21 Nov 2015 22:51:07


Posts: 792
Joined: 15 Apr 2011

Insulin Dose and Cardiovascular Mortality in the ACCORD Trial

Published online before print October 13, 2015, doi: 10.2337/dc15-0598 Diabetes Care October 13, 2015


OBJECTIVE In the ACCORD trial, intensive treatment of patients with type 2 diabetes and high cardiovascular (CV) risk was associated with higher all-cause and CV mortality. Post hoc analyses have failed to implicate rapid reduction of glucose, hypoglycemia, or specific drugs as the causes of this finding. We hypothesized that exposure to injected insulin was quantitatively associated with increased CV mortality.

RESEARCH DESIGN AND METHODS The authors examined insulin exposure data from 10,163 participants with a mean follow-up of 5 years. Using Cox proportional hazards models, we explored associations between CV mortality and total, basal, and prandial insulin dose over time, adjusting for both baseline and on-treatment covariates including randomized intervention assignment.

RESULTS More participants allocated to intensive treatment (79%) than standard treatment (62%) were ever prescribed insulin in ACCORD, with a higher mean updated total daily dose (0.41 vs. 0.30 units/kg) (P < 0.001). Before adjustment for covariates, higher insulin dose was associated with increased risk of CV death (hazard ratios [HRs] per 1 unit/kg/day 1.83 [1.45, 2.31], 2.29 [1.62, 3.23], and 3.36 [2.00, 5.66] for total, basal, and prandial insulin, respectively). However, after adjustment for baseline covariates, no significant association of insulin dose with CV death remained. Moreover, further adjustment for severe hypoglycemia, weight change, attained A1C, and randomized treatment assignment did not materially alter this observation.

CONCLUSIONS These analyses provide no support for the hypothesis that insulin dose contributed to CV mortality in ACCORD.

COMMENT: Insulin resistance is associated with increased atherosclerosis and causes hyperinsulinemia in normal individuals.  Therefore, there is some rationale for hypothesizing that exogenous insulin would result in increased atherosclerosis.  The problem with that syllogism is that there are no studies that demonstrate a relationship between cardiovascular mortality and death from cardiovascular disease and insulin dose.  The ACCORD study is the ideal place to look at this since the intensively treated patients had increased cardiovascular mortality.  Again we find, howover, no association with insulin dose and cardiovascular death.


Can changes in the microbiota caused by lactobacillus change incretin secretion-proof of concept

Posted in Diabetes at Sat, 21 Nov 2015 22:34:24


Posts: 792
Joined: 15 Apr 2011

Intake of Lactobacillus reuteri Improves Incretin and Insulin Secretion in Glucose Tolerant Humans: A Proof of Concept

Published online before print June 17, 2015, doi: 10.2337/dc14-2690 Diabetes Care June 17, 2015


OBJECTIVE Probiotics can modify gut microbiota and alter insulin resistance and diabetes development in rodents. The authors hypothesized that daily intake of Lactobacillus reuteri increases insulin sensitivity by changing cytokine release and insulin secretion via modulation of the release of glucagon-like peptides (GLP)-1 and -2.

RESEARCH DESIGN AND METHODS A prospective, double-blind, randomized trial was performed in 21 glucose tolerant humans (11 lean: age 49 ± 7 years, BMI 23.6 ± 1.7 kg/m2; 10 obese: age 51 ± 7 years, BMI 35.5 ± 4.9 kg/m2). Participants ingested 1010 b.i.d. L. reuteri or placebo over 4 weeks. Oral glucose tolerance and isoglycemic glucose infusion tests were used to assess incretin effect and GLP-1 and GLP-2 secretion, and euglycemic-hyperinsulinemic clamps with [6,6-2H2]glucose were used to measure peripheral insulin sensitivity and endogenous glucose production. Muscle and hepatic lipid contents were assessed by 1H-magnetic resonance spectroscopy, and immune status, cytokines, and endotoxin were measured with specific assays.

RESULTS In glucose tolerant volunteers, daily administration of L. reuteri increased glucose-stimulated GLP-1 and GLP-2 release by 76% (P < 0.01) and 43% (P < 0.01), respectively, compared with placebo, along with 49% higher insulin (P < 0.05) and 55% higher C-peptide secretion (P < 0.05). However, the intervention did not alter peripheral and hepatic insulin sensitivity, body mass, ectopic fat content, or circulating cytokines.

CONCLUSIONS Enrichment of gut microbiota with L. reuteri increases insulin secretion, possibly due to augmented incretin release, but does not directly affect insulin sensitivity or body fat distribution. This suggests that oral ingestion of one specific strain may serve as a novel therapeutic approach to improve glucose-dependent insulin release.

COMMENT: The metabolic effects of changes in the microbiota are a hot topic right now.  For good reason, differences in microbiota may be retated to obesity, for example.  in this proof of concept study the canges in microbiota resulting from lactobacillus ingestion resulted in increased incretin secretion and subsequent insulin secretion in normal indiviuals.  Obviously we are a long way from any therapeutic recommendations, but such studies are opening up a whole new area of research.

Re: Homeopathy will be banned.

Posted in General clinical at Fri, 20 Nov 2015 17:32:12


Posts: 194
Joined: 21 Aug 2011

Amoxycillin, Tamiflu, homepathy and the idiocy of the day are all equally effective for viral URTIs. Most symptoms revert to the mean ie go away, get better whatever the cause. . Its hard to ban stupidity, ideally governments shouldnt pay for such.

Re: Do doctors have a special way of thinking?

Posted in General clinical at Fri, 20 Nov 2015 15:08:28


Posts: 6
Joined: 18 Nov 2015

Difinitely they have. They must be alert to hear each and every word of the patient. Only on a critical thinking, the doctors can find out the real issues with the patients. Each doctor should essentially be a psychologist as well.

Re: Is it autism or neurodiversity?

Posted in Psychiatry at Fri, 20 Nov 2015 14:59:48


Posts: 1178
Joined: 13 Oct 2009

Linda  : "the future of a large number of people is at risk" I think this reflects our concern about this issue. Firstly , that those who have a clear diagnosis have appropriate treatment , but 2) That we allow for normal variation and do not see maximal conformity to a social "norm" as the right aim. (Think China and the little red book). The severely autistic have a disorder , but those with certain personality traits may just need career guidance - perhaps head for dermatology , histopathology or neurology rather than orthopaedics , where different (not worse or better ) coping mechanisms may be needed.. Duane's post is very relevant. The need for obsessional behaviour when doing some forms of lab work far exceeds that required by much of medical practice on a day-to-day basis.  

Re: Trainee doctors' strike - the consultants' situation

Posted in News & media at Fri, 20 Nov 2015 13:32:32


Posts: 1178
Joined: 13 Oct 2009

John D - surely you are aware that doctors in training are supernumerary to service needs and only work in a supervised role...

I find this present vote very interesting. Firstly as regards the overwhelming support and secondly because the changes in terms and conditions are pretty unacceptable and seem part and parcel of a dubious political policy. It is the first time I might have considered voting yes to strike action.

In 1975 I refused to go on strike - it was almost entirely just about money. There were quite a few of us who carried on working and I have doubts about just how much trouble was caused to patients. My wife (in paediatrics) also carried on as this was seen as outside strike action.

Over the years we have had some infrequent junior doctor crises (failure to recruit , illness etc...) affecting the service. What happens is that clinics are cancelled for that day and consultants cover the emergencies and ward patients. It should not be difficult bearing in mind just how many consultants there are now.  It worries me a bit as a 60 year old specialist these days who has been on take  once a month with a registrar may no longer be competent to do the task in hand. I remember one of my consultant physician colleagues stating that "pacing is not a consultant activity" and presumably patients will have to be transferred to a hospital where consultants have the relevant practical skills.

I will make a note of the relevant dates , keep my European health card to hand and be grateful the Channel tunnel is only 3 miles away.

Re: Dermatology revision

Posted in General clinical at Thu, 19 Nov 2015 22:52:48


Posts: 475
Joined: 29 Jul 2010

Correct answer

This is a Pilomotor Reflex  mediated via the Autonomic Nervous system  causing Errector Pili smooth muscle attached to the hair follicle to contract, hair stand to end, known colloquially as Goose Bumps

The condition occurs in mammals beside humans, as the picture below shows :-

Cat fur standing on end