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Re: Reducing Alcohol drink drive limit in Scotland

Posted in Medicolegal at Sat, 25 Oct 2014 12:59:53

John D

Posts: 3298
Joined: 01 Feb 2010

If you would like to think about other confounding factors, lets look at some selected countries, at in particular those with an Islamic society where alcohol is, of course, forbidden.

WHO figures: http://apps.who.int/gho/data/node.main.A997

All respectably low, in comparison with those quoted above.  They may - may! - represent the effect on societies of a general prohibition of acohol, especially when the reckless driving that takes place in some Islamic societies is seen.  I don't know if any of the incidents in this video caused death, but in every one the driver made the incident happen.  They are all unpleasant.  http://www.youtube.com/watch?v=VbVNKpjU5qc

 But  we have the experience of US Prohibition, when the alcohol business was taken over by criminals beause the people still wanted alcohol.   Not a recomendation for enforced abstinence in Western societies.

John

 

Re: Books

Posted in Medical education at Sat, 25 Oct 2014 10:47:24

Odysseus

Posts: 4355
Joined: 24 Feb 2009

In Response to Re: Books:[QUOTE]

In Response to Re: Books:[QUOTE]

I hope that authors will not take offence if I recommend the OxFam book shop?

I always pop-in if I'm passing the one in our town, and often come across something I want to read, or that I realise that I should read  - I have a pile waiting to be read!   At about £2.50 each, it's almost too easy to buy too many, but if you return books that you decide you don't like or want to keep, you will support the charity as well.  Other charity bookshops exist, but IMHO OxFam's are the best

Which brings up the point, at what stage do you give up on a book?   At the flick through in the bookshop?  After a few pages, or do you persevere right through before deciding, Keeper or for the Ditch? 

John

 

Posted by John D[/QUOTE]

Really good question John. For me it varies. If my wife has read the book she will give her opinion on whether to persevere or not  (she knows my tastes) but usually I will know reasonably early on whether it is worth carrying on with. Sometimes I do persevere and am ultimately glad when I have finished the book. 

But I suppose that when we flick through the book in the shop you know whether you are likely to enjoy the book or not. Recently I was reading an excellent newish book about Nazi Hunters (by Guy ?) whilst on holiday in France. I could not put it down and would sit at breakfast on a beautiful summer morning in the hotel reading the book and noticed lots of people observing me. For me it was absolute heaven. My wife had gone on a tour so I was on my own with excellent coffee, full breakfast, sitting outside on the terrace in the lovely sunshine. I would sit there reading for about 2 hours - absolute heaven, then a walk and a swim (hope my wife doesn't read this!!).

I am a very simple person and just having breakfast like that was so enjoyable and it saddens me to see people nowadays using their electronic devices continuously and not appearing to be mindful of the moment and the joy of peace. On my holiday my phone is turned off and left in my suitcase - I am not interested in it until the return journey. Kids in the hotel were inundated with devices and parents also with a phone stapled to their hand and they are constantly checking it.

Likewise I take very few photographs preferring to commit beautiful views to my memory camera. Constantly taking photos devalues them in my view and I find other people's holiday photos intensely boring because they usually have taken dozens and dozens.

I sound like a right old winger and pretty antisocial. I honestly am not I just like to have a holiday when I go on holiday. 

Kirked


Posted by kirked[/QUOTE]

You are not alone, Kirked.

In the moment, no photos, phone put away, book of paper, thoughts immersed, content, tranquil, mindful. Simple, clever. 

Odysseus

 

Re: Is paying UK GPs 55 £ for diagnosing dementia a good idea?

Posted in Neurology at Sat, 25 Oct 2014 06:02:49

rcdeacon

Posts: 155
Joined: 21 Aug 2011

Priceless, very expensive anyway. I  think it is a superb way of improving incomes for the struggling GP.  I think we all agree that the drugs at best may delay entrance to a rest home for just over  2 weeks. I guess we are about to see an epidemic of dementia hit the UK, clearly the person who proposed this should have been identified a fairly long time ago..

Re: Are you active everyday?

Posted in General at Fri, 24 Oct 2014 22:21:38

sken

Posts: 786
Joined: 13 Oct 2009

If you count walking etc... as activity (I would see it as non-sedentary rather than activity) I suppose I average about 3-4 hours most days , but try to do 30 -40 mins proper CVS exercise as well. When working I think it was not dissimilar allowing for the miles walking hospital corridors and stairs etc... . Now retired the pattern is different . I do not do any of the above as an end in itself or as a discipline - it just seems part of normal life. 

Re: What's your diagnosis? Recurrent fever after a holiday in Turkey.

Posted in General clinical at Fri, 24 Oct 2014 20:18:15

Dr.Fawaz

Posts: 2
Joined: 24 Jun 2009

We have to consider  atypical pneumonia (legionella?) in our defferntial diagnosis as well as brucellosis . 

I would suggest CXR in this case. 

Re: Time Capsule

Posted in General at Fri, 24 Oct 2014 19:38:10

Mukhtar Ali

Posts: 856
Joined: 14 Nov 2010

Great Science Frauds

Do vaccines cause autism? Medical experts say no, but we can thank Wakefield for introducing the doubt that won’t die in many parents’ minds. In 1998, the  gastroenterologist at Royal Free Hospital in London published a study describing a connection between the measles-mumps-rubella (MMR) vaccine and autism, after he found evidence of these viruses, presumably from the shot, in the guts of a dozen autistic children, eight of whom developed autism-like symptoms days after receiving their vaccination.

Other scientists could not replicate Wakefield’s findings, nor verify a link between the vaccine and autism. In 2010, the journal that published his paper retracted it, and its editors noted that “it was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false.” Later that year, the General Medical Council in the U.K. revoked Wakefield’s medical license, citing ethical concerns over how he recruited the patients in the study as well as his failure to disclose that he was a paid consultant to attorneys representing parents who believed their children had been harmed by vaccines.

The final shoe dropped a year later, when another prestigious medical journal concluded that his research was also fraudulent, after evidence that some of the timelines of the children’s symptoms were misrepresented.

Wakefield maintains his innocence, and penned a book defending his work and his continued belief in a connection between vaccines and autism. Infectious disease experts and pediatricians, meanwhile, routinely confront conflicted parents who question the safety of vaccines, despite immunization’s long-standing record of successfully controlling childhood diseases with relatively few side effects.

 

Re: Should smoking be banned in public parks?

Posted in Respiratory medicine at Fri, 24 Oct 2014 18:50:00

Loess

Posts: 32
Joined: 10 Nov 2013

Yes, I think back when I would join a friend for a quiet drink or lunch in a pub years ago before the ban. I would come home stinking of smoke on my clothes and in my hair, horrible.

Re: Should the NHS be liberated from political control?

Posted in News & media at Fri, 24 Oct 2014 18:00:55

John D

Posts: 3298
Joined: 01 Feb 2010

The very foundation of the NHS was a political act.   Since, it has grown into the Gov's biggest single expenditure of public money, and governments control the NHS's budget, so it is wishful and impossible to ask politicians not to be involved.   In fact, as it is the public's money, and the politicians are the people's representatives, it is correct that they should have a part in the control of the NHS.

If I may Anne (and I see that you have been corrected already - please don't think we're out to get you!) the question should be, what aspects of the NHS should be under political control, and from which should politicians be banned?   

For the above reasons, politicians should set the NHS's budget.    Doctors should run it, set priorities and manage it  day-to-day.   But BOTH should provide input to the other, listen and act on their advice.

John

Patients who love to talk

Posted in General clinical at Fri, 24 Oct 2014 13:50:08

AnneG

Posts: 537
Joined: 18 Mar 2014

I have to admit that when I go to see a doctor (either for myself or my children) I like to chat (colleagues won't be surprised at this). Often it's a way of getting over either embarassment or nervousness (whatever I see the doctor for I always think they're going to tell me I've only got six months to live). I also think a little bit of me wants the doctor to know that I'm intelligent and someone s/he can engage with on an equal basis. 

Do you like to have chatty patients? Do you think that it helps the relationship and aids your diagnosis? 

William Kayley, a regular BMJ blogger from the US (hence the use of the word 'folks'), wrote this on the subject:

"I've had several visits recently with folks who love to chat - and that's great - and from at least one of those chats I learned the extent to which the patient's primary health concern was really about the health of another family member. It's wonderful to spend a lot of time with folks, and to be thought of as 'that patient, caring doctor.'"

He sounds lovely! I wish my GP (v miserable) was more like him. 

 

 

 

Re: The Ebola Frontline

Posted in Public health at Fri, 24 Oct 2014 13:18:46

AnneG

Posts: 537
Joined: 18 Mar 2014

It's interesting that Mark Zuckerberg has given nearly as much as China! I wonder if he's trying to position himself as the new Gates...

 

Re: Seven Day working weak?

Posted in General clinical at Fri, 24 Oct 2014 12:30:48

John D

Posts: 3298
Joined: 01 Feb 2010

A little while ago, a colleague asked me why I didn't hold Anaesthesia Clinics and Pre.op.Assessment clinics in the evening or at weekends, "so that people could attend".     I had to reply that if I could make an appointment to see my Bank manager, or the plumber for a non-urgent call on a weekend then perhaps I should.

But maybe I could!  I haven't asked my bank, but many other commercial companies are glad to do so, shops are open 7/7 and into the evening, all in pursuit of business and sales.  Is healthcare so very different?   I hope that employees who do provide services 'out of hours' are better paid for doing so, and that those selling their own services or goods will profit from it.    Which brings us to the extraordinary way that the NHS pays its employees, who are either on shifts or sessions, with overtime at all.

When I worked in Sweden, evenings and nights were time and half, weekends double time and public holidays treble time.   If the NHS began to offer that sort of inducement to work out of hours, and employed more people to cover the ordinary working week, then a 24/7 NHS might happen.    But it won't, will it?

JOhn

 

Re: New cardiology clinical champions

Posted in Cardiology at Fri, 24 Oct 2014 09:15:32

denniseya

Posts: 1
Joined: 24 Oct 2014

I am glad to join the team working on the cardiology clinical champion team, hoping that the new team will be able to keep up with the high expectations.

Re: Medical students asking intimate questions

Posted in Medical ethics at Thu, 23 Oct 2014 14:33:11

Maxim

Posts: 235
Joined: 14 Dec 2010

Don't be too sure that your questions won't benefit the patient.  Perhaps because you may have more time than other staff it's not unusual for students to uncover important items of information that are overlooked by others.  For this reason it's important that you don't allow any embarrassment on your part to prevent other essential staff knowing about your findings when debriefing.  Occasionally a patient might ask you not to share information but they will usually understand if you explain why it's to their advantage if you let just those essential doctors know.  It's too often the case that patients are repeatedly asked the same questions when perfectly reliable answers have already been obtained and shared or documented (and the notes read!)  The exception to this is the part of the history which crucially depends on the patient explaining symptoms in their own words and where interpretations by others  have been misleading or inadequate.

If the sensitive questions have already been asked and you know the answers then it's more difficult to justify asking again unless it's to clarify uncertain and relevant facts.   

Re: What's your diagnosis: a previously healthy and active man losing the ability to live independently

Posted in General clinical at Thu, 23 Oct 2014 12:36:14

AnneG

Posts: 537
Joined: 18 Mar 2014

The answer was Huntington's Disease. Go to the second page of posts and you will see the full answer. If you're a BMJ subscriber you can also see it here: http://www.bmj.com/content/343/bmj.d7463

In Response to Re: What's your diagnosis: a previously healthy and active man losing the ability to live independently:[QUOTE]

Ct Brain is essetial .What did it show?


Posted by Satti[/QUOTE]

 

Re: How stupid an people be?

Posted in General clinical at Thu, 23 Oct 2014 12:23:06

Maxim

Posts: 235
Joined: 14 Dec 2010

The answer has to be 'a lot more stupid than that.'  As others have said, you would need to check they they were warned ( even then they might have forgottten) before calling them stupid.  I'm not even sure how many transmissions from shared safety razor use have been well documented.

Perhaps more obstinately stupid are those doctors who persist in walking around with used IV needles instead of putting them in disposal bins at the exact site of use.

New plan for the NHS

Posted in News & media at Thu, 23 Oct 2014 09:18:52

AnneG

Posts: 537
Joined: 18 Mar 2014

What do you think of the five-year plan for the NHS unveiled by six national bodies - NHS England, Public Health England, Monitor, the NHS Trust Development Authority, Care Quality Commission and Health Education England. 

The report calls for extra funding and changes to the way the NHS is run, such as hospitals employing GPs. You can see the review here: http://www.england.nhs.uk/2014/10/23/nhs-leaders-vision/

How do you think the NHS needs to change to meet the needs of 21st century healthcare?

 

 

Re: Which medical innovation has changed your practice the most?

Posted in General clinical at Wed, 22 Oct 2014 21:45:35

sken

Posts: 786
Joined: 13 Oct 2009

Development of fibreoptic endoscopes. Anyone else out there remember using rigid instruments , for bronchoscopy or oesophagoscopy and without a GA ?

I am glad John D likes propofolol. Great stuff I've been given it more than once and tend to have the most vivid dreams in glorious colour afterwards . Not so much last time , so perhaps something has been taken out. but much better than flurothane ... Thanks too for highlighting the diazepam point - what was really surprising was the high doses of the original preparation used by many doctors who also clearly took no steps to avoid the thrombosis - but also continued to be told to use over the emusified version on cost grounds.

Re: Unfading Shadow of Ebola

Posted in Public health at Wed, 22 Oct 2014 19:54:07

John D

Posts: 3298
Joined: 01 Feb 2010

Oh, gosh, it would rude of me to name the other thread that this would appropriate for, as the link reports that "nearly 40 percent of Americans say they are concerned that someone in their family will get the deadly virus within a year" and will throng to A&E and GP surgeries when they get colds or flu.  This, in a nation where a 1991 poll found that 3.7 Americans (2%) had been abducted by aliens.  And it's not just Americans:

 http://www.mirror.co.uk/news/weird-news/alien-abduction-uks-first-support-3444674

John

 

Re: dementia

Posted in Neurology at Wed, 22 Oct 2014 19:45:25

Mukhtar Ali

Posts: 856
Joined: 14 Nov 2010

NHS dementia plan to give GPs cash for diagnoses

http://www.theguardian.com/society/2014/oct/22/nhs-dementia-diagnoses-gps-patients-criticised

Doctors are to be recruited on the basis of values as well as skills

Posted in Careers at Wed, 22 Oct 2014 15:00:57

AnneG

Posts: 537
Joined: 18 Mar 2014

A story on the BMJ Careers site reports that doctors should be recruited on their values, as well as their skills. 

From next autum students enrolling on healthcare courses at universities in England will have to demonstrate values such as respect and dignity, commitment ot quality of care, compassion and everyone counts. Health Education England has said that trusts should recruit staff on the same basis, although it will not be mandatory. 

How doctors would demonstrate such values is a moot point...! 

 

Re: Reflecting on failure in psychiatry exam

Posted in Psychiatry at Wed, 22 Oct 2014 08:56:14

sken

Posts: 786
Joined: 13 Oct 2009

I thought the blog very good. It is a problem in most specialties and I suspect many of those passing may have passed by a very small margin. Of course there should be continuing job opportunities and counselling etc... , but it is all too easy to overlook what goes on in the mind of the individual . Many , many years ago I remember looking at the DPM and what was involved - a formidable set of exams. I suspect other specialties still have a relatively easy time of it - but that may change as reaccreditation and specialty exams are introduced.

A related problem can be those who complete their training but cannot find an appropriate post - or those where a research degree becomes a necessary part of qualification even for supremely clinical positions. At times I feel the medical hierarchy loses sight of the basic questions about service needs and what makes an adequately competent doctor. The entire system can be so difficult for those coming from overseas.

I

Re: Feeding Birds: A Humane Gesture

Posted in General at Wed, 22 Oct 2014 02:50:37

Odysseus

Posts: 4355
Joined: 24 Feb 2009

In Response to Re: Feeding Birds: A Humane Gesture:[QUOTE]


Posted by Mukhtar Ali[/QUOTE]

This is a gallah (pronounced in Oz as g'laar). We call foolish people gallahs. A "cockatoo" was the name for the lookout in an illegal gambing game of "two up" where two pennies were tossed in the air and with betting based on heads or tails. "Two-up" is played on ANZAC Day by some as a sentimental relic of the past. The two pennies are placed on a wooden bat about two inches wide and six inches long and tossed up into the air.

Odysseus

Re: What constitutes poetry when in blank verse; lineated prose or real art?

Posted in General at Tue, 21 Oct 2014 20:35:07

Odysseus

Posts: 4355
Joined: 24 Feb 2009

Homer's vocabulary is so rich and unique, I have a Homeric dictionary.  He and Shakespeare are the bedrock of English and Western intellectual and literary endeavour. 

Ben Johnston said Shakespeare was a man for all time. So was Homer. They were literary Time Lords; intellectual master craftsmen.

One can only read Homer in small pieces are there is so much to digest, so many annotations. It is like drinking OP whisky neat. It needs to be diluted with time and explanation.

Odysseus

PS Greek boys in the time of Pericles were taught to recite large chunks of Homer who epitomised the virtues,    Athenian nationalism and the notion of heroism and valour. Modern education has led to few children being able to recite more than a line of Shakespeare. When I was at school, we could recite extracts from various Shakespearian plays and sonnets but learning something by heart was not disparaged as now. We also used slide rules and log tables.

Re: Antipsychotics for ADHD

Posted in Psychiatry at Tue, 21 Oct 2014 14:13:17

cassandra

Posts: 23
Joined: 24 Apr 2012

I feel it unfair that Dr Gold's thoughtful blog has been misquoted into a tabloid headline.

 

She says " ... when medication is so effective at controlling behavior, the motivation for investing time and effort in relationship-based interventions may be lost. Prescribing medication takes much less time. With atypical antipsychotics the results are often immediate, and can be dramatic.

If risperidone is found to significantly alter the brain’s capacity for emotional regulation, then it might have a role to play. But if it does not, and we have well-established methods of intervention that do, then the possibility exists that by prescribing this medication to children, particularly in the absence of relationship-based interventions, we are actively interfering in their development."
 
Fair enough?

Re: Where was WHO in Ebola outbreak?

Posted in General at Mon, 20 Oct 2014 18:53:32

Mukhtar Ali

Posts: 856
Joined: 14 Nov 2010

Ebola: WHO under fire over response to epidemic

http://www.bbc.com/news/world-europe-29691044