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Re: A tragic case, compounded by legal insensitivity.

Posted in News & media at Fri, 21 Nov 2014 22:31:57

Odysseus

Posts: 4435
Joined: 24 Feb 2009

In Response to A tragic case, compounded by legal insensitivity.:[QUOTE]

You will have read of the poor mother of four children, three of whom had an incurable neurological condition, that would handicap their childhood and deny them adulthood.  She smothered them, while thier father and eldest daughter were away, and tried to kill herself.

I don't want to discuss the family and their tragic situation, but to ask if anyone else was as shocked as I was by part of  the prosecution counsel's case against her for manslaughter.     Ms Zoe Johnson QC argued that because she did not seek help for her depression,  she was culpable for the deaths of her children, even though the Crown Prosecution Service (who Ms Johnson represented) has previously accepted that she was mentally ill, and could not be charged with murder, but "only" manslaughter.

What breathtaking ignorance from an allegedly educated lawyer!    Surely the essence of depression is the loss of selfworth, the feeling that nothing can be done and that the sufferer isn't fit to live let alone be treated?   To say such a thing as a passing, unconsidered remark is at best insensitive, but to have that argument as part of the prosecution case is disturbing, as revealing ignorance in the UK's national legal system about the commonest mental illness of all .

John 


Posted by John D[/QUOTE]

Australia law has an enlightened view of psychiatric illness. My wife psychiatrist has had two such tragedies and the law were compassionate about such matters. Eventually the accused was rehabilitated by treatment and returned to live a normal life if this is possible after such.

The US and UK are not so enlightened legal systems.,

In Australia this case would have laughed out of court.

Odysseus

Re: How to refer to female genitalia...?

Posted in General clinical at Fri, 21 Nov 2014 21:46:42

Odysseus

Posts: 4435
Joined: 24 Feb 2009

Until quite recently, in China patients had a small ivory doll sans clothes about six inches long to show the doctor the area of illness as it was not the done thing for doctors to lay hands upon patients. A friemd's mother had one as she was from Hong Kong. Just point to where it hurts, Madame 

Odysseus

Re: Should the performance data of individual doctors be published?

Posted in News & media at Fri, 21 Nov 2014 19:43:47

rcdeacon

Posts: 163
Joined: 21 Aug 2011

Obviously this same data will be equally valuable when encouraging effective end of life care  ie Hospice doctors will have to publish their own figures. 

Re: Do you have to like your patients?

Posted in General clinical at Fri, 21 Nov 2014 19:27:31

Sidhom

Posts: 470
Joined: 23 Aug 2013

The patient-doctor relationship is one of the most arhcaic relationships. In a TED talk Dr Verghese highlighted the value of human touch in physical examination as one of the rites of passage. Sorry for referring back to psychodynamic literature, some authors referred to the apparent coldness, detachment of doctors as a protective mechanism against emotional drain/attachment and burnout. One cannot verify such statements but they might prove helpful to some.

Re: POISE-2Trial and Pre operative care guidelines

Posted in Cardiology at Fri, 21 Nov 2014 18:31:02

chuck

Posts: 8
Joined: 02 Sep 2011

Do cv risk assessment - pre op and consider asa and statin where appropriate for prophylaxis.

Pre operative intervention has to be case based decision.

VISION Study looks a peri operative myocardial injury in non cardiac surgery. Monitoring of troponin during post operative periods ( days) is suggested  in those at high risk from.

Factors contributing to vascular complication after surgery : -

-

CA thrombosis/  hypotension during surgery/

Post op environmental factors -  procoagulant state/  pro inflammatory state / elevated catecholamiines /inc platelet  reactivity./ post op hypotension at times.

 

Interest in Organic Psychiatry

Posted in Psychiatry at Fri, 21 Nov 2014 17:34:12

Sidhom

Posts: 470
Joined: 23 Aug 2013

A blog post by Dr Roxanne Keynejad discusses her interest in organic psychiatry. The blog is quite interesting because, I noticed many young doctors attempting to join psychiatry in search for the psychodynamic approach in psychiatry. I am impressed to find someone who is impressed by the organic aetiology of mental illness.

Re: What's your diagnosis? A returning traveller with fever, facial swelling and skin lesions

Posted in General clinical at Fri, 21 Nov 2014 14:36:33

imas

Posts: 1
Joined: 18 Apr 2013

African Trypanosoma Brucei Rhodesience.

Slide shows free swimming paracytes in the peripheral smear.

Skin lesion is suggestive of bite mark by tse tse fly, the transmitting vector prevalent in game reserves.

The Rhodesian trypanosomiasis has  a rapid progression rate to neurological infestation and encephalitis hence the acronyme sleeping sickiness unlike the West African variety which has a longer incubation.

Teatment is with suramin and melarprasol which is difficult and toxic.

Are charity singles like Band Aid 30 patronising?

Posted in News & media at Fri, 21 Nov 2014 13:34:31

AnneG

Posts: 597
Joined: 18 Mar 2014

The Band Aid 30 single (that makes me sound old!) has been released and it's aiming to raise money to treat the Ebola outbreak in West Africa.

The song has already attracted quite a lot of criticism for a) being patronising about Africa and its people  b) for rich people singing while it's us plebs who will have to fork out and buy the record and c) because money raised in previous Band Aid attempts has not always ended up going to the people who need it most. 

The clunkier lyrics of the previous Band Aid songs have been changed: eg "do they know it's Christmas time at all..."; "where no rain nor rivers flow....."; "tonight thank God it's them instead of you." (None of which lyrics I can write without hearing the warbling of Bono/George Michael/Banarama et al)

Is the song patronising or is anything okay if it's in the name of charity? 

Will the new duty of candour make patients safer?

Posted in General at Fri, 21 Nov 2014 13:10:30

AnneG

Posts: 597
Joined: 18 Mar 2014

Later this month the new duty of candour will be introduced. The duty requires organisations to tell patients/carer when treatment or care has caused serious injury or death. And doctors and other organisations will also be required to inform employers if treatment or care causes serious injury or death. Doctors will also be required to apologise and put matters right where possible.

Doctors already have a duty to be honest and open under their professional registration so are legal sanctions necessary?

Writing in the Guardian in April Michael Devlin of the Medical Defence Union thinks not: "The proposed statutory duty, with possible criminal sanctions, is likely to do very little to contribute to the open culture of learning from mistakes that we need to build the safest platform on which to deliver care to patients. It could instead lead to delay and defensiveness that are inconsistent with the delivery of safe care."

What do you think? Will the new duty have any impact? 

 

 

Should 'bed-blockers' face legal action?

Posted in News & media at Fri, 21 Nov 2014 11:09:30

AnneG

Posts: 597
Joined: 18 Mar 2014

There's an interesting story on the BBC today about a hospital in Bournemouth which is threatening to sue patients who refuse to leave hospital when they are fit to go.

About 70 patients are on wards in Bournemouth Hospital and are medically fit to leave, with around half that number having a home or care home to go to. The discharge manager at the hospital says families are giving spurious reasons as to why they won't take a family member and view NHS care as free board and lodging.

One family asked the hospital to keep hold of an elderly relative so they could have a two-week holiday in Turkey. 

Katie Whiteside, clinical manager for discharge services, told the BBC: '[Relatives] are deconrating the house or having a granny annexe built and they know that while the patients are here they are being fed, watered and looked after." 

The hospital is planning to give patients a week's notice to leave. 

I have some sympathy with the hospital which says that this is having a knock-on effect elsewhere in the hospital and the NHS is not a care home but what about the 35 patients who don't have a place to go to? 

 

Re: Are overweight doctors a poor example to patients?

Posted in News & media at Fri, 21 Nov 2014 10:35:59

sken

Posts: 806
Joined: 13 Oct 2009

Iris , I follow the points which you making , but equally one cannot duck on the 3 main points about what is a complex problem 1. That it needs to be recognised as a problem by the individual (as you have done ; 2. Whatever the complexity of the causes , the individual in the vast majority of cases can do something - or could have done something - to prevent it. 3 , the problem has arisen in fairly recent years - unless one looks to enhanced fertility in the obese one is obliged to see lifestyle choices as a major factor. It is quite striking how few of those on television about the Ebola problems in Africa - at any age - seem to be obese. That may change once it is rife in major cities.

I think what has promoted the relatively recent challenge to the old view "It's not my fault" approach is firstly that so many now decline to recognise it as a problem in the first place - this is particularly relevant in prevention and when parents are challenged about their obese offspring. This has the rider that it is up to the rest of the world to adapt and subsidise the obese. Secondly , there has been a slow realisation in recent years about the real costs. The 10% (£10 billion) of NHS costs going on obesity and related problems has recently been upped to a £50 billion overall cost to the country ie roughly 1/2 the overall cost of the NHS. 

One hang-up which has afflicted us is that much of the main obesity problem afflicts poorer folk and this means the arguments about smoking have to be relived. Some argued that discriminating unduly about smokers was unfair on those for whom a smoke was one of the few social and personal joys available but the BMA (et al) fought to state that however poor health deserved the same respect , so we may have learnt to ignore poverty as a factor condoning obesity. Our excuse that good diets cost more so often overlooks the important aspect of eating less as well.

Of course in the short term we need to provide support for obese doctors - it cannot make the job any easier by being obese and we need you BUT in the longer term perhaps we should adopt a more positive approach. It took a very long time to change our attitudes towards alcohol and smoking in the profession - and sometimes these were equally obvious to the patient - when these were thought to set a bad example. Almost none of my physician or surgical colleagues was more than "a bit overweight" and I cannot recall any obese junior. Equally I can think of a number of GP colleagues who were obese : perhaps there is already some selection going on or obesity really is a drawback - perhaps obesity in GPs is something of a work-related illness - perhaps more home visits (I walked miles around the hospital every day)  less stress etc... would help. 

Re: Thoughts on IE prophylaxis?

Posted in Cardiology at Fri, 21 Nov 2014 10:18:18

Mukhtar Ali

Posts: 870
Joined: 14 Nov 2010

IE    Intractable epilepsy ?

IE     Infectious Endocarditis ?

IE    Isometric exercise ?

IE   Idiopathic Epilepsy ?

IE   Implanted Embryos ?

Cardiovascular risk, will ezetimibe IMPROVE-IT?

Posted in Cardiology at Fri, 21 Nov 2014 01:45:36

MBittencourt

Posts: 6
Joined: 04 Sep 2014

After quite a long time on the market, the first evidence supporting the use of ezetimibe to reduce CV events became available. The IMPROVE-IT study followed a very large cohort of very high-risk individuals for a very long time to demonstrate a small, yet significant, reduction and a composite CV outcome.

I am not particularly impressed, and would probably only use it for a restricted number of patients, but I am rather curious on how others see the data.

 

 

The Economic Burden of Obesity

Posted in News & media at Thu, 20 Nov 2014 11:33:20

Mukhtar Ali

Posts: 870
Joined: 14 Nov 2010

The worldwide cost of obesity is about the same as smoking or armed conflict and greater than both alcoholism and climate change, research has suggested.

http://www.bbc.com/news/health-30122015

Re: Poll archive 12 to 19th November 2014

Posted in doc2doc feedback at Wed, 19 Nov 2014 12:09:24

AnneG

Posts: 597
Joined: 18 Mar 2014

Do overweight doctors set a poor example to patients?

Yes - 400 votes (72.9%)

No 125 votes (22.8%)

Don't know 24 votes (4.4%)

Have you been bullied at work?

Posted in Careers at Wed, 19 Nov 2014 12:02:46

AnneG

Posts: 597
Joined: 18 Mar 2014

A survey of 50,000 doctors undertaken by the General Medical Council shows that nearly one in ten trainee doctors have been bullied at work nearly 4,000), with nearly one in seven having witnessed bullying (6,700). 

The kinds of bullying behaviour witnessed were belittling and humiliation; threatening and insulting behaviour and deliberately preventing access to training. 

Consultants/GPs within the doctor's own specialty were most likely to have been the bullies, followed by nurses/midwives and then consultants/GPs outside the specialty. 

Niall Dixon, chair of the GMC, said: "There is a need to create a culture where bullying of any kind is simply not tolerated. Apart from the damage it can do to individual self confidence, it is likely to make these doctors much more reluctant to raise concerns. They need to feel able to raise the alrm and know that they will be listened to and action taken." 

Have you been bullied or witnessed bullying? Or have you been a bully yourself? (It's a question I've sometimes asked myself as a parent: what would be worse? For your child to be bullied or be the bully?) 

 

 

Entry into clinical academia?

Posted in General at Wed, 19 Nov 2014 11:01:43

VeeR

Posts: 2
Joined: 18 Nov 2014

Hi,

I'm new to this forum and the UK. I'm trying to get a better understanding of what are the challenges to entering clinical academia here in the UK. 

Is entering clinical academia through the NIHR academic training pathway generally viewed as accessible or challenging? Are there other ways of attaining a senior clinical academic position? 

I'd really appreciate feedback from those who are currently trying to attain or have just attained a clinical lectureship.

Thank you!

Vee

Re: Words to ban in 2015

Posted in General at Wed, 19 Nov 2014 10:23:51

AnneG

Posts: 597
Joined: 18 Mar 2014

Pat Harkin - that is truly horrible! His blog is worth a read: http://asof.me/2011/10/05/a-small-rant/

Many moons ago I worked at Disneyland, Paris and the mangling of the French language displayed there was dreadful (the Academie Francaise would have been appalled). English speaking bosses spoke a horrible franglais examples of which included:

Le challenge (le defi in French)

Le day off or l'off (conge in French)

Le break (la pause - really, that one isn't that different is it?)

Re: Fountain pens; rediscovering the joy in writing

Posted in General at Tue, 18 Nov 2014 20:28:10

Sidhom

Posts: 470
Joined: 23 Aug 2013

Today, I forgot to bring my fountain pen to work with me. I had a lot of writing. I spent my day with 2-3 ballpoint pens. This is the first time in month sto use ballpoint. I discovered, I hate writing with a ballpoint, my writing angle goes more steep, my joints start aching fast, my hadnwritting goes gibberish and writing returns back to an ugly tedious job and joy. I think I'll leave a fountain pen in every office, to avoid such a messy day.

Access to Clinical Academia

Posted in News & media at Tue, 18 Nov 2014 16:28:23

VeeR

Posts: 2
Joined: 18 Nov 2014

Hi,

I'm new to this forum and the UK. I'm trying to get a better understanding of what are the challenges to entering clinical academia here in the UK. 

Is entering clinical academia through the NIHR academic training pathway generally viewed as accessible or challenging? Are there other ways of attaining a senior clinical academic position? 

I'd really appreciate feedback from those who are currently trying to attain or have just attained a clinical lectureship.

Thank you!

Vee

health problem among underground construction workers

Posted in General clinical at Tue, 18 Nov 2014 16:12:36

Biplawi shashi

Posts: 2
Joined: 15 Jun 2012

I am conducting a cross sectional study on health problems among undeground construction works based on secondary data in Nepal. Does anyone has previous expereinceson it or can anyone direct me to some research papers on this. We have very limited access to full papers from Nepal.

Re: Do bilingual Earn More Money?

Posted in General at Tue, 18 Nov 2014 11:26:20

Mukhtar Ali

Posts: 870
Joined: 14 Nov 2010

Speaking More Than One Language Could Sharpen Your Brain

http://time.com/3581457/bilingual-brain-smart/?xid=newsletter-brief

Re: Should patients have the right to record consultations?

Posted in News & media at Tue, 18 Nov 2014 10:04:38

KRIS

Posts: 13
Joined: 29 Oct 2014
I want that post back, or else consider urself a racist country.

Dual anti-platelet therapy after DES, how long should it be?

Posted in Cardiology at Tue, 18 Nov 2014 00:04:07

MBittencourt

Posts: 6
Joined: 04 Sep 2014

The benefit of aditional antiplatelet therapy (clopidogrel, prasugrel or ticagrelor) of DES is well documented. However, due to the increased bleeding, controvesy remains on the ideal duration of therapy. I have mostly recommended one year dual antiplatelet therapy.

4 trials presented at AHA yesterday have conflicting results. While DAPT suggests 30 months is better than 12, two european studies ISAR-SAFE and ITALIC support that 6 months is not different than longer treatments.

What do you usually do? 6, 12 or even more? Individualize? How?

Re: 'Post-oxygenation' increases apnoea time in difficult intubations to >15min

Posted in Anaesthesia at Mon, 17 Nov 2014 23:56:30

John D

Posts: 3325
Joined: 01 Feb 2010

rezanouraei,

Welcome to Doc2DOc!  And thank you for linking to such an interesting article!  To anaesthetists, anyway.

I have to say that even with careful pre-op assessment and the use of the several scoring systems for difficult intubation, anesthetists may still be caught out by an unexpectedly difficult intubation.    This should always be managed by strict application of a Failed Intubation Drill, whose principles are:

1/ Realisation and acceptance that this patient cannot be intubated by the method initially chosen, usually direct laryngoscopy under IV anaesthesia and paralysis.  This is not so easy, especially to the relatively inexperienced, which does not include the authors of this paper.     A rule that I teach trainees, and was taught me by the Ambulance service, was to take a deep breath when I stopped ventilating the patient to attempt intubation.  When I want to breath, so does the patient!

2/ At this point, all attempts at intubation should cease, and the manual bag and mask ventilation recommenced.  If necessary, full stomach, pregnancy, the patient should be turned to the lateral position, to ease airway maintenance and the draining of secretions or aspirate.

3/ While manual ventilation continues, further management may safely be considered, the recruitment of assitance and if appropriate senior help, the use of other aids to intubation, and the absolute need for intubation or indeed for general anaesthesia for this case.

But that is a protocol for dealing with the unexpected.    All of the 25 patients in this study were expected, or known to have "difficult airways", but none were "can't intubate, can't ventilate" (CICV) .    Apnoeic Oxygenation, keeping the oxygen tension in the airway high after preoxygenation so that diffusion alone, without ventilation, forces oxygen down the airway, into the alveolae and into the blood and tissues has been well-known since the days of rigid bronchoscopy.    It is therefore a trivial observation that an open, albeit with difficulty, airway keeps the blood oxygen tension high if the pharynx is filled with pure oxygen, even if the patient is apnoeic.  But it only works if the airway is open, so that it would be useless in a CICV case.

Far, far more important is to anticipate the difficult intubation, and to avoid general anaesthesia or intubation if possible.  If that is not possible, then to have to hand one of the many modern aids to intubation, from a miniature TV camera-equipped laryngoscope blade to a fibre-optic laryngoscope to be used with topical anaesthesia by awake intubation.

I sincerely hope that this paper will not cause the inexperienced or  foolhardy to mess about with nasal cannulae, but to do what every aanesthetist should do,  to keep their patient as far as possible from unnecessary risk.

John