What do you think?

Latest posts

The most recent posts from the doc2doc forums

Re: Antivaccine by Bill Maher

Posted in Public health at Fri, 06 Mar 2015 14:56:43


Posts: 1775
Joined: 08 Oct 2010

I very much like Bill Maher and his comedy. His political views I generally tend to agree with but on vaccines I think he is misguided. Having said that it is worth watching the two clips where he discusses vaccines - the reports of what was said were not complete. Both are here:


Re: Do part time women doctors make a positive contribution to healthcare?

Posted in Careers at Fri, 06 Mar 2015 14:51:04


Posts: 8
Joined: 29 Oct 2013

ljc 123  - couldn't have said it better! 

An eye for an eye

Posted in News & media at Fri, 06 Mar 2015 14:50:53


Posts: 1775
Joined: 08 Oct 2010
In a literal application of  sharia law of an eye for an eye, an Iranian man convicted of blinding another man in an acid attack has been blinded in one eye, marking the first time Iran has carried out such a punishment. 
Mahmood Amiry-Moghaddam, from Iran Human Rights (IHR), an independent NGO based in Norway, condemned the blinding as barbaric. “Medical staff who cooperate with the Iranian authorities in this act have broken the Hippocratic oath and cannot call themselves doctors,” he said.
Reports say the man was 'rendered unconscious' in his cell whilst the eye was removed.
What surprised me was the voluble support for the punishment by Guardian readers in the comments section of the website.
What should happen to Doctors who participate in this punishment?

Re: Picture quiz: A man with a blistering eruption and tuberculosis

Posted in Respiratory medicine at Fri, 06 Mar 2015 11:43:08


Posts: 688
Joined: 21 Feb 2012

In Response to Re: Picture quiz: A man with a blistering eruption and tuberculosis:[QUOTE]

The only thing I would add to Chid's expert analysis is to check for iron overload in the usual ways and to venesect if excess iron is present.

The other possibility with a blistering eruption and Hep, C occurs with cryoglobulinaema but the appearances are rather different to the ones shown.

Posted by Maxim[/QUOTE]

yes Sir,

phlebotomy  may  be included,I  forgot to  include it.




Re: Is it OK for doctors to accept gifts from patients?

Posted in General at Fri, 06 Mar 2015 04:03:43


Posts: 10
Joined: 02 Jun 2011

I certainly think that it is inappropriate to accept  personal gifts in most circumstances. 

We are not always aware of patients motivations (indeed, sometimes they are not aware), and it certainly muddies the waters ethically to accept gifts, especially ones of significant monetary value.

Having said that, accepting a small token (a box of chocolates or bunch of flowers, for example) on behalf of the team at the end of a treatment episode, and ensuring that all can take pleasure in it, is another matter entirely.  

What not to learn from airlines

Posted in General at Thu, 05 Mar 2015 20:04:30


Posts: 218
Joined: 14 May 2012

The Event


Recently (Feb 2015) I was waiting at Stockholm to board BA781. It was scheduled to depart at 1850. The departure monitor showed a delayed expected departure time of 2010. Naturally, I was anxious and annoyed. I changed my arrangements in UK to suit a delayed arrival.

I then checked London Heathrow Terminal 5 arrival board which said the flight was on time (in contradiction to the Stockholm departure board). I then checked BA's website which also showed that the flight was on time.
Now my hopes raised slightly. Suddenly Stockholm departure board showed a new departure time reducing the delay and a little later the board at Stockholm stated that the flight will depart on time. We were allowed to board at the originally scheduled departure time without any delays.
I boarded the flight and then cancelled my changed arrangements in UK.
Once we were settled in our seats and the doors were locked the captain made an announcement.
The captain said that there was some equipment which was faulty. Replacement equipment was arriving soon by the next BA flight from London. The new equipment will be fitted in by the engineer and only then we will leave. There will be a delay expected to be around 50 minutes or so.
All these happened and the aircraft finally took off at about 1945 hours.
Of course the reasons were explained (apparently there was only one aerobridge for that kind of aircraft), BA staff were polite and courteous.
What are your thoughts on this event?
My reflections on this event forms the rest of my blog which can be found at

Re: If you could change one thing in the NHS, what would it be?

Posted in General clinical at Thu, 05 Mar 2015 10:46:01


Posts: 349
Joined: 14 Dec 2010

If I were allowed only one thing it would be to change the obsolete system of party political control and disruption of the NHS with electoral cycles but I won't elaborate as we have discussed all that before.  The point in this context is just that it would allow at least proper discussion of some crucial considerations mentioned above. And to forestall the usual objections, it does not mean excluding 'politics' and politicians.

If I were allowed one more it would be to stop giving credence to some of the same tired old names trotting out their meaningless slogans and rotating around the endless cycle of 'expert' panels and round tables.  There are some exceptions in those listed above but too many of these and others in that coterie are uncomprehending and unrepresentative of those who depend on the NHS and of those who devote their working lives to it.

Re: Unfading Shadow of Ebola

Posted in Public health at Wed, 04 Mar 2015 22:47:42

John D

Posts: 3457
Joined: 01 Feb 2010

BUT, in the week up to March 1st, no, none, zero new cases of Ebola in Liberia!

and 'only' 132 in Guinea and Sierra Leone.


It IS on the retreat, but obviously no one there will drop their guard for some time.

AND, as Mukhtar reports Presidet Sirleaf's plea,  it reinforces those poor countries need for aid, to restore their economies and build up health services, so they can stop Ebola running amok again.  As the epidemic winds down, the media will forget West Africa - our Governments must not.



Re: GMC registration

Posted in Careers at Wed, 04 Mar 2015 19:04:04

Dr Ali

Posts: 15
Joined: 30 Apr 2009

one year internship work/training is usually required in the UK before medical gradutes can work on full capacity,it is also called pre registration officer,what country in the EU your medical school and if this internship is part of their school curriculum,you can write or email the GMC and expect their reply,you can also find the address of the nearest postgraduate dean,they can advice you of the best route to apply,finally you can approch the jobcentre they have information about free movement and work for EU nationals in the medical sector,good luck

Drugs Live: Cannabis on Trial. Channel 4, UK

Posted in General clinical at Wed, 04 Mar 2015 18:35:47

John D

Posts: 3457
Joined: 01 Feb 2010

Who watched the programme on Channel 4 last night, "Drugs Live: Cannabis on Trial"?

It involved some most eminent doctors and scientists in the field, as well as prominent broadcasters, some of whom took part in a double blind trial of 'normal' marihuana, "skunk" mariahuana and a control, by inhaling a vapourised bagful of the stuff.

In the UK, you can watch it again on '4OD', Channel  4's online repeat website, at http://www.channel4.com/programmes/drugs-live/on-demand/56137-001

and anyone can read Channel 4's press release here: http://www.channel4.com/info/press/programme-information/drugs-live-cannabis

As it might, the programme claimed some world firsts, including "MRI" evidence (Surely 'Functional Positron Emission Tomography'?) of markedly different effects of traditional and the much stronger "skunk" cannabis on brain function.    

Rather than expressing my own views and reactions, perhaps you might like to give yours?   About the programme, please, not on the usual cannabis legislation question.


Re: CQC Inspection

Posted in General at Wed, 04 Mar 2015 15:43:54


Posts: 1165
Joined: 07 Sep 2009

I've just started a poll based on a recent Pulse debate.

Is the CQC’s inspection regime fit for purpose?



Pulse debate: Is the CQC’s inspection regime fit for purpose?

Posted in General clinical at Wed, 04 Mar 2015 15:39:21


Posts: 1165
Joined: 07 Sep 2009

Following on from Pat Lush's account of his recent CQC inspection, this debate, from GP magazine Pulse, is interesting.

Arguing 'yes' is Peter Higgins, chief executive of Lancashire and Cumbria LMC

He says the CQC has provided clearly defined measures by which practices can be reviewed and can be used for practices to lobby for resources to improve themselves. He believes it is an invaluable system to flag up practices that are compromising patient safety and an essential component of reform. He says, "In many cases, GPs might be up to date with their clinical skills, but let down by a lack of organisation. The CQC gives these few practices a wake-up call, which previous systems failed to do."

Arguing 'no' is Peter Swinyard, GP in Swindon and chair if the Family Doctor Association

He says prioritising box-ticking over improving quality of care is not a robust inspection process, and calls the risk ratings 'scurrilous' and some of the criteria 'bizarre'. He says, "It’s still not clear why ratings are reliant on QOF results for retired indicators when the framework is voluntary." He believes CQC inspections would work much better if inspectors sat in consulting rooms, congratulating their colleagues on the areas where they performed well, and advising on urgent improvements.

Re: Clinical question of the week: What test would be your first line investigation?

Posted in Respiratory medicine at Wed, 04 Mar 2015 06:12:59


Posts: 37
Joined: 11 Feb 2009

Sputum Examination to see if there is bacteria and puss cells and  AFB staining

Re: Poll about smoking in cars

Posted in General clinical at Wed, 04 Mar 2015 05:55:44


Posts: 37
Joined: 11 Feb 2009

Smoking should be discouraged anywhere and every where

Re: Student Mental Health- How to deal with the taboo

Posted in Student BMJ at Tue, 03 Mar 2015 20:29:24

Juan Zambon

Posts: 7
Joined: 20 Apr 2014
Simply put, the article makes me feel that I'm not alone! The pressure is overwhelming, expectations on us, students, all the time. Posts around the web saying medical student are less happy than other areas, that suicide more, that uses too much stimulants to keep up on the study. It's alarming situation but still a silent thing. This amazing article is a heads up to take a look for the health of health students.

Re: Medicolegal Case Report - Gastroenterology

Posted in General at Tue, 03 Mar 2015 15:07:39


Posts: 1775
Joined: 08 Oct 2010

In Response to Re: Medicolegal Case Report - Gastroenterology:[QUOTE]

Maxim - quite right. There are some complicating factors. There is a service (eg GI bleeds) and training aspects to endoscopy lists. Similarly , I might expect help for certain cardiac procedures. After my first retirement , I carried out some waiting-list initiatives for endoscopy. Initially some of these were done at a local private hospital in part exploring the possibility of the hospital providing a contract. These failed - some of the patients were clearly totally unsuited (background medical problems , no help with the "clerking" , patients recently in hospital with bleeding but not endoscoped etc....). One suspects someone wanted the lists to fail....

 The other lists were at a small DGH with space but heading towards closure. As I was not so much time limited there was opportunity to discuss management but it was surprising how often patients had no real indication (or one that was  questionable) for the procedures. The management pressure of course is to go ahead and again there are training needs. I am sure you are well aware of the dilemmas. Doing my own thing I survived for a few years and used quite a bit on the income to fund quality ongoing CPD without having to bother about too many application forms to the Trust.

One of our best endoscopists was not even an associate specialist and from management's viewpoint one has to question the need to have endoscopy lists paid for at consultant rates. I am possibly one of a small group who argued that my post retirement work did not merit the salary initially suggested. Easily replaced as a gut doctor I think the general physician side has been a bit more of a problem. Acute physicians are not quite the same thing however competent.

Posted by sken[/QUOTE]

Many thanks sken, I appreciate the comments. When I first started, a principal aim was to give more detail than the Defence organisations give in their cases 'roundup', but I have gone too far with the details. Also, as you say whilst this case is interesting it probably has a rather limited appeal. I will broaden the range of cases, put a summary as an initial post then use the blog area to give more detail as interest dictates.

I actually enjoy doing these cases because I learn quite a lot from the discussion that usually takes place.

Quite apart from the purely medical matters here Mrs A made very strong criticism of the medical and nursing staff - attitude, professionalism, false imprisonment etc etc. . Having heard all of the Doctors and Nurses give evidence and assessing the documentary records the Judge rejected completely Mrs A's allegations


Re: Smoking Banned in Cars!

Posted in Respiratory medicine at Tue, 03 Mar 2015 14:48:30


Posts: 12
Joined: 15 Feb 2013
We have had this legislation in place in several Canadian provinces for years. Enforcement is no problem. Most people understand the purpose and self-enforce. Police will also check a car if it is pulled over for another reason - random inspections for alcohol use, verification of up to date maintenance stickers, seat belt use, etc or if the vehicle is stopped for a traffic violation. The police are quite supportive. The ETS exposure to developing lungs in cars can be very intense and be repeated frequently over many years. The legislation makes sense.

Repeated Flu Shots May Blunt Effectiveness

Posted in News & media at Tue, 03 Mar 2015 10:43:23

Mukhtar Ali

Posts: 904
Joined: 14 Nov 2010

Universal influenza immunization programs, available in virtually every province and territory, may need to be reconsidered in light of emerging evidence that repeated flu shots may blunt the vaccine's effectiveness in subsequent seasons.


Average penis length published to help counsel men with body dysmorphic disorder

Posted in General clinical at Tue, 03 Mar 2015 10:43:18


Posts: 1165
Joined: 07 Sep 2009

Research News:The British Journal of Urology International has published asystematic review of >15000 men concluding that the average length of a flaccid penis is 9.16 cm, a stretched flaccid penis is 13.24 cm, and an erect penis is 13.12 cm.

The review was conducted to help urologists, sexual health doctors, and GPs counsel men with 'small penis anxiety' and body dysmorphic disorder.


Will you use this graph to help with such consultations?

The 'big feet' theory was also reviewed: "One study found stretched length to be significantly weakly correlated with foot size (r = 0.27) and one study did not find a correlation between penile length and foot size."

Re: MRCGP Question of the Day from OnExamination: breast cancer treatment

Posted in General clinical at Tue, 03 Mar 2015 08:35:34


Posts: 1165
Joined: 07 Sep 2009

Click here and go to BMJ OnExamination for the answer

Re: Would you consider becoming a medical manager?

Posted in Careers at Mon, 02 Mar 2015 16:44:43

From Twitter

Posts: 18
Joined: 19 Jan 2015

I learnt hard way now got internal training programe and I coach all CDs

Re: Question of the week: "Bad diet advice." Was Woody Allen right?

Posted in General clinical at Mon, 02 Mar 2015 14:27:42


Posts: 891
Joined: 13 Oct 2009

The DGAC guidelines seem pretty standard. The media will always enjoy creating concern on almost any health issue. I must admit I had been taught that the dietary intake of cholesterol as such was fairly irrelvant when balanced against the body's production of it. 

there are only 2 big rules on the question of nutrition :

1. People tend to eat too much ;

2. The food industry is all but uncontrollable.

One can add a third : Joe Piblic will expect someone else will bail them out if there are problems.

Meanwhile in the UK we have a further crop of stories about starvation in hospitals , just as we have had over the past 40 years with temporary expressions of "something must be done".

Inner city fast food outlets linked to diabetes and obesity

Posted in Cardiology at Mon, 02 Mar 2015 10:42:19


Posts: 717
Joined: 15 Apr 2011

Inner city fast food outlets linked to diabetes and obesity

From Diabetes.co.uk web site14 November

A new study has revealed there are twice the number of fast-food outlets in inner cities, which can be linked to diabetes and obesity.

Research from the University of Leicester found these outlets were within 500 metres of high density non-white ethnic minority groups and socially deprived neighbourhoods.

The study was based on 10,000 people in the UK, with researchers warning that important implications for diabetes prevention can be taken from these findings.

The researchers, writing in the journal Public Health Nutrition, said that two additional outlets per neighbourhood resulted in the expectation of one additional diabetes case. This was assuming a causal relationship between the two.

Diabetes and obesity

Obesity is one the factors that can increase the risk of type 2 diabetes, which is assessed by having a body mass index (BMI) of 30 or greater.

Lead researcher, Prof Kamlesh Khunti from the University of Leicester, said: "The results are quite alarming and have major implications for public health interventions to limit the number of fast-food outlets in more deprived areas.

"This number differed substantially by key demographics, including ethnicity; people of non-white ethnicity had more than twice the number of fast-food outlets in their neighbourhood compared with White Europeans.

"We found that the number of fast-food outlets in a person's neighbourhood was associated with an increased risk of screen-detected type 2 diabetes and obesity."

COMMENT: If you have read Salt Sugar Fat: How the Food Giants Hooked Us by Michael Moss, these findings would not surprise you. The manufactured food business mangers know their stuff, so they put their outlets, be they convenience stores or fast food outlets where their market is.  So the prevalence of obesity is now highest among the lowest socioeconomic strata of society.  A new form of malnutrition has become epidemic in our inter cities.  As I have said before, unless there is governmental intervention, this trend is unlikely to wane.


A large cohort study suggests that aspirin prophylaxis only benefits people with a prior cardiovascular event

Posted in Cardiology at Mon, 02 Mar 2015 10:40:21


Posts: 717
Joined: 15 Apr 2011

Impact of Aspirin According to Type of Stable Coronary Artery Disease: Insights from a Large International Cohort

American Journal of Medicine Volume 128, Issue 2, Pages 137–143, February 2015

Verbatim Abstract


Aspirin is recommended in stable coronary artery disease based on myocardial infarction and stroke studies. However, benefit among stable coronary artery disease patients who have not suffered an acute ischemic event is uncertain. The objective of this study was to evaluate the impact of aspirin in stable coronary artery disease. We hypothesized that aspirin's benefit would be attenuated among individuals with stable coronary artery disease but no prior ischemic event.


An observational study was conducted from the INternational VErapamil-SR/Trandolapril STudy cohort. Ambulatory patients ≥50 years of age with clinically stable coronary artery disease requiring antihypertensive drug therapy (n = 22,576) were classified “ischemic” if they had a history of unstable angina, myocardial infarction, transient ischemic attack, or stroke at the baseline visit. All others were classified “non-ischemic.” Aspirin use was updated at each clinic visit and considered as a time-varying covariate in a Cox regression model. The primary outcome was first occurrence of all-cause mortality, myocardial infarction, or stroke.


At baseline, 56.7% of all participants used aspirin, which increased to 69.3% at study close out. Among the “non-ischemic” group (n = 13,091), aspirin was not associated with a reduction in risk (hazard ratio [HR] 1.11; 95% confidence interval [CI], 0.97-1.28; P = .13); however, among the “ischemic” group (n = 9485), aspirin was associated with a reduction in risk (HR 0.87; 95% CI, 0.77-0.99; P = .033).


In patients with stable coronary artery disease and hypertension, aspirin use was associated with reduced risk for adverse cardiovascular outcomes among those with prior ischemic events. Among patients with no prior ischemic events, aspirin use was not associated with a reduction in risk.

COMMENT: The determining the risk/benefit ratio of prophylactic aspirin use for the prevention of cardiovascular events has become a complicated issue.  The current recommendations from the CDC http://www.cdc.gov/heartdisease/aspirin.htm recommend aspirin prophylaxis in those with prior cardiovascular events.  The data presented in this paper comports with this recommendation.  However, the CDC recommendations for those without known cardiovascular disease (men aged 45-79 and women aged 55-79) are rather vague in helping the clinician determine which of such patients would the benefit outweigh the risks of bleeding.  The current study concludes that even in those with known CAD, aspirin prophylaxis showed no benefit in the absence of a prior cardiovascular event.  One can reasonably conclude then that aspirin prophylaxis will be unlikely to benefit those individuals without a history of cardiovascular events.


Higher Whole Grain Intake Linked to Lower Mortality

Posted in Cardiology at Mon, 02 Mar 2015 10:37:41


Posts: 717
Joined: 15 Apr 2011

In preparation for my case ofthe week i ran accoss severay articles on diet that I felt would be of interest to the readers of the Cardiology forum.  i am posting them today.

Higher Whole Grain Intake Linked to Lower Mortality

By Jenni Whalen from 6 January 2015 NEJM Journal Watch

Edited by David G. Fairchild, MD, MPH

Higher intake of whole grains is associated with reduced overall mortality and especially cardiovascular mortality, according to a JAMA Internal Medicine study.

Researchers followed approximately 74,000 women from the Nurses' Health Study from 1984 to 2010, and nearly 44,000 men from the Health Professionals Follow-Up Study from 1986 to 2010. Participants were free of cancer and cardiovascular disease at baseline; they completed dietary questionnaires every 2 to 4 years.

After adjustment for confounders (e.g., age, smoking, BMI), higher whole grain intake was associated with lower total mortality (hazard ratio for highest vs. lowest quintile of whole-grain consumption, 0.91). In particular, cardiovascular mortality was reduced — especially with high intake of brans (HR, 0.80). Whole grain intake did not reduce cancer mortality.

The authors conclude: "These findings further support current dietary guidelines that recommend increasing whole grain consumption to facilitate primary and secondary prevention of chronic diseases and also provide promising evidence that suggests ... benefits toward extended life expectancy."


JAMA Internal Medicine article (Free abstract)

COMMENT: This analysis of two large cohorts further supports the hypothesis that increased whole grain intake is associated with lower total mortality.  Like all epidemiology studies, however, this conclusion is only hypothesis-generating.  There are a multitude of reasons why persons who consume higher amounts of whole grains might exhibit improved mortality besides the consumption of whole grains per se.  These limitations are discussed in an op-ed column by Nina Teicholz entitled, “The Government’s Bad Diet Advice.”  http://www.nytimes.com/2015/02/21/opinion/when-the-government-tells-you-what-to-eat.html?_r=0 that I cited in my case of the week post.