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Re: Is it becoming increasingly hostile to practise medicine today?

Posted in Medicolegal at Fri, 30 Jan 2015 18:10:57


Posts: 256
Joined: 29 May 2013

" You're only dead when you're warm and dead"

Don't know where that on came from - should be "You're only dead when you're COLD and dead" (think CPR).

Re: What is the most important medical advance since 1840?

Posted in General clinical at Fri, 30 Jan 2015 17:46:17


Posts: 167
Joined: 21 Aug 2011

Anaesthesia is just for wets surely, what was ever wrong with a half bottle of rum and a  good bite on a leather belt? Not shitting in the water supply still sits close to the top then  regularly  actually using soap is  still slightly more important  that the invention of soap as the tonnage of post op antibiotics reminds us. In terms of malaria  death reduction rates, some still  feel very sad about the passage of DDT.

The most ludicrously over-sold/abused medical advance has surely to be Antibiotics. 

Knowing the genetic blue print/cheap access to the genome is a long long way from usefully doing anything  truly with it. Most people know exactly how the Mona lisa was created, a few people know the exact chemical composition of the paints used. Does this make them artists?

Re: Unexplained medical symptoms; waste-paper basket for modern medicine

Posted in General clinical at Fri, 30 Jan 2015 17:29:12


Posts: 167
Joined: 21 Aug 2011

I thought the moronic mush around " medically unexplained symptoms" never ever left the trash bin. Most cultures understand that when the house burns down, the job is lost and the family emigrate without telling the individual , they may then  present with certain symptoms that would otherwise be hard to explain.

The diagnosis of their illness still fits into the label of 'there is a lot of it about but it should go away fairly soon".  I thought the concept of psychosomatic/mind body etc was  all over the course syllabus for med students, as well as intuitively grasped by anyone without a medical degree since the beginning of time. ie no medical transaction has any meaning without knowing where the patient is truly at. Not knowing the background   can be called 'unexplained'  if that works for the Clinician- because obviously it never works for the patient,  but mostly the extra 30 seconds  may stop the silly blood test or sillier scan.

Re: What's better for Medical Education?

Posted in Careers at Fri, 30 Jan 2015 16:22:50


Posts: 2
Joined: 24 Oct 2011

I trained at Bristol 35 years ago. 

I was easily able in a ER and grand round scenario at that time as I was challenged to diagnose through clinical years .a list of differential diagnoses still centres my treatment plan today

Re: Is Medical Education a Bubble Economy

Posted in Medical education at Fri, 30 Jan 2015 15:15:09


Posts: 849
Joined: 13 Oct 2009

Many thanks. Initially I had thought this might refer to postgraduate education and the way this can be used for income generation. Of course medical greed was rampant even when medical education was relatively free in the UK but I have the impression that the current system , which leaves many students with a significant debt , has enccouraged doctors to concentrate even more on their earning capacity and given it respctability. It will be interesting to see in a few years time whether there is a difference in attitudes between those who have been through a private medical school and those who have not. In the meantime in the UK there is a problem of recruitment into those specialties where the opportunities for very high income levels is less. Pricking the bubble by reducing the rewards could be counter productive and might need to be selective.. Does anyone have any UK private health insurance data? At one time the companies made some effort to reign in some of the greedier abuses but suspect it has been easier just to pass on higher premiums to the customer. It would be great to feel that the private sector could make the pickings less attractive financially - and equally if the NHS stopped just trying to buy its way out of political targets with "waiting list moneys" .and concentrated on having adequate numbers of staff. What is the highest rate for a session that doc2doc folk have come across - any takers at £1,000=?

Re: Top doc2doc users in 2014

Posted in General at Fri, 30 Jan 2015 15:10:27


Posts: 17
Joined: 26 Feb 2010

What about most  original thoughts for 2014?

Should birth and methods of birth, including complications of birth, such as Pre-clampsia be added to school curriculum in Biology? Too many girls say, "Nature will take its course, I'll have my baby" as if it wetre a dead certainty, and she did not attend any antenatal classes, as she saw no point in attending for having a baby is as simple as going to Tesco and chosing one off the shelf. How naeve? Is it not time to educate, so they can make truely inform choice as to whether to get pregnant or delay until they desparately want a baby?

Re: Recurrent Flu Symptoms: Opinions Wanted!

Posted in Respiratory medicine at Fri, 30 Jan 2015 15:05:17


Posts: 676
Joined: 21 Feb 2012

In Response to Re: Recurrent Flu Symptoms: Opinions Wanted!:[QUOTE]


This is a difficult area and I appreciate that the rise of 'e-medicine' suggests that it's perfectly acceptable to cast a wide net when looking for answers to a close relative's problem.  It's been part of medical education for decades to post 'case histories' and ask for diagnostic and therapeutic answers.  I'm pretty sure that many of these, outside formal CME sites, are thinly disguised as personal requests but I would answer your question by suggesting that there are important differences between depersonalised cases and individual, real-time consultations. 

The tradition, at least in the UK is that personal consultations are best addressed to one clinician at a time and that, by answering such a request, any registered and licenced doctor is implicitly accepting some responsiblity for their opinion.  It may be that some clinicians feel they can do this informally without seeing the patient, indeed that's sometimes inescapable in exteme circumstances, but I think that to give anything other than the most general advice here is often a hazardous undertaking for both patient and doctor.  The other risk is that you might get multiple different opinions and you have no easy way of knowing which, if any, are correct.

This is only my personal answer and others on this site may have different views.

Posted by Maxim[/QUOTE]


I agree with you.



Re: Swearing at work - which specialty does it most?

Posted in General clinical at Fri, 30 Jan 2015 12:59:35


Posts: 316
Joined: 14 Dec 2010

Unusually for me, I'd posted comments before reading fully the article in BMJ careers mentioned by Sabreena.  Having now read it I wouldn't retract anything I posted earlier but would like to make 3 comments about the article.

1) It completely fails even to attempt a defintion of swearing.  This is important as there's clearly no agreement within the medical community or even the public at large.  Some of the commentators clearly included the use of vernacular terms to describe micturition and defaecation when talking with patients who are not familiar with Latin or medical euphemisms.  Yet Richard Vautrey from the BMJ (specifically discussing swearing) warns against using language the patient can't understand.

2)  The article falls into the common trap of giving prominence to 'shock-horror' comments and allusions to abuses of power whilst being willing to stereotype groups of doctors in true tabloid style.  We are told that one study showed that orthopaedic surgeons swear more than others, one apparently scoring one swearing point every 29 minutes.  Leaving aside the banality of such a survey I can't think of more than one or two of my old surgical colleagues who would ever go that long!

3) The article makes only passing reference to the one study that attempted a proper analysis of swearing by clinicians.  Unfortunately, this paper by Zimmerman and Stern is available only in abstract if you don't pay.  I can't get past the firewall even with my University library password or other tricks.

Using any language to bully or insult people who can't easily answer back is always wrong but some of the nastiest characters I've known have treated people in these ways using only perfect English with nothing that could have been considered swearing.

Sorry to be critical, but I think the BMJ can do better than this article when discussing a serious subject.

Re: Diagnosing and treating MI in women - a paper to change practice

Posted in Cardiology at Thu, 29 Jan 2015 19:55:49


Posts: 8
Joined: 04 Sep 2014

I would say this paper starts to shed light on what we should think about with the new troponins. I have worked with them for a while, and if it increases sensitivity, it also has significant problems with specificity, particularly on atypical cases, which are more common in women. I do not think we have the final answer yet, but I believe there is important additional value on its use, if clinical context is considered.

Re: Recurrent Flu Symptoms: Opinions Wanted!

Posted in General clinical at Thu, 29 Jan 2015 19:02:45

John D

Posts: 3400
Joined: 01 Feb 2010

Me too, Naushad!

Cold at Xmas, persistent cough ever since, end of last week and weekend another nasty cold - progressive nasal, throat and then tracheal soreness, nose pouring, mild pyrexia, headache and sinus symptoms) now recovered and coughing the same as before.   "Hacking" cough, I sound like the sort of Old Man you used to see who would cough loudly and juicily and then spit (but I don't) .    Hadn't considered antibiotics - it's obviously a virus and my nasal discharge (sorry, anyone having their tea) is  non-purulent - let alone steroids!

Grateful for any tips, too - except steroids - as I'm fed up with the cough and so is Mrs. JD.    Or should I just move somewhere warm?  Like Saudi?  Where it's between 17 and 27C today?   Minus 1 and snow predicted here.


Re: Fountain pens; rediscovering the joy in writing

Posted in General at Thu, 29 Jan 2015 15:29:32


Posts: 538
Joined: 23 Aug 2013

In Response to Re: Fountain pens; rediscovering the joy in writing:[QUOTE]

I write in hospital notes with a Pilot V7 Needlepoint Rollerball pen ... it wrote very nicely, it had a window to see how much ink is left, and it's not so precious ...

I do have two nice fountain pens at my desk, however.  A Cross pen, which was lovely until it was dropped on the floor by a friend who borrowed it, and the nib has never quite been the same since.  A Waterman, given to me by my Mother at the time of my graduation, which writes very well - I keep it for "best".

We are told by our clinical risk assessors that we should not write in fountain pen as the ink is water soluble, so if there is a flood, the notes we write will wash away.  

I still use my fountain pen.

Posted by DundeeChest[/QUOTE]

Thanks DundeeChest,

I am sorry to hear about your fountain pen's accident. I guess it might be difficult with respect to one's feelings of anger and frustration for the nib, and having to deal with the one who cayse this to happen.

Rollerball pens seem to capture the best of two worlds; the wet look of a fountain pen, and the ease of use & practicality of ballpoint pen. It's my second best after the fountain pen, owing to its smoothness.  Generally, differentiating between fountain pen writing and ballpoint is rather easy, however, telling the difference between rollerball & fountain pen can be a bit trickier and one has to look for line variation.

With fountain pens, it's not uncommon to learn about people dedicating a certain pen to a certain task. I am not exempt from this as well, I have a pen for show (quite a formal one), and one that I use at home and a workhorse.

Re: how to fight smoking in school children

Posted in Respiratory medicine at Thu, 29 Jan 2015 14:16:35

Eman Sobh

Posts: 173
Joined: 02 Jan 2014

In Response to Re: how to fight smoking in school children:[QUOTE]

It's tricky.  Smoking advertising has been banned in the UK for years, decades now.  But smoking is still commonlace on TV, TV soap operas have smokers on screen frequently, the corner shop in Coronation Street has the cigarette display in a completely daft place, just so it can be seen on screen every time there's a scene in there.  Films have smokers, or there's packets of cigarettes lying around.  Often there's no reason whatsoever for the character to be a smoker, they just are, for some reason.  So children are exposed to smoking as a cool thing to do, all around.  And before the watershed too.

The advent of shisha sticks means kids can 'vape' at school, and 'avoid the harmful effects of cigarettes'.  One argument is that Cigarettes simply get kids addicted to nicotine and they transition on to real cigarettes once they're old enough to buy them.  There's no evidence of that being the case, but it's too early to say, I think.

When firends have told me of their concernt that their children might take up smoking, I point them to Yale Rosen's most amazing Flickr photo stre@m of lung cancer pathological specimens.  That usually does the trick.

Posted by DundeeChest[/QUOTE]

it is very interesting site but I wonder " how can pulmonologist or cardiologist still smoker with all his knolowlege and cases of lung diseases he see?"

Re: Magna Carta 800th Anniversary

Posted in General at Thu, 29 Jan 2015 10:54:22


Posts: 4529
Joined: 24 Feb 2009

Sorry for typos in my post. I affirm that no Islamic country has such a tradition of assertion of the rights of the citizen or of the aspiration to a democracy and rule of law. 

Our system has flaws but I can live with them and am fortunate to live in the shadow of the Magna Carta. It is a big tree with much shade.


Re: Incidental finding on TRUS study

Posted in Radiology at Thu, 29 Jan 2015 10:01:01


Posts: 1
Joined: 29 Jan 2015

Ca prostate

Re: What's your diagnosis? A teenager with a cough, fever and poor appetite

Posted in Respiratory medicine at Thu, 29 Jan 2015 05:27:42


Posts: 7
Joined: 02 Jul 2011

Tuberculer abcess

Re: DRCOG exam

Posted in Careers at Wed, 28 Jan 2015 23:57:00


Posts: 1
Joined: 28 Jan 2015

Did u complete the onexamination once  only?.Did you go through all the green top guidelines?




In Response to Re: DRCOG exam:[QUOTE]In Response to DRCOG exam:
[QUOTE]Hello, Anyone got any tips on how to pass the DRCOG exam...I had used onexamination.com and read a couple of books, but marginally failed the exam. There are so many websites for practice exam questions..anyone recommend any in partciular? Thanks
Posted by mimisoko[/QUOTE]

I passed recently. Must admit, used onexamination for most of my revision but felt it focused on the rare conditions too much without going into detail about common conditions. Think that's the key. Also a book called "Questions and Answers for the DRCOG" by Kochhar & Sinha was useful. 
As a core text, I found Obstetrics and Gynaecology by Impey most useful - despite using it in my undergraduate years.
Hope that helps, good luck.

Posted by StevieG[/QUOTE]


Re: CT-Scans, When Are They Warranted?

Posted in General clinical at Wed, 28 Jan 2015 23:25:12

Eman Sobh

Posts: 173
Joined: 02 Jan 2014

I agree that thoracic US now is taking much more from CT indications and the sensitivity and specificty of US for eg pneumothorax is 100% also follow up of  cases of pneumonia. interstial lund diseases is now going totally by US also guided biopsies from peripheral lung or pleural lesion and CT was reserved for initial stting

the fear of breast cancer in females exposed to radiation imaging is going up and many studies recommend to avoid as possible 


Re: Is the NHS in a "perilous" state?

Posted in News & media at Wed, 28 Jan 2015 23:09:52


Posts: 1454
Joined: 15 Apr 2010

The Scottish referendum may have delivered a 'No' vote, but we have had devolved health policy for some time, and it continues as such, up here.  So while England and Wales have had a variety of changes imposed, Scotland has remained remarkably unchanged, and we're all the better for it, I believe.

We are pressurised, pushed to the limit in many areas, but these stresses arise from increasing demand on primary and secondary care services, rather than GP commissioning, Payment By Results, or such.

So I can't answer your question, Sabreena - it's a little binary anyway, isn't it?

Re: Why did evolution come up with sex? Meditations on the sadness of sperm

Posted in General clinical at Wed, 28 Jan 2015 23:06:12


Posts: 1454
Joined: 15 Apr 2010

Aye, but it's fun though, eh?

Re: NEJM Images in Medicineine this week

Posted in Respiratory medicine at Wed, 28 Jan 2015 21:46:49


Posts: 1454
Joined: 15 Apr 2010

It's a great CXR.


Re: What do you remember about your first dissection?

Posted in General clinical at Wed, 28 Jan 2015 20:43:57


Posts: 1454
Joined: 15 Apr 2010

I remember exactly where our cavader was in the dissection room. We had a black man, which I remember being unusual in East Anglia, and all the other cadavers were white.  He was a very big man, giant organs, easy to dissect, not as fiddly as some of the smaller cadavers.

In first year we started with the chest, moving on to the arm, while the second years dissected the head and neck.  Each week we'd go back to discover that the neck dissection had moved on a piece.  Until the head was removed completely, and we had a headless corpse to dissect.  

The plastic box, with saqdust filling, was gradually filled up through the year, until all that remained on the table was a pair of legs.

I could tell you some stories about what we did in dissection, but suffice to say if any medical student were caught doing that sort of thing now, I would throw them out of the medical school.  How times change.

We went to the funeral service for our cadavers - I am as religious as a pottetd plant, but felt a deal of respect towards our cadaver, and went in spite of the religious portion.

I remember the sweat dripping from Patrick's forehead as he carried out the most tricky parts of dissection (he's a cardiologist now, but an interventional one)

I remember being very hungry after Tuesday morning's dissection, with a craving for tuna.

I remember being thirsty half way through Friday afternoon's dissection, with a craving for Old Speckled Hen.

We have Thiel Cadavers in Dundee - one of very few places to offer Thiel dissection.  The specimens are very lifelike, soft, pliable, not hard, stiff and inhuman.  Dissecting a Thiel cadaver is very much like operating on a very much alive patient.  We aim to offer this to every one of our students - I remember much of what I learnt in dissection, and use that knowledge almost every day.

Re: our mind inside the heart not the brain

Posted in Cardiology at Wed, 28 Jan 2015 20:01:17


Posts: 538
Joined: 23 Aug 2013

In Response to Re: our mind inside the heart not the brain:[QUOTE]

Mind is a collection of  experiences , which starts right from the moment one is born or may be right from the intrauterine life, its not an anatomical entity, its an impression of one's interaction with the universe call it to surroundings.

Posted by jagmohan[/QUOTE]

According to Merriam-Webster Dictionary: the mind is: the part of a person that thinks, reasons, feels, and remembers. All these faculties have been proven beyond doubt to exist inside the brain were brain damage can affect none/any/all of them depending on the site and magnitude of the damage.

I think it might be unhelpful to merge the philosophical, mystical, spiritual with the scientific definition as this does not do good to any of them. Most are non-overlapping magesteria. The philosophical attribution of the mind as an ethereal superhuman, metaphysical entity (soul-like), may have been backdated to the impact of Rene Descartes, who Cartesian dualism has been named after him, in his famous motto 'Cogito ergo sum' "I think therefore I am", highlighted the place of the mind as an equivalent to existence, and may have raised it above faults, in some way.

Re: "The Eichmann Show"

Posted in General at Wed, 28 Jan 2015 13:55:56


Posts: 1105
Joined: 16 Aug 2012

human beings have great potential, for good and evil alike, only it takes patience to see the fruits of good.

we must never forget history's lessons but also be watchful today - history may repeat itself in a slightly different manner.

Re: Will mHealth save low income countries?

Posted in General clinical at Wed, 28 Jan 2015 09:52:00


Posts: 1085
Joined: 07 Sep 2009

You can watch the conference live from UCL's website. Click the image below to get there



Re: Should GPs see everyone with three weeks of dyspesia?

Posted in General clinical at Tue, 27 Jan 2015 21:37:25


Posts: 849
Joined: 13 Oct 2009

 Another cuckoo idea from the "cancer brigade". I am beginning to think that they come from a different planet and have absolutely no interest in  overall health nor in the  survival of the NHS. There was another survey recently where those not seeking attention for symptoms that might just possibly be a symptom of cancer were seen as "in denial" rather than just trying to show common sense and get on with their lives. I don't think any of those who had not chosen to seek urgent medical advice were shown to have come to harm.