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Re: Do you let your junior colleagues call you by your first name?

Posted in General at Tue, 16 Sep 2014 20:41:29


Posts: 4209
Joined: 24 Feb 2009

In Response to Re: Do you let your junior colleagues call you by your first name?:[QUOTE]


My son is a pilot and this hierarchical system does not exist in Australiabut does in Asian, Middle Eastern and Indian systems. It has lead to catastrophe as the junior pilot hold his tongue as the aircraft flies into a mountainside. The paralysis of critical analysis due to the hierarchical bullshit factor reigns supreme. 

Many patients call me by my first name but others call me by title eg professor. It is not the title but the attitude that counts. It is the heart if man, not his tongue.

I note that children now address their parents in a disrespectful way which was intolerable in my childhood.

There is a growing trend that everyone is equal until things go pear-shaped. I don't want my students or juniors addressing me by my Christian name. When my juniors have thirty years of experience and have a C.V. thirty pages long they call address me as equals. But I will listen when they voice considered disagreement about my decisions. 


But is that not a contradiction? On the one hand, you are not happy for your juniors to call you by your first name but on the other, as you rightly say hierarchies lead to catastrophe. It is great that you listen to a junior who disagrees with you but what if they do not speak up because of the hierachical structure in which we work? I'm not saying that after 30 years experience you are cannot be called Dr "Odysseus" if you want to but I'm asking whether you think that might prevent juniors from speaking up?




Posted by Odysseus[/QUOTE]


Posted by Abi Blumenthal[/QUOTE

Relationships are not just a matter of titles but body language and a lot of non-verbal stuff. If you create a harmonious, mutually respectful relationship, it should be easy to sense there is a culture where the senior can be politely challenged if wrong or off track. The job of leadership of a team, not to be a feudal baron lording it over vassals. 

A mutually respectful hierarchy is nice to work in. For the junior, it is nice to have a father-like figure as guide and mentor. The senior should regard his junior like a son or daughter or perhaps like nephew or niece.



Re: Would you support the introduction of a health tax?

Posted in News & media at Tue, 16 Sep 2014 20:30:37


Posts: 76
Joined: 29 Jan 2009

I would go further - as a pensioner, I feel that all pensioners should pay NI. The only reason for them not paying the tax was because they were considered to have "already paid into the fund" but this is nonsense. There never was a fund, and taxpayers pay as they go.  The level of NI should taper so that the richest pay the most. 

This extra funding should be hypothecated for the NHS, as the elderly use it the most.

Re: MS relapse triggered by stress

Posted in Neurology at Tue, 16 Sep 2014 20:29:36


Posts: 150
Joined: 21 Aug 2011

There may be a few psychopaths who do not have a major link between life event burdens and physical symptoms/illness . Doesnt  'mind-body' medicine kind of state  the obvious? "Proving" anything with an MRI and a few creative questions and interpretations is   easy  ?  The term CAM has been changed to Stuff that works and stuff that does  not, so a large number of hemi-gluteal therapies still  lurk in category B.   Placebos are   powerful therapies but   we should be honest about what is working.

Those who fear they have MS, or have been given a wrong diagnosis of MS   sometimes suffer far more than those with MS. People always see Jacqueline du Pré   or some such shadow in a wheelchair when they think of MS. The truth is sometimes a lot kinder and easier to live with. Deconstruction of the persons fears   is mostly  useful. 

Re: Attitudes to rape victims

Posted in News & media at Tue, 16 Sep 2014 19:04:55

John D

Posts: 3224
Joined: 01 Feb 2010

Two things.

1/ What!!!!!  A "Two Finger Rape Test"?   That sounds just as ridiculous as the "Reflex Anal Dilatation" test that was vaunted a few years ago as part of the ritual satanic child abuse scandal that was led to many upright Scots being castigated and even jailed.

2/ What!!!!!  I thought that children i such trial gave their evidence by closed circuit TV, from a room away from the court.  No?  Why not?


Re: Should The New Pope Allow Priests To Marry?

Posted in General at Tue, 16 Sep 2014 17:24:35


Posts: 5
Joined: 01 May 2009

I guess so. And I think that Clark Kent should marry Louise Lane. (I add this comment because I think both topics belong in the same literary genre [fantasy]).

Re: Ashya King case: breakdown of communication?

Posted in News & media at Tue, 16 Sep 2014 13:29:03

Pat Harkin

Posts: 60
Joined: 26 May 2010

My (Daily Mail medical correspondent-level) understanding of proton beam therapy is that unlike X-rays, which ionise and hence damage at all points where the beam travels through tissue, the proton beam penetrates a certain distance before ionising, reducing damage to tissues superficial or deep to the tumour. It might, therefore, reduce skin effects and look or even be less distressing to the patient in cases such as this but, as you say, the nature of medulloblastoma is that it is necessary to irradiate the entire spine and brain anyway. I suppose the use of proton beam might affect the incidence of radiation-induced leukaemia from spinal column marrow even if it doesn't affect cure rates in this tumour.

Incidentally, Britain DOES have a proton beam unit, but it's a "low power" one which doesn't have the depth of penetration needed here and is used for ophthalmic tumours. http://www.clatterbridgecc.nhs.uk/patients/treatment/protontherapy/

Re: A patient with Acute Coronary Syndrome

Posted in Medicolegal at Tue, 16 Sep 2014 01:33:53


Posts: 628
Joined: 21 Feb 2012

In Response to Re: A patient with Acute Coronary Syndrome:[QUOTE]

This EKG may have been taken just before infarction , and that is why the ST segment is slightly raised

The following article from MEDSCAPE explains more :-

Wellens syndrome was first described in the early 1980s by de Zwaan, Wellens, and colleagues, who identified a subset of patients with unstable angina who had specific precordial T-wave changes and subsequently developed a large anterior wall myocardial infarction (MI).[1] Wellens syndrome refers to these specific electrocardiographic (ECG) abnormalities in the precordial T-wave segment, which are associated with critical stenosis of the proximal left anterior descending (LAD) coronary artery.

Wellens syndrome is also referred to as LAD coronary T-wave syndrome.[2]Syndrome criteria include the following:

1/ Characteristic T-wave changes
2/ History of anginal chest pain
3/ Normal or minimally elevated cardiac enzyme levels
4/ ECG without Q waves, without significant ST-segment elevation, and with normal precordial R-wave progression

Recognition of this ECG abnormality is of paramount importance because this syndrome represents a preinfarction stage of coronary artery disease (CAD) that often progresses to a devastating anterior wall MI.

Ref :-  http://emedicine.medscape.com/article/1512230-overview


Posted by alaminium[/QUOTE]


Thank you.I have mentioned the same website in my post.

 Will you please explain the short PR interval and Bradycardia,could it be due  to Rt  C.A. Lesion also.Will  a V4 Rt  rule  out this query.I suspect Rt vent.M I .





Re: Young child removed from heart transplant list

Posted in News & media at Mon, 15 Sep 2014 17:49:51


Posts: 1642
Joined: 08 Oct 2010

Carolin, this seems an extraordinary legal situation. Of course I know nothing of German Law but I cannot understand how a court can order that a child be compulsorily put on a transplant list. How would a Doctor be committing offences if for bona fide reasons he/she does not feel the child is not suitable for transplant?

I will be interested in the outcome. Whilst it is very sad the child suffered brain damage following Cardiac Arrest it would seem fairer to give a heart to a child with better prospects for survival and quality of life. A hard decision.

Keep us informed.


Re: A general thread to discuss qualifications, career aspirations and new opportunities

Posted in General at Mon, 15 Sep 2014 17:20:37


Posts: 1642
Joined: 08 Oct 2010

Thankyou so much to you all. It is just starting to sink in and I am so glad to have finished. John, your BTec is not feeble at all. Clearly you love Motorsport and as an expert medic for such events it will be fascinating for you to get to grips with engineering.

How do you feel about retirement? Has it been hard to relinquish your NHS post? Will you be doing locums? I admire you greatly for joining a group of young lads where there will be a generation gap - this shows great humility on your part.

I look forward to seeing you in the pit lane leaning over your Zimmer frame assisting Lewis Hamilton! Am genuinely delighted for you.

My next aim (but not for a year or two) is to undertake a Degree in English Literature. I will do it by distance learning so I can do it at my own pace even if it takes quite a few years.

A general question to everyone: If you were not a medical Doctor what do you envisage yourself being/or have done?


echo in africa

Posted in Cardiology at Mon, 15 Sep 2014 11:47:03


Posts: 1154
Joined: 17 Jun 2011

The British society of echocardiography are launching a programme to undertake screening for rheumatic valve disease amongst secondary school age children. The project will be funded by donations and charities.

If anyone is interested in learning more about the programme please visit



Re: Challenging guidelines

Posted in Cardiology at Mon, 15 Sep 2014 11:40:59


Posts: 1154
Joined: 17 Jun 2011

and to be fiar most cardiologists probably didn't follow them either!  From my point of view preoperatove cardiovascular assessment is one of the most difficult areas - my general approach is if I don't think it was clinically indicated anyway I'll think twice before I recommend treatment becasue someone is having an operation. My exception to this is if the clinical condition is heart failure.


Re: Why is generalship so lacking in medicine?

Posted in General clinical at Mon, 15 Sep 2014 10:38:21


Posts: 4209
Joined: 24 Feb 2009

When we hand over we like to think we are throwing the ball to someone on the same team who is imbued with the same goal, the same desire and élan, to swerve and dodge the opposition so that eventually you will experience the vicarious pleasure of seeing someone else achieving what you so much sought; crossing the true line.


Re: Neurological?

Posted in General at Mon, 15 Sep 2014 09:28:11


Posts: 420
Joined: 18 Mar 2014

Don't worry about that. I can do it.

Good luck... I hope you find an answer/diagnosis


Re: What's your diagnosis: A newborn with hypotonia and abnormal facies

Posted in General clinical at Mon, 15 Sep 2014 09:27:17


Posts: 420
Joined: 18 Mar 2014

You're all so clever. Maybe I'm giving you too many clues. Here's the article (for BMJ subscribers): http://www.bmj.com/content/342/bmj.d2938

And below is the answer from the BMJ:

Myotonic dystrophy type 1 is one of the most common hereditary neuromuscular diseases. The phenotypic expression of the disease and its clinical presentation are extremely heterogeneous, and symptoms may go unnoticed or not be taken seriously by carriers, as in the mother of this case. Obstetric problems are common, particularly the need for vacuum extraction (as in this case), which was reported in 21% of cases. Other problems during pregnancy include polyhydramnios, probably as a result of decreased fetal swallowing, and decreased fetal movements, which are thought to be the cause of the increase in abnormal presentations (such as breech or abnormal cephalic presentations). Furthermore, only half of pregnancies reach full completion because of the greatly increased rate of preterm labour, especially in women who have symptoms before conception. The phenotypic appearance of the newborn was strongly suggestive of the congenital form of this condition, also known as Steinert’s disease.

Admission to a neonatal special care unit is crucial for respiratory and haemodynamic monitoring and support, because neonatal mortality is strongly related to cardiopulmonary problems; namely, respiratory failure and the prolonged need for mechanical ventilation. Fortunately, this was not the case with this patient, who maintained spontaneous ventilation with oxygen dependence during the first 24 hours of life, with further favourable respiratory outcomes. Chest radiography was normal with the exception of thin ribs and mild high displaced diaphragmatic hemicupulas.

Newborn blood evaluation for signs of infection (full blood count with white blood cell differential and platelet counts, measurement of C reactive protein) and cerebral ultrasound detected no abnormalities, such as signs of cerebral atrophy, haemorrhage, or ventricular dilation or enlargement. Echocardiography showed no structural abnormalities and good function.

Major problems were global hypotonia, along with inefficient sucking and swallowing, which resulted in exclusive gavage feeding in the first week. Domperidone and positional measures were used to manage gastro-oesophageal reflux. She was discharged at 15 days with partial enteral tube feeding and consistent weight gain.

Sexual harassment at university

Posted in Student BMJ at Mon, 15 Sep 2014 09:08:38


Posts: 420
Joined: 18 Mar 2014

A survey by the National Union of Students finds that sexual harassment and "lad culture" is rife at universities.

A survey of 2156 men and women (57% of respondents were women) showed that 37% of women and 12% of men said that had faced unwelcome sexual advances. More than a third of women - 36% - who took part in the survey said they had experienced unwanted sexual comments about their body and two thirds said they had seen students put up with unwanted sexual comments. 

More than a third of respondents said they had seen posters with sexualised images of women, with half of women saying these images made them uncomfortable. 

Is this your experience of university - either as a student or as a lecturer? 



Re: Poll archive 8-14th September

Posted in doc2doc feedback at Mon, 15 Sep 2014 08:25:57


Posts: 420
Joined: 18 Mar 2014

Should continuing ethical training be mandatory?

Yes - I would value the opportunity to discuss ethical dilemmas - 159 votes (82.4%)

No - I do enough training - 26 votes (13.5%)

Unsure - 8 votes (4.1%) 

Re: Should boys receive the HPV vaccine?

Posted in General clinical at Mon, 15 Sep 2014 08:14:03


Posts: 420
Joined: 18 Mar 2014

Welcome back MDWSN

The HPV vaccine does protect boys as some oral cancers contracted by men are linked to HPV (I don't have any references but the actor Michael Douglas raised this a year or so ago).

So, I think it's an interesting ethical dilemma but not valid in this case. 

Re: Cycling promotion is racist and ageist

Posted in General at Sun, 14 Sep 2014 21:47:47


Posts: 420
Joined: 18 Mar 2014

That advertisement is outrageous...! i wonder if anyone from British Cycling saw it before it went out given the success of British women in cycling. 

n Response to Re: Cycling promotion is racist and ageist:[QUOTE]

Why should moslem women who want to bicycle not do so?

Have you seen what Moslem women who want to swim wear?  A quick Google wil reveal the vast range of  non-revealing swiiming costume that are available: https://www.google.co.uk/images?hl=en-GB&q=islamic+swimming+costumes+for+ladies&gbv=2&sa=X&oi=image_result_group&ei=ZkMUVIy3JYfdaMG2gdgN&ved=0CCcQsAQ

The 'sports hijab' is well established in football and in cycling:  http://nashata.com/blog/?p=720

Was it this picture that offended you?   Now that IS sexist!

Posted by John D[/QUOTE]


Re: Interesting case

Posted in Neurology at Sun, 14 Sep 2014 16:06:28


Posts: 3
Joined: 14 Sep 2014

my sister in law had a cholecystectomy and had similar issues. she was given a treatment powder called cholestyramine resin (Questran) Due to bile salts acting as a laxative in her bowels.

Re: Obesity in the headlines - again

Posted in Respiratory medicine at Sat, 13 Sep 2014 17:50:51


Posts: 1642
Joined: 08 Oct 2010

'Fat shamed', I am not sure how this is done. Direct abuse hurled at fat people? Of which I would not approve. Or as I have personally witnessed a very 'portly' gentleman indeed arriving at checkin for an internal flight in the USA being told by staff that because of 'the comfort and safety of all passengers on the flight' he must purchase a second seat to accommodate his girth. He was enraged. I must stress that this gentleman was not obese, he was massively obese. I would not like to have sat next to him.

Ultimately he bought another ticket. But was very loud in his opinion that staff were discriminating against him for being overweight.

I do not believe this was any sort of discrimination.

The above 'study' does not seem rigorous to say the least

I have had conversations with people who go to their GP with various ailments and the GP highlights that losing weight would help. They say that it is not worth going any more because 'he keeps going on about my weight'. Some of these folk are very overweight and the GPs advice seems sound to me.




Cerebral agenesis

Posted in Psychiatry at Sat, 13 Sep 2014 16:00:23


Posts: 423
Joined: 23 Aug 2013

A recent case report published in Brain discussed a case of 24 y/o who suffered nausea and disturbed gait on brain imaging it revealed that she has no cerebellum.

I wonder if you ever seen a case like this, and what are your expectations for management and prognosis.

Re: Should patients be able to email their GP?

Posted in General clinical at Sat, 13 Sep 2014 15:53:20


Posts: 423
Joined: 23 Aug 2013

With enhanced security, frequently changing passwords for a secure communication, emails do not seem like a bad choice. Some regulations might help e.g. no prescription over email, just general enquiries, as Odysseus mentioed appointments, if a patient is about to take herbals, CAMs, or an OTC, it might be easier to contact the GP immediately esp. this does not require doing physical examination, to check possible drug-drug interaction.

Re: Should continuing ethics training be mandatory for doctors?

Posted in Medical ethics at Sat, 13 Sep 2014 12:29:55

Iris McMillan

Posts: 26
Joined: 31 Jan 2013

Without a doubt, ethics training should be treated as manadtory CPD, not just for clinicians, but  for all staff dealing or coming into contact with patients and their  medical records and test results.

Re: Dying of a broken heart

Posted in General at Sat, 13 Sep 2014 07:51:54


Posts: 725
Joined: 13 Oct 2009

The recent work just being a slight expansion of the work done 20 years ago...... 

Re: Sugar, Uric Acid, and the Etiology of Diabetes and Obesity

Posted in Diabetes at Sat, 13 Sep 2014 06:41:30


Posts: 1
Joined: 13 Sep 2014

Very informative post! Child Obesity is a growing problem in America. The main causes are poor eating habits and lack of exercise. Regardless of cries that unhealthy food laws are stealing consumers' right to choose and supporting the nanny state attitude, sometimes, the regulations actually work as intended. A study published Monday in Pediatrics notes that strong unhealthy food laws may have a strong connection with lower kid obesity rates.