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Re: Nepal Earthquake and Looming Dangers

Posted in Public health at Sun, 24 May 2015 15:29:32

Mukhtar Ali

Posts: 956
Joined: 14 Nov 2010

Thousands of people have fled to safety following a landslide in western Nepal which blocked the flow of a river.

 

Re: POISE-2Trial and Pre operative care guidelines

Posted in Cardiology at Sun, 24 May 2015 12:00:56

sken

Posts: 951
Joined: 13 Oct 2009

John D well said - and for some folk operation may free them for a level of activity for which they are not accustomed. I am aware of patients perceived to be at somewhat higher risk are turned down for operations with reasonable prospect of improvement in quality of life on account of slightly higher possibility of mortality. What worries me is trying to strike a balance. The intensive pre-op assessment recommended on an ageist basis to avoid any preventable complications really needs to be subjected to common sense and selection. Pre-op assessment for the lower risk patient should not be more inconvenient than that associated with the surgery?

Of more concern is knowing just how to choose one's anaesthetist. I should be having surgery soon and the possible surgeons seem much of a muchness but I  want to know just who anaethetises for each one.... Perhaps we should think about a system where we look to the right anaesthetist and then see which surgeon he/she recommends. And of course we need to measure more than just anaesthetic mortality - we need eg to measure mental function etc...

Re: How long should the prison term be for wrong diagnosis?

Posted in General clinical at Sun, 24 May 2015 11:04:56

Maxim

Posts: 414
Joined: 14 Dec 2010

Just a thought.  When was a diagnosis of frontal lobe damage made?  It sounds as if this doctor would struggle to demonstrate capacity and the disabllity might be longstanding.  Whilst not absolving this doctor  of personal responsibility, a case might be made for those who failed over years to stop his practicing being equally deserving of conviction.  I guess more detailed chronology and facts have to be known before saying much more.

Re: Philosophy of Coffee & Personality

Posted in Psychiatry at Sun, 24 May 2015 10:54:51

Maxim

Posts: 414
Joined: 14 Dec 2010

Sidhom

I share your doubts about Berman's work and conclusions.  He's right that we in the West tend to intellectualise and describe in words what we're feeling and experiencing. We generally have to use metaphors and analogies to describe complex tastes and smells but I'm not convinced about the personality types conclusions, at least from the brief account on the BBC site.  I think there's another aspect that might be more relevant and about which you probably have more knowledge.

I've never lived in The East ( The East End of London probably doesn't count) but for some years I've taken a bit of an interest in mindfulness.  One of the key things I've taken from practicing this is to be able to pay attention to exactly what's being felt from moment to moment without trying to describe it. Jon Kabat Zinn even says it's best not to even mention to anyone that you're practicing mindfulness meditation for the first five years! 

The implication of this for experiencing the pleasures or otherwise of coffee, wine, music, art or many other things might be just to pay attention without analysing it or using words to tell others what it's like. There may be other good reasons for doing those things in various settings but trying to assess personality from the descriptions and preferences seems a bit far fetched.

Re: "there is lot of discussion about Sglt2inhibitors in forums, which has an edge Cana. or Dapaglifazone? "

Posted in Cardiology at Sun, 24 May 2015 03:10:45

diabetesMD

Posts: 737
Joined: 15 Apr 2011

I was able to find precisely one paper that compared the two agents on various aspects of glucose reabsorption inhibition and postprandial glucose excursions (Diabetes, Obesity and Metabolism 17: 188–197, 2015.) that was published in February.  The authors demonstrated a superior benefit of Canagliflozin on postprandial glucose that they attributed to its greater ability to inhibit SGLT1 and thus gastrointestinal glucose absorption.  There are two caveats.  First, the sponsor of the study was Janssen Research & Development; the drug’s development company and five of the authors were its employees, introducing at least the potential of bias.  Second. There have been no head-to-head comparisons of efficacy such as lowering of A1C of the two agents.  Their registry trials suggest equal efficacy.  The bottom line is that it is not possible with the data available to differentiate the two agents.

How much exercise is enough?

Posted in Diabetes at Sun, 24 May 2015 02:22:39

diabetesMD

Posts: 737
Joined: 15 Apr 2011

Gretchen Reynolds recently reviewed two studies examining the benefits of varying the duration and intensity of exercise for the New York Times.

The Right Dose of Exercise for a Longer Life http://nyti.ms/1D0fPH8

She opens the article with a cute analogy: “Exercise has had a Goldilocks problem, with experts debating just how much exercise is too little, too much or just the right amount to improve health and longevity.” She then describes the results of two new, large-scale studies addressing these questions, both published recently in an April edition of the JAMA. Internal Medicine.  I summarize these finding below.

The current broad guidelines from governmental and health organizations call for 150 minutes of moderate exercise per week to build and maintain health and fitness, but the scientific basis for this recommendation is shaky to say the least.  There is no doubt that any amount of exercise is beneficial.  Nevertheless, quantitating how much is needed to achieve maximal benefit and how intense does it need to be has proved to be difficult.  Additionally, we do not know at what point too much or too intense exercise becomes harmful.

In the broader of the two studies, researchers with the National Cancer Institute, Harvard University and other institutions gathered and pooled data about people’s exercise habits from six large, ongoing health surveys, winding up with information about more than 661,000 adults, most of them middle-aged.  The data were stratified by their weekly exercise time, from those who did not exercise at all to those who worked out for 10 times the current recommendations or more (meaning that they exercised moderately for 25 hours per week or more).  Then they compared 14 years’ worth of death records for the group.  They found that, unsurprisingly, the people who did not exercise at all were at the highest risk of early death.  Those who exercised a little, not meeting the recommendations but doing something, lowered their risk of premature death by 20 percent.  Those who met the guidelines precisely, completing 150 minutes per week of moderate exercise, enjoyed greater longevity benefits and 31 percent less risk of dying during the 14-year period compared with those who never exercised.

The maximal benefit, however, was achieved by those who tripled the recommended level of exercise, working out moderately, mostly by walking, for 450 minutes per week, or a little more than an hour per day. Those people were 39 percent less likely to die prematurely than people who never exercised.

The subset of individuals engaging in 10 times or more the recommended exercise dose gained about the same reduction in mortality risk as people who simply met the guidelines. They did not gain significantly more health benefit, but neither did they increase their risk of dying young.

The other new study of exercise and mortality reached a somewhat similar conclusion about intensity. While a few recent studies have intimated that frequent, strenuous exercise might contribute to early mortality, the new study found the reverse.

In this study, Australian researchers analyzed health survey data from over 200,000 Australian adults, determining how much time each person spent exercising and how much of that exercise qualified as vigorous, such as running instead of walking, or playing competitive singles tennis versus a sociable doubles game.

As in the previously described study, they found that meeting the exercise guidelines substantially reduced the risk of early death; this was true even when the exercise was moderate, such as walking.

However, adding occasional vigorous exercise, demonstrated an additional reduction in mortality. Those who spent up to 30 percent of their weekly exercise time in vigorous activities were 9 percent less likely to die prematurely than people who exercised for the same amount of time but always moderately, while those who spent more than 30 percent of their exercise time in strenuous activities gained an extra 13 percent reduction in early mortality, compared with people who never broke much of a sweat. Again the study did not demonstrate any increase in mortality, even among those few people completing the largest amounts of intense exercise.

Klaus Gebel, a senior research fellow at James Cook University in Cairns, Australia, who led the second study concluded that anyone who is physically capable of activity should try to “reach at least 150 minutes of physical activity per week and have around 20 to 30 minutes of that be vigorous activity,” Additionally more exercise does not seem to be unsafe.

 

Reevauating the use of metformin in the presence of renal impairment

Posted in Diabetes at Sun, 24 May 2015 01:37:39

diabetesMD

Posts: 737
Joined: 15 Apr 2011

Using metformin in the presence of renal disease

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1758 (Published 14 April 2015) Cite this as: BMJ 2015;350:h1758

This editorial encourages the increased use of metformin in persons with renal impairment and points out the discrepancies among various guidelines.  In the opening paragraph the authors state:

“In January, the electronic Medicines Compendium (eMC) updated the Summary of Product Characteristics for Glucophage (metformin), approved by the UK Medicines and Healthcare Products Regulatory Agency (MHRA). The summary states that “Metformin may be used in patients with moderate renal impairment, stage 3a (creatinine clearance [CrCl] 45-59 mL/min or estimated glomerular filtration rate [eGFR] 45-59 mL/min/1.73 m2) only in the absence of other conditions that may increase the risk of lactic acidosis . . . If CrCl or eGFR fall <45 mL/min or <45 mL/min/1.73 m2 respectively, metformin must be discontinued immediately.”  This is reiterated in the patient information leaflet.”  Additionally they point out that the guidelines for use in renal disease are even more restrictive for generic metformin (making no sense at all) and points out the state of our confusion, viz. “Renal failure or renal dysfunction (creatinine clearance <60 ml/min)” is a contraindication to use."

The initial confusion with the use of metformin resulted from a misunderstanding about the difference between two biguanides, phenformin and metformin.  Phenformin was associated with an unacceptable incidence of lactic acidosis and was removed from the US market.  However, the incidence of lactic acidosis with metformin is much less and virtually always occurs in patients who have contraindications to the drug.  This is because phenformin enters the mitochondria where lactic acid is made at therapeutic concentrations, whereas metformin only does so at concentrations above its therapeutic range resulting from a decreased excretion  such as in heart, liver or (severe) renal failure.  The new NICE guidelines nicely balance the risks and benefits of using metformin in the presence of renal disease.

“Guidelines from the UK National Institute for Health and Clinical Excellence (NICE) suggest that metformin dose should be reviewed at an eGFR of 45 and stopped at an eGFR of 30.”  The benefits and safety of metformin have been studied for 50 years.  Nevertheless, we still see confusion about its use in the presence of renal disease.  I would urge that based upon more recent studies we reevaluate its use in moderate renal impairment.

                                                            

Re: MRCPsych Question of the Day from OnExamination: Which antidepressant to use?

Posted in Psychiatry at Sat, 23 May 2015 23:38:02

Jorge Ramirez

Posts: 5
Joined: 09 Jan 2015

I disagree with the answer.

The meta-analysis of published and unpublished studies of agomelatine is misleading
http://www.bmj.com/content/348/bmj.g1888/rr/762419

Any reason not to retract?
http://www.bmj.com/content/348/bmj.g1888/rr/763197

Agomelatina: lo ultimo en antidepresivos 
http://www.medicossinmarca.cl/medicos-sin-marca/agomelatina-lo-ultimo-en-antidepresivos/

I think it is quite the opposite. 

"Until regulatory agencies decide to withdraw agomelatine from the market, it is up to healthcare professionals to protect patients from this unnecessarily dangerous drug."

Agomelatine: a review of adverse effects. Prescrire Int. 2013 Mar;22(136):70-1. 
http://www.ncbi.nlm.nih.gov/pubmed/23593692

I also think that concerns expressed by several authors (listed on websites as the Council for Evidence Based Psychiatry, Mad in America, davidhealy.org, NoGracias, Médicos Sin Marca, others) regarding the effectiveness and safety of antidepressant drugs in humans are legitimate and well-argued. 

Re: Putting GlaxoSmithKline to the test over paroxetine
http://www.bmj.com/content/347/bmj.f6754/rr/816737

I am almost certain that the correct answer is not listed on the five possible interventions for this patient: psychotherapy.

It is better to talk and being listened than just medicated with a drug of unknown effectiveness and potentially harmful. 

I am still surprised how in many countries around the world psychiatry had - inadvertently - is slowly resembling more to an authoritarian specialty instead of an academic and scientific field of the medical profession.

"In the Soviet Union, the need for psychiatric care is more likely to be seen as a cause for shame. Treatment there emphasizes medication rather than talk."
The New York Times, January 30,1983.
http://www.nytimes.com/1983/01/30/magazine/the-world-of-soviet-psychiatry.html

The use of psychiatric drugs is not supported by the evidence and their use frequently involves coercion, violation of the autonomy of patients (one of the principles of medical ethics).

Re: What Does the New York Times Have Against Psychiatry?
http://chaoticpharmacology.com/2015/05/21/re-what-does-the-new-york-times-have-against-psychiatry-%E2%80%95-drjlieberman-2/

Psychiatry could also be misused as a powerful instrument to suppress whistleblowers.

Psychiatry versus whistleblowers
http://www.bmartin.cc/dissent/documents/#psychiatry

I am not anti-psychiatry at all.

I know excellent psychiatrists, from Colombia and as well as many other countries, some of which were my professors and some of them were also my psychiatrists when I needed to talk about my life struggles, psychiatrists such as Gloria Macias (Cali, Colombia) and José Salmeron (Managua, Nicaragua) emphasizes on psychotherapy for the treatment of their patients, prescribing medication only when it is absolutely needed and - very important too - for a limited period of time.

This is an invitation to dialogue: not only about antidepressant drugs (we need to discuss antipsychotics too).

---

Related information

Psychiatry Gone Ashtray
http://davidhealy.org/psychiatry-gone-astray/
(Spanish translation via No Gracias: http://www.nogracias.eu/2014/08/10/la-psiquiatria-se-hunde)

Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics
http://joannamoncrieff.com/2013/12/20/psychiatry-has-its-heads-in-the-sand-royal-college-of-psychiatrist-rejects-discussion-of-crucial-research-on-antipsychotics/

 

Re: Medical student finals sample question from OnExamination: hyoscine

Posted in Finals help! at Sat, 23 May 2015 21:45:11

shahida

Posts: 2
Joined: 26 Feb 2010

hyosine is antispasmotic

Re: Clinical question of the week: what's causing this change in mental state?

Posted in Psychiatry at Sat, 23 May 2015 15:37:21

Mukhtar Ali

Posts: 956
Joined: 14 Nov 2010

Thanks sidhom for sharing important info. Is the literature of Lithium available in your country contains a warning/ precaution that a patient on this medication should avoid dehydration.

 

Trust and doctors charged with Corporate manslaughter

Posted in Medical ethics at Sat, 23 May 2015 10:56:58

John D

Posts: 3543
Joined: 01 Feb 2010

The CEO and a consultant anaesthetist from the Tunbridge Wells NHS Trust were in court recently, charged with corporate manslaughter and "gross negligence" manslaughter respectively, after the death of a mother from bleeding after a Caesarian Section.   http://www.kentonline.co.uk/maidstone/news/hospital-trust-and-doctor-due-36063/

"Corporate manslaughter" became a new legal entity after the "Spirit of Free Enterprise" ferry disaster, when it was found that company policies and practices had caused many deaths, but that the Law then required a person the be charged with actual negligence or manslaughter.      The 2007 Act has been applied in several cases since, but this is the first hospital to be so charged.

The case continues.

John

 

Head of New Hospital New Zakho Kurdistan

Posted in General clinical at Sat, 23 May 2015 04:08:34

rast

Posts: 1
Joined: 23 May 2015

Good afternoon everyone.

Im searching for a medical professional from the UK to help start a Brand New Hospital In New Zakho Kurdistan.

This is not a recruitment drive nor is an agency!!!!!!!

The Chairman of Rast who is Building the city has a desire to improve standards and with the help of the right person to assist with Design layout and organisation structure this could be the start of something good for the region.

Please email me for more details!! or send a resume if directly interested.

https://www.facebook.com/newzakho

 

Best Wishes

Rast

Rethinking how we deliver primary care in the 21st century

Posted in Diabetes at Sat, 23 May 2015 03:59:26

diabetesMD

Posts: 737
Joined: 15 Apr 2011

Health Care 2020: Reengineering Health Care Delivery to Combat Chronic Disease

American Journal of Medicine April 2015Volume 128, Issue 4, Pages 337–343

Abstract

Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic.

COMMENT: I recommend this thoughtful article that presents evidence that the American (and most other) health care system will be increasing focused on the treatment of chronic diseases and that it is woefully designed to treat them.  The opening paragraph sets the scene:

“Chronic disease represents the major driver of illness and health care utilization in the US, and its prevalence in the population is increasing. In 2010, chronic disease was responsible for 7 of every 10 deaths in the US and accounted for over 75% of total health care costs.1, 2 In just a 5-year span, from 2005 to 2010, the prevalence of chronic disease increased from 46% to 47% of the US population, equivalent to an additional 8 million Americans, and by 2020 it is projected to increase by an additional 16 million, comprising 48% of the population.3 It is noteworthy that over half of these individuals, or approximately 81 million of the US population, will have multiple chronic conditions.4 Total cost of health care also has increased steadily over this period, and it is estimated that two-thirds of this escalation is due to the increased prevalence of chronic disease.”

The authors then goes on to provide evidence of the current system’s poor performance:

“Although chronic disease represents the leading cause of death in the US, 40% of all premature death is due to behaviors amenable to change. Maximizing disease outcomes will therefore require the necessary time and expertise needed for a careful assessment and modification of lifestyle factors.15 In the primary care setting, the median length of a physician visit is <15 minutes, during which a median of 6 topics will be covered, leaving little if any time to formally assess and address the root causes of many chronic diseases, including poor nutrition and physical inactivity.”

The remainder of the manuscript describes a number of evidence-based changes that have the potential to effectively address the issue including a complete change in the patient care paradigm with closer integration of other health care providers and the increased use of self-management technologies.  This thoughtful article is well worth your time to read.

Lack of physician trust haunts the Chinese health care system

Posted in Diabetes at Sat, 23 May 2015 03:12:01

diabetesMD

Posts: 737
Joined: 15 Apr 2011

Comments on the Perspective entitled

Lessons from the East — China's Rapidly Evolving Health Care System

by David Blumenthal, M.D., M.P.P., and William Hsiao, Ph.D.

N Engl J Med 2015; 372:1281-1285April 2, 2015DOI: 10.1056/NEJMp1410425

As my readers know I have been involved in diabetes care in China for nearly three years.  We have two inpatient centers in Hangzhou and Ningbo.  Therefore I read with great interest this article about the evolution of China’s health care system.  My first experience with the system was in 1979 when I went to China with a group of US health policy staff.  As the article states, the advances in the health of the Chinese people was very impressive.  Using local “barefoot doctors” with as little of six weeks of training the focus was on public health.  When I returned in 2012, China was, of course, an entirely different country and the health care system was modern and well equipped.   However, I am taken by how skeptical the patients are especially when using insulin was suggested.  At first, I attributed this to a cultural needle phobia.  However, this article has convinced me that the source is quite difference.  Let me quote the key paragraph:

“Third, physician professionalism may be underappreciated as a foundation for effective modern health care systems. The inculcation of professional norms during and after training and the existence of professional institutions that reinforce these norms certainly do not guarantee that professionals will act only in the interest of their patients and the public. But there seems little question that the lack of a widely shared tradition of professionalism has complicated China's efforts to create a health care workforce that its leaders and the public trust to do the right thing.”

Quite simply the Chinese public does not trust its physicians.  In a recent survey when patients were asked directly if they trusted their physicians, 66% said no.  This is a potentially disastrous situation for the treatment of diabetes and other chronic conditions that now threaten to consume the Chinese health care system.  When we started our programs in China we focused on patient-centered care, patient education and continuity of care.  It appears that this is a winning strategy to develop trust.  Now we have enough experience and patient data to examine the effects on outcomes and patient satisfaction.  Our patient satisfaction scores are consistently high.  We hope to begin to analyze our outcomes and success in developing continuity of care in the near future.

Re: A typical case of FUO... does anyone has any suggestions or answers!! Please help.

Posted in General clinical at Fri, 22 May 2015 20:40:41

tagreed

Posts: 9
Joined: 20 Mar 2009
I sujest blood test to exclud brucellosis. If negative. I will do bone marrow aspirations

Re: Have you ever fallen asleep on the job?

Posted in General at Fri, 22 May 2015 18:00:33

Mukhtar Ali

Posts: 956
Joined: 14 Nov 2010

One of my old thread of 2011”What happened when you are deprived of sleep “Contains interesting personal experience of valued contributors.

 

http://doc2doc.bmj.com/forums/off-duty_general_happens-deprived-of-sleep?plckFindPostKey=Cat:OffDutyForum:GeneralDiscussion:f9b76a24-f008-4ec3-848b-e257fbd385b1Post:dfa09611-e880-41f3-bbb4-825f88d712d3#plckforumpostonpage=1&plckpostid=&plckforumpostshowfirstunread=&plckfindpostkey=

 

It is time to break the silence on physician suicide.

Posted in News & media at Fri, 22 May 2015 17:35:25

Jorge Ramirez

Posts: 5
Joined: 09 Jan 2015

There is an increasing trend of reports concerning doctors that committed suicide. (1,2)

Widespread corruption and wrongdoings involving the American Association of Addiction Medicine (ASAM) and Physician Health Programs (PHPs) have been denounced by different sources as a key factor involved in the abuse, hopelessness, and suicide of our colleagues.(3) ASAM and PHPs are coercing physicians into 12-steps recovery programs, an intervention not supported by the evidence, but "spiritual recovery" and irrational prescription of active pharmacological principles (e.g., suboxone).(4) The creation of "addiction medicine" as a medical specialty is also part of this problem and far away to be the solution.

One thing is for certain. When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model. The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come." ―Michael Lawrence Langan.(5)

I am concerned about the insufficient information about physician suicide in countries outside the United States (considering that there is also not enough information about this matter in the US). In Colombia, a statistical report by the national institute of legal medicine, reported eight cases of suicides of doctors and other healthcare professionals in 2011.(6) However, this report does not provide specific details about these eight cases of suicide. A more recent publication by the National Institute of Legal Medicine (2013) unfortunately does not report the number of suicides among doctors and other healthcare professionals in Colombia. I knew two colleagues in Colombia that committed suicide but the circumstances, motives, and predisposing factors remain hidden behind a wall of silence.      

If we continue keeping the silence involving the suicide of our colleagues, it will be very difficult for us to prevent  the suicide of our patients, as well as effectively supporting families suffering by the suicide of one of their loved ones.

References

1. Google News (search query: "physician suicide"): https://goo.gl/vp72Ub

2. Pamela Wibble. Physician suicide 101: Secrets, lies and solutions. 
http://www.kevinmd.com/blog/2014/11/physician-suicide-101-secrets-lies-solutions.html

3. Michael L. Langan. Category: Physician Suicide.
http://disruptedphysician.com/category/physician-suicide-2/

4. [(Chaos) x (Suboxone + J Addict Med + Am Soc Addict Med + Like Minded Docs + Addiction Medicine + Spiritual Interventions + 12 Step Recovery Programs + Drug Testing)]
http://disruptedphysician.com/2015/01/30/chaos-x-suboxone-j-addict-med-am-soc-addict-med-like-minded-docs-addiction-medicine-spiritual-interventions-12-step-recovery-programs-drug-testing/

5. Re: Drug policy: we need brave politicians and open minds BMJ 2014.
http://www.bmj.com/content/349/bmj.g7603/rr

6. Comportamiento del suicidio en Colombia, 2011. Instituto Nacional de Medicina Legal.
http://www.medicinalegal.gov.co/documents/10180/34616/6-F-11-Suicidio.pdf/6b2966e7-cbcb-4618-a3c3-af5cd111629e

Re: Shit people say to women doctors

Posted in BMJ at Fri, 22 May 2015 17:01:11

nicudoc16

Posts: 1
Joined: 22 May 2015

When being interviewed for my first job (and the director was desperate for me to stay on), the chief of Pediatrics asked my why I cared about my salary, because, wasn't I married? I helped with the department budget, so I knew what had been offered to a male physician with half my education and none of my publications. I wonder if he asked him the same questions?

Re: 'All UK final year medical students should sit the same exam, says Future Forum...' Really?

Posted in Student BMJ at Fri, 22 May 2015 16:32:55

Maxim

Posts: 414
Joined: 14 Dec 2010

I agree with NCantley; it's difficult to see how any final exam could improve the preparedness of medical graduates.  That comes about through sustained training and education that better reflects what a new doctor needs to be able to do.  Simulation has been a valuable adjunct but competence, which is such a strangely popular concept, does not predict well how someone will perform in the real world. That requires more experience with real patients in real settings.

Some experience, that is too often optional, should be mandatory, in particular enough experience of dealing with acute problems at night.  It's also worrying how many students can come to graduation never having had direct experience of dealing with all the procedures surrounding a death. That also includes the need to declare to HMRC all income from cremation forms.  Every few years many doctors continue to have to learn this lesson the hard and expensive way!

 

Re: News updates: The unfading shadow of Ebola

Posted in Public health at Fri, 22 May 2015 14:51:40

Mukhtar Ali

Posts: 956
Joined: 14 Nov 2010

The World Health Organization is to set up a $100m (£63m) emergency contingency fund following the Ebola outbreak, its director-general has announced

 

Re: Any idea what placebo is?

Posted in General at Fri, 22 May 2015 13:48:45

jeffnevil

Posts: 4
Joined: 26 Feb 2014

Above comments are correct.

A placebo is basically a medicine that isn't actually a contributor to the effect of the medicine iself.

Meaning that the results of any placebo a patient may feel will be due to the belief in the medicine itself.

It's basically a un true feeling!

"In a diabetes patient with pulmonary TB what management plan is advisable with insulin or without? "

Posted in Careers at Fri, 22 May 2015 05:06:00

Dr valluri

Posts: 31
Joined: 02 Nov 2013
Dear Diabetes specialist, what is your advice in 30 yr patient who contracted PT, do you put him on insulin? But he. had needle phobia. Do you suggest other oral agents Like dpp4 inhibitors. Please give your opinion. Dr Valluri Ramarao DNB

Re: Should the NHS work at weekends as it does in the week?

Posted in BMJ at Thu, 21 May 2015 22:23:47

John D

Posts: 3543
Joined: 01 Feb 2010

When we had this before, we didn't have the half-baked 'plan' from the PM, now details below.    Then, I think, I pointed out the other time that the Government - of a different colour then - thought it could cure the NHS's problems at a stroke, the New Consultant Contract.    Labour were convinced that consultants spent most of their time in private work or on the golf course.   

Right!  they said, We'll fix them!  They'll have to justify their time by saying exactly what sessions they do, where and when.   And Lo!   Very many consultants turned in FOURTEEN session contracts, becasue they were working so hard.  I believe that the cost of the New Contract, which was supposed to save money, was twenty percent more than the old one.    All because they went with their prejudice.

And this 24/7 NHS is based on prejudice, backed up with some results of increased weekend mortality that contain no indication where it comes from or even if it is real, and not a statistical 'glitch', and is even more likely to cost more money, this time FORTY per cent! (2/5 x 100!)

John

Re: Doctors and nurses who kill—Chua, Shipman, (Jack the Ripper?)

Posted in News & media at Thu, 21 May 2015 18:03:38

sken

Posts: 951
Joined: 13 Oct 2009

These doctors and nurses are an extreme aspect of professions where many of their practitioners have very real problems with death and dying. At the other extreme are those who just cannot accept when a patient under their care is dying , however apparent this is to others. Both extremes perhaps would like to see death as somehow under their control. I seem to remember one nurse liked to produce a need for CPR to practise skills in resus : someone combining both extremes ? In between are those many doctors who really do have problems in seeing death as a natural outcome or in discussing death with patients or their own families but these should perhaps be seen essentilly as within the normal range.

What we have to do is to try to identify those folk at the extremes before too much damage is done. It seems fairly unlikely that selection processes will be able to pick out these folk before training begins. It should be possible to identify the Shipmans of this world but those at the other extreme are not usually seen as criminal and may be quite highly respected and religiously driven - it is just that one would not want to be under their care for oneself or for family or friends. 

Re: Are junior doctors' human rights breached when rostered to work after giving advance notice of special events?

Posted in Careers at Wed, 20 May 2015 19:30:57

John D

Posts: 3543
Joined: 01 Feb 2010

Breach the Human Frights Act?   What a ridiculous notion!

Trainees will spend the rest of their  lives working to a rota, a weekly programme or on-call.    When they are senior, it will be up to them to arrange a swap, or otherwise make themselves free for such needs.  Time to get used to it now.

John