What do you think?

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Re: diabetic dementia.

Posted in Diabetes at Sat, 20 Dec 2014 16:06:21

neuromedicine

Posts: 590
Joined: 23 May 2012

Early metabolic control relatively cure and prevent diabetic dementia  thereby prevent structural damage.

Re: Medical Electives! Pakistan? Uganda? Turkey? Malaysia? Where??!

Posted in Student BMJ at Sat, 20 Dec 2014 14:01:51

M.A.K

Posts: 8
Joined: 03 Dec 2009

Those are brilliant points!

Correct me if I'm wrong, but medical school's purpose and reasons for encouraging travelling for the elective experience is purely to benefit the medical student as opposed to providing any sustainable benefit else where.

From an angle, it is quite selfish.

Should this change to actually going to places where one feels they can make a difference?

 

In Response to Re: Medical Electives! Pakistan? Uganda? Turkey? Malaysia? Where??!:[QUOTE]

Electives themselves are an incredibly unethical framework that we are forced to use im afraid to say. 

The unethical scale is hightened more whenever you go to low and middle income countries (NOT third world and NOT underdeveloped- sorry the terminology is a bit important). 

Consider this- a low and middle income country in africa has an underdeveloped health care system with no centralised system but instead made up of rural based hospitals or remote community health care centres primarily run by a small number of staff- some of which may have the correct level of training and the correct level of resources for a short period of time for the year. You as a medical student with a maximum of two years experience doing clinical placements and 0 experience as an actual doctor arrive to "learn about the healthcare system." You take up a proportion of the time of the doctor's that are there that is already stretched trying to deal with the volume of patients there, you take up limited resources at the hospital potentially trying out clinical proceedures on these patients. Maybe you do help out for a short period of time and then you leave after 6 or so weeks. Maybe you bring along some resources from your high income country hospital to try and "make a difference" or "save lives" in the hospital that you have raised from 20 billion bake sales or money collections. 

In reality you are a drain of resources, you provide a limited amount of support for patient clerking that is then gone within a short period of time, you potentially bring with you a small amount of resources that are either: not appropriate for the hospital, expire within a short period of time, dont actually benefit the hospital needs or last for only a tiny amount of time leading to shortages in the long term. 

Electives are UNETHICAL whenever you provide no sustainable benefit to the place that you are visiting and act as only a drain on resource and time for people who are already stretched thin. 

I know this post provides no additional benfit to the original question but thought it should be said.


Posted by NCantley[/QUOTE]

 

Re: 1year old girl with history of wheeze associated recurrent respiratory infections

Posted in General clinical at Sat, 20 Dec 2014 10:34:55

John D

Posts: 3363
Joined: 01 Feb 2010

Coarctation + Patent PDA

JOhn

Re: Feeding Birds: A Humane Gesture

Posted in General at Sat, 20 Dec 2014 10:18:36

John D

Posts: 3363
Joined: 01 Feb 2010

It may be climate chnage, but feeding the birds brings more and more into our garden that are raely seen.  This winter we have a pair of blackcaps, a treecreeper, jays, and the sparrowhawk that feeds off the birds that feed off our feeders!

Not my photos!

John

Re: Should female soldiers serve on the front line alongside men?

Posted in News & media at Fri, 19 Dec 2014 22:33:16

NCantley

Posts: 416
Joined: 23 Dec 2011

I dont really see the arguments for not allowing women to serve on the frontline. It seems very harsh to not allow basically half the population be grouped as a single entity instead of making decisions on someones actual ability and individual fitness. 

Taken too long for us to get to this point if you ask me. 

Re: Should obesity be classed as a disability?

Posted in News & media at Fri, 19 Dec 2014 13:00:24

Maxim

Posts: 283
Joined: 14 Dec 2010

Clearly obesity can be disabling but classing it with other, currently unavoidable, disabilities to gain convenient advantages (we'd all like bigger parking spaces, wider seats on planes etc) seems unfair.

As John D points out, we already provide special facilities where these are clinically necessary.  It's worth remembering also that society has been responding over hundreds of years to our getting steadily heavier and taller.  Look at clothes and furniture from a few centuries ago; much of it now looks as if it were made for children. 

Re: What's your favourite medical myth?

Posted in General at Fri, 19 Dec 2014 12:51:00

Maxim

Posts: 283
Joined: 14 Dec 2010

"Flu vaccination gave me flu"

No it didn't!

Re: What is the diagnosis?

Posted in General clinical at Fri, 19 Dec 2014 04:56:08

ahyperdoc

Posts: 4
Joined: 13 Nov 2014

Hiatal hernia and/or a ruptured esophagus, IMO. Definitely a gastric component considering the heartburn and weight-loss.

Re: Music to play in the operating theatre

Posted in General at Thu, 18 Dec 2014 20:20:15

Sidhom

Posts: 509
Joined: 23 Aug 2013

Symphonic/Classical

  • Mozart: Divertimento
  • Faure: Pavane
  • Vivaldi: four seasons
  • Bach: Anna Magdalena
  • Ravel: Melodie Hebraique, Bolero
  • Albinoni: Adagio
  • Dvorak: string quartets

Jazz

  • Dave Brubeck: Take 5
  • Miles Davis: Birth of the cool
  • Oscar Peterson: Paris Concert
  • Duke Ellington: Mood Indigo
  • Diana Krall
  • Norah Jones

Smooth Jazz

  • Acoustic Alchemy
  • Kenny G
  • Earl Klugh
  • Spyro Gyra

Ambient

  • Ray Lynch
  • Eric Satie
  • Brian Eno

 

Re: Do you find mother Teresa unethical?

Posted in Medical ethics at Thu, 18 Dec 2014 20:07:28

Sidhom

Posts: 509
Joined: 23 Aug 2013

Hitchens stated that the money she received was enough to build a series of grand hospitals not a nursing home. Most of her time was spent outside slums, for the propaganda of the work. Hitchens highlighted her compliance to an agenda about banning contraception, abortion and other values.

Re: Are medical electives in low and middle-income countries unethical?

Posted in Student BMJ at Thu, 18 Dec 2014 14:49:23

HopscotchHealth

Posts: 1
Joined: 18 Dec 2014

Electives are not a one sided transaction about acquiring clinical skills.

Electives are an opportunity for a student to acquire a multidimensional perspective of health, community, resource planning,innovative use of skills.You get to test your assumptions on ethical issues and appreciate the equality of human strength and the frail balance that inequality brings into human existence and find ways to give something in return without feeling you are draining resources. 

What would be nice would be if individual medical schools could encourage students to reflect on how they could create sustainable partnerships to cooperatively improve healthcare in their hosts.Lifelong friendships can be forged across international borders and mutual self respect can be nurtured.

 

 

 

 

Re: Should sterilization camps be discontinued in India?

Posted in BMJ India at Thu, 18 Dec 2014 14:10:11

John D

Posts: 3363
Joined: 01 Feb 2010

NCantly has it - surgical sterilisation of a woman, is complex, costly and higher risk.   

Vasectomy is cheap, simple (if no less skillful) and low risk.   It's even reversible.

 Yet women here and in poorer countries are still subjected to the procedures, which should be reserved for couples in which the man is the greater surgical/anaesthesia risk.

As Shakespear knew, Men are deceivers ever:

"Sigh no more, ladies, sigh nor more;

    Men were deceivers ever;
One foot in sea and one on shore,
    To one thing constant never;
        Then sigh not so,
        But let them go,
    And be you blithe and bonny;
Converting all your sounds of woe
    Into. Hey nonny, nonny.

Sing no more ditties, sing no mo,
    Or dumps so dull and heavy;
The fraud of men was ever so,
    Since summer first was leavy.
        Then sigh not so, 
        But let them go,
    And be you blithe and bonny,
Converting all your sounds of woe
    Into. Hey, nonny, nonny."

But then Beatrice seemed unconcerned about pregnancy

John

Re: ECG question

Posted in General clinical at Thu, 18 Dec 2014 13:19:01

Dr.Chid

Posts: 670
Joined: 21 Feb 2012

Intraventricular Conduction Delay?

I doubt LBBB due to small" r" in V1. Small": r" wave deflection shows septal activation from the septal branch of Lt Bundle activating left part of septum in a left to right direction, this cann't be seen in LBBB.Hence this can be considered as intraventricular conduction delay.Again terminal S waveinAVL (Figure not Clear)  shows  terminal forces going in a left to right direction..

Should obesity be classed as a disability?

Posted in News & media at Thu, 18 Dec 2014 12:31:16

AnneG

Posts: 671
Joined: 18 Mar 2014

The European Court of Justice has ruled that in certain circumstances obesity can be classed as a disability.

The ruling said that if obesity hindered "full and effective participation" in the workplace it consituted a disability. 

The case was brought by a Danish childminder four years ago who says he was sacked by his employer because of his weight, although the employer claims he lost his job because of a reduction in the number of children at his nursery. 

An employment lawyer told the BBC that employers might have to make adjustments to seating or access to the workplace. However, health professionals have not welcomed the ruling. Tam Fry from the National Obesity Forum said it would cause friction between obese and non-obese workers. 

What do you think?

Re: Do you consider the financial implications of your clinical decisions?

Posted in General clinical at Thu, 18 Dec 2014 10:27:06

John D

Posts: 3363
Joined: 01 Feb 2010

No, despite the best intentions of the managers.

When Propofol, the Total IntraVenious Anaesthetic, first became available by computer driven infusion pump, I wanted to use it.  I was the only anesthetist who regularly used TIVA, then by manaul and mental calculation of the dose.   ICI were giving away the pumps - just like the vapour manufacturers gave away vapourisers - but these pumps used pre-filled syringes of the drug, that cost 90 pence more than the same in a vial.      I had to complete a Business Case for buying the more expensive drug, and concluded that the Hospital would spend £300 more a year if I was allowed to do so.

The technique was a wow!   Three months later another seven of my colleagues became converts to TIVA, and we were spending £30,000 a quarter on Propofol.  Soon everyone used it, some of the time, and I hadn't even taught them.    Didn't get a kickback from ICI either!

JOhn

Re: Should Doctors pray over patients or introduce religion to patients who are very ill

Posted in General at Thu, 18 Dec 2014 10:17:43

John D

Posts: 3363
Joined: 01 Feb 2010

By Dr.Crandell's account, the EM department wanted a consultant cardiologist's opinion on whether they should stop resuscitating a collapsed patient.   If that happens in US hospitals, which I doubt,  it doesn't in the UK so the patient could not have been just "clinically dead", there must have been some doubt in the ressus team leader's mind already.

If Dr.Crandall, in a nation of people who believe in their Gods, wants to become the go-to doctor for the religious, fine.  But he should not wave his bible in the face of anyone who happens to fall over in frornt of him.

And oh!   Those scrubs!   What?!   Screen dressing, imposed on him by the TV director?   When his interviewer wore the usual formal suit?  

And the worn black bible on his lap.    I hope he washes his hands after touching it, before he ministers to any patient.

John

Re: Is Big Pharma not so evil after all?

Posted in News & media at Wed, 17 Dec 2014 16:29:07

NCantley

Posts: 416
Joined: 23 Dec 2011

As far as I am aware, when looking at the division of costs within drug manufatcure, the r and d associated with the drug and the cost of marketing. Actually, if you take r and d and production and they put less into the marketing and markup then it would still be much less than what is currently costed.

In Response to Re: Is Big Pharma not so evil after all?:[QUOTE]

You confuse the cost of producing the drug with the cost of manufacture. Once the drug has been identified from the tens of thousands of varients, and safety and efficacy proven, then manufacture can begin - but the cost of discovering the drug doesn't go away. If companies can't make a profit from their products, why would they fund new research?

The cost of producing a drug far outstrips the cost of manufacturing it.

Posted by Pat Harkin[/QUOTE]

 

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

Posted in News & media at Wed, 17 Dec 2014 14:24:21

kirked

Posts: 1719
Joined: 08 Oct 2010

In Response to Re: Should the performance data of individual doctors be published?:[QUOTE]

The same applies to anonymous ratings of doctors on the Internet. Comments about me vary from close to angelic to recommending I be struck off the medical register. There is no accountability, no names just venom or praise. My competitors could have written some. We are so naive.

We have descended into an abyss which threatens the practice of good medicine and the mental state of medical practitioners. Let's introduce bread and circuses as that works.

Odysseus

 

Posted by Odysseus[/QUOTE]

I agree. If one looks at such web review sites it is impossible to know if comments are fair or completely exaggerated. Perhaps if there are lots of comments on a specific matter it might suggest their is some accuracy in them - but how can you tell? Doctors will probably not gain very much by responding to comments made about them and who would want to spend time looking at negative views? Perhaps an official practice website might be better where the Doctor can respond properly to people whose identity he knows and the complainer is likely to be more fair if they know the Doctor will read and respond. But the Doctor will always be on the back foot because he must exercise caution in what he writes and must not breach confidentiality.

Any Doctor that goes to anonymous web reviews will see that comments range dramatically - as Odyysseus says they can range from fabulous to appalling - it can be sobering for all Doctors to go to such reviews and see what people are saying. The same applies to Lawyer reviews (fortunately they are less common) where losing parties automatically assume that their lawyer was bad. They forget that their lawyer may have told them that their case is poor and it is better to concede than waste lots of money only to lose in court. But again, lawyers must be cautious about how they respond - professional rules dictate how lawyers must express private client information.

kirked

Re: A decision at 17

Posted in Student BMJ at Wed, 17 Dec 2014 13:18:58

Pat Harkin

Posts: 122
Joined: 26 May 2010

In Response to Re: A decision at 17:[QUOTE]

 My wife also medic ) reminds me from time to time that at her university medics were seen as the "thickies". Times change (I think) ......

Posted by sken[/QUOTE]

Good heavens! Where/when was that? Not the UK in the last 40 years, surely?

Re: What's your diagnosis? Recurrent hypoglycaemia in a man without diabetes

Posted in General clinical at Wed, 17 Dec 2014 13:12:04

Pat Harkin

Posts: 122
Joined: 26 May 2010

Insulinoma

Alcohol. Or drugs to which he isn't admitting

Auto-immune insuline syndrome (Auto-immeune disease is an answer to all diagnostic quizzes!)

Factitous hypoglycaemia (family have diabetes - has he access to insulin?) Or drugs as above.

Malicious hypoglycaemia (family have diabetes - and hence possible access to insulin)

Glycogen storage disease (age seems unlikely for that)

Re: Poll archive 10/12/14 - 17/12/14

Posted in doc2doc feedback at Wed, 17 Dec 2014 11:46:21

AnneG

Posts: 671
Joined: 18 Mar 2014

Does it matter if privately educated students are over-represented at medical school?

Yes, doctors need to come from all backgrounds - 159 votes (54.1%)

No, abilitiy is what counts - 131 votes (44.6%)

Don't know, four votes (1.4%)

Re: Words to ban in 2015

Posted in General at Wed, 17 Dec 2014 11:27:44

Pat Harkin

Posts: 122
Joined: 26 May 2010

May I suggest "Catch 17" which Catch 22 after 3 years of efficiency savings.

Re: If we play their music in the theatre, why do song writers hate us so much?

Posted in General at Tue, 16 Dec 2014 23:30:09

John D

Posts: 3363
Joined: 01 Feb 2010

It's a sad comment, Anne, but that is a common theme of song lyrics trhat mention doctors.

John

Re: Does competency-based medical education make students incompetent?

Posted in Student BMJ at Mon, 15 Dec 2014 23:18:02

NCantley

Posts: 416
Joined: 23 Dec 2011

As a medical student can I say that having to do nothing but spend my placements trying to chase signatures is one of the most degrading aspects of medical education today. I feel completely humiliated everytime I have to walk up to a senior doctor smile sweetly and say can i get your signature for attending a stupid bloody ward round. I was always going to come to the ward round why can I not be trusted to do so without having to chase around half the time finding someone to get a signature to prove it. 

I hate and abhor it. If anyone in medical education reads this can I plead with you on my hands and knees to stop it as it is something that I cannot stand. 

Please. 

Re: Are men more idiotic than women?

Posted in General at Mon, 15 Dec 2014 23:11:41

NCantley

Posts: 416
Joined: 23 Dec 2011

Are men more idiotic than women?

Yes.

Yes they are.