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Re: Vale Phil Hughes

Posted in News & media at Fri, 28 Nov 2014 02:24:54


Posts: 663
Joined: 21 Feb 2012

Yes.Our sympathies to his family members and other cricketers.He was an excellent batsman .The incident still  lingers on in the mind  of cricket lovers.

Re: A 30 years old man.....

Posted in General clinical at Fri, 28 Nov 2014 02:13:38


Posts: 663
Joined: 21 Feb 2012

In Response to Re: A 30 years old man.....:[QUOTE]

With most of my General Practice patients, one of the first things I think about is; could the symptoms be iatrogenic. I think this relatively young man with Ulcerative Colitis is lightly to be on sulphasalazine, This has probably caused the haematological changes.

Probably stop the Sulphasalazine, if he is on this.

Also I think check for GPD [ glucose 6 phosphate dehydrogenase deficiency ]?

Posted by Pat Lush[/QUOTE]

yes ,you are correct.Congrats!


Re: Why don't we expect more from patients?

Posted in Respiratory medicine at Thu, 27 Nov 2014 21:07:15


Posts: 815
Joined: 13 Oct 2009

It will be interesting to see how the views of your blog writer mature as the years pass. The division between doctor and non-doctor is often far from clear cut and some are very clearly doctor and patient. To-day I had lunch with a frail 95 year old retired doctor who was very much subjectively and objectively a doctor in his approach to ailments and treatment.  Others just want to be told what to do. Increasingly I find that those writing on this subject fail to grasp the breadth of responses in what folk have as their aims in treatment and what is acceptable. And the idea of treating someone as one would like to be treated oneself is clearly a nonsense for very many patients and suggests a total failure to grasp just how different  these aims and needs of  different people can be.

When leading a group on an academic psychiatry ward we sometimes had a number of medical patients. I well remember one who had had full Adlerian analysis and clealrly wished to make the group a power struggle and take over from me (SHOs were often dropped in it in those days - but what a way to learn to live by one's wits). Roles had to be established. This had to be done by the group not me and in his present capacity he was clearly a patient - my job was one of interpretating the behavioural challenges later on. About the same time we had a couple of desperately depressed doctors where it was crucial that some degree of inital paternalism was essential. "Taking over" can be a crucial step sometimes.

Perhaps the blogger is finding the uncertainties in the world of psychiatry particularly challenging . Her seeking a more paternalistic approach early on could well be part of her disorder . At a later stage of treatment and support a different longer term approach may be more appropriate.

Personally I have always felt that whenever we see someone with an illness we should not see it in isolation , but ask ourselves whether there is a responsibility to help the person in how future illnesses will be tackled. This view of course is now totally outdated.

Re: Why medicine is not like flying a plane

Posted in Medicolegal at Thu, 27 Nov 2014 18:45:38

John D

Posts: 3330
Joined: 01 Feb 2010

Indeed, Anne, the WHO pre-list brief and post-list debrief, and immediate pre-incision check, has brought a sort of pre-flight checklist into theatre, but in some cases it was extraordinarily difficult to get the co-pilot to actually be there on the tarmac for those checks.    They were either in the departure lounge, glad-handing the passengers, somewhere else more important, or they sent the luggage loader to take their place.  I think they have all got the message now, though.


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

Posted in Respiratory medicine at Thu, 27 Nov 2014 13:51:48


Posts: 663
Joined: 21 Feb 2012

Cavity with Air Fluid Level in the Rt upper lobe,she may go in for pyothorax,so Intercoastal Drainage can be one option.Sputum,for Gram,AFB staining and Sputum for Cuture and sensitivity.MxTest.

Broncoscopy may be done and the aspirated  may be sent for testing Tuberculous and non tuberculous organisms.

Would you like to write for the BMJ?

Posted in General clinical at Thu, 27 Nov 2014 11:53:57


Posts: 613
Joined: 18 Mar 2014

The Endgames section of the BMJ - where I take many of the What's your diagnosis? articles from - is looking for authors to contribute case reports and picture quizzes for primary care doctors. 

The series was initially aimed at junior doctors but the editors would like to focus on topics included in the curriculum of the Membership of the Royal College of General Practitioners (MRCGP) exam. The new GP-focused articles will maintain a similar structure to the current Endgames reports while reflecting primary care practice where doctors face more uncertainty regarding diagnosis and management, deal with multiple co-morbidities and  social and family problems, have limited access to tests and examinations.  

The new series of articles could include some of the following questions:

  • What do these clinical findings mean?
  • What is the differential diagnosis?
  • What is the potential diagnosis?
  • Is the patient's social/family history relevant?
  • What would you prioritise in this patient?
  • How would you manage this patient?
  • What advice would you give to this patient?
  • What other concerns do you have regarding this patient?

To view recently published Endgames articles click here and to view the submission and author guidelines go to this link and click on the Endgames section or email Amy Davis: adavis@bmj.com


Re: What's the most pointless piece of medical kit marketed to patients?

Posted in General clinical at Wed, 26 Nov 2014 21:21:12


Posts: 815
Joined: 13 Oct 2009

Interesting how we use these gadgets differently. My use is similar to that of Pat Harkin - I keep them for making calls - so often do not even have them switched on. But more and more texting seems referable as it does not interrupt what the other person is doing. But I find very little place for either - remembering to use 1 or other or both every few months to avoid disconnection by the provider is a pain. Such easily portable access to taking photos , maps or the internet makes them worth while , not the chatting. I suppose in part I am reacting to having carried a bleep for nearly all my working life and having learnt to hate telephone calls generally. 

I am incredibly fortunate in having a tolerant wife - so if I need to be contacted by mobile I  give her number . Now she really is gadget literate which helps my Luddite tendencies...


Re: dementia

Posted in Neurology at Wed, 26 Nov 2014 20:09:15

Mukhtar Ali

Posts: 872
Joined: 14 Nov 2010

The brain has a weak spot for Alzheimer's disease and schizophrenia, according to UK scientists who have pinpointed the region using scans.


Should patients address doctors by their first name?

Posted in General at Wed, 26 Nov 2014 11:35:02


Posts: 613
Joined: 18 Mar 2014

This week's poll idea stems from a thread discussing whether doctors should like their patients. Odysseus, who, despite his name, hails from Australia, wrote that many patients in Australia address their doctor by first name. "We are less impressed by societal stratification and titles," he says. 

There is quite a lot written about how doctors should address patients, including an interesting blog here. But if a patient asks you to call them by their first name should you return the courtesy? I call my dentist by his first name but I do see him fairly regularly - at least four times a year for my own and my children's check ups. He's a great dentist and I don't feel any loss of respect towards him - in fact, I feel we have a better relationship because he's so friendly and warm. 

I've never addressed a doctor by their first name but if I had a condition which required that I saw  a doctor regularly would I expect to address him/her by their first name? I'm not sure.

So what do doc2doc members think? 

Re: Do you have to like your patients?

Posted in General clinical at Wed, 26 Nov 2014 11:08:15


Posts: 613
Joined: 18 Mar 2014

I don't think you're too tolerant Pat - most people are likeable to some degree aren't they?

Re: Poll archive - 19th to 26th November 2014

Posted in doc2doc feedback at Wed, 26 Nov 2014 10:49:54


Posts: 613
Joined: 18 Mar 2014

Should performance data of individual doctors be published?

Yes - 60 votes (31.9%)

No - 113 votes (60.1%)

Don't know - 15 votes (8%) 

Re: What's your diagnosis? A returning traveller with fever, facial swelling and skin lesions

Posted in General clinical at Tue, 25 Nov 2014 23:01:03


Posts: 23
Joined: 04 Apr 2013

Lymphatic Filariasis


Posted in General clinical at Tue, 25 Nov 2014 21:25:13


Posts: 11
Joined: 19 Jun 2014

Any opinions on this new medical website designed to help physicians easily convert ADHD medications for their patients. ( I was asked to consult on it.). www.adhdmedcalc.com



Re: Should 'bed-blockers' face legal action?

Posted in News & media at Tue, 25 Nov 2014 17:16:07


Posts: 83
Joined: 15 Jan 2010

On the other side of the coin, we had an issue that my late father was in hospital following a fall and head injury, with a care package in place at home. When the acute incident had been sorted out,  and he was back to the same status as prior to the fall, within about 36-48 hours, we wanted to take hime home, but the ward discharge policy dictated otherwise. He had to be assessed by the discharge team despite the fact that there was no change to his circumstances, which took 2-3 weeks, by which time the care package had been withdrawn and had to be set up again, and he had become quite institutionalised, calling for ambulance men if he toppled over at home and not letting us lift him, and becoming incontinent because he wasn't bothering to get up to go to the lavatory, which had been quite a walk away when he was on the ward. Took him a long time to settle down again. You could argue that the discharge team needed to sort out a strategy for his repeated falls, and I wouldn't disagree with that, but they didn't (couldn't?), apart from the thigh padded pants he was already wearing. And yet when we inquired if there was anywhere which provided respite care for us to get away for a holiday ourselves, there was none available. Even when we self-funded, there was no space in nearby nursing homes, and we ended up taking him a long drive away, and after a long wait to find somewhere. He wasn't especially disabled or chronically ill, just elderly and not very mobile.

Re: What should a fourth year Medical student learn from a four week attachment to UK General Practice?

Posted in General clinical at Tue, 25 Nov 2014 15:23:24


Posts: 1
Joined: 25 Nov 2014


I am a 4th year medical student currently attached to Bartongate practice.

Here are some of my thoughts on what skills I feel are important to develop during this placement.

  • Furthering the ability to take ones own consultations including management plan
  • Improving skills such as BP, fundoscopy, IM injections
  • Continue to refresh knowledge on chronic conditions such as diabetes, COPD
  • Learn how a general practice is run and understand the pressures GPs face day to day
  • Continue to treat the patient as a whole person, as there is often a psychological/social aspect of his/her disease.

I have found it is useful during this placement both to sit in on GP consultations as well as to take my own. I have been able to take the experienced doctors consultation skills and adapt them to suit my own style, thus improving my own consultations.  

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

Posted in News & media at Tue, 25 Nov 2014 15:15:19


Posts: 4
Joined: 16 Aug 2014

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

Posted by AnneG[/QUOTE]

If the doctors or hospitals performed well; they will be awarded by some golden words. Also, publish the opinion of the patient as well.


Re: Identify the lesion on the nose

Posted in General clinical at Mon, 24 Nov 2014 16:06:09


Posts: 1
Joined: 24 Nov 2014
So What's bes treatment of rhinoscleroma

Re: Winter`s Blues

Posted in General at Mon, 24 Nov 2014 11:49:23


Posts: 613
Joined: 18 Mar 2014

How very dare they.....?

I'm a proud Yorkshire-woman but even I would find Scarborough out of season a bit grim....!

In Response to Re: Winter`s Blues:[QUOTE]

I know it's Grim Up North, but penguins, depressed by Yorkshire weather?

Surely not?  In God's Own County? 

Posted by John D[/QUOTE]


Re: A tragic case, compounded by legal insensitivity.

Posted in News & media at Mon, 24 Nov 2014 11:02:39


Posts: 4443
Joined: 24 Feb 2009

It is but a game; smoke and mirrors with justice an accident and not a given. That is why Lindy Chamberlain went to jail and so many innocents to the gallows.


Re: Should drinking during pregnancy be criminalised?

Posted in Medical ethics at Mon, 24 Nov 2014 10:58:22

Andrew Morrice

Posts: 22
Joined: 29 Jan 2009


But where would we be  without our fortnightly invitation to say whether or not the law should force people to do as doctors would wish?. 

Nearly always I read the question and say no. 

The law is a blunt instrument, we would do better with education, accurate unbiased information, social policies to reduce the alienation and desperation, and economic policies that help make unhealthy behaviours and products more expensive. 

However, keep the "should we ban/criminalise X?" questions coming.  We never seem to tire of them.  Do we?


Re: Should patients have the right to record consultations?

Posted in News & media at Sun, 23 Nov 2014 19:48:23


Posts: 10
Joined: 31 Mar 2014

I wonder if the silence to date (in a thread such as this) concerning the CQC and 'surveillance', comes about because practitioners are failing to appreciate that, in the New Year, the new guidance will apply to them.

It will not apply only to 'care homes' (and\or "granny cams"). It will cover all registered medical 'service providers' and will include, for instance, audio-recording by patients.

The so-called 'green light' to issue guidance to the public was given last week (19 11 2014).

Furthermore, the CQC board has insisted that the legal position of 'service users' is properly spelled out, and that it is clear that e.g. covert recording by a 'service user' can be a 'totally legitimate' thing to do.



Posted in Respiratory medicine at Sun, 23 Nov 2014 15:30:31


Posts: 663
Joined: 21 Feb 2012

In Response to BOOP(COP):[QUOTE]


           this is a patient 35 y immnuocomptent male living from south india

                             history of fever/chills-5 days

                             dry cough - 3 days

                             no SOB/ no hemoptysis/no wheeze

                    no past h/o TB

          CECT CHEST: bilateral basal segments consolidation with air bronchograms.

                                      centrilobular nodules seen..consider BOOP!!!

                        help me  frnds with what would cause a bilateral lower lobe consolidation in an immunocomptent adult...i would rather consider BOOP(cop)as my last DD??

Posted by aravi[/QUOTE]





Re: Ebola - a new facet

Posted in Psychiatry at Sun, 23 Nov 2014 15:06:19


Posts: 263
Joined: 14 Dec 2010

Given this 'ready-made' and unguarded biological weaponry it wouldn't be surprising if some nutters (and I use that term advisedly) didn't try to use it for terrorism purposes.

Re: Thoughts on IE prophylaxis?

Posted in Cardiology at Sat, 22 Nov 2014 13:47:45


Posts: 7
Joined: 04 Sep 2014

Infectious Endocarditis!

Tribute to Robin Williams

Posted in Psychiatry at Sat, 22 Nov 2014 11:31:41


Posts: 473
Joined: 23 Aug 2013

The loss of Robin Williams was quite a sad one on the human aspect. The media coverage has been criticized for the way it dealt with it. I just came across this blog post from Greg Smith MD blog which discusses the issue from an interesting empathic psychiatric perspective.

I would be grateful to learn your thoughts about it.