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Re: Should the NHS be liberated from political control?

Posted in News & media at Wed, 22 Oct 2014 13:21:50

Jon Laake

Posts: 4
Joined: 12 Aug 2014

Unfortunately, even doctors aren't exempt from making silly decisions. And yes, democracy is a stupid way of government, until you consider the alternatives...

Re: How stupid an people be?

Posted in General clinical at Wed, 22 Oct 2014 13:11:51


Posts: 781
Joined: 13 Oct 2009

Maybe they were just given the standard advice that transmission within marriage is unusual , maybe they thought safety razors must be safe , maybe they will get away with it......

Re: What's your diagnosis? Recurrent fever after a holiday in Turkey.

Posted in General clinical at Wed, 22 Oct 2014 13:00:11


Posts: 232
Joined: 14 Dec 2010

If I was looking a infections still particularly prevalent in Turkey that could be persistent and associated with the symptoms, signs (splenomegaly) and dietary history, Brucellosis and Salmonellosis would be high on my list of differentials.

The blood culture results with Gram negative rods would fit Salmonella rather than Brucella but difficult to know whether it might have been some other Gram negative infection caused by instrumentation.

I suppose I ought to go for Salmonella first and that should be easy to define microbiologically but I'm reluctant to rule out Brucella.

Re: Is paying UK GPs 55 £ for diagnosing dementia a good idea?

Posted in Neurology at Wed, 22 Oct 2014 10:03:28


Posts: 527
Joined: 18 Mar 2014

Sken - if it's okay by you I'll delete your post and keep this thread going. If you want to repost your original words of wisdom onto this thread that would be good. 


Re: Reflecting on failure in psychiatry exam

Posted in Psychiatry at Wed, 22 Oct 2014 08:56:14


Posts: 781
Joined: 13 Oct 2009

I thought the blog very good. It is a problem in most specialties and I suspect many of those passing may have passed by a very small margin. Of course there should be continuing job opportunities and counselling etc... , but it is all too easy to overlook what goes on in the mind of the individual . Many , many years ago I remember looking at the DPM and what was involved - a formidable set of exams. I suspect other specialties still have a relatively easy time of it - but that may change as reaccreditation and specialty exams are introduced.

A related problem can be those who complete their training but cannot find an appropriate post - or those where a research degree becomes a necessary part of qualification even for supremely clinical positions. At times I feel the medical hierarchy loses sight of the basic questions about service needs and what makes an adequately competent doctor. The entire system can be so difficult for those coming from overseas.


Re: dementia

Posted in Neurology at Wed, 22 Oct 2014 04:02:08


Posts: 589
Joined: 23 May 2012

Changes of diet, brain stimulation, exercise, adequate sleep, few medicine and vitamins reverse memory loss in dementia. Do you think , its possible?.

Re: Books

Posted in Medical education at Wed, 22 Oct 2014 03:38:23


Posts: 1
Joined: 22 Oct 2014

An Irish country Doctor and An Irish country Village by Patric Taylor are excellent books to read on general practice

Re: Feeding Birds: A Humane Gesture

Posted in General at Wed, 22 Oct 2014 02:50:37


Posts: 4351
Joined: 24 Feb 2009

In Response to Re: Feeding Birds: A Humane Gesture:[QUOTE]

Posted by Mukhtar Ali[/QUOTE]

This is a gallah (pronounced in Oz as g'laar). We call foolish people gallahs. A "cockatoo" was the name for the lookout in an illegal gambing game of "two up" where two pennies were tossed in the air and with betting based on heads or tails. "Two-up" is played on ANZAC Day by some as a sentimental relic of the past. The two pennies are placed on a wooden bat about two inches wide and six inches long and tossed up into the air.


Re: What constitutes poetry when in blank verse; lineated prose or real art?

Posted in General at Tue, 21 Oct 2014 20:35:07


Posts: 4351
Joined: 24 Feb 2009

Homer's vocabulary is so rich and unique, I have a Homeric dictionary.  He and Shakespeare are the bedrock of English and Western intellectual and literary endeavour. 

Ben Johnston said Shakespeare was a man for all time. So was Homer. They were literary Time Lords; intellectual master craftsmen.

One can only read Homer in small pieces are there is so much to digest, so many annotations. It is like drinking OP whisky neat. It needs to be diluted with time and explanation.


PS Greek boys in the time of Pericles were taught to recite large chunks of Homer who epitomised the virtues,    Athenian nationalism and the notion of heroism and valour. Modern education has led to few children being able to recite more than a line of Shakespeare. When I was at school, we could recite extracts from various Shakespearian plays and sonnets but learning something by heart was not disparaged as now. We also used slide rules and log tables.

Re: What's your diagnosis: a previously healthy and active man losing the ability to live independently

Posted in General clinical at Tue, 21 Oct 2014 19:40:55


Posts: 12
Joined: 09 Mar 2009

Major depression and maybe starting dementia, Creutzfeld-Jacob, frontotemporal,...

Re: Antipsychotics for ADHD

Posted in Psychiatry at Tue, 21 Oct 2014 14:13:17


Posts: 23
Joined: 24 Apr 2012

I feel it unfair that Dr Gold's thoughtful blog has been misquoted into a tabloid headline.


She says " ... when medication is so effective at controlling behavior, the motivation for investing time and effort in relationship-based interventions may be lost. Prescribing medication takes much less time. With atypical antipsychotics the results are often immediate, and can be dramatic.

If risperidone is found to significantly alter the brain’s capacity for emotional regulation, then it might have a role to play. But if it does not, and we have well-established methods of intervention that do, then the possibility exists that by prescribing this medication to children, particularly in the absence of relationship-based interventions, we are actively interfering in their development."
Fair enough?

Re: The Ebola Frontline

Posted in Public health at Tue, 21 Oct 2014 13:41:22


Posts: 1490
Joined: 09 Dec 2011

In Response to Re: The Ebola Frontline:[QUOTE]

It seems that the UN meeting has moved the US and UK Governments.

Yesterday, President Obama said that 3000 US soldiers would be mobilised to help in West Africa against Ebola.

And I've just heard on the radio that the UK Army will construct, staff and run a 300 bedded hospital there.   I missed the details, and the BBC are ahead of the Internet, as there is only an old report of a 62 bed unit in  Sierra Leone on Google.

THAT is more like it!  Well done to the Govs for sparing a moment from their Referendun and Islamic Sate obsessions to deal with a "clear and present danger".

BUT, A report toady says that a team of health workers with journalists is missing in Guinea, having gone to a village to infomr and eductae the people on Ebola.  Two senior doctors from the region's hospital were in the party and seven bodies have been recovered.  Perhaps they need armed troops, not only the Medical Corps!  (I know that medics are armed, but they are not supposed to fight with them)


Posted by John D[/QUOTE]

Hi John,


Great Post,  Yes the Medics from USA  will be armed, some of them!   They are allowed ro engage enemy, but are not ideal for combat,  Alas some combat troops will go as well.  IE- Mlitary Police, Rangers, etc.  The American Doctor did carry some immunity by the way, and his blood was used to help other Ebola victms, Those with same blood type!   In answer to a common question, NO - Plain Paper Masks are not enough for Ebola,  N95 or better Yet N-100 masks are recommended by CDC, USAMARIID, and WHO, plus NIH etc.  Althoug Eboal is not Airborne, it is a Brinkmanship champion. That is to say, the aprayed airborne droplets from a cough, sneeze, or vomit are capable of infecting, so proximity danger is real!  Full Tyvek or other impermeable gear, along with PAPR gear and full face shield are warranted,  Ideally portable PAPR suits like USAMARIID wears are best. There is a program in USA right now where HAZMAT and CBRN people like myself are teaching hospitals about proper use of the gear, and it is worth its weight in Gold!  Proper education is paramount.  Our Doctors and Nurses deserve protection, the best there is, and I will do all I can to be sure they get the training they deserve....



Re: New cardiology clinical champions

Posted in Cardiology at Tue, 21 Oct 2014 05:14:04


Posts: 4351
Joined: 24 Feb 2009

How about Amiodarone for Dummies?

I saw an old man last week with  severe complex sleep apnoea on Amiodarone and with a serum TSH of 80mU/L (0.20-4.00). He is now on an ASV pump and increasing thryoxine dosage.


Re: Where was WHO in Ebola outbreak?

Posted in General at Mon, 20 Oct 2014 18:53:32

Mukhtar Ali

Posts: 852
Joined: 14 Nov 2010

Ebola: WHO under fire over response to epidemic


Vitamin D Might Help Kids With Eczema

Posted in Cardiology at Mon, 20 Oct 2014 18:23:58

Mukhtar Ali

Posts: 852
Joined: 14 Nov 2010

Daily vitamin D supplements might help children with eczema that gets worse in the winter, a new study suggests.


Help with ABFM national boards

Posted in Medical education at Mon, 20 Oct 2014 13:53:55


Posts: 1
Joined: 20 Oct 2014

I let my Family Medicine boards expire in 2004.  I want to prep to take them but don't know where to start.  Any advice is appreciated.  Thanks.

Re: Poll archive - 13/10/14 - 20/10/14

Posted in doc2doc feedback at Mon, 20 Oct 2014 08:49:15


Posts: 527
Joined: 18 Mar 2014

Should all adults over the age of 45 be screnned for abnormal glucose?

Yes - 102 votes (73.9%)

No - 33 votes (23.9%)

Don't know - 3 votes (2.2%)

Re: Medical students asking intimate questions

Posted in Medical ethics at Sun, 19 Oct 2014 18:53:23


Posts: 781
Joined: 13 Oct 2009

I don't see that you can clerk a patient with anal SCC without looking into the sexual aspect. Sadly , I suspect many doctors duck on this issue even when qualified. Just how you do it is the problem and perhaps you are not ready for it just yet. John D's advice is excellent. Just what more do you need to wonder about HIV ? There may also be marital problems - heterosexual anal sex also seems  common and it is not just men who are vulnerable - I was not sure whether your patient was a man or a woman. It has become increasing relevant in discussions about HPV immunisation. It could be there are aspects of care here that have escaped a surgical admission and if you (reasonably) choose to duck now , then highlight your concerns so that someone else will step in. Equally if you have good rapport with the patient then it could be a great learning experience but you must back away if the patient does not want to go ahead and leave it to others. But sometimes patients find it easier to talk to the less authoritative people on the ward.

The sexual aspect is also particularly relevant in what it means for the patient. STI clinics are all very well , but it always saddened me to see those not working in that specialty who miss HIV disease or syphylis etc...

PS And remember patient denial does not mean there are no relevant risk factors. I well recall the male prostitute initially under my care who had obvious AIDS but adamantly denied any risk factors during his first few re-admissions -- his choice.

PPS On occasion I have also ducked - perhaps more often than I would like to admit.


Re: help me...dnt knw what to do:(

Posted in Student BMJ at Sun, 19 Oct 2014 10:36:47


Posts: 232
Joined: 14 Dec 2010


Thank you for sending additional information about the location of your Medical School.  You’re right that your system is very different to that in UK Medical Schools but the advice I would offer is what should apply to academic study anywhere.  For obvious reasons I am unable to give you more personal advice and I restrict all my correspondence to this group forum.

The impression from all your posts is of chaos in your studies and it’s not possible for anyone here  to understand exactly why you’re in such difficulties.  For these reasons, the best plan (as would be the case in the UK) has to be for you to spend enough time there with a personal tutor who can analyse the problems, discuss study habits and to consider if your health is suffering to an extent that interferes with your studies and whether you need a break.

Going without sleep to cram in more study time always makes things worse.

Whilst the supervision there is probably different to the UK, I have to believe that any institution calling itself a credible Medical School has to have some system of personal academic supervision and support for its students.  Others using this forum may have more information about your country but if what I describe doesn’t exist, the problem is not yours alone.

Perhaps you could tell us, via this forum, what happens.


Re: Should smoking be banned in public parks?

Posted in Respiratory medicine at Sat, 18 Oct 2014 21:57:55


Posts: 11
Joined: 28 Aug 2013

Yes it should be immediately 

passive smoking is worst than smokingsmoking

Re: Imposing Tax On Sugar To Curb Obesity?

Posted in General at Sat, 18 Oct 2014 18:08:33

Mukhtar Ali

Posts: 852
Joined: 14 Nov 2010

Sugary drinks warning signs change habits of US teens


Re: Ulysses contracts/agreements in medicine

Posted in Medicolegal at Sat, 18 Oct 2014 18:07:22


Posts: 11
Joined: 13 May 2009

If the patient with schizophrenia has tardive dyskinesia then  another drug must be used. In my experience a great deal can be done with nutrients to prevent or minimise TD. See www.alternativementalhealth.com. A good book on nutrient therapy in mental health is Nutrient Power by William Walsh PhD whose website is www.walshsinstitute.org. I really enjoy psychaitry a lot more since I found  how useful it is to get the biochemistry  right. Did you know for example that high copper is a major factor in post-natal depression and using zinc together SSRI can usually speed up recovery much more quickly?

Re: Ebola Has Hit the USA....

Posted in General clinical at Sat, 18 Oct 2014 14:16:59


Posts: 1490
Joined: 09 Dec 2011


Yes your right, the Dallas Presbyterian Hospital did exactly what they could, and in a manner consistent with  basic precaution.  I  have no Quarrel with their procedures, However, the CDC and Or USAMARIID should have been dispatched immediately upon confirmation of a Level 4 Contagion Loose in the public!  USAMARIID and NIH etc Have Level 4 Biocontainment suits that are portable!   I will post pics below.  Yes the suits being worn by the people transporting the dallas nurse were those type suits with enclosed ventilation supplies.  Either PAPR or full Air bottle, like SCBA.  PAPR is Powered Air Purifying Respirator.  



Above link is an infectious disease PAPR system available to health care facilities.




There are a number of suits available, mostly PAPR and some actual SCBA with enlosed Air Supplies,  but PAPr is sufficient, and will keep the wearer free from infection.  There is a contest underway to design a suit with portable cooling unit to keep wearer cool since these suits are cumbersome and Hot, and very tough to live in for long.    I would Advise N-100 Masks Minimum, full face shields, Tyvek suits or other non permeable suits, full rubber boots and gloves, taped at joints for non close care workers, IE- techs that check vitals on monitors in room,  Nurses and Doctors in room with infected patient ideally should be in full PAPR gear, with 100%  enclosure, clear Hoods for vision, but 100% sealed from Air.  I realize Ebola is not Airborne right now,  but as a precaution for the sudden mutation, and realizing the CBRN redundancy of overprotection you cannot go wrong.    Also as a side note,  a patient couging or sneezing could cause airborne droplets of saliva possibly tainted with blood and other body fluids to become "Airborne"  in a small area, and land in your eyes, mouth, nose etc.  This is known as a Border danger, IE - Border between Airborne and Bloodborne, or Bodily fluid.   Just because the Nurse that becomes infected was not infected by an Airborne Contagion does not mean that she is any less infected!  Little good the definition of Airborne V.S Bloodborne does her.   

By the way John, Yes I saw the picture of the man with the clipboard following the PAPR suited caregivers.  No he was not safe - 100%, nor will he be later - 100%!  Like Kirked said in his post one has to account for human error!   I would classify that as a Large human Error, sort of akin to standing next to an exposed rod of Plutonium.   Very Stupid, in my opinion.      

As for links,  I would be glad to provide any assistance to any Doctor in BMJ for Technical Info.

Below are some general links of interest.





I will be available if more links are needed,  and for consult as needed.  



Re: Seeking a second opinion; sign of weakness or strength?

Posted in General clinical at Sat, 18 Oct 2014 11:36:22

John D

Posts: 3286
Joined: 01 Feb 2010

In NHS cancer treatment, part of the process after diagnosis and before treatment starts is a Multi-Disciplinary Meeting, an MDM.    They are regular, weekly or more often, where new patients are discussed between oncologists, surgeons, radiologists etc. etc. etc.   Thus cases that may be 'difficult', unusual or may fall between two classifications may have several opinions and expertises given about them and the best decision made.

 Is this a concept that could be transplanted into non-cancer medicine? Forgive my presumption, anaesthetists aren't involved in MDMs, except to give an opinion on anaesthesia risk if surgery is one of the options, so you may do so already!

   The other forum is the monthly Audit meeting.  In my department these always incude some Mortality and Morbidity, presentation of cases where complications have ensued and/or the patient has died.  So presenting a case that is likely to do so can be most useful by obtaining a body of opinion on how to manage them.   It may be a big personal step to go to a colleague to ask for help, but if such round table discussion is usual. 


Re: Research beneficial for medical students?

Posted in Student BMJ at Sat, 18 Oct 2014 11:16:34

Umm e

Posts: 1
Joined: 17 May 2014

In Response to Re: Research beneficial for medical students?: hello ! I found ur reply very insightful . Can u  forward me as well the links you talked about? 

Speaking as a medical student currently doing research I can tell you it is definitely a worthwhile enterprise to pursue if it interests you. It allows you to gain a wider skill set and soft skills in communication, critical analysis and team work. 

As you say in your post, there are a wide variety of things that you can do as a student but you should know that very little of them matter in the context of standard F1 appllications since all medical students (in the uk at least) are graded depending on their exam results both within the course and Situational Judgement test. This means in the context of applying for F1 it wont directly have much impact on your scores. 

However, if you are considering applying for academic posts then being involved in lots of different initiatives such as essay writing, writing papers and research projects can strengthen your application as the academic programme is incredibly competitive with those engaging in research already having the advantage. 

I would be more than happy to forward to you some links to things you can do if you like. March is quite timely time to be considering doing research as this (march time) is getting towards the end of the time for applications to summer research studentships. 

I want to stress that there are lots of things that you can do to enhance your experience without spending lots of money and another thing to stress is that you should try to do things that can both enhance your career development and be enjoyable. There is no point in exhausting yourself between your course and your other commitments. Believe me as I have done it and it isnt fun. 

Let me know if you would like some links and if you would like to talk more. 

Best wishes,


Posted by NCantley[/QUOTE]