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New to doc2doc? Introduce yourself here...

Posted in General at Sat, 06 Feb 2016 23:49:26

John D

Posts: 3937
Joined: 01 Feb 2010

If you're new to doc2doc - welcome! We're delighted you've decided to join BMJ's community - we hope it will be a useful resource for you.

Please introduce yourself below - tell us which country you're from, what stage in your medical career you are, and what you would like to learn from being part of doc2doc. We have a very friendly and supportive community - I am sure they will give you a warm welcome and will be on hand to offer clinical insight, support and advice.

By the way, I'm Matt (mbillingsley) and along with Sabreena & luisad help to run doc2doc. We moderate the forum, and think about the types of discussions the community may be interested in discussing and also how we can help to in your careers. If you have any questions please do email us: community.doc2doc@bmjgroup.

And don't forget we have a New member of the month competition! where we offer a 3 month online subscription to any BMJ Journal for new members who post 20 times or more within their first month of joining!

We look forward to meeting you!

*Please note, this new thread is the new version of our previous thread: Introductions for new members

Should UK junior doctors strike over new contract plans?

Posted in Careers at Thu, 11 Feb 2016 01:25:43


Posts: 1
Joined: 11 Feb 2016

Over 50k people have signed an online petition in support of a junior doctor strike in the UK.

This is a response to the government's plans to impose a new contract for doctors in training which is likely to increase working hours and reduce pay.

It is proposed that basic pay will increase but the definition of "sociable hours" will be changed from 0800-1900 Monday to Friday to 0700-2200 Monday to Saturday which means junior doctors will not be eligible to receive supplemental pay (non-pensionable banding supplements) for work unless it occurs outside these times.

From the Review Body on Doctors’ and Dentists’ Remuneration (DDRB)  paper, "Contract reform for consultants and doctors & dentists in training – supporting healthcare services seven days a week"


It is also implied that doctors on maternity, paternity or sickness leave, those working less than full time, and those without a training number would not be eligible for the annual incremental pay increases that most UK doctors currently receive. Instead, pay increases would correspond with stages of training/increases in responsibility (rather than time served or years of experience).


Kitty Mohan, co-chair of the BMA's Junior Doctors' Committee, suggests the following to juniors doctors: 

1. The DDRB recommendations affect different people in different ways. If you have not yet managed to do so, please do read the juniors section of the DDRB report published on 16th July.  It can be found at: https://www.gov.uk/government/publications/contract-reform-for-consultants-and-doctors-and-dentists-in-training-supporting-healthcare-services-seven-days-a-week

2. Talk to your colleagues at work and make sure they are as informed as you. Start with other junior doctors but please do talk to other doctors, nurses and other health professionals. We are still being contacted by juniors who have no idea what is going on and if this affects them.  Let’s be clear, this affects us all.

3. Talk to your medical students, this will be their future contract, and to non-medical families and friends. Encourage them to spread the words regarding the concerns as well.

4. Many of your Royal Colleges may have already made a statement regarding junior contracts but please continue to lobby your College, Faculty or Royal Colleges. We’ve seen Royal Colleges both speak out strongly against the changes, and those who feel this isn’t their concern. The implications of a disenfranchised and devalued medical workforce affect everyone. Lobby your specialty trainee group as well – the more people who speak out against the changes the better.  

5.  Contact your local and regional BMA junior doctors reps and tell them your thoughts on what the next steps should be. The list of the Regional Junior Doctors Committee Chairs can be found at http://web2.bma.org.uk/rjdc

If you are a local or regional BMA junior doctor rep, please discuss these issues with your local and regional members and canvass their views on next steps over the next few days. We want to hear from as many people as possible.  Or email Andrew and myself at jdcchair@bma.org.uk . Thank you to the many of you who have contacted us so far.

6. Attend one of the NHS Employers junior doctors engagement events. Details of the events can be found at NHS Employers

7. Please take to Facebook and Twitter and share your concerns. On a simple level the more voices heard, and the more concerns raised the better. It is the level of outrage by junior doctors and their supporters that has turned this into a news story. Please get involved in discussions and debates, write blogs or opinion pieces, and generally do everything you can to get out messages out there.

8. Finally, whatever your opinion of the BMA is, the protection BMA membership affords regarding our terms and conditions is unparalleled.  Please remain a member or consider rejoining. This is the single biggest threat to the terms and conditions of current and future junior doctors.

Is fertility a human right?

Posted in Medical ethics at Sat, 13 Feb 2016 13:21:05


Posts: 1676
Joined: 09 Dec 2011

Recent advances in fertility medicine have raised enormous questions that exercise the ethicists as well as ordinary doctors.   Unregulated, it can lead to gross exploitation and even regulated to situations where the whole medical journey must be hedged with contracts and guided by lawyers.   It seems as if a new Human Right is being established.

Human rights started with the Four Freedoms promulgated by the Allies in WW2; Freedom of Speech, Freedom of Religion, Freedom from Fear and Freedom from Want, and was expanded into the Universal Declaration of Human Rights http://www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf    That includes Article 16/1, "Men and women of full age, without any limitation due to race, natuonality or rlegion, have the right to marry and to found a family"


But I think that the authors of this great document would today write "to attempt to found a family".     For the routes by which a family by be obtained are so outlandish that they test not only ethics and the law, but also respect for other humans.     Poor women in poor countries, pregnant with rich children that are unrelated to them.    Rich women in rich countries, pregnant at an age when when they are unlikely to see their child reach adolescence, let alone adulthood.   It seems that the progress of medicine and the possibilities of medical treatment for low fertility have vastly outpaced the way that society has discussed and assimilated it.    A Right to Fertility seems to have become established alongside the obvious and necessary ones of the Declaration.

Why do we not call a stop to it?   An embargo on all new research, or at least the application of it while we come to terms with what we have and might have in the future.  Not a chance, I fear, whilst barren couples have the fierce desire for children, the expectation of thier right to have them and in the Western World where the research is rampant, the means to enrich anyone who will offer them hope.

I do not intend to insult my colleagues who work in infertility, especially those in the NHS who do so for no more than any other NHS doctor. But 'follow the money', and that is what is corrupting honorable and ethical work, when the dishonorable and unethical get their claws into the desperately infertile.


BREAKING NEWS! FDA Adds New Warnings on SGLT2 Inhibitors.

Posted in Diabetes at Fri, 12 Feb 2016 05:15:43

Joey Rio

Posts: 985
Joined: 13 Apr 2011


EMPAGLIFLOZIN, CANAGLIFLOZIN, DAPAGLIFLOZIN the so-called SGLT2 Inhbitors so far in the market (and others are coming)  invariably induce glycosuria,  many times urinary tract infections, and a few times acute pyelonephritis.

These New  Warnings from the FDA came in because of more than just a few cases have been reported of Severe Acute Pyelonephitis with UroSepsis requiring ICU Admissions and Diabetic Ketoacidosis both in Type 1 AND Type 2 diabetics!  One of the main risk factors for Diabetic Ketoacidosis seems to be a reduction in the  glucose intake or stopping the use of insulin secretagogues, and......ETC.......(see the above link).


1. I Do Not Envision a Bright Future for this Class of Drugs., because severe side-effects are just appearing too soon.

2. It was massively informed in the medical and lay press and media that these drugs acted through Insulin Independent Mechanims, But here, at least in those Bizarre Iatrogenic Cases of Ketoacidosis side-effects, we Can See a Clear Interaction with Insulin Mechanisms.

All Best,


Cardiology Quiz

Posted in Cardiology at Thu, 11 Feb 2016 17:33:46


Posts: 2
Joined: 11 Feb 2016

42 years old patient presented with headache and dizziness one hour after he woke up in the morning, the ECG shown was taken in the A& E  at the same time

1/ What is the diagnosis ?

2 /What is the  differential diagnosis ?



Junior doctors’ strike February 2016: Live blog

Posted in BMJ at Thu, 11 Feb 2016 13:48:31

Johann Malawana

Posts: 6
Joined: 15 Oct 2015

This week, junior doctors in England will be taking industrial action for the second time in as many months after failing to reach agreement with the government over their proposed new contract. The strike action will result in junior doctors offering emergency care only for 24 hours from 8am on Wednesday 10 February to 8am Thursday 11 February. The BMJ will be charting events as they unfold this week. If you have any strike-related pictures, musings or tweets to offer us, please post them here or send them to Gareth Iacobucci at giacobucci@bmj.com

Do you have enough information about the Zika virus?

Posted in BMJ at Thu, 11 Feb 2016 19:20:25

Joey Rio

Posts: 985
Joined: 13 Apr 2011

How worried are you about the Zika virus? We're having daily meetings here at BMJ to discuss how we cover this global state of emergency in terms of providing information to clinicians?

We've created this page: bmj.com/freezikaresources with lots of links to information about the virus.

Let us know what you think? Are the FAQs meaningful? Have we missed anything? We'll be updating the page as more information comes to light.


MRCP Part 1 practice question from Onexamination: spastic paraparesis

Posted in General clinical at Fri, 12 Feb 2016 03:30:08


Posts: 798
Joined: 21 Feb 2012

An 18-year-old female presents with a three day history of progressive weakness and numbness of her legs, urinary retention and back pain for two weeks following an upper respiratory infection.

On examination there is spastic paraparesis, sensory level up to T5, extensor plantars.

Examination of cranial nerves and upper limbs is normal. MRI of the spine is normal.

Should David Bowie have gone public?

Posted in Diabetes at Sat, 13 Feb 2016 03:38:10

Joey Rio

Posts: 985
Joined: 13 Apr 2011

The suggestion made elsewhere is that DB should have used his cancer to the promote anti-smoking campaign. But what if he had no overall regret ? As a columnist in the Guardian (again) pointed out that ,whilst recognising that alcohol had contributed to her cancer , she did not intend to stop drinking as this was a quality of life issue trumping pure length.

There is also the point that by apparently dying fairly suddenly the public did not have a chance to prepare themselves. Nor did the journalists have good time to do the write -ups in advance. That must have hurt.

I hope the medical profession is a long way from being obliged to release details about the health of prominent people becuase it is "in the public interest" . That should remain very different from "because the public is interested".

UK response to Assange judgement is depressing

Posted in Careers at Sun, 07 Feb 2016 17:40:09


Posts: 560
Joined: 14 Dec 2010

The UN team has spent some time weighing up the rights and wrongs of how Julian assange has been treated and on strong grounds has come to the conclusion that he should be released. As I gather he might well be anyway if the more recent relevant UK laws were applied retrospectively. UK and Sweden prefer to ignore international law.

The whole business seems somewhat malodorous - he is not charged with an offence under Swedish law - just "wanted for interview" which could easily have been carried out in the UK. The whole business seemed designed to expedite his exradition to the USA , which has a very limited view of justice in this respect and a very punitive approach to anyone who might have upset them.

It would be healthy for medicine and nursing  generally for whistleblowers if a conciliatory and compromise approach was adopted. Those readers of Private Eye will have seen recently - in some detail - how very critical a judge has been of the way in which the nursing hierarchy treated a whistleblower to the point of suggesting the evidence used against her was falsified her : the high court judge apparently felt "there had been "a crude attempt to frame her".

The message that one has an obligation to whistleblow in the knowledge that doing so is likely to lead to persecution , loss of employment and be generally destructive of family life is the wrong message.

Of course I am not suggesting investigation into a charge of rape should be dismissed but that should be a separate issue. Currently it seems that Sweden does not have the evidence to make a charge and is not primarily interested in that aspect of the overall case. 

PS John D - Yes , I have looked at the Guardian comments , but I think one has to view the UN jydgement as a whole.

Clinical question of the week: Gout in a patient with heart failure

Posted in General clinical at Tue, 09 Feb 2016 06:10:02


Posts: 798
Joined: 21 Feb 2012

When managing gout in a patient with heart failure, once their gout has settled, should you treat any asymptomatic hyperuricaemia? Should you treat to a target serum uric acid level, and if so, what is the target?

Your first rotation as a junior doctor

Posted in Student BMJ at Thu, 11 Feb 2016 17:39:20


Posts: 303
Joined: 29 May 2013

Student BMJ interviewed four doctors about their first rotations as juniors here. They shared their best and worst moments, key lessons they learned, and their recommendations.

What was your first rotation like?

High exercise levels do not require calories?

Posted in General clinical at Fri, 12 Feb 2016 22:09:28

Joey Rio

Posts: 985
Joined: 13 Apr 2011

There is a curious report in the Guardian to-day that light to moderate exercise use energy and burn calories but "people who do more than moderate activity had nothing to show for it in terms of increasing the energy they expended". Evidence is given that those with higher levels of activity do not have higher energy consumption. Note this is not referring to rates of energy consumption or to the rate at which a given task is performed but to overall calorie expenditure during exercise.

Just think what the equivalent would mean for the motor industry - drive a car hard enough and it no longer uses up the fuel....

Anyone read the original paper?

When your blood is not right

Posted in General clinical at Sat, 06 Feb 2016 22:13:03


Posts: 4
Joined: 26 Jan 2016


Today I've been provided with a case that is very interesting for me. It's a real one, so I do not want to give too much information. 

19 y.o. girl with anemia, hypotension, allergic to pretty much everything since the childhood. Leukemia and breast cancer in family.

The problem for her now is that she has too low number of erythrocytes with the large number of white blood cells. She doesn't have any significant sympthomes apart from feeling weak, but I link it to hypotension mostly.

Lately, she has been diagnosed with fibroadenoma, but it doesn't seem to be bothering. 

Changes in the numbers of blood cells (called here - sympthomes) are thought to have started 3 years ago. The thing that confuses me is that it came without any environmental changes. Normally, you could say that allergy could be behind it. However, since allergy was with her all the time, instnacy of sympthomes is quite interesting.

Moreover, she's been taking iron, but it didn't help at all. Erytrocytes level stayed the same. 

I am not hoping to find full diagnosis here, but I would like to be provided with some kind of advice. Do you have any theories?

I am especially curious about the fact of organism not reacting to iron and sympthomes occuring suddenly.

"market is flooded with gliptins we need to know the various aspects of this molecule.which gliptin is uniformly indicated"?

Posted in Diabetes at Thu, 11 Feb 2016 04:31:38

Joey Rio

Posts: 985
Joined: 13 Apr 2011

DR DIABETES- FOCUS ON gliptins for T2DM-which is safe and commonly used?is there is serious s/e like pancreatitis?



Just why does the Guardian fail to get the message?

Posted in Diabetes at Tue, 09 Feb 2016 10:56:16


Posts: 1253
Joined: 13 Oct 2009

This stems from an article in to-day's Guardian and one really has to think the messages of the last few and coming years has bypassed them along with the enormous potentials of new treatments. 

Recent articles pushing for all things for all people all the time is no longer realistic. The elderly are a case in point . Recently I had been having discussions with a prominent figure in USA healthcare who felt that maybe we are all spending too much on the elderly - yet within days I was reading how we need to provide care for all even when the causes are not primarily medical and covering obesity , old age and loneliness. The NHS cannot cope with all of Society's problems. At the same time an 85 year old died following a disastrous mix up over blood transfusion during an operation for aortic aneurysm. The family were wanting the doctor to be struck off and for them to receive enough compensation to care for the woman's elderly husband. Both the blood with the money coming from the NHS - and I wonder if the family had ever been blood donors. The point missed is that this level of surgery was scarcely envisaged at the start of the NHS and without she might have had a limited lifespan anyway.

Some years ago rationing of a number of drugs and services was accepted but now each attempt is followed by a public outcry. At the same time there is a level of affluence in Society scarcely envisaged when the NHS was founded. This week I met someone who needs injections to preserve her sight at £2,000= a time. Purists would argue that if it is not available to everyone on the NHS then she should not have this option but lose her vision. So who will fund these let alone the newer advances in looking at retinal stem cell transplantation which is just emerging ? It is the expensive treatments for common diseases that need to be weighed in the balance more than the expenses of one-off treatments for the rarities.This view is no longer tenable and increasingly it is becoming possible to buy better care - not just more convenient - heatlth care in certain specialties. This may well apply increasingly in the treatment for infertility.

Until opinion leaders such as the Guardian can engage in debate about exploring some of the underlying and fundamental issues about the provision of healthcare and affordability we may end by dismantling the NHS though neglect. It is time for a thorough review - and seeing the NHS as a religion with little regard for historical context is not a good starting -point. Perhaps we should start by recognising that some problems now seen as under the umbrella of medical care really need politicians to address what are problems in Society as a whole - taking on the food industry would be a good start.

DOI Strong supporter of an NHS - just worried that it will be dismantled for want of positive discussion and new ideas.

Are CQC inspections too stressful? Should they be abolished?

Posted in Careers at Mon, 08 Feb 2016 14:40:58


Posts: 1530
Joined: 07 Sep 2009

GPs at the BMA’s conference of local medical committees in London last week called on the BMA to campaign for the abolition of general practice inspection in England by the Care Quality Commission (CQC).



This piece from The BMJ reports that GPs are “living in a climate of fear because of inspections.” And that “80% of practices in a survey found preparing for CQC inspections very stressful,” and “80% of GPs said that they were more likely to want to leave the profession as a result.”



Who goes first?

Posted in General at Fri, 12 Feb 2016 11:31:43

John D

Posts: 3937
Joined: 01 Feb 2010
I have just finished reading a book called 'Who Goes First?: The story of self experimentation in medicine' by Lawrence K Altman
It was a fascinating read about pioneers of medicine who put their own body and safety first to test out new medicines, find out more about diseases or effect new procedures.  He cites many examples and ultimately gives thought to why such self experimenters used themselves as guinea pigs. We all know of Dr Marshall in Australia and Helicobactor Pylori and Werner Forsmann trying out cardiac catheterisation (initially he had been sacked but ultimately received the Nobel Prize for Medicine) but most of the others I had never heard off (but doc2doc Doctors may be more familiar). Some proved their point others were proven wrong.
For example:
Stubbins Ffirth was investigating the Yellow fever epidemic of 1793 which had killed about 5000 people, roughly half the population of Pensylvannia at that time. He felt sure it was not contagious and set about proving it. He decided to bring himself into direct contact with bodily fluids from those that had become infected. He started to make incisions on his arms and smeared vomit into the cuts, then proceeded to pour it onto his eyeballs. He continued to try to infect himself using infected vomit by frying it and inhaling the fumes, and, when he did not become ill, drank it undiluted. He  progressed on from vomit, and would go on to smear his body with blood, saliva, and urine. He still managed to avoid contracting the disease and saw this as proof for his hypothesis. However, it was later shown that the samples Ffirth had used for his experiments came from late-stage patients who were no longer contagious. He was wrong.
In 1886 Nicholas Senn pumped nearly six litres of Hydrogen through his anus into his bowel. The pressure through the inserted tube was monitored on a manometer.  He was attempting a diagnostic procedure to identify if a bullet had ruptured the GI tract. He had already tested this procedure on dogs and verified that the gas escaping from bullet wounds was hydrogen by setting it alight.
What do you think drove men to experiment on themselves. Nowadays it is frowned upon for perfectly good reasons but I wonder how modern medical colleagues would react to a Doctor testing out a dangerous procedure or drug on himself?

Zika and the Rio Games

Posted in General clinical at Fri, 12 Feb 2016 12:15:41

John D

Posts: 3937
Joined: 01 Feb 2010

International Journal of Infectious Diseases: Unexpected and Rapid Spread of Zika Virus in The Americas - Implications for Public Health Preparedness for Mass Gatherings at the 2016 Brazil Olympic Games

 “Mass gatherings at major international sporting events put millions of international travelers and local host-country residents at risk of acquiring infectious diseases, including locally endemic infectious diseases. The mosquito-borne Zika virus (ZIKV) has recently aroused global attention due to its rapid spread since its first detection in May 2015 in Brazil to 22 other countries and other territories in the Americas. The ZIKV outbreak in Brazil, has also been associated with a significant rise in the number of babies born with microcephaly and neurological disorders, and has been declared a ‘Global Emergency by the World Health Organization. This explosive spread of ZIKV in Brazil poses challenges for public health preparedness and surveillance for the Olympics and Paralympics which are due to be held in Rio De Janeiro in August, 2016. We review the epidemiology and clinical features of the current ZIKV outbreak in Brazil, highlight knowledge gaps, and review the public health implications of the current ZIKV outbreak in the Americas. We highlight the urgent need for a coordinated collaborative response for prevention and spread of infectious diseases with epidemic potential at mass gatherings events.”


What will Zika mean for the 2016 Rio Olympic Games?

To discharge or not

Posted in Cardiology at Sat, 13 Feb 2016 13:27:03


Posts: 560
Joined: 14 Dec 2010

In a patient with known prior CAD s/p stent, recent improved/ negative nuclear stress test 1 week prior for similar symptoms-presented with some 'atypical' chest pain(on sub-optimal anti-anginal therapy), no EKG changes, ctrop neg X2-chest pain free in ER. Should a patient like this be admitted for diagnostic cath/some other tests or be discharged on optimal medical therapy?To add to the dilemma-this happens on a Friday afternoon(if further work-up needed, pt will have to stay over weekend, with additional LOS/expense/inconvenience etc).

Mixing politics with medicine.

Posted in General at Thu, 11 Feb 2016 11:15:05

Joey Rio

Posts: 985
Joined: 13 Apr 2011

Local news this evening : woman in late 60s goes to hospital on a Friday evening with abdo symptoms , UTI diagnosed and she is allowed home. Dies over the week-end - perforated bowel. Coroner blames lack of CT facilities at a week end for her death but confirms "natural causes". 

Hospital tries to explain that for a UTI a CT not really indicated and the hospital does have CT facilities at the week-end anyway. Not sure whether the local BBC channel understood the relevance of this.

Not even clear that any mistake made but clearly it seems that the wrong point is being made.

Family already heading for a civil prosecution.

There must be a better way of trying to resolve what sounds like a tragic death ? I am left wondering whether the coroner's comments could have been influenced by a political policy currently in the news.


What your patient is thinking: Help make miscarriage less devastating

Posted in General clinical at Tue, 09 Feb 2016 13:12:28


Posts: 1530
Joined: 07 Sep 2009

In the latest What your patient is thinking piece from The BMJ, an anonymous author describes how it felt being told she'd had a miscarriage during her 12 week scan, waiting for the doctor in a waiting room full of expectant mothers, and responding to the doctor's curiosty about her job.

"Finally, after about four hours (it was a busy day) a young doctor led me into her office to talk through my options for how to end the pregnancy. I was trying to remain calm and not show how dreadful I was feeling so I smiled at her. She asked me what I did for a living. I was a radio producer, I told her. “Oh, that’s interesting”, she said, “is it hard to get your ideas made into programmes?” I tried to answer, but my mouth was dry and I was on the brink of tears. What I really wanted at that moment was someone who would reassure me, perhaps ask me if I wanted a hug."

Advice from the author: It matters where you wait;  a word of sympathy or silence is more welcome than small talk.

The author's experience occurred 13 years ago. Is communication/support following miscarriage different now?

As this is based on a patient-authored piece, The BMJ will be inviting patients to comment here. Please bear this in mind when responding.

Doctors strike - have your views changed?

Posted in Careers at Fri, 12 Feb 2016 17:45:21

John D

Posts: 3937
Joined: 01 Feb 2010

Difficult question for me and one has to tease out dislike of Jeremy Hunt as an influencing factor. Yet the way it is being portrayed must lose a certain amount of sympathy for the BMA. 13.5 % (I think that is the figure) pay rise on basic pay must make many employed folk envious. Perhaps those golden contracts from many years ago making overtime payments such a large proportion of income on some contracts were inappropriate - we should have concentrated on fighting for more doctors.

I also think the objections to Saturday working are open to criticism - I can see how Jewish doctors might object on religious grounds- but many doctors seem prepared to work Sats if extra pay is on offer. My impression is that many folk do now work on a Saturday , even if not "at work" in the usual sense. My limited experience of working Saturday clinics is that they were appreciated by many patients.

So more and more I am coming across the impression that this strike is now about the question of money and that public support is beginning to wane. Perhaps a "working to rule" will be more effective than further strikes. We need some form of resolution for future planning.

Those doctors interviwed who talk about "quitting medicine" - as opposed to moving elsewhere - certainly lose much of the sympathy which I had initially. Maybe they would not be able to take the coming pressures anyway.


"We have assumed the challenge to unionize" (...)

Posted in News & media at Thu, 11 Feb 2016 11:05:47

Jorge Ramirez

Posts: 49
Joined: 09 Jan 2015

A few weeks ago I wrote some posts about labour conditions for doctors in Colombia as well as the attention of doctors in this country to the events taking place in the UK.




Last year, several doctors trade unions in Colombia obtained legal approval. General practitioners created SIMUC (Sindicato Médicos Unidos de Colombia) on April 2015, on the meanwhile, each one of the medical specialities had created their own union. I believe that one of the most remarkable aspects to highlight about these newly created doctors unions in Colombia is the fluent communication between Colombian doctors to do written and spoken statements, individually and collectively, about the current situation of the health care system in our country. For example:

"Trade unions of general practitioners and specialists from Colombia: Open Letter

The labour unions of general practitioners and specialists from Colombia due to the serious and bothersome situation deteriorating our health care system, publicly denounce the following issues:

1. The purpose of the health care system is to cover the entire population with services provided under the principles of quality and opportuneness has not yielded the expected results.

2. The well-known limited flow of financial resources on behalf of the national government and health insurance companies (EPS – Health Promoting Entities) have limited payment of obligations to all the stakeholders in our national health care system. As a result, several hospital services such as emergency units and surgical rooms are now closed, many beds in hospitalization rooms have been lost. It is unnerving, disturbing and inappropriate the complete closure of pediatric services by hospitals and clinics (IPS) as well as by the EPS. This situation has happened without any anticipation of the consequences secondary to the improvisation by governmental authorities at local (i.e., cities, municipalities, and departments) and national level (i.e., health ministry).

3. Closure of hospitals, clinics, and health insurers have caused a widespread deterioration in the delivery of medical services, adversely affecting the well-being and the overall health status of our patients, even to the point of causing death in some unfortunate cases by provision of health care services with are untimely, ineffective, and delivered in shoddy installations with an insufficient number of well-trained of medical professionals necessary to do the job consisting on the primary, secondary, and tertiary prevention of human illnesses.

4. The overcrowding of installed capacity causes uncontrollable events resulting in a high psychosocial risk factor to do our medical profession, doctors are not only exposed to lawsuits or investigations of any kind (e.g., civil, criminal, ethical nature, disciplinary, etc) but also to physical and verbal abuses by grievers. Faced with this situation the EPS and IPS have not taken any corrective measures to guarantee their employees and contractors with the least guarantees of safety and well-being at the workplace, it can even be interpreted as setting up a form of labor deprotection steps, this situation have not been yet acknowledged by the ministry of labour without any intervention on behalf of healthcare workers across the country."

(Translation of points 5-8 of the letter in a consequent post - original letter in Spanish here: 

Here is a video in Spanish with English subtitles showing the president of SIMUC speaking at the clinic of Champagnat - Saludcoop Cali, Colombia. 


It will be very interesting to exchange ideas about some obscure situations that doctors face every day (e.g., violence, unemployment, reprisals from whistleblowing, etc) and how unions can effectively protect us.


New Science and Medicine Podcast

Posted in General at Sat, 13 Feb 2016 21:07:09


Posts: 1
Joined: 13 Jan 2014

There is a new podcast called 'Health Care X-Ray' featuring interview with experts on various aspects of medicine and innovation. Click here for a sample episode featuring Professor Philip Butcher discussing the his cutting-edge use of genomics in combating tuberculosis or please go to www.healthcarexray.com for further info.