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Poll archive

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


Posts: 671
Joined: 18 Mar 2014

I love the new poll feature, its a great way to see what everyone thinks on some of these issues. What do people think of creating a page with all the previous poll results on?

A decision at 17

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

Pat Harkin

Posts: 122
Joined: 26 May 2010

Looking back on it now I was a naive and vunerable teenager. I despised biology in school and yet a family acquaintance who was a psychiatrist persuaded me that a career in medicine was right up my street, that I had the intellect and charisma necessary for a career in same.


Once I was accepted into med school that same acquaintance disclosed how challenging they found medicine and that they would never advise such a career for any of their off-spring. 


Over the years the acquaintance always told me how "the clinical years would be better", "medicine is a broad church - you are bound to find something you like". And truth be told I haven't really - I enjoy interacting with patients, but I find that medicine and surgery isnt something really rivetting. The workload is challenging and despite the hours I put in I feel my grades dont reflect same.


One year shy of FY1 I'm unsure what best to do or how to proceed....................maybe many people face similar situations as med students........................

Does competency-based medical education make students incompetent?

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


Posts: 416
Joined: 23 Dec 2011

In a personal view in the BMJ Jonathan Glass attacks today's competency-based medical training, arguing that a tick-box approach to medical education "suppresses quality in medical students and discourages their personal development when the student is encouraged not to seek the wider experience, but simply to fill a book with signatures."

Glass has had enough of students knocking on his door, asking if they can perform a procedure because they need to sign it in their record book.

"The process suppresses quality in medical students and discourages their personal development when the student is encouraged not to seek the wider experience, but simply to fill a book with signatures," he says.

What do you think of today's focus on tickboxes and forms?

Words to ban in 2015

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

Pat Harkin

Posts: 122
Joined: 26 May 2010

For the fourth year running Time is asking readers which word or phrase should be banned in 2014 - previous winners have been OMG, YOLO (you only live once) and twerk (obviously not a terribly influential poll).

Its list of words is here two of which (bae and turnt) I have never even heard of!

  • Bae
  • Basic
  • Bossy
  • Disrupt
  • Feminist
  • I can't even
  • influencer
  • kale
  • literally
  • om nom nom nom
  • obvi
  • said no one ever
  • sorry not sorry
  • turnt
  • yaaaasssss

I find selfie in its "pure" form and all is variations - belfie etc - incredibly infuriating. I also hate "like" when it's used instead of "said" - ie, "I was like, is that what you mean? And he was, like, Yes..." I also find "leverage" very annoying - ie, "We want to leverage our position." I don't even know what it really means and I can't be bothered to find out! 

Do doc2doc-ers have any words to add to the list? 

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

Posted in Student BMJ at Tue, 16 Dec 2014 19:56:14


Posts: 671
Joined: 18 Mar 2014

Hello all,

I hope you're well.

Thank you for clicking on here and please contribute even if you say a word.

Must soon decide exactly where I should do my elective. Hopefully going with a good friend.

What are your reflections on where you went? Do you have any advice with regards to selecting an appropriate place?

A lot to chose from!



Feeding Birds: A Humane Gesture

Posted in General at Fri, 19 Dec 2014 20:48:28

Mukhtar Ali

Posts: 882
Joined: 14 Nov 2010

Feeding birds is a humane  act  and an immemorial  popular custom of  every society. For many, it is a thing of joy, the joy of inner and soul.

Are you bird enthusiasts?

Thanks for your input.

Feeding the birds:

Of course my heart is open to the birds

whose song may lift my soul both night and day.

Cheering better with their song than words

Could ever bring  happiness into play.

In feeding the birds I hope to attract

the small ones that twitter and tweet in tune.

I'm hoping the kindness in this small act

may cause my little feathered friends to croon.

My plan worked as well as any plan does

the garden is now full of pretty birds

but also attracts some far larger crows

and from our neighbours  some rather harsh words.

Into my feeders I fit a large scoop

and clean the car daily, it takes off the poop.


Should the performance data of individual doctors be published?

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


Posts: 1719
Joined: 08 Oct 2010

From today the NHS website  has started to publish the performance data of individual surgeons in 11 specialties. Two more specialties - neurosurgery and urogynaecology - will come online soon.

The data has been provided by surgeons' own specialty associations and patients can search for individual surgeons by name. I've had a cursory glance at the data and, as a patient, I would find it incredibly difficult to understand and work out whether the surgeon booked to do my operation had a higher risk or not. 

Critics of the plan have pointed out that the data does not show whether the procedures performed by individual surgeons are high-risk or not. 

John MacFie, president of the Federation of Surgical Specialty Associations, said the data published was crude and misleading.

"In reality ver few deaths can be attributed to surgical error alone and this data only attracts attentio away from institutional failings," he said. He told Radio 4's Today programme that there was anecdotal evidence that publishing this data has encouraged risk-averse behaviour among surgeons. 

But Bruce Keogh, himself a heart surgeon and medical director of the NHS, told the programme that publication of the data means that surgeons and patients now share the risk of the operation.

He said: "That really focuses the mind about the appropriateness of surgery for that particular individual and well functioning surgery groups will share between them that risk and ensure that the most appropriate surgeon does the operation." 


What's your favourite medical myth?

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


Posts: 283
Joined: 14 Dec 2010

A blog in the Guardian debunks various historical myths - that Catherine the Great had sex with a horse, that the suffragettes were a single homongenous group, that it is only in the last 20 years or so that women have worked.

So, I thought this might be a good thread to start on doc2doc: what is your favourite (or perhaps most hated) medical myth? 

Here are some of mine:

That we should rink at least eight glasses of water a day

We only use 10% of our brains

XXX causes cancer (usually courtest of the Daily Mail)

What medical myths make you laugh or seethe with anger?

Music to play in the operating theatre

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


Posts: 509
Joined: 23 Aug 2013

An article in the BMJ discusses which are the best songs to play in the operating theatre - surgically, anesthetically and recovery themed - and comes up with the following list

  • Stayin Alive (Bee Gees)
  • Smooth Operator (Sade)
  • Un-break my heart (Toni Braxton)
  • Comfortably Numb (Pink Floyd)
  • Wake me up before you go go (Wham)

And suggest avoiding the following:

  • Another one bites the dust (Queen)
  • Everybody hurts (REM)
  • Knives Out (Radiohead)
  • Scar Tissue (Red Hot Chilli Peppers)
  • Anything by House of Pain

Can you add any to either list? to the first I would add:

  • I close my eyes (Pretenders) - need to ensure the patient is asleep
  • Livin Thing (ELO) - to aim for
  • Novocaine for the Soul (Eels) - a reminder to the anaesthetist 
  • Get Lucky (Daft Punk) - when all else fails
  • Workin day and night (Michael Jackson) or Working all day and all night (Kinks) - for a really long procedure
  • Cigarettes and Alcohol (Oasis) - what the surgeon is looking forward to

And to the list of songs to avoid I would add:

  • Rip her to shreds (Blondie)
  • Play dead (Bjork) 
  • She's out of my life (Michael Jackson) - whoops
  • That's Not my Name (the Ting Tings) - I think we've got the wrong patient....! 

I could be here all day doing this.....!



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

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


Posts: 1
Joined: 18 Dec 2014

This week's poll idea comes from a post on another discussion thread about where to spend an elective. I'll quote medical student NCantley's comment in full.

He writes: "Electives themselves are an incredibly unethical framework that we are forced to use I'm afraid to say. The unethical scale is heightened 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 zero 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 on 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, don't 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."

Is Big Pharma not so evil after all?

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


Posts: 416
Joined: 23 Dec 2011

An opinion piece in The Times rushes to the defence of Big Pharma - it's written to celebrate the promising results of GSK's Ebola vaccine. 

The article is behind a paywall so here are a few snippets:

"Big Pharma can't win. Develop a drug and it is accused of making us sick so that it can profit from our misery.... It is a different story when, as with HIV drugs, the product turns out to be undeniably effective in which case Big Pharma is expected to distribute it free to everyone regardless of the billions it cost to develop. If companies cannot make a profit on the few drugs that turn out to work after exhaustive tests they will not raise the capital to develop any at all. 

"If Bob Geldof, Bono et al were forced to give away all their music and throw open the dorrs to their concerts fo free we wouldn;t have much of a music industry. The same is true with Big Pharma."

What do you think? Does the author have a point or is he being too simplistic? 


ECG question

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


Posts: 670
Joined: 21 Feb 2012

This is the ECG of 50 years old man presented with palpitation and chest pain

What abnormalities that can be detected ?



Do you find mother Teresa unethical?

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


Posts: 509
Joined: 23 Aug 2013

Mother Teresa has been credited for humanitarian works in slum areas. Christopher Hitchens casted doubts on her secret agenda, in a report named 'Hell's angel'. Recently a group of Canadian academics reached similar conclusions regarding the possibility of fraud in her work.

I wonder whterh you find mother Teresa's work a contrubution to humanity or a fraud.

Should sterilization camps be discontinued in India?

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

John D

Posts: 3361
Joined: 01 Feb 2010

The recent sterilization deaths of women in Chhatisgarh have invoked discussion on whether mass sterilization through camps are a fair and approrpriate approach. 

Read here articles in The BMJ on the issue (free access): http://www.bmj.com/content/349/bmj.g7509/related


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: 3361
Joined: 01 Feb 2010

The Christmas issue of the BMJ includes another review, of song lyrics, entitled "Healer, dealer, heart stealer" http://www.bmj.com/content/349/bmj.g7179

The thesis seems to be that singers, songwriters and not just of the rock'n'roll persuasion, don't like doctors.  That is their concluson and they have lots of quotes to back it up.

But hang on.   What about that good old trad number "Hello Central, give me Dr.Jazz!"  https://www.youtube.com/watch?v=HTYAaX7lqjQ                                                                                                  

Hello Central give me Doctor Jazz/  He's got what I need, I'll say he has/   Whnn the world goes wrong and I've got the blues/ He's the guy who makes me/ Put on both my dancin' shoes

Got any other Dr.Feelgood lyrics?



What is the diagnosis?

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


Posts: 4
Joined: 13 Nov 2014

This is the CXR of a 55 years old man C/O chronic cough, heartburn  and weight loss

What is the diagnosis ?


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: 3361
Joined: 01 Feb 2010

When you decide on a course of treatment for a patient do you consider the financial implications? 

If you are deciding on a drug or a therapy do you consider its cost or does evidence and what is best for the patient trump everything? If you had two similarly appropriate treatments would you go for the cheaper option? 

Answers will depend on the country you practice in, your specialty and your level of seniority but it's an interesting question and one that NHS doctors at least will have to consider more in the coming years.

Are men more idiotic than women?

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


Posts: 416
Joined: 23 Dec 2011

I'm just taking cover after posing that question....!

This thread is inspired by one of the BMJ's legendary Christmas papers which looks at sex differences in idiotic behaviour. Researchers studied the Darwin Awards which each year honours the person who has killed themselves in the most idiotic manner possible. 

Researchers looked at the previous winners over a 20-year period and found that men made up 88.7% of Darwin Awards winners hence proving the "male idiot theory."

Does this prove that men are more idiotic than women?! 

This has been one of the most viewed BMJ papers ever with around 250,000 page views! 


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: 3361
Joined: 01 Feb 2010
A number of times on doc2doc we have discussed religious issues and medicine and particularly whether Doctors should be overt about their beliefs - e.g. Wearing religious dress or their religious views influencing their practice. The links below are very interesting and I am curious about how it is received here. A Cardiologist in the US is a committed Christian and truly evangelical in his quest to bring God to the sick. I am an atheist and find his interview somewhat sickly and dislike the way he prays over patients and speaks in tongues over patients in extremis.
He sites several examples but attracted attention when he claims a man had been in cardiac arrest for over 30 minutes and was declared dead. The Doctor claims that that The Lord told him to pray over the dead man, which he did. He then claims that the grossly cyanosed man with fixed dilated pupils then raised his hands and feet and came back to life!!! He does not say if the patient was e.g. Hypothermic or any other medical reason why the patient might have seemed dead.
He comes across as a very decent and kind man but is it right that he prays over patients and tries to bring them to God?
The links are not long. Apparently he now has a booming practice and has many religious people as patients (who probably don't mind the religious aspect). I dislike the titles of the videos but of course on the God channel things are interpreted in certain ways. The interviewer is a well known televangelist who has made some peculiar statements over the years - e.g. That the New Orleans floods were a message from God that he doesn't like homosexuals. He also is persistently trying to get money from viewers to fund a very lavish lifestyle by selling books, dvd's etc.
Is there anything wrong with praying over/with patients? Would he be happy if he was ill and e.g. an Imam preached Islamic prayers over him? 
Am I just cynical?
There are two short videos, the second one is worth watching if you can bare it.

Should obesity be classed as a disability?

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


Posts: 283
Joined: 14 Dec 2010

The European Court of Justice has ruled that obesity should be classed as a disability if it hinders "full and effective participation" in the workplace.

The case was brought by a Danish nursery worker who claims he was sacked because of his weight (around 25 stone). His employers say he was sacked because of a reduction in the number of children coming to the nursery.

A lawyer told the BBC that employers might have to make changes to workplace such as improving access to accommodate obese workers. 

Health campaigners have not welcomed the ruling with Jane Deville Almond, chair of the British Obesity Society, telling the BBC that the ruling was "implying that people have no control over the condition, rather than something that can be greater improved by changing behaviour."

What do you think?

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

The case below was printed in the BMJ's Endgames section a few years ago. I'll print the anwer in a couple of days.

A 37 year old man presented with a sensation of weakness, irritability, and poor concentration. His blood glucose was 2.4 mmol/L (reference range 3.6-11; 1 mmol/L=18.02 mg/dL). Three months earlier he had noticed a craving for sweets and episodes of weakness, sometimes associated with foggy sensorium.

He felt cold, clammy, and fatigued during these episodes and his wife noticed that he acted strangely and had no memory for long periods. After drinking large amounts of cola he felt better and had gained 30 lb (13 kg) in weight during this time. His symptoms recurred when he had not eaten for several hours, particularly at night and in the early morning.

Several days before his current presentation, he had presented to another hospital with similar symptoms and was found to have a blood glucose of 2.6 mmol/L. He responded well to dextrose infusion and was discharged home.

His medical history was unremarkable except for an umbilical hernia repair and back surgery 10 years earlier. He was taking no prescription or over the counter drugs. He did not smoke and drank beer socially. He denied taking illicit drugs. His family history was positive for diabetes but he had not been diagnosed as having diabetes.

On arrival his blood pressure was 124/76 mm Hg, pulse was 94 beats/min, and respiratory rate was 18 breaths/min. He was confused, cold, and clammy. Examination of the rest of the neurological system; skin; joints; and cardiovascular, respiratory, and abdominal systems was unremarkable.

His haemoglobin, white blood cell count, and platelet count were in the normal range. Sodium, potassium, urea, creatinine, and liver panel results were normal. Glycated haemoglobin was 5% (31 mmol/mol). He responded to a dextrose infusion and was admitted for further investigations.

Should female soldiers serve on the front line alongside men?

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


Posts: 416
Joined: 23 Dec 2011

Defence secretary Michael Fallon has announced that women should be allowed to serve in the infantry for the first time. This would mean that they would see active service.

Mr Fallon said military roles should be "determined by ability not by gender" and that arguments that women lack the killer instinct and that they would undermine the cohesion of a unit have to be put to bed.

However, some have said that women are not physically capable of serving alongside men and would not pass the battle fitness test where they are expected to pick up another man and carry him 200 metres.

What do you think?

Should obesity be classed as a disability?

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


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?

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

Posted in General clinical at Fri, 19 Dec 2014 15:48:07


Posts: 2
Joined: 19 Dec 2014


For more detailed case discussion please visit www.jssmcradiology.com 

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

Posted in Radiology at Fri, 19 Dec 2014 15:44:18


Posts: 2
Joined: 19 Dec 2014


For  detailed case discussion please visit  www.jssmcradiology.com