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The most viewed discussions on doc2doc this month

Fears of the Spread of new Viruses

Posted in General at Fri, 28 Aug 2015 14:33:31

Mukhtar Ali

Posts: 1009
Joined: 14 Nov 2010

One of the serious health hazards of Globalization is the spread of the viral infections. Wendy Barclay Professor at Imperial College London, comments about viral infections are very valuable. “We will never be able to eradicate viruses, but by understanding them better, we can develop new vaccines, antiviral agents and good strategies to minimise their harmful impact”

Read more here about fears of the spread of a new respiratory virus.http://www.bbc.co.uk/news/health-21442519


Am I Mad? Considering quitting Core Medical Training

Posted in General at Wed, 26 Aug 2015 13:55:37


Posts: 1
Joined: 06 Feb 2011

Hey all, 

Just posting here to see the opinion of my colleagues here since I am worried if my thought process is getting confused or if I am turning just tired of work and not seeing the big picture.

I have just started (Aug 2015) my Core Medical Training Year 2, and to be honest I don't enjoy the work at all since core medical training year 1. I feel overworked,  underpaid,  unappreciated and unfortunately demoralised.

Am I mad of thinking of quitting this non sense and just going to be a Locum SHO and thereafter a Locum reg forever ?? 

By being a locum SHO now I can earn what a consultant earns right now, and that without any weekend on calls and no night on calls and the same time enjoying life, taking holiday when I need, and for how long I feel and "living so called better life financially". I obviously appreciate being a locum SHO is exact same job, however, no on calls, no nights , no weekends (since I decide what shifts I want to do), I appreciate that its less secure.

However, in comparison after my foundation training I did a year of Locum work and Masters Degree in Cardiology (My passion is cardiology and I LOVE cardiology) and truly enjoyed it, obviously it is a headache moving hospitals every now and then. However, I was working around 6-8 days max a month, and I did then 12 hour admission shifts and I was making more what I currently earn as a trainee doing much more work. And when I did normal working hours Monday to Friday I was earning substantially more than now.

Not that I care sooooo much about money, but the locum work took away nights, weekends,  etc and give me longer holiday and more flexible life, more quality time with family and friends, and amazingly enough the consultants were much more appciative of my work.

Am I being mad and not thinking right for the long term by thinking to go all the way locum forever, or is it being a trainee medical registrar and thereafter a consultant a better life?

Mark "better life" is the most important for me, hence I have also thought about going to Australia or New Zealand, however I am not sure if it truly better or if I am living a delusion  "that it's greener on the other side”. 

My dream is to become a cardiology consultant, but not at the cost of happiness and quality of life.

I would be grateful for all your thoughts, and I hope I don't sound like I am moaning, its rather I am trying to see if the map I am fellowing at the moment will get me to my destination, 


Gun technology - what is acceptable to the American people?

Posted in News & media at Thu, 27 Aug 2015 13:29:03


Posts: 1596
Joined: 09 Dec 2011

A self-aiming rifle has been announced.   An American company, XactSystems, is marketing the TrackingPoint, Precison Guided Firearm (PGF) rifle:

This weapon is laser guided, in that once it is 'locked onto' its target, it then calculates the best moment to fire, based on the way the shooter holds it, wind speed, barometric pressure and temperature(air density) as well as the range to the target.   The only impediment is the price.  At $22,000 it's not a Saturday Night Pistol, and, as Duane has taught us, the manufacturers will inform the Federal liicencing system of who buys one.  But this gives anyone capable of lifting the device the ability to kill humans from three quarters of a mile away, and as we have established before, it could be sold on to anyone, without telling the Feds.
If, as we should, we recognise the right of Americans to decide if they should be armed or not, this then raises the question, what with?    Automatic weapons, extra large magazines, very high powered ammunition and now this, which in the wrong hands can make anyone a expert sniper.  To quote the website, "Using the PGF, you can be an elite, long-range marksman in minutes.

Inevitably, i appeal to Duane to explain what Americans think and why.   


Where do you stand on e-cigarettes?

Posted in Public health at Mon, 31 Aug 2015 07:58:16

Tim Webb

Posts: 4
Joined: 21 Jul 2015

According to this feature from The BMJ, the public health community is divided in its opinion on e-cigarettes:

Deborah Arnott, chief executive of the UK charity Action on Smoking and Health (ASH):

“Do you want the tobacco industry to carry on making cigarettes which are highly addictive and kill when used as intended, or do you want them to move to a product which is much nearer licensed nicotine replacement therapy and is unlikely to kill anyone?”

Kevin Bridgman, chief medical officer of BAT’s electronic cigarette company, Nicoventures:

“Regulators should resist the urge to apply highly restrictive measures that would have the perverse effect of prolonging cigarette smoking.”

Simon Capewell, professor of public health and policy at Liverpool university’s Institute of Psychology, Health and Society:

e-cigarettes should be “subject to the same controls as tobacco” and that the benefits of fewer people smoking must be weighed against “the risk of electronic cigarettes leading to more people starting to smoke, particularly children.”

Fifty six specialists in nicotine science and public health policy in a complaint to the director general of WHO in May 2014

The “critical strategy” of harm reduction has been “overlooked or even purposefully marginalised.” Harm reduction is “part of the solution, not part of the problem.”

One hundred and twenty nine public opposing experts —organised by the director of the WHO Collaborating Centre on Tobacco Control and American Legacy Foundation distinguished professor of tobacco control at the University of California:

It is “fundamental” that WHO and other public health bodies do not “buy into the tobacco industry’s well-documented strategy of presenting itself as a partner.” If it were serious about reducing tobacco harm, it would stop manufacturing cigarettes, “rather than adding e-cigarettes to its product mix and rapidly taking over the e-cigarette market.” By moving into the market, the tobacco industry was “only maintaining its predatory practices and increasing profits.”

Gerry Stimson, former director of the department of social science and medicine at Imperial College London

E-cigarettes and other nicotine delivery systems have “huge potential . . . to help shift people away from smoking.” But “the quandary for many public health experts . . . is that the solution to smoking might well lie with the much reviled tobacco industry.”

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine:

There is no doubt that tobacco companies are entering the e-cigarette market “solely so they can say they are part of the solution.”

“Greatly dismayed” by ASH’s support for e-cigarettes. There is still no evidence that e-cigarettes are effective in helping people to quit smoking, with recent studies indicating that smokers who used them might even be less likely to quit than those who did not.

Where do you stand?

Body cams for Doctors

Posted in Medicolegal at Wed, 26 Aug 2015 11:24:07


Posts: 299
Joined: 29 May 2013
Jeremy Brown MD is Director of the Office of Emergency Care Research at the National Institutes of Health in the US and asks whether Doctors should wear body cameras just as Police Officers are now doing?
This short article is from 'Emergency Physician Monthly'.
It is an interesting suggestion which he thinks might help when defending malpractice claims and reduce violence. It does of course raise many issues including ethical concerns. Any thoughts?

Retirement/part time

Posted in General at Sun, 30 Aug 2015 19:26:19

John D

Posts: 3695
Joined: 01 Feb 2010

I would like to hear from our retired Doctors here about the transition from full time practice to retirement. I am in a position of being able to end my current job and just do consultant work periodically. But, I love my work and everything that goes with it. Of course it has aspects that are frustrating but on the whole it is very satisfying.

What was it like to stop full time practice where you were in a responsible position?

Do you wish you had gone part time if it were possible?

Would you like to have kept on working?

What have you done in retirement?

Have you kept in touch with medicine?

(I would not strictly be retiring as too young but cutting down).


Requesting legal advice: whistleblowing and political abuse of psychiatry

Posted in Medicolegal at Mon, 31 Aug 2015 08:48:48

Jorge Ramirez

Posts: 31
Joined: 09 Jan 2015

Dear members doc2doc,

My story is summarized in this release to the public opinion by the league of users from Caprecom (Valle del Cauca, Colombia). 


For users proficient in the Spanish language, I recommend this post by No Gracias:  Loca de Rebeldía

I recently commented here about physician suicide, whistleblowing, human rights, and other topics.

I think that all cases involving the reprisals of whistleblowers are complex and difficult. I have read some posts here on doc2doc about whistleblowing and how it should be effective. There are many recommendations for whistleblowers which are described throughly with great detail in the website of Brian Martin (bmartin.cc) - without doubts, the website of Brian was my best resource for effective whistleblowing. After all the events that happened to me during the last two years (i.e., whistleblowing reprisals), I just know one big thing [that's the reason why I'm writing this post (*)]: I can't resist only by myself, I would kindly appreciate some support and legal advice. Please be aware that the context of the region in which this take place is very complex. Currently, there is an ongoing peace process in the middle of a complex political scenario in the country. But, I am also aware that there are many places with similar conditions to Colombia - or much worst in terms of the current arm conflict - here the intensity of the arm conflict has been decreasing - I am quite optimistic, but aware that the resolution & complete reconciliation between the population will take a long road ahead - 


However, there is another civil war which I don't really now where the situation of academic freedom is worst (UK or Colombia). Well, I also think it perhaps depends on the specific situation involved. 


In Colombia, psychiatrists could take out a Ph.D degree and replace it with a label of mental illness. Involuntary placement and psychiatric hospitalization is torture and violation of the principles of autonomy in the medical ethics.

The drug suggested to treat my "mental illness" was quetiapine - a very bad idea.


Es un tema abstruso:

Do human and animal rights really exist?   

This is an scenario of corruption and regular violations of human rights in healthcare.

I am wondering about the actions that could be taken to the international law.

I know several cases of healthcare professionals and students (pre- postgraduate) that have been abused by psychiatry.


Widespread violation of the principle of autonomy (medical ethics). 

Hospitals in economic crisis in different cities of the Country with several stopped investigations involving kickbacks.

Asunto: Investigaciones por corrupción en el Hospital Universitario del Valle – Derecho de Petición

This is for anyone willing to start learning Spanish (he escuchado que la empatía comienza con entender el lenguaje de los demás).

The person who wrote this note was calling out my name in a group network of over 17000 physicians from Colombia. 

P.D. Soporta la evidencia la información escrita en este corto comentario? (referencia 3)

(*) Texto producto de captura de pantalla + anonimízación de la fuente (no es necesario hacer un calling-out aquí).

En la página web cáotica encontraran suficientes calling outs (ej. rector de la Univalle, Director del Hospital Universitario del Valle, Vicedecano de Investigaciones Univalle (periodo 2014), funcionarios también de Icesi y otras entidades (ej. IETS - creado como una analogía al NICE del Reíno Unido). 

Muchas gracias.



1. Roddick John. The key to effective whistleblowing is interprofessional collaboration BMJ 2009; 339 :b305 http://www.bmj.com/content/339/bmj.b3055

2. Bent science http://disruptedphysician.com/2015/02/28/bent-science-and-bad-medicine-the-medical-profession-moral-entrepreneurship-and-social-control/

3. Linkedin or http://chaoticpharmacology.com/about/

4. Stop calling people out https://hbr.org/2014/10/stop-calling-people-out/

5. Prices of new medicines threaten Colombia Health care reform  http://chaoticpharmacology.com/2015/02/04/prices-of-new-medicines-threaten-colombiass-health-reform/

6. Absolute English http://aeon.co/magazine/science/how-did-science-come-to-speak-only-english/

7. The importance of 2nd languages http://doc2doc.bmj.com/forums/off-duty_general_importance-of-2nd-languages?plckFindPostKey=Cat:OffDutyForum:GeneralDiscussion:cc32ef38-6976-48e6-bcf6-bb8dc249147bPost:818d04d4-8d54-4aae-ade9-bafd30dbc353

8. http://www.madinamerica.com/2015/04/forced-psychiatry-torture/

9. (*) James C. Coyne. Hat tip: The parable of the Fox and the Hedgehog. 


Are UK junior doctors right not to re-enter contract negotiations with the government?

Posted in Careers at Wed, 26 Aug 2015 11:03:54


Posts: 9
Joined: 10 Jun 2015

The UK's junior doctors' committee has decided not to re-enter negotiations for a new contract for doctors in training. Co-chairs of the BMA committee, Andrew Collier and Kitty Mohan, explain why here:

The forthcoming paradigm of psychiatry

Posted in Psychiatry at Thu, 27 Aug 2015 07:58:34


Posts: 1871
Joined: 08 Oct 2010

In an inspirational TED talk Dr Thomas Insel speaks 'Towards a new understanding of mental illness'. It seems that in the next couple of decades might look brighter in terms of evidence-based diagnosis.

I wonder whether you think this would be feasible.

Restarting work after maternity - what are your tips?

Posted in Medical mums at Sun, 30 Aug 2015 09:52:26


Posts: 1
Joined: 03 Feb 2009

Next week I'm restarting work after a year of maternity leave (+ 8 weeks of annual leave) for my first child. I'm thankfully restarting at the point in the year when all the trainees rotate, so we'll all be new together and I'll get a full induction. I was wondering what tips the other medical mums & dads can offer on restarting work, how to get back upto speed and how to cope balancing work, baby & e-portfolio?

Clinical question of the week: should RBBB be an indication for primary PCI?

Posted in Cardiology at Mon, 31 Aug 2015 07:52:49

Tim Webb

Posts: 4
Joined: 21 Jul 2015

In a patient with symptoms suggestive of acute myocardial infarction, a new-onset left bundle branch block (LBBB) is considered an indication for reperfusion therapy i.e. primary percutaneous coronary intervention (pPCI) or thrombolysis. In contrast, a new-onset of right bundle branch block is not considered as an indication for administration of reperfusion therapy in this context. The question arises: 

#rsjc journal club: Incidental findings on chest CT imaging (Thorax)

Posted in Respiratory medicine at Fri, 28 Aug 2015 22:35:14


Posts: 2
Joined: 24 Aug 2015

We are excited to invite you all to participate in advance or during (depending on the time zone) on our respirology and sleep online twitter journal club (@respandsleepjc) #rsjc this week where we will be discussing the recent Thorax BMJ article by Jairam et al on "Incidental findings on chest CT imaging are associated with increased COPD exacerbations and mortality".  (http://thorax.bmj.com/content/early/2015/05/29/thoraxjnl-2014-206160.abstract)

It will be held  on THURSDAY August 27, 2015 starting at 7pm EDT (midnight BST)

Every month we discuss 1-2 articles on this journal club with participation world wide. Often the authors participate too! If you have any advance points of discussion, questions or comments feel free to post them starting at noon EDT on August 27th on the twitter feed. Please include #rsjc in all your comments so that others can see them too. If you are in Canada this is a Royal College accreditied S1 activity for MOC credits but you must tweet your attendance to participate. 

For those interested who do not have (and may not want) a twitter account please send any comments or questions to this thread....we will do our best to reply to them all!


Thanks again, Anju Anand MD FRCPC Respirology & Sleep Medicine moderator and creator of @respandsleepjc #rsjc

Aphantasia: a real disorder or a fantasy?

Posted in Psychiatry at Fri, 28 Aug 2015 17:11:06


Posts: 1596
Joined: 09 Dec 2011

The BBC Health reported a case of aphantasia; describing a man who cannot visualise or form imagery.The only reference cited is from Cortex journal a letter to the editor named lives without imagery; congenital aphantasia. doi:10.1016/j.cortex.2015.05.019

I wonder how much syndromes can be built on single case reports, and I have my concerns about such labels, and whether these would have any significant clinical implication or not. I am not sure I have encoutnered any case of 'aphantasia' I am a bit curious about your practice whether you met with cases that would qualify to this disorder or not.

Pros and cons of doc2doc

Posted in doc2doc feedback at Mon, 31 Aug 2015 15:27:30

Mukhtar Ali

Posts: 1009
Joined: 14 Nov 2010

BMJ is considering changing the way it provides community. Your opinion on this is very important so please answer the questions below with as much detail as possible.

Many thanks


1.     Would you prefer BMJ to provide a separate website dedicated to community (like doc2doc) or to provide the ability to post instant, unedited comments (like some daily newspapers)

2.     Which aspects of doc2doc do you like and want to keep?

3.     Which aspects of doc2doc would you want to get rid of or change?

4.     What new features would you like to see?

5.     Would you like us to highlight things we think you would like based on what you have clicked previously?


All comments welcome.

Interesting ECG

Posted in Cardiology at Fri, 28 Aug 2015 06:30:36


Posts: 737
Joined: 21 Feb 2012

This ECG strip was taken from a patient at rest, what is the diagnosis ?

ACC/AHA Cholesterol Guidelines Found Efficient and Cost-Effective

Posted in Diabetes at Wed, 26 Aug 2015 19:34:15


Posts: 759
Joined: 15 Apr 2011

Physician's First Watch

July 15, 2015

By Cara Adler

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The 2013 American College of Cardiology/American Heart Association cholesterol guidelines improve detection of individuals at increased risk for cardiovascular disease, a JAMA study finds. Moreover, the guideline's 10-year CVD risk threshold for primary statin treatment is cost-effective — and could even be lower — another JAMA study suggests.

Among more than 2400 adults not on statins at the start of a community-based cohort study, 39% were eligible for statins using the ACC/AHA criteria, compared with 14% using criteria from the 2004 ATP III guidelines. During roughly 9 years' follow-up, the risk for incident CVD in patients eligible for statins versus noneligible patients was significantly higher when applying the ACC/AHA criteria (hazard ratio, 6.8) than with the ATP III criteria (HR, 3.1).

In a separate simulation study, researchers found the ACC/AHA guideline's 7.5% 10-year CVD risk threshold for initiating statins had an "acceptable" incremental cost-effectiveness ratio of $37,000 per quality adjusted life-year (QALY) compared with a cutpoint of 10%. (Commonly used cost-effectiveness values are $50,000–$150,000 per QALY.) However, if the cost-effectiveness ratio were $100,000 per QALY, a 4% cutpoint would be optimal.

Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "These studies further support the wisdom of transitioning the guidelines from a focus on cholesterol levels to the level of the patient's risk. It is also important to remember that the guidelines are broad recommendations and each decision depends on the preferences of each individual patient."


JAMA article on cost effectiveness (Free abstract)

JAMA article on statin eligibility and incident CVD (Free abstract)

JAMA editorial (Subscription required)

ACC/AHA CV Risk Calculator (Free)

COMMENT: We have had a number of posts on the subject of the value of the new guidelines and the cost-effectiveness of increasing the number of people who should be put of statins.  The two papers discussed in this post add significant data both to the preventative value of using the new risk-based guidelines versus the old LDL-based guidelines.  Taken together these papers provide strong evidence that  the new guidelines provide a cost-effective means for preventing future events

Nurse or Doctor?

Posted in General clinical at Sat, 29 Aug 2015 12:15:15


Posts: 1596
Joined: 09 Dec 2011
Medicine has changed dramatically over the years with new drugs and treatments revolutionising the way patients are cared for. With that has come an overhaul in the way staff work. In particular, the demarcation between doctors and nurses. What was once the preserve of doctors - prescribing drugs, ordering x-rays, referring patients and diagnosing - is now also done by many senior nurses who have had extra training. They go by a variety of titles from nurse consultants and clinical nurse specialists to nurse practitioners. Some specialise in a particular condition - diabetes or heart disease for example - while others coordinate care in A&Es and or community settings. Go to a walk-in clinic or minor injury unit and the chances are you'll be seen by a nurse. Some GPs also use nurse practitioners to ease their workload by carrying out consultations.
Matt Hodson is a nurse consultant who specialises in respiratory disease. He has a masters and doctorate and leads a team of specialists who provide care in the community and in hospitals in east London. Unless a patient has an emergency, they need never see a doctor - something the public still does not fully appreciate. "Before we started, patients either saw their GP or went to hospital," he said. "But now we are able to look after their needs - we can refer, prescribe, give clinical advice. "If problems flare up we can provide oxygen or a nebuliser. These are the sort of things traditionally done in a hospital but there is a lot nurses can do," added Mr Hodson.
(extracted verbatim from the BBC website)
What is your opinion/experience of Nurse Consultants/Advanced Nurse Practitioners? Would you be happy to be seen by an ANP rather than a GP? How far can it go?  

BMJ Open journal club: are GP-led walk-in centres effective?

Posted in General clinical at Fri, 28 Aug 2015 10:38:22

Emma Gray

Posts: 2
Joined: 25 Aug 2015

A paper recently published in BMJ Open, by Arain et al, takes a look at the perceptions of healthcare professionals regarding the effectiveness of GP-led walk-in centres in the UK, and the impact that these centres may have on other urgent care services.

Despite health services in the UK being overstretched, the authors found that the presence of the walk-in centre did not have an effect on the demand on emergency department services. Many participants interviewed for the study felt that the centre was just duplicating already existing healthcare services. This may be due to a lack of public awareness of the service; inappropriate use of the centre; or public confusion as to the function of the service.

What do you think can be done to increase the effectiveness of GP-led walk-in centres? Are they a useful part of the urgent care system?


More information about this article:


Objectives This study aimed to identify the perceptions of healthcare professionals regarding the effectiveness and the impact of a new general practitioner-led (GP-led) walk-in centre in the UK.

Setting This qualitative study was conducted in a large city in the North of England. In the past few years, there has been particular concern about an increase in the use of emergency department (ED) services provided by the National Health Service and part of the rationale for introducing the new GP-led walk-in centres has been to stem this increase. The five institutes included in the study were EDs, a minor injuries unit, a primary care trust, a GP-led walk-in centre and GP surgeries.

Participants Semistructured interviews were conducted with healthcare providers at an adult ED, an ED at a children's hospital, a minor injuries unit, a GP-led walk-in centre, GPs from surrounding surgeries and GPs.

Results 11 healthcare professionals and managers were interviewed. Seven key themes were identified within the data: the clinical model of the GP-led walk-in centre; public awareness of the services; appropriate use of the centre; the impact of the centre on other services; demand for healthcare services; choice and confusion and mixed views (positive and negative) of the walk-in services. There were discrepancies between the managers and healthcare professionals regarding the usefulness of the GP-led walk-in centre in the current urgent care system.

Conclusions Participants did not notice declines in the demand for EDs after the GP-led walk-in centre. Most of the healthcare professionals believed that the GP-led walk-in centre duplicated existing healthcare services. There is a need to have a better communication system between the GP-led walk-in centres and other healthcare providers to have an integrated system of urgent care delivery.

Link to the full text article: http://bmjopen.bmj.com/content/5/8/e008286.full

Extra Interesting ECG

Posted in General clinical at Mon, 31 Aug 2015 13:07:35


Posts: 737
Joined: 21 Feb 2012

This ECG taken from 35 years old male patient  in the A&E following a collapse, what does it show ?


That e-petition, asking for a no confidence debate on Health Sec. Hunt

Posted in News & media at Wed, 26 Aug 2015 17:03:39

John D

Posts: 3695
Joined: 01 Feb 2010

You may recall the e-petition asking for a no confidence debate in Parliament on Secretary of State for Health Hunt.  And that the 'tariff' for such petitions is that 10,000 signatures will "get a response from the Government" and 100,000 "will be considered for a debate in Parliament".   The "No Confidence in Hunt" petition got over 200,000, and this ws the response:

The Government has responded to the petition you signed – “To debate a vote of no confidence in Health Secretary the Right Hon Jeremy Hunt”.

Government responded to all who signed the petition this:

The Government is committed to delivering seven day services to make sure that patients get the same high quality, safe care on a Saturday and Sunday as they do on a week day.

Many people do not realise that if you are admitted to hospital on a weekend, you have a 16% greater chance of dying. The Government wants to change this so that everyone can be confident that they will receive the same level of care whatever day of the week they are admitted to an NHS hospital. 

NHS consultants already provide an outstanding service and show great dedication to ensuring patients get the best outcomes. But the Government has a duty to make sure the system is set up in a way which makes it as easy as possible for hospitals to organise their resources to maximise patient safety across every day of the week.

To understand more about the possible issues for staff contracts, last year the government asked the independent pay review bodies for NHS staff - The Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB) for their observations and recommendations about how the reform of employment contracts could help support the delivery of seven day services in England.

The reports were published this month. They identified that a major barrier to seven day services is a decade old contractual right in the consultants’ contract negotiated by their union representatives in 2003 that allows senior doctors to refuse to work non-emergency work in the evenings, at nights and at weekends. No junior doctor, nurse or other clinical group has any such right. Other senior public sector professionals who work in services required to keep the public safe, such as police officers, firemen and prison governors, do not have this opt out either.

Whilst the vast majority of consultants work tirelessly for their patients, the opt out allows individuals to charge employers hugely expensive payments which are much higher than national contract rates (up to £200 an hour). The average earnings for a hospital consultant are already in the top 2% in the country at £118,000, and these inflated payments can make it difficult for hospitals to provide the weekend cover they know patients need. 

The report endorsed the removal of the opt out, as well as broadly supporting other changes to the consultant contract that would ensure the right level of cover is available every day of the week; not just Monday to Friday.

Under the new plans, doctors will still continue to receive a significantly higher rate for working unsocial hours and there will be a contractual limit (not an expectation) of working a maximum of 13 weekends a year.

By the end of the Parliament, the Government hopes that the majority of consultants, in line with existing practice for nurses, midwives and junior doctors, will be on reformed contracts, working across seven days, to deliver a better service to patients. Hospitals like Salford Royal and Northumbria that have instituted seven day services have already seen improvements in patient care and staff morale.

These new plans will mean that doctors working in some of the toughest areas in the NHS, such as A&E and obstetrics, will at last be properly rewarded and there will be faster pay progression for all consultants early on in their career. Under the new proposals, the highest performing consultants could be able to receive up to £30,000 a year in bonus payments, on top of their base salary.

Of course, improving weekend care requires more than just ensuring greater consultant presence. That's why the government is also addressing issues such as access to weekend diagnostic services, provision of out of hospital care to facilitate weekend discharges, and adequate staffing cover amongst other clinical groups,. But NHS leaders and the independent pay review bodies are clear that increasing the presence of senior clinical decision makers at weekends is vital, and that the consultant opt out remains a barrier to organising broader support services and staff rotas.

The Government feels it is under an obligation to the public to do all it can to make NHS care at the weekend as safe as during the week through the delivery of seven day services this Parliament and that is what it will continue to do.

Click this link to view the response online: https://petition.parliament.uk/petitions/104334

The Petitions team
UK Government and Parliament

A disappointing response, I have to say, and not just because they refused, but because of the manner of it - a mere re-statement of Hunt's statistical distortions.

But!   My MP happens to be of the other persuasion, and although I emailed them because they are my MP, to register my concern at this brush-off, not to garner solidarity, they have emailed me thus:

Thank you for your email regarding a no confidence debate on the Health Secretary. As this petition has well over 100,000 signatures it will be considered for a debate by the backbench business committee. I will monitor developments very closely. 

I am deeply concerned at the lack of confidence which the medical profession seems to have in Mr Hunt and hope he either takes drastic action to improve the situation by listening to their concerns and acting upon them or considers his position. 

If you feel I can be of any further assistance on this or any other matter please do not hesitate to get in touch. 

So may I ask all members of D2D who did sign the petition, to contact their own MP, of any persuasion, and ask them about it?  The BackBench Business Committtee is important, as it choses the subjects for debate in "backbench time".    Even if the majority there follows the Tory Party Line and rejects it, it will generate more publicity about Hunt's Plan, and doctors fears about it in repsct of patient care.




Corridor consultations/advising friends

Posted in General at Wed, 26 Aug 2015 10:54:51


Posts: 1073
Joined: 13 Oct 2009

We have probably discussed this in the past but I haven't checked and I see no harm bringing it up again. What is your personal policy (if you have one) for when friends or family members seek your advice as a Doctor? Are you always willing to help where possible or perhaps a little careful not to get too involved?

And in reverse. Do you feel comfortable asking medical friends for informal advice about yourself or family member? Does it depend on the nature of the enquiry?


Children bearing children

Posted in Public health at Fri, 28 Aug 2015 16:51:04

John D

Posts: 3695
Joined: 01 Feb 2010

We had a thread recently, on the sad case of a girl in a South American country, not even a teenager, who was pregnant by her abusive father, in a state where the Law forbade abortion.  A sad, even pitiful case, if there were only one, but there is more, much more of this.


This article from today's Guardian, writes of the 5100 girls less than 15 years old who became pregnant in Guatemala last year alone.   It tells the stories of girls who were 12 or 11, who became pregnant after having only one menstruation in their lives, because they were already being abused, frequently, by the men of their families.   

The United Nations Population Fund report, "Motherhood in Childhood"  http://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP2013.pdf concentrated as UNFPA does on pregnancy in 15-19 year olds, showing the deprivation of education as well as deprivation as poverty that such early pregnancy imposes.  But it also found that Latin America and the Caribbean is the only region in the world where births to girls under age 15 is rising (Page 5).  But Guatemala is not even listed in the UNFPA report, "Adolescent Pregnancy" as a country the highest prevalence of adolescent pregnancy (Niger, Chad, Mali, Guinea, Mozambique )  http://www.unfpa.org/sites/default/files/pub-pdf/ADOLESCENT%20PREGNANCY_UNFPA.pdf

In the world of 2013, there were 7.2 million births to girls under 18, and 2 million of those mothers were less than 15 years old.   This is not an isolated case, or a  single country where young girls, pre-adolescent girls are abused so badly.  It is a powerful force in the world that perpetuates poverty, ignorance, morbidity and death.


London Low Emissions Zone fails.

Posted in Public health at Thu, 27 Aug 2015 11:03:26

John D

Posts: 3695
Joined: 01 Feb 2010

The London LEZ was supposed to improve atmospheric conditions and the health of the people by excluding potentially polluting vehicles from Greater London - approximately within the M62.   But it hasn't, among school children anyway.

Effects of Air Pollution and the Introduction of the London Low Emission Zone on the Prevalence of Respiratory and Allergic Symptoms in Schoolchildren in East London: A Sequential Cross-Sectional Study.   Wood HE,Marlin N,Mudway IS et al  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109121

The study confirmed the association of  vehicle pollutants with respiratory morbidity in schoolkids, but found no reduction in the pollution levels in the three years since the LEZ was started.



Emotional resilience

Posted in Medical mums at Mon, 31 Aug 2015 16:40:34


Posts: 1596
Joined: 09 Dec 2011

So the GMC wants doctors to be trained in "emotional resilience". Always outwardly unmoved and professionally content whatever is thrown at them by patients and management , so burn out becomes a thing of the past. How far is this feasible ? Can one really train people fresh from school to see and survive unscarred the worst that may be thrown at them without reference to specialty - and without doing harm? Or is this just a way of weeding out more sensitive souls - or developing a non-complaining workforce?

Survival techniques can be invaluable (wish I had learnt about them a bit sooner) but surely must be acquired on the job helped by  supportive mentors rather than just being the odd session given to students . As with medical ethics etc.. learning resilience is not just a classroom exercise. 

USPSTF recommends depression screening for adults

Posted in Diabetes at Mon, 31 Aug 2015 07:25:43


Posts: 759
Joined: 15 Apr 2011

The U.S. Preventive Services Task Force has issued a draft grade B recommendation endorsing depression screening in the general adult population, the group announced July 28.

The draft is an update to the 2009 USPSTF recommendation, which suggested screening only when staff-assisted depression care supports are in place.

“In recognition that such support is now much more widely available and accepted as part of mental health care, the current recommendation statement has omitted the recommendation regarding selective screening, as it is no longer representative of current clinical practice,” the USPSTF said in a statement.

In addition, the new recommendation supports screening for depression in pregnant and postpartum women, groups that were not reviewed for the 2009 recommendation.

About 7% of the U.S. population met the criteria for a current depressive disorder from 2009 to 2012, according to the National Survey on Drug Use and Health and the National Health and Nutrition Examination Survey, the USPSTF noted.

“Major depressive disorder is a common and significant health care problem,” the statement said. “It is the leading cause of disability among adults in high-income countries and is associated with increased mortality due to suicide and impaired ability to manage other health issues.”

A USPSTF review of clinical trials found that adult patients reported a 46% remission rate with antidepressants and a 48% remission rate with psychotherapy after 10-16 weeks. A separate review concluded that older adults who received antidepressants were twice as likely to achieve remission as older adults who received placebo (odds ratio, 2.03), the task force reported.

In addition, a review of clinical trials that evaluated the effect of screening in pregnant and postpartum women showed 28%-59% reductions in risk of depression at follow-up, compared with usual care. Another trial, which evaluated screening plus provider support, found that 45% of intervention participants reported a 5-point or greater reduction in Patient Health Questionnaire-9 scores, compared with 35% of usual care participants (OR, 1.74), the report said.

Data from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions reported depression prevalence of 9.1% in pregnant women, 10.2% in postpartum women, and 13.1% in women in childbearing age who were not in the postpartum period.

“For pregnant and postpartum women, there is at least moderate certainty that the net benefit of screening for depression is moderate based on the evidence of benefits and harms when [cognitive behavioral therapy] or other evidence-based counseling is available,” the USPSTF reported.

COMMENT:  This is major change by the Task Force.  It is prompted by the increased recognition of the prevalence of depressions and the effectiveness of treatment.  The recommendation also takes note of the increased availability of resources in the medical community for the treatment of depression.  Depression is increased in persons with diabetes and is often a significant factor in poorly control patients.