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

Posted in General clinical at Wed, 01 Oct 2014 10:35:54


Posts: 4282
Joined: 24 Feb 2009
We have a fourth year Medical student attached to our Practice for four weeks. I hope she will learn someting obout General Practice, learn some medicine and hopefully enjoy her time at this busy General practice. What things do you thing are the most important thing to learn from a General Practice?

Medicolegal Case Report - Complications of Colonoscopy

Posted in Medicolegal at Tue, 30 Sep 2014 12:35:16


Posts: 751
Joined: 13 Oct 2009
A 50-year-old accountant, Mrs A, developed altered bowel habit and rectal bleeding. She saw consultant colorectal surgeon Mr C, who found large prolapsing haemorrhoids and recommended a haemorrhoidectomy and colonoscopy. Mr C removed a 5mm polyp in the caecum with a snare and then went on to perform a haemorrhoidectomy. Both procedures were described as uneventful and Mrs A was stable throughout the anaesthetic.
A few hours later, after the operation, Mr C noted Mrs A was well and ready for discharge. She subsequently developed minor rectal bleeding and abdominal discomfort, and was kept in overnight. The following morning, her routine blood tests were normal and her observation chart had been unremarkable, but the abdominal pain persisted.
A chest x-ray revealed bilateral sub-diaphragmatic free gas. Mr C prescribed broad-spectrum antibiotics, intravenous fluids and kept Mrs A ‘nil by mouth’. An urgent CT scan confirmed an extensive pneumo-peritoneum but no signs of any fluid collection.
Mr C examined Mrs A and found a “completely soft abdomen with no peritonism and normal bowel sounds”. He explained that the perforation had probably occurred at the polypectomy site, but appeared to have sealed as Mrs A was well and the CT scan had revealed no fluid collection.
Mr C recommended conservative management with surgical intervention only in the event of septic complications. Over the next few days, Mrs A remained well, was apyrexial and had normal inflammatory markers. She commenced oral fluids and was discharged home with seven days of antibiotics.
Mr C reviewed her at the end of the week and noted “she continued to feel well, clinical examination was normal and the site of her haemorrhoidectomy was healing nicely”. The pathology report of the polyp revealed a completely excised low grade tubulo-villous adenoma and Mr C explained the need for surveillance colonoscopy.
Two weeks later Mrs A contacted Mr C complaining of night sweats, abdominal pain and vomiting. He saw her immediately and arranged an ultrasound scan, which revealed a large pelvic abscess. Mr C organised her admission to another hospital for radiologically guided drainage of the abscess, but this proved unsuccessful. Her condition deteriorated and Mr B, the consultant surgeon oncall at this hospital, undertook an emergency laparotomy to drain the abscess and perform a defunctioning ileostomy.
Mrs A had a stormy postoperative recovery, initially requiring ITU support, and spent three weeks in hospital. Mr B subsequently reversed her ileostomy but Mrs A developed problems with an incisional hernia, requiring several attempts at repair. She also needed psychological support for post-traumatic stress disorder, resulting in prolonged absences from work.
Two years later, Mrs A brought negligence proceedings against Mr C. It was claimed that Mr C should have acted sooner by performing an x-ray and CT scan on the evening when Mrs A initially developed pain. It was also alleged that Mr C had selected inappropriate antibiotics and had discharged her too early, allowing the development of her abscess. It was suggested that these acts of negligence had delayed appropriate surgical treatment and directly led to all Mrs A’s subsequent complications.
Expert opinion did not substantiate any of these claims. It was agreed that non-operative management for perforations after colonoscopy was an acceptable practice if the patient was stable, exhibited no signs of sepsis and the perforation appeared to have sealed.
The CT result, together with the carefully-documented clinical findings, nursing charts, and absence of a rise in the patient’s inflammatory markers over several days, all supported this approach. Microbiology experts agreed that the antibiotics prescribed were appropriate and the length of administration sufficient. Mr C was also able to produce audit evidence of his colonoscopy practice, demonstrating a high volume (400 per annum) with a very low complication rate.
Whilst the time and stress involved in legal claims can be considerable, it is important to remember that many cases are defended successfully (and often long before court proceedings) because Drs simply practice good medicine. Hindsight alone is not actionable.
(From MPS)

Importance and Limitations of Gram Staining in Diagnostic Microbiology

Posted in General clinical at Wed, 01 Oct 2014 20:40:31


Posts: 4282
Joined: 24 Feb 2009

Importance and Limitations of Gram Staining in Diagnostic Microbiology                                                 Majority of the Microbiology Laboratories do a culture work for Bacterial identification from several specimens arise from the Hospitals. Gram staining is a common traditional procedure and an age old procedure since Christian Gram’s contribution in 18th Century, for Bacterial studies. The differentiation of bacteria into either the gram-positive or the gram-negative group is fundamental to most bacterial identification systems. This task is usually accomplished through the use of Gram’s Staining Method. Unfortunately, the gram stain methodology is complex and prone to error. The technique is used as a tool for the differentiation of Gram-positive and Gram-negative bacteria, as a first step to determine the identity of a particular bacterial sample. The Gram stain is not an infallible procedure for diagnosis, identification, or phylogeny. However it is of extremely limited use when saprophytes and commensals are associated with careless specimen collection AND PRECESSING IN OUR Laboratories however it is a procedure which helps when Gram stains are performed on body fluids, CSF or biopsy when infection is suspected. It yields results much more quickly than culture, and is especially important when infection would make an important difference in the patient's treatment and prognosis; examples are cerebrospinal fluid for meningitis and synovial fluid for septic arthritis. Many Grams’ stains from specimens with Polymicrobial flora are fallacious as it is in Diabetic foot, Sputum, faecal, and urinary specimens. Many juniors and even the Seniors Microbiologists believe the first impressions and come to hasty conclusion in advising the therapeutic options. My experience proves that when we process THE BACTERIA  from the Culture plates, by Macroscopic observation   many of our conclusions may not be true, and  have little determination and patience to think all you see and define by naked eye ( Macroscopic Observations ) may not prove correct when we really do a Gram’s staining, many Micrococci, Diptheroids, and Candida spp and other normal flora mimic as pathogenic isolates  and processed with confusing uncharacterised  Biochemical reaction, and tested for Antibiograms, this is an area where the Gram’s staining plays wonders to enlighten us.  Problems with Gram’s Method have led to a search for other tests that correlate with the cell wall structure of the gram-positive and the gram-negative cells. Several improvements/alternatives to the classical gram stain have appeared in the literature. Many conflicts in our Laboratories between members of the staff and technicians are due to ignorance as when we have a little interest to go in a Methodical and Scientific way. However Microbes prosper with advantage by our ignorance in Diagnosis and Treatment.   Dr.T.V.Rao MD Professor of Microbiology

What's your diagnosis? Jaundiced after a party

Posted in General clinical at Tue, 30 Sep 2014 15:03:52


Posts: 6
Joined: 25 Dec 2010

The case below was printed in the Endgames section of the BMJ. I will post the answer in a few days.

What's the diagnosis and what would be your first line of treatment?

A 24 year old male student from Poland attended the emergency department with a one week history of jaundice. He also had orange urine and non-specific abdominal pain, which he attempted to relieve by drinking alcohol. He had experienced no vomiting or change in bowel habit or stool consistency.

There was no history of jaundice, illness, surgery, or blood transfusion. He was not taking any regular drugs and gave no history of drug allergies. He denied intravenous drug abuse but admitted taking ecstasy at a party a fortnight ago. He had recently spent two weeks in Poland over Christmas. During the previous week he had drunk about 21 units of alcohol. He was homosexual but had not been sexually active for two weeks before presentation.

On examination he was afebrile and overtly jaundiced. His abdomen was soft, non-tender, he had no palpable masses, and bowel sounds were present. It was noticed that he had an abdominal piercing. There were no signs of hepatic encephalopathy.

On admission his liver function tests were deranged: alanine aminotransferase (ALT) was 2891 IU/L (reference value <40), alkaline phosphatase (ALP) was 246 IU/L (30-130), bilirubin was 285 μmol/L (<17), albumin was 40 g/L (35-51), and international normalised ratio was 1.2 (0.9-1.2).

Ashya King case: breakdown of communication?

Posted in News & media at Tue, 30 Sep 2014 10:06:20

Pat Harkin

Posts: 76
Joined: 26 May 2010

For those outside the UK the news over the last few days has been dominated by the case of Ashya King: a five year old boy with a brain tumour who has been removed from hospital by his parents against medical advice. Ashya and his siblings are now in Spain where his parents were hoping to raise funds for private medical treatment. 

The parents have been arrested and face extradition back to the UK. They are in Madrid while Ashya and his siblings are in Malaga. You can see much fuller coverage of the story here: http://www.bbc.co.uk/news/uk-england-29009883

Social media has been a big factor with Ashya's father and brother posting videos explaining their actions and how they are caring for him - countering statements from the police. 

What are your thoughts on this case and how the authorities have acted and what the UK hospital could have done? There have been similar cases of parents disagreeing with doctors but few have been so dramatic. 

Clinical question: What advice would you give this so-called "pre-diabetic" patient?

Posted in Diabetes at Tue, 30 Sep 2014 08:47:06

Joey Rio

Posts: 891
Joined: 13 Apr 2011
This clinical question comes from one of our diabetes specialists, Joey Rio.
Dr Johnstone is a happily married retired academic physician, epidemiologist and statistician, who was referred to my university diabetic and hypertension clinic. He is a 78-year-old upper middle class retired physician and was diagnosed as having pre-diabetes about four years ago. He has a 40% carotid plaque in his right common carotid artery and 25% at his left common carotid artery. He has no angina symptoms. His treadmill test was normal six months ago.
He has a BMI of 28. He follows a healthy diet, walks 30 to 40 min three times a week, and does muscle anaerobic exercise once a week. For the last three and a half years he had microalbuminuria but is now non-albuminuric.
He is on aspirin 100 mg/day, Atorvastatin 20 mg because of a previous LDL Cholesterol of 130 mg;dL which is now 85 mg/%.and Metformin 500 mg extended release by night. He complains of muscle pain and bouts of impotence.
He also takes amlodipine 5 mg by night only. His eGFR has been stable for the last five years at 65 ml/min.
Six months ago he had 24-hour arterial blood pressure monitoring which showed a mean daytime systolic BP of 139 mmHg, with a night time BP drop of 12%. Diastolic BPs were unremarkable: no patholological hypotensions or hypertensive peaks!
HBA1C levels have been stable at the level of 6.1% for the last four measurements. He has done no fasting glycaemias for the last three years.

Tattoos - the good, the bad and the ridiculous

Posted in General at Wed, 01 Oct 2014 00:53:19


Posts: 4282
Joined: 24 Feb 2009
As far as I can tell visible tattoo's aren't acceptable for Doctors (rather understandibly). I think that they have the potential to isolate/intimidate patient's (especialy, but of course not exclusively the elderly). I was recently flicking through my tattoo magazine's and admiring the art and I'm considering a tattoo. I want a rather large leg peice dedicated to my family and inspirations and as I grow (I'm only 20) it will be extended to hopefully cover my full leg. I thought my leg would be a good option as its relatively easy to cover when I'm working. I'm really looking for opinions on tattoo's. Do you have one? or do you work with someone that does? 

Thanks, Arron.

Should hospitals offer free wifi?

Posted in General at Wed, 01 Oct 2014 16:00:07


Posts: 1
Joined: 03 Feb 2011

It seems like everywhere you go these days you get offered free wifi (not that it always works as I found recently...) so should hospitals offer this to patients?

It might help patients feel less isolated and enable them to bypass the ruinously expensive TV service on offer in most hospitals. The staff might enjoy it too! Obviously, as a bit of a luddite I don't see why patients can't be happy with a good book but I know that not everyone thinks like me. 

As Olly, the young researcher in the comedy the Thick of It, says to spin doctor from hell Malcolm Tucker about his spell in hospital: "Well, you know, there's no wifi, there's basic Freeview. It's like living in 2003."


What's your diagnosis? Persistent fever and rash in a young boy.

Posted in General clinical at Tue, 30 Sep 2014 17:02:27


Posts: 34
Joined: 11 Feb 2009

The case below was published in the BMJ. What's your diagnosis and what treatment would you pursue? I will publish the answer in a few days.

A 22-month-old white Australian boy presented to his GP with irritability, red eyes, and a two day history of high fever (highest at 41°C) that did not respond to paracetamol and ibuprofen. He had no history of cough, coryza, or rash. His medical history was unremarkable and immunisations were up to date.

On examination, he had bilateral non-exudative conjunctival injection and was diagnosed with a non-specific febrile illness with associated conjunctivitis. His family then took him on a planned family holiday to Thailand where his conjunctivitis improved, but the fevers continued unabated. In addition to the fevers, his parents noted a mild nappy rash.

On day 8 of the illness, his parents took him to a local clinic after a couple of episodes of diarrhoea. He was diagnosed with gastroenteritis. Later that day he became more unwell with increasing irritability and a progressive rash so his parents took him to hospital. He was dehydrated and lethargic and physical examination showed cervical lymphadenopathy, fissured lips, and an injected pharynx.

His hands and feet were oedematous and his legs were covered in a pink maculopapular rash. Blood tests showed leucocytosis and increased acute phase reactants, but other haematological markers were normal. A chest radiograph was normal. He was admitted with presumed bacterial sepsis and started on broad spectrum intravenous antibiotics. However, after two days of antibiotics, his symptoms did not improve.

What do you think?


Is obesity the biggest threat to the health service?

Posted in General clinical at Tue, 30 Sep 2014 12:53:27


Posts: 9
Joined: 21 May 2014

NHS England chief executive Simon Stevens told a conference earlier this week that "obesity is the new smoking, and it represents a slow-motion car crash in terms of avoidable illness and rising healthcare costs. If as a nation we keep piling on the pounds aroudn the waistline, we'll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat."

Do you agree that obesity is the biggest threat to the health service or are there other larger threats such as funding cuts, privatisation, constant reorganisations...? 

need advice

Posted in General clinical at Tue, 30 Sep 2014 13:51:33


Posts: 202
Joined: 14 Dec 2010

Hi all, 

Just posting to get some advice here, from more experienced colleagues. 

I am a CMT trainee in the UK and struggling at the moment. 

I am working in a ward were there are 2 registrars who are completely absent. Both are never in the ward. In the last month I have seen both only twice, on first day and once in the first week. However, both are daily in the hospital, attending their clinics and procedures etc. 

However, we have a consultant who is helpful and reviews any sick patients we ask him to review. However obviously he doest do all full ward round daily. 

In the ward we are one CMT trainee and another FY1, on occasions we are 1 CMT, one trust grade CMT and one FY1. 

We have around 30 patients to look after and, we are struggling and on regular basis finish around 7 pm at best.

The issue is, as stupid question as it sounds;

Is the registrar indeed supposed to regularly review patients in the ward on a daily basis and help out seeing patients? (Obviously not doing the jobs), it would have been immensely helpful if he like seen 5-6 patients with us daily. Or is this not the practice? 

The reason I am asking since I have seen so different practices in different hospitals, in my previous posts (outside this trust), indeed there were a registrar daily helping for 2- max 3 hours in the morning or if they have clinic they come in the afternoon in to the team to see if they can offer any help (usually reviewing few patients).

The problem is, when I have asked around different trainees, in this hospital this seems to be a regular culture and several CMT2s I have spoken to tells me this is how the job also was when they were in my rotation last year. Moreover, in my next rotation which is oncology, I have been told usually it just one CMT (me) that is there and that’s it. If any issues you just call the consultant. Finally, one example that shocked me from the first day, FY1s in my team and other teams in the hospital on a regular basis have been asked to see patients by them selves alone and report to the consultant if anyone needs to be seen or reviewed or discussed.

So pretty much each team in the hospital, there are around 2 - 3 doctors, they just divide all the patients (usually 30-35) between themselves and sees the patients alone, and report up to the consultant back the case, if any concerns or any review needed by the consultant.

So I guess what I am asking, is this how CMT training is and what I am supposed to get used to? 

To be honest feels I am just over working, leaving at 7pm at the earliest so exhausted that basically I have no energy to do anything. Moreover, the problem in 2 years time when I apply for a registrar post no one cares how hard or amazing doctor one is in the ward. What they care about how many publications/teaching sessions/research/presentations etc. one has done, so how will I get the time for that I am not entirely sure yet.

Thanks in advance for anyone who takes their time to answer.

Does your workplace help you stay healthy?

Posted in General clinical at Wed, 01 Oct 2014 10:00:43


Posts: 4282
Joined: 24 Feb 2009

Colleagues on BMJ Careers have sent a freedom of information request to trusts to find out what they do to help their staff stay healthy.

Some 46 trusts responded, with 44 saying there was some kind of healthy food option in the canteen and six said they offered staff access to slimming clubs. Over a quarter said they provided exercise classes for staff with just over a fifth offering discounted gym access. Two trusts had an on-site gym and four offered a cycle-to-work scheme.

University Hospitals Birmingham foundation trust said that in the autumn staff would have access to community orchards and gardens where they could exercise and grow their own fruit and vegetables. That sounds lovely.

What does your workplace offer, if anything? And do you think workplaces should do more seeing as we spend so much time there? 

Need feedback looking for CME Conference

Posted in Medical education at Tue, 30 Sep 2014 16:15:29


Posts: 3
Joined: 30 Sep 2014

Has anyone else heard of The Heart Course? I am looking for a CME conference focusing on acute cardiovascular problems, and this one sounded interesting. It's out in Las Vegas in October and would like to know if anyone else is thinking about going or attended a Heart Course conference before.

Here is the link if anyone wants to take a look at the meeting https://theheartcourse.com/


Breath Test for TB Developed

Posted in Respiratory medicine at Mon, 29 Sep 2014 10:20:26


Posts: 4282
Joined: 24 Feb 2009

Researchers have developed the first breath test for TB in the laboratory.


Is a history of TB (treated and disclosed) a reason for shame?

Posted in Public health at Tue, 30 Sep 2014 14:44:09

Pat Harkin

Posts: 76
Joined: 26 May 2010

Is a history of TB (treated and disclosed) a reason for shame?

Is general practice in crisis?

Posted in General clinical at Tue, 30 Sep 2014 10:17:45

Joey Rio

Posts: 891
Joined: 13 Apr 2011

It's the Royal College of GPs annual conference this week (as well as the Conservative party) so expect lots of news stories about doctors with low morale.

The general message over the last couple of years or so is that general practice in crisis - the chair of the RCGP, Maureen Baker, has warned of a "mass exodus" from the profession and a BMA survey in March found that two thirds of respondents were considering early retirement.

The GP press regularly carry stories about GPs quitting, towns being left without a GP practice and patients unable to get appointments with their family doctor.

Is general practice in crisis? What's your view? 

Ebola Has Hit the USA....

Posted in General clinical at Wed, 01 Oct 2014 19:22:28

John D

Posts: 3258
Joined: 01 Feb 2010



In my entire life I never believed for an instant that Ebola would land on the shores of the usa.  I always suepected that as a High speed prone to burn itself out disease, Ebola would steer clear of the United States due to sheer over-efficency of it's own Microbiology, and Biophysics!   Alas, many were wrong, including myself, and to be sure the NIH and CDC will have their hands full doing the trace back and contact investigation and notification.  As a CBRN consultant my career field just became more complex, dangerous, and busy to be sure.   The main worry I have is mutation do to Biophysical differences in Africa's climate and the USA.   If Ebola were to grow wings - Become Airborne for instance, life might well be like so many pandemic movies,  Contagion, Outbreak, and or any other Apocalyptic scenario.



Phone phishing

Posted in General at Mon, 29 Sep 2014 09:10:44


Posts: 471
Joined: 18 Mar 2014

Every day a new way that criminals try to take your money.     Yesterday, a voice message was left on my phone. It was from my bank, which provides my credit card, and asked me to ring a number because card fraud was suspected.  I've been ripped off before, and then criticised my bank for their luke-warm attempts to contact and warn me, when they knew the card was being ripped.  So I rang the number, that started 0845.   

That should have warned me from the first!  Anyone can rent an 0845 number - banks have their own.  And when the line was answered, I was asked to confirm my name, and then to answer the security questions that are attached to the  card. You know, second letter of mother's maiden name,  favourite book etc.    And I came to my senses  - no bank would ask those Qs before they had established by other means that they were talking to the right person.  I rang off, and then washed my hands!

But I had no evidence that my card wasn't at risk, so I got out my bank's number to ring about card fraud, which is not an 0845.  They said, "No problem!  But let's check." and they did, right through all the bank's departments that might have found there was one.   Total blank, which confirms that I was nearly the victim of 'phone phishing', criminals trying to obtain your security details so that they can rip off your card.

Be suspicious! I can't tell you how a bank will warn you if they do suspect your card is at risk, but they won't do it as above!  Don't ring the number that the caller will give you, ring your bank on its usual number, and ask for the card fraud department, which should be available 24/7.


What can you get from a dating website? Apart from a date, that is?

Posted in General at Mon, 29 Sep 2014 17:35:19

John D

Posts: 3258
Joined: 01 Feb 2010

Toady's Guardian G2 section includes an article by the "numbers guru" at a 'well-known' dating website.  He has data-mined the site's records,  the answers to screening questions and the personal descriptions given by its users.   He says this is a function has led to its' success, and the information he retails is interesting.

Women and men are asked what age of the opposite sex they fnd most attractive.  Women between 20 and 50 years old said men who were three years older to four years younger, as the women grew older.    Men, on the other hand, across the same range of age, wanted women who were between 20 and 23 years old.

Then they looked at the words most often used in the personal profiles of the site's British users, and compared those with users from the rest of the English speaking world, to produce the words that are 'Most British".   I'll omit place names, and list only wot, wasters, twat, trousers, trainers, consultancy [sic!], bloke, moaning, kebab,nan, lecturer [really???], bolognese, housemate, b*gg*r and sh*te.    Maybe the last two won't get through D2D's Robot Censor.

And, - who would have thought it? - dating sites see the user's pictures and have a way of grading "attractiveness".    They applied this algorithm to users of a sister-site for casual office staff looking for work, and plotted that against the number of  times potential employers asked to interview the applicants.  They found that for men, the curve was a flat line  - an attractive man was no more or less likely to get interviewed.  But for women, the curve was exponential!   Even if the employer was a female, an 'attractive' woman got far more interviews!

Finally, they looked at the questions the website asks clients, to illuminate their personality and help others match themselves to them.   There are over 300 questions and users can choose how many they answer.   Then they looked for  questions that were associated with both clients who became long-term partners.   And the best questions to identify your perfect partner are:

"Do you like scary movies?"

and "Have you ever travelled alone to another country?"

The last pair, as association never proves causation, I must leave to you, to use or not as you wish.  But the picture this paints of the language and attitudes of people who use dating sites is either depressing in the 21st Century.


how to fight smoking in school children

Posted in Respiratory medicine at Mon, 29 Sep 2014 06:18:21

Eman Sobh

Posts: 168
Joined: 02 Jan 2014

smoking is now increasing among children and adolescents

what is most likely to fight this

what can be done in school community to encourage smoking cessation

Is a history of TB (treated and disclosed) a reason for shame?

Posted in General at Sun, 28 Sep 2014 22:39:09

Eman Sobh

Posts: 168
Joined: 02 Jan 2014

Is a history of TB (treated and disclosed) a reason for shame?

Medical events around the world. Where to find them?

Posted in Medical education at Tue, 30 Sep 2014 16:31:25


Posts: 3
Joined: 30 Sep 2014

Dear Colleagues,

I can’t say for sure if a congress is as it should be or not….nevertheless I came across a website that is totally different from what is out there, that would change the way we physicians/doctors can find a medical event of our choice. It is called http://www.allcongress.com and it really includes many medical events with full details on each one. The last 2 conferences I attended I found them there. Soon we will be able to buy our attendance directly from them...no messy browsing and no frustration with mulriple accounts...i suppose something like booking.com. It worths checking it out. Tell me what you think.

Will the seven-day-a-week GP pledge actually happen?

Posted in General clinical at Wed, 01 Oct 2014 13:59:41


Posts: 471
Joined: 18 Mar 2014

UK prime minister David Cameron has said that if his party win the next election GP services will be open seven days a week by 2020.

This is quite a startling pledge - GP numbers are dwindling as patient demand is soaring and the RCGP has said that an extra 8000 GPs will be needed just to keep up with current mind, never mind practices opening seven days a week. 

RCGP chair Maureen Baker has also questioned whether patients even want seven-day-a-week opening and Chaand Nagpaul, the BMA's GP leader, has said that immediate solutions to the current general practice crisis are needed.

As ever the devil is in the detail on this one. At the moment I can see a GP (not my GP) at the weekend through the out-of-hours service but this is not for routine appointments. Does this mean that if I'm worried about a wart on my hand I'll be able to see my GP at 4pm on a Sunday afternoon? Or will I only be able to see the GP at the weekend for more urgent queries. As Maureen Baker says I'm not sure if I'm really that bothered about seeing the GP at the weekend - I think I would prefer later evening opening. 

Before they took office the Conservatives promised no top-down reorganisations of the NHS and looked what happened there so can we believe them on this GP pledge? 


Medical regulator may scrap PLAB test by 2017

Posted in Careers at Wed, 01 Oct 2014 13:22:49


Posts: 471
Joined: 18 Mar 2014

The General Medical Council has said that it wants all medical graduates who wish to practise in the UK to sit a single, common exam.

The exam will apply to all UK and overseas graduates but GMC chairman Niall Dickson said that European rules may make it harder to impose the exam on doctors from the European Economic Area. 

The GMC has set 2017 as a provisional date for the introduction of the test. 

What do you think? Would you welcome the scrapping of the PLAB test?

Time Capsule

Posted in General at Wed, 01 Oct 2014 19:36:10

John D

Posts: 3258
Joined: 01 Feb 2010

The original work and concept of Time capsule is a very good idea and appreciable effort, but here I request every user to add your choice pic, documents etc. for building an imaginary time capsule that will in one or other way reflect our thinking process and feelings about the society we live in and the world around us.

The Wikipedia article about Time Capsule will help you to expand your idea about time capsule.


Thanks a lot for your contributions.