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Medical students and professionals sharing their thoughts and experiences.
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One ‘Buzzword’ at a Time

The US Healthcare System Briefly Explained.  
Catherine Bruce
about 1 year ago
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HASHTAG.

NB References to previous blog post 'Method to My Madness' https://meducation.net/resources/1709038-Method-to-My-Madness  
Catherine Bruce
over 1 year ago
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Doctors’ Rotas: The Jokes, The Incompetence and The Illegal

Have you ever felt an organisation was treating you as another cog in a machine? Welcome to junior doctors' rotas  
jacob matthews
over 1 year ago
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Common Not Benign - Let's Get It Under Control

Diabetes Management and Education  
Catherine Bruce
over 1 year ago
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Being Black in America is Bad for Your Health

Being Black in America is dangerous. We hear about the deaths by police shooting or white supremacist - and by gun violence generally, which disproportionately plagues Black communities. But we hardly ever discuss the persistent discrepancy in life expectancy between white and black. There are many ways to attack the latter through healthcare policy and practice -- if we are willing. That remains the question for America 48 years after King was killed.  
Andrew Tarsy
over 1 year ago
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Introducing Confidence

We've launched Confidence - a free exam room for medical students with over 3,500 questions and explanations written by expert educators.  
Jeremy Walker
over 1 year ago
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A plea following the death of my partner

A Pecha Kucha talk (400 second video). I hope that by sharing my personal story in this way, it will help raise awareness of unfit drivers and the responsibilities involved when assessing fitness to drive.  
Dr Genevieve Yates
almost 2 years ago
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Developing Resilience at Work

Don't wait for others to change things for you, do what you can now, especially if that means stopping.  
Dr Dee Gray
over 1 year ago
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Another Way Down Under

A snapshot of how I ended up starting my "FY3" in Australia teaching anatomy to medical students and the lessons I have learnt along the way. I hope this will help current foundation year trainees consider something a little different...  
Dr. Luke Farmery
over 1 year ago
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Earning While You Learn

Why you should worry about your future medical career right now, and what recourses can help you find a job if you are a med student in the UK or the US. Volunteering, part-timing, freelancing - it's up to you to decide.  
Lesley J. Vos
over 1 year ago
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Make families part of the medical team

Families know more about their loved ones than medical professionals can ever know or have time to learn. Involving families can improve diagnoses, care and outcomes.  
Bonnie Friedman
over 1 year ago
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Method to My Madness

There is method to my madness. Promise.  
Catherine Bruce
over 1 year ago
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How to Attract More Patients to Your Medical Practice

A doctor is nothing without patients. But, unless they make themselves known in the community, and make themselves available, they are not going to be able to attract a lot of patients. One of the most important thing for many people is that doctors have convenient hours. This is no longer a nine to five world, and people often need to have appointments that will fit in with their schedules. One way that doctors can gain a good reputation in the community and increase their caseloads is to be accessible. This means offering things like early or late hours. When doctors increase their availability, it means fewer trips to the emergency room for patients when they need to see doctors after hours. In addition to having better hours, there are other ways that doctors can attract new patients. These include: Electronic Health Records One of the things people hate the most about visiting a medical office is having to fill out a bunch of forms each time they visit. When you have electronic health records, they will only have to fill out one form. All of their information will be recorded and easy to access, so you will always have the information you need, when you need it. You can even use the system to send out prescriptions to pharmacies. Better Telephone Hours Many people don’t have time to call for a medical appointment when they are working, and prefer to call during their lunch hour or even after work. If your office closes for lunch, you are going to miss getting calls from patients who need to call at this time. Have a member of your staff on hand to answer the phones during the lunch hour. That way, patients will be able to get through, and you won’t be missing any calls. If there is no one to answer the phone, most people are likely to call another doctor, and will never call you back again. You may also want to consider extending your telephone hours, so patients can call after 5 pm. Use Yempl.com You need to get your name out there, and one way to do it is to be up front with pricing. Often, patients will want to know what procedures cost before having them done. You can use Yempl.com to inform potential patients about your rates. They compare your information to that of other doctors in order to make the best decisions. Offer Wi-Fi No matter how organized your office is, there are still bound to be patients waiting in the office for appointments. They are not getting anything done while they are just sitting around, but they can be more productive when they are able to connect to the Internet. You can provide free Wi-Fi services so your patients can use their mobile devices to connect to the Internet and check emails, shop, chat with friends, get work done, and more. With so many people carrying mobile devices these days, it makes little sense not to offer this service. Create a Web Portal When you have a web portal that is easy to use, patients can schedule appointments, reschedule appointments, access and print out forms before their visits, and more. You can use the portal to easily update things like contact, insurance, and personal information about your patients. This is a great way for patients to be able to make payments, get prescription refills, get results from tests, and get messages from doctors to avoid missed phone calls. Be sure to include a smartphone app so patients can contact you from anywhere. Image Source: Seaside Medical Practice  
Jessica Wiles
almost 3 years ago
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Neuropsychiatry's Fuzzy Borderlands

In NeuroPsychiatry it might be difficult to locate its territory, and find its niche. This might be an uneasy endeavour as its two parent branches neurology and psychiatry are still viable, also it siblings organic psychiatry, behavioural neurology and biological psychiatry are also present. This blogpost attempts to search for the definition and domains of neuropsychiatry. Neuropsychiatry can be defined as the 'biologic face' of mental health (Royal Melbourne Hospital, Neuropsychiatry unit). It is the neurological aspects of psychiatry and the psychiatric aspects of neurology (Pacific Neurpsychiatry Institute). It is not a new term. Many physicians used to brand themselves as neuropsychiatrists at the rise of the twentieth century. It has been looked upon with a sense of unease as a hybrid branch. Also, it was subject to pejorative connotations, as the provenance of amateurs in both parent disciplines (Lishman, 1987). The foundational claim is that 'all' mental disorders are disorders of the brain' (Berrios and Marková, 2002). The American NeuroPsychiatric Association (ANPA) defines it as 'the integrated study of psychiatric and neurologic disorders' (ANPA, 2013). The overlap between neuropsychiatry and biological psychiatry was observed (Trimble and George, 2010) as the domain of enquiry of the first and the approach of the second will meet at point. Berrios and Marková seemed to have focused on the degree of conversion among biological psychiatry, organic psychiatry, neuropsychiatry and behavioural neurology. They stated that they share the same foundational claims (FCcs): (1) mental disorder is a disorder of the brain; (2) reasons are not good enough as causes of mental disorder; and (3) biological psychiatry and its congeners have the patrimony of scientific truth. They further elaborated that the difference is primarily due to difference in historic origins. (D'haenen et al., 2002). The American Neuropsychiatric Association (ANPA) defines neuropsychiatry as the integrative study of neurological and psychiatric disorders on a clinical level, on a theoretical level; ANPA defines it as the bridge between neuroscience and clinical practice. The interrelation between both specialities is adopted by The Royal Australia and New Zealand College of Psychiatrists as it defines it as a psychiatric subspeciality. This seems to resonate the concept that 'biologisation' of psychiatry is inevitable (Sachdev and Mohan, 2013). The definition according to Gale Encyclopedia encompasses the interface between the two disciplines (Fundukian and Wilson, 2008). In order to acknowledge the wide use of the term 'neuropsychiatry'; the fourth edition of Lishman's Organic Psychiatry, appeared and it was renamed as 'textbook of neuropsychiatry'. The editor stated that the term is not used in its more restrictive sense (David, 2009). Ostow backtracked the origin of biological causes for illness to humoral view of temperament.In the nineteenth century, the differentiation between both did not seem to be apparent. The schism seems to have emerged in the twentieth century. The difficulties that arose with such early adoption of neuronal basis to psychiatric disorders are that they were based on on unsubstantiated beliefs and wild logic rather than scientific substance. (Panksepp, 2004). Folstein stated that Freud and Charcot postulated psychological and social roots for abnormal behaviours, thus differentiating neurology from psychiatry. (David, 2009). The separation may have lead to alienation of doctors on both camps and helped in creating an arbitary division in their scope of knowledge and skills. The re-emergence of interest in neurospsychiatry has been described to be due to the growing sense of discomfort in the lack of acknowledgment of brain disorders when considering psychiatric symptoms (Arciniegas and Beresford, 2001). There is considerable blurring regarding defining the territory and the boundaries of neuropsychiatry. The Royal College of Psychiatrists founded section of Neuropsychiatry in 2008. The major working groups include epilepsy, sleep disorders, brain injury and complex neurodisability. In 1987 the British NeuroPsychiatry Association was established, to address the professional need for distinction, without adopting the concept of formal affiliation with parent disciplinary bodies as the Royal College of Psychiatrists. The ANPA was founded in 1988. It issued training guide for residents. The guide included neurological and psychiatric assessments, interpretation of EEG and brain imaging techniques. With regards to the territory, it included delirium, dementia, psychosis, mood and anxiety disorders due to general medical condition. Neurpsychiatric aspects of psychopharmacologic treatments, epilepsy, neuropsychiatric aspects of traumatic brain injury and stroke. The diagnosis of movement disorders, neurobehavioural disorders, demyelinating disease, intellectual and developmental disorders, as well as sleep disorders was also included. The World Federation of Societies of Biological Psychiatry (WFSBP) was established in Buenos Aires in 1974 to address the rising significance of biological psychiatry and to join local national societies together. The National Institute of Mental Health (NIMH), is currently working on a biologically-based diagnosis, that incorporates neural circuits, cells, molecules to behavioural changes. The diagnostic system - named 'Research Domain Criteria (RDoC) - is agnostic to current classification systems DSM-5 & ICD-10. Especially that the current diagnostic classficiations are mostly based on descriptive rather than neurobiological aetiological basis. (Insel et al., 2010). For example, the ICD-10 F-Code designates the first block to Organic illness, however, it seems to stop short of localisation of the cause of illness apart from the common prefix organic. It also addresses adverse drug events as tardive dyskinesia but stops short of describing it neural correlates. Also, psychosocial roots of mental illness seem to be apparent in aetiologically-based diagnoses as Post-Traumatic Stress Disorder, acute stress reaction, and adjustment disorders, the diagnostic cluster emphasise the necessity of having 'stress'. Other diagnoses seem to draw from the psychodynamic literature, e.g. conversion[dissociative] disorder. The need for neuropsychiatry, has been increasing as the advances in diagnostic imaging and laboratory investigations became more clinically relevant. Nowadays, there are tests as DaT-Scan that can tell the difference between neurocognitive disorder with Lewy Bodies and Parkinson's Disease. Vascular neurocognitive disorders warrant imaging as the rule rather than the exception, vascular depression has been addressed is a separate entity. Frontal Lobe Syndromes have been subdivided into orbitofrontal and dorsolateral (Moore,2008) Much training is needed to address this subspeciality. The early cases that may have stirred up the neurological roots of psychiatric disorders can be backdated to the case of Phineas Gage, and later, the case H.M. The eearlier fruits of adopting a neuropsychiatric perspective can be shown in the writings of Eliot Slater, as he attempted to search for the scientific underpinnings of psychiatry, and helped via seminal articles to highlight the organic aspect of psychiatry. Articles like 'The diagnosis of "Hysteria", where Slater, challenged the common wisdom of concepts like hysteria and conversion, rejecting the social roots of mental illness, and presenting a very strong case for the possibility of organicity, and actual cases of for which 'hysteria' was a plain misdiagnosis was way ahead of its time prior to CT Brain. Slater even challenged the mere existence of the concept of 'hysteria. (Slater, 1965) Within the same decade Alwyn Lishman published his textbook 'Organic Psychiatry' addressing the organic aspects of psychiatric disorders. Around the same time, the pioneers of social/psychological roots of mental illness became under attack. Hans Eysenck, published his book 'Decline and Fall of the Freudian Empire'. Eysenck stated clearly that the case of Anna O. seems to have been mispresented and that she never had 'hysteria' and recovered she actually had 'tuberculous meningitis' and she died of its complications (Eysenck, 1986). To summarise, it seems difficult and may be futile to sharply delineate neurpsychiatry, biological psychiatry, organic psychiatry and behavioural neurology. However, it seems important to learn about the biological psychiatry as an approach and practice neuropsychiatry as a subspeciality. The territory is yet unclear from gross organic lesions as stroke to the potential of encompassing entire psychiatry as the arbitary distinction between 'functional' and 'organic' fades away. Perhaps practice will help to shape the domain of the speciality, and imaging will guide it. To date, the number of post-graduate studies are still low in comparison to the need for such speciality, much more board certification may be needed as well as the currently emerging masters and doctoral degrees. This post is previously posted on bmj doc2doc blogs Bibliography Eysenck, H.J., Decline and Fall of the Freudian Empire, Pelican Series, 1986 German E Berrios, I.S.M., The concept of neuropsychiatry: A historical overview, Journal of Psychosomatic Research, 2002, Vol. 53, pp. 629-638 Kieran O’Driscoll, J.P.L., “No longer Gage”: an iron bar through the head, British Medical Journal, 1998, Vol. 317, pp. 1637-1638 Perminder S. Sachdev, A.M., Neuropsychiatry: Where Are We And Where Do We Go From Here?, Mens Sana Monographs, 2013, Vol. 11(1), pp. 4-15 Slater, E., The Diagnosis of "Hysteria", British Medical Journal, 1965, Vol. 5447(1), pp. 1395–1399 Thomas Insel, Bruce Cuthbert, R.H.M.G.K.Q.C.S.P.W., Research Domain Criteria (RDoC): Toward a New Classification Framework for Research on Mental Disorders, American Journal of Psychiatry, 2010, Vol. 167:7, pp. 748-751 Organic Psychiatry, Anthony S. David, Simon Fleminger, M. D. K. S. L. J. D. M. (ed.), Wiley-Blackwell, 2009 Neuropsychiatry an introductory approach, Arciniegas & Beresford (ed.), Cambridge University Press, 2001 Biological Psychiatry, Hugo D’haenen, J.A. den Boer, P. W. (ed.), John Wiley and Sons, 2010 Gale Encyclopedia of Mental Health, Laurie J. Fundukian, J. W. (ed.), Thomson Gale, 2008 Biological Psychiatry, M. Trimble, M. G. (ed.), Wiley-Blackwell, 2010 Textbook of Neuropsychiatry, Moore, D. P. (ed.), Hodder Arnold, 2008 Textbook of Biological Psychiatry, Panksepp, J. (ed.), John Wiley and Sons, 2004 The American Neuropsychiatric Association Website www.anpaonline.org The Royal Melbourne Neuropsychiatry Unit Website http://www.neuropsychiatry.org.au/ The British Neuropsychiatry Association website www.bnpa.org.uk The Royal College of Psychiatrists website www.rcpsych.ac.uk The World Federation of Societies of Biological Psychiatry website www.wfsbp.org  
Dr Emad Sidhom
almost 3 years ago
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Pennyless Med Students: Medical student finance FARCE

There are roughly 7000 medical students graduating each year from 33 medical schools in the UK. Medical degrees take either 4, 5 or 6 years depending on the route you take. The government via the Student Finance Company will pay for your tuition fees for the first 4 years of any undergraduate degree. After this the NHS will pay for the last year or 2 years of the undergraduate medical tuition fees. The maintenance loan depends on family income. The figures aren’t easy to find for the background of most UK medical students but a ‘guestimate’ based on my medical school is that 50% went to a private school, 30% went to selective state schools and 20% went to a comprehensive. Of the private school kids probably about half had a scholarship or bursary. So, a rough guess would be that 70% of med students come from a “middle class” family who have a decent income but not huge wealth and are therefore eligible for a ‘maintenance loan’ above the minimum. This majority therefore rely on there loan to get through the year. An average student income is between £1000 and £1500/term (£1200 average-ish). Most university terms are 10 weeks, hence average income is about £120/week. As a preclinical medical student this is fine and we are on par with everyone else. As soon as we become clinical med students the game changes! Clinical years are far longer, more like 40 weeks a year rather than 30. Students are on placement, have to dress professionally and travel to placement daily. This adds additional costs and requires the money to stretch further. Doubly bad! Once, the NHS starts paying the tuition fees, the Student Loans Company starts reducing the maintenance loan, by half! Why? A final year student or a 4th year who has intercalated now has to survive at University for one of their course’s longest years with half the money they had previously. >40 weeks on a loan of roughly £1500/year. This situation is pretty much unique to medical students. Some students are lucky enough to have parents who can afford the extra couple of thousand pounds required for the year. Some students get selected into the military and get a salary. A greater proportion find part time jobs to help cover the cost and the rest have to resort to saving money where they can and taking out loans. When I was a member of the BMA medical student committee I did a project as part of the finance sub-committee investigating the loans available for medical students. Many banks used to “professional development loans” which allowed medical and law students to borrow money for a year before they had to start repaying the loan. Hardly any banks now offer this service, so the only loan available is an overdraft or a standard loan that requires you to have a regular income. This means that final year medical students with limited family support may have to live for a year on less than £2000. Does this seem fair? Does this seem sensible government policy? Medical students are 99% guaranteed to be earning over £25 thousand pounds within a year. We will be able to repay any loans. So why isn’t the Student Loan Company allowing us to continue having a ‘normal’ maintenance loan? And why aren’t banks giving us the benefit of the doubt and helping us out in our time of need? When I was on the BMA MSC there was talk of having a campaign to lobby government and the banks to rectify this situation but I can’t say I’ve been aware of any such campaign. Are the NUS, BMA, UKMSA or anyone else doing anything about this? Please do leave a comment if you do know if there has been a progress and if there hasn’t why don’t we start making a fuss about this!  
jacob matthews
almost 3 years ago
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Why doesn’t the NHS make money?

The NHS provides care free at the point of us to British citizens and anyone who needs emergency care while in the UK. It tries to provide every kind of service and treatment that it can but obviously there are limits. The NHS gets its money mainly from governments taxes, charities, research grants, some payment for services and from renting out retail space etc. Healthcare is a financial blackhole, any money put in the budget will get spent, efficiently and effectively or not. The NHS is constantly being expected to provide a better, more efficient service and new treatments, without a comparable increase in government funding. So, why doesn’t the NHS set up services that could make it money? Some money making suggestions Gift shops and NHS clothing brand – The American hospital I went to for elective had quite a large shop near the entrance that sold hospital branded goods. People love the NHS and it could make itself a brand, “I love the NHS” t-shirts, “I was born here” ties, “I gave birth at Blah hospital” car stickers, hats, jackets, tracksuits, teddy bears in white coats and so many more things could be sold in this shops to raise money for the NHS. Patients in a hospital are a captive market and their visitors are semi-captive. The captives get very bored! Why not provide opportunities for these people to spend their money and relieve the boredom while they are in hospital with some retail therapy? For instance, new hospitals should be built with a shopping mall in them and a cinema. A couple of clothes shops would give people something to do and raise money from rent. While we are on the subject of new hospitals, they should be designed with the input of the clinical staff who know how to maximise the flow of patients through the "patient pathway". Hospitals should be built like industrial conveyor belts: patients enter through ED, get stabilised, get fixed in theatre, stabilised again in ITU, recover on the wards and out the exit to social services and the outpatient clinics. New hospitals should be designed to sit on top of HUGE underground multi-story car parks. If shopping centres can do this then so can hospitals. Almost all hospitals are short of parking spaces and most car parks are eye sores. So, try to plan from the beginning to get as many car parking spaces as possible. Estimate how many are needed for staff and visitors - then double it! Also, design a park and ride system so additional parking is available off site. If costa can make money from a coffee shop in an NHS hospital, why isn’t the NHS setting up its own brand of high quality coffee shops in the hospitals and cutting out Costa the middle man? “NHS healthy eating” – NHS branded diet plans or ready meals could be produced in partnership with a supermarket brand. Mixing public heath, profit and the NHS brand. “Good for you and good for the NHS” The NHS could set up hospitals abroad that are for profit institutions that use the NHS structures, or market our services to foreigners that they then pay for. Health tourism is a thing, why not make the most of it? “NHS plus” – the NHS should be a two tier system. Hours of 8am til 6pm should be for elective procedures free at the point of use and free emergency care. Between 6pm and 11pm the hospitals currently only do emergency care, so there is loads of rooms and kit lying about unused. Why not allow hospitals to set up systems where patients can pay for an evening slot in the MRI scanner and cut the queue? Allow surgeons to pay to use the facilities for private procedures in the evenings. Allow physicians to pay to use the outpatients clinics for private work after hours. An “NHS Journal” could publish research and audits conducted within and relevant to the NHS. “NHS pharma” – the NHS buys a huge amount of off patent drugs, why not produce them itself? Set up a drug company that produces off patent medication, these can be given to the NHS at cost price and sold to other healthcare providers for profit. NHS pharma could also work with British universities and researchers to produce new drugs for the British market that would be cheaper than new Drug company drugs because they wouldn’t need huge advertising budgets. There are so many ways the NHS could make more money for itself that could then be used to deliver newer and better treatments. Yes, it is a shift in ideology and culture, but I am sure it would have positive outcomes for the NHS and patients. If you have any ideas on how the NHS could produce more money then please do leave a comment.  
jacob matthews
almost 3 years ago
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The NHS should care … for it's staff

The NHS is one of the largest employers in the world. It is one of the largest healthcare providers in the world and it is one of the most loved and needed institutions in this country. The downsides to the NHS is that it is constantly ‘in crisis’ and it is expected to provide better care and newer treatments with less money and not enough staff. Recently, this has caused a significant drop in staff morale and the beginnings of an exodus of trained staff out of the NHS. This needs to be addressed. If you read almost any management textbook, journal article or magazine, they will tell you that happy staff perform better. This ethos is easy to theorise but less easy to practice. Companies like Google and Apple have taken this to heart but so did some of the old Victorian companies like Cadbury’s and Roundtree. These companies aimed to make a profit but also to invest and look after their staff because of moral and economic principles… and it worked. I believe the NHS needs to embrace this old fashioned paternalistic concept, if it wishes to continue to be a world leader in excellent, affordable healthcare and professional training. If the NHS invests in its staff now, it will increase staff morale, encourage people to stay working in the NHS and ensure top quality patient care. The reforms Staff canteens open 24/7 (or near enough), that serve good quality, healthy and affordable food. If staff have to work unsociable shifts, it seems unfair not to provide them with the chance to eat a healthy meal at 2am rather than a Domino's. Staff canteens also allow the staff to unwind and socialise away from the wards and the public, they can be unofficial hubs of productivity where the 'real business' takes place away from the meetings. Staff rooms with free tea and coffee - it doesn't cost much and every appreciates a 'cuppa'. A** crèche** for the children of staff, on site or nearby. Reduces the stress of having to take children to carers and pick them up, allows greater flexibility for the staff. Free staff car parking (if they car share). Staff have to get to work and cars are the most practical way for most people, so why punish them by charging car parking? An onsite gym that is free/reduced price for staff and open 24/7 so that staff can pop in around their various shifts. The physio gym could just be expanded so patients and staff use the same facilities. Providing healthcare is stressful, takes long hours and is antisocial. All these factors make it easy to put on weight, especially with most hospitals only providing unhealthy meals, Costa and Gregs. So, an onsite gym would make it a lot more convenient for the staff to get the exercise they need to burn off all that stress and calories. Healthier, happier staff! A hospital/ centre social society like a student ‘MedSoc’ to organise staff socials and sports teams etc. This organisation could even organise special events for the staff like a summer ball or sports day. Anything fun that would bring the staff together and let them blow off steam. It could easily incorporate, elected officials from the professional bodies and elected representatives of the different employees and act as an unofficial staff voice. Regular staff forums that allow each group of employees to raise concerns or solutions to problems with the organisations management and senior staff. Staff rota’s should not just be imposed by management but should be organised in a flexible manner that allows staff input. The NHS management should encourage and provide extra learning opportunities for the staff. By investing in staff education they provide people with opportunities to develop them selves which will benefit the organisation and increase their sense of satisfaction with what they are doing. Team based points systems for good performance and regular rewards for excellent care. These points systems can then be used to promote competition between teams which should raise the level of care. Have a monthly leader board and reward the best team with a day at a spa or something. These changes may hark back to ideas that are out of favour now with the increased desires for measured ‘efficiency’, but I believe that these suggestions would hugely increase staff well being, which would hopefully improve their attitudes towards the organisation they work for and would hence make them happier and less stressed when they are caring for patients. If you have any other suggestions for improving staff wellbeing please do leave comments. The NHS is enormous and has a huge variety. It would be fascinating to survey as many parts of it as possible and see how many places have these services available for the staff already. Please feel free to contact me if you know of any study like this or if you are keen of setting up a study like this with me.  
jacob matthews
almost 3 years ago
08351cc6554d766296c2a2e368fb1f89
2
105

Clinical Exam Still Matters

After I retired from my academic position at the University of Miami, I started working as an intermittent ob & gyn in various cultural settings in the US and abroad. In 2006 I practiced in a hospital in New Zealand. I saw many interesting cases during my six months at Whangarei Hospital. One stands out in particular. This was a middle aged native Mauri woman who had been seeing her family doctor for several years because she was gaining too much weight, her abdomen was getting bigger, and she was constipated. Each time the family doctor saw her, he did not examine her but patted her on the back and encouraged her to eat less, eat more fruit and vegetables and be more active so that she would lose weight. When much later he finally examined her, he noticed a large tumor in her abdomen and referred her to the hospital. To make a long story short, we operated on her and removed a large ovarian cyst weighing more than 18 kilograms (about 40 pounds). This cyst fortunately turned out to be benign and the woman did well. The operation itself was something else as we needed an extra assistant to hold the tumor in her arms while we removed it without breaking it. Even though this large tumor was certainly not a record, we ended up publishing the case in a New Zealaned medical journal for family practice (see reference below), not so much for the nature of the tumor itself as for pointing out to family doctors (all doctors, in fact) that examining patients before giving them advice is most important. Alison Gale, Tommy Cobb, Robert Norelli, William LeMaire. Increasing Abdominal Girth. The Importance of Clinical Examination. New Zealand Family Physician. 2006; 33 (4): 250-252  
DR William LeMaire
almost 3 years ago
B0ebbe67e0896c6ce794e7e839259713
2
70

Dying to do an expedition

As a hospital doctor, surgeon or GP we encounter death frequently. We quickly learn to cope. It helps when we know that we have done everything within our power to prevent death. When death is close we have the ability, medication and specialists services to make the process as 'comfortable' as possible. In the final moments it is rare that the patient is alone; whether in the company of family, friends or health care professionals. When an individual dies on expedition it may have been avoidable, you have very little kit to prevent it, they may be alone and they probably were your friend. No one prepares you for the potential of a client dying. But it happens. First of all, I am not trying to put you off doing an expedition. I love expedition medicine and have dedicated the last five years of my life to it. But I was not prepared for my first near death experience and I want to make sure you are. AVOIDABLE DEATHS During an expedition injuries, near misses and deaths are sometimes avoidable. There may have been a faulty bit of kit, medication which wasn't packed or route marker that fell down ... Hindsight is a wonderful thing. You, the team and the organisers work within what is feasible and normal health and safety don't and can't apply. I am NOT saying it is ok to be negligent, but a degree of pragmatism is need. What you need to remember is the competitors/ clients are aware of the dangers and, as medics, we should be too. LIMITED KIT Many medics are shocked by the lack of kit taken on expedition. But you need to think about the environment you are in and then think rationally. If your nearest decompression chamber is 3 days away by boat, is there much point taking oxygen on a diving expedition? If you are on expedition in the middle of the jungle is there any point taking a defib if any client in need of a defib is unlikely to survive extrication. You have to work within the limits of your environment and with the kit you have. As the medic you need to be aware of the nearest hospital and their facilities, the nearest large hospital with surgical and ITU facilities and the casevac plan. THE CLIENTS During expeditions the clients often become good friends. You will experience their highs and lows and share incredible experiences. This makes it especially hard when unfortunate events occur. At this point our role as medic often broadens to counsellor and bereavement officer. The other clients, organisers and medics need support during this time. Try to start this process whilst you are out there. Even with near misses, the psychological effect on people can be huge. Signs and symptoms are generally easy to spot, but screen for them at clinics. Be aware during race events that grief may manifest though clients pulling out, loss of performance and increased injuries due to lack of sleep, low mood or poor concentration. No matter what happens when you are on expedition my advice is; you can only work within your skill set and with the equipment you have. As a foundation doctor, if you’re faced with an unresponsive client - you are not expected to perform RSI and intubate. Work through your ABCDE and work within your limitations. If you would like to suggest any other blog topics or have any questions please post below.  
Dr Rachel Saunders
about 3 years ago

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