Wardround 24xi6

This week's two minutes were themed about 'a patient who changed me/my practice'and with the discussion paper on end of life, turned into quite a discussion. It is useful to reflect on how we change our views as we gain experience and mature and the nature of professional versus societal responsibility.

Next week's two minute tutorials will be based on 'some common tests':
CRP (DK)
Troponin (HG)
D-dimer (PL)
Urinalysis (SS)
Keep it concise and precise.

The paper for reading is A PIECE OF MY MIND, Cripe, Larry D. JAMA 296(15):1815-1816, October 18, 2006. Access it via the elibrary.

Interesting topics
AION
Papilloedema
Drug rashes

MJM

Wardround 17xi6

A brief blog, sorry.

This week we discussed alternative medicine. I would like to hold on to the concept from the professor of alternative medicine in Exeter: Alternative medicine (as opposed to conventional medicine) is a treatment that has not yet been shown (with scientific rigour) to be effective. By his definition a substantial part of conventional practice is 'alternative'. We should not forget that. I find the NCCAM website http://nccam.nih.gov/ a useful first port of call when a patient asks about a specific complementary treatment.

The read and think for next week will be Measuring quality of life. Is there such a thing as a life not worth living?
Bobbie Farsides,  Robert J Dunlop BMJ 2001;322:1481-1483 ( 16 June ).

I had to leave before the end of the presentations this week so if you already have assignments for next week, do those. If not, let's have two minutes on "an episode which changed me/my practice".

MJM

Wardround 3xi6

This week's two minute talks were on poisoning. We heard about paracetamol (PL), and the importance of early treatment, early liaison with the transplant unit, and factors which make toxicity more likely. I didn't realise that Gilbert's disease was included in this list. The talk on ethanol and methanol (JW) led us to discuss the early management of unexplained coma (ABCDE-BM). I like the idea of ethanol poisoning being a 'diagnosis of exclusion' but would recommend you have in your mind what you intend to eclude before accepting the diagnosis (true of every diagnosis of exclusion). Tri-cyclics (CC): I agree with Dr Jones that these are the most worrying of the common diagnoses. The watchword should be 'beware'. Be aware of vital signs, ECG (PR, QRS and QT), and acid-base status. Finally we came to carbon monoxide poisoning (AC), and AC raised an interesting point as to possibility of imcreasing oxygen deliverty with CPAP. Prize for the best talk goes to AC.

We had a chance to discuss the Bruno Sachs paper, which had a mixed response. I have to admit that despite trying quite hard I could not bring myself to like it. It did however kick off a discussion about the way we learn what might be called the social aspects of practice.

For next week's talks the theme is making decisions for patients, the legal aspects. Two minutes please on:
Adults with incapacity act (PL)
Emergency detantion orders (CC)
Short term detention orders (SS)
Compulsory treatment orders (AC)
PHA (JW)
Be concise and precise, and quote your sources.

Reading for next week: What's a good doctor and how do you make one? Hurwitz B et al , BMJ 2002;325:667-668

Interesting topics this week:
Tolosa-Hunt syndrome
HOCM

MJM