Wardround 23iii7

This week’s two minute tutorials were on the investigation of a patient with abnormal LFTs. My test, if it can be called that, for each talk is to ask “Would it be useful for a new resident”. I am not sure that the talks did that. The bones of what to do and what it means seem to have been lost in the telling. Could I ask each person to post one sentence in the comments, please - on your topic.

The reading was Lying to Each Other. When Internal Medicine Residents Use Deception With Their Colleagues. Michael J. Green, et al. Arch Intern Med. 2000;160:2317-2323. An unsuspected side effect was that several of you could not access the paper. Try again. Remember to log in to the elibrary before navigating to the paper. The conclusion of the paper was, in brief, “A substantial percentage of internal medicine residents report they would deceive a colleague in various circumstances, and the likelihood of using deception depends on the context. While lying about clinical issues is not common, it is troubling when it occurs at any time. Medical educators should be aware of circumstances in which residents are likely to deceive, and discuss ways to eliminate incentives to lie.” We discussed ways of controlling lying. One being to be open to criticis. Perhaps the more insidious lies though are those we use internally to guide decisions. They are not open to scrutiny and will remain hidden, but can exert significant effects.

The two minute talks for next week are about diarrhoea. So two minutes please on:
Clinical assessment for diagnosis and definition TJ
Traveller’s diarrhoea DK
Investigation DL
Hospital acquired CS
Elderly out-patients DF
Keep it precise and concise. Make the handout count.

The reading for next week is Clinical decision-making: Coping with uncertainty. A F West; R R West. Postgraduate Medical Journal 2002;78:764

Interesting topics

Cor Pulmonale

TRAPS


MJM

Wardround 16iii7

This week's discussion and tutorials were based on the plague of Athens as described by Thucydides. The diagnoses suggested were: Ebola (DF), Anthrax (RT), Unknown (DK), and Measles (DL). You might want to reflect that each of you chose an 'organism' rather than a 'syndrome'. Dr Taylor might dispute this having described different clinical syndromes of anthrax, but her diagnosis was still organism based. Infectious disease diagnosis in clinical practice is ususally of a clinical syndrome first and possible organisms (note the plural) next.
If you would like to see a published discussion about the plague of Athens have a look at The cause of the plague of Athens: plague, typhoid, typhus, smallpox, or measles? Burke A. Cunha, Infect Dis Clin N Am 18 (2004) 29–43.

The prize for best argument/talk this week goes to DF.

Next week's talks are about the approach to a patient with abnormal LFTs:
Imaging (DL)
Viral serology (DF)
Autoimmune serology (DK)
Genetic screening (RT)

Keep to time, no more than two minutes and try to base the talk on the clinical scenario of a patient with abnormal LFTs.

This week’s readings are about lying. First I would like you to read Hugh Gallagher’s essay which can be found at this site. Then brace yourself and read Lying to Each Other. When Internal Medicine Residents Use Deception With Their Colleagues. Michael J. Green, et al. Arch Intern Med. 2000;160:2317-2323. Which you can get via the elibrary.

Is it ever right to lie? If so, when?

If you feel like reading more (but no fibbing) you might like Truth-Telling in Clinical Practice and the Arguments for and Against: a review of the literature. A. G Tuckett. Nursing Ethics, September 1, 2004; 11(5): 500 - 513.


MJM

Wardround 9iii7

This week we had two minute talks on the various waves and segments of the ECG. My prize for the best talk/handout goes to DF. I have a list of normal values on this wiki.

The reading for discussion next Friday is the description of the plague of Athens in The History of the Peloponnesian War written by Thucydides in 431 B.C. If you click on the link it will take you to a copy of the piece. The web page begins with chapter VI, but you can skip down to chapter VII (unless you would like to read about the war). If you cannot find the right section, press ctrl-F and type in plague.

You need to have an opinion on the diagnosis and be prepared to argue your corner. Make sure you revise the signs and symptoms of the disease you choose. Your two minute tutorials should be aimed at convincing a sceptical consultant (Dr YT) that your diagnosis is correct.

Furthermore, give some thought as to how you would work up such cases if they pitched up on MAU during your take.

Interesting topics
Transient Global Amnesia


MJM