Tardy wardround

Sorry folks. The posting is late this week due to foreign travel and computer problems.

I will just cut to the quick and give next week's reading:

BMJ 2003;326:151 ( 18 January )

Filler

Endpiece

A good physician versus no physician

The difference between a good physician and a bad one is certainly very great; but the difference between a good physician and no physician at all, in many cases, is very little.

If during the course of the common epidemic diseases which occur in this island every spring and autumn, two hundred patients were taken promiscuously, and one half delivered to the care of the faculty to be treated according to the art; that is, as private patients by whom they are fee'd every time they prescribe, and the other half delivered to the care of nurses, instructed to give them no physic whatever, but merely cooling drinks, and such light and simple foods as the patients' appetites might lead them to, I am convinced the world would be a good deal surprised at the result of the experiment.

---

J Moore, Medical Sketches. London: A Strahan and T Cadell, 1786

Jeremy Hugh Baron, honorary professorial lecturer, Mount Sinai School of Medicine, New York

Remember that a short read means more time for reflection.

You already have your assignments for two minute talks on endocrine dysfunctions.

MJM

EULAR

The EULAR meeting has been interesting and thought provoking. As well as the usual expected tide of data regarding biologics efficacy and safety, there has been a growing focus on strategies for treating Rheumatoid disease. More of which over the next few days.

Other sessions included neuroendocrine and intracrine influences on RA, circadian rhythms, SLE and crystals.

I hope the team back on Ward 10 will choose a subject for the two minute talks next week.

MJM (Barcelona)

Wardround 8vi7

The two minute talks this week were stimulated by a recent case of tetanus. We heard about the toxin effects of Tetanus (J Wallace); C. diff (G Bell); Botulism (N Mohan); Staph Toxin (L Frame). Very interesting topics. I was not aware of the neuromuscular effects of aminoglycosides. My prize goes to NM. You can find out more trivia about botulism at Naveen’s blog.

For next week’s talks we will address the four giants of geriatrics. Our mental search for the fifth giant reminded me of Terry Pratchett’s fifth horseman of the apocalypse. I once did a podcast on the subject and remain taken by the thought of that fifth horseman, Ronnie, who left before they became famous. The assignments for next Friday are:

Falls (MJM’s SHO)
Delirium (KL)
Incontinence (JW)
Immobility (NM)

Two minutes please. Keep it precise and concise, quote your sources and make a one page handout that is so perfect people will want to keep a copy to show their grandchildren. Given the subject matter I would prefer that you avoided practical demonstrations, especially JW.

The paper discussed this week was The dogged physical examination in the era of the C.A.T. Riegelman K. Primary Care 1980 Dec;7(4):625-35. I hope this has stimulated each of you to think about those parts of the exam that are particularly useful, yet easily and often omitted. You might want to read the last paragraph of the previous paper as well.

For next week I would like you to read and think about: Aunt Sophie’s Choice: the perils of paternalism. Schafer A.

PS beware Pratchett's four minor horsemen of the apocralypse: panic, bewilderment, ignorance and shouting.

MJM