Is this true in medicine?

“Any truth is better than indefinite doubt… – Arthur Conan Doyle”

Something to read

The Personal Equation in Medicine. JAMA. 2009;302(20):2265 reprinted from JAMA. 1909;53(22):1825-1826

Couldn't find it? !!!

If you would like to read more, there is a good discussion of the approach to diagnosis in 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.

MJM

Making a diagnosis

The reading for Friday 18th is a description of the plague of Athens, written in 431BC by Thucydides in The History of the Peloponnesian War. 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. The challenge is to make a diagnosis. You will have two minutes to make your case for the diagnosis of your choice. We will then have a chat about how to manage the situation.

MJM

Pharmaceutical Sponsorship

There is a suggestion that pharmaceutical companies sponsoring meetings should only be able to talk about drugs on the area formulary. What do you think about this? Do you think we should have sponsorship at all?

Have a read of The road to recovery. Is it time to bid farewell to the drug reps? by David Psetsky. It is on Medscape, but registration is both easy and free.

For the Friday meeting, those not presenting the case (and only one is doing that) are asked to give brief presentations on:
Benign Intracranial Hypertension
Aseptic meningitis related to drugs
Tuberculous meningitis
Herpes simplex encephalitis

Share them out between yourselves. I am looking for two minutes on the subject. Keep it concise and precise. No waffling. No powerpoint!

MJM

What's this?

Welcome to Ward 10

Welcome to Dumfries and Galloway. I will consider giving a prize to anyone who can identify where this picture is.

And welcome to the ward. You will find more information about your time on ward 10 by clicking here.

If you are reading this page in the hospital you will not be able to see the image above.

MJM

2vii9

Summer Break....

Back for the new intake in August.

MJM

Wardround 5vi9

The talks for Friday will be The use of serology in the diagnosis of:

Hepatitis B (ZB)

Hepatitis C (CM)

HIV (FY1)

Keep to the two minutes, drop the snippets of information that we already know and aim to leave your audience able to use serology appropriately in these situations. Remember to quote your sources. I am away on Friday, but will be testing the effects of the talks by asking some questions on the following Tuesday.

The paper to read for Tuesday will be Spellbinding and spellbreaking in convalescence<. George Day. Lancet 1961; 279 (7222):211-213. Log on to the NHS Scotland elibrary with your Athens password and choose the Lancet. You will be offered several sources, choose the Sciencedirect Lancet site.

For 19v9

The reading for Tuesday will be Ethical Debate: serious drug overdoses, B Dahal, BMJ 1995;311:115-116

You already have your talks for Friday, about diagnosis of various rheumatological conditions. remember classification criteria are not diagnostic criteria....or are they?

MJM

Wardround 24iv9

The reading for Tuesday will be "Stepford doctors": an allegory. GM Sayers. Medical Humanities 2006;32:57-58. Read and think.

This week’s two minute talks were about drugs with significant potential for adverse effects: warfarin, rifampicin, aminoglycosides and penicillin (with reported allergy). Take a minute or two and ask yourself what you now know about the the use of these drugs that you didn’t know before.

For next Friday the task is a two minute tutorial on the interpretation of results from:
Urinalysis
Arterial blood gases
Pulmonary Function tests
(and an extra in case we have an extra person…oxygen saturations)

MJM

wardround 3iv9

This week's talks were a challenge of summarising what needs to be done about a coincidental chronic illnes in a surgical patient. Both of you recognised the need to address issues directly related to the surgical aspects (risk of hypoadrenalism and thrombosis in lupus and blood sugar/ketones in diabetes) as well as a plan for checking that their longer term management was on track. That's your first two minutes out of the way. Now for next week, the two minute talks onFriday will be recognising the effects of:

Heroin (AB)
Cannabis (free)
Cocaine (CM)
Amphetamine (BS)

Be concise yet precise, and remain anchored in the real world... and just two minutes please.

For discussion on Tuesday I would like you to read Why are medical journals so dull by Richard Asher. Originally published in the BMJ in 23 August 1958. Tempted as I am to leave you to get hold of the paper using your own initiative there is a link here if you do not feel like taking up the challenge. The link works for me but if you are unsuccessful I can give you a paper copy (folded in the shape of a dunce's hat!)

MJM

Wardround 27iii9

We did not get to discuss our paper on Tuesday so let's give it ago this coming week. Read and think, then discuss intelligently It's the evidence stupid, F Godlee, BMJ 2008;337:a2119

The talks today were the management, in two minutes of particular scenarios. The mild biochemical hypothyroidism (FI) was well researched and summarised, since it is in fact quite a complex topic. It is important to consider the usefulness of recommended tests both from a resources standpoint but also as a discipline for yourself. When would you order thyroid autoantibodies?

The abnormal LFT scenario talk (BS) had less meat to it, but thereis always next week eh? Think carefully about timing of tests and use investigations as part of an overall plan.

For next Friday the scenario is a patient under orthopaedic care with a wrist fracture. The surgeons have asked for the patient's medical condition and treatment to be reviewed and optimised. The osteoporosis team are already on the case. So what will you be checking for this patient with:
SLE (FY1)
Chronic liver disease (BS)
Type 2 Diabetes mellitus (CM)

MJM

Wardround 20iii9

The two minute tutorials for Friday are "What to do about..."
A 45 year old woman with aches and positive ANA (CM)
A 60 year old woman with abnormal LFTS ALP167 AST 60 ALT 90 (BS)
A 40 year old with TSH 7 T4 12 (FI)

Two minutes only, be practical rather than theoretical.

The tuesday reading is It's the evidence stupid, F Godlee, BMJ 2008;337:a2119

MJM

Wardround 13iii9

The choices for important figures in infection were Fleming (FI), Koch (ST), Pasteur (BJ). Anybody turning in their grave about being overlooked?

For those who would like to read more about the plague of Athens could pass a little time reading 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 paper to read and discuss for next Tuesday is On the antiseptic principle in the Practice of surgery. Joseph Lister. Lancet 1867, Sept 21, 90 (2299) 353-356. You should be able to get the PDF using your Athens password. doi:10.1016/S0140-6736(02)51827-4 (don’t know what a DOI is?....better find out, you will come across them again).

The two minute tutorials for Friday are based on occupational lung disease:
Lung (FI)
Skin (ST)
Other important Occupational diseases (CM) - or choose from neurological, GI/GU, musculoskeletal, infectious.

Remember two minutes only; be concise yet precise, make it worthwhile to listen and quote your sources.

Interesting Topics:
Eplerenone
GI bleeding on low dose aspirin
Paronychia

MJM
P.S. Why the above picture?

Wardround 27ii9

The two minute talks on Gram positive cocci and gram negative bacilli were well researched and presented.You should now have a structure to help choose an appropriate antibiotic regime. We will test this on the ward rounds over the coming weeks. Dr Jones has also asked for a brief on the use of Tigecycline and Daptomycin for next week

The paper for discussion next Tuesday is Unburdening the Difficult Clinical Encounter, Kurt Kroenke, Arch Intern Med 2009;169 333-334.

Friday will be you opportunity to shine while solving the Plague of Athens.

Interesting Topics:
Nutritional support in chronic liver disease
Aortic stenosis

MJM

Wardround 20ii9

Good efforts in your talks about thrombolysis. I would like you to make the talks more specific and precise. Tell us the actual evidence, precise numbers and sources. Don't waste time with introductions or telling us stuff we all know already. Make the two minutes count. Let's have the re-hashed talks on thrombolysis on Tuesday.

The assignment for Friday is to produce a diagnosis of the illness in Athens described by Thucydides in 431 B.C. in The History of the Peloponnesian War . 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 could be on some aspect of your chosen disease.

MJM

Wardround 6ii9

The reading for discussion on Tuesday is Aunt Sophie’s Choice: the perils of paternalism. Schafer A.

The two minute talks this week were about abscesses. Good talks which I hope you found helpful. Remember the basics: consider the types of organisms that are possible, which will be altered by travel and immunocompetence. Always, ALWAYS, have your own plan in mind when seeking advice, then make sure you understand why any new plan differs from your own.

For nest week the two minute talks will be Neurology: recognising and understanding the following as causes of impaired walking:
Amyotrophic lateral sclerosis
Myelopathy (Dr Teo)
Peripheral neuropathy (Dr Jani)

Two minutes only. Be concise and precise. Quote your sources.

Interesting Topics

Benzodiazepine withdrawal exacerbated by quinolones (papers in patient's notes)

MJM

Wardround 30i9

The reading for Tuesday will be "Human guinea pigs"--a history. M H Pappworth. BMJ 1990 December 22; 301(6766): 1456–1460. Read and think.

This week's talks were about clinical assessment of parietal lesions, cerebellar dysfunction and differentiating bulbar and pseudobulbar palsy.

To simplify things, I like to think of parietal dysfunction as Motor: Dysphasia (dominant) and Dyspraxia (non-dominant); Sensory: Inattention and astereognosis. (The inability to recognise a deficit is called anosagnosia). I had not come across cerebellar DASHING before, and being stuck in my ways I will be keeping to DANISH. Pseudo and true bulbar palsy have many subtle differences, I would concentrate on tongue wasting with fasciculation and absent gag in bulbar palsy and increased jaw jerk and choking episodes in pseudobulbar disease.

For Friday, the assignments as two minute talks are Abscesses: contributing factors, organism and treatment. Choose among yourselves which sites to talk about from:
Brain
Liver
Psoas
Empyema (not an abscess, I know)

Interesting topics

Dyspraxia

Arteria Lusoria, see here for diagrams of the anatomy, and NEJM Volume 346(21), 23 May 2002, p 1637 for a case report.

MJM

Wardround 9i9

The reading for Tuesday is Immoral advances: Is science out of control? - science-in-society - 09 January 2009 - New Scientist. Read and think.

For Friday the two minute tutorials are about imported fevers. Two minutes please on your choice of these cases returning to the UK with a fever:

Fell in the water of Lake Malawai
Was bitten by a dog at Giza
Was bitten by a bug on the Amazon
Has a nosebleed having returned from Wagadugu
Fell in a well in Thailand

Post in the comments which you will be doing.

Interesting topics:

Very Basic Echocardiography
Diastolic failure



MJM