Monday 26 February, 2007
Warning: This article is as much tongue-in-cheek as useful advise.
|As much as we aspire to EBM (evidence-based medicine) I suspect that many of us perform “GBM” (or Google-based medicine)!|
Google has become an invaluable tool as part of my day to day practice. Indeed, I find certain aspects of practice irritating without access to the internet (e.g., the current general practice I’m working in as well as the occasional hospital ED that is restricted by a firewall).
Monday 29 January, 2007
Consider a discharge of a patient from hospital (be it a ward or emergency department admission); what is the goal? You are trying to achieve a smooth transfer of care from the hospital team to the general practitioner. Thus, this article has an alternative title:
“How not to annoy the general practitioner with hospital discharges”
As a hospital JMO (the “turfer“), discharging a patient back into the community is often a relief. For the general practitioner who is on the receiving end (the “turfee”), there can often be many things that are frustrating and annoying. Having worked on both sides of the system, this article is about how to discharge patients without annoying the general practitioner (too much), and thereby, improving continuity of care.
Tuesday 26 December, 2006
Warning: the following is a rant of my personal opinions on the issue.
This article for inspired by a comment received by a family member of a chronically ill child. The comment is representative of many “difficult parents”. In this article, I will dissect it and give you an alternative way of thinking.
I’m not a doctor but a grandmother of a baby that was born with Christmas Tree Anomaly. As a result she has short gut syndrome. She was admitted to hospital for dehydration after a gastro virus made her vomit. They were hydrating her very well but as always before they seem to overdo it and now she is in ICU because her sodium and potassium levels shot up. So when your calculating the IVs, please consider that this is a person’s life you are messing with. This is a 15 month old beautiful baby girl that is spending her 2nd Christmas in the hospital all because her levels were not being watched properly and they did not account for what was already in her body when they smacked another IV drip up there. Doctors, listen to your patients and their parents. They may know more than you think they do and maybe more than you do. After all, this baby is the little girl that will be sneaking up on Christmas morning to peek at presents that someone loves so dearly. And one day it may be your loved one.
Sunday 22 October, 2006
Caffeine is the most widely used stimulant worldwide, and this is certainly true among Australian junior medical officers. Every morning, the wards are frequented by bleary-eyed junior doctors who do not become their cheery selves until the morning “cuppa”.
Juliano and Griffiths (2004) categorised and described a “caffeine-withdrawal syndrome” in a comprehensive review, and even concluded that “there is sufficient empiracal evidence to warrant inclusion of caffeine withdrawal as a disorder in the DSM [Diagnostic and Satistical Manual of Mental Disorders]” (1).
Tuesday 12 September, 2006
Warning: pseudo-intellectual mumbo-jumbo ahead!
Titian: Sacred and Profane Love (1514)
The term “the sacred and the profane” is more commonly used in a discussion on the nature of religion. The “profane” is the “realm of routine experience”; “the sphere of adaptive behaviour and is essentially utilitarian”. The “sacred” is the realm of human experience that “evokes an attitude of awe and reverence”, is “non-utilitarian”, “non-empirical” and “impinges on human consciousness with moral obligation and an ethical imperative” (1).
Sunday 30 April, 2006
“Catbert” the evil
Administrators are not working for you. They are working for themselves primarily and secondarily for the “system”. From an administrator’s point of view, the “system” is working if they meet budgetary constraints, meet performance indicators like “length of stay”, and there are minimal complaints from members of the public. If medical administration can get this done by bullying the junior medical staff to work harder, longer, with less supervision and less pay, then they will, and they do.
We want our meal vouchers,
Assuming that you work about 50 hours per week, you will be spending over a quarter of your life in and around hospital. If you are lucky and have good supervisors and mentors in the hospital, you may have people in the “system” that are both “on-the ground” and “proactive” in maintaining your interests.
The usual situation, however, is that you can be fairly certain that no one really cares about you. The only reason that your work hours are not excessively onerous, that you are paid rostered overtime, etc., is because of labour laws, your award and the guidelines as set by the PMC (Postgraduate Medical Council). Though these things offer a basic level of protection they are no good at providing any form of short or medium-term assistance with regards to industrial issues. The PMC, though a wonderful organisation, can really only act, “after the fact”.
There will be times when a patient will relay you a history where you will think that another doctor’s management or clinical decision to be baffling, inexplicable or plain wrong.
Be aware that there are malicious people who view doctors as a soft target for litigation. Don’t let a careless comment ruin someone’s year.
“Big pharma” only loves your
“Big pharma” spends billions of dollars each year on advertisements to doctors, and they are not doing so out of charity. Every doctor you speak to will think that they are not influenced by the pharmaceutical industry and this is the great swindle of our profession. Drug advertisements are so pervasive that it is sometimes hard to know where they end and where real medical education and trial results begin.
Part of the problem is that drug representatives are invariable really nice people so it is almost impossible to turn them away. They develop good if not great rapport with most doctors and what they say always seems to make perfect sense. Never forget, however, that they are still working for a big multinational whose goal is to make money; and their way of making money is to convince you to prescribe their most expensive drugs to as many people as possible.
Your patient is more than the sum of
It is easy to loose perspective during a busy medical or surgical term. Patients become known by their illness or disease, and you may soon find yourself doing tests and asking for consultations on routine rather than for clinical indication. It is easy to be too heavily focussed on the “tree” and miss the “forest”. Many hospitals have set protocols and they are generally a good idea as it means that a clear clinical pathway is followed. However, a protocol is not a substitute for thinking and clinical decision making; context is important.