Sunday 12 November, 2006
Looking back, I never even once received a copy of the Public Hospital (Medical Officers) Award when starting work at a number of NSW Public Hospitals. The Award sets out the conditions of employment for junior medical officers (i.e., interns, residents, registrars) and is set by the Industrial Relations Commission of NSW.
The second publication is a policy directive from the NSW Department of Health that I will go through.
I strongly encourage that all JMOs read through the Award. My experience is that NSW Public Hospitals (or their administration) do not follow many of the finer details of the Award when they think that they can get away with it. This is really quite disgusting. The purpose of the Award is so that your rights and entitlements are documented in stone. You shouldn’t have to fight for them.
Don’t let medical and hospital administration get away with labour theft because of your own ignorance of your employment contract and conditions.
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).
Monday 16 October, 2006
Tuesday 26 September, 2006
There are many reasons why patient interactions can be frustrating or difficult. Most commonly these can be traced to factors relating to the patient, the physician, or the health care system (1).
The management of a “difficult” patient requires time, good communication and firm limit setting.
“Difficult patients” are common and unavoidable. That being the case, “avoidance” should never be the goal of management. More often than not, these patients have real physical and/or psychological health needs. Try to restrain yourself from the all too easy temptation of categorising “difficult” with “undeserving” or tossing them into the “too hard basket”.
Saturday 19 August, 2006
Metformin hydrochloride is the first line oral hypoglycaemic agent in Australia for the treatment of type 2 diabetes mellitus. It is the medication with the best evidence base for preventing macrovascular complications (1).
However, it is not without problems. Lactic acidosis is a life threatening complication. Luckily, it is fairly rare with an estimated number of cases of 0.03 per 1000 patient years (or 1 case per annum in 30,000 patients on metformin) (2) (3). The mortality of lactic acidosis is close to 50%.
Type 2 diabetes mellitus is common, and will become more so with the expanding Australian waistline. The large government funded Australian Diabetes, Obesity and Lifestyle Study (AusDiab) revealed that there are almost a million people over the age of 25 years with diabetes (1). Even more startling is that almost 1 in 4 Australians over the age of 25 either have diabetes or impaired glucose metabolism (impaired glucose tolerance or impaired fasting glycaemia) (1).
Oral hypoglycaemic agents are the first line therapy for patients diagnosed with type 2 diabetes mellitus if lifestyle modifications are insufficient. One or more of these agents should be commenced (except for those who present with non-ketotic hyperosmolar coma whereby insulin should be used).
In a nutshell (2):
Symptomatic hyperglycaemia and/or obesity
See below for details
Aim for a target of:
HbA1c < 7.0%
Fasting blood glucose < 6.5 mmol/L
Wednesday 2 August, 2006
Although starting antidepressants is not outside the realm of common experience (1), the changing of antidepressants is shrouded in the aura of mystic voodoo that many consider to be best left to the psychiatrists. The reality, however, is that there isn’t much to it.
For the first line and most common antidepressants used (SSRIs except fluoxetine, mirtazapine, venlafaxine and the tricyclic antidepressants):
|Taper the dose of the first antidepressant by 25% per day (with complete cessation in 4-7 days).
Start the second antidepressant 3 days after the cessation of the first.
Sunday 30 July, 2006
One of the best resources I received when I worked at The Sydney Children’s Hospital, Randwick, was a laminated card (the size of a business card) attached to my ID badge lanyard. On this card included normal values for weight, heart rate, respiratory rate for infants and children, the correct dosage for a variety of emergency drugs as well as the recommended sizes for endotracheal tubes, nasogastric tubes and indwelling catheters by age.
Saturday 29 July, 2006
Bullying and other workplace conflict is a common scenario as a medico – from patients, from nurses and from other colleagues. There has been increasing media coverage on this regarding in particular the NHS medical system in the UK, and our own more close to home situation in Queensland (1). In a study of the National Health System (NHS) in Britain released in 2002 specifically of junior doctors, 37% of respondents identified as being bullied in the past year and 84% had experienced one or more bullying behaviours (2).
Bullying should not be accepted passively
Friday 28 July, 2006
Hypoglycaemia (US: hypoglycemia) or a “low BSL” is a common call on the ward. Unless you have a good story that the patient is alert, oriented and able to immediately take some form of oral carbohydrate, it must be treated as a medical emergency.
Hypoglycaemia is a potentially life-threatening medical emergency. Go assess the patient as a matter of urgency.
If the ward nurses are experienced, it is usual that resuscitation equipment and the resuscitation trolley will already be next to the bed. Before you dive into reversing the hypoglycaemia, remember the “ABCs” of resuscitation. The patient will die from airway, breathing and circulatory problems quicker than from hypoglycaemia.
In the emergency situation for adults:
50 mL of 50% dextrose intravenous as a bolus
glucagon hydrochloride 1 mg intravenous (or IM or S/C)