Monday 26 February, 2007

Google-based medicine

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Rants, Wards at 23:00 by Michael Tam

Original article by: Michael Tam :: Printer friendly

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).

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The “fingertip unit” of topical steroids

Posted in Dermatology, Emergency Dept., General Practice, Michael Tam at 21:16 by Michael Tam

Original article by: Michael Tam :: Printer friendly

The fingertip unit

This article was inspired by a comment from Dr Ewen McPhee (a rural GP) who mentioned the use of the “fingertip unit” in the article on topical corticosteroids.

The “fingertip unit” was original described by Long and Finlay in 1991 and is a handy guide for both doctors and patients to describe quantities of corticosteroid cream (1).

In essence, one “fingertip unit” is equivalent to 20-25 mm of cream or ointment squeezed onto the “fingertip”. One “fingertip unit” is approximately 0.5 g of cream or ointment is is enough to cover the front and back of a single hand.

One fingertip unit = 0.5 g of cream or ointment = two hand (palm) surfaces

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Sunday 11 February, 2007

STI screening tests

Posted in Emergency Dept., General Practice, Michael Tam, Sexual health at 0:38 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Diplococci of Neisseria gonorrhoeae

Sexually transmitted infections (STIs) are common. Many can be treated easily. Some may be asymptomatic but may lead to significant longer term problems if left untreated (e.g., chronic pelvic inflammatory disease from chlamydia increases the risk of ectopic pregnancies and infertility) (1).

It is a reality that people have sex, and some people have many sexual partners. As such, taking a sexual history and offering screening is an important part of preventative health care.

Note: the following guidelines are specifically for the broader Australian population. It may be appropriate to perform additional tests in specific cultural or regional groups (e.g., screening for HIV and syphilis is certain indigenous communities). These guidelines have been adapted the article by Ooi in the February 2007 edition of Australian Prescriber (2).

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Wednesday 7 February, 2007

Physical examination begins with the hands

Posted in Advice, Emergency Dept., General Practice, Medicine, Michael Tam, Wards at 22:25 by Michael Tam

Original article by: Michael Tam :: Printer friendly

All too often for JMOs, physical examination of the hands is forgotten. In situations other than test conditions, most people “go for the money” – jumping immediately to the body system expected to have the problem. This is perhaps understandable in the time poor hospital environment.

Nevertheless, I feel that all physical examination should always begin with the hands. Even if there are no specific physical signs, the hands can tell you much about the patient:

  • Are they warm and well perfused?
  • Is the patient nervous and sweaty?
  • Do the hands tell you something about the patient’s occupation and lifestyle?

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Tuesday 6 February, 2007

How to write a PBS prescription

Posted in Emergency Dept., General Practice, Medicine, Michael Tam, Resources, Wards at 23:05 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Application for approval to prescribe medications under the Pharmaceutical Benefits Scheme (by a registered medical practitioner)

The is the Medicare Australia application form for a prescriber number [118 Kb]

Writing an R/PBS (repatriation/pharmaceutical benefits scheme) presciption (aka “external” script for hospital based JMOs) is easy and simple when you know how. Incredibly (looking retrospectively), I don’t think that anyone actually went through with me how to write one. I’m sure there were more than a handful of community pharmacists shaking their heads (or their fists) at my dodgey scripts when I was a resident in ED!

This article is aimed mostly at interns and residents on how to write a community R/PBS prescription.

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Free medical textbooks

Posted in Good Websites, Michael Tam, Resources at 21:00 by Michael Tam

Original article by: Michael Tam

I recently came across a blog by a Victorian anaesthetic registrar “gasboy07” about his exploits. I noticed on his blogroll a number of links to “free medical textbooks” and was amazed by what I found.

Chances are that these resources are somewhat illicit. Nevertheless, the convenience of being able to search through your favourite textbooks (rather than the tedium of looking through the page of contents and index) is extraordinary. In fact, it completely changes the act of studying!

Get them while they’re still available!

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