Thursday 26 April, 2007

Summary of treatment of asthma in adults

Posted in Emergency, Emergency Dept., General Practice, Medicine, Michael Tam, Resources, Wards at 0:28 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Asthma Management Handbook 2006 (National Asthma Council Australia) [1.1 Mb]

The management of asthma is clearly and in excruciating detail described by the National Asthma Council of Australia. Last year, the NAC published the 2006 update to the Asthma Management Handbook (1) which for all intents and purposes, should be considered the “gospel” of asthma management. Nevertheless, I have a number of criticisms against the publication. According to its own introduction, it is designed as an evidence-based guideline of asthma management aimed at general practitioners. However, I question whether more than a handful of GPs would actually read the entire 157 pages of the handbook! The lack of summary pages on management is unhelpful.

This article was written to address some of the deficiencies by distilling the management of asthma in adults into digestible chunks.

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Monday 26 March, 2007

Hints and tips on the medical consultation

Posted in Advice, Emergency Dept., General Practice, Michael Tam at 21:37 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Whether you are seeing a patient in an outpatient clinic, the emergency department or in general practice, the ability to engage in a medical consultation is vital to clinical practice.

The medical consultation is your basic tool and good communication is king.

Throughout all modern Australian medical schools, the idea and skills of being a good communicator is drummed into students so I won’t necessarily repeat skills that are obvious or self-evident. Rather, the following are some tricks and suggestions that may make you a better communicator.

A good way to think about the goals of a medical consultation is that it has three functions (1):

  1. Build the doctor-patient relationship
  2. Collection of data
  3. To agree on a management plan

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Wednesday 7 March, 2007

Collect blood in the serum tube first

Posted in Emergency Dept., General Practice, Michael Tam, Procedures, Wards at 22:00 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Vacutainer system

This short article is relevant for those people or institutions that use vacuumed tubes for venepunction and does not apply to using a needle and syringe.

One of the disadvantages of using a vacuumed tube system for directly withdrawing blood is that there is always a possibility that the needle dislodges or that the vein collapses before all the necessary tubes are filled.

For a long time, this would involve an apology from myself to my patient and a second venepuncture to collect the necessary blood. This is actually a reason that to this day, I still prefer using a plain needle and syringe (despite the increased needlestick risk) for patients with either difficult access or who require blood in many tubes.

However, this is a trick that I learnt from experience:

Always collect blood in the serum tube first.

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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

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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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Monday 29 January, 2007

How to do a good hospital discharge

Posted in Advice, Emergency Dept., Michael Tam, Rants, Wards at 21:44 by Michael Tam

Original article: Michael Tam :: Printer friendly

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.

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Develop your “outside” interests

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Wards at 21:15 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Cycling is fun!

As a junior medical officer, your time is often not your own. Between work, study, medicine related projects (e.g., research papers, presentations), family, meals and sleep there is often precious little time left!

Do not sacrifice your interests and hobbies for medicine as a junior medical officer. These “outside” interests makes you a holistic rounded person and in doing so, gives you a better understanding of humanity. This can only make you a better doctor.

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