Thursday 26 April, 2007
Summary of treatment of asthma in adults
Original article by: Michael Tam :: Printer friendly
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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.
Monday 26 March, 2007
Hints and tips on the medical consultation
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.
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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):
- Build the doctor-patient relationship
- Collection of data
- To agree on a management plan
Wednesday 7 March, 2007
Collect blood in the serum tube first
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:
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Always collect blood in the serum tube first. |
Monday 26 February, 2007
Google-based medicine
Original article by: Michael Tam :: Printer friendly
Warning: This article is as much tongue-in-cheek as useful advise.
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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).
The “fingertip unit” of topical steroids
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.
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One fingertip unit = 0.5 g of cream or ointment = two hand (palm) surfaces |
Sunday 11 February, 2007
STI screening tests
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).
Wednesday 7 February, 2007
Physical examination begins with the hands
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?
Tuesday 6 February, 2007
How to write a PBS prescription
Original article by: Michael Tam :: Printer friendly
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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.
Monday 29 January, 2007
Develop your “outside” interests
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.
Saturday 6 January, 2007
The new cervical cancer vaccine
Original article by: May Su :: Printer friendly
There has been much in the media recently about the new cervical cancer vaccine, “Gardasil”. The first vaccine was initially produced in the 1990s by a team of researchers in Queensland, headed by Professor Ian Frazer; who received Australian of the Year in 2006 for his work. The vaccine was then marketed by CSL pharmaceuticals and released in 2006. It is a vaccine aimed at preventing infection with the human papilloma virus (HPV), also known as the wart virus.
There is a clear relationship to human papilloma virus (HPV) and the development of cervical cancer (1). There are more than 100 different forms of human papilloma virus (HPV), but not all of them are linked to causation of cervical cancer (2). HPV 16 and 18 are indicated in causing over 70% of cervical cancers detected. The other genotypes linked to developing cervical cancer are types 45 and 31. Types 6 and 11 are linked to the clinical manifestation of genital warts and are low risk for developing cervical cancer.
