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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Tuesday 26 December, 2006

Rant: parents of chronically ill children

Posted in Michael Tam, Paediatrics, Rants at 18:45 by Michael Tam

Original article by: Michael Tam :: Printer friendly

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.

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Sunday 3 December, 2006

Opioid analgesic dose conversions

Posted in General Practice, Medicine, Michael Tam, Wards at 19:37 by Michael Tam

Original article by: Michael Tam :: Printer friendly

morphine

Opioid analgesics are the cornerstone to treatment and control of severe pain. Equivalence of dose potency is not absolute and care must be taken in changing analgesics. In general, it is safer to use a lower regular dose with breakthrough analgesia rather than to convert immediately to the “equivalent” dose.

It is important nevertheless to know the approximately dosage conversions.

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Sunday 12 November, 2006

Common MBS item numbers for general practitioners

Posted in General Practice, Michael Tam, Resources at 17:32 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

MBS Item Numbers for GPs

A one page list of the most commonly used MBS item numbers used in general practice. (Last updated: 12 November 2006) [57 Kb]

For better or worse, general practitioners who chose to run a bulk billing practice must wade through the arcane tome that is the Medicare Benefits Schedule (MBS). Despite Medicare Australia’s attempts to make this volume “user friendly” with copious indices, colour coding and cross-referencing, it is nevertheless futile using it to find an item number on-the-fly. Although the MBS has now been released on-line, I still find it next to useless given its primitive search capabilities.

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Know the NSW Public Hospital (Medical Officers) Award

Posted in Advice, Emergency Dept., Michael Tam, Resources, Wards, Workplace at 9:29 by Michael Tam

Original artcle by: Michael Tam :: Printer friendly

Resources

Public Hospital (Medical Officers) Award

Serial C4272. Industrial Relations Commission of New South Wales. Issued 16 December 2005. [117 Kb]

Public Hospital (Medical Officers) Award – Hours of Work and Tenure

NSW Health Department Policy Directive (no. PD2005_457). Issued 28 January 2005. [32 Kb]

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.

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Sunday 22 October, 2006

Caffeine is not a substitute for sleep

Posted in Emergency Dept., Michael Tam, Rants, Wards, Workplace at 21:53 by Michael Tam

Original article by: Michael Tam :: Printer friendly

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).

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Monday 16 October, 2006

DMARDs for rheumatoid arthritis

Posted in General Practice, Medicine, Michael Tam, Resources, Wards at 23:33 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis

An excellent two page summary from the National Prescriber Service [65 Kb]

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Sunday 15 October, 2006

How to start an intravenous glyceryl trinitrate (GTN) infusion

Posted in Emergency, Emergency Dept., Medicine, Michael Tam at 20:20 by Michael Tam

Original article: Michael Tam :: Printer friendly

An understanding of how to start and setup an intravenous infusion of glyceryl trinitrate (GTN) is a rather useful skill. Unfortunately, setting up a GTN infusion is sufficiently complicated that it can’t be worked out in an emergency situation. In a nutshell:

Start with glyceryl trinitrate 5 mcg/min

then

increase infusion rate by 5 mcg/min every 3-5 minutes if needed

when infusion rate is GTN 20 mcg/min or more

increase infusion rate by 10 mcg/min every 3-5 minutes if needed

GTN infusions are not trivial. Call for help. It should best be performed under the supervision of someone who has experience with them (e.g., a medical registrar or emergency medicine registrar).

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Sunday 8 October, 2006

How to give thrombolysis in acute myocardial infarction

Posted in Emergency, Emergency Dept., Medicine, Michael Tam at 17:42 by Michael Tam

Original article: Michael Tam :: Printer friendly

In the major urban hospitals, there will be little place for thrombolysis in acute STEMI (ST-elevation myocardial infarction). Primary PCI (percutaneous coronary intervention) is clearly the treatment of choice (1).

Don’t forget to take documented informed consent prior to giving thrombolysis. It is a commonly forgotten step.

However, if you work in a rural or remote setting where the local hospital does not have a cardiologist who can offer primary PCI, then thrombolysis makes a difference. The 30-day mortality in newly diagnosed acute coronary syndrome from 1987-2000 decreased by 47%. This has been attributed to aspirin and coronary revascularisation procedures (e.g., thrombolysis and PCI) (2).

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