Month: July 2016

Brave New Medical World 2084

Death has been banned and we will all live forever. Hurrah! The medical profession has decreed that as long as we take all the necessary measures to avoid risk that we can live forever. Doctors through scientific research have established the major risk factors in life and the government is now seeking to tackle these under new legislation. The most basic risk avoidance involves wearing a crash helmet at all times to avoid head injury. Suits developed by Michelin the French tyre makers will need to be worn to avoid possible damage from falls. Masks and sunblock will be...

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Why have an operation if you can avoid one?

George Ampat is a consultant orthopaedic surgeon hoping to help patients find non-surgical solutions. Why have an operation if you can avoid one? It’s a simple question with an obvious answer but increasingly surgery is being used where it may not be necessary. There is a general consensus amongst the general public that surgery is a “fix all” solution; but, by and large, this is not the case. Unfortunately the onus of explaining the risks of surgical interventions and the potential lack of benefit following surgical intervention solely rests on the surgeon. The Medical Director of NHS England, Sir...

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The merits of time off from practice

Although we would otherwise think and hope it, there remains a culture within medicine that disincentivises time off for anything, from parental leave to sabbaticals. The reasons for this are myriad, from concerns about de-skilling to the fear of the unknown and coming off the conveyor belt of speciality training. There is, of course, security and contentment in knowing where you are heading and following a chosen and well-trodden path, weathered by many before us. But what are we denying ourselves by racing to the end without exploring the diverse options available to us? Despite being a motivated, intelligent...

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Tasked based medicine and the generalist

Perhaps I have had a run of bad experiences but I sometimes feel that our secondary care colleagues are beginning to act as technicians and not physicians, directing themselves to a particular task to rule in or rule out a particular diagnosis, and ignoring the fact that the patient is suffering from symptoms, not from a diagnosis. For instance, you may refer a patient complaining of acute onset shortness of breath to the medical team, querying a PE, to have them sent back to you with ‘no exertional desaturation, d-dimer negative, no evidence of PE’. So now you find...

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The blue pyjama brigade: primary care in Lesotho

Here at RCSI Bahrain our students wear blue scrubs to hospital attachments, but it’s a long time since I have been in scrubs. With some trepidation I had agreed to take four final year RCSI students to work for a fortnight in a small hospital in Lesotho. Lesotho is a small mountainous nation, landlocked within South Africa. 40% of the population live on less than 1 US$ per day and almost a quarter of the adult population is HIV positive. You are 10 times more likely to die in an RTA than in the UK, and 50 times more...

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