Wow, what a weekend! Today is Monday, so it's Ayr......having driven rather a lot in the past 3 days, and also spent a fair ammount of time working doing techy things like building amp lands and running 9with others) approx 10km of cables in a room smaller than a tennis court, running 5 events in 2 venues, across 27 hours, and getting 12 hours sleep.
It was stressful, enjoyable, tiring, exhilerating, long, fun, heavy, work but the results were great ad everyone seemed pleased. There were no losses of temper, no shouting and only a bit of blood and tears, but plenty of sweat.
However, i dented the Ka and also cannot find my glasses. I was wearing contcats when the former happened so the 2 events are not connected!
Tuesday, October 28, 2008
Sunday, October 19, 2008
interesting ethical issues
I've been percolating on this one for a week or so now, but want to share it with you all because I need some other opinion.
In a session on peri-operative care, one of the consultants said that it was no longer 'normal practice' to order a chest Xray prior to an operation. Previously, JHO's and Fy1's had always ordered one for the anaesthetist. However, since the Surgeon didn't need it, and the anaesthetist usually didn't need it, the reports attached to the Xray were not read, and on occasion, small tumours etc were missed, which were later investigated and the Radiologist report read "the mass seen on dd/mm/yyyy has enlarged". The family got upset that no one had read the report of the original mass, and sued the NHS.
The consultant then went on to say that we should also never order blood tests that we did not need for the current management of the patient, because if we found an adverse result we would have to act on it.
I guess this comes down to 2 main questions:
a) should NHS hospitals be screening people for common ailments just because they have been admitted with a different condition.
b) if a hospital finds an adverse result and commences management as an in-patient, does the hospital pay instead of the PCT.......
Some patients do seem to fall through. we saw a lady with gallstones who had an irregularly irregular pulse. to us Med students that indicates AF. Yet despite having her pulse taken every 4hours, no one had noted the rhythm/character or done an ECG (she was admitted via GP not via A&E). She was due an operation at the tail end of last week, so it will be interesting to see if she received an ECG / cardiology referral, or if the anaesthetist was the first to notice in theatre! If so, might it be the downside of the assertion that investigations should not be carried out unless necessary. no-one thought it necessary, and they have to deal with the result.
Similarly, we saw a patient on an orthopaedic ward who had a BP of 180/100mmHg, despite being on triple therapy for Hypertension (Angiotensin 2 receptor antagonist, Calcium channel blocker and ACE inhibitor), and despite an inpatient stay of 2 weeks, had not had a review done by anyone from the Medical side of the hospital.
Conversely some departments are very good. Especially those with links. Vascular wards are quite good for getting cardiology to come and check out patients who display any cardiac signs - many get ambulatory ECG or 24hr recording monitoring to establish the nature of any cardiac complaint. But again vascular and cardiology are very closely linked physiologically and pathologically.
In a session on peri-operative care, one of the consultants said that it was no longer 'normal practice' to order a chest Xray prior to an operation. Previously, JHO's and Fy1's had always ordered one for the anaesthetist. However, since the Surgeon didn't need it, and the anaesthetist usually didn't need it, the reports attached to the Xray were not read, and on occasion, small tumours etc were missed, which were later investigated and the Radiologist report read "the mass seen on dd/mm/yyyy has enlarged". The family got upset that no one had read the report of the original mass, and sued the NHS.
The consultant then went on to say that we should also never order blood tests that we did not need for the current management of the patient, because if we found an adverse result we would have to act on it.
I guess this comes down to 2 main questions:
a) should NHS hospitals be screening people for common ailments just because they have been admitted with a different condition.
b) if a hospital finds an adverse result and commences management as an in-patient, does the hospital pay instead of the PCT.......
Some patients do seem to fall through. we saw a lady with gallstones who had an irregularly irregular pulse. to us Med students that indicates AF. Yet despite having her pulse taken every 4hours, no one had noted the rhythm/character or done an ECG (she was admitted via GP not via A&E). She was due an operation at the tail end of last week, so it will be interesting to see if she received an ECG / cardiology referral, or if the anaesthetist was the first to notice in theatre! If so, might it be the downside of the assertion that investigations should not be carried out unless necessary. no-one thought it necessary, and they have to deal with the result.
Similarly, we saw a patient on an orthopaedic ward who had a BP of 180/100mmHg, despite being on triple therapy for Hypertension (Angiotensin 2 receptor antagonist, Calcium channel blocker and ACE inhibitor), and despite an inpatient stay of 2 weeks, had not had a review done by anyone from the Medical side of the hospital.
Conversely some departments are very good. Especially those with links. Vascular wards are quite good for getting cardiology to come and check out patients who display any cardiac signs - many get ambulatory ECG or 24hr recording monitoring to establish the nature of any cardiac complaint. But again vascular and cardiology are very closely linked physiologically and pathologically.
Art I like!
This is the new sculpture in T5 and Heathrow. Sadly it is only on the luxury levels, but it looks great. It uses flip-dot technology (like the old train display boards in in stations did) .
See also http://troika.uk.com/cloud.htm
This is how they made it
See also http://troika.uk.com/cloud.htm
This is how they made it
................and those chicken sewing pictures
Initially we made a wound
then started sewing in our aseptic operating theatre
it was an intricate job
some of us did some nice stitches
others need some more practice.
Friday, October 17, 2008
I feel like......................Chicken Tonight1
The problem:
You are a Medical student, on a surgical block. You are staying at the attachment. There are 8 of you down there. You want something to do in the evening vaguely Uni related but also relaxing (i.e. not examination).
The solution:
Get the A+E Teaching Guy to give you suture kits and tools, and all of you sit watching Silent Witness whilst lacerating and then repairing the wounds to the muscular layer and the superficial fat /skin layer......................of a multipack of chicken thighs and drumsticks.
The cost:
£1.50 for the chicken, and whatever the NHS pay for sutures and single use tools.
The pictures:
To follow
You are a Medical student, on a surgical block. You are staying at the attachment. There are 8 of you down there. You want something to do in the evening vaguely Uni related but also relaxing (i.e. not examination).
The solution:
Get the A+E Teaching Guy to give you suture kits and tools, and all of you sit watching Silent Witness whilst lacerating and then repairing the wounds to the muscular layer and the superficial fat /skin layer......................of a multipack of chicken thighs and drumsticks.
The cost:
£1.50 for the chicken, and whatever the NHS pay for sutures and single use tools.
The pictures:
To follow
Sunday, October 12, 2008
Week 1 at the Seaside!
My laptop logs me into Blogger automatically and I had thus forgotten my password, so down at Seaside hospital i was unable to post this week because I could not remember my password, and there is no wifi except for Health Board computers.
Anyway:
Accommodation
Functional is the best description, dated is another. It is just uncared for. Not that it is dirty, or even dangerous, it just ahs no owner and thus no proper care. They have bought new LCD TV with built in DVD player though, so it is not all bad! We Surgical students are spread between 4 house on a cul de sac, with normal people living in the other houses whoich are/were local aauthority social housingm, though some maybe let to short term doctors from oevrseas who are working at the hospitals as well.
Teaching
We get a lot, but mostly of the tutorial kind, with only a few examples of bedside teaching. This we stalk the wards late at night (ok, 5.15pm) looking for patients and such like to examine. We also get (another) 5 day course in the care of critically ill patients, but this one includes a day in SIM-MAN up at the angry hospital.
Travel
Well I stayed down for all 4 days and did not miss my flat too much, except for the broadband and freeview the latter will hopefully be solved by taking my box with me).
Entertainment
Tuesday night is pub quiz at 9pm; the FY1's also enter a team, They came second and the 2 teams of medical students (both teams were a mix of medical and surgical students) came joint 3rd, but the other team beat us in the tiebreak! Wednesday and Thursday, we watched Silent Witness and muttered about the pretentious Medical Student in it (so clearly at a London Med School) and also tried to second guess the plot twists.
Anyway:
Accommodation
Functional is the best description, dated is another. It is just uncared for. Not that it is dirty, or even dangerous, it just ahs no owner and thus no proper care. They have bought new LCD TV with built in DVD player though, so it is not all bad! We Surgical students are spread between 4 house on a cul de sac, with normal people living in the other houses whoich are/were local aauthority social housingm, though some maybe let to short term doctors from oevrseas who are working at the hospitals as well.
Teaching
We get a lot, but mostly of the tutorial kind, with only a few examples of bedside teaching. This we stalk the wards late at night (ok, 5.15pm) looking for patients and such like to examine. We also get (another) 5 day course in the care of critically ill patients, but this one includes a day in SIM-MAN up at the angry hospital.
Travel
Well I stayed down for all 4 days and did not miss my flat too much, except for the broadband and freeview the latter will hopefully be solved by taking my box with me).
Entertainment
Tuesday night is pub quiz at 9pm; the FY1's also enter a team, They came second and the 2 teams of medical students (both teams were a mix of medical and surgical students) came joint 3rd, but the other team beat us in the tiebreak! Wednesday and Thursday, we watched Silent Witness and muttered about the pretentious Medical Student in it (so clearly at a London Med School) and also tried to second guess the plot twists.
Sunday, October 5, 2008
Is all advertising good advertising?
And this in the week that Sir Ian Blair was fired, and the ongoing inquest intoo the events of 22/07/05 continue......
Thursday, October 2, 2008
Thoughts on life and death
See here and here for starters. It has been a strange week all round really. With the main features seeming to revolve around life and its two extremes.
One one hand my sister's brother-in-law and his wife had a baby (well he didn't but you get the picture) on Monday - their first, and only 2 weeks late! I got the text about it on a day iw as talking to a patient on placement who was in for a knee replacement, and yet, had been swimming until 6 weeks before, helped into the pool by friends, because in the pool she could move freely and with less pain. She had been a runner from being you and ha been very active until her knees developed osteoarthritis about 4 years ago. They were the positives.
Then today I was writing up two cases. One is a woman whose son was horrifically injured 7 years ago, and who died last year. She herself has had Oesophageal and soft palate cancer for 7 years, and had a recent acute admission with gallstones. She spoke of the future with so little hope and expectation, and seemed to have a very low quality of life, due to her illness and the side effects of the vaious therapies. The patient is depressed, has problems sleeping and can only consume liquids, but still smokes 60 cpd to help with 'the stress'
The second is a lady with alcohol problems. She drinks a litre of whisky a day (28 units) at home, and sometimes goes out with friends. She was admitted with acute pancreatitis, and is the same age as my Mum, yet was very slow in spoeeach, tired easily, looked about 70, cannot walk waell due to bruises and breaks sustained whilst drunk. Her mouthw as a mass of ulcers, and her blood results indicate severe hepatic disease of one type or another, as well as acute pancreatitis and gastric erosion. Again, she had no hope for the future, and was convinced that only by drinking could she escapoe the situation she was in.
In both cases, I have struggeld in my write up to avoid being judgemental, and yet to try and understand their thinking, their viewpoint and how best to help them (albeit in a hypothetical Management plan). And yet, we get 2 or 3 such cases into the wards every week on this small unit.
So I find myself, having written both cases up, needing a small reminder of the positives of human nature, and why we as creatures care for each otehr, and as asociety why we demand that the NHS care for everyone equally regardless of status or outlook. I guess I'm tired and just a touch drained after 4.5 weeks in DEPCAT hospital.
One one hand my sister's brother-in-law and his wife had a baby (well he didn't but you get the picture) on Monday - their first, and only 2 weeks late! I got the text about it on a day iw as talking to a patient on placement who was in for a knee replacement, and yet, had been swimming until 6 weeks before, helped into the pool by friends, because in the pool she could move freely and with less pain. She had been a runner from being you and ha been very active until her knees developed osteoarthritis about 4 years ago. They were the positives.
Then today I was writing up two cases. One is a woman whose son was horrifically injured 7 years ago, and who died last year. She herself has had Oesophageal and soft palate cancer for 7 years, and had a recent acute admission with gallstones. She spoke of the future with so little hope and expectation, and seemed to have a very low quality of life, due to her illness and the side effects of the vaious therapies. The patient is depressed, has problems sleeping and can only consume liquids, but still smokes 60 cpd to help with 'the stress'
The second is a lady with alcohol problems. She drinks a litre of whisky a day (28 units) at home, and sometimes goes out with friends. She was admitted with acute pancreatitis, and is the same age as my Mum, yet was very slow in spoeeach, tired easily, looked about 70, cannot walk waell due to bruises and breaks sustained whilst drunk. Her mouthw as a mass of ulcers, and her blood results indicate severe hepatic disease of one type or another, as well as acute pancreatitis and gastric erosion. Again, she had no hope for the future, and was convinced that only by drinking could she escapoe the situation she was in.
In both cases, I have struggeld in my write up to avoid being judgemental, and yet to try and understand their thinking, their viewpoint and how best to help them (albeit in a hypothetical Management plan). And yet, we get 2 or 3 such cases into the wards every week on this small unit.
So I find myself, having written both cases up, needing a small reminder of the positives of human nature, and why we as creatures care for each otehr, and as asociety why we demand that the NHS care for everyone equally regardless of status or outlook. I guess I'm tired and just a touch drained after 4.5 weeks in DEPCAT hospital.
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