Some things are still a Clinical Diagnosis
16th May 2018
I saw a man of 28 as a new patient this week, born in France.
I saw a man of 28 as a new patient this week, born in France. Episodic severe right upper quadrant pain. The more I listened to him, the more it was clear that it was very episodic (3-4 per year) and very severe. On one occasion he had been to A&E. The doctors had been concerned about a blood test suggesting inflammation somewhere and wanted to do an operation, but he felt it was not needed. I asked him if his parents were French, and he said one was from Morocco. Therefore, the diagnosis is probably……….Familial Mediterranean Fever. This is an inherited disorder that occurs in some people of Mediterranean origin, who are subject to these episodic attacks of abdominal pain due to peritoneal inflammation, severe enough to occasionally have lapaorotomies which turn out to be normal apart from some serous fluid in the peritoneal cavity. They can also be subject to pleuritic pain and joint pain. Tests are essentially normal between attacks, while inflammatory markers are significantly raised during episodes of pain. Attacks can be prevented by using Colchicine, and controlling the inflammatory process is important, as there is a risk of developing Amyloid.
Minimum Unit Pricing (of alcohol) - now is the time!
24th July 2017
At last – a lead article on the front page of an influential national broadsheet newspaper, denouncing the government’s record on reducing liver disease deaths and advocating the immediate introduction of Minimum Unit Pricing (MUP) for alcoholic drinks. The Lancet Commission on Liver Disease in the UK, in conjunction with many other institutions and charities involved in liver and alcohol research, have produced new data showing that over five years, more than 63000 people will die and more than £16bn of NHS money will be spent on alcohol-related liver disease. MUP is a carefully targeted measure that only affects those that drink alcoholic drinks that are designed to be cheap but alcohol rich, especially the very strong lagers and ciders. It will have no effect on the average pub beer drinker or home wine drinker. Read the Guardian article on the link, and lobby locally and nationally in favour of MUP. https://www.theguardian.com/society/2017/jul/24/heavy-drinking-will-kill-63000-people-over-next-five-years-doctors-warn
Senior Decision Making - what does it really mean?
19th June 2017
In NHS hospitals, the phrase 'Senior Decision Making' is now much used when talking about how good decisions are made for patients so that they get the best and most timely care. This particularly applies in the Emergency Department, where the time taken for a patient to meet a 'Senior Decision Maker' (be it doctor, nurse or other) is often used as a benchmark. It is worth giving a thought to how that person learns to make good and quick decisions based on what may be sketchy information. Then spare a thought for the London Fire Commissioner (only been in the job for a few months), who had been woken up at 1.00am last week, had driven to West London from Kent, had been faced with the inferno that was Grenfell Tower, and then having to decide whether to authorise firefighters going into the building even though it had not been deemed to be structurally safe, against normal protocol. She did authorise them going in, and many lives were saved. I doubt if any doctor-on-call of any seniority has had to make such a quick and difficult decision, based on so little information. Humbling!
One Person's Influence - a memorable Charge Nurse
22nd February 2017
Funerals are obviously sad occasions, but the reflection that they bring can temper that sadness with a realisation of many good things that are around. This was clearly demonstrated this week when I attended the funeral of a Charge Nurse with whom I had worked for over 30 years and who died far too young. There was a huge turnout including a large number of colleagues. His care and concern for patients was always evident, but what came across even more than that in the funeral address was his care and concern for his fellow staff, be they people he was managing, colleagues at his own level, those who managed him, or indeed anyone with whom he came into contact. He was unfailingly supportive, always had time for people, went out of his way to ask about people’s welfare, and would always stick up for the staff and say ‘No’ to what was not in the best interests of staff and patients. There was much to learn from how one individual in the middle of a huge organisation can have such a profound influence on so many people.