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Words, listening, and the art of applying the general to the specific

24 Jul, 14 | by Bob Phillips

A little bit of a swirl around a decade-old paper by @iona_heath on the trouble with turning a patient’s experience into something that might require medically fixing that was floated about twitter recently.

The paper, which is densely written and has lots of lovely quotes from proper writers, and speak of many aspects of doctoring, holds to a thesis that the truth of the patient’s condition is their living of it, and as doctors, we mould and warp and misrepresent it to fit into a diagnosis, reject a diagnosis, or hold as an uncertainty. more…

StatsMiniBlog: Kappa

16 Jul, 14 | by Bob Phillips

After a short pause while brain cells were diverted elsewhere, we’re returning with the critically acclaimed (well, slightly positively tweeted) StatsMiniBlog series.

(As an aside – do let me know via comments, Facebook or Twitter if there’s an issue you’d like to see covered)

Kappa (κ) is a measure of agreement, usually between two observers of a dichotomous outcome although there are variants for multiple observers.  It gives you a measure of what agreement you see that is ‘beyond chance’


“Compared to standard care”

9 Jul, 14 | by Bob Phillips

There’s a decent argument in the analysis of quantitative studies of therapies, particularly using RCT designs, that says that we should be looking at the totality of unbiased evidence (systematic reviews) rather than looking at individual, cherry-picked, studies. The best estimate from this come from a pooling of all the results: meta-analysis.

There’s a challenge to this, though, when the comparisons are not quite the same. In the case of trials of drug A vs. B, C, D and E it can be quite easy to spot (and then perhaps undertake a network meta-analysis to address the issue). When the trials are A vs. standard care it’s a greater challenge to see if & how “standard care” varies.  more…

A Message To Paediatricians

6 Jul, 14 | by Bob Phillips

The Children and Young People’s Health Outcomes Forum, an “expert group” formed to advise the English governmental agencies on improving heath outcomes for folk from before their birth to 25 years old, held a summit in June and were addressed by a number of young people who had used health services in different ways.

One of those people, Lucy Watts, has taken us up on an offer to speak to an audience of paediatricians, phamacists and others involved in the care of young people through this blog site. She writes:

I would like Paediatricians to know that not all parents that challenge you or disagree with you are neurotic parents, and I think parents should be appreciated and used as an important pool of knowledge: you have the medical training, but they are the experts in their children. They know their patterns, behaviour, routines, diet, and they know when their child is sick. You get the odd neurotic parent, but that doesn’t mean all parents should be treated that way (especially mothers).When a child/teenager becomes sick, and needs care, it’s the parents who step up and fill that role. For example, my mum, who never wanted to be a nurse, has learned so many procedures she could rival any qualified nurse.  She’s the one who gives me my medicine, runs round getting medications and supplies, does all the phoning around and chasing up appointments, gets up with me at night, sleeps on my floor when I am poorly, empties my bags round the clock, she does my TPN – something many nurses do not know how to do – as well as IV medication, central line care, PEGs, injections, mixing medications, catheterising, dressing, stoma bags, can catheterise a blocked stoma….many things a parent should never have to do. Some doctors do not appreciate how far a parent goes to keep their child alive, many give up their lives, like my mum has, to keep us alive.

This is hauntingly familiar to me, an oncologist. If we listen, we hear this message from many parents, young people and children, and while we need to balance it with the truth that there is “the odd neurotic parent” the appreciation of how we make people feel while they are seeking explanations for them feeling unwell is very important.

(I appreciate that nearly all the hard work of filtering the non-malignant diagnoses has been done before folk get to me – and that I benefit hugely from this.)

I also know that I fail to recognise the massive effort that families put into caring, often, as I emerge from just 5 days of QDS medication to be delivered.

How do you respond to this piece?

- Bob Phillips


The despair of the box-ticking paediatrican

1 Jul, 14 | by Bob Phillips

So, as the annual assessment of learning by paediatric trainees reached fever pitch in many ares of the UK, a question rang out across Twitter:

In (trainees approaching ARCP), does (shoehorning logbook to curriculum) compared to (reflecting on clinical experiences) improve outcomes?

And while this, I feel, is more of an emotional outpouring to garner peer support, love and recognition of the need for coffee rather than an evidence request, there are some data supporting the use of work based assessments and e-portfolios


Naming of Reviewers

29 Jun, 14 | by Ian Wacogne

Peer review has controversies. There are numerous criticisms, but when it comes down to it, to paraphrase Churchill on democracy, it’s the worst way of doing it, except for all the others. I don’t want to discuss the whole process of peer review here, except to state that when we publish something, because we’re not always experts in that field, we ensure that there has been peer review.  The question I want to pose here is around the degree of anonymity.


(Not) A minion

25 Jun, 14 | by Bob Phillips

In 2015 a NEW film to go, see, and sing to...

In 2015 a NEW film to go, see, and sing to…

There is a temptation as a junior doctor to refer to oneself as “just a minion”. This is particularly true of FY1s/residents, but it persists a fair way up the food chain. After all, we just go around obeying orders and doing as we’re told, right? WRONG.

A junior doctor tends to be the first person to be called to a sick patient, whether a new admission or a current inpatient who has deteriorated. Every day we make decisions about whether to start or stop fluids, analgesia, antibiotics etc. We are the ones who decide whether a new admission can wait to be clerked in by us or whether we need to intervene immediately. When we review patients, we are not robots, simply asking a series of questions. We are interpreting (sometimes vast amounts of) information and making complex decisions based on that information. We have spent many years training to become critical thinkers, analysts, problem solvers. It would be utterly ridiculous to then unleash us into a job where we are simply yes-men. Yes, we have limited experience compared to our seniors, but we are still expected to think relatively independently.


Parity of esteem

22 Jun, 14 | by Bob Phillips


Lots of my clinical work, with children and young people with cancer, requires the team I work with to understand physical and psychological elements of a young person, and their family’s, health.

I also know, mainly from working groups and Twitter, that there is a statutory requirement to work to parity of esteem for physical and mental health.


I don’t think I’m the only one who will ask someone if their broken finger is getting better if I meet them in a corridor, but only ask about the depression in a private space. Or feel awkward when I ‘suspect’ someone of having a mental health disorder. (Suspect here, seems different than suspecting tumour progression or cardiomyopathy. Not like a clever detective finding the answer to a riddle but the difficult moment when you’ve waiting for a bus with amorous teens at the other end of the shelter.) I could blame this on the stigmatisation of mental health disorders in the UK generally. I’m not sure it’s not just that I’ve not worked hard enough to dispel my own prejudices.

How can we – in child and adolescent medicine – work towards making mental and physical health have parity of esteem? What steps have you taken (or know have been taken) to get there?

I’d love to hear – and then try them out.

- Bob Phillips




What’s in a number? (Part 2)

18 Jun, 14 | by Bob Phillips

Picture1 A quick task.

Grab a sheet of paper or open a blank screen on your computer.

Write down:


  • Your phone number
  • Your partners or a family members phone number
  • Your National Insurance Number
  • The sort code from your primary bank account
  • Your NHS Number

How did you do? Were you able to remember them all? Which did you struggle with? (hopefully you can remember more than just your own phone number!) more…

What’s in a number?

18 Jun, 14 | by Ian Wacogne

Picture1 Here’s a brief summary of a question put to me by Vin Diwakar, stimulated by the Children and Young People’s Health Outcomes Forum Summit 2014, and my response.

Importantly, in the original discussion I made an error; the NHS number does in fact have a check number.  For more info, and an explanation, read on.

The question was:  Why do hospitals use their own hospital numbers instead of their NHS number if the NHS number is a unique identifier? more…

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