” Appraising the value of innovation and other benefits: a short study for NICE, ” the report by Sir Ian Kennedy contains one of the best critiques of the new buzz word “innovation” but perversely goes some way to recommending it be included in cost effectiveness. more…

A hundred and five thousand people with flu symptoms were prescribed Tamiflu via the new hotline last week. But there are some unintended consequences. Although consultation rates for flu like symptoms are levelling, Pulse magazine reports on a new problem. Now patients are making appointments to see their GP complaining of the side effects of Tamiflu. more…

Talk of swine flu seems to have died down considerably since the launch of the national flu pandemic service in England last week. Despite the lack of news generally, it’s no longer on the front page of every newspaper - perhaps due to the telling off that the media got at the weekend (see Monday’s blog). more…

It wasn’t until the last couple of weeks that I began to have terrible, panic-stricken nightmares about my dreadful communication skills.  I wake in a trembling state, sweating because I can’t remember how to ask my patient ‘Does the pain radiate anywhere else? Does it come and go?  Is it sharp, stabbing pain?’
In my night terrors, it’s always the same patient, and me standing open mouthed bubbing like a goldfish. Now don’t worry, this memory problem isn’t pathological, I’m not dementing or growing a tumour, I’m moving to Guatemala for work.  Despite my 6 months of Spanish lessons slotted in around understaffed rotas, without a doubt I’m going to have some total communication failures.  The Calgary-Cambridge model probably isn’t going to cut it in the event I forget the words for ‘I need some help, she’s haemorrhaging’. more…

If you’re pregnant lock yourself in the house, shut the curtains and wear a facemask if you so much as put your nose outside the door… has advice to pregnant women finally gone too far? Or, given that at least six healthy women in their second and third trimesters of pregnancy are reported to be in intensive care with pandemic flu in Australia is this reasonable advice?

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A journal editor told me he was once asked to act as an expert witness defending a doctor accused of negligence for failing to diagnose a rare condition. The defence hinged on how soon a doctor could reasonably be expected to be aware of a medical development after it had been reported in a journal. To my friend’s relief, but my disappointment, as I’d have liked to have heard his answer, the case was settled without his expert testimony, but his story set me thinking. Journals are in the business of transmitting knowledge and ideas, but most seem content with the most old-fashioned and passive mechanisms and virtually never try to find out what methods work best. more…

A pandemic of panic

A “panic pandemic” is worsening the crisis in the UK said health ministers over the weekend. Andy Burnham, the health secretary, told The Observer of the need for people to keep a sense of perspective.

“If people are made unnecessarily anxious, it makes the lives of NHS professionals, who are already under enormous pressure, far more difficult as people become unduly worried.”

His plea was backed up by the president of the Royal College of Paediatrics and Child Health, Professor Terence Stephenson: more…

Iran has done what the United Kingdom has not dared: it has devised a single exam to be taken by its 20,000 doctors who are competing for 1600 residency positions. The UK system seemed to me unfair, but then an Iranian doctor explained Iran’s system. Rather than the UK’s online medical training application service (MTAS), set up in 2007 to rank medical students according to their 150 word answers about teamwork, prioritisation skills, and professional behaviour, Iran has one simple exam. Held yearly, it comprises 200 multiple choice questions that cover all aspects of clinical medicine, from psychiatry to ophthalmology. Unsurprisingly, just to pass this exam can take 2-3 years of 10 hours’ training a day. Whether those 6000 hours cooped up over books actually makes you a better doctor is debatable because it is difficult to gain any clinical experience during this critical time in training.
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Last week 100,000 people are estimated to have had swine flu in the UK. 840 are in hospital and 63 are in intensive care according to Chief Medical Officer Sir Liam Donaldson. The number of deaths has climbed to 26, while worldwide 700 are thought to have died.

GP consultation rates rose dramatically last week. The RCGP’s figures show that it doubled from 73.4 to 155.3 consultations per 100,000 people in England and Wales. They will be at epidemic levels when the rate goes above 200. The QSurveillance figure, based on the diagnostic codes used in GP practices, puts the consultation rate above this threshold at 221.4. more…

So, one year of medical school finished, just five more to go. What have I learnt this year? As well as a load of useful medical things, and how to do my own washing and cooking, I have learnt some things they don’t tell you about in the prospectus…

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