Am I the only member of the ePortfolio fan club? If the recent vitriol on Twitter is anything to go by, one would be forgiven for thinking that the fan club comprises n=1. The most notable tweet about ePortfolio was from an anaesthetic trainee who said, “The portfolio is the medical profession’s equivalent of Mao’s cultural revolution—detainees given diaries to write down their own faults.” more…

The last few weeks have been life-changing for thousands of final year medical students, present company included. Final exams themselves have been a far off concept for many of us since the very beginning of our medical student lives—we have been perpetually aware of them, but they always seemed to happen to someone else. Even at the beginning of my final year, when one would (reasonably) expect these dreaded exams to become more of a reality, in my mind at least, they remained more a story of fiction. more…

It’s coming up to that time of year once again, where—for newly qualified doctors across the country—the jubilation associated with passing finals gives way to the incipient dread of the first day in a new job, and the knowledge that very soon patients’ lives really will be in their hands.

It’s well known that if you want to avoid those taking their first professional steps on the wards you should avoid becoming unwell in the first week of August. Type “junior doctors” into a search engine and it will helpfully suggest you might be looking for “changeover dates.”  Surely it is at least slightly surprising that after five or six years of full-time training the public still don’t have a great deal of faith in our ability to do our job? more…

Out with pacey surgical ward rounds; pain controlled, E+D, BO, OE – alert, obs stable, neurovascularly in tact, plan – drain out, fluids down, OT/PT, home when safe, OP 6/52. Out with debates about thromboprophylaxis, clotting and bleeding. Out with preadmission clinics. Out with being the crash team leader – I’ll not be sad to relinquish that duty. And in with a new hospital, a new team, and a new specialty.  I packed my bag after my night shift as the orthopaedic SHO oncall, left for good, and began preparations to start in paediatrics the next day, whatever that entails. more…

The award-winning experiential health website, healthtalkonline.org, launched a new section devoted to carers of people with a terminal illness on Wednesday. The website’s real life stories are proving a valuable resource not only to patients but also to health professionals.

healthtalkonline already hosts thousands of videos of people talking about their experiences of different medical conditions, from autism to pregnancy. The new section features 240 video clips taken from interviews with 40 men and women who have cared for a dying loved one. They cover the hidden aspects of caring, from dealing with financial issues to coping with conflicting emotions following the death. more…

I am very glad the Cochrane Collaboration exists. However, it is important to consider how its activities might be harmful and to take every effort to mitigate this risk.

I periodically re-read Joel Lexchin’s review of outcome in industry supported vs non industry supported studies to remind myself of the powerful and pervasive impact that conflict of interest has on the evidence base. Given most randomised controlled trials are industry funded, there is a risk that Cochrane Reviews  lend this biased evidence base legitimacy. more…

On the Today programme on Radio 4 on Monday morning there was a feature on these recently released data. Two areas were discussed. Hospital mortality is higher out of hours ie nights and weekends. The other item discussed was the smaller number of senior doctors in the hospital out of hours.

John Humphrys interviewed a spokesman for Dr Foster and one for the NHS Confederation. Unfortunately nobody who knows anything about the working of a hospital was interviewed. There is nothing unusual about this state of affairs. more…

Why are patients in English hospitals more likely to die at the weekend? A good question, put to Dr Mark Porter, head of the BMA’s consultants’ committee by John Humphrys on the Today programme on Radio 4 yesterday morning.

It was a difficult question for him to answer in a couple of sound bites. The question emerged (or perhaps re-emerged) in light of annual figures from the research company Dr Foster which show a 10% spike in weekend deaths, compared with weekdays. more…

‘Most doctors and nurses will have a deep well of patient stories – examples of great fortitude and its converse. It is clear to any clinician that some patients either feel their symptoms (or report them) more than others.

It’s the first week of August and in the NHS that can only mean one thing. Changeover has arrived and thousands of newly qualified doctors are let loose on the wards.

For decades, patients and doctors alike have joked that it is best to avoid a hospital stay in August. Lately, this myth has been gathering evidence with suggestions of increased mortality around the changeover period. [1] Whilst by no means conclusive, the trend shouldn’t be ignored. more…