A wise man once said that he knew nothing at all except that he knew that he knew nothing at all. Socrates would have made a good medical student.

Chronic Fatigue Syndrome (CFS) is characterised by overwhelming fatigue, post-exertional malaise, cognitive symptoms, sleep disturbances, and a vague constellation of muscle and joint aches. It is a frustrating disease, for doctors, for patients, and for medical students. more…

On Monday, a friend posted a picture of an enormous, triple layered chocolate cake on Facebook. It was, she wrote, a present for her boyfriend—a final year medical student—to celebrate his being awarded his top choice of location for his first job next year. Getting the first choice has meaning beyond simple preference: it enables the couple to spend the next two years living in the same part of the country.

But the elation and the chocolate cake were soon followed by sadness and anger. As you will have heard by now, the job allocation process is to be rerun, and, like thousands of other final year medical students, my friend’s boyfriend has no idea whether he will achieve the tantalisingly glimpsed first choice job again. more…

The junior doctor’s applications process has metamorphosed from an individual interview process, to modernising medical careers (MMC), to the foundation programme application system. There has been a big push towards centralising services for the majority of NHS training applications. This year has also seen a change with regards to the application itself. A two hour “situational judgement test” (SJT) now forms the basis of the application as opposed to the previous “white space” questions. Whilst this was previously heralded as a fairer and more accurate reflection of the abilities of each individual to manage complex scenarios, and therefore a better way of discriminating between medical students, there have been problems. The two key ones include a lack of foundation programme training positions for medical students to apply for, and the latest news that there has been an error with the marking of final year student SJT papers. This means that the thousands of medical students who received their deanery information yesterday may have been given incorrect scores and information about their futures. more…

Tomorrow I’ll go to work and among other things, prescribe drugs. I’ve been told that they work and that they’re mostly safe. There’s plenty to encourage me in believing this: whether enshrined in official guidelines or treatment protocols (or not), lots of other doctors prescribe these drugs in the same or similar patients, for the same or similar conditions. As Ben Goldacre points out in his latest book, Bad Pharma, this is an “ad hoc oral tradition.”

At medical school we learned the physiology underpinning which drugs to give for what condition. There was an elegant simplicity in the study of pharmacology—this molecule acts at this receptor, and via these signalling pathways, brings about this change. Then we were told that given classes of drugs worked for certain conditions, with the occasional reference, by a clinician or lecturer, to a particular trial to align our faith to a particular named drug. more…

A pulse oximeter in the operating theatre doesn’t make surgery safer; it’s the anaesthesia provider using the oximeter effectively who will save lives.

For Lifebox, the BMJ’s Christmas charity, provision of education is inseparable from donating equipment.

That’s why we’re excited to share a recent conversation with Sandra Leal the president of the association of medical anaesthetists in El Salvador (AMAES—Asociación de Médicos Anestesiólogos de el Salvador).   more…

My wife and I arrived in Zambia in August 2012 for a six month placement as surgical registrars in a busy rural hospital in the Eastern Province. This was my first experience of hospital care in the developing world and I was soon working all hours of the day and night, operating on everything from minor wounds, to major trauma, and abdominal catastrophes.

St Francis’ Hospital is unique in the local area because it provides an entirely free service and always has at least one experienced consultant surgeon from Europe. Patients travel for hundreds of kilometres to the hospital expecting, and receiving, a high quality of care. more…

When people talk about the crisis of unsafe anaesthesia worldwide, there’s one particular publication that is frequently referenced—it’s too shocking to ignore.

“Deaths associated with anaesthesia in Togo, West Africa,” published in Tropical Doctor in 2005, demonstrated that anaesthesia mortality in Togo could be as high as 1:133 patients.

Lifebox recently spoke to lead author Fataou Ouro-Bang’Na about the origins of this paper, the culture of surgical safety, and his role in a recent Lifebox training workshop in the capital city of Lomé. more…

“Can I ask your advice doctor?” The recovery nurse who I had been teaching looked puzzled. “I have been asked by some of my colleagues on the wards how to wake up patients who have not recovered from their anaesthetic after one or two days. What do you suggest?”

My heart sank; all of the drugs we were using for anaesthesia should have cleared within hours, and a patient who was still asleep after two days was more likely to have suffered some other untoward event. After a few months of working in Ethiopia, I had a near certain guess as to the cause. more…

Just 3.5% of the 234 million major operations taking place each year are in low-resource settings, often carried out in very dangerous conditions due to lack of resources and training.

Lifebox Foundation, the BMJ’s christmas charity, works in more than 70 countries to improve the quality and safety of surgical care.

They spoke recently with Patrick Kyamanywa, dean of medicine at the National University in Kigali, about the challenges of delivering safe surgery in Rwanda. more…

Whenever I tell people I work for Lifebox, they often say, “Oh, is that the pulse oximeter charity?” I’ve heard this so many times now that it is easy to fall into the trap of believing that’s all we do—send out pulse oximeters.

Don’t get me wrong, we do send out pulse oximeters, and they play a vital role in surgical safety. Patients are over a thousand times more likely to die from a general anaesthetic in sub-Saharan Africa compared to the UK, and in many cases we know why. Hypoxia goes undetected, aspiration is missed, or the oesophagus is intubated by mistake. Each time these mistakes could have been detected with a pulse oximeter, yet there are still thousands of operating rooms that don’t have one. It is one tragedy after another, and support from BMJ readers will make a life saving difference. more…