I broke my stethoscope this week. I was listening to a chest, on a ward round, as you do, and the ear-pieces just went all wonky. The metal spring hidden in the rubber tubing had snapped. My stethoscope is like Trigger’s broom – I’ve had the same stethoscope since 4th year of medical school; I’ve […]
Are you asleep yet?
I don’t do a lot of sleep medicine. It’s never appealed to me. But I work in a relatively small department, so it’s inevitable that I will see people with sleep apnoea, and have to deal with it. In all senses. We have a relatively small population to serve – about 450,000 across the whole […]
How many decisions do you make in a day? How many could you? Or should you? Last weekend I moved house. A weekend full of decisions. Not massively meaningful decisions you might think, but you’ve probably not met my wife. What should we take first? Where should we put the sofas? Where should we put […]
Exercise, but exercise restraint?
I wrote last time about the ongoing problem of breathlessness in our patients, with no organic cause beyond obesity. My usual response is to encourage weight loss by increased exercise – seems to be a winner, as exercise not only leads to weight loss, but it’s really good for us, right? And those patients who […]
We manage our ward work differently these days. Different from when I was a lad. We do blocks of time on the ward, looking after all the patients in the ward for those two weeks. It makes for a high intensity fortnight, not least because we look after all the patients in the high dependency […]
I teach the first year medical students about breathlessness. I also teach the FY docs, ST docs, nurses, physios, and anyone who’ll listen, about breathlessness. I’m a stickler for minutiae, so I spend at least one slide, usually a couple, teaching, then reminding, that breathlessness is a symptom, not a sign. One cannot tell if […]
NEJM Images in Medicine This Week
A nice image in medicine in the NEJM this week – not something we see a lot, but my radiology colleagues are always telling us to look under the diaphragm, behind the heart, and behind the clavicles. Nice example of why they’re right. Sometimes. […]
Coiled and ready.
A couple of years ago I went on the advanced bronchoscopy course Palav Shah runs at the Brompton. I walked away with ideas of starting up a cryotherapy service, and excited about trying out some of the new lung volume reduction coils. I had a tinker with a cryotherapy machine, and hope to have another […]
This case in the NEJM has an amazing CXR, not to mention the fact that the lady in question survived. I suspect that even the elemental mercury is pretty bad for you… […]
The WISDOM of ICS
I was speaking at a local educational meeting in Perth last night, the topic being COPD, as it usually is at the moment. Every month another inhaler is released, another device, another pharma company courting our prescribing pens, another combination of drugs. So when I’m asked to go out to speak to our primary cary […]