{"id":36,"date":"2014-04-20T21:54:37","date_gmt":"2014-04-20T21:54:37","guid":{"rendered":"https:\/\/blogs.bmj.com\/thorax\/?p=36"},"modified":"2014-04-20T21:54:37","modified_gmt":"2014-04-20T21:54:37","slug":"confidence-the-demise-of-the-sho-and-lung-cancer-screening","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/thorax\/2014\/04\/20\/confidence-the-demise-of-the-sho-and-lung-cancer-screening\/","title":{"rendered":"Confidence, the demise of the SHO, and lung cancer screening."},"content":{"rendered":"<p>I have been on call this weekend.  Recently in an RCPE survey the consultant body was asked specifically \u201cDo you frequently carry out duties previous carried out by more junior roles\u201d, or words to that effect.  Many a time do I hear my colleagues saying \u201cI do the same job today as I did xx years ago as a house officer\u201d.  I certainly saw plenty of patients today, rewrote a number of treatment charts, prescribed analgesia, night sedation, and the like, looked up blood results, and requested radiology tests.  So perhaps not much has changed since 2000.<\/p>\n<p>One of the tasks today was the removal of a chest drain that was not working, mainly because it wasn\u2019t actually in the thoracic cavity any more.  I asked the house officer to do it, which seemed reasonable enough to me (and the registrar trudging around after me).  2 hours later I got a call from the FY1 telling me that they didn\u2019t feel confident to pull the drain; could I come and do it?<\/p>\n<p>We used to have a sea of SHOs in hospitals \u2013 I remember being one.  The SHOs ran the show \u2013 they knew the patients, they did the ward rounds, they did the jobs, saw the relatives, and kept the hospital running.   We don\u2019t seem to have SHOs any more.  FY2 \u2013 ST2 should be the group of Doctors who run everything.  But there\u2019s been a change.  I\u2019m not sure when registrars started doing all the work, no that\u2019s not right, I don\u2019t think FY2 \u2013 ST2 doctors don\u2019t do any work, they do seem very busy, but they don\u2019t seem to make decisions any more, that\u2019s what the registrars and consultants do.  Perhaps our hospital is different from everywhere else, but I suspect not.  Consultants do what the registrars did, registrars do what the SHOs did, so perhaps the SHOs are doing what the house officers used to do?  House officers seem to have an awful lot of paperwork to do these days.  <\/p>\n<p>I\u2019m sure everyone across the land has had similar conversations.  Our juniors seem to lack the confidence to make decisions \u2013 perhaps that\u2019s appropriate, perhaps the every increasing senior cover is the correct way to go, but I do worry about how the future consultant body will get to the point of making decisions, or at least being confident in the decisions they make.<\/p>\n<p>The most recent edition of <a href=\"http:\/\/thorax.bmj.com\/content\/69\/5\/408.full.pdf+html\" target=\"_blank\">Thorax runs an editorial<\/a> on being confident about our diagnosis of \u2018meaningful\u2019 lung cancer in screening programs.  Overdiagnosis is reported as common most screening programs, lung cancer included.  But we \u2018know\u2019 that some patients have a lung cancer that doesn\u2019t progress, at least not dramatically, so they die \u201cwith\u201d lung cancer, not \u201cfrom\u201d lung cancer.  But identification of these patients is difficult.  Dr Frank C Detterbeck, Division of Thoracic Surgery, Yale, muses that overdiagnosis can only be defined in retrospect, looking back in a population after a long period, yet the clinician has to make decisions prospectively about an individual patient, not a population.  He concludes that the article by Patz in JAMA doesn\u2019t help to determine the benefits of screening, but does suggest how to minimise harm, stating that intervention in non-Broncho-Alveolar-Carcinoma NSCLC is very rately unnecessary, but for BAC we should be more circumspect, and wait for the right time to intervene.  Of course our biggest dilemmas come for patients who have isolated lung cancers, early stage, with no pathological confirmation of malignancy, never mind a sub-type.  Perhaps these cases are more straightforward \u2013 excision biopsy is indicated.  But how confident can we be that these lesions are malignant?  How much functional loss will occur due to the lobectomies carried out to find out?  I don\u2019t think we\u2019re looking at the same situation found in breast and prostate cancer screening, with many unnecessary procedures, but with more widespread use of CT screening, we might get close.<\/p>\n<p>The ECLS lung cancer screening study is underway in East and West Scotland \u2013 too early to see what the screening will lead to, in terms of surgical procedures, but we\u2019ve already seen a lot of people with advanced disease who only presented as they answered the call for volunteers for the study: same patients, a bit earlier, but not early enough.   Time will tell if lung cancer screening does save lives.<br \/>\n<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I have been on call this weekend. Recently in an RCPE survey the consultant body was asked specifically \u201cDo you frequently carry out duties previous carried out by more junior roles\u201d, or words to that effect. Many a time do I hear my colleagues saying \u201cI do the same job today as I did xx [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/thorax\/2014\/04\/20\/confidence-the-demise-of-the-sho-and-lung-cancer-screening\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[6586,2444,599,6585],"class_list":["post-36","post","type-post","status-publish","format-standard","hentry","category-musings","tag-confidence","tag-lung-cancer","tag-screening","tag-sho"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Confidence, the demise of the SHO, and lung cancer screening. - Thorax blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/thorax\/2014\/04\/20\/confidence-the-demise-of-the-sho-and-lung-cancer-screening\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Confidence, the demise of the SHO, and lung cancer screening. - Thorax blog\" \/>\n<meta property=\"og:description\" content=\"I have been on call this weekend. Recently in an RCPE survey the consultant body was asked specifically \u201cDo you frequently carry out duties previous carried out by more junior roles\u201d, or words to that effect. 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