tag:blogger.com,1999:blog-16638275.post6216998003539380402..comments2024-01-05T19:30:12.040+00:00Comments on Dr Jest's Caseblog: Risk Management?Doctor Jesthttp://www.blogger.com/profile/14446967855995345815noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-16638275.post-14291617624063658272007-10-03T17:02:00.000+01:002007-10-03T17:02:00.000+01:00claire-- thanks for the url. And don't worry. Ther...claire-- thanks for the url. And don't worry. There's nothing wrong with good old fashioned cut-and-paste-ing.Doctor Jesthttps://www.blogger.com/profile/14446967855995345815noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-50654634508212000992007-10-01T19:40:00.000+01:002007-10-01T19:40:00.000+01:00very late in the day but have recently come across...very late in the day but have recently come across this by Dr Paul Enright, touching on the (possible) overuse of LABAs: http://blogs.webmd.com/allergies-and-asthma/2007/09/managing-mild-asthma.html <BR/><BR/>One day I'll grow up and learn how to do the jazzy blue writing link thing!Unknownhttps://www.blogger.com/profile/10197163243697367024noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-50859902977448197212007-09-24T15:59:00.000+01:002007-09-24T15:59:00.000+01:00orchidea-- To be honest I'm stagered (but quietly ...orchidea-- To be honest I'm stagered (but quietly pleased) that anybody stops by to read this nonsense at all, let alone leave a comment, but you are always most welcome. Look forward to hearing about the new job if and when you feel able to reveal all, and thanks again for stopping by.<BR/><BR/>xxxDoctor Jesthttps://www.blogger.com/profile/14446967855995345815noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-39976440934537766812007-09-21T11:39:00.000+01:002007-09-21T11:39:00.000+01:00I'm glad the shrink didn't get the EKG thing - I f...I'm glad the shrink didn't get the EKG thing - I feel a little less stupid now. Of course in these parts it's called an Elektrokardiogramm, hence EKG. <BR/><BR/>But I'm not telling you 'owt you don't already know.<BR/><BR/>I'm sorry for being an absentee commenter; my first proper job in yonks is fun but draining. Still reading, just so you know...<BR/><BR/>orchidea xxxAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-16638275.post-87941389788732988462007-09-20T12:49:00.000+01:002007-09-20T12:49:00.000+01:00Dr Grumble-- welcome. You are of course quite righ...Dr Grumble-- welcome. You are of course quite right. It's as though the meds themselves will avert "the evil eye" like a modern day charm. Perhaps we should all join hands and sing "Ring-a-ring a Rosie" as well just for good measure. ;-)Doctor Jesthttps://www.blogger.com/profile/14446967855995345815noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-44828000160205259392007-09-20T08:13:00.000+01:002007-09-20T08:13:00.000+01:00Our rapid access chest pain clinic regularly comes...Our rapid access chest pain clinic regularly comes up with the diagnosis of non-cardiac chest pain - which is no diagnosis at all. And sometimes it doesn't stop them giving the patient a bucket load of medicines which are 'bound to do the patient good'. This bad medicine does seem to have stemmed from protocolisation and the <A HREF="http://drgrumble.blogspot.com/2007/05/protocols-can-be-bad.html" REL="nofollow">removal of thinking</A> from the management of patients.<BR/><BR/>We all know this but saying it openly is difficult.Dr Grumblehttps://www.blogger.com/profile/04417731064007601504noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-50503412302962105132007-09-18T11:46:00.000+01:002007-09-18T11:46:00.000+01:00First sorry to all for the slight hiatus. Three ho...First sorry to all for the slight hiatus. Three hours with the accontants yesterday did little for my humour and robbed any time for comments :-(<BR/><BR/>Shrink-- or can I call you "The". It's just a pesonal quirk of mine, but I like the look of EKG better. It looks more like it comes from the greek taht the bastardized latinizaion, but that ;'s probbaly just me.... <BR/><BR/>As for the free thinking, I fear it being ground out of the upcoming generation of juniours and try to do everything in my power to encourage it. Still there are days when I do feel rather like poor old Cnut trying in vain to turn back the tides.<BR/><BR/>Claire-- <BR/><BR/>"Evidence based policy or policy based evidence - or is that too cynical?"<BR/><BR/>Sometimes I worry that as a profession we aren't cynical, or at least questioning, enough.<BR/><BR/>"Is it possible that a proportion of these were prescribed by 'badge nurses' rather than GPs or would they have needed the GP's sanction?"<BR/><BR/>In reality, certainly locally, all such scripts would be initiated by docs. This is one we can't blame on the NP tendency. In truth the increase in LABA use across the board is fuelld by two or three trends. First it is likely to give a quicker fix than stepping up inhaled steroid doses, so better symptom control (though perhaps not disease control). Next there is a disenchantment with the perhaps more age appropriate LTRAs, which promised much, but in my admittedly limited experience, only work in about half the people wou would hope. Finally there is still a significant amount of steroid resistance in parents who view even modest doses of inhaled steroids as little better than strychnine for their little darlings.<BR/><BR/>(Apologies if this is a bit technical. Let me know if you need translation, but from the tone and content of your previous posts I imagine you have more than a little clinical knowledge.)<BR/><BR/>Bendy Girl-- <BR/><BR/>"It is I suspect supposed to eradicate fraud, but I suspect is likely to do far more harm than good as of course no condition or person can fit a check box..."<BR/><BR/>One of the things that really gets my goat is all the PC nonsense we keep hearing about social eclusion in relation to the urban poor / youth / migrant populations, with not a word about disability. This makes me sound horibly Daily Mailish, which is very far removed from the truth. I'm all for including everybody, but this increasing trend to beureuacratize simple things like aids to daily living cannot but be exclusive in outcome, whatever the intentions behind it. <BR/><BR/>Fight the Power!Doctor Jesthttps://www.blogger.com/profile/14446967855995345815noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-59304941951020294582007-09-17T15:18:00.000+01:002007-09-17T15:18:00.000+01:00Dr J thank you for your kind advice :) I'm also no...Dr J thank you for your kind advice :) I'm also not sure whether the PCT PAL's officer could intervene in a social care arena when they are completely separate services (thus causing a number of the problems I suspect)<BR/><BR/>I'm not sure if you have the equivalent in your area but in mine we have an independent direct payments forum of which I am currently a trustee, set up to challenge such issues. However it is a sad indictment of our current social 'care' services that on balance I personally feel safer without social work involvement in my life.<BR/><BR/>Both your and Shrink's point about doctors being free thinkers is I think even more important with the current moves towards protocols in the welfare area. It is I suspect supposed to eradicate fraud, but I suspect is likely to do far more harm than good as of course no condition or person can fit a check box and most muddle along quite happily free thinking their way through daily challenges rather than procuring a referral or piece of equipment for every new problem that crops up. That I would guess is most likely to apply to those who are 'trying it on' thus creating additional work for doctors. Again. BGBenefitScroungingScumhttps://www.blogger.com/profile/08939136229593231935noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-50494847234655880802007-09-17T11:35:00.000+01:002007-09-17T11:35:00.000+01:00Perhaps not directly relevant but this occurs to m...Perhaps not directly relevant but this occurs to me in connection with the recent Archives of Disease in Childhood paper which expressed concern about the increase in numbers of inhalers containing LABAs to children in the UK (full text available here: http://press.psprings.co.uk/adc/september/ac119834.pdf )<BR/><BR/>Is it possible that a proportion of these were prescribed by 'badge nurses' rather than GPs or would they have needed the GP's sanction?Unknownhttps://www.blogger.com/profile/10197163243697367024noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-69642951460218209362007-09-15T15:27:00.000+01:002007-09-15T15:27:00.000+01:00"Too specific" training is better, and the point a..."Too specific" training is better, and the point about the pharmas influencing the rush to pharmacotherapy is well made. I worry that all the box ticking in this sort of context might create the illusion that this kind of approach is underpinned by solid statistics.<BR/>Evidence based policy or policy based evidence - or is that too cynical?Unknownhttps://www.blogger.com/profile/10197163243697367024noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-73763201529777302422007-09-15T15:14:00.000+01:002007-09-15T15:14:00.000+01:00You've lost me on the whole EKG thingy.Isn't it an...You've lost me on the whole EKG thingy.<BR/><BR/>Isn't it an ElectroCardioGram and thus ECG?<BR/><BR/>PALS<BR/><BR/><I>Doc's tend to be dangerous free thinkers you see.</I><BR/>- true, there <I><B>is</I></B> a tendency to apply common sense and the patient's best interests in to the equation rather than slavishly adhere to protocol. <BR/><BR/>Some see this as most lamentable.The Shrinkhttps://www.blogger.com/profile/10009039342346247138noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-5722192015907799602007-09-14T17:28:00.000+01:002007-09-14T17:28:00.000+01:00bendy girl-- Gaah! that sort of petty minded wilfu...bendy girl-- Gaah! that sort of petty minded wilful misapplication of so called "health and safety" advice really gets on my nerves. I know it is effectivelt a social care issue but have you thought about trying to get you PCTs PALS officer on the case to knock some sense into them. (PALS short for Patients Advocacy and Liaison service. They can be a great help when the NHS monolith needs a kicking. Not so sure how it applies to the more paramedical arena though.... Good luck and keep us posted!).<BR/><BR/>Shinga-- In essence it is in part our own fault. For some years we have known that to get a protocol run properly the very last person to give it to is a Doc. Doc's tend to be dangerous free thinkers you see. Our butterfly minds take us off on all sorts of tangents. If you want boxes ticking a nurse is yer man, (or woman obviously). You see their training is geared to encouraging them to follow protocols and pathways of care and so forth, and quite right too. But, when you get a nice big drug company coming o your cash strapped provider unit and offering free "badge" nursie time to run a diagnostic facility like a RACPC you end up missing the actual "diagnosis" step and fall straight in to the management part. Sadly this is now so endemic that Juniour Docs are falling into the trap too, largely because the only people they tend to come into regular contact with these days are the "badge" nurses perhaps? <BR/><BR/>Claire-- perhaps it's not so much insufficient training as "too specific" training. Our "badge" nurses are a tremendous resource when properly deployed, but this requires more thought and planning than our local trusts seem capable of.Doctor Jesthttps://www.blogger.com/profile/14446967855995345815noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-38666597907184051692007-09-14T16:37:00.000+01:002007-09-14T16:37:00.000+01:00"There is a distressing tendency to emphasise reli..."There is a distressing tendency to emphasise reliance upon tests rather than the clinical history as interpreted by a person with sufficient training/experience to interpret them in context. Possibly, there is a creep whereby guidelines are inexorably transformed into recommendations.<BR/><BR/>I'm not sure why this has happened."<BR/>Shinga<BR/><BR/>Let me guess...insufficient numbers of persons with sufficient training/experience, aka our old friend, 'dumbing down'?Unknownhttps://www.blogger.com/profile/10197163243697367024noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-24176608745239793122007-09-13T10:53:00.000+01:002007-09-13T10:53:00.000+01:00There is a distressing tendency to emphasise relia...There is a distressing tendency to emphasise reliance upon tests rather than the clinical history as interpreted by a person with sufficient training/experience to interpret them in context. Possibly, there is a creep whereby guidelines are inexorably transformed into recommendations.<BR/><BR/>I'm not sure why this has happened.Shingahttps://www.blogger.com/profile/18126212762767721751noreply@blogger.comtag:blogger.com,1999:blog-16638275.post-64803217862379727492007-09-12T23:13:00.000+01:002007-09-12T23:13:00.000+01:00I had thought the inability to manage risk was to ...I had thought the inability to manage risk was to do with fear of litigation or complaint? It's interesting to hear the drug companies and np involvement. I've found it worse in Social Care/OT world though, I was refused a bath lift because my hips were so bad I might hurt myself on it (therefore leaving them liable) You have to laugh really! BGBenefitScroungingScumhttps://www.blogger.com/profile/08939136229593231935noreply@blogger.com