jump to navigation

Blood oxygen measurement overuse leads to over-treatment? August 19, 2017

Posted by drolarn in Uncategorized.
add a comment

“Pulse oximetry as a technology represents a major and significant advance in medicine.… However, its increasing and widespread use in stable infants and young children with bronchiolitis, a self limited disease with a generally benign course, has led to technology driven overdiagnosis of hypoxaemia — fueling uncertainty, increased use of resources, and patient harm,” write Ricardo Quinonez, MD, from Baylor College of Medicine in Houston, Texas, and colleagues.

Babies and young children suffering from bronchiolitis are commonly made to stay in hospital because their blood oxygen as measured by the oximetry machine is lower than an arbitrary threshold that varies from one doctor to another, in spite of the fact that the child may be coping very well with his/her illness. In some cases parents are told that inhalational treatment is necessary and cannot be administered at home therefore hospital stay is necessary, and this in spite of the lack of evidence that such treatment improves outcome.

Advertisements

Australia considers childcare ban on unvaccinated children March 13, 2017

Posted by drolarn in Uncategorized.
add a comment

http://www.bbc.co.uk/news/world-australia-39251585

Clinicians Often Underestimate Harms of Tests and Treatments January 22, 2017

Posted by drolarn in Uncategorized.
add a comment

http://www.medscape.com/viewarticle/874657?nlid=112069_2982&src=wnl_dne_170120_mscpedit&uac=155351MR&impID=1275443&faf=1

French baby death linked to vitamin dose January 6, 2017

Posted by drolarn in Uncategorized.
add a comment

http://www.bbc.co.uk/news/world-europe-38505538

Give peanut to babies early – advice January 6, 2017

Posted by drolarn in Uncategorized.
add a comment

http://www.bbc.co.uk/news/health-38518185

“Finding abnormalities does not always benefit patients, and that’s a really difficult concept for patients and physicians to grasp.” January 6, 2017

Posted by drolarn in Uncategorized.
add a comment

Overuse of medical care remains all too common in pediatric settings, according to the authors of a literature analysis published online January 3 in Pediatrics.

“Overused medical care is not just wasteful, it is potentially harmful,” write Eric R. Coon, MD, from the Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine Primary Children’s Hospital, Salt Lake City, and colleagues.

I spend a significant amount of time telling parents why medical tests they think their child needs or have been suggested to them may not only be unnecessary and unhelpful, but also potentially harmful. A hard thing to do as it is somewhat counter-intuitive and within the confines of a limited time for consultation, parents can go home feeling disappointed. A few that I know of will go to other, perhaps more “obliging” doctors and get the tests done, and as predicted, get results that are unhelpful.

There has also been a number of patients who have come to see me from other hospitals having been through numerous, increasingly expensive and invasive tests, which have not resulted in gaining information that has improved their child’s condition.

The problem of overdiagnosis has been studied much more extensively in adults than children and it is rife in many places. If offered promotional test packages by private commercial hospitals ask yourself who is really benefiting.

 

 

More antibiotic bad news June 3, 2016

Posted by drolarn in Uncategorized.
add a comment

More bad news on the looming antibiotic resistance crisis. This particular “last resort” antibiotic colistin, is frequently (mis)used in this country to treat diarrhoea for which it is unhelpful and  ineffective.

Physician’s First Watch
David G. Fairchild, MD, MPH, Editor-in-Chief

May 31, 2016
Bacteria Resistant to Last-Resort Antibiotic Discovered in U.S.
By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH
Escherichia coli resistant to colistin — the last-resort antibiotic used to treat carbapenem-resistant bacteria — has been identified in the U.S. for the first time, researchers report in Antimicrobial Agents and Chemotherapy. If colistin resistance eventually extends to carbapenem-resistant bacteria, those microbes will become “unstoppable,” the New York Times notes.

This week in medical news: stories that are relevant to many of us. May 18, 2016

Posted by drolarn in Uncategorized.
add a comment

I hope to blog on new medical articles that catch my eye 2-3 times a month, with my take on the subject. Questions and discussions welcomed!

 

FDA Calls for More Restrictions on Fluoroquinolone Use

Fluoroquinolone is a class of antibiotic that is very frequently used in this country, in adults and less so but my no means infrequently, in children. It is relatively new and bacterial resistance is not yet widespread but like ALL strong new antibiotics, frequent misuse is leading to it becoming less effective, and from what I have observed, it is misused many  more times than it is appropriately used. But that is not the only problem, this class of medicine has substantial toxicity. This is what the FDA says:

The risks for “disabling and potentially permanent” side effects associated with systemic fluoroquinolone antibacterials (e.g., ciprofloxacin, moxifloxacin) generally outweigh the benefits in patients with sinusitis, bronchitis, and uncomplicated urinary tract infections, the FDA warned late last week. Fluoroquinolones should only be used for these indications when patients don’t have other treatment options, the agency said.

– See more at:

http://www.jwatch.org/fw111568/2016/05/16/fda-calls-more-restrictions-fluoroquinolone-use?query=pfwTOC&jwd=000013394434&jspc=OBG#sthash.bdlOxj1L.dpuf

Should you listen to your doctor and be compliant when she prescribe Ciprobay® or Avelox® to you? Perhaps ask her how often she prescribes it. If she says very rarely, in your case you need it, then may be OK, but if she says oh I use it all the time it works great, then perhaps be a bit sceptical.

 

Peanuts for your baby?

The evidence for massive reduction of severe peanut allergy risk by early introduction of peanuts in infants less than 6 months of age continue to mount and has turned much of established food allergy avoidance practices on its head.  In the past many doctors gave food avoidance advice for babies based only on weak anecdotal evidence, and many still do.  Instructions on how and when to introduce new foods to babies can get as complicated as you like. The evidence for the benefit of early introduction of peanuts to high risk babies is overwhelming now. The question is: which if any high allergy risk food would also be better introduced earlier rather than avoided for years, like egg white, wheat products, dairy and sea food?

When is bellyaching real?

Non-specific abdominal pain NSAP, and Recurrent Abdominal Pain of Childhood are very common diagnoses. Chances are if  you child has a short lasting tummy ache that comes out of nowhere and just as mysteriously disappears, with no associated vomiting diarrhoea weight loss or loss of appetite, and recurring every now and then, then your child probably has non-specific recurrent abdominal pain of childhood, which is often not a very satisfying diagnosis as it gives no clue as to the cause, and consequently what can be done to prevent or treat the condition.

NSAP should be a common diagnosis as it is a common condition but doctors, and patients, mostly prefer more definitive diagnoses that justify specific treatments, and so other labels are often applied, most commonly dyspepsia or stomach ulcer type problems due to excess stomach acid. Dyspepsia can exist in children but it is extremely rare, it is mainly a condition of middle age men who smoke, drink and stress too much.

This paper shows that  cases of NSAP do not often turn out to be something more serious subsequently, which means judicious use of investigations and treatment should be the rule.

 

How to get into U.K. medical school, part 2. March 17, 2016

Posted by drolarn in Uncategorized.
add a comment

In this section I will give hopefully useful advice for prospective medical students and although this will be aimed primarily at high school students in Thailand, much will probably be applicable to any candidate anywhere.

A long time has passed since I entered the medical school at Edinburgh University. Although much has changed, medical schools are still looking for bright students who will become good doctors. Their methodology in the selection process may have advanced, but they are still looking for very much the same qualities.

The first, although not the most important quality, is academic ability. This is also the easiest criterion for the medical school to judge as all that is needed are your predicted IB scores or A level grades. IGCSE scores are also important but not vitally so. You can find out what the medical school typically requires in terms of grades from the medical school websites. These typical offers are never absolute and if your predicted result falls a little short, you should still apply especially if you make up the shortfall with your other qualities.

What other qualities are these? Different schools will look for different things or ascribe different weightings to the various traits they want to see in a candidate. Almost every school look for passion for the subject, communication skills, capacity of empathy, team-player, leadership quality. Other highly valued traits include creativity, critical thinking skills, self-discipline and mental toughness. It is a challenge for the schools to assess these traits and qualities as it is a challenge for the candidate to demonstrate them. On their websites the school will list clearly if they require the BMAT or UKCAT test. They will of course scrutinise you personal statement and your teacher’s reference. If they like your application you will be invited for an interview or interviews and this may take various forms including the MMI.

All these things: your personal statement, teacher’s reference and interview performance are absolutely crucial and will determine your chance of success even more than your predicted grades. Remember the schools have no shortage of academically brilliant candidates. Getting 40+ points in your IB or A*A*A will almost guarantee your admission into any course but not medicine.

In your personal statement you will need to sell yourself without appearing too boastful arrogant and pompous. You really should not write your personal statement without help or guidance from your teacher or other sources. There are a lot of resources on the internet on how to write a good personal statement. Some medical school websites will even give you extensive tips on what they like to see in a personal statement so you should take advantage of all these resources but in the end make sure your personal statement is indeed personal. If it appears plagiarised your personal statement may be discarded out of hand.

 

If you find you are lacking several of the qualities and traits desirable in a doctor, have no fear! You can cultivate most of them. You only need to apply yourself. Really none of us are perfect. If you know yourself, you know what your deficiencies are, you can work on them.

Passion for Medicine

You will need to demonstrate your passion for the profession on your personal statement and at interview. Here are some ways you can do this. The best is probably to volunteer at a health care institution. Use your initiative here and find out what government health care facilities are near enough for you to go once or twice a week and write to them or go visit them. They will find something useful for you to do, even if it is only to chat to some lonely old folks. Or during your school vacation try going further afield. One example I can give is the McKean Rehabilitation Center in Chiangmai, which used to be a leper colony. You can learn a lot from places like this, you will learn that medicine is not just about prescribing the right pills or cutting off the right bits. This kind of actual exposure is now pretty much compulsory in your application. You will be a serious disadvantage if you cannot claim any experience in health care environment at all. Your application is likely to go nowhere. Some schools will insist that your work experience is verifiable and documented. They mostly do no specify how many hours you need, but a rough guide would be 70 hours. What is vital is you must be able to say how the work experience has benefited you. You are advised to keep detailed logs of what you have done and learned.

Shadowing a doctor is also really useful. Start with your family doctor if you know no-one else. Medical schools want to see that you know what life is really like for a doctor.

You also need to be aware of the health issues in your country and the world. Find out about health care provision in this country and compare it to the UK. Think about how health can be improved for the ordinary people. Is it more hospitals doctors and drugs or is it clean water and nutritional education? Acquaint yourself with the world’s pressing health issues, like the rise of antibiotic resistance, the threat of the superbug, the lack of vaccines for killers like malaria, and the rise of the anti-vaxers, people who believe vaccines are an evil invention. Some global news organisations like the BBC helpfully provide regular health related news and is a great starting point for further reading. Medscape provides doctors with much useful health news and although you will not have full access to Medscape articles, you can learn a lot just from the headlines and do more research on hot topics, like the Zika virus for example. You may be very well be asked at interview about community or world health issues and although you may not know all the facts, you should be able to demonstrate some awareness and make thoughtful comments on the topics.

Team work

Being a team player is a vital quality that you must demonstrate. You can do this, obviously, by being part of a team or teams, like school sports team, or school orchestra or pop band, or school newspaper team. International schools in Thailand mostly provide you with many opportunities for team work, Thai schools not so much. If you feel your school does not provide you with anything you are interested in taking part in, then create your own group or club. No school newspaper? Start one up!

Leadership

It is not difficult to imagine why this is a crucially important skill to have. Again this is something you should be able to demonstrate in your personal statement and at interview. If you are blessed already with leadership drive and skills, that’s great, but what if you, like a lot of other people, normally prefer to be told what to do, and are reluctant to take on the responsibility of leadership? It’s certainly not in every person’s nature to be a leader, it’s certainly not in mine, but I am here to tell you that you can cultivate this skill. You can learn how to step up and take charge. You can try to do this by reading books on leadership, I have seen many in bookstores, although I have never read one. The best way learn leadership, I think, is to just do it. So if you are in a sports team, ask, (or even tell!) your team mates that you are going to be the team captain today. If you are in a school music band then select an ensemble piece and get your friends to agree to play it. If you are not in a school band, start one up. Become the editor of your school newspaper, or sub-editor if the editor position is not free. Better yet start up your own school newspaper and get your friends to contribute. If there is something you like but there isn’t already a club at school, for example photography, film, manga drawing (but NOT manga reading), then start one up. If you have several friends all interested in medicine, form a small group and go volunteering together. Really opportunities for leadership abounds, you just have to have the initiative drive.

Creativity

Creativity is a prized trait in just about for all courses at all universities. Even hard sciences and maths, being creative, and thinking outside the box, can give you a real advantage. Other than the traditional music, art, poetry etc also consider creating internet content like vlog on YouTube.

Time Management

We haven’t even reached the end of the article and you can already see that you have a lot to do to even have a slim chance with your application. You have to work hard at your studies to get the good grades you will need, you have to do the work experience, and you have to do several extra-curricula activities. You also need time to relax. Doctors are always having to juggle work commitments, weekend work, night duties etc and so medical schools wants candidate who can handle do of this without going crazy.

Communication skills/ The Interview

Among many other things you will be judged at interview is your communication skill. Yet another crucially important skill you must have. If you do not have it your must start acquiring it, as soon as possible. Being an introvert is a common thing. Many of us are reluctant to talk to strangers, or are no good at making small talk. But obviously as a doctor you will have to communicate will with your patients and your colleagues. I would say the best way to do this is just to talk to the patients you will see on your voluntary work period. Patients are often all too pleased to talk to someone who is empathetic. Don’t just ask about the symptoms, ask about how the illness has affected their lives. Again write down what you learn.

The medical school interview will be only the first of the interviews in your life that could potentially change your life. It’s natural to feel nervous and the nervousness can cause you to give a poor first impression. If you are a super-candidate all your 4 choices may invite you for interview, and by interview 4 you will probably do much better than at interview 1 because you will learn from experience. The sensible thing to do therefore is have practice interviews before interview 1. I can tell you that it really is possible to improve from being a flustered nervous wreck to a confident and engaging interviewee. You need to practice, and you need to switch off that switch in your head that makes you shy and nervous. Again there are now many resources on the internet to help you with interviews. You can even go on paid courses. It is truly worth investing much time and effort if not also money learning how to be good at being interviewed.

Being a well-rounded person

Medical schools do not want students who are weird or obsessive or too highly strung, no matter how academically brilliant. They know that someone who has no adequate outlet for their stress, does not know how to relax, and does not engage socially with the rest of the world will not become good doctors. Some may not even survive the medical course. I can tell you genuinely that I have seen medical students who got top marks in exams who did not last even a year in medical school because he wasn’t a “real” person and was far too obsessed with study. The stereotypical Asian student who regards the arts, sports, and socialising as wasteful distractions from serious study really does exist. Such character traits might even be a positive boon if you want to become a brilliant scientist, but they will not help you get into medical school. If such is your character trait, consider that you may be able to do much more for the world and for yourself by becoming a top scientist in a field you enjoy than becoming a doctor.

This article is a work in progress, I will add more to it if I think of something else. I will close by saying that you never win if you don’t play the game, so give it your best shot, make it happen. I myself was far from being an ideal med school candidate. I still feel now that medical schools seem to expect seventeen-year olds to have the wisdom of a thirty-year old. I only hope that you will pursue this goal for the right reasons.

Do please leave a comment if you feel this has been helpful or not so helpful, and ask any questions.

 

 

How to get in to medical school in the U.K., advice for students applying from Thailand March 8, 2016

Posted by drolarn in Uncategorized.
add a comment

So you want to be a doctor, and you want to go to a U.K. medical school, and eventually come back to Thailand to work? My advice can be summed up in just one word: don’t. I will tell you why you should not do this. I will also tell you later why you should do it and give advice on how you may achieve this but it is important to start by telling you the many reasons why you should not put yourself through the process.

Firstly, it’s extremely competitive. If you were a UK home student it would be very hard. As an international applicant it will be extremely hard. Medicine AFAIK, is the only course in UK university where international student places are strictly limited because the UK does not produce enough doctors for its domestic needs with many vacant jobs (the UK has to rely on many doctors from the EU and south Asia) . International students have to pay more tuition fee than home students and there is no possibility of a student loan, but even then the medical schools do not make a profit from international students. This mean there are major disincentives for UK medical schools to take on foreign student. . You will be competing against many candidates from all over the world, all of whom are capable of getting excellent exam grades. According to the Edinburgh university medical school website, the odds for an oversea student getting in is about 1 in 40. But it’s far from being all about academic excellence. Even if you are capable of getting the most extraordinary exam result your school has ever seen, you may find yourself with no offer from any of the 5 med schools you are allowed to apply to through UCAS. So the odds are very much against you and you must ask yourself if you are willing to do all that it takes (and it takes A LOT) to get in, and if you will be able to handle the disappointment if you fail.

If you do get in, you will be in for 5 or 6 years of hard graft. Medical students have very much less time than other students to enjoy university life. The hard work starts in year one and gets progressively harder. You will be staying in 6 nights of every week to study. In the last 2-3 years of med school you will not even have any end of term holidays. You will need much self-discipline and mental toughness to get through the course.

Once graduated you will spend some time working in the UK as a junior doctor. Recently junior doctors in the UK went on strike because they are forced to work long hours and weekends are unfairly compensated. If your heart is not truly in medicine, you will have a very miserable time as a junior doctor. There is a significant risk of burn-out. In the US by some estimates 50% of all hospital doctors will experience burn-out.

After getting some experience under your belt, or may be even some post graduate qualifications, you then return to Thailand, you will find that your hard won degree does not allow you to practice in Thailand. You must take a licencing exam. It has long been the strategy of the Thai Medical Council to make it really hard for foreign medical graduates to work in Thailand. The Thai licencing exam is designed to fail most foreign graduates because the TMC wants to screen out Thai doctors who could not get into a Thai medical school and got their degree from less than prestigious schools in neighbouring countries. If I understand correctly, the pass rate is well under 50%. You will be examined on every medical school subject including all the basic medical sciences you learned in year 1, up to all the clinical subjects. That is all the knowledge that you took 5+ years to learn will be examined at once.

And then there is the question of why do you want to be a doctor at all? Is it for the approbation of your parents? Is it for the bragging rights because only the cleverest people get into med school? Is it the promise of a secure, well paid job? These are all very bad reasons for becoming a doctor. First of all if you parents are wise, they would not push you into spending your life doing a job you don’t like. 5++ years of your life you would sacrifice to please your parents so mommy can tell auntie and all her friends that she has a doctor son (or daughter)? That would be foolish indeed. While it’s true that as a doctor you will probably always have a job it doesn’t always pay that well. Given the brains that you have chances are you will make more money in life as a business person. Be honest with yourself, look deep into your soul, do you really see a doctor there? A good doctor? Because there is no point in aiming to be anything less.

Then there is the very considerable risk that no matter how good of a doctor  you are, you will be sued by a patient. You don’t even have to make a mistake to be sued (although we all make mistakes). If outcome is anything less than perfect, some clever lawyer can persuade your patient to sue you, after all lawyers get paid win or lose. Being sued by your patient can be soul-destroying. Many doctors have their spirit broken from being sued, even when they don’t lose. In the US a very large chunk of your income may be even half, will be spent on malpractice insurance. It is not as bad as that in Thailand, but it is definitely heading that way. There are all too many examples of doctors in this country who are burned out, only going to work for the income, and all the while wishing they had got an MBA instead of an MD degree.

You should be very sure that medicine is what you want to do. It is ok if you are not sure that you have the abilities to become a doctor but you should be sure that you want to become a doctor. Try talking to any doctor that you know, may be even ask if you can shadow them for a day or two. Try to get a real feel of what life is like as a doctor in Thailand. Many Thai doctors will tell you they regret their decision to go into medicine, and how their lives would be much better now if only they had gone business school instead.

Medicine is a vocation. If you feel it in your heart that this is what you want to do then all the negative things I have talked about so far will not put you off. If helping people recover from sickness, helping them avoid getting sick, saving lives even, if these are the things that gives you satisfaction, and gives you meaning in your life, then I urge you to do what it takes to become a doctor. The world needs more good doctors, every country needs more good doctors. Given determination and requisite academic ability, you can win through. You might not get into your dream medical school, you may have to  look elsewhere other than the UK, but you can win through and I wish you all the best and I hope the sections to follow may be of some help to you in achieving your dream.