This week I learnt . . . Antibiotics are no longer indicated for simple diverticulitis (NICE guidelienes from 2019), This is based on a bang up to date RCT from 2012. In major trauma, a high glucose(>11) is associated with mortality. (But not as much as age and hyperthermia). Emergency doctors and patients disagree about the presenting complaint about a third of the time. It probably makes not difference if you use Normal saline or hartmann’s/plasmaltye.
-
-
Why I spent my day off standing in front of JP Morgan
So today, I spent my day off from working as an A&E doctor, not in any recreational pursuits or undertaking any hobbies, but feeling a bit silly standing in the cold outside of JP Morgan’s headquarters. Why would I undertake such a strange action? A tiny, seemingly pointless gesture in the grand machinations of the world. In my work as an emergency doctor I have worked in British A/E departments and in refugee camps. I see and treat the most vulnerable in our society and around the world. They arrive into my departments or tent hospitals at the worse points of their illness, at the culmination of a series of…
-
Teamwork, ambition and the peak/end rule.
Visa problems, national catastrophe and local events had reduced out international team to two. I wondered what this would do to the last two weeks of my mission. It turns it would make them awesome. I had vaguely been aware that out team lead was a slightly legendary figure, casual stories of negotiating with the Taliban and facing off angry militaries for several months to advocate women’s rights. But then as you get to know a person well you start to appreciate the underlying characteristics that make for these stories. So I had been at our remote clinic a week, just feeling good again after another bout of gastro on…
-
Measles, adventure and vaccines
It has been commented several times that I had a more “interesting” first mission than most. Now the adjective “interested” is a dangerous, loaded term when working for MSF. So on my second the day in the clinic, when the nurse lead comes in and says to my colleague “you have had measles cases!?” I knew that things were going to get “interesting”. It is a truism of measles that it is impossible to see only one case, if you have seen one, there are many many more nearby. This is a disease literally 8 times more infectious than Covid, and the most infectious disease in the world bar none.…
-
Donkeys, “primary” healthcare and complexity
After the quiet significant detour of being transferred to be lead doctor in a field hospital ofa refugee camp, three quarantines, an enforced holiday to Ethiopia and more than weeks waiting a travel permit I was finally on a UN plane to Nyala, Darfur. The donkey-based project I had originally be earmarked for. The UN plane was something that, predictably, sounds much more exciting than it is, saying that, Khartoum domestic terminal was an experience, much more akin to a chaotic bus station than an airport, with families cramping huge plastic bags through tokenistic security with on the vaguest suggestion of a queue amongst the throngs of people Arriving at…