Monday Musing: I Got In.

My hardwork has paid off – on Wednesday I received my first medicine offer! This means that, providing I get the grades, I’ll be off to med school in September. Hopefully I’ll meet some nice people there, as I’ve successfully bored my friends to death by talking it about it incessantly, so now need to make some new ones.

I’m not sure what will become of this blog, I’m going to keep writing every week for the time being. But at some point in the future I may stop, and start again in September to keep some sort of a diary of my time at medical school.

I’ll have to think of a new name for my blog too…

Monday Musing: Drug to Cut Salt Intake

Newscientist have an article about a potential drug which may be able to reduce the amount of sodium absorbed from food (http://www.newscientist.com/article/dn25229-saltbuster-drug-cuts-sodium-absorbed-from-food.html#.UydRgqh_tGY). The drug, known as Tenapanor – also called AZD1722 and RDX5791 – is being investigated for use in end stage renal disease.

It works by inhibiting a molecule in cells in the intestinal wall that transports sodium from the small intestine into the blood stream. In the studies so far, “the drug cut sodium levels in urine…by up to a third,” and increased the amount in faeces by a similar amount. As the sodium levels in urine is a surrogate outcome (i.e. it should give an indication of effectiveness but not necessarily) larger and longer term studies need to be done to confirm if the drug is actually effective at cutting sodium levels.

Theoretically as the drug “works solely within the bowel and isn’t absorbed,” it should affect other body systems but again that needs to be proved in clinical trials.

Of course, the easiest and most foolproof way to cut salt absorption would be to change your diet to reduce your intake to begin with.

Monday Musing: All About Competence

I mentioned that I had an interview for medical school a couple of weeks ago, a large part of my interview was on empathy, which led us to discuss consent and competence. It’s a large part of medicine so I wanted to write about what I’ve learnt from reading my medical interview book and from articles on the internet (like this: http://student.bmj.com/student/view-article.html?id=sbmj.g1455).

First of all, adults are assumed to be competent unless proven otherwise (e.g. if a mental illness has impaired the patients ability to understand the information given to them, and weigh up pros and cons). If an adult patient is not competent then no one else can give consent for them, doctors must act in the patients best interests and use any advanced directives written by the patient.

Similarly, 16 and 17 year olds are presumed to be competent for most procedures, but cannot refuse treatment unless supported by a parent or doctor.

Young children can be competent to make decisions about certain procedures, providing they are mature enough to understand the information given to them. A doctor has to involve a parent if the child is not thought to be competent.

EDIT: I updated the part on mental illness affecting ability to consent following a comment written below. The comment had a good definition of what it means to be competent, which is something I failed to mention: “To be competent, you have to be able to understand information given to you, weigh up the pros and cons, and communicate your decision.”

Monday Musing: What is care.data, and what is the problem?

I’ve wanted to write an article on care.data, and the way it has been handled for a couple of weeks now. What should have been an excellent step forward for medicine has turned into a bit of a fiasco. When I first heard about the plan, I thought it sounded great: having read Bad Pharma recently, I knew that there are lots of problems with drug trials, and I thought making the unidentifiable medical records of 60 million people available to researchers could do wonders for reassessing drug efficacy. And I still do. But the way the project has been handled by the Health and Social Care Information Centre (HSCIC) has been somewhat lacking.

The fact that I only heard about care.data in the last couple of weeks is bad. It’s such an important project, yet people were ‘informed’ via a leaflet drop which didn’t really explain much. This lack of transparency about what is happening, how data will be protected, and who it will be available to is worrying. Hopefully the HSCIC will be more open about their plans as we get closer to the start of the cara.data extractions. I don’t think it’s right for the organisation to assume people will, or should, blindly trust that their data is going to be used responsibly.

There are many other smaller worries about the scheme, this article in the Guardian by Ben Goldacre I think summarises the entire problem so far very well: http://www.theguardian.com/society/2014/feb/21/nhs-plan-share-medical-data-save-lives

 

I really hope that this 6 month delay doesn’t irreparably damage public faith in care.data. It has so much potential, providing HSCIC can sort out how they are going to manage the data and prove to the public that they should be trusted with our entire medical records.

Monday Musing: Cancer Testing in Remote Regions

This’ll be another short one today, I’ve got a medicine interview on Wednesday so am trying to get a few earlier nights in after my hectic week in Austria! I saw on the New Scientist website that engineers from Cornell University have created a device to diagnose Kaposi’s Sarcoma, “one of the most common forms of cancer across sub-Saharan Africa.” It has a low survival rate due to late diagnosis so hopefully this solar powered piece of equipment will drastically improve the chance of successfully treating patients.

http://www.newscientist.com/article/dn25103-solar-dna-tests-detect-cancer-without-electricity.html#.Uwu5q-N_tGY

Monday Musing: Personalised Medicine

ImageSo, it’s going to be a short one this evening: I’m in Austria skiing at the moment!  Understandably I haven’t got much time to write about much. But I saw an article on BBC Health News (http://m.bbc.co.uk/news/science-environment-26213522) which was vrry interesting. 

It spoke about how drugs can be ranked on their efficacy for individual patient, which will help doctors identify which drug will best suit each patient. Give it a read!

Monday Musing: Lack of Ownership

My father has recently had an operation on his neck to relieve spinal cord compression, it was an anterial discectomy and fusion. After a long waiting period, he had the operation and was sent home after a few days. It should have only been one night but he was having trouble swallowing after the operation due to swelling.

He came home having been told he had been urgently referred to a voice + language specialist and a physiotherapist. But it has been a couple of months since then and very little has been done. He has started to have sessions with the physiotherapist in the last week but hasn’t heard from the voice and language team, despite being “urgently” referred. I can only imagine that this is because there is no one who is checking up on whether referrals have actually been followed up on. A problem seems to be that the surgical team of doctors is content that they have passed on the patient, but there is no one above them who is checking the result of that referral (i.e. has anything been done?) as my Dad seems to have been forgotten.

Of course, I do realise that doctors are incredibly busy and it can be easy to forget a patient who is not on a ward, but I do think that this shows there needs to be someone who is following the patient journey from the beginning (GP appointment) to the end (discharge) and making sure the patient is not forgotten. The person does not need to be directly involved with the patient, and can look over many patients at once as they only need to look at the very basic journey the patient takes through the various facets of healthcare. Essentially, there should be someone managing patients and each patient should be overseen by at least one person.

Anyone else agree?