Lets inject some life into this forum!

[slim_slag]

Hmm, this place has gone awfully quiet. Well, I'm back from the limb and things are going to change.

liquidhockey's post mysteriously disappeared. A shame, because it was indeed an interesting question. One that should be examined further. So where where we at when we were denied further debate.

Let me summarise.

The question was asked whether somebody who took a drug which was legal to possess and use, but not to supply, would fail a cabin crew medical. He said the chemical was a steroid, which we went onto assume was an anabolic steroid.

There was a rumble from the backwaters of SW England and QDM, obviously just back from a morning surgery of dealing with 'little Johnny with a sore ear', was a touch bored and had to stir things up a bit. He majestically proclaimed that 'if you abuse yourself, you are not responsible enough to look after others'. He then retired for a lunchtime curry with the drug rep, but only having a chicken korma as he had previously found out his favourite madras was very abusive to his GI tract and he had more patients to look after in the afternoon.

And that's where the thread went to pot (and that is not a freudian slip). Slag, with his customary diplomacy, enquired of QDM whether that meant people who smoked and didn't floss their teeth should be trusted to look after others.

QDM, back from a decent lunch and another afternoon of picking up the pieces, conveniently ignored slag's devastating comment. He took some time out to proclaim that 'those who take chemicals proven to cause physiological and pyschological harm should not be allowed to look after others' Especially when ths concoction is not prescribed by a medical chappy, we don't know how the product was prepared, what the formulation is, and the amount of active ingredient being administered per dose.

QDM then retired to his local cider bar, where as GP in a small community he was held in high regard and he liked this. He lorded it up and had several jugs of extra rough scrumpy brewed locally by some farmer in his orchard.

Slag, although he was a bit slow cos he was recovering from a similar session (but caused by a fine vintage Bordeaux, scrumpy being a part of his past and he liked it that way), would have pointed out that scrumpy fitted all QDM's criteria. Those who have done battle with rough cider know it is a dangerous drug which totally destroys physiological and pyschological well being, where you don't know what the hell is in there, how it was made, and how much alcohol is in each dose unit (except its a lot). Should we really ban people who partake in a bit of a knees up on Christmas Eve. For Gods sake, if you were to ban everybody who abused themselves and liked a drink, where would Virgin get it's cabin crew?

Not only that, but there is overwhelming evidence that alcohol is really not very good for you at all.

QDM, agreed that abuse of alcohol was a bad thing but it obviously didn't count when the drug of choice was anabolic steroids. Slag enquired why?

(And QDM, don't take this too seriously, it's all in good jest, so don't be getting tense when you have to put your super cub down in a stiff crosswind. Them rudder pedals are not for resting your feet on like you do with the five year pile of unopened BMJs by your desk. Remember to dance, baby, dance!)

In all good threads where intelligent men partake in a bit of verbal sparring, you are going to attract the monkeys. And this thread is no exception as takenthefifth barges in and starts throwing peanuts from the gallery, attempting to defend the good doctor, yet not really knowing what the hell he defending him from.

Anyway, takenthe5th tells us all that anabolic steroids are 'very dangerous', that the new buzzword in the medical world is 'evidence based practice', and slag really doesn't know what is going on. If takenthe5th had been a good boy and just sit down and shut up, he might have got away with it. But no, takenthe5th had to prove he didn't have a clue about 'evidence based practice'. Alas, he posted a link to a goverment drug propaganda web page that was based upon anecdote, hearsay, case studies and had no evidence on it whatsoever. Unfortunately takenthe5th didn't understand he was making a fool of himself and reappeared later on in the thread. Alas, I feel takenthe5th has no idea what 'p' means, except when he is putting out one of those fires he has started.

Slag, who as a little boy used to cut the legs off spiders and still had a sick urge to play with people who obviously could not defend themselves, lowered himself to reply. He quickly found a balanced summary of the psychological effects of anabolic steroids, with a decent bibliography which made it an 'evidence based' summary indeed. Slag declared (or as far as his opinion would allow him, and you may have realised by now that slag is an opinionated git) to the world that it showed the jury was out on the matter.

gingernut in probably the most sensible posts of the thread, made similar points about the5ths link and the subject in general. Gingernut obviously understands what 'evidence based practice' really means, maybe he/she should start a thread?

So what is the real question here? I humbly contend that it is Can the medical profession prevent somebody from going to work and supporting themselves and their family if there is no evidence that what they are doing to themselves is harmful

QDM obviously thinks so. He will prevent somebody working if they are on anti-depressants even though QDM himself said he believed the patient to safe.

I don't. I think that blanket bans are appropriate if a substance is proven to be harmful to the population in general, with waivers for those where the substance is proven to have no deleterious effects, and if the user is under responsible medical care.

I say innocent until proven guilty. Others say guilty until proven innocent.

Right, I'm off back to my limb, no doubt that makes more than just me happy :)

Cheers

Slag

[QDMQDMQDM]

Hey slag,

I'm a very sad, rather obsessive character, trying to claw meaning in life from the hundreds of hours I spend a month on pprune.

What's your excuse? ;-)

QDM (on 'roids)

[gingernut]

Well said slim slag.

Why do the interesting threads go to ? Who is responsible for the censorship and why ?

Of course I'm in favour of evidence based medicine. My point was that take the 5ths link was based on opinion and case studies, which, of course is not evidence based medicine. In fact its just the opposite, the sort of stuff that has held nursing back for years !

Having said that,sadly only about 30% of my practice is based upon robust evidence. If take the 5th is a hospital nurse, then I suspect that her practice is less evidence based. Perhaps he/she should continue doing what the good doctor tells him/her.

[takenthe5thamendment]

Dr Nut -

My point was that take the 5ths link was based on opinion and case studies, which, of course is not evidence based medicine
The slag was asking for information about the use of Anabolic Steroids - I was trying to help that was why I posted the said link, yes they were case studies with information about side effects - I did hope this might be useful:)

The medical profession was accused of 'Abuse of power' by the slag - we KNOW that the concept of evidence based practice is to EMPOWER the patient/client by giving as much information as possible thereby enabling the patient/client to make an informed decision.

Perhaps he/she should continue doing what the good doctor tells him/her.
The above remark is really funny - sometimes it's the other way round - yes I do work in a hospital environment and I have to 'babysit' PRHO's and HO's(Pre Registration House Officers and House Officers) who -
Can't catheterise male patients - 'I have never done it Staff - have you done the course?'

Have no idea what Apomorphine is - 'Do you think that this patient may benefit from an Apomorphine Trial Doctor' - 'What is it Staff? I've never heard of it'.

Have problems cannulating - 'Can you do it Staff - I can't get it in'

Decide that a patient's condition is ok without even going further than the end of the bed - 'He looks ok to me Staff'

Don't know the amounts of Diamophine etc to be used in a Syringe Driver! - 'What else is usually added, what's the amount?'

And not forgetting the prescribing of 'inappropriate' night sedation for the elderly confused!

Nope I cannot take your advice there :D

Why do the interesting threads go to ? Who is responsible for the censorship and why?
The original post was obviously deleted by Liquid, for whatever reason he decided not to let it continue - if one starts a post and it's the first thread that is deleted, it deletes everything ever posted.
slag is an opinionated git
Censorship is by the editing of particular threads by the moderators - as you can see this was done on slim_slag's post by Min after it was reported to her that he had made scurrilous remarks about Liquid Hockey :eek:
C'mon slim_slag - play fair!

Love, the5th
(a she, not a he!) x x

[min]

Play nicely, people....the topic, not the person, remember :)

M.

[slim_slag]

Well QDM,

I guess I have the same problem as you :) I blame scrumpy for my brain damage, unfortunately closer to the truth than I like to admit!

Taken5th

I would agree that patients who are unfortunate to be admitted on August 1st of every year should be grateful for the experience and guiding hand of the nurses on the wards. Like a PPL, an MBBS is a licence to learn, and you really don't have a clue what you are doing when you first get one. Just stop calling the poor houseman at 3am so you can put 'Doctor informed' in your notes :D

Talking of sticking tubes in people. I remember being sent up to the wards to put a NG tube in having never done one before. The nurse brought the tube, and handed it to me. I asked the nurse if she had done one, and she said she had, so I asked her to show me how to do it. The nurse refused, saying she wasn't allowed, so the patient suffered while I totally ballsed it up. So it goes both ways, long time ago of course, and I hear nurses will do more these days.

I like the story of the houseman who was constantly being bugged by the nurse at all times of the night for what the houseman thought were silly things.

Nurse at 1am: Doctor, the patient in bed five is dead.
Houseman. The patient isn't dead until I say he is. 15 minutes neuro obs until I get there in the morning.

Probably as true as the rest of them :)

[takenthe5thamendment]

slim_slag :D:D

After 23 years of wearing the uniform - would I ever wake one of these babies for the 'ell of it?
Noooooooo, bless, they need all the sleep they can get ;)

[DX Wombat]

5th, you obviously get your HOs straight from Uni so why do you expect them to be all-knowing? We get ours after they have been let lose onthe general publce for a year or two but they still need help. Changing jobs with the regularity that new drs do is a daunting prospect, no sooner do they get used to the system in one place than they have to learn a new one for the next job. We all have to start somewhere and there is much which it is not possible to practise in pre-registration training and much to be learned afterwards. If there were not, there would be no need for further training. All the above comments also apply to newly registered nurses. Learning is, or should be, lifelong in medicine and nursing. Your comments about Drs not knowing how to catheterise a patient are unfair - didn't you ever have to be shown? I did. As for the remarks about not knowing the dose and diluent for Diamorphine, words fail me. Do you not have Ward Guidelines and Protocols? We do. They are there to protect the patients and the staff alike. If you do not have any guidelines or protocols I suggest you get some sorted pretty quickly. It may be a tiresome task but if it saves one life it will have been worth it and it will save many frayed tempers if the new Dr is shown where they are and how to use them. Nobody is born perfect and all-knowing so just take a deep breath and remember what it was like when you first started and how you felt - frightening wasn't it - all that responsibility? Ease up a little and be helpful it will work wonders.

[takenthe5thamendment]

Dx - I was merely demonstrating to Dr Nut that to Perhaps he/she should continue doing what the good doctor tells him/her. is not always the best course of action.

As for be helpful it will work wonders.
I dont think you can suggest I am not helpful - I'm certain all my colleagues will confirm that I am more than helpful.:)

[QDMQDMQDM]

Er, this forum is better in its semi-dead state!

The doctor vs. nurse debate is always good for a laugh, but ultimately sterile. There are good examples of both, idiotic examples of both, good examples of practice by both and idiotic examples of practice by both. Exactly how you balance the scales depends on which side you're from and nothing more really.

I wouldn't fancy generally doing what nurses do (among other things I have a proven allergy to human faeces, no honest!) and most nurses probably wouldn't fancy doing what doctors do.

Horses for ze courses, as they say.

QDM

[Mac the Knife]

Well, about a million years ago I was a new houseman in Dorset and it was Mr Pope, the old charge nurse who taught me most of these basic skills, even though he wasn't supposed to do most of them. I'll raise a glass to his shade for he must have been pushing up the daisies these many years.

We used to have a little book called the House Officers Vade Mecum that we used to look up stuff like dosages in, but I suppose HO's these days distain such auch aids. Too busy studying Practice Management and being taught the empathy and common sense that they should have had anyway.

You haven't lived until you've done a manual evac. or 30!

Where are the Mess Bars of yesteryear?

....subsides growling...

[slim_slag]

Ah Mac,

Most interesting mess I saw was at Guy's in London. The wall was a gallery of females in lithotomy positions being assaulted with equipment used to extract babies in those days when C-sections were a sign you had failed. All lovingly carved into the pine wall with dates and initials of the artists. Bit of a sterile mess though, all the action was in the dive med student bar in the basement which would stay open until the cleaners woke everybody up at 6am, but at the turn of the 20th century it must have been the place to be.

Legend had it during the Blitz, when the hospital was bombed, all the housemen were sent to save the wall - the patients came a definite second.

Back in my days we only used to carry the BNF, it had everything you needed to know and a nice pocket size too. OK, wasn't quite the authoritative source but dragging around the Oxford Textbook would require a trolley and that was a pain when you got crashed. If it dealt with a drug and you needed to know the side effects, it was in the BNF, so I thought it interesting when gingernut quoted from the relevant BNF section in the deleted thread.

Back to the limb.......

[gingernut]

Take the 5th....if you can't beat them , join them.

Three emerging themes,

a) technological changes, disease management, and the tools to beat it are becoming more complex.

b) demand is increasing, and the public is demanding more.

c) "supply" is decreasing, more and more GP's/docs retiring, working time directive etc.

Who is in the best position to fill the void, for the best of our patients, yes, nurses.

It sounds from your reply, that you are more expert at male cathetirisation/giving diamorphine etc than your medical colleagues, so why aren't you doing it !

The opportunity is there. We (nursing), are getting the support from the top to explore our boundaries, and to challenge this traditional medical / nursing divide.

You will meet some resistance, but not surpringly, from your medical coleagues. It will more likely come from your own ranks, particually those who are quite comfortable with their traditional roles and responsibilities.

Stop hiding behind your uniform, get out there and do something about it. After all, its about whats best for your patients at the end of the day.

;)

[Mac the Knife]

Roger that _slag. Did my Cas job at Guy's in the 70's. My auntie by marriage in Denmark was an anesthetic nurse and gave anesthetics for years, mostly unsupervised, with few problems.

I learned (also in Dorset) that when an experienced nurse rings you up in the night and says "I'm not happy about Mr X. All his obs are OK but there's something wrong" it's time to put on your socks and go and see, because as sure as sugarpuffs she's right.

It's a sad thing, but neither medicine nor nursing are particularly attractive professions these days as witnessed by declining student applications for both. Society doesn't seem to be attuned to concepts of caring so much (except for busybody social workers, medical administrators and thought police). Financial worth seems to be our only criterion for success. The combined assault on the medical profession by the legal fraternity, the antiscience lobby and the tabloids has led to far-reaching "reforms" of dubious value which have had serious effects on medical training and on students perceptions of medicine as a career choice.


Among the specialisations, surgery is increasingly hard hit, with gigantic malpractice premiums deterring trainees from entering the field. Most American residency programs have unfilled places these days and serious shortages are forseen in the future.

While the First world attempts to fulfil it's nursing needs by attracting graduates from less developed countries, in those countries themselves even private hospitals are experiencing increasingly serious staff shortages because even there nursing is no longer seen as a worthwhile career.

Yer reap what yer sow.....

[takenthe5thamendment]

Hi Gingernut
It sounds from your reply, that you are more expert at male cathetirisation/giving diamorphine etc than your medical colleagues, so why aren't you doing it !

Because there's 26 patients to 2 trained nurses and 1 Auxillary on the night shift, on a very busy acute medical ward I do what I can, but it's not always possible.:(
I have extended my role in more ways than one and don't wish to lose those skills.
As for the Diamorph - it was way it's sometimes prescribed, not the administration........ the docs don't usually administer meds.

[Tinstaafl]

Speaking of catheterisations, it's interesting that in the UK female nurses are usually qualified to do women (but not not men), while for male nurses it's the reverse.

In Oz when I trained both male & female student nurses had to get a tick in the box for both genders.

Damned if I can work out the UK logic for not including the other gender in normal nursing training.


Slightly off topic, but the first time I worked in a UK hospital I thought I'd stepped into a Jack the Ripper set.

Suffice to say I'm not terribly impressed with the NHS. I've told my family that if I get anything seriously wrong with me I'll be on the first jet back to Oz. If I'm too ill for that I'll crawl onto whatever plane is heading for Scandinavia or Germany...