Revised gunshot and knife wounds guidance: my view from A&E

Disclosure is a fraught issue – and this is a really useful take on the updated GMC guidelines

Medical professionalism and regulation in the UK

Dr Adrian Boyle, Consultant Emergency Physician and Caldicott Guardian at Addenbrookes Hospital in Cambridge, and Chair of the Quality Emergency Care Committee at the Royal College of Emergency Medicine, reflects on the practical application of our revised guidance – Confidentiality: reporting gunshot and knife wounds (2017).

The GMC guidelines on confidentiality have recently changed. This is a potentially fraught area for doctors who treat victims of intentional injury. Research has consistently shown that doctors care for many assault victims who the police are simply unaware of, despite the severity of injury. Over 70% of assaults treated at emergency departments are never recorded by the police [i].

Patients may have many reasons for not disclosing their assault to the police. They may be too frightened of reprisals, they may not want their own behaviour scrutinised and they may make a judgement call that the police won’t take action. Wherever possible…

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All Scientists Are Awesome

There are weeks in science when even your successes feel like a failure.

That is, if you’re lucky. If you’re unlucky there will be months of it. The criticisms will stretch out before you and though they may be paired with encouragements, you’ll only see the words:

  • “We’re sorry to say your application was unsuccessful”
  • “We cannot recommend this paper for publication”
  • “This was interesting but I didn’t quite understand this bit . . .”

We think the praise is there to soften the blow, because it’s how we pull our own punches when we’re trying to help.

You’ll be scored on your teaching, or on a job application, or a grant proposal . . . 3/5 they’ll say and instead of concentrating on the 3 points you got, you’ll stare at the 2 you didn’t. You’ll be given feedback on a paper and you’ll gloss over “this is interesting” and jump straight to “I disagree with this conclusion”. They’ll tell you they wanted a range of subjects on offer, you’ll hear “you weren’t good enough”.

Sometimes you might think about leaving, working for an NGO, or industry, and you’ll wonder if you’re weak, if you just can’t hack it. Maybe, sometimes, in the dark of night, you might even think that about your friends who got out, but I guarantee you won’t think it for long because you know it’s not true.

Be kind to yourself. You work in a very stressful field, one that is under unprecedented threat, and it was never that stable to begin with. You put too much pressure on yourself, and you always have.

You are awesome.

You were awesome when you stopped what you were doing to explain that thing to your colleague. You were awesome when you pulled a bunch of slides together and stood up to talk about thing no one in that room had done. You were awesome when you listened to their opinions. You were awesome when you cried because it hurt and you were awesome when you were able to shrug it off and you were awesome when you reined in your training and left good feedback for the next person.

You are awesome, and you will continue to inspire awe in me no matter what you do.

Every attempt to manage academia makes it worse

Very important stuff when it comes to measuring academia.

Sauropod Vertebra Picture of the Week

I’ve been on Twitter since April 2011 — nearly six years. A few weeks ago, for the first time, something I tweeted broke the thousand-retweets barrier. And I am really unhappy about it. For two reasons.

First, it’s not my own content — it’s a screen-shot of Table 1 from Edwards and Roy (2017):

c49rdmlweaaa4if

And second, it’s so darned depressing.

The problem is a well-known one, and indeed one we have discussed here before: as soon as you try to measure how well people are doing, they will switch to optimising for whatever you’re measuring, rather than putting their best efforts into actually doing good work.

In fact, this phenomenon is so very well known and understood that it’s been given at least three different names by different people:

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Academia, Love Me Back

If you’re a lecturer and you think your student has plagiarised something the way to deal with it is:

1) Put the work through a plagiarism checking service, e.g. TurnItIn, which is capable of recognising sequences other than words
2) If TurnItIn flags the work up as plagiarised check – because TurnItIn is way too sensitive and usually it’s a grammatical error
3) Inform the student what plagiarism is, showing them in the work the examples and show how they can quote without falling afoul of plagiarism – students must be able to change their work for the better after receiving feedback.
4) ??? profit from the improved education of your students?

Sorry this had to happen to Tiffany 😦

TIFFANY MARTÍNEZ

My name is Tiffany Martínez. As a McNair Fellow and student scholar, I’ve presented at national conferences in San Francisco, San Diego, and Miami. I have crafted a critical reflection piece that was published in a peer-reviewed journal managed by the Pell Institute for the Study of Higher Education and Council for Opportunity in Education. I have consistently juggled at least two jobs and maintained the status of a full-time student and Dean’s list recipient since my first year at Suffolk University. I have used this past summer to supervise a teen girls empower program and craft a thirty page intensive research project funded by the federal government. As a first generation college student, first generation U.S. citizen, and aspiring professor I have confronted a number of obstacles in order to earn every accomplishment and award I have accumulated. In the face of struggle, I have persevered and continuously produced…

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An “open” letter to the editor of the BMJ

Important thoughts on editorial responsibility, peer review, and the ethics of publication

Big Up the NHS

Fiona Godlee

Editor

British Medical Journal

12/09/2015

Dear Fiona

Imagine that you are about to board a long haul flight on a Sunday morning and you read in your copy of The Telegraph that the airline runs on a skeleton staff at the weekend and as a result your aeroplane is much more likely to crash.

Most people would cancel the trip, or rebook with a different carrier. The consequence for people with no option but to fly would be a very uncomfortable journey. The increase in stress and anxiety for nervous passengers could be very significant.

And the newspapers publishing this sort of allegation had better be confident that it is true. You can be sure the airline will use the full weight of the law to sue for reputational damage and loss of income if there is doubt about the veracity of the story.

Sadly emergency NHS patients…

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Weekend Mortality and the 7-day NHS

Necessary reading for anyone looking to understand some nonsense figures being batted about by UK politicians

juniordoctorblog.com

“If you are admitted to hospital on a Sunday, you are 15% more likely to die than on a Wednesday”.

This is Jeremy Hunt- quoting a paper without atribution from the Journal of the Royal Society of Medicine, conducted in 2010 by Freemantle et al [1] amongst nearly 15 million admissions.

Here is the actual paper:
Here are the ACTUAL conclusions
  1. Patients admitted on a Sunday were more likely to die over the next thirty days than a similar cohort of admissions on Wednesday- the ratio was 1.16 and the result significant, suggesting a true result of increased deaths by 16%
  2. 94% of these ‘admissions’ were emergencies
  3. 34% of deaths occurred within three days of admission
  4. You are actually less likely to die if you are IN hospital on the weekend – the Sunday to Wednesday ratio here is 0.92, or 8% LESS likely. As the authors also conclude, this…

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New book: Thing Explainer

I’m a big fan of Munroe’s science explanations, and I’ve been thinking of setting my students an Up-Goer Five formative assessment. We’ll see, eh?

xkcd

A while ago, I posted the comic Up Goer Five, an annotated blueprint of the Saturn V rocket with all the parts described using only the thousand most common English words.

Today, I’m excited to announce that I’m publishing a collection of large-format (9″x13″) Up Goer Five-style blueprints. The book is full of detailed diagrams of interesting objects, along with explanations of what all the parts are and how they work.

The titles, labels, and descriptions are all written using only the thousand most common English words. Since this book explains things, I’ve called it Thing Explainer.

cover-web

The diagrams in Thing Explainer cover all kinds of neat stuff—including computer buildings (datacenters), the flat rocks we live on (tectonic plates), the stuff you use to steer a plane (airliner cockpit controls), and the little bags of water you’re made of (cells).

Thing Explainer will be published by Houghton Mifflin Harcourt on November 24th. You can preorder it now (AmazonBarnes & Noble

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