Monday, 27 September 2010


Astham patients took 50% of the amount of their inhaler 50% of the time.

Another example of poor adherance being a problem is when doctors prescribe a medication to someone newly admitted to hospital who says there taking an ACE Inhibitor. There not actually taking it but they are supposed to. Then, said patients gets severe postural hypotension, falls over and breaks knee

Friday, 24 September 2010

Acne and Isotretinoin

Does Isotretinoin therapy cause depression? Maybe, maybe not - all depends on who you speak to.

The argument against Isotretinoin therapy causing depression is that its used for severe acne. Having severe acne could probably cause depression anyway. Well, thats what the latest psychiatrist to take a mild interest in the Fuddled Medics education said. According to wikipedia though, Isotretinoin has produced behaviour of dperession in rars though.

Another example of how you can argue anything you want in medicine if you think about it (althoug some things are set in stone).

The above point also illustrates how psychiatry is linked to the rest of medicine, depression arises due to a severe, disabling skin condition. Another one is that 10% of hospital patients will get delirium, something that can be quite hard (in practice, not in theory) to distinguish from dementia.

And with regards to dementia, is it due an underlying organic cause? Or are they quiete and unresponsive due a care home induced depression?

Dermatology is often seen as a bit of a joke subject by student, if you have a patient with a rash in front of you just flick though a book until you find the right picture. This can't really be done, textbooks show pictures of the "classical" disease, not the shades of grey in between.

What also isolates this speciality is that there is no dermatology wards, 99% of dermatologists deal with outpatients and dont do ward rounds.

Tuesday, 21 September 2010

Ashworth, Rampton and Broadmoor

Today I visited one of the above places, a high security psychiatric hospital. Broadmoor is the most high profile, but they are all pretty much the same. It was a bit scary at first, being searched, going though four/five locked soors. The gentleman giving the tour pointed out that forgetting to lock a door behind you was a disciplinary matter.

In 1998 the Fallon report was published as a result of children being groomed by residents at Ashworth in 1998. What happened was that the patients with Personality Disorder were running the ward. Sticking a buch of people who are highly manipulative is not usually a good idea. Patients were able to take advantage of low staff morale who did not feel they could turn for management for help. From what I can gather these concerns were first raised by one of the patients who was ignored.

One surprise to me was the idea that patients would often want to be in prison as opposed to "hospital." The theory being that in prison you have access to drugs and there can be a hiearchy of power. Whilst in a secure psychiatric hospital you cant smuggled stuff in by bribing staff.

So are these places necessary? Or a throwback to a bygone era? Some of the people in these places have commited no crimes, society has acted pre-emptively. Others have been deemed "safe" by doctors but the Home secretary got the jitters and overuled them. Any after speaking to a patient intense debate was given when we were asked whether or not she should be released back into society

Friday, 17 September 2010


Some of you who read this blog may have gathered that I am not a fan of religion. Therefore I am going to do a taoken post on the popes visit.

Today his holiness has been ranting about how religion has been marginalised. Tough bloody luck. If you had not persecuted non-believers and people who disagreed with you down the ages and you kept your crazy views about wine turning to blood then I might feel sorry for you. I dont, I feel anger towards you, you brought on the attacks on religion yourselves by poking your noses into other peoples businesses and fostering your views on others.

Religion deserves all the criticism it gets

Monday, 13 September 2010


I sometimes dont know what is more scary, meeting someone who is actually a bad/evil person. Or a good person who genuinely believes in something stupid.

Saturday, 11 September 2010

Tennis and Saturdays

On Monday I shall be found in the pub, hopefully watching a Federer-Nadal final. But today will be spent lying on the sofa watching cricket highlights after an exhausting two hour tennis match.

Anyhow, hope all my readers are enjoying the sunshine, I certainly am. it means my washing will be dried sometime today

Tuesday, 7 September 2010

Socks, Simpsons and Trouble

Today I was on the Ward when one of the Patients decided to have a go at Doctors, Nurses and Students. This involved shouting at how unprofessional we all were. One doctor came under criticism for having unruly hair, another for sitting on the table. Yours truly, the Fuddled Medic came in for criticism for wearing inappropriate socks.

Should medical students or any other healthcare professionals refrain from wearing comedy socks on the Ward?

I shall be wearing my Simpsons socks in the future

Monday, 6 September 2010


It is likely that i have an orbitofrontal cortex lesion which is relatively small. This is because I sometimes tell boring and irrelevant stories that dont lead anywhere, as well as making bad puns. Thanks to wikipedia I have a diagnosis.

Saturday, 4 September 2010

Thinkers, Workers and jealousy

According to the latest consultant that I chatted to medical students and doctors can be classified into two categories (although there is some overlap)

The first group is the thinkers, they sailed through A-levels getting three A's by default. They automatically know everything by instinctively picking it up during the day and applying the underlying theory/philosophy.

The second group are the workers, they struggled to get the 3A's and had to work hard. They have an incredible work ethic which they bring to medical school. Nothing comes easy and they have to work throughout the term and still do lots of revision for exams.

The workers are jealous of the thinkers, bloody know it alls who do sod all during the year and still get 90% in exams. Am sure you all know someone like that. Although as I mentioned earlier there is some overlap between the groups. Even the thinkers will at one stage have to sit down and do some work, something which may not come naturally to them.

I am a worker, nothing comes easily and I have to constantly run in order to at least stand still (oxymoron alert).

The enxt part of the conversation turned to people and there personalities. Medical students and doctors either overestimate there abilities which has the potential to cause harm to patients or they underestimate themselves.

Is this a bad thing? If you constantly question your abilities you are likely to always ensure you seek senior help when its required. However you may be struck down by fear and question yourself at the wrong time, when you should have acted straight away?

Thursday, 2 September 2010

Careers, Sleep and the Weather

As my lovely readers will be of aware the FM is interested in psychiatry and was seriously considering it as a career. This took a bit of a battering due to the FM feeling drained and tired of dealing with patients with mental health problems and the issues that arose.

My consultant took my arguments on board and then calmly pointed out that I am relatively young, in two or three years times I will deal with emotions differently, I will have more clinical (and life experience) and perhaps I shall be better placed to cope with stuff better.

Maybe, are you a different person when your 23/24 as opposed to 20/21?

The weather in Fuddled Medic land has been hot and sunny. This is good, not so good is being stuck in clinics, sitting in a nice comfy chair and having the patients smiling at you and asking if your ok as you drift in and out of consciousness.

Thankfully the lovely receptionist came riding to the rescue and offered me a cup of coffee. Brilliant, thank you!