12 Nov 2008
Posted in People, Work at 11:42 pm by alby
My dad had some problems a while back with his wrist after breaking his forearm. He ended up with what’s called carpal tunnel syndrome.
His consultant said that he should try “resting splints”. He told me this and my response was “Waste of time, you need an operation”.
Consultant’s response on hearing this from my dad. “He doesn’t know what he’s talking about”.
Well I’ve just been reading the Cochrane review (top quality medical review) of treatment for carpal tunnel syndrome.
The conclusions of this review?
“Surgical treatment of carpal tunnel syndrome relieves symptoms significantly better than splinting.”
Hah!
How much is this guy getting paid?
Pfft.
Oh and my dad needed surgery in the end after all.
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31 Oct 2008
Posted in Life, Work at 9:35 am by alby
Our work has a classified advert service where staff can sell stuff.
There’s one up at the mo selling:
“International mediumship, tarot readings, angel cards, palmestry, past present and future readings. 30 years experience.”
I had a look at the TaC’s of the service and apparently all ads should be
“legal, decent, honest and truthful.”
I wonder if I can get the thing pulled because of breaching the rules?
Hmmm…..
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23 Oct 2008
Posted in Work at 7:30 pm by alby
Well doesn’t the NHS seem to be in the news this week?
Another story on the beeb about how bad hospital canteens are.
So canteens are rubbish and have no healthy food.
About 6 years ago (so I have no clue if this criticism is still true, but I would expect so) I used to work at Glenfield Hospital in Leicester which for those who don’t know is a cardiac speciality unit. In other words people come from all over the country (in some cases) to get top heart work done.
As a group, us physios used to go to the canteen on our Fridays for lunch. Every week we used to fill in one of their feedback forms with comments along the lines of
“This is a cardiac health centre - why is sausage and chips £1 but a salad big enough for half a person £2?”
The canteen never even condescended to give us a reply. We must have sent over 50 of them in.
Tsk.
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21 Oct 2008
Posted in Rants, Work at 8:12 pm by alby
OK so I’m incontinent today but:
Coo there’s your actual news story about us physios on the BBC. It’s about the idea that people should be able to self-refer to physios rather than taking time up going to see the GP first.
This has been taken in some strange ways on their HYS about the topic.
First off people seem to think that it means that people can just phone in and get a physio appt. This isn’t what self-referral is. When a GP refers us a patient s/he has to fill in a referral form with lots of questions on. This then gets looked at by me (usually) and then I decide whether it gets accepted or not (and if not, why not and a letter written back to the GP), and then whether the patient needs to be seen urgently or whether they can be left on the waiting list for a while. All self-referral means is that the patient will fill a form in to start the process rather than the GP filling it in.
Then there are comments like:
In theory, this sounds like a fantastic idea.
In practice, I fear that physios will be over-burdened with hypercondriacs and time-wasters, something that is becoming more common in recent times.
For example, Mrs A is recovering from a car accident and needs a physio appointment, but the physio cannot see her because she is busy with Mrs B who is just overweight, lazy, and looking for attention or a sick note.
Unfortunately this is what happens anyway. The person who refers is irrelevant. Yes we’ll get more people into the system at first but we won’t be letting regular malingerers in on a regular basis (and yes we do know when you are malingering). I refer you back to the bit about me writing back re why we’re not accepting a referral.
Then the worry seems to be:
This pre-supposes A) The referring individual knows what’s wrong with them, and B) That they know physio will be of benefit to them.
This also means that the physio will have to be able to effectively screen out those who need to see a doctor.
Given the above, I’d be prepared for a lot more mis-diagnosis, complications from inappropriate treatment, and a few people dropping dead as their back pain turns out to be something altogether far more worrying indeed!
and
I am aware of someone who went to his GP and asked to be referred to a physio for back problems etc. The doctor was not happy and referred the person to hospital. The back problem was caused by pressure from a tumour!
Paragraph 1 is pure rubbish. Part A: so people need to know what’s wrong with them before they see a GP? And part B: Why? Surely finding out that physio is not helpful just leads to further investigation. This is what happens now.
Paragraph 2: Erm. Ok I can do condescending (as DB once said, “I know I’ve read your blog”) but that is appalling. What does this guy think we’re trained in? No doubt he’s a “give me some massage” type. Assessments routinely ask “red flag” questions - IE looking for stuff that needs urgent follow-up. We know what musculo-skeletal patterns are there. We know the commonest symptoms and patterns of non-MSK origin. That’s why we spend 3 years or more at uni then years of on-going training on the job.
So paragraph 3 is rather redundant. I’d pick a physio to spot nasty back symptoms in a 45 minute assessment over a rushed non-specialist GP in an 8 minute assessment any day of the week.
The second one is again just what we do day in day out. I’ve spotted tumours, MS, cancer and so on in patients who have been “screened” by GPs. It’s one of the things we’ve been trained for.
And then there’s the political argumentative types:
I wish these imbeciles would stop meddling with the system, they havent got a clue what they are doing as has been found with the contracts and out of hours care….
Let the reshaping suggestions come the other way……far to much meddling from the top is costing us Billions in waste…..
You mean like the large number of studies done re self-referral that show it’s worked well, is cheaper, quicker and less wasteful than GP controlled care? Yeah really top down that stuff.
Oh and the lunatics:
GPs should always be the gate keeper but would benefit from more pain management training and a wider choice of therapies to offer such as massage.
and
The physio also needs to be given the power to refer someone back to their GP if they feel that they should.
So massage is useful (quote from the European Back Pain guidelines “We cannot recommend massage therapy as a treatment for chronic low back pain.” NB this is written by an international committee looking at vast amounts of published and reviewed literature - not merely some bureaucratic nonsense) and someone thinks that physios should be able to refer back to GPs. Like they can’t now? Again it’s what I do multiple times daily should I need to.
But one of the comments made me smile:
Given that most visits to a physio make a trip to a medieval torture chamber seem like a gentle day out, the more malingerers that get folded and half and have their big toes poked up the noses, the better.
Have fun.
PS AAARRRGHHH!!!!
However, telling folk to exercise more isn’t the answer to stop physio referrals as it’ll just increase sports injuries cause by lack of warm ups/downs and good posture.
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13 Oct 2008
Posted in Rants, Work at 9:00 am by alby
I’ve just got to work to find my first new patient of the day. The referral is for a nice straightforward hand problem. We have a protocol that basically says hand problems go to the “hands team” at one of the local hospitals.
So naturally it was sent there.
It came back with a rather lovely note.
“Dear Team, I am returning this to you as it should be within the capability of any MSK OPD [musculoskeletal out-patient dept] therapist to treat this condition.”
I love that the thought is that we can’t deal with it. The problem the patient has is very simple and dealable with; and indeed could be dealt with by any MSK physio.
The reason the patient got transferred to them was because “that’s the rule”. Hands go to the hand team. Is it really so very difficult to understand?
In times of few patients they’d be screaming at us for patients like this as they’d be losing staff through having no work for them. But now in times of plenty rather than stick to the guidelines they’d rather just have a dig at the apparent competence of our staff. And they wonder why we had a messy divorce a few years ago.
As well as their business comes our business. We still have something like 50% over-referral so having guidelines like “hand problems go to the hand team” (which were agreed with them) are useful in helping us to not implode through under-capacity.
Never mind, the patient will be in soon and much to the surprise of the hands team I’m sure will probably get a lot better with a bit of time and treatment here.
How sweet of them.
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25 Sep 2008
Posted in People, Work at 9:39 pm by alby
I like my colleagues. Today we had a staff do after work. Being go-getting types we tend to go for “doing” something rather than simply eating or drinking.
Charlie had us do a basic rock climbing intro session thingy.
Was fun. The old bloke who taught us knew his stuff and was v helpful. The team was supportive at the right moments and sarcastic when it was time.
My left shoulder is a little sore as my lack of arm strength told (again).
And we got some pics. Nowt special in quality but that’s quite hard to do with a complex camera and it being passed round from one to another. But they’re good enough as a record of the silliness.
You can see them here if you wish to.
Have fun.
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08 Sep 2008
Posted in Juggling, Self-indulgence, Work at 9:18 pm by alby
Way back at the EJC I had a strange encounter with Luke B.
He’d asked me ages ago if I’d be ok to do an interview with him re my PhysioMonkey work and that.
Well he went and interviewed me and has now only gone and stuck the interview out on his podcast. And I’m quite pleased. I don’t actually sound too much like an idiot. Well not too much.
Some over-usage of one or two phrases and a bit of unclarity at one or two moments but generally not too bad.
Pleased.
Have fun.
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21 Aug 2008
Posted in People, Work at 11:44 am by alby
I met a patient today. A man not 5 years older than me.
He’s 10stone overweight. He has diabetes. He’s had 2 strokes. He has heart disease. He’s recently suffered major ulcers in his leg. He has clearly appalling circulation to his feet. He takes 15 different drugs daily. He walks with a zimmer at home, a stick out in the outside world.
And I’m going to stick my neck out and say that the majority of that is self-inflicted.
Before anyone whinges and says that the diabetes is probably the main factor then I shall point you at Steve Redgrave - diabetes sufferer and example of not having to sit on your arse and wait for bits to pack up or fall off.
Bloody hell this guy is only 5 years older than me. Unbelievable.
And my job with this guy? The GP has asked me to help his painful ankle. It’s probable that he’ll get some relief but the state of his leg suggests that he’ll be heading towards amputation (assuming he survives that long).
I do feel sorry for him now but he really could have done plenty back when to avoid pretty much all of this.
Sigh.
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20 Aug 2008
Posted in Work at 7:33 am by alby
Here’s an entry in the “things we didn’t know last week” category.
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28 Jul 2008
Posted in Blog, News, Work at 8:24 pm by alby
I had noticed. And it was mentioned to me yesterday.
My blog has been more than a tad quiet this week.
A combination of business and not being in the mood I suppose.
But then there’s stuff to look forward to.
EJC is nigh on upon us. Really looking forward to that. At least I am assuming my keeping fingers crossed re car surviving works. I’m half expecting me to be spending a day sorting car issues during the holiday. But hopefully I’m just being paranoid.
Other stuff.
The Bugle remains the funniest thing I’ve heard for a while. Certainly much better than the current Now Show series. In fact radio 4 comedy is a bit rubbish now. ISIHAC is finished what with Humph dying, Now Show is a bit rubbish at the mo, Just a Min has worn out its welcome to me as well. It doesn’t leave much else there.
My brother hit 40 this week. It’s the first time he has celebrated a birthday that I remember my dad celebrating way back when. I am now starting to feel old. No do though so he had to make do with a card. I’ll take him booze next time I visit.
Work is interesting but summer always makes the world of work more fun.
I’ve had about 4 no shows today. I’d be paranoid if I’d seen them before but they were all new patients. Annoying but its occasionally nice to chill a bit on warm days.
There’s too much on in the news for me to get to all of it. Although I do wonder what the hell Weston Super Mare has about it to warrant nearly lead item on the news today. Nice to see that a damaged pier takes precidence over murder on honeymoon, 50 people killed in suicide bombings in Iraq, a dozen more in Turkey etc… Our editors must all go to the school of mundanity. V poor.
Have fun.
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