Clean hands, Cool head, Warm heart.

GP, Gardener, Radical progressive

  • 47 Posts
  • 148 Comments
Joined 1 year ago
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Cake day: May 7th, 2024

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  • Like every new technology that is hailed as changing everything it is settling into a small handful of niches.

    I use a service called Consensus which will unearth relevant academic papers to a specific clinical question, in the past this could be incredibly time consuming.

    I also sometimes use a service called Heidi that uses voice recognition to document patient encounters, its quite good for a specific type of visit that suits a rigid template but 90% of my consults i have no idea why they are coming in and for those i find it not much better than writing notes myself.

    Obviously for creative work it is near useless.



  • I’ve been thinking a lot about this issue, obviously with high quality and cheap generative AI essay writing is meaningless for assessment, which is a shame because crafting an essay is an excellent exercise for thinking through a concept.

    In my undergrad I wrote a lot of essays but also had a lot of small group tutorials where our contribution contributed to our grade. In medical school assessment outside of examination was almost entirely based on interaction with professors and supervisors. I’m also aware of verbal examination where a professor effectively interrogates a student to assess their knowledge which I think in undergrad settings is mostly historical but could make a comeback, oral examination is used extensively in postgraduate medical training.

    For a degree to mean anything assessment needs to be not easily cheated. There are assessment methods that are available although they are less efficient.

    If I were running an undergrad humanities degree I’d have essays be 10-20% of the total grade, have a brief 15-20min oral examination and tutorial participation make up the bulk of the grade. I don’t know how else a degree can mean anything.






  • I’m a GP, here’s my opinion

    Can’t have eaten/drank anything for the last half hour

    • in principle could alter your BP but I wouldn’t worry too much unless it’s quite a large meal

    Feet flat on the floor

    • yes, this is important

    Lying down but sitting up

    • for some purposes docs want lying/sitting/standing but for home measurements do them sitting

    Back against the chair

    • yes

    Don’t cross your legs/ankles

    • yes, feet flat on the floor

    Only use your left arm

    • myth, if there is a significant difference between your left and right arms there is something funky going on with your subclavian arteries

    Hand facing upward/downward

    • not super important

    Keep your arm down/raised

    • keep your arm relaxed, ideally resting on a table or desk at close to 90deg or hanging straight down

    Most important is be relaxed, sit still, don’t move your arm, if you get a high reading calm yourself and take it once more then leave it.

    When I’m taking a BP in clinic the most important thing I do most of the time is distract the patient from the machine with some patter as for most people the biggest confounding factor is stressing about what the reading will be, I don’t correct posture etc unless they are substantially moving their arm around.















  • Okay, I’ve been happily ignoring your little idee fixee on LDL aside from one gentle comment but I feel the need to comment here again.

    This article is utterly disingenuous and sets up a complete strawman to knock down. It sets out to disprove a notion of cholesterol that was last current decades ago. Right in the first paragraph and throughout the article LDL is referred to as “the” major cause of atherosclerosis which to my knowledge even the Framingham authors wouldn’t have been comfortable with, it is however a significant contributing factor.

    It is well known that some people with elevated LDL or total cholesterol are at low risk(this is the reason for weak or negative results in whole population studies), atherosclerosis is a complex disease with multifactorial causes, no practising doctor I know thinks it is “the” major cause, or even the most important contributing factor.

    That being said it is thoroughly established that statin use in select patients reduces the risk of MI and CVA, especially in those with established atherosclerosis, but also those with other substantial risk factors (high BP, family history, smoking, diabetes etc.). This is totally uncontroversial and the pathogenic mechanisms, while complex, are increasingly well understood.

    I have been a doctor for over a decade and I consider myself diligent in keeping up with research, and although the selection of patients for statin therapy is an ongoing and regularly changing area of research on which experts can disagree, the fact that select patients will have substantially lower risk of coronary events due to statin therapy is uncontroversial.

    Here is an article written by people who payed attention in stats class and have bothered to make their case with evidence rather than knocking down strawmen

    Efficacy and safety of long-term treatment with statins for coronary heart disease: A Bayesian network meta-analysis (2016)

    Or for a more succinct and easy to read summary here is the Cochrane conclusion

    “Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event which compares well with other treatments used for preventing cardiovascular disease.”

    Statins for the primary prevention of cardiovascular disease