Thursday 11^th October - Certification and Benefits

Today’s session was at Kidderminster and had a great turnout, fuelled at coffee time with a generous array of food brought by Patrick - thank you.

We started the session by going over one of Sarah’s cases from last week - this led to a discussion about osteopaths and whether we should give them details of patients scan / x-ray results, how we feel about them giving treatment at a large expense to vulnerable patients for whom the treatment may not be beneficial, and who "owns" patients details and results. Chris and Roy also shared with us their experiences of being computer-less for two days!.

We then started the pm’s main topic (led by group 2) with an introduction to certification and benefits by Louise introducing us to the doctors role and the basic documentation. This led on to a very interesting case presented by Charnjit – a lady attending surgery requesting a sick note both for the future and to back date from the time her husband had a MI although she herself was not ill. We split into groups to discuss this case looking both from the doctors and the patient’s perspective.

After the much needed caffeine and sugar burst Amina then did a presentation on the certificates and how to fill them in. This was very informative. For a fantastic overview of this go to the DWP website and look for IB204 ‘A guide for Registered Medical Practitioners’.

Emma then presented her hot topic – chronic fatigue syndrome. There was a lot of debate about how valid it is as a diagnosis but to review the NICE guidelines was extremely useful as I’m sure we will all have patients in the future with CFS. It seems to be the extreme fatigue after mental or physical activity that is the main diagnostic factor.

Today’s session at Redditch was bound to be an entertaining affair with the title being Sexual Medicine led by Group 6 with Alex at the helm! The afternoon kicked off with our usual interesting case discussion – today’s scenario brought up by Jason concerned a request for post needlestick, Hep B testing on an elderly lady with dementia. We had a fairly animated discussion around issues of capacity and consent, brought to timely close at 2.30 on the dot (as agreed last time)!

Group 6s sexual problems then took centre stage. Alex hosted an entertaining quiz on fetishes or paraphilia – a topic that he seemed to have an unhealthy knowledge of! We now have new insights into the delights of emetophilia, gerontophilia and trichophilia. Probably best not to Google them on a work PC!

Following this we divided into groups to discuss sexual health scenarios with some good feedback by Alex.

After the usual "cakes" – a wholly insufficient description of the treats brought by Sarah D, the hot topic was presented by Lizzie who gave a really interesting talk on the use of Diamox (acetazolamide) in altitude sickness following her recent climb of Mount Kilimanjaro – quite inspirational.

The session was rounded off by a well-resourced sexual health picture quiz by Jason and Sarah gave an overview of contraception, which provided a useful update. Group feedback suggested that this was a very useful session and it was certainly an entertaining afternoon.

Roy Williams

Today’s topics were menopause and HRT and it all kicked off with the usual "Funny thing happened…" during which two cases were discussed. The first was a patient presenting with dental abscess and the dilemma was: do you treat with antibiotics or do you send to the dentist and opinions were divided as to what should be done. The other was, I believe (I was not present at this time) an interesting case of Delusional Parasitosis.

The real meat of the day kicked off with Kate giving us an over view of Menopause. It was a very informative talk on the subject and it was very quickly followed by Emma presenting three interesting cases, which were discussed in groups, that each explored the different aspects of menopause and HRT and what to do. It was a good interactive discussion which got most of the people present actively engaged.

After finally sorting out an initial computer glitch which had to do with an incompatible version of PowerPoint presentation, Veera followed up with a very good presentation on HRT which started with an overview, then clarified the differences between OCP and HRT, talked about the benefits and side effects of HRT, the risks, contraindications, preparations, starting and stopping HRT.

Returning from coffee and cake break ( yes, there was cake, lots of it and bits to nibble) I presented the Hot topic of the session which, as was pre-arranged, was on the nMRCGP ePortfolio, in which I gave a brief overview of the nMRCGP, the ePortfolio and a live demo of the ePortfolio. I then went on to highlight some of the issues with the ePortfolio in its present version which hopefully will be addressed in the new version 2.0 that is imminent. I was particularly struck by the general scepticism about the ePortfolio from most of the people which one cannot blame anyone for given the disaster that was MTAS. As a Medical Informatics student, it once again highlighted to me what sour taste a badly managed medical IT project can leave behind that goes on to affect future projects and what a megadisaster it will be if that subsequent project too gets badly manage – there will be very tiny little faith if any, left for IT projects in healthcare, basically.
Manuel then followed with a well enjoyed Quiz session, with the answers given after Soumen gave a brilliant and well researched 2007 update on HRT. The update was a good trawl through the current literature showing evidence in support of HRT, HRT and breast cancer risk, current recommendations on the use of HRT as published in a recent issue of the BMJ as well as a brief touch on alternative therapies for menopause.
All in all it was a good attendance, interesting topics, informative presentations and if the individual feedbacks I gathered were anything to go by, a very well received session. Some people did raise the question that if we were able to manage so well without the Course Organisers …
… to which I must quickly add that their absence was palpably felt and moreover it is to their great credit that they have nurtured us into some degree of independence. I have always known that there was a great reason behind all those days of ball throwing, hula hooping and speed dating.

- C V Patrick Onyeaka.

The Final VTS half day teaching of the 2007 was helmed by a depleted group 6 in cold and misty Kidderminster.

Whilst we waited for the majority of the group to park we kicked off with the usual ‘anything interesting this week’. Roy came up trumps telling us about a typically anxious middle aged female whom he had been seeing over the course of a month or so with a variety of seemingly unconnected and varied symptoms. The most recent presentation required a home visit upon which he found her confused, disorientated and behaving very oddly - including making sandwiches inspired by Letitia Cropley (Vicar of Dibley). After referral for further investigation (this sparked further discussion about whom such patients should be referred to – consensus medics) it turns out she has a frontal Glioblastoma/Meningioma. Emma very aptly pointed out ‘that will stop us getting anxious about our anxious patients!

Parking sorted it was time to kick off the main event. The topic today was ‘Fitness to Travel.’ Olu (where have you been Olu) started off with a very thorough run through of the general advice and assessment of any patient wishing to travel. In groups we then discussed various special cases – Diabetes, Asthma, Post-surgery and finally discussed management of avoidance of Malaria and Travelers Diarrhoea.

A few interesting points were raised and argued over (imagine if Alex and Jason had been there too)

1. We decided that decisions about when to travel after surgery should be made by the surgeon – therefore tell patient to contact secretary.

2. That sensible patient who request ‘just in case’ medications e.g. steroids for asthma should be given them (on a private prescription) with advise about seeking medical help if the medicine is required.

We then had a break – food provided by Emma I think???? An array of Quality Street, popcorn, Pringles and Cookies and a very small pot of tea and coffee – cheers Kiddi.

Beena now took the lead and told us everything there is to know about Pregnancy and Flying – the key message being that it is impossible to guarantee a problem free pregnancy and therefore its very difficult to advise patients. As an aside to this in typical VTS fashion the question was raised as to the Nationality of a child born on a plane. After a little research I am pleased to inform you that the Birthplace is the place where the child first disembarks the plane. The Citizenship of the child however is the country where the plane is registered. The child can also claim citizenship of the country in which the parents reside.

The session finished with a aptly themed Christmas flying Quiz written by Sarah (on nights) presented by Beena and Olu featuring a rather sickly family all who seemed to wanted to fly after various high risk procedures! Oh and another point was raised that bigger colostomy bags should be worn on planes.

It should be noted that we are saying goodbye to the oldies this week (no not Gilly, Steve and Chris) but Soumen, Rupen, Raj, Bipin and Sunaina – good bye and good luck. We also had the return of Karen from the wilderness of Psychiatry in Warwickshire and a new addition to the group Louis – Welcome!

Next session is a WHOLE DAY session on the 9^th February venue TBC (study leave required).

Tom G