January 19 2011 (Wednesday) - Plant Food !



A fascinating talk today. A chap came in to A&E having overdosed on drugs. Not an uncommon event. But this chap had OD-ed on plant food!
I’m reliably informed it’s like amphetamines. One lives and learns… 

(as always, the presentation is available in the archive)

January 17 2011 (Monday) - Howell-Jolly Bodies



Named for William Henry Howell and Justin Marie Jolly, Howell-Jolly bodies are basophilic nuclear remnants in circulating erythrocytes. They appear as a black spot on the otherwise eosinophilic (pink) erythrocyte on a standard stained blood smear. These inclusions are normally pitted out by the spleen during erythrocyte circulation, but will persist in individuals with functional hyposplenia or asplenia.

Common causes of asplenia are splenectomy following trauma to the spleen, and autosplenectomy caused by sickle cell anemia or related conditions.
Up to ten percent of patients with coeliac diseases also present with splenic atrophy with subsequent Howell-Jolly bodies. Other causes are radiation therapies which damage the spleen.
Howell-Jolly bodies are also seen in severe hemolytic anemias, megaloblastic anemia, hereditary spherocytosis (occassionally), and myelodysplastic syndromes.

January 15 2010 (Saturday) - Malpractice



If a member of the public has a complaint about a health care professional then there is a very open process by which allegations of unprofessionalism, incompetence and malpractice are followed up. It’s laid out by the HPC, as are the results of their investigations. Such investigations are a matter of public record. Periodically I go through the archives. Some make macabre reading, some are downright criminal. And this one amazed me – a psychologist who told his patient that she was both psychic and a witch.
I spend a lot of time telling family, friends and the public at large how wonderful the NHS is (and it is!), and then I find myself undermined by this sort of thing…

January 13 2011 (Thursday) - An Assessment



As an assessor myself I enjoy assessing other trainees. I like visiting other hospitals. I feel I get a lot from the experience; I learn a lot, and (hopefully) at the end of my visit everyone is smiling after a successful assessment. (I failed one once, but that’s another story…). However when I have an assessor in to see one of my trainees I am worried sick. I hate it!
The point of the assessment was to examine the trainee’s pre registration portfolio and to see if he had met all the criteria. I’ve actually gone to the trouble to produce a website all about this pre registration portfolio. Ideally someone else would have done this already, but the formal advice we receive about this is minimal. The idea is that the advice should be minimal to encourage the trainees to be artistic and creative in compiling their portfolio. No two portfolios should be the same; each should show the individual compiler’s input.

Some assessors (like me, I hope) have taken this philosophy on board. Others (to be fair it is a small minority) come along with a fixed view of right and wrong; their way being right and everyone else’s being wrong. I have encountered such narrow minded assessors in the past, and had to fiercely argue my trainee’s worth.
In one such case I challenged the assessor to explain why she felt certain work was not up to the required standard. Her answer was “I don’t like it!”, snarled in a rather arrogant fashion. She eventually admitted defeat very gracelessly. Another assessor once criticised one of my student’s work for having both too much and too little health and safety input. And then went on to refuse to see any contradiction.

As part of the assessment process the assessor interviewed me, and asked if I had any difficulties in mentoring. I told her that I hated the variability between assessors. She laughed, and related her experiences. She’d had dealings with a chap who would only accept work from a student in a question-and-answer format. Essays, case studies, reflections were all worthless to him. I liked today’s assessor. She (like me I hope) knew what she was doing. My chap passed his assessment. That’s now nineteen trainees I’ve overseen to qualification.

January 12 2011 (Wednesday) - INRs


Today’s talk was due to be on hereditary spherocytosis, but with only three days to go, or planned speaker realised that he was on a night shift today. Woops!

Fortunately a volunteer stepped into the breach. Having recently received a CD of talks given at a conference he recently attended, Dan presented on the topic of variability in the measurement of INRs.
There were flashbacks of a talk given a few weeks ago – who actually prepares normal ranges these days? (Rather than look them up in a book). And an interesting discussion on ISIs. Surely they need to be device specific, rather than one ISI for all the devices in one clinic?

January 7 2011 (Friday) - What is Hematology?



Rather American rather than UK-based, but it brings home what the job is all about…

January 5 2011 (Wednesday) - Auto-Antibodies

Today’s lunchtime seminar was on the detection of auto-antibodies. I won’t attempt to blag it; I slept through the entire seminar.
Mind you, the session wasn’t entirely wasted on me: as the organiser I shall make sure the window is open for future sessions.