TSR Med Students' Society Part III

The problem is that once the implants burst, they cause pain and scarring and are nigh on impossible to completely remove. I'm not sure of the ability to predict bursting, but I imagine the move is one of cheaper prevention rather than have potentially thousands of new chronic pain cases. And that's before we even approach the psychological aspect...

There are what, 40000 patients with these implants in the UK? If the rupture risk is 2% then that's 800 ruptures. I can see that these 800 women are not going to agree with me, but I'd say it was better to run that risk than to operate needlessly on the remaining 39200, given that the replacement procedure is hardly without risk of pain and scarring and infection and everything else that general anaesthetic brings with it. When you get breast implants, you take that chance that the implant might rupture - it's a recognised risk. If the women want to play the psychological trauma card, then I would suggest that unless they have evidence of impending rupture then they should perhaps pay for the replacement procedure privately.

Could someone please explain how to check for a collapsing pulse in a CVS exam, and what it's a sign of? cheers

There are what, 40000 patients with these implants in the UK? If the rupture risk is 2% then that's 800 ruptures. I can see that these 800 women are not going to agree with me, but I'd say it was better to run that risk than to operate needlessly on the remaining 39200, given that the replacement procedure is hardly without risk of pain and scarring and infection and everything else that general anaesthetic brings with it. When you get breast implants, you take that chance that the implant might rupture - it's a recognised risk. If the women want to play the psychological trauma card, then I would suggest that unless they have evidence of impending rupture then they should perhaps pay for the replacement procedure privately.

Aortic regurg. Feel the pulse at the wrist, quickly elevate the arm and feel for a collapsing or decreasing volume pulse.

As with many of these eponymous signs, it is totally operator dependant with shoddy sensitivities and specificities, an unfortunate relic of the past when echos didn't exist.

If you want to treat patients privately and it goes wrong, you take responsibility for that - your coustomer is not supposed to be my patient.

Looking closer at the offer by the NHS to remove the implants, they said they will remove them if there is clinical need.

Which is fair enough to be honest.

If you feel a collapsing pulse in a 20-30 something patient in A&E/AMU, you may not have time to echo them before they die. There certainly is still a place for it in modern clinical practice.

From studies, it has shown to have a pretty awful sensitivity for AR. Even it's specificity is not great (low 60s). That means, objectively, it is pretty useless for ruling out AR. If there are other suggestions from the H&E that it is a case of AR (I guess your getting at a Marfan's/Ehler Danlos/Syphilitic presentation of Aortic dissection here) then yes, it could be contributory to the overall global picture, but alone it is not reliable. We just have these relics back from the days where there was nothing else but clinical skills.

I've never felt a collapsing pulse before, wouldn't know if it hit me in the face. And besides, what's the cutoff that determines a positive finding? A 'little' bit of collapse, as felt by me? A 'lot'? It is totally operator dependant.

Loads of these clinical signs that we trot out in OSCEs are totally bogus.

Edited

Some would argue, nowdays, we do tests like smarties going out of fashion. You can quote large scale studies all you like, but given number of times old school consultants are on the money, the signs are good, if you know what you're doing.

Clinical skills are alright if they correlate with real life, that's fine. Caput medusae suggesting portal hypertension, fine. Scleral icterus suggesting jaundice, fine. Random stuff that was invented hundreds of years ago that actually doesn't correlate well with pathology (Homan's sign anyone) = bin that stuff ASAP.

We do appropriate tests because they are precise, accurate, reliable and management changing. All you have to do to put this into perspective is to think back to a time when you and a mate had a listen to a chest and one heard crackles, the other one didn't. That is the flaw of clinical signs, they are operator dependant. A well calibrated CT will show the same thing, time after time again, all over the world.

'You can quote large scale studies all you like' Yes, I will since that is actual scientific evidence, designed to stop old school consultants going about their business like they did when they qualified in the 70s and 80s. Or is it OK to keep giving cef and met 'because that's what the consultant likes' still?

Clinical skills are alright if they correlate with real life, that's fine. Caput medusae suggesting portal hypertension, fine. Scleral icterus suggesting jaundice, fine. Random stuff that was invented hundreds of years ago that actually doesn't correlate well with pathology (Homan's sign anyone) = bin that stuff ASAP.

Let me guess, the US are big fans of the testathon? This combined with defensive medicine will be the downfall of clinical acumen.

But the issue is these days very often tests are done inapropriatly, and then results are not interpreted properly, after which people do down treatment algorithems. Modern technology is not as definitive as you make out, everyone has something abnormal with them which you will possibly find with your battery of tests, the point is to interpret them.
"All you have to do to put this into perspective is to think back to a time when you and a mate had a listen to a chest and one heard crackles, the other one didn't."

Yes, I do put that into perspective - it's called being a student. Just because you or I arn't experienced enough to spot and interpret clinical data, it does not mean that the methods are wrong.

Let me guess, the US are big fans of the testathon? This combined with defensive medicine will be the downfall of clinical acumen.

How many of you guys had done stuff MTAS points related while in your first two /three years of Med school?

I certainly didn't! Didn't have anything apart from my ranking and answers and got 82. The FPAS guidance notes state that actually most applicants don't have any publications,posters etc.

Excellent. I have the option of helping with an audit at my MedSoc but it's psych related (boo) and I have no idea what I'm supposed to be doing for it as my end of year MedSoc report. From what I gather all the evidence has been collected I just have to collate and evaluate it but I have no idea what that involves.

My ranking (decile) is probably going to come out quite shabby unless I stop playing video games which probably isn't going to happen.