More regulation of doctors by the GMC...
Greu sa nu iti placa de englezi...
Nu stiam de ce fug englezoaicele de mine
July 18, 2010
Theresa May va 'aboli' UKBA. Mai exact, probabil îl va împărţi în două, o bucată care să se ocupe strict de immigration şi visas, şi cealaltă cu enforcement. E posibil să fie o mişcare care să eficientizeze aplicaţiile pentru cei care vor mai avea nevoie de AWC-uri şi work permit-uri până la 1 ianuarie anul viitor. Sursa
Iata ce-am citit azi pe AOL news...
January 18, 2010
din nou in atentia presei…
Si in sfarsit ceva pozitiv despre Romania!
De la doctors.net.uk
Medical registrars buckle under work-load 7 04/03/2013
Britain's trainee physicians are struggling with heavy work-loads and lack of training opportunities, according to a hard-hitting report published today.
As many as 37% of these doctors said they faced an "unmanageable" workload in a survey conducted by the Royal College of Physicians.
And just 38% said their training in general medicine was good or excellent. This compared with their training in their main specialty, which 75% said was of good quality.
Today the college called for a range of measures to head off a crisis in hospital medicine.
It said more doctors must be trained in general, acute, emergency and geriatric medicine.
It also called for a reassessment of the role of medical registrar.
And it called for the hospital workforce to be reorganised to meet the needs of elderly patients.
Its report Hospital workforce: Fit for the future? warns of uneven distribution of senior specialists, able to conduct training - with twice as many in London as the East Midlands relative to the population.
In 2011 as many as 50% of vacancies in geriatric medicine stayed unfilled, it said.
Medical registrar Sarah Logan, who wrote the report, said: "Medical registrars are struggling up and down the country to provide good care to patients. Instead of facilitating this, too often the system makes this difficult to achieve.
"Changes within hospitals, such as improved staffing deployment would help. Crucially, the out-of-hours workload in particular must be better shared across the wider clinical team."
Dr Ben Molyneux, pictured, chairman of the BMA junior doctors' committee, said the report highlighted the need for junior doctor training to be a priority.
He said: "Medical registrars should not be drowning under the weight of their workload - this is not conducive to good training or high quality patient care. Hospital services need to be redesigned to ensure that frontline service delivery should not fall disproportionately on this group of doctors in training.
"If we don't do this we risk the next generation of consultants avoiding careers in acute medical specialties."
But the NHS Employers' organisation said the report highlighted the need for changes to consultants' contracts.
Chief executive Dean Royles said: "There have been great steps forward in obstetrics, gynaecology and paediatrics around consultant level doctors sharing the burden with registrars during evening and weekend shifts.
"If consultant level doctors in all medical fields embraced out-of-hours shifts, it would go a long way towards ensuring there are enough experienced doctors available at all times, and that registrars were being well trained and supervised."
August 30, 2012
Parca cineva incearca sa inteleaga...parca...
Felicitari celor din interviu!
August 30, 2012
Subscriu la "No comment"-ul tau Fanule! Cu durere... si o furie functionala sa zicem asa...
Si revin cu un alt articol din The Independent pe subiectul mult dezbatutei "invazii romanesti"ce sa apropie... appearantly! Comment-urile sunt si ele de ceva insemnatate! Macar de aici transpare o Romanie mai cum o stiu eu...
April 14, 2010
April 14, 2010
Alt politruc semianalfabet! Bravo Romania! Sau sa fi fost emotiile si sunt eu carcotash?
" Dacă soarta nu te face să râzi, înseamnă că nu eşti în stare să te prinzi de poantă."
Iar despre immigration...
Did 2012 prove that psychiatric disease doesn't exist?
Dr Raj Persaud, Consultant Psychiatrist, and Professor Sir Simon Wessely, Professor of Psychological Medicine at the Institute of Psychiatry, King's College London
It has been a year where common sense invocations of mental illness appear to be the only way the public and media have found to grapple with cases like Anders Breivik, the “Batman” mass killer, and the Connecticut school shooting. Strange, incomprehensible, counterproductive or destructive behaviour clearly exists - debate rages over how to explain it.
In the case of Breivik, court-appointed psychiatrists disagreed about what the diagnosis was and whether he was suffering from mental illness. The court decided he wasn't mentally ill. All those supposed advances into how to make a reliable psychiatric diagnosis appeared to let psychiatry down just when the media spotlight was at its most intense. Although, to be fair to the profession, the vast majority of psychiatrists did think the court had got it right.
The debate from the 1960s as to the very existence of mental illness has never gone away - it has just changed. Another milestone (or millstone if the critics are to be believed) in that debate arrives shortly when the “Diagnostic and Statistical Manual” or DSM is about to be formally updated and published in May 2013. This is a kind of catalogue published by the American Psychiatric Association, in which lists of symptoms indicate whether you qualify for a particular psychiatric diagnosis.
In many countries insurance companies and government agencies will only grant support and benefits for mental disorders when there is a clear diagnosis. And even more significantly, in the US insurance companies will only pay for treatment when your diagnosis appears in the DSM. The DSM and similar catalogues are fundamentally important because they determine what exists, whether you have it and, if you do, whether someone is willing to treat you for it.
But critics have, with some justification, drawn attention to an apparent psychiatric “mission creep”.
Back in 1917, the American Psychiatric Association (APA) recognised 59 psychiatric disorders. With the introduction of the DSM in 1952, this rose to 128 disorders. By 1968 and the publication of the DSM-III, which represented a real watershed in classification, it had risen to 159, followed by 227 in 1980, and 253 in 1987. The current version, DSM-IV, has 347 categories, and it is to be expected that the DSM-V will increase this further.
In the run up to the publication, debate and controversy over what disorders should be included and what counts as a symptom of psychiatric illness, tend to reach fever pitch. This doesn’t happen to anything like the same extent in the rest of medicine. For many diseases a diagnosis follows smoothly from administering tests, such as blood work or a particular scan, and then the results make it fairly clear what is going on. This is because an underlying measurable pathology can be located, which explains symptoms and signs.
But despite the best intentions, including those of the authors of the DSM, psychiatrists still rely, just as Hippocrates did, on talking to the patient, collecting symptoms and then deciding. Even if this can be made reasonably reliable, in the sense that different psychiatrists interviewing the same or similar patients around the world, can at least agree on the presence or absence of symptoms, this sadly does not go very far in explaining what the cause actually is, or even whether or not a person is suffering from any specific disorder at all. Social workers and psychologists for example might record the same symptoms, but come to a very different conclusion as to whether or not this indicates a disorder.
Two philosophical and political parties, “ontological realism” and “operationism”, dominate the dispute and help to explain why the debates about classification that surface every time a new DSM is about to appear, seem much more heated amongst mental health professionals than, for example, amongst surgeons or cardiologists.
Most but by no means all psychiatrists will follow the principle of ontological realism even if they might not necessarily use that term. They will affirm that that an entity, for example schizophrenia, exists independently of the instruments or methods deployed to measure it. So the medical model, which is an ontological realist position, holds that the reason we have no test for psychosis, is not that people with schizophrenia don't have an underlying common pathology located somewhere about their person. It's just that this pathology has so far eluded our best efforts to characterise it, because our instruments aren't that advanced, while our understanding remains limited.
Behavioural symptoms are manifestations of an underlying physical difference yet to be found, but real nonetheless. The underlying pathology is distinct from the symptoms. So you could have a lurking disorder yet to produce symptoms. You might have “latent” schizophrenia, displaying no symptoms as yet, just as you could have an unsuspected brain tumour.
“Operationism” in contrast defines how something is to be gauged and then asserts that the entity being assessed is the same as the method used to measure it. This perspective claims theoretical concepts don't have meaning beyond operations deployed to measure them.
Dr Benjamin Lovett, Assistant Professor of Psychology at Elmira College, and Dr Brian Hood, Assistant Professor of Philosophy at the University of West Florida, give a neat example of this in their paper “Realism and operationism in psychiatric diagnosis”, published in Philosophical Psychology. They say that in operationism the meaning of ‘‘length’’ is exhausted by the operation of placing a ruler (or some similar instrument) alongside an object.
The instrument du jour in psychiatry is DSM (there is a WHO equivalent, known as the International Classification of Diseases, which is rather less prescriptive than the DSM, but let's leave that argument for another consultation). So if you line up a patient with DSM, and the instrument says you don't meet the criteria, then you don't have the disease.
Operationism means a disorder doesn’t cause problematic behaviour; the disorder is the behaviour.
Dr Lovett and Dr Hood explain that for operationists, psychological disorders are fully specified by the set of sufficient conditions specified in a manual such as the DSM.
Oddly enough for a publication produced by the American Psychiatric Association, this position isn't the medical model. The medical model asserts there can be latent disorders - that is, diseases for which the patient is asymptomatic. As medicine has advanced, the notion of catching a pathological process before it has deteriorated into causing morbidity has become ever more important. Hypertension is treated before it becomes a heart attack.
Dr Lovett and Dr Hood explain that socioeconomic status (SES) is a good example of operationism in action - level of income, educational attainment, and occupational prestige are not caused by your SES. Instead social scientists derive SES from these variables. The concept of SES refers to a composite of these measurements.
The medical model would argue that some as yet undiscovered underlying pathology causes schizophrenia and schizophrenic symptoms; the operationists would contend that a particular pattern of auditory hallucinations, delusions and thought disorder are schizophrenia. It would make no sense to diagnose asymptomatic schizophrenia. But you can have an asymptomatic brain tumour.
It is no coincidence then that one of the new diagnostic categories proposed by the DSM that has attracted the most controversy is Attenuated Psychosis Syndrome, in which people present with symptoms that are admittedly a little strange, but fall well short of what psychiatrists previously have labelled as schizophrenia.
Some argue this is fine, because such people are at considerably increased risk of going on to develop schizophrenia, and also that treating them early (with drugs) prevents this, but others see this not as a prodrome, but an attempt to medicalise mental phenomena that are not symptoms let alone disorders, such simply hearing voices, which turns out to be rather commoner in normal people than hitherto believed.
Likewise, as the New York Times reported recently (24 January 2013), that removing the so-called “bereavement” exclusion from the diagnosis of depression might mean that many elderly people grieving for their spouses will receive antidepressant medication rather than the support of their friends and family.
In response to what has become a storm of criticism, the chief architect of the DSM, Professor David Kupfer of the University of Pittsburgh, welcomed the debate but countered that the committee was mindful of the reverse possibility, that serious depression could masquerade as grief, and also that clinicians needed to be aware of how easily normal grieving could give way to clinical depression. He told the New York Times that the distinction will require “good clinical judgment”.
That’s the fascination and also the problem with psychiatry. It does require good clinical judgment. It is perhaps easier for those who work entirely within the strict medical model, or ontological realism, as the philosopher Lovett calls it. Your brain tumour will be illuminated by the brain scan, whether you have symptoms or not, whether you disagree with the training of your doctors, or whether you are even conscious or not.
On the other hand the training of your psychiatrist, his or her beliefs about normality and disease and your willingness to co operate with the interview, will all influence whether or not you currently receive a diagnosis. DSM or no DSM, it often does come down to clinical judgment, as Kupfer says. No wonder it is sometimes so difficult but also so interesting…
So at the heart of the debate about DSM-V are some fundamental challenges. Can we really reliably diagnose disorders such as depression or schizophrenia until we make a fundamental breakthrough in brain scan technology? Is depression something more and deeper than a cluster of symptoms such as tearfulness and suicidal thoughts? Are we living in a society now where children are no longer allowed to be shy, but instead have something called social phobia that needs treatment? Or is it possible to have psychiatric disease while not exhibiting any symptoms, just as it is possible to have hypertension yet look and feel totally healthy?
And finally, is there any point in making any psychiatric diagnoses in the absence of a definitive test, or possibly proper treatments? If you are interested in any or all of the above, then you might enjoy a 2-day conference at the Institute of Psychiatry, London, in June 2013.
- Lovett B J and Hood S B. Realism and operationism in psychiatric diagnosis. Philosophical Psychology 2011:24;207-222
- Span P. Grief over depression diagnosis. New York Times, 24 January 2013
- Wessely S. Anders Breivik, the public and psychiatry. Lancet 2012:379;1563-1564
April 14, 2010
E din presa romaneasca...dar pentru continuitate...postez aici
" Dacă soarta nu te face să râzi, înseamnă că nu eşti în stare să te prinzi de poantă."
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