Rude health: Weekend of death?
Don’t be afraid to stick your hospital tongue out on Saturdays or Sundays, as Maurice Gueret examines the evidence.
Some scary statistics have emerged from UK hospitals about the risk of snuffing it at weekends. It couldn’t happen here, of course, but it has been claimed that admission on a Saturday increases undertaker call-outs by 10pc. The hearse quota rises to an unmerciful 15pc for Sunday admissions. This study provides fodder for politicians who want hospitals fully staffed seven days a week, but won’t raise taxes for the privilege. But truths can get trodden upon by statistics. Admissions at weekends are much fewer. Patients who go in on Saturdays and Sundays are more likely to be in emergency situations. The study didn’t examine deaths at weekends, it examined deaths within 30 days of being admitted at weekends. A patient who died under the knife on a Tuesday was regarded as a weekend death if he was first admitted on a Saturday morning. There is a moral here. Be wary of all you read about hospitals.
I am delighted to see that the Pharmaceutical Society, which governs chemists here, has taken a stand on the food-intolerance-testing malarkey. They have reminded pharmacists of their code of conduct and responsibilities in this area. Pharmacies have been warned that the diagnosis of any condition relating to the ability to digest or “tolerate” foods, and the level of clinical significance of this, including any planned actions, such as dietary restriction, should be made only after careful consultation with a doctor, and should not be based on the use of testing services that have not been recommended by a doctor. This isn’t a turf war. It’s about standing up for good science and protecting patients from poor diagnosis.
You don’t need a medical degree to know that too much alcohol is bad for you. But I remain to be convinced that scaring minor tipplers about cancer is a good way to create a new temperance society. The latest wheeze is this American research which tells women who have one glass of wine a day that they are at higher risk of breast cancer. Medical statistics can show you absolutely anything you want to see. The French like to tell us that a glass of wine preserves your memory, narrows your waist, boosts your immune system, builds better bones and reduces your risk of ovarian cancer. I believe neither Americans nor French. You are born with your own judgment. Use it wisely. The wag is often more important to professional finger-waggers than the message.
Doctors have medication foibles like anybody else. When it comes to antibiotics or anti-inflammatories, I’m quite happy to take the generic version of these drugs. But on engineered items like asthma inhalers, there is something ethereal about the quality of the original devices that I find more reassuring and prefer. Generic substitution is state-backed, and practised in all chemists today. This means that a cheaper brand can be given to the patient even when a more expensive one is prescribed. But there are exceptions, and epilepsy is one such condition. Seizure-preventing drugs are not on the list of interchangeable medicines, and in ordinary circumstances, should never be substituted.
Isil medical school
The British Medical Journal has been investigating the activities of doctors in Islamic State (Isil). They report a steady flow of Western-educated doctors into the militant-run regions, including nine British medical students who went together earlier this year. Now it would appear that a new Isil medical school is about to open in the town of Al-Raqqah in northern Syria. Doctors have been used in recruitment videos for the college, and there have been applications from a range of nationalities. Unverified reports suggest that female doctors can only treat female patients, and have to work in gloves and complete dress-cover at all times. Places in Irish medical schools are hard to come by, and many of our students already travel to cities in eastern Europe to fulfil this dream. But it may take more than a conversion for them to travel this road north of Damascus.
'Stick out your tongue'
We continue our weekly clinical examination with a glance at a powerful muscle that many exercise too frequently. We have reached the tongue. “Stick your tongue out” may appear to be an innocuous command, but a patient with tongue-tie or a malignancy might not find it so easy. Stroke patients may stick the tongue out towards the paralysed side. A very large tongue can be found is some hormonal conditions like acromegaly (giant extremities) or severe hypothyroidism. And a tongue tremor is worth looking out for. It may just be a touch of nerves, but an astute physician might think of an overactive thyroid gland, Parkinson’s disease, or the delirium tremens of somebody thirsty for a drink. The tongue can be pale in anaemia, ruby-red from wine, or dry from dehydration or advanced kidney failure. Scarlet fever may cause a bright-red strawberry tongue. White, furry tongues are more common in smokers, mouth breathers, and those on a milky diet. A black, hairy tongue may indicate fungal infection, perhaps after a strong dose of antibiotics. Pernicious anaemia can cause a bald tongue that has lost all its bumps. Glossitis is the medical term for inflammation of the tongue. A scrotal tongue is furrowed with wrinkles; thankfully of no medical significance. Ulcers, cysts, lumps or growths around the tongue should not be ignored and need to be firmly stuck out at your doctor or dentist. It’s noses next week.
Dr Maurice Gueret is editor of the ‘Irish Medical Directory’
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