If you are a fan of medical dramas like St. Elsewhere or ER, or even Britain’s Casualty or Holby City, you might have heard a normal heart rhythm referred to as ‘sinus rhythm’, or ‘normal sinus rhythm’. What, I hear you yell in frustration, has my heart got to do with sinuses? They’re in my head, aren’t they?
The term ‘sinus’ is used to describe many areas of the body – the thing they have in common is that they are usually holes or hollowed-out bits. Like the sinuses on your head and face, and like a small area on your heart in which the ‘natural pacemaker’ resides. This area of specialised neuro-muscular tissue kicks off at around 70-80 times per minute under normal circumstances, and keeps you heart beating regularly. It can be upset by all sorts of things. One of the commonest reasons for an oddly-beating heart among the general population who attend emergency departments is use of artificial stimulants.

It only works with intra-muscular (IM) injections. I’ve never practised it myself, or indeed seen it done, but I am quite certain it exists.

Most IM injections are drawn up into the syringe out of the phial they come in, using the same needle that you inject into the patient. The needles are actually little miracles of engineering, with an angled, sharpened point at the end. If that point is tapped firmly on the bottom of the glass phial while the drug is being drawn up, the point bends round very slightly at the tip. You now have a barbed implement. It goes in alright, but on withdrawal it catches on muscle fibres and tears them, causing unnecessary pain and a very nasty bruise afterwards.

As I say, I’ve never done this or seen it done. But the very fact such a phenomenon is even talked about is one very good reason to be nice to your nurse and your doctor. If you need one.

So here’s the first of what will probably turn out to be occasional brief rants about such people.

The woman who booked in because her false fingernail had come off and she wanted us to stick it back in place.

The woman who actually called ‘999′ (the emergency services number) for an ambulance because she had chewing gum stuck in her hair. In fact the trick to get chewing gum off clothes is to put the clothing in a freezer for a couple of hours so the gum goes hard and can be cracked off. So I advised the patient to go home and stick her head in the freezer for a couple of hours.

Of course I didn’t actually. The General Medical Council frown on that sort of thing. But it’s what I wanted to tell her.

The weird thing is that a lot of medical soaps cover exactly this sort of thing these days – inappropriate use of resources, ambulances tied up with trivia while the elderly man quietly dies form his heart attack – that sort of thing. But the eejits who pitch up with their gummed hair and broken nails either don’t watch popular TV shows as they are too busy attending museums and art galleries (unlikely), or they are just so stupid that they can’t see the comparison.

Westfield is one of those strange health schemes that pays out money when you are ill. Not enough money to go for private treatment or anything; just a bit of money. One of the ‘triggers’ for payment is admission to hospital – you get a certain amount of cash money for every night you stay on a ward.

Now if you have a chronic illness like emphysema or cardiac disease, you soon learn those magic symptoms that will ensure your admission to hospital. If you have lung disease, just say your exercise tolerance has decreased suddenly. If you have heart disease, say you have got chest pain that won’t go away.

The Westfield Grannies were an informal group of elderly ladies, probably unknown to each other, who would get a few nights in hospital, and then claim their cash. Like Bingo with an overnight stay and antibiotics.

As soon as the Westfield cheque came through, they’d be off to Blackpool or Filey or somewhere for a couple of weeks. All courtesy of their health insurance. And the NHS of course.

These days they probably go to Benidorm to visit their son’s crystal meth lab instead of visiting Filey. But the economics of it are basically the same.

A lucky web designer has just been paid a small fortune to produce an interactive video web tutorial to teach doctors how not to be complete idiots. You can see it here. It’s very pretty and very well done, but as to the content…

In fact that’s the problem with a lot of the GMC’s guidelines. I guess they have to be actually written down somewhere, but if a doctor really needs to be told that it’s best to be polite where possible, honest, not to kill patients or to have sex with them (with or without their informed consent), then that person is probably already heading down the wrong career path.

What we also have – still – is three separate systems to log into in the department where I work. One – the one to order path lab tests – so old that it simply refuses to talk to any of the others. We have a fairly good program for tracking patients through our emergency department, but it’s made by a small company, not one of the ‘big players’ in the initial push for an overhaul of NHS computing.

Then there’s the centralisation of patient records, the so called ‘data spine’ that all our records will soon be on; unless you opt out of the scheme like I have and a lot of GPs have. I can tell you exactly how that scheme will be used primarily. By nosey staff who want a gander at someone else’s medical records. Either out of pure prurience, or for more sinister means such as during employment disputes. It’s just human nature I’m afraid. If you really hated your neighbour and had a bit of plastic that enabled you to see that they were treated for genital warts last Christmas, you’d use it. You know you would.

And unfortunately the ‘data spine’ will not add to patient care at all. Sure, it’s sometimes frustrating in the middle of the night not to have an up to date list of a patient’s meds, but that has never to my knowledge actually held up anyone’s treatment. I actually heard someone talking about this saying that instant access to someone’s blood group could be life-saving. Absolute rubbish. Blood is always ‘cross-matched’ immediately before being transfused. There are many antibodies in blood that are not defined by the simple ABO and Rhesus groups, and one of the easiest ways to kill someone is to give them improperly matched blood. So no – knowing someone’s ‘blood group’ beforehand – whether it’s from a computer or from one of those bracelets people who like to think they’re fighting in the Korean war sometimes wear – that piece of knowledge will never be useful and would sometimes be dreadfully harmful.

In similar vein, how are you going to be sure that the unconscious patient you have in front of you is in reality the same person whose data you are looking at on screen? I work in an area with a large British Asian population. Many of the older people do not know their date of birth – usually it is on records as ‘1/1/35′ or something similar. And many share indistinguishable names too. Am I really expected to decide that someone is not allergic to penicillin, for example, from such flimsy data, before injecting them with the drug which will undoubtedly kill them if the decision is incorrect?

So as you can gather, I’m not a big fan of the NHS Care Records System, and have personally chosen to opt out of having my details on line. A lot of other hospital-based doctors and GPs have too. Details of how to opt out can be found here.

There’s a lot of controversy brewing about the initial decision to go ahead and splurge £12bn in a bit of a hurry. Computer Weekly have it covered here, and wikileaks have a leaked briefing document here.

Twelve.

Thousand.

Million.

Pounds.

Someone I know in the healthcare IT business reckons he could have come up with something that would have worked well for about half a million. You know the most salient question? It’s this. How did they manage to spend that much money and NOT come up with something useful?

It’s all part of the ‘revenue stream’ – hidden ways in which the NHS is not actually free at the point of delivery. I even have to pay to park my car as a member of staff. This was brought home personally recently, when I had to visit an ill member of my family in hospital. Four pounds minimum charge to park you car in a car park that is notorious for having cars broken into.

Then once on the ward, I experienced another part of the ‘revenue stream’, the scandalous charges that are levied to enable patients to make phone calls and watch TV. My family member had to join a premium rate line and pay a charge to register with them even to receive in-coming calls only.

This is all ties up with the idea that mobile phones in hospitals are somehow dangerous, an assumption that has now been pretty much blown out of the water, as reported on The Register recently. It is theoretically possible to get a mobile phone to interfere with sensitive electronic medical equipment like automated syringe pumps and various cardiac devices, but you have to try pretty hard to get it to happen! But at the moment it seems to be in no-one’s interest (except the patient’s of course) to relax the ban on the use of mobiles by patients and relatives. The companies charging for phone services are making a mint out of the ban, and the hospitals themselves get a nice share of the profits too.

The bottom line is that you can’t (at least not in this cynical medic’s opinion) run the NHS as a ‘business’. If you really want to, I know exactly how to make it run at a profit. Stop all those ill people hanging around hospitals. They’re a real drain on resources.

You might have heard about the lottery winner who had to be within half an hour of a hospital at all times because of his medical condition – an aneurysm. An aneurysm is caused by a weakening in the internal wall of an artery, which allows the artery to bulge alarmingly under the pressure of blood inside. Eventually they can burst. If the aneurysm is on an artery inside your brain (as many as a third of us walk around with these potential widow-makers inside our heads I’m afraid) the result is a brain haemorrhage. If the aneurysm is situated on your abdominal aorta (the main artery that carries blood away from the heart and down towards the pelvis), then the result of rupture is usually immediately fatal. A thoracic aortic aneurysm is higher up, and more difficult to operate on. This story had me a bit confused.

In the not too distant past, triple As or Abdominal Aortic Aneurysms were part and parcel of work in most A&E departments, but the condition is usually very treatable – the tricky bit is spotting it in the first place. But this too can be done quite easily using ultrasound. Thanks to a screening program, ruptured AAAs are now quite rare. They are diagnosed early, and repaired – usually by stitching an artificial aortic graft in place of the arterial wall defect.

If our lottery winner has already been diagnosed with an aneurysm, what’s he doing hanging around buying lottery tickets, giving interviews to the press and waiting for it to burst? Why hadn’t he already had surgery?

Well, now he has – as an emergency procedure by the sounds of things. It may have been that his aneurysm was judged too dangerous to repair ‘electively’ (that is planned in advance on a patient with no symptoms) and he was forced to wait until it started to leak before the operation could be done. But it’s still a slightly odd story. Albeit one that lends itself to good headlines – lottery winners with time-bombs ticking inside them make good journalistic copy.

If you are concerned about having an aneurysm, you can be screened in the UK under the national health service screening scheme, although at present you have to be at least 60 years old. Although confusingly according to the official NHS screening website, screening for AAA is not yet available. But it should be soon…

Because your eyes move with incredible speed ( there’s a wikipedia explanation of the arcs and angle and things involved here) when ‘jumping’ from one point to another, you can experience some cool side effects. Some can be experienced when you’re out driving on a motorway. Best done if you are a passenger if you want to avoid crashing. Look at a car in the lane next to you. Now glance forward. Due to ‘persistence of vision’ you will experience, for a split second, a frozen image – in particular you’ll see the car’s wheels appear to have stopped turning. It takes a bit of practice, which is why it’s definitely best not to be driving at the time.

You can notice a similar effect with certain types of lights – do a saccadic jump and you’ll get a ’strobed’ effect trail if the light in question is an LED brakelight, or a 50Hz streetlight. With some of the new xenon headlamps, you can also get a streaked-out spectrum as these lamps emit over a range of light frequencies.

Anyway, that’s saccadic eye movements.