Busting the clotbusters (from SMACC 2013)

As revenge for an incident best left unmentioned, Chris Nickson of LITFL.com and iTeachEM.com handed me the poisoned chalice of speaking on tPA for stroke at SMACC 2013. This is the result. (Un)fortunately there is no actual video footage as I wasn’t important enough, so my Finnish heavy metal air cello will be left to your imagination. The first embed is the audio plus slides, and there is an audio only version below that (which doesn’t work so well – the visuals are kind of key at times)
The slides/audio combo:

Busting the clotbusters from Domhnall Brannigan on Vimeo.

The audio only:


Dundrum Quay (posted in tribute to Seamus Heaney)

Barnacle encrusted stumps remain.
Thrusting, vertebral fossils
From tidal glar pools and rising silt.

The bar is no longer dredged:
Time gently smudges over noisy, dark,
Dangerous memories:
Hard men stooping -
Their iron shovels grate on coal,
Organic metronomes in coal boat bellies.

I remember dimly the last coal boat
That hove to at the quay, then slipped away,
Leaving coal dust to settle, like age.

I’d leap and dive from great stone steps
Measuring days in the high tide times.
I fished here for pollock with dead-man’s-fingers
Torn cruelly from tortured crabs.

But now, luxury seafront apartments crowd
Like schoolyard bullies on the harbour walls
And the silt rises as the stories die.


Health care – do we (and HOW do we) really CARE?

this post first appeared on my original blog, the underneaths of things, and I was prompted to repost it by Andy Neill of emergencymedicineireland.com linking back to it:

This is a re-post of a rant I let slip on a colleague’s FB page – he had just published an article in the local rag (The Mercury) with some great points about future directions in health care provision. His article is republished in the Tasmanian Times HERE. I agree with much of what he writes, and was moved to stick my oar in just a little (nowt new there, I hear you cry). My tuppence was this:

“Let’s put the onus in health care on CARE as the goal rather than on DIAGNOSIS as an intellectual pursuit of intrinsic value for the patient (i.e. we need to rank caring for our patients above a “House-like” detective approach to diagnosis – “see, you have a diagnosis now – you are still going to die, but I, your doctor, feel much happier and you should too!” – somehow we have even convinced the patients that having a label is intrinsically better for them).
Then, if we prioritise CARE over DIAGNOSIS, we might be able to limit overuse of expensive tests that don’t change the outcome for the patient, and put more money and energy into public health, and education about acceptance of illness and death as a normal part of life!”

Of course, if the public (that faceless entity) is happy to keep paying taxes to fund an increasingly inefficient, wasteful and expensive health care system, then that’s fine, but we can’t have it both ways! You don’t hear a lot of people say that they are happy for their taxes to be poured into the drain…

The flipside to this is that it is us as a profession that has created and nurtured unrealistic expectations in our patients (not the lawyers and the media – they just feed on what we give ‘em) and so it really must be our responsibility to remould these expectations. We need to tell our patients the truth. Sometimes, we (as in “we in modern medicine”) just don’t know what is wrong with you. Sometimes, we know what it is, but we don’t know how to fix it. It should be OK to say that. In fact, it should engender trust in the relationship. Frustration, sure, but in the doctor-patient relationship, trust is much more important than keeping a veneer of omniscience. As a good friend, who is very much a thinking physician, once said to a student – “you can’t just make shit up!”

If you don’t know…or more accurately if WE don’t know – SAY SO – it is liberating, I assure you!