Doctors are generally good at ordering investigations but less good at writing a plan.

This generally applies to outpatient clinics, but here is what I think a good PLAN should cover 👇 Too often do I see a plan which solely covers diagnostics. Remember that waiting for diagnostics (sometimes this can be weeks, months or even years) does not generally help a patient.

“Tell me an example of when you felt humbled at work”

I did a colonoscopy on a 65 year old man with a history of ulcerative colitis for over 10 years who was admitted with a flare. He had confirmed Campylobacter in his stool cultures 4 weeks prior… He had been on escalated dose vedolizumab (failed infliximab previously) and presented with ongoing diarrhoea, lower GI bleeding, CRP 200+, low albumin. Repeat stool cultures were negative. Minimal improvement IV steroids and antibiotics.

Sorry, I turned off social media for a month.

This is why I did it and these are my findings…. Life and parenting took its course, and before I knew it, I reached 40 and my BMI hit a record high.

I replaced my morning social media routine with a 5k run. My obesity has been treated and it feels great to reach peak fitness at 40 % 🏃🏻

A lesson in life.

Call from a colleague today…

“Keith, I’ve got a 80 year old man with jaundice and fever from a large 2cm gallstone wedged in the bile duct. He’s on anticoagulation for PE. I just have a bad feeling about him and I think he needs an ERCP today.” “Is he unwell”

Him: He’s sitting out with a NEWS score of 1 (essentially normal observations).

“If he’s not scoring, we can probably wait and do his ERCP when the anticoag has washed out. His bleeding risk is too high to take out the stone.”

He gives a reluctant OK.

Here’s a thread summarising the coeliac disease guidelines in @UEGJournal @my_ueg

journals.sagepub.com/doi/pdf/10.117…

1) What is it?

CD is a chronic, multiorgan autoimmune disease that affects the small bowel in genetically predisposed persons exposed to gluten. 2) Who should be testEd?

Coeliac disease is known as the great imitator. It can cause IBS, anaemia, diarrhoea, weight loss, infertility, osteoporosis, severe fatigue, etc etc.

I recommend reading this endocrinologist’s perspective here:
bmj.com/rapid-response…

Pathology in food - a thread inspired by this wonderful paper and the recent discussions on food and pathology on Twitter.

Credit to the GRAPE working group for the paper and all images and captions:
peerj.com/preprints/2147…

Bon appetit! Grape bunches. Staphylococcus aureus are spherical bacteria known as cocci that grow in clusters that look like grape bunches.

To celebrate the return of Hemospray, here is a summary of 3 recent Hemospray papers from the same group. Hemospray for bleeding peptic ulcer disease (PUD) in @endoscopyjrnl

📅 Jan 16-March 19
🏥 14
🤕 202

✅ Immediate haemostasis: 88%
🩸 30d Rebleeding: 17%
⚰️ 30d Mortality: 22% (32% if monotherapy)

💡 "High immediate haemostasis rates for bleeding PUD"
thieme-connect.de/products/ejour…