A place for things I read, write, and do
There is a maxim in anaesthesia: no trace wrong place. The trace refers to capnography, which measures carbon dioxide in exhaled gas, and its output – a rhythmic waveform rising and falling with each breath – is our gold standard for verifying that an endotracheal tube sits where it should, in the trachea rather than the oesophagus.
Ultrasound-guided vascular access is now a core procedural skill for anaesthetists and intensivists. Teaching it well requires practice on something that behaves like tissue — something that resists the needle, returns recognisable echoes, and lets learners make mistakes without consequences. Commercial phantoms do this. They also cost several hundred pounds each, degrade with use, and generate a…
Medication errors are one of the more uncomfortable facts of clinical practice. They happen in approximately 10% of ICU patient days, and roughly half of those errors occur at the point of administration — not in prescribing, not in dispensing, but in the final step, when the drug actually reaches the patient.
Artificial intelligence already has changed anaesthesia. Before we called it AI, we called it machine learning, and before that it was simply statistics. These lie on a continuum of methods that allow us to offload thinking. We use their products daily in the form of risk calculators, pharmacokinetic models, and waveform analysis.
Single best answer questions are the backbone of written medical examinations. They are reliable to mark, hard to game, and well-suited to testing clinical reasoning across a broad curriculum. They are also expensive and slow to produce. Writing a good SBA requires a subject matter expert, familiarity with the examination format, careful calibration of the distractors, and usually several rounds…
It’s that time of year. The one when you’re desperately trying to think of present ideas for your nearest and dearest – maybe they’ve given you a few ideas, maybe they have hobby which requires a steady supply of supporting materials, or maybe you’re just doing booze this year. Just possibly you’ve bought yourself a 3D printer, and are desperately shoehorning printed presents into people’s…
Almost 79 years ago, in the deserts of New Mexico, atoms were torn apart, releasing colossal amounts of energy, and very importantly not igniting the atmosphere causing nuclear armageddon. Can you tell I’ve watched Oppenheimer recently? Politics, ethics, and morality aside, the 16th of July 1945 is a watershed moment in time. However, we may be standing at another brink in human history, and one…
The General Medical Council wants doctors to be kind, and when the GMC wants doctors to be something, they add it to their set of standards, Good Clinical Practice. On the face of it, this doesn’t sound like it would be too controversial – who wouldn’t want their doctor to be kind? However, this has engendered a slew of discussion, critique, and in some cases, fear.
Like many an aspiring doctor, in my youth I undertook the pilgrimage to the Hunterian Museum at the Royal College of Surgeons, Lincoln’s Inn Fields. As London’s finest emporium of grisly things in jars, there was always plenty to entertain, and plenty to inflict on the squeamish. After a long-awaited revamp, delayed slightly by COVID, this Mecca of the medically inclined has reopened at last.
Medical professionals should not be allowed to congregate in public; that’s my stance, and I am sticking to it. When they do, conversation invariably tends gruesome topics such as rotas, frustrating colleagues, and human cannibalism — apologies to the other patrons of La Terra in Bath last Saturday.
To those of us who’ve begun to dip our toes in the history of anaesthesia, the sordid days of ether frolicks, feuds, and misadventures in dental extractions are rather familiar. Involvement in the early phase of inhalation anaesthesia seems to have carried with it an astonishing self-inflicted mortality rate. However, what I’ve enjoyed most about Anaesthesia and the Practice of Medicine:…
Now strictly speaking this is a mark in a book, and not exactly a bookmark, but I have decided to expand the remit. This dedication is found in a copy of The History of the Study of Medicine in the British Isles (1908), by Sir Norman Moore, a famous physician and medical historian, but not a fan of short book titles.
Breaking bad news is a skill; it’s not something that one is born great at, but takes learning and deliberate practice to improve. Unfortunately, bad news is common in healthcare, while we might wish that everyone gets better, it is the nature of the human condition that eventually we don’t.
I’m currently revising for one of the seemingly endless postgraduate medical exams we have to stump up the money for. This largely involves smashing ones way through online question banks, that you guessed it, are paid for separately. Over time, this becomes a question of identifying give away phrases that point you towards various diseases. For example, if you spend too much time around…
This postcard came to me by way of The Story Of A Surgeon , the autobiography of Sir John Bland-Sutton. It’s a rather rambling book, that surprises with the somewhat fast and loose nature of medical education in the period. Now I admit, this bookmark did prove somewhat challenging, as the tight cursive German quickly defeated the limited amount I can recall from my GCSE classes. However, thanks to…
The First World War is notorious for demonstrating the devastating effects that follow when industrialised nations commit to total war with each other. It is among the bloodiest wars thus far in human history, only eclipsed two decades on by World War II, and has shaped international relations in the century since. The world was introduced to chemical weapons, military aircraft, and mechanised…
Nestled between the pages of Selected Lectures And Essays I found this letter from J. G. Harbottle, a stock broker and mayor of Darlington. Regrettably this is the only half that made it into my book, so what he had the pleasure to enclose is left to the vagaries of time. Regardless, our Dr Hern does not appear to have made it far through his book, as this letter, dated the same year it was…
During the interregnum in COVID-19 waves in the latter portion of 2020, there was much debate about just when we would need to see the return to mandatory lockdown. From calls for circuit breakers, to desperately trying to hammer home the nature of the phrase “exponential growth”, the general consensus agreed that by the time we started to see a significant shift in the numbers, a large part of…
I’m a core anaesthetic trainee in the Peninsula Deanery. I studied medicine at UCL, where I also did an intercalated degree in Medical Physics and Bioengineering — which goes some way to explaining what came after. After an academic foundation programme in Wales, I spent two years in ACCS acute medicine in the Severn Deanery before moving into anaesthetics in 2023. Along the way I picked up an…
Everything here is presented only as my own thoughts and opinions. Where I’ve attempted to make factual claims, I have endeavoured to reference them appropriately. Where I’ve made reference to specific cases, I have redacted or modified details to maintain confidentiality. To anyone I’ve met in real life and lost touch with: I apologise, and would genuinely love to reconnect. I have essentially no…