NEWS DIGEST VIEWPOINT


By Dr Ivor Felstein, Retired Consultant Geriatrician


Whatever happened to phlegmasia alba dolens?


ONE of my favourite Scottish medical consultant mentors had both a memorably cheerful voice and a penchant for traditional medical names. He could not just introduce us to a patient suffering from muscle tremor, rigidity and loss of facial expression and call it Parkinson’s disease. Inevitably he would also have to refer to the older or more traditional term – paralysis agitans. This was not a matter of showing us which era he hailed from or impressing us with his acute memory. Neither was it intended that we should necessarily follow his style ourselves when we passed from tyro doctors to the real thing. Rather it was to indicate that labels can alter with time or be modified to create clarity – or sometimes just to take the sting out of a potentially upsetting term for patient or relatives. Paralysis agitans certainly does not sound particularly nice and early in the 17th and 18th centuries it was more commonly referred to as “the shaking palsy”. Only when English family practitioner, James Parkinson, described the condition very specifically did other physicians use that name eponymously


registering to practise in the UK. This recommendation comes in a new


report on the state of medical education and practice published by the GMC. Each year around 12,000 doctors from the UK, Europe and countries around the world start working in the UK for the first time. The GMC report concludes that more needs to be done to ensure consistency of


l PATIENT GUIDE TO PRIMARY CARE A step-by-step guide to help patients get the most from their GP practice has been launched by the Royal College of General Practitioners. It’s Your Practice: A patient guide to GP servicesis a free resource that


AUTUMN 2011


and Parkinsonism became the accepted name up to the present day. Certainly eponyms or common names


can often be less fear laden than some descriptive terms – just consider necrotising fasciitis. Another prime example from my junior doctor days was the term pulmonary tuberculosis. Simply shortening this to TB fooled no one. Instead we would use a much older (if more difficult to pronounce) term, phthisis. The alternative was to call it ‘consumption’ but this was a misnomer in terms of the symptomatic wasting, poor appetite and clearly sick sufferers. Another example of a disturbing and


potentially dangerous illness was a post- childbirth form of thigh vein thrombosis. It was given the less devastating and more mellifluous cognomen, phlegmasia alba dolens. Likewise, some of the sharpness of epileptic fits (but not the potential dangers) was often blunted by their description as caducity or caduceus (possibly from the Latin word, cadere, to fall). Not all alternate names help ease patient worries. Long before AIDS became the dominant disastrous STD, I recall treating patients in various stages of syphilis, which our caring if not quite accurate VD consultant translated into the “French pox”. Do French physicians employ the term “English pox”? But returning to the subject of eponyms


– in my immediate post-graduate first year, I found myself working at an infectious diseases hospital. Here I had a referral with what must have been one of the last cases


induction for all doctors, and especially for those coming to work from outside the UK. This would ensure that they get an early understanding of the ethical and professional standards they will be expected to meet, and become familiar with how medicine is practised across England, Wales, Scotland and Northern Ireland.


contains information on topics including choosing and registering with a surgery, making appointments, accessing health records and getting involved in the running of a local surgery. Download the guide at www.tinyurl.com/3e3zf2s


of Hansen’s disease (first described by a Norwegian physician of that name) in that part of the UK. For younger doctors this is the eponymous name for leprosy, once a nation-wide chronic bacterial problem that carried a stigma many century’s old. The use of eponyms is not without some


drawbacks – especially when several different doctors emerge to apply their own name to the same illness. A good example of this is still seen with hyperthyroidism. The symptoms and signs of hyperthyroidism were brought to light by – among others - the Irish doctor, Robert Graves, in the 19th century. The illness was also described by the European gentleman doctor, Carl von Basedow, around the 1840s. So, eponymously perhaps, we should be describing this thyroid glandular complaint as Graves- Basedow or Basedow-Graves disease, not solely and separately as Graves or Basedow’s disease. I was once told that, to ensure your medical name is remembered by posterity, you should find a previously unknown complaint and then describe it to achieve an eponym. When I worked in the sexology field, I thought I had finally done so. I came across an unusual male sexual problem, related to a transport form of work and associated use of semi- porn magazines. I had just completed two thirds of my


to-be eponymous syndrome paper when my global research turned up an identical paper on this, already published as Kamin’s syndrome! Alas, no Felstein syndrome is yet extant.


The Chief Executive of the General Medical Council, Niall Dickson, said: "Developing an induction programme for all doctors new to our register will give them the support they need to practise safely and to conform to UK standards. This will provide greater assurance to patients that the doctor treating them is ready to start work on day one."


l HANDOVER TOOLKIT LAUNCHED A toolkit designed to reduce errors during patient handovers has been launched by the Royal College of Physicians. The document defines the principles behind good handover practice, what the handover framework


should contain and how to avoid mistakes. The toolkit is the first of a series aimed at offering guidance on best quality care. It can be downloaded at www.tinyurl.com/63tlaq2


7


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24