- ST elevation in the inferior leads II, III and aVF
- reciprocal ST depression in the anterior leads
Many doctors approach psychiatry with a sense of trepidation and, occasionally, fear. The aim of this article is to give some concrete advice to help trainees to relax and enjoy this fascinating rotation. A spell in psychiatry has the potential to be one of the most useful rotations on the general practice training scheme. Much of psychiatry is now managed in the community and so will form a significant part of your work following qualification. As increasing pressure comes to bear on mental health trusts to cut costs and close inpatient beds this is only likely to increase. When people suffer mental health issues it is very often the GP who is their first port of call, and so a good working knowledge of the area, as well as insight into the mechanisms and frameworks of secondary care, is an asset. During the job, you will also have the opportunities and time to develop your communication skills, occasionally in crisis situations. Continue reading
Below are my 12 tips on how best to ensure accurate and safe diagnosis:
(1) The less severe the presentation, the more difficult it is to diagnose. There is no bright line demarcating the very heavily populated boundary between mental disorder and normality. Milder problems often resolve spontaneously with time and without need for diagnosis or treatment.
(2) When in doubt, it is safer and more accurate to underdiagnose. It’s easier to step up to a more severe diagnosis than to step down from it.
(3) Children and teenagers are especially hard to diagnose. They have a short track record, varying rates of maturation, may be using drugs, and are reactive to family and environmental stresses. The initial diagnosis is likely to be unstable and inappropriate.
(4) Mental illness is hard to diagnose in the elderly. Their psychiatric symptoms may be caused by medical and neurological illness and they are prone to drug side effects, interactions, and overdose.
(5) Take the time and make the effort. It takes time to make the right diagnosis—adequate time for each interview and often multiple interviews over time to see how things are evolving. Except for classic presentations, a quick diagnosis is usually the wrong diagnosis.
(6) Get all the information you can. No one source is ever complete. Triangulation of data from multiple information sources leads to a more reliable diagnosis.
(7) Consider previous diagnoses—but don’t blindly believe them. Based on their tenure, incorrect diagnoses tend to have a long half-life and unfortunate staying power. Always do your own careful evaluation of the patient’s entire longitudinal course.
(8) Constantly revisit the diagnosis. This is especially true when someone is not benefiting from a treatment that is based on it. Clinicians can get tunnel vision once they’ve fixed on a diagnosis, become too married to it, and are blinded to contradictory data.
(9) Hippocrates said that knowing the patient is just as important as knowing the disease. Don’t get so caught up in the details of the symptoms that you miss the context in which they occur.
(10) If you hear hoof-beats on Broadway, think horses, not zebras! When in doubt, go with the odds. Exotic diagnoses may be fun to think about—but you almost never see them. Stick with the bread and butter.
(11) Accurate diagnosis can bring great benefits; inaccurate diagnosis can bring disaster.
(12) Remember the other enduring dictum from Hippocrates: First, Do No Harm.
– See more at: http://www.psychiatrictimes.com/blogs/dsm-5/my-12-best-tips-psychiatric-diagnosis#sthash.euXPGPmL.dpuf
the clavicle or collarbone is a long bone that serves as a strut between the scapula and the sternum. It is the only long bone in the body that lies horizontally. It makes up part of the shoulder and the pectoral girdle, and is palpable in all people; in people who have less fat in this region, the location of the bone is clearly visible, as it creates a bulge in the skin. It receives its name from the Latin: clavicula (“little key”) because the bone rotates along its axis like a key when the shoulder is abducted.
In anatomy, the scapula or shoulder blade, is the bone that connects the humerus(upper arm bone) with the clavicle (collar bone). Like their connected bones the scapulae are paired, with the scapula on the left side of the body being roughly a mirror image of the right scapula. In early Roman times, people thought the bone resembled a trowel, a small shovel. The shoulder blade is also called omo in Latin medical terminology.
The scapula forms the posterior (back) located part of the shoulder girdle. In humans, it is a flat bone, roughly triangular in shape, placed on a posterolateral aspect of the thoracic cage.