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Giles Elrlngton

  • How to spot zebras - motor neurone disease

    Giles Elrlngton's comment 11 Sep 2019 10:13am

    "The third most common adult-onset neurodegenerative condition in the UK"? I think you have overlooked progressive MS.

  • Incidentaloma on the rise: how GPs are left to manage unexpected findings

    Giles Elrlngton's comment 05 Jul 2019 10:25am

    This is a big problem. I propose that firstly that it is mandatory to warn patients of the risk of chance findings on imaging at the time the test is ordered; and secondly that responsibility for addressing incidental findings rests with the doctor who ordered the imaging.

    I can see why primary care colleagues are unwilling to pick up the pieces after useless health screening scans; but it is also a problem for neurology secondary care as increasing brain and spine MRI is ordered in primary care and incidentaloma then triggers referral. It would be helpful if NICE summarised the risk of incidentalomas and recommended appropriate management.

  • Welcome to Planet Advanced Nurse Practitioner

    Giles Elrlngton's comment 26 Jun 2019 6:09pm

    Dr Copperfield, I have worked in Essex for only 26 years and I still haven't worked out who you are but when I do I would like to shake your hand.

  • How long? Seemingly the hardest question to answer

    Giles Elrlngton's comment 16 Feb 2019 10:15am

    How long? "since I was younger"; "when the doctor referred me"

    Has it changed over time? "I have good days and bad days"

    How often does it happen? "there's no pattern to it"; is it hourly, daily, weekly, or monthly? "yes"; "it's all the time, you know, it comes and goes"; "My symptoms last 2-3 days and happen many times a week"; "it's at least twice a month"; and at most? "I just told you, at least twice a month"

    Any treatment? "no... just tablets" which ones? "little white ones with a line across" or "tried everything but nothing works"; how long did you take the treatment "I completed the course"

    Is there illness in the family?"no"; are your parents alive and well "no, they're dead"; I'm sorry, what happened? "Oh, nothing serious"

    It's like a playing "Just a Minute" only here the rules are to speak for as long as possible without communicating any information. Though as a general rule, the vaguer the history the less likely a serious cause.

  • Government medicine regulator launches major opioids review to cut prescribing

    Giles Elrlngton's comment 14 Feb 2019 4:23pm

    If the pain clinics initiated the opiates/opioids (and gabapentinoids) it is their responsibility to help patients come off those drugs.

  • In full: RCGP guide to cannabis-based medicines

    Giles Elrlngton's comment 19 Dec 2018 6:16pm

    This is really helpful. I am a neurologist. Every day at least one patient asks about therapeutic cannabis or cannabinoid(s). My answer is inevitably: no. The hard part is explaining why, and getting that out of the way, to leave time for more constructive discussion.

  • CQC seeking legal advice over online GP providers evading inspection

    Giles Elrlngton's comment 19 Sep 2018 2:28pm

    CQC see QC?

  • Cannabis debate leaves GPs facing a prescribing conundrum

    Giles Elrlngton's comment 25 Aug 2018 10:15am

    Anonymouse3, Omnopom [sic] sounds like too many brits in Oz.

    Seriously though, there is a world of difference between "prescribable" (some cannabinoids are currently prescribable as they have been for years) and "NHS funded" which they are not. So no NHS prescribing. I imagine the cases in the press have been IFRs (for which we all know the CCG default response). Many of my MS patients would like to try cannabinoids but the data, notwithstanding some optimistic anecdotes, is not exactly convincing, hence no NICE approval.

  • This pay ‘rise’ might just push me beyond boiling point

    Giles Elrlngton's comment 25 Jul 2018 7:15pm

    Matt the app?

  • GPs should interview relatives when assessing dementia, says NICE

    Giles Elrlngton's comment 22 Jun 2018 12:39pm

    DecorumEst you would not believe the number of people who come unaccompanied to secondary care clinics for ?dementia. I like to think that they forgot that their excellent GP emphasised the importance of attending with a witness.

  • 'Bulk of doctors' back revalidation processes, says GMC chief

    Giles Elrlngton's comment 06 Apr 2018 10:36am

    Mr Massey should provide the data upon which he relies.

  • Instant wisdom - neurology

    Giles Elrlngton's comment 16 Feb 2018 10:44am

    I'm a neurologist and I think this is all excellent advice however I think it can be helpful to perform a brief neurological examination if only to avoid criticism. I agree it rarely takes diagnosis beyond what's evident from the history.

  • Bawa-Garba: how can we curb this culture of blame?

    Giles Elrlngton's comment 10 Feb 2018 11:45am

    Tom Robinson is right. Compare with flight safety: if the GMC were in charge of that, when the computers are down, there are insufficient pilots and the sole pilot has worked 12 hours without a break the GMC answer is: carry on and log the problem. And if it goes wrong and there is a death, you can rely on the GMC to blame the pilot/doctor. The GMC's statutory purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. They are evidently currently unfit for this purpose - as are the hospital managers who are happy to save on costs when they can rely on the GMC to blame doctors. Refusal to pay the GMC fee is not however the answer.

  • NICE to back use of e-cigarettes in new smoking cessation guidance

    Giles Elrlngton's comment 14 Oct 2017 7:36am

    I have not smoked since 31 Dec 2014. The hard part previously has been avoiding relapse at times of stress. In this context I have found e-cigarette (vape device) invaluable. The best devices are not easy to set up so I advise purchase from shop, not online, to get it set up correctly. Suggest quit normal cigarettes, wait for pangs to happen, then use vape. OK it's not totally safe but no CO2, no tar, no lingering smell, low cost. BMJ says

  • Thousands of GP pension statements 'potentially incorrect'

    Giles Elrlngton's comment 29 Sep 2016 1:45pm

    This is a real, not a potential problem. I'm a hospital doctor and as my 60th birthday approached I checked my pension on the TRS site which, it emerged after much negotiation, had overstated my annual pension by £10K. The BMA advises that any overpayment is the pensioner's responsibility. Do not rely on TRS which is of a quality standard sadly familiar to NHS employees.

  • Jump in private referrals after GPs are told to ask patients about insurance

    Giles Elrlngton's comment 09 Sep 2016 11:21am

    It is a mistake to think that private practice is simply for patients with health insurance. The cost of a private consultation is a little more than a tank of petrol and less than a ticket for a concert at the O2. Remember also that many insurance policies have an excess, and that insurance does not normally cover the cost of prescriptions, or offer cover for chronic disease.

  • Orthopaedic clinic - winged scapula

    Giles Elrlngton's comment 26 Aug 2016 4:22pm

    Pain followed by scapular winging is caused by neuralgic amyotrophy. It is a neurological not an orthopaedic matter. It recovers naturally without medical (or surgical intervention. Must dash now to write review of how to do a hip replacement (not)!

  • Should drug possession and use be legalised?

    Giles Elrlngton's comment 13 Aug 2016 9:47am

    My son died of "recreational" drugs earlier this year having successfully completed rehab and been drug (and alcohol) free for over 6 months. I am sure that the behaviour of the Police triggered his relapse (he was on very long term bail without charge. When he died his desk was covered with his legal papers: as stressful as a GMC investigation). We need societal control, to eliminate criminality, and severely restrict (i.e. abolish) use by teenagers. Criminalisation clearly does not achieve this, but instead stimulates an uncontrolled market that targets the vulnerable. Tax "recreational" drugs like cigarettes & alcohol, restrict sale to adults, and the problem becomes manageable. As in all health matters there is no perfect solution but decades of criminalisation has seen an explosion of drug use and is evidently counterproductive.

  • General practice's gender problem

    Giles Elrlngton's comment 09 Jul 2016 9:44am

    Sexism is indeed unacceptable. The term "grow a pair" is however sexist.

  • Abandon ship: The partners bailing as their practices head for the rocks

    Giles Elrlngton's comment 04 Jul 2016 3:56pm

    I hope you mean bale not bail