A confrontation with a patient who is confused and aggressive might be one challenging situation that you could encounter as a junior doctor. As Sunjay Parmar’s brilliant cover illustration shows, this state of confusion is not only present in the patient, but it can be shared by the junior doctor who must unravel the root cause of the patient’s confusion. Is it acute, chronic, or acute on chronic—that is, delirium in a patient with pre-existing dementia? In the latest instalment of our You’ve Been Bleeped series, Hayley Andrews and colleagues present this common on-call scenario and help you work out what to do (doi:10.1136/sbmj.h3266).
Wim Weber’s Research Explained on p 16 reinforces why the recognition of delirium is important. Delirium is common in hospitalised patients and, in the study that the article focuses on, outcomes for patients who had delirium when in the intensive care unit were investigated. The meta-analysis found that nearly one third of critically ill patients reported in 42 studies experienced delirium. When compared with control patients, they were also more likely to experience increased hospital mortality, spend longer in hospital, and require a longer duration of mechanical ventilation. As Weber writes, “Delirium is a potentially modifiable risk factor for adverse outcomes in critically ill patients in hospital,” and therefore it is something that needs to be recognised quickly (doi:10.1136/sbmj.h3361).
From the confusion of others, to my own. What I find particularly odd is that on one hand medicine in the United Kingdom is a competitive and oversubscribed course, yet the country has a shortage of doctors—particularly in general practice. This means that the NHS often needs to employ doctors from overseas because we do not train enough. In recent issues we have looked at various aspects of the Shape of Training report. Graduate entry medicine has been shown to be a great way to diversify the medical profession. However, as Adam Sullivan explains, it is under threat because of the report’s recommendations (doi:10.1136/sbmj.h3283). The attraction for many graduate entry medics is that it gives people from various backgrounds a second chance to study medicine—usually in an intensive four year course, which keeps the costs down. However, under the proposals in the Shape of Training report, these courses will not comply with European Union law because they do not fulfil the 5500 hours of training required to be a licensed medical practitioner on graduation. Currently, graduate entry medics are able to make up this time in the first year of the foundation programme where only provisional registration is granted. The fear is that if these courses are extended by an extra year, applicants will be put off by the additional cost and time to train. The implications of moving the point of registration seem to fly in the face of various initiatives set up to widen participation in medicine, as well as the goal of training up more GPs—both of which many graduate entry courses have contributed to. Paul Garrud and Ajay Clare suggest how four year graduate entry medicine courses could be made sustainable for students, medical schools, and the NHS, if the point of registration is moved (doi:10.1136/sbmj.h3282).
Do you ever get frustrated at the inaccuracies in films when they portray medical conditions? Stephanie Hills does. She picks out examples where films have inaccurately portrayed the recognition and treatment of diabetes mellitus (doi:10.1136/sbmj.h3291). She argues that this is disturbing because these films might be the only exposure to diabetes that some non-medical viewers get, and the misinformation being conveyed could have serious consequences.
And finally, what I hope is clear is the future direction of Student BMJ. If you have a minute or two, please take the time to read my editorial (doi:10.1136/sbmj.h3385). It explains some of the developments around Student BMJ that we hope will benefit readers. Have a great summer and we look forward to seeing you in September with our new look print and online editions.Matthew Billingsley, editor, Student BMJ
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Cite this as: Student BMJ 2015;23:h3423