41 minutes into Tottenham and Bolton's FA cup game yesterday, Fabrice Muamba, the 23 year old Bolton mindfielder, suddenly collapsed. As the paramedics rushed to his attention, it became apparent that he had suffered from a cardiac arrest. CPR was commenced and the patient taken immediately by ambulance to the London Chest Hospital where cardiac output was re-established and he was admitted to the intensive care unit. According to statistics, every week in the UK 12 apparently fit and healthy individuals under the age of 35 die from an undiagnosed cardiac condition. Often this is brought on by extreme exercise, as happened in this case. Common causes include obstructive hypertrophic cardiomyopathy, long-QT syndrome and coronary artery abnormalities. A family history of sudden cardiac arrest should prompt further investigation in a healthy individual, particularly if they are about to start an exercise programme. Professional footballers all receive medical assessments before signing a contract but should we be screening more individuals? I'm meant to be running a marathon in seven months - maybe I should have some kind of screening assessment? Or would people prefer to get on with their lives, enjoy sport and accept the risk? Perhaps after what happened to Fabrice Muamba there will be an influx of worried healthy people wanting referred to a cardiologist or investigated further.
Other things which I've been reading about this week:
BMA announces paid shadowing for FY1 doctors - After lobbying the Department of Health, the BMA has announced that all newly starting FY1s this August will have a paid four day 'shadowing' period before starting work. I think that it is good that the Department of Health have recognised that this is a necessary implementation (not optional) for new doctors starting work and should therefore be counted as paid work. Hopefully this new plan will ease the stress of the new doctors starting in August and help to improve patient safety.
People over 65 years old should be screened for atrial fibrillation. A BMJ poll asked whether everyone over 65 be screened for atrial fibrillation. In the poll 61% of respondents answered yes. It seems that there are still high numbers of patients not being treated effectively for atrial fibrillation. Improved management of patients with this condition could greatly reduce the numbers of patients having a stroke each year.
A man with 'locked-in syndrome' has been granted permission by a high court judge to apply for a court declaration that would allow a doctor to kill him without risking a murder charge. He is arguing for voluntary euthanasia rather than assisted suicide. This whole issue is extremely complex - does a person have the right to end their life? Is there ever a case for someone to assist someone to end their life? The condition which this man has is truly awful but even if he is successful with his case, I do not think he will be able to find a doctor who would assist him to end his life.
And finally...I've been reading more in the BMJ Careers section about the topics which I've raised previously about out-of-hours care and the surplus of doctors in training. It seems increasingly likely that consultants in the future will be expected to provide more out-of-hours care including night shifts and weekends. Reading this is drawing me more and more towards pursuing the general practice career route!
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