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Introduction
The May 2006 'General medicine for the physician' conference was the first time this regular symposium, organised by the Royal College of Physicians (RCP), has taken place outside London. Over 250 delegates attended the two-day event, highlighting its success and reinforcing the importance of regional events.
In an era of the European Working Time Directive, increasingly complex shift patterns, 'ward-based' care and the disappearance of experienced senior house officers, the consultant physician can be forgiven for feeling an increasingly isolated figure. For those with a specialist interest it is also a disquieting observation that colleagues in other specialties often appear to have a fairly rudimentary knowledge of contemporary investigations and management of patients within general medicine. The disquiet arises less from concerns about their actions but that, as time passes, our own actions in the arena of general medicine outside of our specialty may be found wanting. To this end the conference allowed an excellent opportunity to allay fears and bolster confidence with an emphasis on practical aspects of diagnosis and management in a range of conditions which frequently present to the medical assessment unit (MAU).
Highlights of the conference
Professor Peter Mathieson presented a practical review of the early management of renal failure. He emphasised the importance of correctly interpreting any given serum creatinine level and the non-linear relation to glomerular filtration rate (GFR). He endorsed the usefulness of the estimated GFR which is now calculated automatically by biochemistry laboratories across the country upon receipt of urea and electrolyte requests. He emphasised the importance of recognition and management of both hyperkalaemia and fluid overload and the need for early referral to a renal unit if conservative measures were ineffective. 'Renal-dose' dopamine appears to have been consigned to the history books.
The assessment of 'query subarachnoid haemorrhage' (SAH) in the MAU is always a source of concern. Miss Joan Grieve, however, presented some reassuring data; computed tomography (CT) remains preferential to magnetic resonance imaging in the early assessment of SAH and will detect 95% if performed within 48 hours. Xanthachromia will be present in cerebrospinal fluid taken at 12 hours in 96% of patients. She illustrated that SAH occurring outside the working symptom definition of sudden onset (first or worse) headache, usually maximum...