Clinical Examination of the chest is probably the most common examination that is not properly done. Majority of patients I asked told me their doctors examined their chest with their cloths on. The diaphragm was placed ones or twice on the front and in the back of their chest. The notes clearly state “chest clear” – this is false, because the diaphragm of the stethoscope will be rubbed by the clothes and so you will hear crackling sounds of the cloths. Please read my comments and information below.
Nurses and doctors are abusing the stethoscope by simply placing the chest piece on patients chest without carrying out proper clinical examination as expected. They are also documenting information in the notes as “Chest clear or has crepitations or wheezy chest” and offer their diagnosis as “Chest infections or Asthma” to justify and prescribe antibiotics. This was not a major problem but numerous mistakes have been committed in the last ten years.
“Mid-Stratforshire Hospital enquiry report” makes a mockery of healthcare system in UK. and bring us all shame. Hospitals and authorities are blaming the problem on “Target Culture”. Unfortunately they do not admit the real problem has occurred because Mrs Patricia Hewett, shifted power to prescribe from doctors to nurses. The nurses were made to work as doctors (clinically examine,, diagnose and prescribe drugs).
We have identified numerous problems that has not been addressed. Nurses with no formal medical education or training under supervision were diagnosing, referring for admission or prescribing treatment (drugs) in Emergency, Out of hours service, nurse led practice and A&E. Some of them did not even know how to use stethoscopes properly were diagnosing illness as LRTI, URTI and UTI and referring children for admission to hospitals. Report in Archives of disease in childhood (May 2013) highlight the problem and state this as “Systematic Failure of Primary Care in the NHS“.
GPs and family doctors were blamed and criticised by the media stating GPs were unable to determine straightforward cases and blamed the problem on targets. The culture of dependence, loyalty of British press to nursing profession and institutions (GMC, BMA) turning a blind eye to the problem created by allowing nurses to prescribe drugs.
Yes we agree the GPs do make mistakes as we identified but the number of patients referred or admitted to hospitals or treated with wrong antibiotics and other drugs was much higher and serious. 37,000 patients are said to have died diagnosed as “Septicemia” and the claim for compensation to medical error paid out was around 20 Billion in 2012.
As doctors it is our duty to protect fellow human and make sure the documentation of notes is true.
We worked as a doctor, locum GP, salaried GP in a nurse-led practice, emergency primary care centres, A&E, Out of hours clinics, MOD, RAF, prisons and NHS triage, in UK (2000-2010). During this period, we collected information to find common problems that make patient anxious and demand emergency appointment, visit hospitals or call NHS Direct. We have meticulously gone through every notes and read the notes of the patient written by the doctor or a nurse who had either diagnosed or advised treatment.
Majority of patients told us, the doctors or nurse whom they saw before had not clinically examined them or explained to us how they were examined. We also received a complaint written by a young girl claiming to be “Medical Student” for asking her to remove her top to examine her chest. She mentioned it was embarrasing because numerous doctors and nurses who examined her before had not asked her to undress. Unfortunately, this girl has been shaving excessive growth of hair on her chest and breast – one that could have been prevented, if the doctors or nurses had asked her to undress and examined her chest.
We are publishing this to make sure patients visiting family doctors in the future know and understand why and how doctors must clinically examine their chest. Millions of $ is spent every year to treat the so called “Chest Infection” diagnosed by GPs or family physicians. I have admitted and managed very sick children presenting with symptoms like “Breathlesness, Grunting or septic shock”. After clinically examining, I often diagnosed this as “Pneumonia” and treated them with late dose of intravenous antibiotics. Not one parent of these seriously ill children complained about cough as their main symptom. Some parents told me their child was treated with oral antibiotics for URTI (upper respiratory tract infection).
Medical text books do not classify disease or illness as “URTI, LRTI or Chest Infections”. URTI (upper tract infection) could be otitis media (ear infection), sinusitis. tonsillitis, rhinitis and LRTI (lower tract infections) may be Pneumonia, pleuritis, lung abscess, tuberculosis, plural effusion or pneumonitis. When I worked as a GP in UK for almost ten years, I was not only angry but felt ashamed to say I am a doctor because we must have not allowed this to happen. Patients have been given wrong diagnosis, treatment and made to abuse antibiotics. As a doctor, I found it difficult to re-educate people because majority of GPs could not understand the problem. The reason this is important is because:
- Abusing antibiotics result in creating more resistant bacteria that can threaten our very existance
- Delay in diagnosing infections or giving low dose antibiotics can result in severe sepsis resulting in long term problems or death of patients
- Wrong or missed diagnosis result in complications that can harm patients
Numerous patients mainly children admitted to hospitals with Abusing Antibiotics without proper clinical examination or investigations is “Un-Ethical and Sub-Standerd Medical Care“. We must stop this to help reduce spreading antibiotic resistant bacteria in the community and colonising in patients who knowingly or unknowingly abuse antibiotics.
Patient with cough, runny nose or fever access emergency service or visit A&E, walk-in-clincs or demand emergency appointment to consult a doctor. The demand to consult a doctor has been gradually increasing in the past twenty years. The number of antibiotic prescriptions and complications occuring because of sub-standerd care has gradully increased. The invasion of “Antibiotic Resistant Bacteria” has made us realise we are soon likely to encounter a major threat to human and so MUST stop abusing antibiotcs NOW.
My Work & Experience
As a clinician working in the hospitals, we have performed this examination over and over again for almost thirty years. As a doctor working in intensive and critical care it was very important for me to be 100% sure the child or baby has the focus of infection in the lungs. Treating critically ill child or patient as infection based on assumption can result in not only delay making the correct diagnosis but also result complications or death.
When working in the community (Family practice) I was shocked to read notes written by doctors and nurses and hear complaints from patients how their family doctors Gps and nurse working in the walk-in-clinic, A&E or surgery diagnose chest infection and prescribe antibiotics. As a doctor, it is my duty to protect fellow human and so “Abusing Antibiotic” is now un-ethical medical practice as this can result in harming patients who consume them.
Doctors and nurses document “Chest is clear” or “Wheezy chest“, “Crackles, crepitations or simply stated as “Crepts” are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation. They are often heard only with a stethoscope (“on auscultation“). Bilateral crackles refers to the presence of crackles in both lungs but this is very rare and often not true.
Do you know we can hear crackles because the cloths rub on the stethoscope. If a doctor or nurse tell you that you have “Chest Infection” after examining your chest with your blows or shirt on – please consult another doctors because “We cannot diagnose chest infection by examining you fully dressed”
Please see the video below to learn how and why the chest has to be examined properly to say “You have chest infection”. The lungs have what we call as “Lobes” (see picture). The lobes are like rooms in your house. If we do not place the stetascope on each area properly, then we can miss infection in that lobe but we cannot digonise “Chest Infection” by placing the stetascope on the chest on one are of your chest.
To examine heart, we must place the stetescope on the perticular spot before diagnosis and it is mandatory to properly examine all your pulses properly before clinically examining your heart. If any doctor or nurse examine your heart without properly examining your pulse, then you may have to consult another doctors.
Common Medical Errors
- Absorption of penicillin in the stomach is very poor so giving low dose is “Harmful”
- Low dose of antibiotics will kill only good helpful germs in the stomach and intestine resulting in colonisation of resistant bacteria. The most common and well known antibiotic resistant bacteria living in the intestine that kill – Chlostredium.
- The dose of antibiotics given to children must be depending on the weight of the child
- Have you been prescribed Penicillin 250mg or Amoxacilin 250 mg to be taken 4 times a day?
- Has your doctor checked the weight of your child before prescribing antibiotic?
- Have you been told the antibiotics must not be given along with milk?
- Have you been told the antibiotic must be taken before food?
- Low dose of antibiotic act like a “Bacteristatic” antibiotics that limit the growth of bacteria by interfering, multiplication or replication.
- You need “High” dose of antibiotics (often given via veins) to get good blood level for the antibiotics to enter the lung and kill bacteria “Bacteriocidal“. (This like saying you can only kill an elephant using a double barrel gun and not using an air rifle)
- High dose of antibiotic given by mouth result in killing good friendly bacteria that live in our intestine and so produce severe diarrhoea.
Please Watch This Video To Learn About Lobes & Heart