Correspondence

The One Minute Preceptor (OMP) model of teaching has an important role to play during the COVID-19 pandemic. It’s quick and easy to learn and can be applied to any clinical setting. By responding directly to a student’s needs, and building on the knowledge they already hold, the OMP is able to offer relevant and opportunistic teaching that the learner can immediately apply. Finally, the OMP can be taught in under two hours meaning medical staff not used to regularly teaching can develop the confidence to offer high quality educational interventions.

The article by Subbe et al raise important considerations as to what is deemed quality care in medicine. Throughput in acute medicine is highly prized. Prompt decision making, and action, is certainly required for several groups of unwell patients, but there is system-wide pressure to maintain this fast pace for all patients. It does not automatically follow that quicker medicine benefits all patients to some degree. ‘Productivity’ may come at the cost of too much medicine - characterised by overdiagnosis, overtreatment, and substantial resource utilisation.

Every day, emergency departments and acute medical units all over the world receive and assess thousands of patients. Most are stable, but a few require immediate stabilization. To identify these, all patients are routinely triaged and have vital signs measured. Our group has shown that thermographic images of the face can be an alternative method for identifying patients at increased risk of 30-day mortality. In our previous studies, the thermographic images were taken after the patients had been inside for at least 30 minutes. However, to identify patients at risk, the images have to be available as quickly as triage, i.e. at the door when the patient arrives. Therefore, we have performed a small study, with the aim of illustrating the effect of such heat-gradients on thermal images of the face.

I read the recent article by Apsey et al with interest, which recommended “the potential benefits of thrombolytic therapy in massive and submassive pulmonary embolism”. This would appear to go against current NICE guidance which states “Do not offer pharmacological systemic thrombolytic therapy to people with PE and haemodynamic stability with or without right ventricular dysfunction”. Both recent NICE and European pulmonary embolism (PE) guidance are clear that only high-risk PE (previously called ‘massive’) should routinely be thrombolysed.