Clinical Conversations

In this brief episode, Dr Marilena Giannoudi, Co-Chair of the Trainees and Members’ Committee, gives an overview of the Royal College of Physicians of Edinburgh's podcasts relevant to doctors-in-training. These include: this podcast, 'Clinical Conversations'; 'Career Conversations' including the new 'Demystifying PACES' series; and the Recently Appointed Consultants' Committee's podcast, 'Consultant Conversations', relevant to senior trainees.

All RCPE podcasts can be found at https://podcasts.rcpe.ac.uk/

The 'Demystifying PACES' podcast series can be found at https://podcasts.rcpe.ac.uk/show/career-conversations/category/paces/ 

Recording date: 23 January 2024

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RCPE podcasts including 'Demystifying PACES' series (17 June 2024)

In this episode of clinical conversations, Dr Kat Ralston chats with consultant toxicologist Dr Emma Morrison about poisoning in the older adult. 

They explore why we need to think differently about deliberate self-harm in the older adult and talk through common toxicology cases, including decision-making around escalation. Finally, they consider a common sense approach to what we can do differently as clinicians to reduce the risk of self-harm and suicide in this patient group.

Dr Morrison trained in medicine at the University of Glasgow, with an intercalated BSc in Physiology. She also completed a PhD investigating to role of short RNAs as biomarkers and mediators in toxic injury. In 2020, Emma become a Consultant Physician at the Royal Infirmary of Edinburgh.

Emma’s NHS work continues to support her passion of ensuring transparent and equitable decision making in prescribing, supporting the central tenets of value-based medicine. Her roles within medicines governance include Chairing Lothian’s Area Drug and Therapeutics Committee and is a committee member of the SMC.

Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC).

--Useful Link--
TOXBASE - https://www.toxbase.org/

Recording date: 19 December 2024

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Poisoning in the Older Adult (31 Mar 2025)

In this episode Dr Emma Spencer discusses decompensated cirrhosis with Dr Michael Williams. This discussion includes the definition of a decompensation event, how to recognise these events on the medical take and the importance of doing so. They also discuss key steps in investigating causes of decompensations of cirrhosis and how to manage these unwell patients.

Dr Michael Williams is a consultant hepatologist, working on the Scottish Liver Transplant Unit in Edinburgh. His clinical interests are liver transplantation and autoimmune liver disease.

Dr Emma Spencer is an IMT3 doctor in the South East of Scotland and a member of the RCPE's Trainees & Members' Committee (T&MC).

Recording date: 13 March 2025

-- Useful Links --
BSG/BASL Decomp Cirrhosis Care Bundle - https://www.bsg.org.uk/clinical-resource/bsg-basl-decompensated-cirrhosis-first-24-hours

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Decompensated Cirrhosis (28 Apr 2025)

In this episode of Clinical Conversations, Dr Aoife Duignan  chats with Dr Claire Steel and Dr Shelagh O'Riordan about Hospital at Home. 

They explore what Hospital at Home is, and the evidence base behind it, thinking through which patients may benefit from it. They also consider how technology can enable patients to receive care in their own homes and what a day in the life might look like. Finally they consider some top tips for becoming involved with Hospital at Home. 

Dr Claire Steel is a consultant physician in older people’s medicine in NHS Lanarkshire. She is the President of the UK Hospital at Home Society and clinical lead for Hospital at Home in NHS Lanarkshire. She works closely with Healthcare Improvement Scotland to support the growth and development of H@H in Scotland.

Dr Shelagh O'Riordan is a consultant physician and lead for the Hospital at Home service in East Kent. She is President Elect of the UK Hospital at Home Society and National Clinical Lead for Hospital at Home/Virtual Wards for NHS England. 

Dr Aoife Duignan is a geriatric medicine registrar in Edinburgh. She is also the Representation Co-Vice Chair for the RCPE Trainees and Members' Committee (T&MC). 

Recording date: 16 April 2025

-- Useful links --
Hospital at Home Society Health Improvement Scotland Toolkit - https://www.ihub.scot/project-toolkits/hospital-at-home-toolkit/hospital-at-home-toolkit/
Hospital at Home RCT - https://pubmed.ncbi.nlm.nih.gov/35129936/
PPL South East Region Virtual Wards Evaluation - https://ppl.org.uk/what-we-do/virtual-wards-consultancy/
Cochrane Review - https://www.cochrane.org/CD007491/EPOC_hospital-home-services-avoid-admission-hospital
UK Hospital at Home Society - https://www.hospitalathome.org.uk/
NHS England Virtual wards operational framework - https://www.england.nhs.uk/long-read/virtual-wards-operational-framework/

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Hospital at Home (12 May 2025)

In this episode, Dr Kat Ralston hears about a case that changed the practice of Dr Chris Tiplady. They discuss the importance of recognising when a patient may be entering the last phase of life, what we owe to patients and families in understanding what matters to them, and how we can navigate managing uncertainty and being wrong as clinicians.

Dr Chris Tiplady has been a Consultant Haematologist in Northumbria since 2001 and has held a number of roles in postgraduate and undergraduate medical education over the years. He has been a Director of Medical Education in two trusts and now leads the Master of Medical Education course at Sunderland University. He also has a regular blog published by the Royal College of Pathologists, discussing professionalism in medicine.

Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC).

Recording date: 14 April 2025

-- Useful Links --
NHS England, Last 1000 days - https://www.youtube.com/watch?v=HynytVepxZc
REDMAP toolkit for future care planning conversations - https://www.spict.org.uk/red-map/
The King's Fund, Patients' preferences matter: stop the silent misdiagnosis (May 2012) - https://www.kingsfund.org.uk/insight-and-analysis/reports/patients-preferences-matter

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Cases that changed me - why you should ask about the beetroot (26 May 2025)

In this episode, Dr Marilena Giannoudi hears about a case that changed the practice of Professor James Dear.

They discuss the challenges of caring for a patient without a diagnosis, who to talk to if you are feeling uncertain in how to treat a patient, and how you can own up to and move on from mistakes you may make.

Professor James Dear is a Consultant in Clinical Pharmacology at the Royal Infirmary of Edinburgh and Personal Chair of Clinical Pharmacology at the Centre for Cardiovascular Science at the University of Edinburgh.

Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members & Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD.

Recording date: 9 June 2025

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Cases that changed me - managing mystery diagnoses (23 June 2025)

RCPE's Podcast Series 'Clinical Conversations' by the Trainees & Members' Committee (T&MC) and 'COVID-19 Conversations'.