Today’s Best Practice Will Be Rubbished Tomorrow



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Charles Todd qualified as a GP in 1981 and then spent twenty years working in Zimbabwe. He recently retired as a GP partner in Buckinghamshire.

IN MY FIRST JOB AFTER QUALIFYING in 1977 as a house physician in cardiology, on call frequently involved “clerking” mostly middle-aged men having heart attacks and admitting them to the Coronary Care Unit. Their ECG was continuously monitored for 2-3 days, and if frequent ventricular ectopics or other worrying rhythm problems occurred, we loaded them up with antiarrhythmic drugs with the aim of reducing the incidence of ventricular fibrillation. Our focus was on preventing “warning arrhythmias”, a dogma that persisted for several years.1 We did not use effective drugs which were available at the time, notably aspirin and streptokinase.

Two years later I was working in paediatrics. One of the commonest reasons for admission in infants was gastroenteritis and dehydration. We gave iv fluids, starved the affected child of milk and solids, then initiated an elaborate scheme of reintroducing milk at increasing strength over several days. This was done to allow the gut to “rest”. The regime was strictly imposed, even when the child was screaming with hunger. Working in Zimbabwe two years later I understood that such practice was bunk; rather, most cases should be treated with oral rehydration solution (ORS) and reintroduction of milk and solid food as soon as possible. By 1979 the evidence of the effectiveness of ORS was already substantial – although perhaps it was viewed as too low tech by doctors in western countries.


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