This document contains 7 articles written by Dr. Syed M. Raza discussing various topics in acute elderly care and cardiology. The articles debate whether separate elderly care units are needed, the benefits of competition in healthcare, the roles and responsibilities of doctors, induction programs for new doctors, and challenges in diagnosing indolent endocarditis.

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1. Acute Elderly Care Unit- Do We Need One?
o SYED RAZA, SpR Acute Medicine &Cardiology
DEWSBURY, United Kingdom
Acute Medical Units in most hospitals admit patients aged 16 and above. A fair proportion of
patients are 'frail elderly' reaching 100th birthday and beyond. These patients have multiple co-
morbidities with complex needs. Very often the admissions are deemed 'inappropriate' or
unnecessary. Dealing with these patients do require expertise for which all acute physicians are
not adequately trained. It is often noted that these patients are either under or over treated. They
often suffer complications which are iatrogenic. They also tend to stay longer on the Acute
Medical Assessment Unit which leaves the units with fewer beds for younger but more sicker
patients.
Keeping the above in mind, should there be a separate unit that would cater the needs of these
elderly patients? Do we need trained acute geriatricians? Should there be a compulsory period of
training for all acute medicine trainees?
Competing interests: None declared
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Published 22 December 2007
1. Survival of the fittest
o SYED M RAZA, Consultant Cardiologist
Dr Sulaiman Al Habib Hospital, KSA

2. It is without any doubt that competition which is healthy and with a clear vision is always
beneficial. This holds true for competition in any sphere of life including healthcare.
It is essential that there is a clear goal as to why one is competing. Any competition in a healthy
spirit is always mutually rewarding. As far as the healthcare setting is concerned this certainly
would lead to improvement in services, better provision of care and patient satisfaction. The
competition should not merely be to grab the funding but to survive as the fittest!
Competing interests: None declared
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Published 6 July 2011
1. Are doctors Jacks of all trades?
o SYED M RAZA, Consultant Cardiologist
Dr Sulaiman Al Habib Hospital, KSA
This is in reply to the recently published view, 'if we as doctors should be reporting potential
terrorists.' In my view this is common sense that any and every potential threat must be reported.
Doctors have been seen in various roles i.e. teacher, manager, clinical leader, and so on.
Having said that, one must not assume that we as doctors can play the role of a police or
investigating officer and actively look for any suspected potential terrorist. We are just doctors
and not a Jack of all trades.
Competing interests: None declared
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Published 21 July 2011
1. Re:GMC Induction Program: Welcome but more fundamental
action needed.
o SYED M RAZA, Consultant Cardiologist
Dr Sulaiman Al Habib Hospital, KSA
Safety for patients is the paramount issue for all NHS hospitals today. GMC has issued several
key statements and guidelines as how to be a competent and safe doctor. Despite this there are
several untoward incidents and 'near misses’ in NHS hospitals countrywide of which many go
unreported.

3. Induction program for new doctors being introduced by GMC is welcome by all medical fraternity
but I feel this came too late. There are several countries worldwide which introduced this
programme a long time ago.
The recruitment process for employing new doctors should be more stringent. This should also
hold true for hiring locum doctors. Currently, there is very little induction programme for locum
doctors. The locum doctors must show a sense of responsibility towards patients' care and more
importantly must demonstrate that they are capable and safe doctors. Unfortunately, the pre-
employment assessment process for the above is lacking.
Competing interests: None declared
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Published 21 September 2011
1. Re: Indolent endocarditis missed despite several admissions
o SYED M S RAZA, Consultant Cardiologist, MD,MRCP(UK)
Dr Sulaiman Al Habib Hospital, KSA
Prosthetic valve infective endocarditis affects 2-3% of patients after surgery. The acute
endocarditis usually develops within 2-3 months of surgery and is usually caused by more
virulent and antibiotic resistant organisms. Late-onset infections on the other hand are caused
mainly by contamination with low-virulence organisms during surgery or by transient
asymptomatic bacteremias, most often with streptococci; S. epidermidis; diphtheroids; and the
fastidious gram-negative bacilli, Haemophilus sp, Actinobacillus actinomycetemcomitans, and
Cardiobacterium hominis.The later is usually more difficult to diagnose.
Although Transoesophageal Echocardiogram(TOE) has much higher sensitivity in identifying
endocarditis vegetation and abscesses compared to Transthotracic Echocardiography (TTE)-
97% versus 67%, it can occasionally miss anterior aortic root abscess which is in fact better
picked up by TTE.
Competing interests: None declared
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Published 27 December 2010