Report of AFMS 2013 Biarritz

Thursday 3 -Saturday 5 October

Pascale MACE started the conference in her usual well-organised and clear style with a presentation on protein HER2 and the potential for much more targeted treatment of cancers as our understanding of the fine detail improves. She concentrated on breast and bowel cancer with a review of normal and abnormal cellular mechanisms and the scope for …imab and …inab drugs to be tailored to the specific abnormalities in individual disease.She reminded us of the present lack of specificity and sensitivity of tests and therapy as well as the potential for novel side-effects..

John ALTRIP showed us the other end of medicine, far from the laboratory in relating his experiences as a volunteer at a visiting cleft lip and palate surgical unit in the Philippines provided by the charity ‘saving faces’. He acted as pre assessment for the surgical teams and had to make hard decisions to refuse individuals not suitable for surgery the same day who might have travelled for several days for their one chance of a normal life. He showed the etiology of mid facial deficits and harrowing pictures of local people of all ages with these socially damaging conditions. The surgical results in the short time the teams were present were astonishing. Follow up is clearly impossible in almost all cases.

Paul BENFREDJ tried to put us off our lunches with pictures of ano-rectal lesions in Crohn’s disease! His lucid presentation of the differences between the different types of IBD and the rapid advance in treating the more distressing symptoms such as incontinence ands pain specific to anal lesions was very informative. As ever, taking the patient’s wishes into account, but not rushing into treatment that cannot be reversed and might have serious consequences, is key. The surgeon should do as little as possible if symptoms can be managed, but clearly pain, suppurations and incontinence need to be managed actively.

Jean-Louis LARGE told us about the use of PRP, platelet rich plasma, in the treatment of sports injuries. The product is made from a double separation of the patient’s blood to produce around 2ml of product rich in growth factors, insulin-like GF, for example. The results of injections of PRP can be dramatic in aiding healing and reducing scarring, but is often accompanied by pain after 3-4 days (often a sign of efficacy). It is relatively expensive but so useful that it is being used more frequently. It has been accepted by the governing bodies of sports as not being doping. It requires great accuracy and so should be limited to specialised centres.

Mike KELLY and Patrice METAYER gave presentations on their experiences of complaints work and the various regulatory and civil systems in England and in France. It is safe to say that both countries have incredibly complex systems that take a very long time to resolution. I will make no attempt to describe the algorithms they showed and the tortuous routes that complainants take in the two jurisdictions. In brief, most of the money in settlement cases goes to lawyers; no-fault compensation is fraught with difficulties; expert witnesses have an extraordinary amount of work to do in even quite simple cases, but fortunately, on both sides, settlements are almost always agreed without a full court appearance. The cascade of acronyms from both speakers demonstrated the depth of knowledge required to undertake this work, but also suggested that attempting to progress a claim must be very difficult for an individual. (Try for example to understand ONIAM, CRCI, CRUQPC on the French side!)

Helen MACKAY gave us a personal view of her attempt to have some period of her past FRCS training in France. Taking time out meant a delay in her completion of training and no income. Getting adequate cover to work in France seemed extremely difficult and she spent an unpaid period acting well below her level of competence. The bureaucracy on both sides of la Manche almost defeated her, but Liverpool folk are resilient, particularly red-haired orthopaedic surgeons.

Vincent GUION from Midi-Pyrénées presented to us his bid for the Prix J Foray. He wishes to study the potential for telemedicine in the care of patients requiring palliative care in nursing homes, in French, EHPAD, établissements hospitaliers pour personnes âgées dépendantes. His fluent English presentation about the need for palliative care and the requirement to provide it in more homely situations was impressive. He plans to spend an extended period with Scottish experts. (We fear the quality his English might be adversely affected by going to Dundee, however.) One point of vocabulary for the British. Le bassin de santé means a mobile multidisciplinary team. Vincent is going to be a very important member of the international GP community in due course, it appears.

No fewer than 6 students presented their experiences in the James Tudor prize competition.

• Lorna CLEMENS
• Bryony HOPKINSHAW
• Colm MCALINDEN
• James MCDONALD
• Gordon MCKENZIE
• Sonia SADHEURA

The presentations were very varied from a case report of dengue fever to the problems of doctor and patient not sharing a language, to a quite technical review of a case of eye trauma. The quality overall was good, with audience participation being requested from the students, and being enjoyed by the audience. There has to be a winner, and Sonia Sadheura was awarded first prize at the gala evening. The others shared second place.

We always feel a little sorry for the person who has to start on Saturday morning, but Julia GROSSAC’s report of her study for the J Foray prize in 2011 was truly a great way to commence. She studied advanced imaging of traumatic brain injury at Cambridge, showing that, like in stroke, there is an area of impairment in the volume around the damage visible on conventional imaging. These pericontusional regions seem to match the clinical deficit noted by patients, and there may well be a suitable approach, like thrombolysis in stroke, that can rescue more useful function.

John BEAVAN teased us with his title ‘La Petite Reine et la Santé’. He presented the evidence for increased exercise in middle and even old age, with particular reference to cycling. The world champion time trialist for persons over 100 years started his cycling at 68!

Janet HALL and more importantly Sophie TATE, perhaps the first patient to present at our meetings, gave a salutary lesson to us about the need to consider what the patient tells us, and not what our prejudices from our specialist practice suggests. She has a rare condition indeed, but was badly handled for 5 years until Dr Google gave her the answer of Hughes syndrome (seronegative anti phospholipid alpha). Treatment subsequently has transformed her life, but at the great loss of those years of her early 20s. Psychiatric diagnoses should be made for positive reasons and not by default. Her blog of a hypochondriac should be compulsory reading for doctors, particularly those she suggests are ‘arrogant pricks’. (Janet translated this very elegantly.). Our profound thanks to Sophie, and I think we would all like to add our apologies on behalf of our colleagues, while remembering that we are none of us free of hubris. A very necessary and salutary lesson.

Michel BISMUTH and Marie-Françoise CHATELET told us about the new national structure for continuing professional development in France. Not completely surprisingly the system has been organised from the centre with administrative, political and then scientific oversight groups. Courses have to be signed off as fulfilling educative criteria. Reflective practice with audit cycles seem to be the core, and Mme Chatelet described one such programme on common ophthalmological conditions. There was a baseline questionnaire, a studyday with specialist input, then a second mini-audit with a follow up meeting. The structure sounded excellent, but there were some questions raised about the costs involved for GPs, and also the practicability of such an approach to cover all the areas of learning required. Certainly the preliminary sessions were well received by participants with defined learning outcomes. The French members were not a little surprised by the appraisal and reaccreditation requirements in UK where the licence to practice can be lost if CPD is not undertaken. We might return to this topic fruitfully in future years.

The conference was rounded off in fine style by Marie-Eve ROUGE BUGAT who demonstrated a new way go involving GPs in the care of patients undergoing chemotherapy. In France, as in UK, the GP can feel rather left out of the care of the patient at what is a critical time for the patient. In this work the GP is sent information prepared by specialists and GPs about side effects of chemo protocols. This permits a much greater involvement and potentially is therapeutically valuable. Certainly most participant GPs welcomed the data sheets and made use of the information. There was a lot of discussion about tailoring the information and keeping the data current.

A very useful interactive end to an excellent meeting in Biarritz.