study that was prepared for an independent review body. JAMES BUCHAN GEOFF PIKE Institute of Manpower Studies, University of Sussex, Sussex BN I 9RF 1 Dyson R. Shortage of therapists. Br Med J7 1990;300:4. (6 January.) 2 Buchan J, Pike G. PAMS into the 1990s-professions allied to medicine: the wider labour market context. Brighton: Institute of Manpower Studies, 1989. (IMS Report No 175.)
Overprescription of cholera vaccine SIR,-Dr Alison Mott and Dr Paul Kinnersley make some valid points concerning the overprescription of cholera vaccine by general practitioners.' They rightly stress the importance of education as well as immunisation. But I disagree with some of their conclusions. To my knowledge it bas never been the contractual responsibility of British general practitioners to advise patients who are about to travel abroad on health requirements. The NHS general medical service statement of fees and allowances2 and the Department of Health and Social Security's booklet Immunisation Against Infectious Diseases3 make it clear that the onus is on the traveller and suggest contacting the embassies or consulates of the countries concerned for advice.3 It is only because of the impracticability of these sources and the failure of the travel industry to give clear and reliable advice that general medical practitioners have become increasingly involved. Giving good advice takes time-in our own experience 20-30 minutes-and professional time, like vaccines, is not cheap. The number of travellers and their destinations has increased enormously over the past 10 years. So have other demands on our time. I, like many colleagues, have delegated this complex task to suitably trained and supported practice nurses. I cannot, however, expect them to make professional judgments on the relative merits of different sources of apparently authoritative advice. We decided to choose only three sources for general,4 malaria,5 and meningococcal6 advice. I agree with the authors that the Department of Health booklet Before You Go' is overgenerous in its recommendations for cholera vaccine. It is, however, authoritative, updated annually, and actually given to patients for further reading. It could create confusion and worry if the general practitioner or the practice nurse did not take time to explain adequately why they were apparently ignoring official DoH advice. Unlike the authors we concluded that it might be simpler and even cheaper to stick to the DoH recommendations. Could I make a plea for a single authoritative, regularly updated source of advice for travellers. Qf course it already exists. It is called the Medical Advisory Services for Travellers Abroad, and quite rightly it charges a fee for its excellent advice. Perhaps we should be similarly rewarded if we provide an equally professional service. The whole question of whether the apparently underresourced NHS should fund foreign travel advice and immunisation should be reconsidered. P G BADDELEY
4 Department of Health. Before you go. London: HMSO, 1989. (SA40.) 5 Bradley DJ, Phillips HPA. Prophylaxis against malaria for travellers from the United Kingdom. Br Med J 1989;299: 1087-9. 6 Department of Health. Bnrtish national formnulary. No 18. London: HMSO, 1989:417.
Hazards of blood splashes SIR, -I would like to present some data in support of Mr J H Jessop's statement that orthopaedic surgeons may be exposed to even greater risk of being splashed with body fluids than other surgeons because of their use of power tools in most major procedures.' I routinely wear spectacles with large plain lenses at all operations. Over the past two years I have prospectively recorded all of the open operations that I have performed on patients under general anaesthesia and whether power tools have been used and whether or not my glasses have had spots of fluid on them at the end of theprocedure. The amount of blood was classified as small (1-5 spots), moderate (6-10 spots), or large (>10 spots). The table gives the results. Incidence ofblood splashes on spectacles duringoperations. Figures are numbers (percentages) No of splashes 1-5 6-10
Power tools used
Power tools not used
(n=240)
(n=271)
63 (26) 36 (15)
9 (3) 8 (3)
>10
27(11)
Total
126 (52)
3(1)
20 (7)*
*p
Overprescription of cholera vaccine SIR,-Dr Alison Mott and Dr Paul Kinnersley make some valid points concerning the overprescription of cholera vaccine by general practitioners.' They rightly stress the importance of education as well as immunisation. But I disagree with some of their conclusions. To my knowledge it bas never been the contractual responsibility of British general practitioners to advise patients who are about to travel abroad on health requirements. The NHS general medical service statement of fees and allowances2 and the Department of Health and Social Security's booklet Immunisation Against Infectious Diseases3 make it clear that the onus is on the traveller and suggest contacting the embassies or consulates of the countries concerned for advice.3 It is only because of the impracticability of these sources and the failure of the travel industry to give clear and reliable advice that general medical practitioners have become increasingly involved. Giving good advice takes time-in our own experience 20-30 minutes-and professional time, like vaccines, is not cheap. The number of travellers and their destinations has increased enormously over the past 10 years. So have other demands on our time. I, like many colleagues, have delegated this complex task to suitably trained and supported practice nurses. I cannot, however, expect them to make professional judgments on the relative merits of different sources of apparently authoritative advice. We decided to choose only three sources for general,4 malaria,5 and meningococcal6 advice. I agree with the authors that the Department of Health booklet Before You Go' is overgenerous in its recommendations for cholera vaccine. It is, however, authoritative, updated annually, and actually given to patients for further reading. It could create confusion and worry if the general practitioner or the practice nurse did not take time to explain adequately why they were apparently ignoring official DoH advice. Unlike the authors we concluded that it might be simpler and even cheaper to stick to the DoH recommendations. Could I make a plea for a single authoritative, regularly updated source of advice for travellers. Qf course it already exists. It is called the Medical Advisory Services for Travellers Abroad, and quite rightly it charges a fee for its excellent advice. Perhaps we should be similarly rewarded if we provide an equally professional service. The whole question of whether the apparently underresourced NHS should fund foreign travel advice and immunisation should be reconsidered. P G BADDELEY
4 Department of Health. Before you go. London: HMSO, 1989. (SA40.) 5 Bradley DJ, Phillips HPA. Prophylaxis against malaria for travellers from the United Kingdom. Br Med J 1989;299: 1087-9. 6 Department of Health. Bnrtish national formnulary. No 18. London: HMSO, 1989:417.
Hazards of blood splashes SIR, -I would like to present some data in support of Mr J H Jessop's statement that orthopaedic surgeons may be exposed to even greater risk of being splashed with body fluids than other surgeons because of their use of power tools in most major procedures.' I routinely wear spectacles with large plain lenses at all operations. Over the past two years I have prospectively recorded all of the open operations that I have performed on patients under general anaesthesia and whether power tools have been used and whether or not my glasses have had spots of fluid on them at the end of theprocedure. The amount of blood was classified as small (1-5 spots), moderate (6-10 spots), or large (>10 spots). The table gives the results. Incidence ofblood splashes on spectacles duringoperations. Figures are numbers (percentages) No of splashes 1-5 6-10
Power tools used
Power tools not used
(n=240)
(n=271)
63 (26) 36 (15)
9 (3) 8 (3)
>10
27(11)
Total
126 (52)
3(1)
20 (7)*
*p
