Results Are Out...

So, results came out today.























I guess you're going to want to know how I did right?





















You're going to have to keep scrolling.

























Click here to find out:
http://thelittlemedic.blogspot.com/

Training a Bunch of Monkeys

Because a) I've got nothing better to do, b) I quite enjoy it and c) the £40 will pay for a takeaway, today I volunteered yet again as a patient for the 3rd year OSCE exam. It is the 5th or sixth time I've done so but each time I learn something new about the whole process. Today I had aortic regurgitation and 39 candidates did their best to impress the examiner as I laid there watching the ducks out of the window.

Now I should say that I think OSCEs are a very important assessment of a medical student's abilities. However, they aren't, certainly at my institution assessed effectively in my opinion. I recognise the difficulties in running a fair exam but when you're trying to do so simultaneously at 4 sites, with different equipment and different examiners in the morning and afternoon but supposedly the same stations it must be impossible! You might think that it all averages out in the end, and perhaps it does eventually but there are huge inconsistencies. I would have thought some methods are employed in an effort to standardise the marks but it would be almost impossible to do this for every conceivable variable. Blah, blah, blah, I could moan about this all day long.

Lets take today for example, admittedly I only saw a snap-shot of what went on, just 1 out of 13 or 14 stations. We started in the morning with one examiner, who's marking was rather erratic. There was one student who was a country mile above the rest who scored average to below average whereas others who were average at best were scoring higher. It doesn't help that the mark scheme leaves things very open to interpretation by the examiner but what can you do? An open mark scheme is too open to subjectivity but a more rigid mark scheme makes it more difficult for students to score consistently. Overall that examiner was fairly generous. In the afternoon, same station, different examiner. This time, a much more consistent marker but at the same time, much harsher with the marks (perhaps rightly so). Next we should consider the students, frankly, overall they weren't that great but I'll get to that in a minute. For no particular reason that I could see there was a significant variation between the morning lot and afternoon lot. The morning lot were on the whole, ok (remember they also had a generous marker) whereas the afternoon lot were, apart from one, not as good (and also had a harsher marker). I might not have explained that too well but what I'm getting at is that there was more than one variable affecting each group skewing the distribution of marks further between morning and afternoon.

As for the students themselves, let me explain what I thought was wrong. This might sound a little harsh and hypocritical (I was exactly the same when I was a 3rd year). Neither is it really the students fault. Every student was able to make a decent effort at completing a cardiovascular examination. But, you could teach a monkey to do a textbook cardiovascular examination. Very few students looked like they were actually looking to elicit signs. Perhaps the main issue here is that it is such a fake situation and the students are expecting a normal volunteer to examine therefore there won't be any signs so it doesn't matter. I spoke to the examiner about this and he agreed, he had previously examined a thyroid station where students had all done a textbook examination but 5cm above where the thyroid actually is. They are only 3rd years, perhaps it is unfair to expect them to elicit signs at such an early stage. You can clearly tell the students who've examined real patients and who are actually trying to elicit the signs from those who are just going through the motions, the former group generally score higher, I believe rightly so.

During finals for instance we had 6 stations of real patients, these were not only the most difficult but were the most interesting and dare I say it, enjoyable stations from my point of view. Why not have a few real patients for earlier years? Yes, it would take more organisation but patients are usually quite willing to spend a morning being examined. We're not trying to train monkeys, we're trying to train competent, dynamic doctors who're able to think on their feet so why aren't we assessing this properly?

My experience of OSCEs from both sides has led me to the following conclusion:
Performance = 30% luck in each and every station + 30% examiner subjectivity + 30% confidence (or false confidence) + 10% knowledge

Clearly, luck makes up a rather large proportion and this is what needs to be eradicated if possible. How we do this I'm not quite sure. Perhaps having more stations 30, 40 (as some other medical schools do I believe) to average things out, or improving the consistency of marking by reducing the subjectivity.

I love to get my hands on a chunk of results data to run some of my own statistical analysis on. Although the chances of that happening are about the same as winning the lottery.... 4 times. If I asked for it, I'd just be ignored.... again.

One other thing from today; what is with all the all black stethoscopes? At least half the students had them and yes they might look quite cool but they sure as hell don't make you any better at using them!

If you've not already done so check out my latest, and probably final post here: http://thereallm.blogspot.com/

Everyone Wants My Money

After 5 years at university accruing several tens of thousand pounds of debt I suppose it should come as no surprise that the final few weeks are full of costly expenses. I suppose I should get used to it, things are only going to get worse, I should really count my lucky stars that I didn't have to pay to sit my final exams.

Among the expenses, GMC provisional registration (£135), MDU (£20 approx), graduation robes (£37) was a colourful leaflet from the BMA listing all the potential benefits of being a BMA member as an F1. I am a student BMA member and enjoy my regular sBMJ so I figured I'd probably keep my membership up as an F1. I looked all the way through this colourful leaflet and couldn't find anywhere how much its going to cost me, something tells me it won't be cheap.

Becoming a doctor has always been an expensive process but it really doesn't come at the best of times towards the end of student life.

Perhaps, rather than medical school I should taken up a life renting graduation robes. Lets do some maths. So my graduation robes are going to cost me (well, hopefully my parents) £37 to rent for a couple of hours. There will be over 400 people graduating from the medical school alone, that is the best part of £15,000. Multiply that up for all the students graduating throughout the country and I'm fairly sure it will come to a very substantial amount.

Whilst I've got my chequebook out, who's next?

The Week After The Week Before

Wow, its now a week after my last exam. Doesn't time fly when you're having fun or, in my case doing bugger all.

What exactly have I done in the last week? Well, not a great deal really. My post-exam to-do list which was already as long as my left arm hasn't been reduced and now in fact stretches around my back and down my right arm too. Saying that I have been 'busy', after all I must have been too busy to blog right? Well, yeah, but then again, I've not had a great deal to blog about. There is only so much material one can get out of waking up, playing computer games, eating and sleeping.

My main objective for the week involved a great deal of football manager, for those of you who know, I need say nothing more. For the rest of you, it's a totally addictive, virtual football manager PC game, like a boy's version of sims according to missbliss. I also got a new gadget on Tuesday and have spent many an hour playing with it, and i've not even read the mahousive instruction manual yet (by far the most exciting part) and yes, every single page is in English - no being disappointed when 5/6ths of the book is in Japanese/German/etc etc.

Yesterday, an excursion took us to the hospital I'll hopefully be working at come August. It was the first time I'd been there, and the first time I'd even been to the city in question. The city is lovely, if slightly quieter and more serene than what I'm used to. The hospital reminds me of a hospital some of my clinical placements were at. It is relatively small, seems mainly modern, and has a few odd, but rather cool quirks. We went for a wander round, obviously to scope out the important places, those being a) the shop, b) the cafes and c) the chocolate machines, all of which, I'm pleased to say, were up to standard.

This week has gone ridiculously quickly, perhaps I should be grateful after all that we have to wait a month for results! Hopefully next week, I'll be able to tick a few things off my to-do list.

The End ........ (hopefully)

Yes ladies and gentlemen, it is over. My last exam on Friday went ok, it was certainly better than Monday's. I broke my rule of "never change your first answer" and that cost me a couple of marks I think but on the whole it was OK.

As I'm moving out of deanery I don't have to do my shadowing period now, in fact, I don't have to do it until the week before I start my job. This means that I'm now free, free to do whatever I want until the end of July!

I am now in a strange sense of limbo, I don't know what I am. I have a whole month to wait until results. Don't even get me started on that... honestly, how long does it take to put all the multiple choice papers in a scanner?

Hopefully I'll be able put results out of my mind and just enjoy my free time, sadly, I don't think it'll be that easy for some.

Wheeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee!

The OSCE

So now everyone has done their OSCE, I think I’m ok to talk about what came up. Especially as the information will be freely available here in a couple of weeks time. I’d advise anyone sitting finals to register and take a look at the section where feedback has been collected from students who’ve sat finals in the past few years at most of the medical schools in the country.

OSLERS – 15 minutes history/5 minutes discussion

Asthma
This wasn’t too bad; I’m not entirely sure what type of history you’re supposed to take from someone who has had their diagnosis for 30 years. It’s more of a chat about their condition than anything I hope. You’re supposed to consult with them for 15 minutes and then tell the examiner what you think their diagnosis is. Now for some things this is easier than others. It sort of gives it away when the patient tells you their diagnosis (I don’t think they’re supposed to do that). When you’ve finished the history, there is a 5 minute period for questions. The examiner was a little mean and impatient but I think I did ok.

MS
This was harder than the other OSLER, mainly because it wasn’t barn door MS. At first I thought it could be MND, then I thought it was some weird myasthenia problem but I eventually did decide it was MS (mainly because when I asked if he saw any specialist nurses – he told me he’d seen the MS nurse before). Again I think I did ok with the history part and managed to waffle my way through most of the questions.

5 Minute ‘Spotter’ Stations

Charcot’s joint
A strange station really, I was told to purely inspect a patient’s leg and not to examine it. There was an obvious amputation and slightly deformed ankle, I wasn’t entirely sure what else I was supposed to see/say. I guessed it was charcot’s joint and the examiner seemed quite pleased. I was able to answer most of the questions quite well too.

Parkinson’s
Not the most of obvious of Parkinson’s, must have been pretty well controlled on medication. I found that the patient had increased tone but I thought it was spasticity rather than the typical rigidity of Parkinson’s. I did spot the shuffling gait and managed to reel off and demonstrate a number of other tests for Parkinson’s.

Stoma
Probably my best station. I was asked to inspect a patient’s abdomen, he had an obvious stoma. The rest of the station was questions. I managed to answer them all confidently and completely. We finished in about 3 minutes and spent 3 minutes talking about politics.

Dupryten's cotracture
Another barn door diagnosis, I was slightly unsure what to examine in terms of the patient’s hand, but the station was mostly question based and I think I coped with them pretty well.

Psoriasis
What annoyed me most about this station was the examiner; I felt she was rather mean. I managed to spot the diagnosis of psoriasis and answer the questions well, if not perfectly but the examiner still didn’t seem particularly happy for some reason. Maybe she was bored as it was my last station and she’d been there all day long

Heart Murmur
The only 5 minute station I really didn’t like. I was asked to examine a patient’s heart. I was told to go straight to auscultation and at first couldn’t even tell whether or not the patient even had a heart. When I finally found it, I could hear an obvious murmur and I tried to time it with the pulse and decided it was a diastolic murmur. I then decided that it was loudest in the tricuspid area and so decided on a diagnosis of tricuspid stenosis. God knows why, patients with that must be as rare as hen’s teeth. Anyway, the examiner told me that it was in-fact systolic and atrial stenoisis. Oops! I managed to answer the questions though so I’m hoping that brought my mark up for that station.

10 minute stations

Abdominal examination
I made such a hash of this potentially easy station. It is because I was told to go straight to the abdomen. If I’d had to examine the whole system it would have been the easiest station of the lot. Anyway, the ‘patient’ was simulating that she was in a lot of pain which put me off completely. I didn’t want to cause her any more pain by examining her. I royally fucked up the order of my examination but did eventually mention most things in a haphazard manner. I gave a decent differential diagnosis and mentioned just about every possible test under the sun.

Testicular examination
This was my first station, and I was well chuffed. It was a nice easy start. I’m pretty sure I had my testicle examination down to a fine art. And apart from a question on the cause of painless epididymitis, I also did quite well with the questions.

Hearing tests and hearing aid viva
I wasn’t impressed with the examiner in this station. I knew exactly what I had to do and I had it perfectly clear in my head about Rinne's and Weber's tests. Unfortunately the examiner decided to take me round in circles and completely confused me by twisting what I’d said. Anyway, I managed to get the other questions right so I’m hoping to have only dropped a mark for getting slightly confused.

Diabetes – Driving DVLA
My worst station, I didn’t have the faintest idea about diabetes and driving. The scenario was; “a patient has come for his routine diabetes check-up”, here was me expecting to have to examine him but no. He had actually come to ask about driving as he’d just got a new job. Would he have to tell work and the DVLA about his diabetes? I didn’t know, I said I’d have to look up the details but I told him to notify the DVLA and encouraged him to tell work. I don’t think he as the patient was particularly pleased with the outcome of our discussion so god knows what the examiner thought. Here’s hoping I got a mark for washing my hands.

Child psych – mother concerned about daughter losing weight
I haven’t a clue how I did in this station because I’ve no idea what it required us to do. It was difficult to take a history from the mother as third person but I got in most of the important questions. I presented a decent differential diagnosis and made a vague effort to explain to the mum about the possibility of anorexia.

Explaining bad news and consenting a schizophrenic with cancer
This station had come up before, just as the other scenarios I asked about had. Again I’ve no idea what was expect of us and how I did depends entirely on what the mark scheme asked for. The simulated patient who kept hearing voices during my consultation first of all declined surgery but was happy to consider it by discussing with his parents by the time we’d finished so that has to be a good thing. I think he had capacity but I found it difficult to get this point across to the examiner who didn’t say a word to me throughout the whole station apart from “you have 10 minutes to use as you please” as I asked her a question.

Pill counseling
Hope I did OK in this station, in hindsight (AKA talking to missbliss) I could have done better but at the time I think I mentioned most things that I needed to. My mind went blank with regards to the side effects but I remembered the other things. The simulated patient was annoying in that she kept asking me questions about things I’d already told her about, but I suppose that made her an accurate patient!

Death certificate
One of my better stations, don’t think this was too challenging though I think I spelt pneumonia wrong. They were sneaky in trying to catch us out with a particular detail which I wasn’t sure about but said I could check. I was able to answer most of the examiner’s questions. There was a fair amount of spare time in this station during which I sat there like a numpty trying desperately to think of more answers to the questions.

So there you have it, 5 years of medical school condensed into 2 hours 40 minutes.

4 weeks to wait to find out whether or not I passed.

Finals Update

Following a rather disastrous start to my finals on Monday(although it seems most people feel the same), yesterday was the OSCE. This is the big one, the most important one, the one everyone is most worried about. I'm usually quite calm around exam time but OSCEs bring out the nerves in even the calmest of us.

It is the waiting that annoys me most, we reported to the hospital about 12, only to be forced to sit and wait for an unknown period of time, a period where minutes feel like hours. I imagine it is like waiting for an execution, only at least with that you know what is going to happen, with an OSCE, you never know if you'll come out dead or alive! In that final hour, some nervously flick through their notes aiming to cram those final few facts, others sit calmly contemplating what is to come. Only when we had to put all our belongings in quarantine did the reality of the situation hit me, I don't often get butterflies in my tummy but at that point yesterday a swarm of them descended upon me. I defy anyone to sit an OSCE without feeling those nerves. When we were finally marched upstairs and given a short briefing I knew this was it, 3 hours that could make or break my future.

Placed outside the first station by an unfamiliar but friendly face, I could feel my heart beating, in fact, it felt like it was about to explode. The time had come, my body responding with its fight or flight mechanism. As tempting as it was to run out of the door and never look back, my thoughts were interrupted by the first buzzer and the fight began.....

That I'm afraid is where the story must end for today. I will write about each station but as other students still have to sit the OSCE I don't think it would be a good idea to talk about it till Thursday.

All I will say is that it could have been much worse...

Just Friday to go.

What a Ridiculous Exam

- If you're going to insist on asking us a load of microbiology questions, please tell us in advance so we can learn it. Alternatively, you could, you know, actually teach us something rather than making us do it all ourselves in PBHell.

- If pt x has so and so wrong with them, my 'initial management' would probably include the answers a, b and e. Please don't make me guess what Dr Jones wanted as the correct answer, based on how he was feeling when he wrote the question, when all 3 are potentially correct.

- To all of those studying a PBL course, unsure what exactly you need to know, the answer is everything. Yes, absolutely every last possible detail of every conceivable thing. You must know every textbook inside out and be prepared to answer questions on everything.

- I've done this exam 5 times now, and this time was by far the hardest in my opinion. At least most people seem to have found it rather difficult.

- I pity the poor 1st years who did the same exam, they must have literally had to guess all but a couple of questions.

- I've got a headache.

- OSCE tomorrow.

- Onwards and upwards

Close To The End

3 years of life in hospital as a medical student hopefully came to an end today. Shitters

Exams Monday, Tuesday, Friday next week. Shitters

Then its all over. Shitters.

Results 1 month later (don't even get me started on that). Shitters

Argh shitters!

The next update will probably be Tuesday after my OSCE. See you then

Blogging Revision

Ok, so I'm not supposed to be blogging because I'm supposed to be revising but I had a wonderful thought - what if I combined the two?

What better way to revise ethics and consent than to discuss it. It's a grey area without a yes or no answer. It is more a matter of common sense and opinion so I'm asking for your opinions on the following scenarios:

1) You are the SHO on an upper GI surgery firm, you are told to explain a diagnosis of gastric cancer and start to consent a schizophrenic patient for surgery.

2) You are a new GP partner in a GP surgery seeing a woman who is going in for a elective operation, and she doesn't want the people in the hospital to know about her Hep C status... it turns out that she thinks if the hospital knows about her Hep C status, her social worker would find out and not let her to see her daughter.

3) A husband slept with prostitute in Thailand on business trip. Wife is unaware but attends GP with sore throat & demands to know what’s wrong with husband & wants same treatment.

So, how might you approach the above situations, go on, leave a comment and help with my revision.

Shingles Mingles

So missbliss has shingles, poor her, everyone who has had it seems to have oodles of sympathy. Unfortunately, nobody seems to be quite sure whether or not I've had chicken pox. I thought I had and was merrily poking her rash before she went to the doctors, but it seems that I might have just made up me having chicken pox as a child. I guess we'll find out in about 14 days or so (the incubation period) right before my finals start. Wahey.

On the plus side, the football rocked my socks. And so I've got the champions league final (no legs involved missbliss) after exams.

piss off!

I don't seek out the most remote and quietest place in the library for you to come and sit on the table next to me and spend 10 minutes talking to your 'bro' on your mobile. Prick. Kindly piss the hell off!

They Think Its All Over....

Well it very nearly almost is. I finished my last clinical placement on Friday. This signifies a couple of things, firstly that I'm supposed to know everything that I could possibly need to function as a doctor and secondly that finals are in 2 weeks.

2 weeks tomorrow, my first exam, then 2 more, spread out over the rest of the week and that is it. I'm free...at least for a month until results.

As a result of this, I'm not going to be writing, or reading blogs much over the next 3 weeks. Well that is the plan anyway. I know I've already mentioned my upcoming exams plenty of times and thanks to all those of you who've wished me luck.

Best of luck to all those readers who are also sitting exams as we come towards the end of another year.

A Dream Becomes Reality - But Not In A Good Way

How many people have dreamt about being a hero at the scene of an accident? For the majority it will remain just a dream, one in which they are cool, calm, confident and heroic. For others, this dream becomes real, but the reality of the situation is somewhat different to the heroic dream.

This afternoon we went for a drive in the countryside, the sun was shining and we were merrily winding our way around the country roads. Up ahead, over the brow of a hill I noticed an accident, it soon became clear that it was quite serious. There was a distinct lack of emergency services, I was faced with a decision, should I stop or carry on? Despite having little to offer I decided to stop, I pulled over, just beyond the accident. My heart began to race, I hadn't paid much attention to the scene as I was pulling over so I didn't really know how serious things were. The accident had obviously happened barely a minute before we passed and a couple of other people were already on the phone to the emergency services.

As I approached, I realised this wasn't just a shunt, it was a high speed, head-on collision involving two cars (car 1 with one man in, car 2 with two women). Metalwork was strewn across the carriageway and the cars were in quite a state. I approached what I initially thought was a police woman talking to an obviously distraught and injured passenger. I introduced myself as a final year medical student and asked if there was anything I could do. It wasn't until afterwards that I realised that she was just a smartly dressed passer-by.

As a final year medical student I've not exactly got a wealth of experience of medicine, let alone in pre-hospital care. I'm not afraid to admit that I was terrified, realistically, what could I do? No experience, no equipment, no nice doctor telling me exactly what to do, absolutely no idea what I was doing. Not only that, all my brain could think was "Oh SHIT!" So not exactly the cool, calm, confident hero?! I went to the driver's window of car 2, the driver was slumped, she was barely breathing. I tried to introduce myself but she was barely, if at all conscious. The only thing I could think of was ABC (Airway + c-spine, Breathing, Circulation), she was obviously trapped and severely injured, I tried to assess her pulse, I couldn't convince myself that she even had one. I tried the back door so I could get in to stabilise her head and neck but it was stuck. I was focused on trying to assess ABC it wasn't till later that I noticed (actually missbliss pointed it out) her other arm was broken so badly it was bent in 3 places. Eventually a policeman who'd arrived managed to get into the back and to stabilise her head, but by this point she looked terribly grey. I'm no expert, I'm not even a novice, but something inside me thought she was probably exsanguinating internally.

By this point the only emergency services on scene were the police, I moved on to the driver of car 1, he was the better of the 3 casualties, although he was still trapped inside his vehicle. Again I introduced myself and briefly assessed him, he was alert, although completely disorientated. I tried to reassure him as much as I could, his neck was painful, so I was doing my best to make sure he kept his head still. By now the scene had become littered with firemen, although they were concentrating on the other car so I stayed with the man in car 1 talking to him, although he couldn't remember anything at all.

Eventually the ambulance arrived, I explained who I was and one of the paramedics asked me to stay with the man I'd been talking to until the other ambulance arrived. I could hear the emergency service working frantically behind me to free the women in the other car. I kept being as reassuring as I could and after what seemed like days the other ambulance arrived, I briefly explained what I knew and what the man in car 1 had told me about his condition. Finally I took a step back to look at the carnage.

Despite the carnage, the whole scene was rather calm and quiet. It is impossible to describe but certainly the reality is completely different to anything you could ever dream or see on TV. As I stood there talking to one of the witnesses, he asked who I was and I explained. "Coming towards your exams eh? You'll soon have a different title then won't ya?" he said. The reality is that if I pass these exams he's right, I won't be a final year medical student, I'll be a doctor. My worry then is that people will expect things of me in such a scenario. It was clear to me that there are no heroes in a situation like that, it takes a real team effort by everyone involved. Without that, things wouldn't get done, and people would die. I don't know what happened to the casualties today, indeed I may never know but I really hope that everyone involved is ok, and my thoughts are with them and their families.

Finally, and not that I've ever had anything but respect for paramedics and the emergency services but after today, I've got a whole new admiration for the work they do. It is one thing being the doctor in A+E surrounded by all their equipment and a team of nurses on the receiving end of an ill patient, but a paramedic, first on the scene to something like this. They really do deserve a great deal of respect!

As for exams, they're a walk in the park compared to this. Reality is so much more terrifying.

It was so difficult to even begin to write about today's events, I'm not even sure I should have. I know I had little to offer and I don't think anything would have been different if I hadn't stopped, but I'm glad I did, and if I'm ever in that situation again, I hope I'll be a little more confident that I can do something, even if it amounts to little more than nothing.

A Momentous Occasion

Today was a momentous occasion in terms of my career as a medical student. I have been counting down to today for the past 8 weeks at least! In fact, it was a cause for celebration for at least 8 of us, although only 4 bothered to turn up. Have you guessed yet? Today was my last ever PBL session, the last 2 hours of problem based learning I'll hopefully ever have to endure (at least as a student).

I was going to bring cake, and even champagne to celebrate the occasion but I'm not sure hospital is the best place for alcohol and I couldn't find any suitable cakes. As it turned out, only 4 of us turned up anyway, quite sad really that final session was more of a damp squib than anything else, not that PBL is much more than that in the first place.

The session itself was more a small tutorial than a classical PBL, saying that, we've not done 'textbook' PBL for years. I'm just happy I never have to waste 2 more hours of my life sat in a room trying to teach each other medicine from the titbits of knowledge we've all cobbled together from various sources. It is quite ironic that such emphasis is placed on group learning and PBL, where we're encouraged to help each other to learn, only to be examined and assessed against each other when it comes to exams and ultimately ranked against each other when it comes to job applications. I can't quite understand that logic.

I must have done a couple of hundred hours of PBL in the last 5 years and I can probably count on one hand the number of useful sessions. I can't even remember how PBL is supposed to be done, it is that long since we followed the proper steps. I'm still very much of the opinion that PBL doesn't work as an exclusive method of teaching medical students. I think there are huge gaps in some of our knowledge, some of us more than others of course. Sadly too much time, effort and money has been put into developing such a course that even if those that be wanted to revert to a more traditional style, it would be far from easy.

Who knows, perhaps in a few years I'll be proved wrong and it'll be the PBL trained doctors leading the way, unfortunately I just can't see it happening that way. I expect that once more evidence becomes available, PBL will be shown to be the pointless, farcical waste of money that it is.

In the mean time, I'll rest safe in the knowledge that the words "time for PBHell" will never again cross my lips!

HELL YEAH!!!!!!!!!!!!!!!!!

The Final Push

A month from now it'll all be over one way or another. 3 more weeks until exams, I'm ridiculously fed up with waiting for them. I can't wait till they're over and I can spend my time doing bugger all/playing computer games/sleeping or a combination of the three.

4 more weeks and medical school is over. Shitters


Also want to take this opportunity to say hi to the people who've been reading through most of my archive. Some of you seem to have spent hours reading, considering exam time is approaching, I'm guessing you're all procrastinating!

Finally is anyone else having problems with blogger emails? I'm not getting messages about comments and other various emails.

Univeristy Says No

Yesterday we began a series of 'safe prescribing' lectures, there is the potential for a station in our OSCE on prescribing but I think these lectures are more aimed towards making us safer doctors. It is a shame that these lectures are starting 3 weeks before finals, it would have been much more useful to have them regularly throughout the year or even the whole 5 years. It was fairly basic stuff and it would have been better had there been slightly more pharmacology involved.

That said, the lectures were quite useful but it was the other things I learnt which I found most interesting. We asked why these sessions had been left so late, after all we've better things to be concentrating on at the moment. The answer was most enlightening.

It seems that they have had some trouble putting on these sessions, and others like them. In fact, we learnt that in previous years, one of the surgeons had offered teaching sessions throughout the year on things he thought were lacking in our course, suturing for example. Unfortunately for the students, the university had contacted the surgeon in question and ordered him to stop giving the sessions as it would be unfair on students at other hospitals. (For those of you who don't know, the 3 clinical years of our course are spent at 1 of 4 teaching hospitals in the region). Let me get this straight, the university had told staff at this hospital, not to teach us topics where there might be gaps in our knowledge? I was flabbergast, I really hope I've misunderstood something here because as far as I can see the university are actively withdrawing learning opportunities! Perhaps they're right, maybe it isn't fair on students at other hospitals, but that is the university's problem, it shouldn't prevent people from offering to teach! The university should be doing everything it can to ensure everybody gets these opportunities, not preventing them! It must be virtually impossible to prevent this kind of teaching at all 4 hospitals, so I'm sure somewhere some students are going to be getting something that other students are missing out on.

Why don't they just lock us all in a room for 5 years with some textbooks? God forbid we might actually be taught something!

What sort of institution is this and what sort of doctors is it trying to produce?

If you knew then what you know now...

A topic came up over lunch the other day which I think sums up quite well just how low morale is among medical students and junior doctors at the moment.

The question was: knowing what you know now, would you apply to medical school again? The answer from 3 out of 4 of us was a fairly firm no, surprisingly I was the only one who probably would apply again albeit to completely different medical schools.

I opened this topic up to a wider audience and was pleased to see that not everyone had lost faith in medicine. It was also interesting to note that among those who would apply again, many would have applied to different places for a variety of reasons.

So...

Whatever stage you're at, be it 1st year student or consultant (not that any consultants are likely to be reading this), if you were applying to university today, knowing what you know now, would you choose medicine again?

A Revelation

Two Things

a) This article doesn't surprise me, especially the bit at the bottom: "Medical students formed the largest group of complainants "

More importantly
b) How, after almost 5 years did I not know about The Office of the Independent Adjudicator for Higher Education ("OIA")? An independent complaints board. Something else to add to the list of things to do after finals!

Have the BBC Missed The Point?

This story appeared quietly and with little fuss over the weekend. Afterall, unless its about £100,000 salaries or patients dying, nobody seems to care what happens to doctors.


The BBC story highlights an important point, although I can't credit the BBC as the remark originally came from a professor at the Royal College of Physicians. With the complete introduction of the European Working Time Directive (EWTD) from 2009, all professions, including doctors will be limited to working 48hours a week down from the current 56 hour limit. Now I don't know about other professions but this has some pretty serious consequences for doctors and perhaps more so for patients.


The BBC article states that patient care will suffer because there will be less staff available, this clearly makes sense as if all doctors are working 48 hours rather than 56 each doctor is working 8 hours less. Who is going to cover those lost hours? Patients are still going to get ill 24 hours a day, 7 days a week. Who is going to be there when Mr Jones arrests but Drs Smith, Brown and Wood have all worked their 48 hours this week? Of course, everyone knows that the vast majority of doctors are still going to work more than 48 hours a week, they just won't get paid for it as it is effectively 'illegal'. When it comes to auditing hours, these doctors will be 'encouraged' to lie about their hours to make the trust EWTD compliant. So patient care probably will suffer in the short term, but Dr Smith and his colleagues won't leave Mr Jones to die, they will ignore the EWTD, safe in the knowledge that what they are doing is illegal and they're not getting paid for it. Another solution to this problem is the use of night nurse practitioners and such like. I'm sure Dr Crippen wouldn't approve and to be honest, I know who I'd rather be looked after in the middle of the night during an emergency.


Anyway, I think the BBC have missed the point, it isn't the short term, immediate care of patients which is at risk. I'm far more worried about the implications for the future in terms of training. Talk to a doctor who qualified 5, 10, 20, 30 years ago and they'll tell you about the 'good times', the 100-120 hour weeks, the 48 hour shifts without sleep. Strangely, most of them will tell you they enjoyed it in a sadistic kind of way. Not because they get a kick out of working more hours than there are in a week, but because of the experience they gained. Most doctors will tell you that on call, during the night is where they learnt the most.


Lets consider for a second Mr Bone, a consultant orthopaedic surgeon. He became a consultant within about 11 years of graduating from medical school. When he qualified, he worked 100 hour weeks as a house officer and similarly throughout his training. That is about 50,000 hours or so of training.

Next, lets consider me (or equally one of my colleagues) who, having studied a PBL course doesn't know all that much to start with. If I were to become an orthopaedic surgeon about 11 years after qualifying having worked no more than 48 hours a week. I would have received about 25,000 hours of training. About half that of today's consultants. It certainly won't be considered acceptable to double the length of time it takes to become a consultant and so we're left with one scenario.

In 10, 15, 20 years time, the 'consultant led' NHS is going to be staffed by doctors with roughly half the amount of training their predecessors had.

Who would you want to replace your hip?

Random Musings For a Sunday Morning

- This year it was my turn to pick the winner of the Grand National. (About bloody time too I've not won owt for years). As comply or die romped home I was cheering at the TV, as I tend to do when I get a little overexcited. I was very pleased indeed to collect the best part of £100 of winnings.

- Bring back winter! At least on those dark, cold, dreary mornings, you can lie in quite happily and sleep until your heart is content. I was really looking forward to a lie in this weekend but on both days we've been awake well before 8. Its ridiculous, I've not had a lie in for weeks! It doesn't help when you have curtains that may as well not even be there they lot so much light through. It feels like daytime but its so early and I just want a lie in now and again! Is it really too much to ask?

- We're going to Glastonbury!! Just got tickets! It'll be the last time we get such an open opportunity to go so we thought we'd better make the most of it.

- Pancakes for breakfast. Yum Yum Yum. Now if only I had someone to deliver my Sunday Times...

The Student Becomes the Master

(I wish)

This week a friend and I took it upon ourselves to teach the 4th years. It is approaching the end of the year and therefore exam time for everyone. Thursday afternoon a group of about 15 or so 4th years assembled themselves in the skills lab to be taught obs and gynae for OSCEs. I was taken a little by surprise and consequently hadn't prepared. I ended up going over breast exam, pelvic exam and pregnant abdo exam all from memory. I think it turned out quite well, although who knows what the students thought, it was also very useful revision for me as I learnt things from them too. As you'd expect, they were more interested in what stations had come up previously and any hints and tips for the exam. I tried to emphasise the important things and even collected a list of email addresses to send round some resources.

Today I was slightly more prepared in that I'd read what I was supposed to be doing and prepared handouts. At half 12 there was hardly anyone there but 5 minutes later a group of 20 or so had appeared expecting to learn about orthopaedics and neurology. We split them into two and I took half to 'teach' them cranial nerve examination and neurological examination of limbs. My cranial nerve exam was a bit rusty but again I hope they found it useful, certainly they seemed quite pleased with the handouts which out to make up for any gaps in what we'd taught. In the end we ran out of time so I didn't get chance to go through everything with the second group and by now I'd run out of handouts but lovely person that I am, I took all their email addresses and promptly sent a copy to those who'd missed out.

And so, the students had become the masters. Albeit masters in the very loosest sense of the word. It was more going through the examinations together and pointing out where each other had gone wrong. Nevertheless, teaching this was and a sparkly certificate I shall get. Not only was it good revision for me, I enjoyed the experience. It was refreshing, if rather more difficult than I thought it'd be, to teach other people. The students were quite willing to learn and I wasn't short of volunteers which made things easier. I've never really been a position where people are expecting me to teach them and I did quite enjoy the whole thing, I just hope it was useful for them. I can certainly see why people are obsessed with feedback forms, having done these sessions I can see how difficult it is to assess how useful a session is.

Oh well, I'm sure they at least found the handouts useful.

I look forward to being able to do some more teaching in the future. Apart from surgery, medical education is another interest and I hope to be able to pursue that further.

Surgical Consult

Without a doubt I want to be a surgeon. There is nothing else in medicine that inspires me like surgery. I realise that medicine and surgery might be considered separate entities but you get the idea. Medical specialties just don't press my buttons, I much prefer the blood and guts (particularly relevant to lower GI which I'm doing at the moment) world of surgery. Surgery has the tools and gadgets which I enjoy playing with so much, it requires focused attention to detail with which I'm slightly obsessed.

I spent the morning (and most of the afternoon) elbow deep in bowels, I realise this might not be everybody's cup of tea but I was fascinated. Even when not scrubbed up I can quite happily just sit (standing and watching gets ever so slightly tedious) and watch. I learnt today that my back muscles are going to need some work if I'm to fulfil my ambition. The other thing that I'll have to work on is my anatomy, I've said this before and I really resent not being taught any useful anatomy. I suppose I shouldn't be surprised, we've not really been taught anything, I had to go elsewhere (and pay) to learn how to suture, God knows what else we've missed out on. If I go on and pass finals, I'm determined not to waste my last ever summer and in between much computer game playage, I will learn some anatomy.

I don't know which surgical specialty appeals most at this stage, although I've always had a soft spot for orthopaedics. To be honest, I'm not really bothered, as long as I get to cut people up (when they're still alive I should add) I'd be happy.

Who knows whether I've got what it takes but with little else that inspires me I'm determined to try my bestest.

Interesting Research

I missed this in the news a few weeks ago but was reminded about it over the weekend. Slightly worrying.

Liverpool and Manchester - pioneers of PBL in the UK.

A Fitting End

Contrary to the title of this post, it isn't a story about rectal diazepam.

Tomorrow heralds the start of my final 4 week hospital placement: lower GI surgery. Rather fittingly, this is the same as my first ever clinical placement at the start of 3rd year (I wonder if the consultant will recognise me?). I wonder how much I've learnt and how far I've progressed in that time? Hopefully quite significantly! How much time I'm actually going to be able to devote to this placement I'm not entirely sure as I have an ever-growing list of other things to attend. I hope to spent most of the time with the F1 (fingers crossed that they'll be friendly and helpful, although its all change next week anyway as the F1s rotate).

The fact that this is my final placement means a couple of things: the first and most important thing is that finals are just 6 weeks away, secondly, in seven weeks it'll all be over one way or another, thirdly, that I have 4 PBL sessions left EVER and finally, that in 6 weeks I will hopefully never have to set foot in a certain city ever again!

To be perfectly honest, I wish finals were tomorrow. I just want to do them and get them out of the way. Sure 6 weeks is a long time and I've still got lots to learn, never mind revise but I'm awfully fed up of just waiting for these exams to come.

This weekend I attended the medicine version of the revision course I wrote about 2 weeks ago. It was a completely different style to the surgical one in that it concentrated on exam technique more than knowledge but it was useful nevertheless.

Vein Hunter

I'm a vein hunter. No, not an assassin of those with Narcissistic tendencies, but instead a pursuer of veins. My time in A+E has turned me into some sort of sadistic predator. My chosen weapon is a venepuncture needle. I stalk, like a cheetah on the savannah, just waiting for the chance to pounce. Every patient is a potential victim, but each with their own particular characteristics. A young man with magnificent engorged vessels entwining his arms - it would be almost too easy to swipe two bottles. Or you’d think so, until he begins to whimper in desperation, "I don't like needles", but it's too late I think, as the blood begins to flow and I reassure him; "almost done". A middle-aged man with similarly bulging veins, barely even flinches as my weapon penetrates his flesh with the greatest of ease. But these examples are like feeding meat to a crocodile, it is too easy, where is the fun, the challenge, the adventure?"

Go and bleed the lady in 9" my heart flickers, slightly nervous knowing that the 86 year old's veins are likely to be buried deep. This is more like it, I think to myself as I cleanse my hands in the ritualistic sacrifice of bacteria. I assemble my weapon and approach, pausing briefly to introduce myself, a mere interruption to what lies ahead. I strap on my tourniquet and begin to look for a potential victim. Like rabbits hidden in a burrow there is nothing, not even the scent of prey. I ask the patient to squeeze her hand while I gently feel my way around. Still nothing. Am I to fail at the first hurdle? I retrace my steps, carefully examining for the hint of blood streaming through a vein, hidden deep. YESSS! What's that, invisible to the eye and barely palpable, the mere hint of a vein? My fingers tell me its exact position and I load the needle. It is time.

Majestically, I recheck the vein, I panic as momentarily it's gone, but no, there it is. Oblivious to the world around me, I almost fail to hear the elderly lady announce "the district nurses always have trouble, they can never find any blood" - this just encourages me! I get into position, needle poised, "sharp scratch" I announce as I ease forward through the skin. With practice you can feel the needle puncture the vein, you think it's there. You ease back the syringe plunger and without delay a gush of red pours into the tube. You've hit the jackpot, first time too, perfect - but it’s not over yet. You've got to change the tubes, keep the needle perfectly positioned and finally, withdraw the needle. All in all a triumph, a perfect hit, another victim.

It's become a game, no longer challenged by the simplest of veins, only the difficult ones give the same satisfaction, the same feeling of achievement, the same buzz. I'm a vein hunter!

Reacting to Unexpected Situations

I've been in A&E for a couple of weeks now and you can never predict who or what is going to come through the door next. It could pretty much be anyone, from any background with anything wrong with them. You can't foresee every possible situation you might have to deal with.

What happens when its not something clinically relevant, but it surprises you nonetheless? For example what if a patient, during the middle of a consultation, says something unexpected? What if they go on a 5 minute racist rant about the state of 'our' country? How do you react to something like that? Particularly as a medical student, but even as a doctor or nurse. You can't possibly sit there and agree. At the same time you can't really challenge the person's views, that isn't what you're there for. So, do you just sit there politely and let them rant until they can rant no more? Do you look at your shoes, at the patient, at the wall? Do you make your excuses and leave? Is there a difference if your patient is a 30 years old or 90? Male? Female? What about afterwards when you have to present the case to a senior and the only seniors around are of a different race? Do you warn them of the patient's beliefs? Do you pretend you'd not heard anything? Do you go for an early lunch?

Being a doctor is much more than dealing with clinical situations.

What Next?

I'm not usually an ill person, sure I get the occasional bout of man flu once or twice a year but other than that I'm usually quite healthy. That was until this year, I've been ill almost constantly since before Christmas with one thing or another.

This weekend I was struck with a mysterious vomiting bug! It only lasted about 36 hours or so but I'm still feeling the effects now. Vomiting is not fun, especially when there is nothing left to bring up apart from tiny amounts of water that you've managed to drink to keep you hydrated.

I'm thoroughly fed up of being ill, it is quite literally, driving me insane!

What is wrong with me?

A Vision of Revision

I've spent this weekend camped in a lecture theatre at a finals lecture course, not only that, I paid for the privilege. At £95 a weekend, its not cheap, especially when there is one for surgery and one for medicine. I guess whether or not they're worth it is a personal opinion, perhaps sitting at home reading a book would be just as effective and £95 cheaper for some people. A few thousand students each year attend one of the finals revision courses run by companies like the MDU so there must be something about them that makes them popular, perhaps its the misguided vision that attending such a course is a one-way ticket to finals success. I'm not as naive to think that and if anything this weekend has made me more scared than I was before.

You do get comprehensive notes but its a bloody expensive text-book! The lecturer, who was a most charismatic surgeon from Imperial, must do rather well financially out of the weekends although he does have to give up 5 or 6 weekends each year in order to lecture around the country. He didn't strike me as someone who was doing it for the money, he seemed passionate about teaching which is perhaps what made it so good, he also seemed like quiet the high flyer and had accomplished rather a lot for his modest age. He was adamant that it shouldn't be just a session about finals and paid more attention to things which will be useful if we actually get through finals to our foundation years. His lecturing style was very clear and concise with the occasional humorous anecdote to keep us all awake. He did well, lecturing by himself, to keep my attention for 2 whole days. It was odd being back in a lecture theatre having not had a proper lecture for almost 3 years (not that we had many lectures before that). There were a number of comments from the audience, made up of students from various Northern medical schools, about a percieved lack of knowledge. Without saying it explicitly, the lecturer was rather critical of some of the modern medical education methods, there was no shortage of students who agreed with him either. Many students, and not just from my medical school, are worried about serious deficiencies in their knowledge. I imagine medical students have always been worried about how much they know as they approach the end of the course and I suppose you might say its as much the students fault as the universities - but is it though? Not in my opinion, I recognise the importance of self-motivated learning, but there is a different between being self-motivated and having to teach yourself EVERYTHING! I could sit here and rant about things as I've done so in the past, but I won't, I'll leave it there but I really wished I'd been lectured to a little more in the last 5 years!

It is no wonder such intensive revision courses are so popular with a promise to prepare you for finals and personally I think it was worth every penny. I've learnt a lot and revised a lot over the last couple of days. Admittedly I missed my lie-in and doing physiology on a Sunday morning is not something that I particularly enjoy. One of the things I've realised is that there are more important things than finals, what about when we actually become doctors? It isn't going to matter who knows about Landau Kleffner syndrome, its going to matter who can actually deal with patients and who is competent.

Flipping Shoes

This is a picture of our living room floor, you might thing its staged, but I can assure you it isn't! This is just the normal state of our house. There are no less than 7 pairs of shoes here, all of which belong to missbliss. This colossal mountain has accumulated over a matter of days! How many pairs of shoes does one person need to wear in a few days?! Never mind have immediately available on demand in a pile on the living room floor. I don't think I've worn this many different shoes in the last......well..... ever!

Hopefully I'll make it out of the house today avoiding the huge obstacle that is this pile of shoes.

"There is a 3:38 in Bay 5"

Having spent a few days in A+E, it is already immediately obvious what the most important thing is. Wouldn't you think that in 2008 the central focus of care in the A+E department would be the patient? It isn't the nurses' fault, nor the doctors', both of whom work very hard to ensure patients receive the best care possible, but there is something more important on their minds. What can be more important than the patients I hear you cry with horror? I'm sure most of you have guessed by now: the 4 hour target.

The 4 hour target effectively means that all patients presenting to A&E, regardless of what is wrong with them, must be seen, assessed, treated and shipped out (either sent home or forwarded on to another department) within 4 hours. This might seem like a good plan, and well, it is wonderful that nobody has to wait for more than 4 hours before they see a doctor, but unfortunately every patient is different. You can't shoehorn all patients with their vast range of problems into the same 4 hour bracket. Things just don't work like that in real life.

Sometimes it is easy to see, assess and treat patients within 4 hours. But in a fair number of cases, and particularly on a Friday or Saturday night, this is simply not possible. Or rather, it isn't possible to assess patients properly and provide the best possible care. It really shouldn't matter how long it takes, it should matter that it’s done right!

Patients are no longer known by their names, or even by their conditions any more. At best they might be known by their location – “bed 5” - but more often than not patients are referred to by a very special number. This number tells you how long they've been in the department. Displayed prominently on an electronic whiteboard is a list of all the patients currently in A&E and waiting to be seen, and the second a patient ticks past a 3 hour wait, their name lights up like a Christmas tree in bright red. If their stay approaches 3 hours 30, then the managers start to appear from their hidden lair (where I imagine they must watch intently the time spent in A&E by each individual patient). Of course they don't actually care in the slightest about Mr Jones who is having a heart attack right there in the department. The fact is, they are there to remind you that he has got to go. Wherever it may be. As long as its not A&E, and as long as it's not their problem any more. If you even mutter the word 'breach' (the description of those who miss the 4 hour target) in the vicinity of the A&E department you'll either be shot, or smothered in managers eager to find out what you know and what they can do to stop it.

In my few days in A+E I've already seen patient care put at risk due to this target. To me this is ridiculous, in fact, it's beyond ridiculous, it's dangerous. I imagine this target was thought up by someone in an office somewhere who'd not been near an A&E department since getting a little too drunk one night during their Philosophy degree. That is the problem with these things, they're dreamt up by people who haven't the faintest idea about how they will work in real life. Targets, targets, targets is all anyone seems to care about these days, forget the patients in hospital, they don't matter. I'm sure it makes wonderful headlines and prodigious soundbites for the government. Which voter wouldn't want to see "A&E Waiting Times Down!" plastered across the media? And there we have it, as much as the government, it's the fault of masses who demand reassuring statistics and some of the media, who leave only a few huddled words below a headline that hits the reader between the eyes. We need our journalists, and the voters, to look beyond headlines and ask, “waiting times might be down, but at what cost?”

A & E

So today, I finally made it for my first day in A&E, admittedly I was a week late thanks to being ill but I was glad to have made it eventually. Only then did I realise that my supervising consultant was in fact on leave all last week and is on leave all this week too so he doesn't yet know I even exist let alone that I was off all last week. His secretary had received all my messages and was pleased to see that I seemed to have recovered satisfactorily. I've been in the department before as a student so I had the briefest of tours of the department before being seconded to on of the FY2s. It is safe to say that as a student in A&E I stand out like a sore thumb, or perhaps more like a large grey blob in my beautifully coloured grey scrubs. I'm not sure whether or not they got a really good deal on awfully coloured scrubs or if it is intentional that we stand out quite blatantly so as not to look anything like we know what we're doing and we can be avoided at all costs.

Anyway I was promptly given my first majors patient and sent off to see them. The FY2 who was a bit cranky having done 8 days straight including a couple of 12 hour weekend shifts was very friendly indeed and not once made me feel in the way which is always a bonus. And so the morning continued and before I knew it lunch time had hit, although I didn't take all that long for lunch and was soon back on a now hectic shop floor. Things soon calmed and organised chaos was restored.

I didn't see any particularly interesting patients, in fact, it seems like the local GPs couldn't really be bothered this morning and had sent everyone to A&E. I was pleasantly surprised to hit some veins first time, although one 21year old almost collapsed after I'd finished with him. I enjoyed my first day, it wasn't too taxing, I learnt things and got in some good practice. I'm looking forward to the next 3 weeks...

In 30 Years Time...

Technology fascinates me, maybe its because I've grown up with it but I've always felt affectionately towards it. In some ways it fascinates me more than life itself, what is a few billion years of evolution compared with with the technological advances of the last 30-50-100 years? Sure evolution is pretty dam clever but the technological revolution which allows me to type this and instantly have potentially millions (or, more realistically, about 30 - I can dream...) of readers is simply staggering.

Can you possibly imagine what the next 30-40-50 years hold in terms of technology...what about beyond that? Where are the limits? I'm sure some of my older readers can remember a time when there were no computers, no Internet, no CD players, no mobile phones. Of course now my mobile phone does all of that and a whole lot more. With my mobile phone which is smaller than a pack of cards I can calculate my exact position on the Earth using GPS, find out where my nearest book shop is and navigate my way there. When I get there and I've forgotten the name of the book I'm looking for I can use the Internet on my mobile phone to check, then, if they don't have it in store, I can order it over the Internet there and then and have it delivered to my door. I can do all that whilst listening to my entire CD collection and taking pictures of myself at the same time! Why I would want to do any of that when I could have ordered the same book online at home without any of that hassle is beside the point - I do it because I can! Oh and I suppose I could mention I can use my mobile phone to make phone calls too! I remember when my dad got his first mobile, he was quite an early adopter for business reasons, you can buy cars smaller than the phone he had back then and all it could do was make calls, sometimes. Nevertheless I was fascinated and of course I instantly knew everything about it before well before he did. Now, almost every person over the age of about 10 (although many younger people have them too) has a mobile phone which makes everyone almost instantly contactable. The pros and cons of this are another post in itself but as technological feats go its gigantic (the instant contact breaks down a bit when people have their phones tucked in the glove compartment for emergencies only *cough* older generation *cough*). It is almost impossible to imagine going back to a time pre-mobile phone, young people today cannot possibly imagine a life without it how would they possible communicate 150,000,000 sms messages worth of information per day! That is just in the UK, an average of nearly 3 messages per person every single day! Extraordinary.

The mobile phone is just one example of the technological revolution but what is the most important? In my opinion it is the Internet, not only the Internet itself but much advancement has been brought about because of the Internet. I know, that right now, I can find out almost anything I want or would ever need in about 10 seconds using Google. I can buy almost anything, I can download and listen to almost any song ever made, I can chat to people on the other side of the world.

I'd never imagined a life without technology before our Summer trip to the Solomon Islands but even there, in one of the most remote places on Earth technology is slowly creeping in. Its a long way behind and the people of Lata are a long way off plasma screen TVs and mobile phones which access the Internet, in fact, these things may never make it there - perhaps they don't need to. I couldn't live like that knowing what I do now about the world so if I ever do emigrate to the jungle I'll be taking the biggest possible satellite dish a mountain of toys. Technology is what I missed most about the developed world.

I can spend hours reading about technology, studying my favourite magazine T3 is one of my favourite things and the first blog I usually check is Engadget. If I could muster the same enthusiasm for studying, I'd never have any motivational issues. The kick of adrenaline I get when researching a new gadget purchase is only super seeded by that of opening the box and reading the instructions. Many would call it sad, I'm sure, but to me its a hobby, apart from missbliss, technology is what I live for. I love it.

Metaphorically, technology runs through in my blood, it probably won't be long before that metaphor becomes literal as nanobots sweep through my veins zapping cancer cells as they form. I know it sounds like science fiction now, but what about all that we've got now? That was the science fiction of 50 years ago. I can't wait to see what happens during my lifetime I don't think any of us can imagine some of the changes to come in the next 30 years never mind the next 100 or 200.



N.B. I recently bought myself a TomTom 520 GPS Sat Nav system for adventures ahead in new places. Whether this was the inspiration for my declaration of love to technology I don't know.

I'm Improving - just a little

You'll* be pleased and relieved to know that I'm improving.
*I know some of you won't, but still.

Its slow though, I'm taking my Pen V religiously and I think its probably that which is helping. Having caught sight of my tonsils I've decided I probably have tonsillitis with a bit of sinusitis thrown in for good measure. I'm thoroughly fed up of being ill but I want to get right, which I'm still significantly far from, before I venture back into hospital. As a result I think this week has been a complete washout, rain-stopped-play!

I did the washing up this morning, something which is usually a something and nothing job, there wasn't even a lot of it but it almost killed me. Half way through I was fighting exhaustion, pain and hotness and clinging on by the skin of my teeth. I purposefully sprayed the cold tap at my face on several occasions to prevent me collapsing. After the mountainous load of a few cups and plates I couldn't face the the pan and promptly went to bed, collapsed and fell asleep for about an hour, I was absolutely shattered, it was like I'd run 7 marathons in 7 days.

I've also started to eat a little bit, which ought to improve my energy as for about a week I've had a bit of scrambled egg and a bit of toast. I'm wasting away. I even refused fish and chips last night and that is NOT like me!

I'm looking forward to hopefully (crossing fingers, touching wood and praying) feeling better next week when hopefully I'll have something more interesting to blog about than my temperature and mucus.

Poorly

I'm so very poorly and its driving me fucking insane! This year so far, I've had more illnesses than I've had in my entire life.

WARNING GROSS DETAILS BELOW FOR THOSE OF YOU WITH A FRAGILE DISPOSITION

For the past 3 months I've had sort of a chronic sore throat, except its not actually my throat its more my nasopharynx (the bit above my throat) It was more of an irritation than anything most of the time with a feeling of sticky mucus I needed to clear. Sounds a bit like PND (post-nasal-drip) right? well yeah, that's what the doctor thought that I saw about a month ago. Unfortunately that night I awoke with a raging fever and was ill for a good few days, my throat became acutely worse, was painful to swallow, I felt generally like shit, had a headache, was clearing some greeny mucus from my nasopharynx and had a few days off. I couldn't get a doctors appointment and I improved but was left with the same chronic PND like symptoms, I checked myself out for malaria and glandular fever, both were -ve but I did have some raised white cells.

Last week I awoke with the same fever- even with the same accompanying dream. By this time it was starting to drive me slightly crazy. The symptoms got worse and worse over the weekend and I finally got to see a doctor (I basically had to crawl there feeling atrocious) He didn't have much of a clue but agreed that it might be time for some antibiotics so gave me some penicillin.

So what were my symptoms? Fever, vomiting, Very painful swallowing (but I don't think in your typical tonsillitis type way) Lots and lots of mucus I had to clear which was green and brown (clearing this did offer mild relief), foul taste in my mouth, being barely able to talk due to throat, sinus headache and feeling generally like shit.

Things do seem to have improved in the last day or so with the antibiotics in that my fever and generally shitty feeling have gone now but my throat/nasopharynx is still ridiculously painful and is producing lots of mucus which since the antibiotics has become black and reddish. Drinking cold water relieves my throat temporarily, I must have drunk litres and litres of it this last week.

I've been taking loads of paracetamol and decongestants as well as my penicillin which is helping too, at least to make the mucus a bit less sticky. missbliss has been looking after me but all I've managed to eat is a bit of scrambled egg.

I've missed the start of my A&E placement which I'm really pissed about as it only 4 weeks and i'm probably going to miss about a week of it. I was really looking forward to it too. I'm thoroughly, thoroughly pissed off with life at the moment.

What the fuck is it and how do I get rid of it for good?

Tonsillitis?
Sinusitis?
Something else?

sorry for not blogging recently
This illness is DRIVING ME BLOODY BONKERS!

The GP Inside

This week was the last of my 8 week community (GP) placement, given that my foundation years don't include a GP placement I might well have spent my last days in a GP.

When I started medical school the one thing I was sure of was that I didn't want to be a GP - under any circumstances. I'm not entirely sure why I felt this way, but I was determined, despite the fact that about half of us would ultimately end up as GPs, that I would pursue a career in hospital medicine. During my first GP placement in 3rd year my opinion changed for a few short weeks but this was mainly due to having a brilliant GP supervisor rather than me uncovering a hidden love for coughs and colds. My 4th year GP placements only reinforced my original thoughts that general practice wasn't for me. I was therefore dreading 5th year and its 8 week stint of general practice. 9 weeks ago, I was looking for any excuse to avoid as much time in GPs as possible, I volunteered for every meeting possible to avoid a morning or afternoon here and there. In fact, I'd rather have spent 8 weeks tied up, naked, covered in scorpions.

Why is it then, that I sit here 8 weeks later, rather sad that my time in GPs is over? Maybe its the dictaphones (I'm still not bored of them), or maybe its a new-found love of general practice. Perhaps love is too strong a word, but I've definitely mellowed towards general practice. Not so much that I'm not destined for a career as a GP but I can certainly see why the lifestyle appeals.

I've thoroughly enjoyed this 8 week placement, helped by the fact I was at a nice practice with a lovely supervisor but I think its more than that. I enjoyed having my own surgeries, my own patients and my own room, its a rather nice feeling when a patient comes back to see you when they're feeling better. Maybe its the novelty of having my own patients that made the experience so interesting and useful - a novelty that would rapidly wear off as 'heart-sink' after 'heart-sink' patient knocks on the door and sits down with a list.

I've learnt a lot in the last 8 weeks and it will undoubtedly be useful when I'm in the position of looking after my own patients in hospital.

I'm still fairly sure I don't want to be a GP but I can see it definitely has its benefits, and perhaps I shouldn't rule it out to the extent that I did before I'd even started medical school.

Next we have 4 weeks in A&E, something which i'm really looking forward to. So begins the last 8 week block of 5th year, where has this year gone?

If A Job's Worth Doing

I thought I might reflect a little more on my job allocation.

Already facebook is full of groups, one for each deanery with splinter groups now forming for each individual hospital. This means that not only can I spy on what other people I know are up to but can also see who my colleagues are likely to be come August. I'm not sure whether this is a good thing or a bad thing, it means I’ve already pre-formed opinions on some of those I’ll be working with, but the groups are useful for sharing information (something which there is a significant lack of elsewhere).

The allocation process itself was interesting to say the least. I can't decide what to think about the whole thing but I'm surer than ever that it’s more of a lottery than anything else. When the whole process started I was quite apathetic towards the whole thing, I thought it was probably the best of a fairly bad idea. Once I got my score (from application form and academic ranking) I was still rather apathetic, I did muster some feeling when I asked for the individual breakdown of my score (so the score I got for each question on the form - still with me?). There is something quite bizarre about my individual question scores but I shall say no more about that here. I submitted my ranking of all 300 or so jobs, without much expectation. I wasn't particularly bothered about what I ended up with. And so, fast forward to yesterday, it was a very pleasant surprise to find a rotation almost perfectly suited to me. Apparently the rotation I ended up with was about 15th on my list (of a total of 300-odd), which I think is pretty good considering I went for probably the most popular ones.

There is only one problem with my rotation in that it is at different hospitals for F1 and F2. There is a significant geographical distance between them which will probably result in more home changes for us and job changes for missbliss which is not what we wanted. Although that is slightly annoying I’d much rather it is that way round with a good rotation than have a bad rotation at the same hospital. Other than that, my rotation is almost perfect - the only other thing I could have possibly wanted was a gastro placement rather than renal but I’m not complaining in any way, shape or form.

Amazingly I avoided psychiatry - what a result! I also avoided obs and gynae, GP, geriatric medicine, breast surgery and a multitude of other things which I have no interest in what-so-ever.

I'm by far most excited about the F2 year with A+E, Orthopaedics and Paediatrics. (If they change it, I WILL scream, shout, cry, etc, etc. I guess the next job will be to decide what career I want to pursue. Shitters.

It seems that I was lucky in this lottery (makes a bloody change) and I’m really looking forward next year, to a new place, to new people, hell, I’m even almost looking forward to finals in a sadistic sort of way.

Pretty Damn Pleased

After much pressing of 'F5' this morning the job allocation suddenly appeared. At first glance all you could see was a code which unless you'd memorised the list meant nothing.

On checking what the code actually meant, I was pretty damn pleased with my foundation jobs. I will be moving hospitals between F1 and F2 unfortunately but the rotation is pretty perfect.

So, what am I going to be doing? Well....

F1

Renal Medicine
Vascular Surgery
Acute Medicine/Surgery

F2

A&E
Orthopaedics
Paediatrics

The F2 year suits me perfectly, I couldn't have wished for a better year. The F1 year is more generic and i'm less excited about it but its still pretty good. I'm slightly worried about starting out on renal medicine as I've never done any renal and know next to nothing about kidneys. I'm also not entirely sure what acute Med/Surg is.

So it seems that the foundation lottery has been quite generous to me. Wahey. Hope everyone else got what they were after.

Now I just have to pass. Arghhhh!

J-Day

Today is Job-Day. Or at least it's supposed to be, wouldn't surprise me if it was postponed.

I thought the results would be puiblished at midnight - they weren't and are still not there as yet.

I hope the site will cope under a barage of 'F5' presses.

Watch this space....

"Not The End Of The World"

Today we had an all day communication skills session. Sounds like a real barrel of laughs eh? Even more so when it’s about terminal cancer and dying! There was an interesting start to the morning, as an icebreaker exercise (despite being in the same groups in previous sessions and having spent the last 2 and a half years together) we had to pretend to be QVC presenters in pairs. This provoked much eye-rolling, not only by me but most of my colleagues and there were understandably no volunteers so I volunteered the tutor to go first. To be fair, he did, and he showed it how it should be done. So, in turns we spend 5 minutes trying to sell ridiculous objects that the tutor had brought along ranging from a Cliff Richard CD to 2 self-help books on parenting. To start with I thought this exercise was pointless and ridiculous but when it came to my turn I was actually quite enthusiastic, unlike my partner who looked like she’d rather be dancing naked on the town hall steps. Our ‘item’ was an original artwork (a collage concoction put together by the tutor’s daughter I think). I actually had fun trying to sell this fantastic piece to my audience who were at the ready with their phones and credit cards. It was mentioned that perhaps medicine is the wrong career for me and that I perhaps have a future with QVC.

Anyway, from there, the day got more depressing as it went on. The case ran all day with a series of simulated patient sessions. By early afternoon the ‘patient’ had taken a turn for the worse and didn’t have long left. I was lucky in some ways when my scenario came round. The patient’s son had come from London and wanted to talk to me, the F1, about his father’s condition. This made it fairly easy from my point of view as all I had to do was not tell him anything because of patient confidentiality, of course I had to tell the son this and empathise at the same time. All in all, it was quite successful despite me refusing to tell him anything – I think we had quite a nice SP (simulated patient), others might have shouted at me. I felt a bit sorry for the poor chap who drew the short straw and had to tell the son that the patient had died – the SP was very good and promptly broke down there in-front of him. “Not the end of the world” was perhaps not the best phrase for him to use.

I can never really decide what I think about communications skills. I really like the simulated patient aspect and actually learnt quite a few tips today. We had a pretty good tutor who didn’t drag things out too much and was quite concise. The simulated patient sessions are very useful experience indeed and in a sadistic sort of way I enjoy doing them myself (not quite enough to volunteer openly though). I think they’ll come in useful in reality when we face some of these situations in the real world. I just hope I remember some of the tips I learnt. My feedback was generally good and the tutor was surprised when it was announced that I wanted to be a surgeon. Apparently surgeons are generally lacking in the communication skills department.

The sessions can be quite voyeuristic as you’re sat there looking into the lions den, watching as one student acts out a scenario being critiqued by all those around. Sometimes it goes well, others, things can go a little wrong. It’s rather obvious who’re going to be the best communicators come August and it’s not always the ones you expect. I was pleasantly surprised, if not shocked, at how good some people were and nobody was really bad. I wonder, will those with better communication skills be the better doctors?

Old Enough To Be Your Doctor?

The only reservation I ever have about university (apart from the atrocious error of judgment in choosing this particular one) is that I was too young when I started. I was barely 18 (only by a couple of days) when I started the 5 year journey of university. I've always been one of the youngest in my year and I’ve always wondered what would have been different if I’d been in the year below. Children's lives are defined by their school year group and there can be up to a year between students in the same groups. I started school at the age of 4 although I was allowed to fall asleep in the corner in the afternoons whilst the older children were kept awake! I wonder how long it takes for the August babies to catch up with their September friends - is there even anything to catch up? I'd say so - 1 year is a long time when you're 4 or 5! I always enjoyed being one of the youngest in my year at school, especially when it became clear that I was cleverer than many of those around me (how arrogant is that for a child?!)

Anyway, back to topic. I started university and was among the youngest around, in fact, I’ve never met anyone younger than me in my year - although statistically there must be some people younger than me (don't Scottish school years differ anyway?). I was surrounded by people who'd taken gap years and traveled the world, people who'd already done other degrees or people who already had entirely different careers but fancied a change. I was mature for my age, but compared to the people around me, was still relatively immature. I'd toyed with the idea of a gap year but for various reasons decided against it, I wonder now if it would have made any difference to my time at university. I don't regret not doing so, I just wonder what would have been different. Fortunately we've had the chance to do some traveling and it was great, I’m hungry for more.

I remember thinking when I started that I'd still be one of the youngest in the year group 5 years later when we all became doctors. Now that prospect is getting ridiculously close. Others around me have done intercalated years, resit years, or were just older when they started. So come August (pending finals) I’ll probably be one of the youngest out there, there is a high probability that I’ll be the youngest in the SW deanery what with 6yr courses, intercalation etc etc. Personally I think that’s quite cool, I’m not sure the patients will though. I think I look about my age so I’m certain I’ll get plenty of comments about being too young to be a doctor, behind my back mostly I expect. It doesn't bother me, they're probably right. Who would you want to be treated by? The 35 year old doctor who spent 10 years as an accountant before deciding on a career in medicine or fresh faced me who'll still be 22.