Kidneys - What Do They Do?

As finals are approaching fast, we're having a series of revision sessions from consultants. Yesterday's we had 2 hours on kidneys. This seems to be a notriously neglected topic by medical students, at least at my medical school. I remember back in 1st year we had a PBL case on the kidney and we were supposed to learn EVERYTHING about the kidney in a week or so with no support lectures whatsoever. I gave up before i'd even began and along with many of my collegues ended up neglecting the kidneys entirely. Fast forward 4 years to last night and this revision session was more like a first-vision.

The session itself was very useful and I feel that I learnt quite a lot. If only we'd had lectures on the kidney 4 years ago... perhaps PBL wasn't the best choice for me. I have an amazing ability to remember stupid facts that i'll probably never need to know, this is at the expense of remembering useful concepts. I haven't got the foggiest idea about renal physiology, I just about know my proximal from my distal tubule but other than that its just a load of wee.

I can tell you how many people are waiting for a kidney transplant and how long transplants last
(god knows why I remember that!) - but I can't tell you anything about ADH.

I've decided to pretend that kidneys don't exist - its much easier that way. I guess a career in renal is out then.

A Lesson in Ethics

Today's communication skills session was on ethics, it was a useful session and brought up some interesting discussion. Its also a potential OSCE station for finals so it was useful in that respect too. The session was based around simulated consultations and I thought I'd share some of the cases with you to get your thoughts and opinions.

1) You are an FY2 in GP practice, an elderly patient's relative comes to see you. They are concerned that their elderly relative is unfit to drive. They would like you to contact the DVLA.
The elderly patient does not see that he has a problem despite arguments with his relatives and is reluctant to come and see you.

What do you do?

2) Last week a pregnant young woman came to see Dr Pickles at your practice with PV bleeding. Today, her sister has come to see you to complain that Dr Pickles did an internal examination on the pregnant woman without informing her that he would do so and without having a chaperone. The sister is also concerned that this internal examination may have led to the patient having a miscarriage later that day.

What do you do?

3) You are an F1 on the ward, a patient comes to you and reports that she just saw a more senior doctor "sniffing a white substance". She is reluctant to make a written statement or to follow-up the complaint, although she is very concerned.

What do you do?

4) You are an F1 on the ward. A social worker has asked to see you about Miss 'Caine, unfortunately Miss Caine discharged herself earlier that day and her whereabouts are unknown, you hope her GP will persuade her to return. Miss Caine was an IV drug abuser who has Hepatitis B. The GPs referral letter mentions that Miss Caine's 13yr old son, Tom, has Hepatitis B. As far as you know, Miss Caine, and her son, may or may not be aware of this diagnosis. Tom is currently in social services care, he is in a house with 2 other children and has been known to bite in the past. The social worker wants to know about Miss Caine's care and about Tom. She needs to know if he has Hep B and is a danger to those around him.

What do you do?


I ended up having number 4, which was apparently the hardest, fortunately the argumentative simulated patient was away today. I'll post what I said in the comments later.

Answers on a £10 note to the usual address.

Communication Skills

This afternoon we have 4 hours of communication skills, we tend to have 3 or 4 communication sessions scattered througout each clinical year. The sessions do tend to drag a bit but they're certainly not entirely useless. Sessions in the past have included; breaking bad news and dealing with angry patients. They use actors as simulated patients and we each take it in turns to practice situations. This is very useful as it doesn't matter if you make any mistakes or mess up telling someone they're going to die, of course they're not actually going to die as they are actors. But it means that if and when the time comes for you do it for real, you'll at least have some experience of the situation. The dealing with angry patients sessions last year was interesting, the actors are very good and do tend to get quite into their character so it can be quite realistic.

This afternoon's session is on ethics, I suspect this should be quite useful as we don't do ethics at any other time really.

The Patient's Agenda

Any doctor, or even any patient will know that most people go to the doctors with their own agenda. A lot of the time they've got their own thoughts and ideas about what is wrong with them, sometimes they know exactly what treatment they want and occasionally they come in with the intent try and get something out of you which they don't deserve.

Its difficult to pick out these patients unless you know them and their history well and even then you can never quite be sure. Every doctor has their own 'heart sink' patients who persistently visit the doctor with chronic, often vague problems. What is their agenda I wonder? They've already been investigated up to the eyeballs, they've already tried numerous tablets with no effect, and there is little more that can be done. And so, a never ending cycle begins whereby these patients come for regular review, they're the ones that often take 25minutes even though very little can be done.

This morning I had 5 patients, and they all had pretty text book symptoms, they were all there on their own agenda and they had an idea what they wanted. I find it useful to ask what patients are most concerned about - this usually elicits exactly why they've come to see you and so you can actually help, even just by offering reassurance.

Sometimes patients trick you. I've seen this a couple of times recently. Firstly a patient came to see me and when I brought the doctor in to review the case, they denied everything as I presented their history to the doctor. I don't mean just picking up mistakes in my history I mean flat out denying that they'd ever said things to me, they ended up reporting an entirely different set of symptoms to the doctor. Why? Why would anyone do that? It made me look ridiculously stupid. I have an idea about why they did it, but still - bonkers. I seemed to remember this happened a couple of times back when I did psychiatry also, one of the reasons I despise it so much. Another patient came to see me. They seemed very unsure and nervous but I built up a good rapport and was able to find out all about the problem. I'd had a quick flick over the recent history on the computer and noticed a couple of previous visits with the same thing. So, I presented to the doctor who decided that they should be referred and off the patient went. Only after I'd dictated the referral did I take a detailed look at her past history to find that she'd been referred previously for the same thing. Shame that they'd neglected to tell me anything about their past history despite me asking specific questions about it.

So what did I learn today, well I learnt that patients really do often have their own agenda and they're often reluctant to deviate from it, so much so, that in some cases they even lie. How exactly do they expect to be treated then?

Perhaps this post is slightly hypocritical as in the past I've probably been quite selective with the truth to a doctor in order to fulfil my own agenda. That is unavoidable, I know too much about the system.

Bits and Bobs 2

My Portfolio meeting turned into a bit of a lame affair. I managed to waffle on for so long that the dean barely had any time to actually look through my portfolio so it didn't really matter what I had in it although he seemed quite pleased. In the past we've had some interesting debate about the course, PBL and such but yesterday was little more than a relaxed chat. I was left sort of unfulfilled because I usually enjoy moaning although I did manage to get in a few important things which the dean seemed rather concerned about.

New year's resolutions update: Well I'm not doing TOO badly really. Since the 1st of Jan, I've done some exercise and more work than usual. I've kept my car fairly clean but most impressively i've not had any chocolate, sweets, crisps or biscuits - I've almost given in a few times - so much so that I had a bag of wine gums in my hand but I forced myself to put them back. Improvements are still necessary though, more exercise and more work.

I'm still enjoying my GP placement especially having my own surgeries. Although its slightly annoying when people book appointments with me when all they want is a repeat prescription as I can't help them and it only takes 2 minutes.

Not a lot else to say really - will blog again later.

Wherefore Art Thou Portfolio

Tomorrow I meet with the dean at my hospital to review my portfolio. Along with most of my colleagues, my portfolio is something which tends to get neglected until shortly before its due to be reviewed. We've had the idea of a portfolio hammered into us since we started medical school but particularly in the clinical years. I was going to describe exactly what a portfolio is, or is supposed to be, but I can't. I don't really know. I mean sure, I get that its supposes to be a record of your progression, your achievements, your reflection and all that but I'm still not entirely sure what this is made up of. I quite enjoy reflective writing (never thought I'd hear myself say that), that is one of the reasons I enjoy blogging - not that I often do much deep reflection here but you get the idea.

So I'm wondering what else should I put in my portfolio. Perhaps I should just print out my blog although I don't think that would go down too well. Some of my posts might be useful though. Fortunately today is my 'study day' so I've got plenty of time to get my portfolio in order, although saying that its already 11:00 and I've got a million and one other jobs to do today. I will do a SWOT analysis, for those of you who don't know, that is a breakdown of my Strenghts, Weaknesses, Opportunities and Threats. That should be interesting, perhaps I'll share it over at the real little medic.

My portfolio meeting could go one of two ways, it could be an easy half hour chat where I don't approach anything controversial, or it could be a half our discussion about what I really think, I've yet to decide which way to take it. A few people seem to think the dean is a bit scared of me (well not scared, so much as, apprehensive), mainly because back in 3rd year my portfolio meeting (usually strictly half an hour) took an hour as I had a list of things to talk about so long that he never even looked at my portfolio.

I actually think these portfolio meetings are rather important for a couple of reasons. Firstly there is the portfolio, nobody likes to admit it but its a fairly important aspect of being a medic, nurse or anyone else really. Its particularly relevant to medical students and doctors as reflective writing is key to the 'white box' application forms used throughout nowadays. And IF you ever finally get to be interviewed, its always useful to have a good, up-to-date, polished portfolio. More importantly as a medical student, these meetings give us individual time with the dean to express our concerns, feelings, thoughts and worries. I think this is a very important aspect of life as a medical student - but hey, maybe its just me.

I really like the dean at my hospital. Unlike every member of staff I've ever come across affiliated with the university (no offence PHD Scientist - I've never come across you so you don't count) he is actually willing to listen and empathise. He might not be able to offer a solution to things but he'll certainly let you rant away at him (at least he lets me). Sure he has his own peculiarities but don't we all? I know some people don't like him because of this, but I think he's a genuinely nice guy.

Any suggestions for portfolio material are welcome...

Wanted: TLM for Stealing His Own Debit Card

Here is a letter I've just sent to Wetherspoons about today's events.

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TLM's House

TLM's City
January 19, 2008

Dear Mr/Mrs Weatherspoon,

This afternoon (Jan 19th) at approximately 2:43pm missbliss and I, along with a friend entered ..... (a pub, somewhere) What followed was the perhaps the most annoying meal I’ve ever had.

At 2:49pm, our party of 3 was ready to order, unfortunately, when we were eventually served at the bar, there were no burgers. According to your menu, burgers are available all day every day, well let me tell you, that is a blatant lie as they sure as hell weren’t available this afternoon. After returning to the table (number 48 incase you’re interested), and consulting the menu again, I returned to the bar with a new order. This time I was told there was no scampi – what sort of restaurant is this? Having queued up for the 3rd time I was eventually able to order. Then came the part where I am supposed to pay for the meal, perhaps I should have expected that things would not go smoothly. Having handed over my HSBC debit card (at 3:03pm) I was rudely told that “Its been declined, gunna have to keep it”, I was then told that the machine had said my card must be retained, however the rude and unhelpful barmaid would not show me the machine. She did make a very brief phone-call to her manager who confirmed that my card would have to be retained and without anymore information my card was wrapped up and bundled into the till. I was asked for alternative payment, which I gleefully provided the £21.67 in the form of cash (one £20 note and one £5 note, both NOT stolen). I was given no information whatsoever about what would be done with my card (despite me offering an explanation as to why the card might have been declined – in that I’d requested a new card that morning from the bank), nor did anyone ask who I was or if I could provide any identification which I would have happily provided had it been requested.

I returned to my table, rather bamboozled by what had just happened. Realising that I’d just let my card be taken by a complete stranger I promptly returned to the till and asked for the card to be destroyed. Unfortunately the person I’d spoke to previously was no longer behind the bar and I was told that they would come to my table when they returned. They never did bother to return and after eating my steak pie (which I shall come onto later) I returned to the till to speak to the barmaid I’d spoken to originally. This time I was told that they couldn’t destroy the card so I asked to speak to her manager, I was again told that they’d come to my table. The manager, who looked barely old enough to drink let alone manage a pub, finally did come to the table and explained to me that they had to retain the card and that policy dictated it would be sent to “head office, then onto the police.” I would have been very interested to read this policy, unfortunately I wasn’t allowed to. She politely explained that it was “my word against theirs” – what she meant by this I’m not quite sure, she clarified this by saying “if you’d stolen the card, you wouldn’t exactly admit it would you?” I was obviously going to get nowhere with this so I told her that I would phone my bank for their advice before phoning the police to report my card stolen by your barmaid. I phoned my bank and reported the card stolen by Wetherspoons. Following that, safe in the knowledge that my card could no longer be used and having decided not to phone the police because I was accruing car parking charges and didn’t really have the time to wait around for this to be sorted out, we finished our drinks and left.

I can just about understand why my card was retained, but it not being destroyed is an infringement of my personal privacy. My personal card details are now available to anyone, including my account number and sort code. What baffles me most is that if I had indeed stolen the card (which, if it isn’t obvious by now, I didn’t), absolutely no effort was made to clarify who I was by asking for ID, no effort was made to contact the police and no effort was made to apprehend a potential thief. Why even bother to retain the card if you’re not in the least bit bothered that someone might be standing there who could have stolen my card? I would have been seriously pissed off knowing that you’d let whoever stole my card sit there for 2 hours without the slightest effort being made to check who he was. Perhaps that is beside the point, but as far as I’m concerned my HSBC debit card was stolen by your barmaid this afternoon at 3:03 pm. I expect, if the situation is reported to the police by yourselves, then the card will be flagged up as stolen as I reported it so at 4:00pm this afternoon. In which case, the police will probably be interested to speak to me about having stolen my own card. I’ll be more than happy to cooperate with the police as it was in fact, a Wetherspoons barmaid who stole my card.

I wish I could say that is the only problem we encountered this afternoon, unfortunately I can’t. We ordered 2 steak pies, unfortunately one of them was burnt to a crisp. The meat was charred and solid as a rock, entirely inedible. The staff were kind enough to replace this steak pie but only about 35 minutes after the other 2 meals had been finished.

Having queued 3 times in the first place, spending the majority of time trying to sort out the debacle with my debit card and waiting an extra 35 minutes for another pie, we had wasted an extra hour and my car parking charges had escalated to an extortionate £1.80.
Fortunately the good company meant this meal was not an entirely infuriating experience but Wetherspoons did everything seemingly possible to make it so!

I shall not be eating at a Wetherspoons in the near future and I look forward to hearing from the police with regards to the theft of my debit card.
If you require any further information please do not hesitate to contact me either by phone, letter or email

Yours Sincerely,
The Little Medic

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I've not written a good complaint letter for ages - you're probably not surprised that I rather enjoy doing them. Anyway, we had quite a nice day overall.

The NHS is Shit*

You know, anyone would think the NHS does nothing but kill people! A quick look at the Health page of BBC news shows so many negative stories its ridiculous, at the most there are 1 or 2 positive stories (which are usually more about scientific advancement than the achievements of the NHS). We all know there are problems with the NHS and that improvements are needed, after all, there are usually 3 or 4 stories every week in the papers about the failures of the NHS. When was the last time you read something positive about the NHS? What about all the lives saved by the hard working doctors and nurses? I can't even remember the last time I read a story praising the work of the NHS or its workers. People wonder why morale is low in the NHS, the negative picture painted by the media certainly doesn't help.

The NHS should always be striving to improve, if it wasn't it would be a failure. Things cannot be improved without identifying the failures within the system but when these failures are picked up by the media, the onslaught begins. Doctors seem to be easy pickings at the moment for the media, barely a day goes by without reading a story about GPs and their "huge salaries for hardly any hours". What about the good work that the GPs do? Of course we don't hear about this, the media aren't interested in positive things.

Yesterday we heard that the NHS spends £8.2bn on prescription drugs, well of course it does, what is is supposed to do? Give out sweeties instead? Sure there are problems, in that at least some of this figure is made up of unnecessary branded medications, or even drugs which just get wasted. But what about the millions of people who rely on these drugs, nowhere in the article does it mention that this £8.2bn improves the quality, or even saves the lives of millions of people in the UK. There are improvements to be made of course, encouraging doctors to prescribe cheaper, generic alternatives rather than branded drugs. Putting the price on medications is a good idea just to give the general public an idea about how much some of these things cost. But seriously, the way these stories are reported in the media, anyone would think that the NHS may as well just thrown £8.2bn down the toilet. This is obviously the media's fault, everybody knows that negative stories sell far more papers than positive ones.

What worries me is that people listen to and on the whole believe almost anything the media tells them. As a result, people are going to start turning against doctors, not in a raging mob storming the hospitals sort of way, much more subtle than that but it will have consequences and they sure as hell won't be good.

Even politics these days is more about the media than the actual policies, Mr Brown and Mr Cameron are more worried about their media image than they are about improving things in the UK. The Labour party don't run this country - the fucking media do!

This country is fucked up.

* I don't think the NHS is Shit, I was merely paraphrasing the numerous stories littering the headlines about how rubbish the NHS is.

OSCEs From The Other Side

This is the second time I've written this entire post, stupid blogger autosave GRRRRR! (anyone who knows where the setting is to turn off word verification for posts will win lots of appreciation)

If you read my last post you'll know that today I volunteered as a patient at the 3rd year OSCEs. I've done this a few times now and its really interesting to see the way things work from the other side.

A new undergraduate centre has just been built at our hospital and by 'just been built' I mean its not actually finished yet. Despite that, for some reason someone decided that the OSCEs would be held in the new skills lab. I arrived early this morning to find the entrance covered in scaffolding, machinery and debris all around the building and a number of workmen sat doing not very much at all - perhaps that is why it wasn't finished yet. The building isn't officially open yet but today went ahead as planned, fortunately they'd just about finished the new skills lab but I swear to god they must have been working until about midnight last night. I arrived early and had a wander round the new building which is much larger than the old (but relatively new itself) one. The new skills lab is huge which is good, but many of the seminar rooms are rather small and won't be much use for group work. Someone with the eyesight of mole obviously picked the carpet, it is absolutely vile, the whole building is covered in these very odd looking carpet tiles which must have been acquired on the cheap from some dodgy bloke down the market as most of them don't even match.

Anyway, enough of that, onto the exam itself. My station was something like this "Please examine this patient for enlarged kidneys. He presented with abdominal pain and weight loss." So it was basically a focused abdominal examination concentrating on the kidneys. This seemed to throw many of the third years who were expecting to have to do a full abdominal examination. I'd forgotten just how young and fresh (that sounds wrong) the 3rd years are, they're all fresh out of pre-clinicals and all so gentle (well, almost all). So I spent the morning with my top off being prodded and poked all over the place. Oh, and it was bloody freezing in this new building, they've obviously not bothered to install the heating yet!

The difference between students was quite remarkable, there were some who were excellent, some who were awful and many in between. There were 3 who stood out, and they were well above the rest, interestingly they were from the same base hospital and my observations were that this hospitals students were significantly better than the others. The better students are easily identified even before they've introduced themselves. The reason for this, and the key to being successful at OSCEs is confidence, or even false confidence. If you approach each station confidently then you can do pretty much anything and still get a good mark. Of course there is a line, which if crossed puts you in the arrogant category, and then you're in trouble right from the start. You don't have to have exceptional knowledge to do well in an OSCE, its much more about confidence and even more about ticking the examiners own requirements.

Because it was really cold, the 30 or so students who examined me today all had freezing cold hands, which was just a tad annoying. Worse than that, having 30 people poke or ballot your kidneys is rather uncomfortable, by the end I swear both of my kidneys were probably enlarged. Some of them didn't actually know where or how to feel the kidneys, and on more than one occasion it was quite painful. In one case I actually winced involuntarily which the examiner noticed, this meant that the person in question failed the station, although to be honest, they were not very good anyway. Thankfully most people didn't bother to palpate my bladder, otherwise i'd have spent the entire time needing to wee. Consultants always say that it is obvious who has actually examined real patients and I always thought that was an exaggeration but today you really could see those who'd examined patients and those who didn't know their kidneys from their ribs. Some of them decided that I did indeed have enlarged kidneys, quite where they got that idea from I don't know.

I once again saw just how objective the OSCEs can be but I don't suppose there is much that can be done about that. On one occasion I almost unconsciously tried to help one of the students by giving them hints (like nodding and shaking my head as they pondered the answers to some of the examiners questions.) I didn't mean to help anyone in particular and the examiner just laughed because he realised it was an accident.

Anyway, it was once again fun, interesting and useful experience. I don't know if I'll get another chance to do it before finals, if not, next time it'll be me. shitters.

OSCE Fun (not really sure those words go together)

Tomorrow brings with it the 3rd Year OSCEs, now they’re not real OSCEs, in the sense that they’re summative rather than formative (maybe that is the wrong way round?!). That basically means they don’t mean a thing with regards to progressing through medical school. Its more of a practice for the summer 3rd year OSCE which is important.

You won't be surprised to hear that I'm again modelling tomorrow which means I get to lie on a bed all day and be prodded and poked by the 3rd years. I wonder what my station will be this time. I've got a pretty good idea but again I'm not going to share any details just in case any 3rd years are reading.

I enjoy being a model for the OSCEs, I get £20, I get to revise something I might not have done for a while and I get free drinks and biscuits - shitters - no biscuits - stupid new years resolution! Probably for the best, last time I ate my way through 2 boxes (admittedly only stealing the best ones).

If you've not already done so, read the latest about PBL at the real little medic.
If you're new and need an invite just drop me an email to imamedicalstudentgetmeoutofhere[at]hotmail.co.uk

"How cool are dictaphones?" "stop", "new paragraph"

Today I had my first surgery at my GP placement. This means that I've got patients of my own, real...live...patients! I have my own room, my own computer, my own sign on the door, my own button on the computer to send in my own patients and all sorts of other cool stuff which I'll come onto later.

Throughout the last couple of years at other gp's I've always been able to see patients on my own before they see the GP but not to the extent that I can now. Now I have my own surgeries built into the computer system and the receptionists book patients in to see me... they must all be stark raving bonkers.

Anyway, it was great fun. That feeling I had from my elective where I felt like I was actually being a doctor came flooding back, although fortunately for the patients I'm still heavily supervised. My GP supervisor has slots in her surgery to come and check on me, make sure I'm not going to kill anyone and sign any prescriptions etc etc.

This morning I had 5xhalf hour slots - so the patients are actually getting a good deal, they get to spend 3 times as much time with me as they do with the doctor. Although most appointments don't tend to take that long, by the time I've worked out how the computer works and written up the histories (hopefully without referring them accidental for a vasectomy.) that half hour is soon gone. My first patient this morning was 40 minutes early, he must have been excited to see me.

It was an odd morning actually, 3 of my 5 patients went away with referrals to the hospital - 2 under the 2 week rule for the same thing. This of course meant that I had to do the referral letters - or more precisely I had to dictate them! This was by far the highlight of the morning, I'd always wanted to play with a dictaphone and dictate my own letters - it was unbelievably cool. So cool in fact that it took me about 40 minutes to dictate my 3 letters because I kept changing my mind about what I wanted to say and I kept recording over myself by accident. I used to sit in clinics and listen to consultants dictate their letters adding all sorts of weird and wonderful phrases wondering when I'd get my hands on a dictaphone. I kept my letters very professional - I dread to think what the consultants will think of them when they get them though - I'm sure I probably filled them with useless information about entirely irrelevant things but not to worry. Ok, I'll stop now, maybe I'm slightly too over-excited by this dictaphone thing, after all - referrals aren't generally that good for the patients.

Anyway, I didn't kill anyone, and even managed to come up with decent management plans. I really enjoyed myself, hopefully I didn't scare the patients too much.

Afternoon surgery starts at 4pm this afternoon, is it really bad that I hope somebody needs referring so I can dictate another letter?

Foundation School Allocations

Well the results are out, and I'm very pleased to announce that I was allocated to my first choice foundation school - (more details coming to The Real Little medic later). The results were not supposed to be out until after 8am but apparently they were out just after midnight.

I'm well pleased to have got my first choice. The second stage is to rank individual programmes (jobs basically). Although I don't yet know the details of this process, it may be that I have to go through all 240+ jobs and put them in order of the ones I'd like or it may just be a case of ranking 20 or so and hope for the best. I assume details of part 2 will surface over the next couple of days.

Hope everyone else got their first choice and good luck with picking your programmes.

UPDATE: - I have to rank all 287 jobs in preference order. That should be fun.

What Is Wrong With Me?

Missbliss and I have not been too well the last few days but as part of my new years resolutions we went swimming this evening. It was good fun and good exercise. But that isn't the most remarkable thing about today, we came home afterwards and had a salad for tea/dinner (depending on whether you're from the North or South). Yes, that's right, a salad! I've not had salad, on its own since....well...ever really! I enjoyed it too, it was crunchy in all the right places and was followed by an Asian pear which was also scrummy. I've never been this healthy - ever. Perhaps even more shocking than me, Little '5 kit kats' Medic, eating salad and doing exercise is the fact that I've not had a single sweet, crisp, biscuit or any chocolate at all. Not the tiniest bit since New Year's Eve, More than a week! I've been tempted and oh so close - so close that I've had 2 malteasers in my hand having been offered them by an unknowing friend, so close that I've been in a shop with a bag of sweets in my hand only to put them down and run away. I can't quite explain just how difficult this is for me, it might sound pretty easy but it aint.

I even did some revision which completes my 4 realistic resolutions for today, go me, I'm going to go away and do a bit more work too. No, really I am. I promise. Seriously there must be something wrong with me.

My GP placement is even going well, I'm quite enjoying myself. I get my own surgery Monday and Friday morning and afternoons starting this Friday, good for me but not quite so good for the unsuspecting patients. Thursdays are half days because the surgery is closed, Wednesdays have PBL in the afternoon (hey, every silver lining has a cloud) and Tuesdays are study days - hell yeah, 4 day weeks are the way forward!

Location Location Location

On Wednesday this week the UKFPO will announce the results of the matching process where final year medical students will find out roughly (within a hundred miles or so) where they will undertake foundation training. I, along with 7000 other final years have been waiting patiently for the results of this lottery, so we can all buy our tickets for part 2.

I went to a meeting today at the NW deanery, mainly to be nosey, but also so that I'm able to answer any questions my colleagues might have about the process. It was an interesting morning, the people in charge were understandably in a slightly awkward position of already knowing a great deal about the results. At least they know about the NW, which doesn't help me a lot. They were very professional in not giving much away, but I suspect its fairly good news nationally, and for those who applied to the NW deanery at least. It was a little uncomfortable going round the table announcing where we had put as our first choice, I was singled out as a traitor, or at least that is how I felt, despite reassurance from the man in charge.

Why we're all bothering I'm not quite sure. Tooke is apparently going to announce tomorrow that foundation training is all wrong, blah, blah, blah. At least that is what I'm told. This is going to be quite a week for the countries junior doctors. Foundation deanery announcements, publication of the Tooke report (although I thought this had already all been published and can't find anything about tomorrow's announcement) and the start of applications for specialty training. I suspect the media will have a luke warm reaction to the weeks events, but will manage to turn the situation round to have yet another go at doctors, or more precisely GPs. The Daily Mail headline this Thursday will be something like this: "Many Junior Doctors Facing Unemployment - GPs to Blame For Not Working Enough Hours" - a preposterously illogical headline, but not beyond the realm of possibility.

As I mentioned earlier, Wednesday is only part 1. Part 2 involves being allocated to a particular hospital trust, then a particular job track. The process for this allocation is going to be different throughout the country, and as yet, I've got no idea how my first choice deanery are going to be doing things. Maybe they'll be kind enough to inform us on Wednesday as the results are announced.

Lets hope that unlike last year, our data is secure. You may or may not remember that last year, the names, addresses, sexual preference, religion and application forms of 7000 final year medical students were accessible on the foundation programme website. This was well before the government lost CDs full of data here there and everywhere. I'm told that this breech of data was malicious and that criminal proceedings are underway. I suppose that is reassuring.

Some of you will have absolutely no idea what this post is about, and its very hard to explain clearly what is going on. Lets just say its quite important (for us at least) and all that remains to be said is good luck to my colleagues who are awaiting their fate, its like Christmas, all over again, but with less wrapping paper.

Buy Your Tickets Here

For the post code lottery,

I recently read this post on the Guardian by a medical student. Mr Thomas (a pseudonym) raises some interesting points but he does so with an exceptionally poor attitude. Judging by some of the other things he has written for the Guardian his attitude isn't a one off. Honestly I wonder how some of these people get into medical school in the first place, I've heard a number of stories recently at various medical schools of students with awful attitudes, in some cases directly towards patients on clinical placements. I wonder how far they have to go before they get kicked out! I know I can have an attitude at times but NEVER towards patients, it is my view that all patients are as important as each other and they should all be be important to me, or you, as a doctor. Mr Thomas however, makes a point that he doesn't care about so-and-so receiving expensive treatment as long as he gets to go home early. It might be fine as student to be able to go home early but once qualified, it should be his patients that come first, not his desire for an early finish.

Anyway, now I'm done ranting I can talk about the actual article: "Expensive Drugs On The NHS Are Not A Right"

Fundamentally Mr Thomas makes a good point, that there is only a finite budget available for the NHS and this must be distributed sensibly and fairly. At the end of the day, things like this always come down to money and as we all know the NHS isn't founded on an orchard of money trees. There always has to be a line and unfortunately some people are always going to be on the wrong side of this line. The important thing is who defines this line and how do they do it?

Basically it comes down to assessing how much quality of life, and how much an extra year of life are worth. This is impossible to accurately quantify, not only does each person differ, but it is morally impossible to put a value on life. Nevertheless this is the way things must be done and is the way they are done when deciding if treatments are worthwhile. The people that fall on the wrong side of these decisions are always going to have a case for challenging that decision. But at what cost? They take the NHS to court (rightfully or wrongly, you decide) which probably costs thousands of pounds. If they win, they get their treatment but at the expense of someone else, the NHS having spent money defending their case which could have otherwise been spent on patient care. If they don't get their treatment they are left feeling hard-done by and the NHS is still out of pocket. There can be no winners in a situation like this!

An important factor which makes this story a media favourite is the fact that regulations often differ depending on your post code. One person living in one town might be entitled to the £10,000 treatment which might improve the patients quality of life. Just down the road in another town, a similar patient might not be. Now this isn't fair, if there is going to be a line then that line should be the same for all patients throughout the country, this might be difficult sometimes as each patient is different but it is morally wrong to discriminate based on post-code. This is the reason we often read about patients going to court seeking their treatment and perhaps they are right to do so. Guidelines need to be standardised before we can defend the decision to withhold a treatment due to cost.

What do I think about these expensive treatments? I don't know enough about them to comment. I would imagine each patient has their own case. It is hard to decide who gets the treatment and who doesn't but unless the NHS finds a way to print its own money, these decisions are always going to have to be made. Is there a solution? I don't know.

What Not to Wear

From Jan 1st 2008, our hospital trust has implemented a 'bare below the elbow' policy following advice from the Dept of Health. A detailed email was sent to all the medical staff (whom this encompasses i'm not sure, it may just be the doctors or it may-be all of the people who come into contact with patients). Medical staff are no longer allowed to wear: long sleeved shirts (or at least they must be rolled up), ties (unless tucked in), jackets (this is going to piss the consultants off), watches, or anything else below the elbow, a solitary ring (gold band) may be worn.

A recent BBC article covered this story, in particular with regards to doctors not being allowed to wear watches. Research showed that doctors were unable to estimate accurately pulse and breathing rate. Personally I think the restriction on watches is going a bit too far, I hate not wearing a watch, especially as the BBC article says, there are very few clocks around the hospital. I can't see many of the consultants being willing to follow the watch part of this policy but I guess we'll have to wait and see. Particularly as many don't even bother to alcohol gel their hands between patients.

What's next? A latex skin tight uniform which can be wiped down between each patient?

This topic brings up another argument as to whether doctors, having disposed of the stereotypical white coat should have a uniform. Personally I think we should all be able to wear scrubs all of the time, but apparently that doesn't match with the professional ethos that doctors are supposed to emit.

I suppose it gives students something else to worry about in OSCEs, i'll be sure to make a point that "I'm observing the bare below the elbow policy".

The Start of a New Year

Today was my first day back after the Christmas break, which I should add, seemed to go ridiculously fast. You might have remembered that I'm now doing an 8 week GP placement and I've not exactly been looking forward to it. In fact I've been dreading it, I don't know why because sometimes when I get into it I quite enjoy my GP placements. Nevertheless, I wasn't feeling very enthused when I awoke this morning.

I arrived at the GPs early and was met by friendly reception staff. The surgery is split over 2 sites, one of which was briefly my own practice. I met my supervisor who seemed really nice, I have a feeling she is going to work me hard and expect quite a lot but that is no bad thing I suppose. I spent the morning with her, although it didn't exactly go to plan to start with. 3 of the first 4 patients refused to have me in. Fair enough I suppose. The rest of the morning was surprisingly quiet, there was only a trickle of patients and about the most interesting thing was an ear with raging otitis media.

All in all it wasn't the most interesting of mornings but I'm pleasantly surprised and slightly more optimistic about the next 8 weeks. I'm also fairly pleased with my timetable, it potentially looks like Tuesdays might be all-day study days which would be fabulous, 4 day weeks are just what I need. Perhaps I will enjoy it (at least a bit) after all. It will get a lot more interesting next week when I get to have my own surgery with half hour appointments of my own! I hope the patients know what is about to hit them.

The rest of the day was taken up by my favourite thing in the whole entire world, yes that's right - PBL. The groups have changed, although 4 people out of 8 didn't make it today, apparently they are still on holiday - how bloody nice for them!!! The process itself was just as boring as ever. I even spent half an hour trying to write a poem about PBL but I was so dispirited that my creative juices were flowing like treacle up a hill.

Back to the real world, here we go with 2008 - Happy New Year!

New Years Resolution Update: Today I went to the post office and they have these amazing wine gum things that I usually eat by the crate full. I had such an urge to have 'just one packet' but I didn't I managed to resist. I almost cracked by the chocolate machine too but will-power prevailed and so far so good, i've not had any sweets, chocolate, crisps or biscuits. COME ON!