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.