I'm a Medical Student, Get Me Out of Here

Results Are Out...

2008-06-13T14:58:00.003Z

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

2008-06-04T16:32:00.005Z

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

2008-06-01T15:50:00.005Z

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

2008-05-23T10:28:00.003Z

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)

2008-05-17T10:51:00.003Z

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

2008-05-15T20:02:00.003Z

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

2008-05-14T09:25:00.003Z

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

2008-05-12T17:09:00.003Z

- 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

2008-05-09T16:19:00.002Z

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

2008-05-04T08:54:00.003Z

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

2008-04-29T20:49:00.003Z

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!

2008-04-27T13:33:00.002Z

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....

2008-04-26T18:22:00.004Z

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

2008-04-23T15:19:00.007Z

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

2008-04-22T17:41:00.004Z

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

2008-04-19T12:16:00.003Z

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

2008-04-16T07:26:00.002Z

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...

2008-04-13T09:54:00.003Z

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

2008-04-10T07:40:00.003Z

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?

2008-04-08T07:22:00.007Z

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

2008-04-06T07:18:00.003Z

- 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

2008-04-04T16:25:00.005Z

(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

2008-04-02T18:01:00.005Z

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

2008-04-01T17:00:00.003Z

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

2008-03-30T17:23:00.003Z

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

2008-03-28T17:12:00.003Z

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

2008-03-26T18:50:00.004Z

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?

2008-03-25T08:05:00.003Z

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

2008-03-16T19:35:00.005Z

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

2008-03-15T07:36:00.003Z

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"

2008-03-13T08:09:00.005Z

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

2008-03-10T17:00:00.002Z

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...

2008-03-08T15:41:00.004Z

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

2008-03-06T14:07:00.003Z

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

2008-03-05T07:56:00.004Z

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

2008-02-24T11:33:00.003Z

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

2008-02-21T17:36:00.002Z

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

2008-02-20T12:21:00.005Z

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

2008-02-20T07:54:00.001Z

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"

2008-02-18T16:30:00.002Z

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?

2008-02-16T15:54:00.006Z

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.

Medstudentitis and Medstudentpartneritis.

2008-02-13T18:58:00.004Z

Well it seems that between me and missbliss in the last 24 hours or so we've had more contact with medical professionals than ever before. You remember I saw my GP yesterday morning with a chronic sore throat that I’ve had since before Christmas, I didn't feel ill at all with it but the irritation is driving me bananas!

Anyway - I’ll start the story where the last one left off.

I picked missbliss up from work and we went straight back to the doctors, it was the end of surgery and they were running significantly late. I already had my own ideas about what was wrong with missbliss and fortunately the GP agreed. He looked up some protocol and considered admitting her for a millisecond, had she vomited, she'd have been spending the night in hospital apparently. He decided it wasn't quite that serious and instead gave her a prescription for antibiotics. This time I had got involved and said that I was a medical student which made the consultation much smoother in my opinion. The locum GP was very friendly despite his vibrating phone (which he later answered but was apologetic for) whilst examining missbliss. His explanation of a urine dipstick was also rather amusing, he didn't know I was a medical student at that point and told us all about the little sponges which change colour. Anyway, we went away happy, with some decent treatment and safe in the knowledge that my diagnosis had also been right - makes a change!

After deciding on an early night we tucked up in bed to watch some Buffy. At about 10:15 I woke up with a roaring fever, although I felt ridiculously cold and was shaking so much missbliss awoke thinking it was a repeat of our summer earthquake experiences. I'd never had a fever like that before; I also had an awful headache and felt really nauseous. I was actually quite worried, as was missbliss - I had no reason to have such a fever and it was very unlikely that I had the same thing as missbliss. I've never done so before but I had missbliss phone the out of hour’s service. I must say I was rather disappointed when a nurse rang back and told me to take paracetamol and ibuprofen in the most patronising manner possible. If I hadn't been slightly confused I might have explained that I was a medical student and wasn't stupid and that I was fully aware it was probably viral (although she saw fit to tell me it was definitely viral - no question about it!) So I laid there - awake for hours now burning hot despite not having any cover at all. There is no way I could have gone to my GP placement today so I phoned in poorly when I awoke this morning.

I kept myself dosed up on ibuprofen and paracetamol all day long and was beginning to feel better - although my chronic sore throat was taking its toll. But not long ago I began shaking again feeling awfully cold. I know it’s probably viral but I've never had such a fever before and it was pretty dam scary.

Meanwhile, missbliss has been looking after me all day bringing me food and squash, despite having an illness all of her own. Poor cherub.

Unless I'm substantially improved in the morning I don't think I’ll be able to manage driving to GPs tomorrow either, besides, I'll only infect my patients. Being ill sucks.

"Little Medic to Room 6 Please"

2008-02-12T13:24:00.000Z

I went to see my GP today, and characteristically was a good 15 minutes early, despite the fact the surgery is 4 minutes walk around the corner. Anyway I'm quite happy to sit there and read my book until it’s my turn. My appointment was for 10:20 and the GP registrar was only running 10 minutes late.

The consultation itself was strange. I'm 90% sure the GP didn't know that I was a 5th year medical student and as such, I felt quite patronised at times. I used a number of medically related words which your average lay (or is it ley? I never know) person probably doesn't know, unless they've read in depth on the internet. The registrar was very nice, although a bit bamboozled by my presenting complaint. There isn't a lot wrong with me, it’s more a persistent annoyance than anything else but I thought it’s about time I got it checked out. I'm not quite sure what I was hoping for - perhaps that is why I don't feel particularly fulfilled by the consultation. I think the GP thought I was looking for antibiotics; although I made it quite clear I wasn't (must be a rarity in GPs). He promised he'd phone me back later with some more advice - although he hasn't yet.

It made me think about the complexities of treating medical professionals. I know some of my colleagues go in to see their GPs and tell them exactly what they want. Whether or not they get it is another matter. Some people say that they're a medical student, others prefer to remain anonymous. A fellow medical student came to see me during one of my surgeries recently and whilst it was only for a trivial complaint. I couldn't help feeling ever so slightly awkward. I remember witnessing a consultation between my supervising GP and a patient who was the young son of another GP. It worked very well, and was very professional, much more ethical than treating your own friends and family. I wrote about patients having their own agenda quite recently but what happens when that agenda is an informed one, from another medical professional. It must make things a little harder to deal with when there are differing opinions between the GP and the 'patient'.

Anyway, I'm going back the GP this evening with missbliss and her problem, which promises to be an interesting consultation. I have my own agenda based on my diagnosis (which is pretty barn door obvious to be honest), I know what treatment she needs, and I expect nothing less. Perhaps I’m wrong for doing so, but hopefully the GP will agree and everyone will be happy!

How Hard Is It To Be On Time?!

2008-02-11T16:35:00.000Z

There is only one excuse for being late - being dead (ok, so maybe are a few more than that..)

How hard is it to be on time. A ridiculous proportion of my patients today have been late, 1 didn't even bother to show up at all?! I understand that GPs are often running late, but that is often unavoidable due to the 10 minute appointment system and it is certainly no excuse for patients being late. I have half hour appointments which are almost always concluded within half an hour so I'm never running late - that is until Miss X turns up at 10:15 and knocks me all out of kilter.

If I was a GP, patients being late would drive me bananas! If you've got a genunie reason, i.e. unforseen circumstances then fair enough but if you're just being lazy and or late for the sake of it then you may as well not bother coming at all. Although, if you're not going to bother coming, it'd be very kind of you to at least ring and let the surgery know. GPs should do what dentists do and charge for DNAs (Did Not Attend), that might make patients think twice about not bothering with their appointments.

I'm a lateness nazi as it is and I can't stand being late (note: this often leads me to be ridiculously early for things - much to missbliss's displeasure) but if I ever become a GP unless you've got a damn good reason for being late - you won't get seen. Simple as.

Computerised Fate

2008-02-10T16:28:00.000Z

My future (or the next two years of it) are now in the hands of the Severn deanery computer system. I finally plucked up the courage to click submit yesterday after weeks of wrangling over the order of the 287 jobs I had to rank. In the end, I didn't have to rank all of them but I still had to rank way more than my friends in the NW (who have about 12 to 16 jobs to rank having already been allocated to hospitals). I devoted hours to this ranking process, i'm not sure why, part of me wishes there was a lucky dip option. I'm resigned to the fact I might well end up with anything, anywhere.

In 10 days (as long as there no problems) the 7000 or so final year medical students eagerly awaiting the results, of what for many, is little more than a lottery, will find out their fate for the next two years. What will it be first? Medicine, Surgery, Psychiatry, A&E, Paediatrics or something even more obscure. Who knows.

Personally i'm not all that bothered with what I end up with. Most F1 jobs are going to be fairly similar whatever you're doing. My first choice which i'm 90% sure I won't get included the unlikely subject of gynaecology. A week in wednesday will be an interesting day fo' sure.

I understand that those of you not involved in this process you'll have little idea what i'm talking about. I can tell you, its exceptionally important to the 7000 people waiting to find out the reslts of what has been a 2 or 3 month process.

Just One More Thing

2008-02-08T19:21:00.000Z

I don’t know what it is about Fridays, particularly Friday afternoons but nearly all my patients today had a list of 3 or 4 different things. Now for me, this isn’t as much of an issue as everyone who sees me has a half hour appointment but the GPs get 10 minutes, and very rarely do people book double appointments if they’ve got a list. It works quite well if they come and see me as they can take all the time in the world telling me their life stories and I can condense what they say into a short summary for the GP.

“Whilst I’m here...”, “Just one more thing...” are a couple of the favourites. Sometimes they’ll bring you a nicely written list. Either way, it can get just a touch irritating when patients expect all their problems to be dealt with. Oh well, its friday. yay.

Before I go - i've jus about finished ranking all 287 odd jobs in my chosen deanery - now I just have to click submit and wait patiently until the 20th of Feb to find out what my first job will consist of and where it will be.

Oh and just one more thing – I’ve made a rare post over at the real little medic, check it out if you’ve not already done so.

Dream Catcher

2008-02-06T08:09:00.001Z

Would someone kindly invent a dream recording machine please?
Thanks.

The Solution

2008-02-05T16:16:00.000Z

I've found a solution to my dilemma regarding giving up sweets, chocolate, crisps and biscuits.

Today is Shrove Tuesday, otherwise known as Pancake day (HURRAY!). This means that Lent begins tomorrow. As of tomorrow I'll be giving up said items once again for the 40 day duration of Lent.

The cleverest among you will have noticed that this gives me the rest of the day to eat as much junk as I possibly can. In order to accomplish such a feat I will spent today gorging myself on mini eggs. I've already eaten 200g worth and expect to have devoured several billion calories worth by midnight. This option has the added bonus of satisfying the 8 of you who think I should have restarted my junk food habits, beginning with an atrocious binge on mini eggs, and those of you who think I should have continued my efforts with no such binge. It'll also satisfy my overwhelming urge for mini eggs.

Whether or not this will make the beginning of lent any more difficult i'm not quite sure but in order to counter the effects of several million mini eggs I am going to to swimming this evening!

The Grim Reaper Comes to Town

2008-02-04T19:25:00.001Z

Today was communication skills part 2 and today, in 3 hours, we learnt how to talk about death. In fact, we learnt how we talk to a wife about her dying husband. I was excused from the simulated patient experience this week having done it last week although a sadistic little bit of me wanted to have a go. There were 3 scenarios this week all based around Mr and Mrs Prostate, unfortunately Mr Prostate was dying of metastatic disease. The first scenario, Mr Prostate had just been admitted after his GP had failed to control his pain adequately. His wife had hugely unrealistic expectations about her husband’s condition and was busy planning a 2 week break in the Lake District whilst poor Mr Prostate was actually dying. His wife wanted to speak to you, as the F1 to see what you were doing for him. The second scenario was based a couple of days later and Mrs Prostate wanted to speak to you about her husbands worsening condition. In the final scenario, a day later, Mrs Prostate had come to collect the death certificate and wanted a word with you.

This is the first ‘teaching’ that we’ve had on dying and death and to be honest, although I was initially quite skeptical, it was quite useful. The simulated patient/actor was very good indeed she made the experience quite believable and I’m almost embarrassed to say it was quite moving at times, I dread to think what it’ll be like for real.

Several important things came out of today’s communication skills. Firstly the potential mismatch between relative’s expectations and reality. It is very easy to skirt around the topic of death and not approach it, but this can reinforce unreasonable expectations. The student who dealt with the second scenario where Mrs Prostate was very upset and at times angry, tried exceptionally hard to hint that Mr Prostate might becoming towards the end of his life, but the patient was left confused. The student felt unable to mention the words dying or death, which is perfectly understandable, after discussion the group decided it was important to try and prepare the relative for the worst, even if that meant discussing death. I believe the phrase was “hope for the best, prepare for the worst” and I think that sums things up quite well.

This post is rather emotionally numb, not at all like I intended it to be. Today’s situation wasn’t real, but it happens every day in real life. In 6 or so months time that might well be a real situation I find myself in, I can say for certain that I’m not looking forward to that! Although 3 hours is an extraordinarily small amount of time to spend on such a topic, I do feel ever so slightly more prepared for such an eventuality in the real world, it won’t make it any easier though.

Wetherspoons Reply

2008-02-02T18:24:00.000Z

I'm sure you remember this disasterous meal we had a couple of weeks ago at Wetherspoons. Well, I got a reply to my complaint letter this morning.

CLICK TO ENLARGE

I must say, I’m rather disappointed with their response. It seems a bit like; "Yeah whatever....blah, blah, blah." I did think they might have sent me some vouchers of some sort, sadly not, even their customer service sucks. They've failed to address a couple of my issues, 1) Why they made no attempt to work out who I was, 2) Why they accused me of stealing my card but weren't the least bit interested in apprehending a thief, and 3) The awful food which we had to wait ages and ages for. I'm tempted to write to them with a reply, but I’m not sure I can be arsed.

In other news, where the hell did January go? I'm pleased to report that I successfully fulfilled my resolution to have no sweets, chocolate, crisps or biscuits in January. There was so much temptation and at times I had sweets in my hand in a shop but I resisted the temptation. Admittedly I did have 1 chocolate mouse trifle in my lunch box one day but I was almost forced to by missbliss so I couldn't argue. Question is, what do I do now? (Please answer the poll) I could continue but I’m getting rather desperate. If I start eating such things again it'll be difficult to restrain myself to eating sensible portions or I could just revert to my multiple kit kats a day diet.

Kidneys - What Do They Do?

2008-01-31T07:38:00.000Z

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

2008-01-28T18:08:00.000Z

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

2008-01-28T07:42:00.000Z

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

2008-01-25T11:58:00.000Z

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

2008-01-24T07:53:00.000Z

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

2008-01-22T11:02:00.000Z

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

2008-01-19T19:36:00.000Z

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

------------------------------------------------------------------------

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

------------------------------------------------------------------------

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*

2008-01-18T07:44:00.000Z

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

2008-01-16T21:30:00.000Z

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)

2008-01-15T19:04:00.000Z

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"

2008-01-11T13:56:00.000Z

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

2008-01-09T08:03:00.000Z

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?

2008-01-08T20:39:00.000Z

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

2008-01-07T14:31:00.000Z

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

2008-01-06T10:17:00.000Z

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

2008-01-04T08:21:00.000Z

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

2008-01-02T19:45:00.000Z

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!

New Years Resolutions

2007-12-29T16:03:00.000Z

I'm not usually one to make resolutions, mainly because the probability of me keeping them is equal to that of winning the lottery without buying a ticket.

This year though, for various reasons I'm determined. I'm going to make some resolutions and am determined to keep them (well, at least some of them)

1) No sweets, chocolate, crisps or biscuits (for at least a month). Now before you all fall off your chair screaming "for the love of god....WHY?!?!" Perhaps I should explain. I'm addicted to sweets and chocolate and by addicted I mean in a Heroin sort of way. Before Christmas I was eating 5 or so KitKats before lunchtime. I've tried to cut down in the past but once I've had one I've got to have more, and then more after that, and another for the drive home and maybe another couple from the petrol station, you get the idea. I've done this in the past for lent, but in the last couple of years even that has failed miserably. I'm doing this for a number of reasons a) I don't want to get diabetes, b) I'll save a fairly substantial amount of money, c) because addictions are bad, d) because I need to prove that I can do it, e) my metabolism seems to be slowing down and my trousers are becoming uncomfortably tight (they're still only 32s though), and f) because it links to another couple of my resolutions.

2) Exercise. I can't remember the last time I did any substantial exercise, and by substantial in fact I mean any at all. My resting heart rate is ridiculously high for someone my age, one of my aims for 2008 is to reduce this to less than 75. I am determined to develop at least some element of fitness. How I'm going to go about this I've not yet decided but watch this space.

3) Work. Perhaps the most important resolution for this year considering finals are rapidly approaching. I've never been a particularly motivated person work wise but I'm going to have to work hard to make sure I get through the week of hell successfully. I intend to plan out some sort of revision timetable and stick to it. Bribery is my best motivation and I've already convinced myself of the following equation.

work = passing exams = Dr Little Medic AND games console (yeah baby) , etc etc.

I'm determined not to waste quite as much time as I do at the moment and I will try my hardest to do some relevant work/revision most days. Missbliss has already been very good about helping and motivating me, now if only I could persuade her to bake me more cakes when i've met my targets (cake of course being exempt from resolution number 1, come on, you gotta give me something)fr

4) Keep my car clean and tidy. "pfft, that's an easy one" I hear you cry. Well you'd think so but usually my car is a tip. Missbliss bought me new mats for Christmas and also offered to clean the inside (which was well overdue....., by a couple of years or so) Missbliss is ideal for this sort of thing, in the same way that in Schindler's List, Schindler saves the children for their small fingers to clean the inside of shells, missbliss is small enough to poke around with a Dyson in a fiesta. Before she began I removed several thousand tonnes of old sweet wrappers. (another reason to give up sweets).

5) Enjoy PBL - those of you that read my predictions for 2008, in particular number 1 will realise why this is here. There is absolutely no way on earth I could keep this one, not even for all the cakes in a French Patisserie. I suspeect this will be broken by 3pm on the 3rd Jan. Hey, nobody is perfect, 4 out of 5 wouldn't be bad.

In effect, these resolutions equate to a normal healthy lifestyle. Hopefully they will. I'm confident they will, no, really they will. Honestly. I think. Maybe. Oh shitters.

Predictions for 2008

2007-12-27T12:57:00.000Z

I hope you all had a very merry Christmas. 2007 is almost over, and as ever, it has gone remarkably quickly. 2007 was a pretty exciting year for me and missbliss, lets hope 2008 is better than ever. I'm now going to make a few predictions for the months ahead. Maybe in a years time, if I'm still blogging I'll look back and see how I did.

1) I will keep all but one of my new years resolutions. (Coming to a blogpost near you later this week)

2) Facebook will see a significant downturn in use as people get bored of it. I think this has started to happen already, it certainly has for me. Facebook won't just vanish off the face of the web but its growth and use will slow. It may well be bought by Google or Microsoft towards the end of 2008

3) The Americans will bottle the opportunity to elect a female or black President, instead opting for the 'safe' option of a white male.

4) 16GB USB memory sticks will be available under £20 by Christmas (currently you can get 4GB memory sticks for under £20). There will be at least one government scandal involving the loss of said USB memory sticks with personal data on.

5) Despite widespread predictions of a house price crash, on average, house prices will continue to rise throughout most of the UK. The rate will be below previous years at around 3-4%. UK Interest rates will dip slightly before rising again.

6) Either Britney Spears (probably whilst pregnant) or Amy Winehouse will suffer a fatal overdose.

7) Portugal will win Euro 2008, The UK will fail dismally in the 08 Olympics, Lewis Hamilton will win 08 F1 championship. Man Utd will win the premiership but Chelsea will beat them in the final of the Champions League.

8) Petrol will hit 110p a litre.

9) I will purchase either an XBox 360, Playstation 3 or Nintendo Wii. Perhaps in celebration of number 10, celebratory kittens may also be in order.

10) I might, just might,actually become a doctor!

So there you have it guys, that's what I think will happen in 2008 (some of them are perhaps a bit bold). Lets hear your predictions for 2008, either here in comments or in your own prediction posts.

Christmas Eve...

2007-12-24T10:21:00.000Z

24th December 2007

1 Day to go till Christmas!!!!!!

tlm fact: Christmas rocks my socks!

MERRY CHRISTMAS BOYS AND GIRLS!

Twas the night before Christmas, and through the blogsphere
Not a blogger was sirring, not even our Veer.

Many posts had been made with care,
In hopes that readers would be there.

(I'll stop now before I do any more damage.)

Advent Update

2007-12-23T09:26:00.000Z

22nd December 2007

3 Days to go till Christmas

tlm fact: The Sunday Times is my favourite newspaper and I always get a bit cranky when I don't get a copy for whatever reason.

23rd December 2007

2 Days to go till Christmas

tlm fact: I am currently addicted to eggs, be they fried, scrambled or whatever. I can't get enough of them.

I failed in my bid to blog everyday - oops. I was just too busy and tired yesterday.

Christmas No. 2

2007-12-21T22:05:00.000Z

21st December 2007

4 Days to go till Christmas

tlm fact: I was sicked on by a toddler today. It wasn't pretty and was over the only pair of jeans I've got at the moment.

I'm shattered. Today has been a noisy affair to say the least. We visited missbliss's 4 nieces and nephew. The accompanying troop of adults (made up of missbliss, her parents, brother + girlfriend and of course, me) took the tally to 10.

Many presents were opened on what is christmas number 2 for the kids and for us, much screaming took place, and there were plenty of barbies among other things. The youngest, 2, summed it up quite well, jumping on the spot at the sight of presents screaming "Cris...miss" staccato-esque over and over whilst waving his arms around frantically.

We gorged on mountains of food which included 3 joints, 45 Yorkshire Puddings (YEAH BABY!) and lorry loads of roast potatoes. More playing ensued, racing tractors up and down the corridor using our hands as gates. Missbliss was off bathing the youngest, who following that, promptly threw his stomach full of chocolate, matey bubble bath and goodness knows what else over me. missbliss just sat there laughing, and being happy that his jammies remained clean, pfft - just you wait.

We rounded off the day by tucking them into bed with made-up stories, mine being superior as it involved fairies and more audience interaction. Missbliss maintains her brief was more difficult (christmas, mermaids, and sleeping beauty) By this point, I was tired and could have done with being tucked in myself.

Bring on Christmas number 3.

Jobs Ahoy

2007-12-20T21:39:00.000Z

20th December 2007

5 Days to go till Christmas

tlm fact: I once spent 22 hours straight playing football manager.

This announcement which appeared on the UKFPO website yesterday was a welcome relief. Apparently all UK medicine graduates are guaranteed a 2 year foundation post. This comes after reports that thousands of non-UK graduates would push the numbers of people applying well above the number of posts available. Apparently there were 7000 applicants for 7200 posts. This will hopefully quash some of the rumours floating around such as there being thousands of applicants for the NW deanery alone.

I always suspected (or perhaps it was just wishful thinking) that things wouldn't be quite as bad as some of the scare mongers had suggested, so I'm very pleased to hear this announcement. Now we all have to sit tight until the 9^th of January to find out which deanery we've been posted to. The UKFPO announcement also said that the majority of people would be placed in their first choice deanery which is also quite reassuring. I still don't know how my first choice deanery is going to allocate particular jobs. The NW are using a 2-round process, first, allocating people to trusts before the second round where people are allocated to particular tracks, this is all done using the same preference system and scores by which we are allocated to deaneries. This doesn't sound all that bad so hopefully it'll be something similar wherever I end up. There is a slim chance that interviews might be used but personally I can't see that happening. It is quite likely that I might have to sit down and rank in preference order 200 or so jobs, that would be fun (anything involving Psych being automatically rejected to the bottom.)

Of course all this is dependant on a couple of factors a) that I pass my exams, b) that my application hasn't been swallowed by the computer never to be seen again. Knowing my luck with 'random' allocation i'll end up in the Shetlands, or worse, the North West!

"Think About Those We Have Lost"

2007-12-19T10:47:00.000Z

19th December 2007
6 Days to go till Christmas

tlm fact: I'm not allergic to but I absolutely hate nuts. I do love marzipan though which missbliss thinks is very odd.

Missbliss and I went to a primary school carol service yesterday evening at a local church. It was very short and sweet which is probably for the best. Now i'm not in the least bit religious but something the vicar said really hit me. At the end of the service he was leading a prayer and listed a huge number of people we should pray for including those that we've lost.

The point is it made me think about my nan who died of lung cancer 10 years ago. I've never known either of my granddads as both died before I was born and only one of my grandparents survives today. I shed a couple of tears there in the church thinking about her, although nobody noticed. When I was young I spent quite a lot of time with both my grandmas, mainly during the school holidays when my parents were out at work. It was great fun we used to go on adventures, build trains out of the the furniture, and all sorts of other wonderful activities.

She was in hospital for quite a while before she died and I remember it vividly. I can even remember exactly which beds she was in. I remember going to see her the day before she died and I can remember the morning she died like it was yesterday.

I don't think about her very often but I know I'll never forget her. It makes me sad that she won't ever know about my future but I know that she'd have been very proud of me becoming a doctor. I hope so anyway.

I guess it is important to remember those who we've lost.

The End of Days

2007-12-18T18:48:00.000Z

18th December 2007
7 Days to go till Christmas

tlm fact: My 4 Favourite films are Leon, My Life Without Me, Eternal Sunshine of the Spotless Mind, and Lilya-4-ever.

Not quite the end of the world I know but term is finished for Christmas. Yipee, no more early mornings for a while. Won't be back in hospital now until March. That makes me a sad bunny because it means that i've got 8 weeks of community (GPs) to go back to on the 2nd of January, 2nd of Jan, what the hell is that about. Jeez. Last time I did community it was ok, and I quite enjoyed it but i'm dreading it this time, not least because i've been hearing very very bad things about the practice i'm going to! And for 8 weeks, the only respite will be PBL on a wednesday afternoon - great!

Hopefully i'll be proved wrong but we shall see, watch this space, i'm sure it'll give me plenty to blog about if nothing else.

In the mean time i'm going to enjoy Christmas.

Get Your Personal Data Here...

2007-12-17T20:14:00.000Z

17th December 2007
8 Days to go till Christmas

tlm fact: I am quite seriously addicted to the interwebnet. Not to worry.

No I've not found one of those lost CDs or been routing through people's bins. If you're English you can't possibly have missed the multitude of stories in the news recently about CDs full of data being lost/mislaid/stolen/left in a taxi. That should be the least of the government's worries.

This morning I went to the Job Centre with missbliss for a 'rapid reclaim' (rapid my arse, she's still not heard anything about getting any money from the claim she made 6 weeks ago!). Needless to say, I wasn't in the mood for any bullshit. It is astounding just how ridiculous this place is. It is a completely open plan office, with desks right next to each other all around a waiting area of sofas. Who needs a disc full of data when, during half an hour of waiting you can pick up enough details about each and every person in there to adopt their identity entirely. It is no wonder identity theft is rife, and was so before these discs started to go missing. Honestly, I'm now completely au fait with Miss Brown who lives at 34 I Can't be Arsed To Get a Job Street, her national insurance number, phone number, qualifications. In fact, almost everything anyone could ever need to know about Miss Brown. Shes not alone, I know all about Mr Black, Mrs Purple and Ms Cream. Confidentiality? Pfft, what a joke, what a complete and utter joke. Any sort of confidentiality is a complete impossibility in that office. So much so that every person in there at the same time as you knows everything about you.

As soon as we sat down I suggested missbliss ask for a private office. A not unreasonable request given the relatively sensitive nature of the things being discussed. Unfortunately, we were informed that there were none, and we couldn't actually go anywhere else because he needed a computer. Yes that is right, there are absolutely NO private facilities available in this place. He even tried to justify it, its supposed to be "warm and welcoming to make us seem easily approachable" fuck that, you're all a bunch of useless wankers, and I would like just a little bit of confidentiality if you don't mind! I was not amused. His best offer was to whisper, although that, coupled with his annoying, impossible to understand voice meant we could barely hear him.

After sitting there for about half an hour, making absolutely no progress. Missbliss started to get slightly upset (understandable given the fuck-ups and uselessness of what is going on.) So, we sat there, in the middle of this "friendly" open plan office and missbliss began to cry. Not only was there no privacy from the freaks in the office but the useless man didn't even offer her a tissue. He did however suggest that we break up to improve missbliss's claim and even almost began to suggest that we should lie on the form. He was very careful with his words though, which unfortunately meant I couldn't jump on him for being a knob.

So after about an hour of him suggesting completely useless things and not actually making any progress at all we decided to call it a day. I had said very little throughout the consultation but couldn't resist a closing quip about the incompetence of every single person we've come across associated with missbliss's claim. It isn't as if I was even trying to be mean, they are all useless.

I'm going to write a very strongly worded letter to as many people as possible about just how inappropriate that place is confidentiality and privacy wise.

Advent Update

2007-12-16T20:22:00.000Z

16
16th December 2007

9 Days to go till Christmas

tlm fact: I have strange thumbs which have made many a person wince in the past.

Father Christmas

2007-12-15T17:36:00.000Z

15
15th December 2007

11 Days to go till Christmas

tlm fact: I don't drink hot drinks. Yep, that means no coffee for me. I very occasionally have a cup of tea but not because I enjoy it. I much prefer juice or water.

Today's advent picture is hugely important. For those of you that don't know it is the front cover of a book called Father Christmas by Raymond Briggs. Christmas is just not properly Christmas without it. I used to love it when I was little and a year ago I was reunited with its amazing Christmasyness.

10 days to go! EEEEK!

Dying

2007-12-14T17:14:00.000Z

14
14th December 2007

11 Days to go till Christmas

tlm fact: I currently look rather like a yeti, i've not had my hair cut since before we went to Solomon Islands, it is as long as it has ever been now. Desperately in need of a trim.

Today was my last day on gastro medicine, i've really enjoyed my time there and actually felt, for the first time, that I can do this doctoring business. I got a good evaluation too which was a nice way to finish off.

There was a sad part to today though, there is an elderly man on the ward at the moment, he's 84, it was his birthday today. He came in with a very mild MI, but has a multitude of co-morbidity. He is almost immobile, he is virtually completely deaf and blind, can just about whisper the occasional sentence and has serious trouble swallowing. He looks even older than he is but he's a really nice old man, even in his state he has a sense of humour.

Today the consultant did his ward round and after trying to explain to the old man what the plan was (by shouting in his ear), he muttered "why, don't you just shoot me", I suspect this was partly a joke but partly a plee to be left alone to die. It actually made me quite sad, this poor old man, who has a lovely old wife who does her best to look after him, is virtually bed-ridden, deaf and almost blind and dumb - what sort of life is that. Later that day it was reported that he couldn't swallow at all, and it was suggested he should have an NG tube passed so he can be fed. The consultant saw sense in my opinion by suggesting this might not be the best idea. In the end, the old man had said that he didn't want it. He will die, its just a matter of when, I hope he gets some enjoyment out of his last few hours/days/weeks. Bless him.

I guess it made me realise how vulnerable and fragile human life is, I don't ever want to get old :(

The United States of Europe

2007-12-13T08:06:00.000Z

13
13th December 2007

12 Days to go till Christmas

tlm fact: I'm currently addicted (quite seriously) to KitKats

I hate Europe, the EU and any concept of the United States of Europe. There are a number of reasons for this and things just keep on getting worse.

First of all, the EUWTD (European Union Working Time Directive), what a fucking waste of space that is. It is all just lovely that people are not supposed to work more than 48 hours a week. In reality its just stupid, doctors for instance, who used to work 100+ hour weeks as of 2009 won't be 'allowed' to work more than 48 hours. Of course doctors will still work more than 48 hours, they'll have to, it just means they won't get flipping paid for it! Not only does this mean that we'll get paid less than junior doctors in previous years, but we'll also be hugely restricted in terms of the amount of experience we get. Most doctors will tell you that the most valuable experience they gained as a junior was doing nights on-call etc etc, but there will be very little of that in future. Instead you might, if you're lucky, be treated by a night nurse-practitioner, whoop-de-fucking-do! So when you're in hospital in a few years time, just bear in mind that the juniors looking after you have perhaps half, or even a third of the experience that the juniors of old had. I certainly wouldn't want to be a patient in that situation. So anyway, the EU, with all their good ideas can go screw, in reality, these things just are not going to work!

Next we have the EU rules which state that all applicants whether they're from England or Poland should have exactly the same rights when it comes to job applications. Now I'm not going to sit here and say that UK grads deserve preference for UK jobs, but if because of this 'freedom' within Europe, any graduates from UK medical schools are left without F1 posts (which isn't unlikely since it has already been announced that there are too many applicants for too few posts) then something is seriously wrong. It costs £250,000 to train us medical students not to mention the fact that we're £20, £30, £40,000 in debt. We should all (or at least those who are competent) be entitled to a job at the end of our 5/6 year slog. But no, that's not the way it is. The EU gets to stick its oar in and control everything.

You can barely walk around a town centre these days without passing a 'Polski Sklep', there has been a huge influx of Polish people since they joined the EU and were able to come here to work. And whilst I'm all for multi-culture I'd hate to think that these EU residents were being given preference for anything over British residents.

Today, Gordon Brown is going to sign even more of our power over to the EU, I really hoped that he'd have the balls to take a step back from Europe when he took over as PM but sadly it seems that I was wrong. It won't be long before we join the Euro, don't even get me started on that! If we join the Euro, I'm off to Australia (or at least I would, but I don't think missbliss would go for it), fuck the United States of Europe.

Two serious posts in a week, I don't know what has gotten into me.

I'm tired.

2007-12-12T22:02:00.000Z

12th December 2007
13 Days to go till Christmas

tlm fact: 2 months after we met, I took missbliss to Paris for her birthday. Well I've got to do something to pay back her cake making.

Oh so very tired, today has been a long day. More blogging tomorrow. Time for bed.

One Laptop Per Child (OLPC)

2007-12-11T12:41:00.001Z

11th December 2007
14 Days to go till Christmas

tlm fact: So far in my life I've broken 9 bones although I've not broken anything for many years now so I must be less careless nowadays.

Today I'm going to talk about the One Laptop Per Child (OLPC) project. You might have heard a bit about this in the news but in case you've got no idea what its about I'll give you a quick brief. The idea is to give children in the developing world a $100 laptop each. Whatever you think about the idea, its certainly ambitious. The vision is to connect the developing world and therefore stop it being left behind as technology in the developed world surges ahead. In principal, I think it is hard to argue against the idea however there are plenty of arguments to be made against it, for example that money would be better spent on providing basic teaching facilities.

The OLPC project has advanced slowly and is currently in the late testing/production phase. The $100 laptop is currently the $188 laptop which is about £93. Testing has seen varying success in places like Nigeria. One thing is for sure, the children love the idea, but hey, who wouldn't? In one Nigerian school, given 300 to test, after only a few months 40 had been broken, lost or stolen.

Orders have been slow as politics and price have prevented many countries from gambling on this venture but orders have been received in the hundreds of thousands, as more orders come the price will go down and the laptop will become more available.

It is all very well giving children in the developing world laptops but it could be said that this money should be spent on providing basic education rather than throwing technology at people who are lucky if they can read. This is only one of the potential pitfalls of the project, laptops being lost, broken or stolen would be a significant problem and there would have to be some way of managing this. If you lost your laptop would it be replaced? If not, would you ultimately lose out on your education because you didn't have one? Each area would require technical support and help in these situations. Interestingly, in some test areas it is the children themselves who become the technical support by setting up workshops to fix broken laptops. To me this is part of the genius of the project and why I think it is a wonderful idea.

I remember when I first was given computer, I was absolutely fascinated. So much so that I had it in bits to see if I could work out how it worked. This was way before the Internet became popular and virtually every house had a computer. By the time I got access to the Internet I was 11, I'd just started high school and was amazed by the wonders of the Internet and email (I still have my hotmail address from then). Since then I've grown up with computers and the Internet around me, so much so that I can't imagine a world without the Internet (as lame as that sounds) and it is the connectivity that I missed most of all in the Solomon Islands. Without the Internet my life would have been SO much different, for starters, organising my elective in the SI would have been virtually impossible.

So where does this leave the developing world. Well, the reason I think the OLPC vision is so important is because I believe it will unlock a whole world of potential. We are talking here about children who might have never seen a computer before, let alone heard of the Internet. Much of the OLPC vision is focused on providing education through the laptops which is undoubtedly important, but to me, it is the potential for use at home (as the laptops are owned by the students they can take them home) which could really be the exciting part of the project. For example, the children who in the short periods of testing have learnt enough to provide support to others with broken machines. These children have the prospect of a better future ahead of them complete with technological skills. These children will pick up the how to use the laptops very quickly, and who knows, maybe the next Bill Gates is currently in school in Nigeria waiting for his OLPC to delivered so he can change the world of computing for ever. Connecting these children to the Internet gives them access to virtually anything (which is of course good and bad), educationally there can be no better resource than the Internet. At the same time, it is also open to abuse, I don't think it would take long for the laptops to become riddled with porn, violence, viruses and goodness knows what else, but strict control might be able to control this to some extent. Are the pitfalls of the Internet really a good enough reason to prevent half of the world having access to it? I certainly don't think so.

Interestingly we met a young man in the Solomon Islands who was there introducing the concept to the SI government. SI are currently testing the OLPC computers and it is countries like the SI who have the most to gain from the project in my opinion. Having experienced the SI culture, I don't know how it would be received there or what would happen if every child in Lata was given an OLPC laptop. I can only imagine how I would feel in that situation, being introduced to a whole world that I didn't even know existed. I think the children there would have a lot to gain from such a project but what they'd lose in return I'm not sure. Perhaps missbliss, having taught in the SI would be better placed to comment on this than me.

There is one exciting part of the project which perhaps solves one of the problems, (the fact that the money should be spent elsewhere). A scheme in the USA called Give 1, Get 1 (G1G1) allows Americans to buy their own OLPC at twice the normal price (which still isn't a bad deal) with another machine being provided to a child in the developing world. This pilot scheme could be the key to introducing the OLPC cheaply and fairly without compromising other educational resources. I know I'd certainly join in such a scheme if it came to the UK (and I had any spare money). I really like this idea and it seems the Americans did too as quite a number were sold under the scheme. If it were my scheme, I'd have some way of linking the machines, perhaps a unique email address for each machine which would allow the beneficiaries of the scheme to say thank you to the person who paid for the machine under the G1G1 scheme. I think this would add another dimension to the project, although again it would be open to abuse although I don't think many paedophiles would travel all the way to Nigeria to indulge their fantasies but lets not even go there!

Sure there are problems, for starters the money really ought to be spent on providing a basic education first before giving each and every student their very own laptop. There is potential for abuse, and what happens if one student loses, breaks or has their laptop broken, will their education suffer or will it just breed a generation of spoilt, jealous, technologically able evil people? Who knows, only time will tell but in my opinion, the OLPC vision is a fantastic one and one which should be pursued in one shape or another.

Communication of the feline variety

2007-12-10T17:30:00.000Z

Thanks to MrsHappyAnna over at The Happy Couple for these great videos. (Missbliss spotted it)

Watch this first:

Now watch the translation:

Tales of an Island Adventure (part 1)

2007-12-10T08:41:00.000Z

10
10th December 2007
15 Days to go till Christmas

tlm fact: I once ate 5000 calories of flapjack in one sitting. Needless to say, I didn't feel particularly well afterwards but it was worth it!

In an effort to re-live some of our time in the Solomon Islands, this is the first part of a series of short (true) stories about our summer adventures. Some of the stories will be things we did ourselves but others will be tales told to us by the Dr Gunter Kittel, the doctor in Lata.

First of all, let me fill you in on some facts; in recent years there has been some 'ethnic tension' in the Solomon Islands, the majority of this tension happened in Honiara, the capital. As a result of this, a group of South Pacific countries formed a coalition called RAMSI (Regional Assistance Mission to Solomon Islands) to offer help to the Solomon Islands. RAMSI have a significant presence in Honiara and on the other islands for quite a while.

The RAMSI police have an outpost in Lata on Santa Cruz island, the island we were on. Feelings seem rather mixed towards the RAMSI group, and RAMSI don't exactly do a lot to integrate themselves into SI society. For example, the outpost on Lata receives its own weekly flight (bear in mind that there are only 2 at best, Solomon Airlines flights per week), on this flight is a supply of food; beef, chicken, apples, oranges, pasta, cheese etc etc. This food is stored in the huge chest freezers in the RAMSI compound. The RAMSI police are told not to buy or eat any local food because it might be dangerous (it didn't do us any harm), they are told not to go into the local police station because it has asbestos in it. (How the RAMSI police are supposed to work with the local police without using the same building I don't know). They are told not to socialise with the locals and especially not the women. I'm sure you get the idea by now.

Dr Kittel doesn't have the best relationship with the RAMSI police, there are a number of reasons for this and we spent many a night listening to Dr Kittel recount stories of his relationship with RAMSI.

One day, a young man presented to the hospital with a laceration to his hand. It was a serious injury caused by a machete. His fingers were literally hanging off his hand, the muscles and tendons having been severed. Dr Kittel doesn't have the equipment at Lata to deal with such an injury therefore the patient had to be referred to the main hospital in Honaira. The patient would have to wait for the next cargo ship, which could feasibly be weeks, by which time he would have lost his hand - maybe even worse. It just so happened that shortly after the patient presented the weekly RAMSI plane, which is empty but for a supply of food and pilot, was heard landing down at the airstrip. Dr Kittel cycled down to ask the RAMSI people to take the patient back to Honiara where he'd be able to receive the treatment he needed. The RAMSI people on the island refused and told Dr Kittel that he should go and contact the main RAMSI base by radio. He persuaded the plane to wait until he'd been back up to contact the main RAMSI base but as he cycled back up to the hospital the plane took off again.

Apparently, RAMSI are not supposed to help out Dr Kittel by transferring patients unless there is a life-threatening situation. This young man might not have been immediately dying but if he lost his hand he wouldn't be able to do much to support his family.

To me its absolutely ridiculous that this empty RAMSI place couldn't be used to take this patient to Honiara which potentially would have saved his hand. It is no wonder that the relationship between RAMSI and the local is quite difficult. It must be said though that after contacting the main RAMSI police, Dr Kittel did get a RAMSI funded plane to fly out a few days later to transfer the patient. What a waste of time, money, resources.

Blogging Issues

2007-12-09T16:59:00.000Z

9th December 2007

16 Days to go till Christmas

tlm fact: I have ridiculously bad eyesight. I'm shortsighted to the extent that without glasses I'm pretty much legally blind. I once tried contact lenses and it took me 2 and a half hours to get the damn things out of my eyes, I've avoided them like the plague since. Instead I wear glasses which cost ridiculous amounts whenever I get new ones as I have to get the 'thin' lenses so I don't look like I'm wearing milk bottles. Eyes are the only thing that I'm queasy about so opthalmology is definitely a specialty to avoid.

I'm finding blogging quite difficult at the moment. It isn't because I've not got much to say, on the contrary, I've got lots to say, I just don't know how comfortable I feel about saying it. I'm not sure why, it might be because people I know read, but I've always known that so why should things change. It always makes me think twice about some of the things I say and some of the topics I blog about. I don't feel I can be as open as I want to be which makes blogging slightly less worthwhile.

I could use the real little medic to get some of these things off my chest in a more secure environment but I'd like the things I've got to say to be open to a wider audience than those at the real little medic so that doesn't really work for me.

I've also found it quite difficult to write about things recently. I tend to just confuse myself when I'm writing and end up not really explaining things how I want to explain them.

I'll keep on going and hopefully work my way through this strange period. I'd like to think that I won't really care and will be able to write free of constraint as I have done in the past, only time will tell if that is the case or not.

What a difference 5 minutes makes!

2007-12-08T14:00:00.000Z

8th December 2007

17 Days to go till Christmas

tlm fact: I once won a spaghetti eating contest in the middle of ASDA, I was fairly young at the time and felt rather ill afterwards. Disappointingly the prize was prize was rubbish; a bag of sweets if I remember correctly.

I had a bit of writer's block for this evening's blog post (it is hard work having enough to blog about each day so apologies if you're getting bored of me scraping the barrel occasionally).

missbliss and I decided that tonight should be take-away night but unfortunately we had no cash (I don't think the take-away man would appreciate being paid in 2p coins), this meant that I had to go out to the cash machine which is a short drive away.

My 5 minute journey infuriated me, the roads full of useless fuckwits today. On the way to the cash machine I had to turn right at a traffic-lighted crossroads, these always piss me off because you have to wait till the lights go yellow so you can go across the lane of traffic. It REALLY fucks me off when people go through yellow/red lights so you can't cross the line of traffic before the other road starts moving. I've not explained this very well but i'm sure people who drive will know what i'm talking about. Anyway, tonight someone came through the lights leaving me stuck in the middle of the junction. For a change there was some justice, I laughed my head off when the traffic light camera flashed at him (at least I hope it flashed him and not me stuck in the middle of the junction - after all it was him that went through the red light) I hope he gets a big fat fine. I therefore propose that all junctions have traffic light cameras installed to catch these cheeky bastards!

Then on the way home I encountered two fools who insisted on blocking where I wanted to go. One car just stopped right in the middle of the road I wanted to turn down, she was obviously lost but seriously, can't you stop just 10 metres further on so people can actually get past you. Only 30 seconds later did someone else do exactly the same thing. Why? Get the fuck out of my way you useless fools!

Anyway, thats enough of that, time for curry, beer and x-factor.

Things i've been pondering this week...

2007-12-07T19:19:00.000Z

7th December 2007

18 Days to go till Christmas

tlm fact: Despite my blogging name; The Little Medic, i'm not actually that little. I'm actually almost exactly 6ft tall.

1) Do swans have arguments? Swans pair for life, and there are a couple on the pond at my hospital. I've spent many an hour this week wondering if they argue with each other in their swanny ways. (This is mainly because they've spent most of the week at opposite ends of the pond which is unusual.)

2) I've become obsessed with the time it takes for my journey to hospital. It is just over 40 miles and I usually set off at 7:00am or so (8:11am by my car's clock which i've yet to put back an hour for daylight saving time and which is always fast anyway - i'm never late for anything!) Its virtually all motorway and i've been obsessed with doing the journey in 45 minutes. I managed it this week but now I'm determined to squeeze a few extra seconds to the extent that I'm even obsessed with the traffic lights and trying to get a clean run through them. I know..... i'm strange

3) I went to the doctors this week with missbliss and unknowingly had my stethoscope in my pocket. About half way through the consultation she noticed it and asked if we were both medics. I found the whole consultation quite hilarious, felt slightly patronising but only because the GP was trying to explain things in the very simplest of terms.

4) Thank god its Friday.

Just 1 more week of gastro before Christmas and on Friday I have to make a presentation on diarrhoea, joy. I'm still really enjoying the placement although the house officer isn't quite as good. I am absolutely dreading after Christmas, 8 weeks of community, I've been hearing exceptionally bad things about my GP too which isn't reassuring. I'm not a fan of GPs at the best of times but for 8 solid weeks? I did try and change my placement to one closer to home as when I gave my preferences I picked place X because I thought we'd be living there. Of course this changed when I decided i'd rather walk barefoot over a bed of nails whilst being showered with lava than live in place X. As usual the medical school were exceedingly understanding and helpful in that they said no. It was my own stupid mistake in the first place but I should have known my medical school well enough not to even bother trying.

One Year On

2007-12-06T13:45:00.000Z

6th December 2007

19 Days to go till Christmas

tlm fact: I am related to Gordon Brown and have had tea and biscuits in 10 Downing Street.

One year ago today I was sat in a GP surgery working on a project, by working I of course mean surfing the Internet. I came across The Angry Medic and from there, I found a plethora of blogs from medical students, doctors and other health professionals. Despite my addiction to the Internet, I'd never previously discovered this phenomenon. I spent hours reading about the experience's of others and that day I decided that perhaps I should have a blog of my own.

(I tried to use this as an excuse to get missbliss to bake me another cake, unfortunately she was having none of it - although she did make a very tasty trifle)

From there I came up with I'm a Medical Student, Get Me Out of Here and wrote my first post. I really didn't expect anyone to read my moans and groans and was very pleasantly surprised to find that I soon built up a small following. I'm not the most articulate of people, especially when it comes to explaining my ideas in writing, I often forget things and I'm sure my vocabulary, spelling and grammar often leave a lot to be desired. Never-the-less, here I am one year on, I'd started blogs before but only written 1 or 2 posts before getting bored and giving up but I was determined to stick with it and I've succeeded so far.

I've enjoyed blogging, its a very helpful release, I enjoy getting some of my moans off my chest here (although I still moan a lot in person too). There have been some great times in the last year, and some really shit times but overall I think blogging has been a positive experience for me. It isn't exactly a portfolio but blogging has also had its uses, it is a way of reflecting on some of the experiences I've had in the past year. This came in useful when I had to write my foundation application form. The writing experience has also done me the world of good as I've improved my writing style and learnt things too.

I'd like to say a huge thank-you to all those who've read my blog and those who've left comments. There would be much less enthusiasm for blogging if I knew that nobody was reading.

I hope I'll be able to continue blogging over the next year. There will be PLENTY of challenges and lots of things to moan about over the next year so stay tuned. There will also probably be a sparkly new blog to come if I pass finals and finally become a doctor.

Oh, and you should all read this post by missbliss, the pictures are hilarious!

The second first day

2007-12-05T17:57:00.000Z

5
5th December 2007
20 Days to go till Christmas

tlm fact: It is my lifetime ambition to own a brand spanking new red Ferrari bought from the showroom, in cash. Hopefully before I'm 45. I daresay missbliss might have something to say about this.

A confusing title indeed, today is the day that all the F1s (junior doctors) in my hospital (and probably most other hospitals) rotated to their new 4 month posts. I suppose it must be better now they've got 4 months experience but it must still be quite stressful, especially going from surgery to medicine for example. I missed that day in August when you should never under any circumstances go near a hospital because the wards are full of junior doctors on their first day but personally i'd give hospital a miss today too if you possibly could as it was somewhat chaotic and it rather scared the shit out of me thinking that i'll be in this position in 8 months!

What scares me the most is the ridiculously little amount of support the F1s on my ward received from their seniors today. My new F1, who is a pleasant chap who has just come from 4 months A+E, I helped him out quite a lot today by doing jobs, hopefully I'll be able to help him settle in a bit as I've been on the ward for a couple of weeks and know how things work. The SHO, who was supposed to be there at 9 ended up walking in at about 9 45 and neither the consultant or registrar were anywhere to be seen. Now I know its unrealistic to think the whole team would be there to greet you on your first day, but it'd be nice if someone was there to explain what the fuck you're supposed to do.

The other F1 who started on my ward today had even less success, nobody from his team turned up so he just took off and did the ward round on his own without having the foggiest idea what the hell was going on.

This situation can't be good for patient care, I know for a fact that things were missed today because of it and patients treatment has been put back by at least a few days until everyone is back up to speed.

Note to self - must make sure when I'm an F1 that I've got a reasonable idea of what I'm supposed to be doing whenever I change jobs. I'm hoping that I'll at least have some support wherever I end up, but I suppose I shouldn't expect there to be much in the way of help.

The Adrenaline Rush

2007-12-04T08:09:00.000Z

4
4th December 2007
21 Days to go till Christmas

tlm fact: All through primary school, I was obsessed with becoming a policeman. So much so that I used to wear my little uniform whenever possible and whenever I wrote my name on my school work, I always wrote: PC Little Medic so I could pretend to be a policeman. Fortunately I did grow out of this and spent many years after that wanting to be a vet. I changed my mind only a year or so before applying to medical school. I've not yet taken to writing Dr Little Medic on my work so I can pretend to be a doctor.

Yesterday, I went to see some endoscopies, expecting a nice relaxing morning. Fortunately for the patients, everyone was normal. That was until there was an addition onto the list, an elderly (70+) lady who'd recently had a GI bleed. She had already been scoped but they couldn't find where the bleeding had been coming from. Her haemoglobin was already ridiculously low (i'd never heard of a Hb so low). They scoped her again and found where the bleeding must have come from and made an attempt to stop any future bleeding. Unfortunately, right there in front of our eyes (well, on camera), an artery started spurting blood inside her stomach. From this point, my heart started pounding in what must have been an adrenaline rush. By now the endoscopist couldn't see a thing because there was blood everywhere so he couldn't do anything about it. He called down the best endoscopist in the hospital to see if he could do anything and he also called the surgeon on call to take the patient to theatre if nothing could be done. Before I knew it, the room was crammed with people. Endoscopists trying to stop the bleeding, the surgeon on call and an anaesthetist assessing him for theatre. Various other doctors were running around like crazy putting cannulas in and taking blood for cross matching. Blood and fluids were being put up by the bucket load. Meanwhile I was in the middle trying to hold the patient down as she fought to remove the endoscope despite being sedated.

They couldn't do anything endoscopically, so they took her down to theatre to open her up and try to stop the bleeding. Unfortunately thats where I had to leave, so I don't know what happened. I guess I'll find out today. I hope she is ok.

I feel bad that I was sort-of excited by the emergency response to her rapid deterioration. I suppose it must have been the rush of adrenaline as people were running around me trying to do their best for the patient. The whole team were fantastically calm despite what I thought was quite a serious situation. I think it was dealt with really well and maybe the adrenaline rush that each member of the team must get helps them to do what they need to do efficiently.

Advent Calender Update

2007-12-03T19:05:00.000Z

3
3rd December 2007

22 Days to go till Christmas

tlm fact: I have a severe phobia of earwigs. The evil monsters scare the living daylights out of me! That is my only phobia.

Things that rock about Christmas

2007-12-02T14:19:00.000Z

2
2nd December 2007

23 Days to go till Christmas

tlm fact: 2 weeks before starting university in 2003, I almost wrote off my brand new car. Since then I've driven 75,000 miles which is the same as driving round the world 3 times! During this time I've spent about
£9,000 on petrol and £6,500+ on car insurance. Despite that, I still enjoy driving and I've spent most of the 3000 or so hours i've been behind the wheel day dreaming (not the best idea whilst behind the wheel I admit), all sorts of things go through my head when I'm driving including lots of blog ideas, unfortunately I tend to forget them when I get out.

1) Christmas cake - quite possibly the best cake ever. Especially when there are huge amounts of icing and marzipan all over it.

2) Clementines/Satsumas - best fruit ever. They are always on offer in ASDA or Salisbury's and we buy them by the crate load. I don't even know if they're particularly christmassy but its a good enough excuse for me to binge on them.

3) Mince pies - oh my god, why don't they sell mince pies all year round. In previous years I have pretty much lived on mince pies from late November to January. Missbliss has tried to put a stop to that but I can often be seen munching on them. The thin ones from Salisbury's are my current favourite.

4) Presents - well it wouldn't be Christmas without them would it? It is always an excuse to buy presents for yourself too!

5) The Christmas cheer - it usually starts on the first of December, people can be heard humming Christmas songs to themselves, and most people just seem to be happier than usual. We went to a Christmas market last week and EVERYONE was smiling and generally being happy.

6) Christmas markets - mulled wine, dutch pancakes, mince pies, and hog roast, oh my god hog roast! *drools*

Leave a comment and tell me what you like about Christmas (if you don't like Christmas then go and watch the "Holidays are coming" advert until you've changed your mind!

"The Holidays are Coming"

2007-12-01T11:22:00.000Z

1st December 2007

24 Days to go till Christmas

TLM Fact: On Christmas eve 1997 I was running down
the stairs and I tripped and fell, I spent the evening limping
around in pain. My mum and I spent Christmas morning in A+E
and later that morning, I came home in plaster having broken my foot.
What a way to round off the worst year of my life during which my parents broke up,
I had to move house, and my nan died.
(I promise not all the TLM facts will be as miserable as this one)

Its true, its the 1st of December and Christmas officially starts now. (I'm not even going to say how long our Christmas tree has been up!) I've already seen the Coca Cola Christmas ad on TV once or twice which made me ridiculously excited so I thought I'd share it with you all. Whether you've never seen it at all, or just not seen it yet this year, watch it. I promise it will stir up the Christmas feeling inside you. (If it doesn't you must be some kind of anti-Christmas monster)

December also marks my 1 year blogiversary and to celebrate this momentous feat, (I never expected to still be blogging regularly a year later, nor that I would ever get any readers) I'm going to try my hardest to write at least a short post every day during December. Will I manage it? Probably not, but we'll see. Also, in the spirit of Christmas, I will also be running my very own advent calender with a new Christmas picture each day, and rather than a chocolaty treat to go with it, there will be a TLM fact of the day (which will probably be exceedingly boring but we'll see how it goes)

Of course you can prod and poke me

2007-11-29T19:19:00.000Z

Today was the 4th Year OSCE for which I've spent the day being a patient. Yesterday I was informed that I should bring shorts, this was a surprise as I'd guessed that I'd be on the shoulder exam station (there is ALWAYS a shoulder exam - well there used to be!). From this I could deduce that I'd either be doing hip, knee or lower limb neuro examination.

As it turned out, I spent the day having my hips examined. It has been a very long day but despite that, it was good fun. I rotated with another volunteer but I must have had 25+ hip exams today, (my hips now feel far worse than they did this morning). It was actually quite exhausting, I don't know why, and I've lost count of the number of times I've confirmed my name and date of birth. By the end I was struggling to remember my own date of birth, at one point I confused one poor girl by telling her I was born in 1895, oops.

The quality of the students differed quite significantly, confidence seems to be the main differentiating factor. Take for example one guy who was very confident and whose knowledge was adequate compared to a very nervous but exceptionally knowledgeable girl. The girl's mark suffered as a consequence of her nervousness whereas the boy gained significantly by being confident (even though it might well have been false confidence).

I was there all day but at lunchtime the examiners changed. I was surprised just how much difference this made. This morning's examiner was quite harsh, he kept putting people off their rhythm with silly questions. The afternoon's examiner, was comparatively lenient, and he let the students get on with it. I suppose it all evens out over the whole exam, but still, they are VERY subjective.

The majority of students wanted to remove my shorts for the examination! Fortunately the first examiner explained that I was adequately exposed but when it came to the afternoon, even the examiner thought I should remove my shorts! Luckily one of the admin staff overheard and saved me. I did get poked in some awkward places though!

It was very interesting to see the exams from the other side of the fence, it was good experience (I could do a perfect hip exam now) and it was good fun. I've lost count of how many biscuits I ate throughout the day. Most of which were to make up for the awful free lunch we were given. Honestly the canteen could do with a visit from Gordon Ramsey, their food tastes like its come out of the wrong end of a cow.

I'm sure there was much more that I wanted to say about today but it escapes me, and right now I'm going to spend some of my hard earned cash from today on takeaway for me and missbliss. mmmmm tasty!

(There is one bit of extra gossip but that is suitable for reallm eyes only)

Are We a Hotel or a Hospital

2007-11-28T20:29:00.000Z

One of the patients on my ward has been medically fit for well over a week, unfortunately he just won't go home. In fact, he probably never needed to be admitted in the first place. He does have a number of issues, and does require some level of support but not medically. At the moment he has his own room with private bathroom and he gets fed three times a day. We're not doing anything for him, he's just using the hospital as a free hotel!

He was admitted with complex symptoms which needed to be investigated but he could have gone home a few days after being admitted. Coincidentally, when he was admitted, his partner (who provides the care he needs) was to be admitted for an elective procedure the next day (so wouldn't be there to provide support for him). The cynical among the staff, suspect that this isn't the coincidence it was made out to be.

And so it is, we're stuck with him, don't get me wrong, I think he probably did need some help at home when his partner was going into hospital but hospital isn't the place. He's medically fit so is just tying up a bed at the moment and who knows when he'll go home. I suspect in the old days he'd have just been kicked out, but now, there are complex issues when it comes to discharges, especially in complicated cases. As a result, its almost impossible to get rid of someone who just won't go.

We're not a hotel, we're a hospital. A hospital that is currently in the midst of a serious bed crisis, so much so that we might be closed next week - not a surprise really with patients like this.

n.b. Patient details changed and omitted for confidentiality.

Being examined...

2007-11-27T15:07:00.000Z

You guessed it boys and girls, its that time of year again, exams. Now the cleverest among you will be wondering what I'm talking about because I've said a few times previously that I've got no more exams until finals and this is true. I am of course talking about the year 4 exams which are happening this week. A year ago this week, I was frantically (hmm, perhaps not frantically but still) revising for the OSCE which covers psychiatry, orthopadics and neurology. When it came to it, I actually did quite well, I made some stupid mistakes which cost me but I was very pleased with my mark. Shortly after this event, I began my journey into blogville and have been going ever since. This of course means that my first blog birthday is coming up shortly but more on that later.

So, what is this post about then? Well, on Thursday I am being examined, not by examiners but by the year 4 students, that's right I'm being a patient in one of the OSCE stations. I've done this once before during last years exam where I was subjected to numerous respiratory exams, my trachea hasn't been the same since! I've got a fair idea of what station i'm going to be on this Thursday, but its only a guess and I shall wait till after the exam to talk about it - just so that in the unlikely event that a 4th year reads this, they won't benefit from knowing what is coming up (not that I know, its just a guess)

There are a few reasons for volunteering for this kind of thing, perhaps the most useful is the fact that you get to see the exam from the other side of the fence which is good experience and you get to see what exactly examiners are looking for. You also get to revise whatever station you're doing as you critique the students being examined. There are also bonuses such as free food and a day off (its a terrible shame that the exams don't fall in my community block). The fact that you get £40 for the day is of no importance at all (I promise ;) )

Check out the reallm for the latest juicy PBL gossip.

I Actually Like Medicine!

2007-11-22T18:54:00.000Z

Yes ladies, gentlemen and others, I actually want to be a Doctor and I'm really looking forward to it. Just about every medical student, goes through periods when then think 'is this really for me?' and i've had my fair share of feeling like that but:....

I've not been this excited about medicine for....well, ever really. Sure when I first started clinicals the first week on the wards were exciting and interesting but following that I fell into sort of a hole whereby I just went along with the flow. I found the work mildly interesting but I wasn't really inspired by it. If I'm totally honest I drifted through most of 3rd and 4th year. I learnt things along the way and really enjoyed parts of it but I never really felt truly involved. I wasn't the first, and I won't be the last person who doesn't really put themselves forward for things. I mean yeah, I was always ready to try and answer questions when others would just stand silently staring off into space but when it comes to being keen or having to actively ask to do or be shown something I just tended to drift into the background. I know this isn't the way to do things, or a good way of learning things and I've always advised others to put themselves forward.

I think perhaps things started to change during my elective, for the first time ever I felt almost useful, like I could really help and make a difference. I liked the atmosphere, I enjoyed learning and I was interested in medicine. On my return I went back into somewhat of a lull, back to my old ways of coasting if you like. Perhaps this is because I was on somewhat of a come-down following the amazing experience of my elective.

I've never enjoyed a week of medicine as much as I've enjoyed this week, I've not done anything particularly special, or seen anything wildly exciting but for the first time in a long time I'm excited, I'm enthused, I'm eager to learn. Very rarely have I come away at the end of the day with the intention of reading up on something I've seen or learnt about, even less so have I followed through on that intention but now I feel like I want to, I'm inspired to. I think I'm behind some of my peers with regards to being involved, some of them have probably been at it since 3rd year. But I don't care, for me, its important that I've finally seen what medicine is really like and that I can see myself doing it, and doing it well. Perhaps its because its 5th year and that things are starting to come together and make sense (still very slowly but still, its progress!), I know what tests patient x needs and why, I no longer feel useless or in the way (although I still probably am) I enjoy helping the house officer out with jobs. I can pin-point one reason which might be contributing to my new found love of medicine - the one-on-one style of 5th year. I have a whole team to myself, there is nobody else to get in the way/compete with/hide behind. Not only do I learn a lot from one-on-one teaching, I find the whole experience much more beneficial, I'm more confident and much more willing to do things. Today, when I had my own patients in clinic I felt like a doctor, I was making taking complete histories, doing full examinations, making diagnoses, coming up with management plans all the things doctors do and I loved it. Ok, so they were not the most taxing of problems but for me, it made me realise that I really do like this medicine malarkey, I really do want to be a doctor, and I really can't wait...

This post is FAR too positive for me, so it should also be noted that I still hate the course and PBL. Perhaps I wouldn't have been so slow in finding my path if I had gone elsewhere, but not to worry, better late than never eh?

The Little Doctor, coming to a ward near you, and excited about it! (if I pass finals EEEK!)

New Firm, New World

2007-11-20T21:04:00.000Z

I've not done a medical firm for a while and it was a bit of a shock to the system when I started my new firm this week. I've been used to the relatively relaxed surgical specialties for a while. Surprisingly I'm loving it! Although its only been 2 days, I'm already getting quite into it despite the long days that I'm not really used to.

Yesterday was my first day, the registrar is off on holiday, the SHO was off sick and the consultant was busy. It was left to the F1 to do a ward round so I tagged along with him. The F1 is really nice, I learnt lots and found it really interesting. There weren't too many patients on our list though each one had their own complex issues. Its supposed to be a gastro firm so why one of our patients is a myeloma patient i've got no idea, it was certainly interesting the two of us trying to take care of this guy (neither of us know much about myeloma) trying to arrange an MRI for query cord compression was a challenge, and I ended up getting shouted at down the phone by a neurologist who didn't want to do his MRI. I left at 5pm, having not even had a 2 minute break all day, I was knackered, god knows how the F1 was feeling, he didn't leave till 7 and he'd done a 14 hour shift the day before.

This morning, I arrived promptly and helped out the F1 by doing some of his jobs, before 9am I'd done all the blood forms and spoken to a nursing home to find out the normal condition of one of our patients. The SHO turned up shortly after 9 and I'd been forewarned about her by the F1, he wasn't wrong, she wasn't the friendliest person in the world but there is always one bad egg isn't there? The consultant came along and it was decided that I should just shadow the F1 for most of my time on the firm which I'm really happy to do as I've already learnt plenty, including lots of tips about being an F1 which will come in handy. I enjoyed the ward round and after lunch (fortunately we had time for lunch today which was kindly bought for me by the F1) I stayed and helped with the jobs. To round the day off, I did an ABG on an old lady with annoyingly mobile arteries, fortunately I hit it, which is surprising as I've not done it for since early in 3rd year!

I'm really enjoying this medical firm, despite yesterday's 8 hour ward round. I'm even surprising myself. I'm looking forward to getting stuck in over the next 4 weeks and getting some really good experience shadowing the F1. I just hope when the F1s change in December that I get a decent replacement...

My Second Favourite Thing in The Whole Entire World World

2007-11-17T08:58:00.000Z

Second I hear you ponder? Well I didn't want to leave missbliss out and no, its not my new eee PC (although I do love it lots).

CAKE! - Fortunately for me, one of missbliss's finest attributes is making fantastically yummy cakes of all shapes and sizes. This goes hand in hand with one of my best attributes, the ability to gobble cake like no other living human!

This post is to celebrate the wonders of cake (particularly the chocolate cake I have waiting for breakfast), missbliss's ability to make said cake, and to rejoice in the chocolaty goodness of the world.

The amazing 'chocolate splurge' cake. (Or as I like to call it - breakfast)
The icing got a bit messy but hey - any mess involving chocolate can only be good right?

My birthday cake - made with 2 of my other favourite things - cream and raspberries.

CHRISTMAS CAKE! - one of the best things about Christmas (and missbliss doesn't even like it so all the more for me!)
This was last years wonder - decorated by none other than the little medic himself - with edible, gold painted holly made from icing

Its getting to the Christmas time of year which can only mean more cake - YIPEE!

UPDATE: After breakfast:

Gadgetery Goodness

2007-11-15T08:55:00.000Z

If you're a long time reader of my blog you'll probably be aware that I'm a bit of a techno geek when it comes to gadgets. If I had the money I'd buy all-sorts of goodies. Sometimes, gadgets come along which are just too good to miss out on (at least in my opinion.)

This situation happened last week and I decided to splash out on a new toy. I was fortunate to find them in stock as they're very new and in demand (for those who know what they are that is.)

Its quite expensive, but also a bargain, and I hope to be able to earn the money to pay for it, well, I've already bought it, but I'd like to earn some of that money back through the following:

a) Selling my PDA on eBay - as much as it pains me because its also a gadget and I love it its sort of redundant now as I have my Nokia N95 and my new toy which effectively take care of anything the PDA can do.

b) Selling old books on Amazon - I've already sold a few, and hopefully will earn a few pennies this way whilst also freeing up some bookshelf space (much needed in our house *glares at missbliss*) 'Sociology as Applied to Medicine' is one of the many wonders now listed on Amazon, I bought that eagerly during my first week at medical school, (yes I was naive) I might have opened it once in the last 4 and half years....oops.

c) Volunteering as a 'model' for the 4th Year OSCEs - at £20 a pop, a few sessions of that will help no end (not to mention it being an excuse to get out of PBL!)

So I'm sure you're all wondering what it is that I splashed my non-existent (at present) cash on, well I could do a cal and not tell you but I'm not that mean, besides, you'd never guess in a million years.

It looks like a laptop, and is in fact a laptop, but its small, about the size of an A5 writing pad, and only 900g in weight. The Asus eee PC, is my favourite new gadget. Unfortunately the operating system is based on Linux which means its completely different to Windows but I'm slowly getting used to it and it can do just about everything that I would ask of it. Its not meant as a main PC but at £200, this exceptionally portable, sturdy and generally cool gadget can be slipped into my bag to be used to surf the web on the move, check emails, write blog posts and most other stuff your £500-1000 laptops can do.

Ok, ok, so you might not be quite as excited as I am because I am a bit of a geek but still, I'd recommend these to anyone. Few things are quite as exciting as waiting for a new gadget to be delivered - so much so that I actually looked forward to PBL this week because I knew that after it, I'd get to play with my new toy. Woo

p.s. Check out the reallm for more PBL tales.