Have the BBC Missed The Point?

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


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


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


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


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

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

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

Who would you want to replace your hip?

OSCEs From The Other Side

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

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

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

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

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

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

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

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

Going Up In The World

4th Year is officially over and done with! I guess that makes me a 5th year! Shitters.

The year concluded this week with 2 mammoth days of everyone presenting their project option. This involved about 40 people talking, for about 5 minutes each (it was supposed to be strictly 5 minutes but there was a mistake in the timing thing which meant everyone had 6 minutes! Ha!) Anyways, my turn came and went without any problems, my presentation was ok and I think I managed to answer the questions. Even my busy supervisor managed to make it which was nice of him. All in all, it was all quite interesting although it began to drag a little towards the end. The worst thing about it was the free lunch, what a pathetic attempt it was. We're always given free lunch at the end of OSCEs but it usually consists of atrocious prawn croissants. This time I couldn't even tell what it was so I stuck with 2 baps and some ham. And the cake?! Don't even get me started, I think it was supposed to be black forrest although you couldn't tell! It was awful, the sponge had about as much chocolate in as my left big toe! (Bloody neurology meetings always get a big juicy chocolate cake WITH CREAM! I often acquire a bit on the sly pretending I'm a neuro doc) So that was a mammoth disaster.

Anyway, yesterday ended and slowly people drifted away. Some of these people I won't see, probably until finals, most of which I won't see until January and all of which I won't see until the end of October. (5th year is very scattered, we're all on electives at different times and at different places) Being the socialite that I am, I decided against going to the pub and decided playing pool would be a far better option and so that's what we did. Suddenly the realisation that we're now 5th years began to dawn on us (helped by a huge brown envelope labelled "tlm, Year 5 Medical Student" No longer can I fall back on the excuse that "I'm only a 3rd year", or "only a 4th year", I'm expected to know stuff. Next year should be fun, I've got a cool elective and some great placements.

And that was that, the end of another year at medical school. 4 down, 1 to go. For me, the next one sort of begins on Monday when I leave for pre-elective travelling. Everything has come together and seems to be sorted out. We just have to finish packing up our cosy little flat (which at the moment is crammed full of full, half-full and empty boxes), move all the stuff, and then we're ready for the off.

I even managed to sort out, at the very last minute, the donation of a fetal heart Doppler from Huntleigh Healthcare, very kind of them indeed. I'm sure it will be much appreciated, that is if UPS decide to deliver it today...

Finally a Response!

Just had an email about my appeal against a mark received in a recent exam, it was a very polite reply from the chair of the assessments committee.

He stated that the matter had been investigated and that no discrepancies in marking had been found. He suggested that as I had reached the required standard for progression to year 5, I should reflect and move on which is fair enough. Apart from the outcome, I'm pleased with the response. I couldn't have expected much more, it is a case of my story against the examiners and obviously his carries more weight in that he is the senior and I'm the student being assessed so am potentially biased towards myself.

I continue to feel an injustice has been done but there is little more I can do. I did suggest that the mark in question should be excluded from my grade which wouldn't change it overall but would be a moral victory for myself. We'll have to see what happens with that. I'm still offended about what the examiner wrote as feedback on my form. I remain oblivious as to how I could have improved for that station, and for that reason I've asked permission to speak to the examiner in question about my performance in that station (opinions on whether or not that is a good idea are welcome in comments?) and how the station should be performed. This was originally suggested to me by a member of staff.

I wonder if I'd be allowed a chaperone for my finals. :D

Anyway, poo to that!

Car Park Dodgems, a New Toy and Another Moan

Parking at hospitals is notoriously stupid! The one I'm at is no exception, it is awful! Cars everywhere, car parks full to the brim. Crazy drivers spending ages looking for a space, the older generation struggling to fit into a space which you couldn't fit a cat in never mind swing it. Having been in Hospitals for about 2 years now, my car looks like its been through a safari park of raging elephants followed by a parade of chavs with baseball bats and keys.There are dents and scratches everywhere! And I'm really fucked off. I didn't do any of them (well maybe one) yet nobody has ever stopped and left their details. Seriously my car must have been hit or scratched about 7 times in the past 2 years. It'd cost me thousands to have it all repaired. Stupid useless drivers! Seriously people should learn how to park, it's not that hard is it?No wonder the consultants all have their own spaces which are about twice the size of everyone elses!

A new toy? It is phone upgrade time, I've been with the network 02 for almost 4years but I've decided to swap to T-Mobile. Mainly for their great data tariffs.Anyway, I've been getting more and more excited recently about the prospect of a new phone (Yes I know I'm lame but I just like new gadgets and toys), I went to the T-Mobile shop yesterday and I knew exactly what I wanted. I toyed with the idea of getting a PDA phone to integrate my phone and PDA but eventually decided to go with the Nokia N95. I've always been a Sony Erricson man before,and this Nokia is going to take some getting used to! I spent last night playing with it (I LOVE getting new things and reading the instructions and setting them up and...and...well everything really) So I now have a sexy new phone with built in GPS which rocks! I've downloaded free maps for the places we're going in summer (Australia, Thailand and California. Sadly there are no maps for the Solomon Islands, I think because there are no roads!) It has great built-in Internet browser so I can surf the net anywhere and a really good camera so I don't need to carry yet another piece of stuff. I expect you're all bored now of me talking about my new gadget so I'll shut up and runaway and play with it some more ...*childlike excited giggle*...

And the moan? Well that is a secret :)

Am I Dreaming?!?!?!

Today I almost kicked the oxygen habit, yes ladies and gentlemen, I almost died! "what happened?!" I hear you screaming at the screen...

Well... I was sat in the library casually procrastinating as you do, you know, perusing the web and checking emails when suddenly it happened. I noticed an email, our placement choices for year 5. I almost died of shock! (I know that is far less exciting that I built you all up for but I'm serious!) We were asked to pick a list of specialties for 5th year and we're told we'd be lucky to get 2 of our top choices, from past experience I expected the worst. As I glanced at the email, little explosions of happiness went off in my head.

I seem to have got all 4 of my top choices, even in the order that I wanted!!! How? How has something in the medical school gone my way? I'm not sure I believe it, its a joke, come on, surely?! Where is Jeremy Beadle?

So whats the explanation? Well, sadly it isn't cause for me to start singing the praises of my medical school. Fortunately the 5th year placements are arranged internally at my teaching hospital! (perhaps its not the worst place on Earth after all, actually of course it is, it's just the staff are all really friendly and considerate)

So my 5th year looks a little something like this:

Block 1 (8 weeks) - Elective, Lata Hospital, Solomon Islands.
Block 2 (8 weeks) - 4 weeks Orthopaedics (woo!), 4 weeks general medicine (gastro)
Block 3 (8 weeks) - Community placement, 8 weeks in GP land (we had to make choices for this too, I bet I'm going to get sent to the Arctic.
Block 4 (8 weeks) - 4 weeks A&E (yay!), 4 weeks lower GI surgery.

All with decent consultants in the same hospital!

p.s. Had typhoid and Hep A vaccination today - my arm hurts SO much!

p.p.s Happy Birthday to missbliss

Thank You

I just wanted to say a quick thank you to those who've read and commented on my blog. Particularly on my last post, and other equally challenging posts. It is reassuring and refreshing to read comments sympathising with me, and equally as interesting to read comments which challenge my thoughts.

My last post seemed to generate a recurring theme that the same kind of things happen elsewhere. Which is reassuring I suppose, although perhaps I'll never be free from this kind of thing? Another message was that people are human and make mistakes, this is true, and I would never blame individuals. It is the institution as a whole which I blame, I've been saying since the end of my first year here that I no longer had any faith in my university. I've been lied to, ignored, and threatened by my medical school in the last 3-4 years, not once have I been offered help, or an apology. I wish I didn't have to rely on them for my degree, and it makes me rather sad to think like that.

I'm fairly sure that people from my medical school read my blog, perhaps some of the university staff do. They probably don't like it and right now I sit here considering getting rid of my blog altogether. Many of us bloggers seem to be rather paranoid about being disciplined because of our rants, perhaps I should be paranoid more than others due to the critical nature of some of my posts.

Anyway, I just wanted to say thanks to my 10,000+ visitors (9990 of which is probably me.) I hope you enjoy reading, and I hope you continue to enjoy it until the time comes when my paranoia gets the better of me and I hit that big red delete button!

Where is my £250,000?

Inspired by this post by a biomed student who for some reason wants to do medicine I'm going to do some maths.

• Ok, so its a well known fact that it costs £250,000 to train a doctor.

• In my year there are roughly 400 students which equals a staggering £100,000,000 to train all of my year to become doctors.

• This equates to £20,000,000 per year or about £50,000 per year for each student.

That leaves me with a question....where the fuck does all that money go? I for one have seen little evidence of it. Next time i'm in the skills lab I'm going to need to use a fuck load of equipment to get my money's worth.

These figures are even more baffling considering the incompetent nature of some of the staff who are supposed to look after us but thats another story which will have to wait till another time.

I'm Famous... well, sort of.

Four years ago I spent months drafting and redrafting my personal statement for my application to medical school. After roughly 26 drafts I ended up with an almost perfect statement about me. It began "From an early age I have been fascinated by the workings of life. The human body is a remarkable machine with many diverse systems producing an organism that could never be artificially reproduced." It worked out quite well and I received 4 interviews although perhaps not for the places I should have applied to.

After starting medical school, as a favour to a friend and in order to help others writing their personal statements, I released it to the world. Reading it back now its rather cringe-worthy but it was all my own work and is all true, I'd spent years beforehand doing work experience and ticking the teamwork, leadership and communication boxes. As a scientist, writing has never been my forte but I don't think it turned out too badly and it was obviously what they wanted to hear.

Last week a story broke here and here about prospective university students using the Internet to cheat in their applications. The focus was on a phrase about burnt pyjamas which a staggering 234 students used as their own personal anecdote [that must have been a particularly flammable batch of pyjamas.] However, it seems an even greater 370 lifted my fascination for the workings of life. I cannot deny that anyone willing to make their career out of the human body would fail to find it interesting, its hardly an original idea in itself. It seems however that my opening has been copied word for word as is written in The Times article.

Perhaps I was naive to think that potential medical students would be able to come up with their own original phrasings. I anticipated that some might lift sections of my statement but never envisaged such a proportion would do so. It doesn't particularly bother me that they've plagiarised my statement, they're not in direct competition with me so why should it? I am quite shocked and disappointed but at the same time quite flattered that my statement is deemed good enough to rip off.

With the introduction of the MTAS application form, the ability to sell oneself is more important than ever. I'm sure this process won't be immune to plagiarism and with successful candidates such as this one allowing their answers to be scrutinised by the world, it probably won't be long before the MTAS shortlisters are reading exactly the same phrases over and over again. I think I can safely say that when it comes to my turn to enter the dragon's den that is the MTAS system my answers will be kept under lock and key.

edit: Links fixed

Mr Bean shows us how it should be done.