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

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

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

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

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

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

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

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

Foundation School Allocations

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

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

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

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

What Is Wrong With Me?

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

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

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

Location Location Location

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

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

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

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

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

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

Buy Your Tickets Here

For the post code lottery,

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

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

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

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

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

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

What Not to Wear

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

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

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

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

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

The Start of a New Year

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

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

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

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

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

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