Tuesday, February 28, 2006

something is amiss

i worked this weekend and it was actually very quiet and manageable with not too many disasters. i also had the pleasure of bumping into The Venial Sinner (yes we now work at the same hospital) doing his on call care of the neuro-screwed. he appeared to be keeping a tight rein on the ward exclusively from the cafe, on his lilo, copy of that sunday's observer in hand. ah! the quiet life!

the weekend was also my last on call pissing about with kidneys (pardon the pun ho ho.) i did do a three hour guest appearance on monday night before going to my "leaving do" which i shall tell you about at another juncture. i have as of today moved back to general medicine - diabetes to be precise.

it was very peculiar.

i have three house officers, ie 3 doctors who are junior to me who do all the mundane stuff (ordering on the computer, looking up results, etc). after we'd seen all the patients, i went off, had lunch and then had nothing to do. well i did supervise one of the kids draining fluid off some guy's lungs but other than that i was twiddling my thumbs at 3pm. i left work at 4.45pm and was home by 5.30pm. i only started work at 9.30 as well.

this is bizarre.

this is wrong.

this cannot be right.

i fear that i have walked into some children of the corn scenario where tomorrow at work i shall be killed by zombie doctors.

after a year of 8am starts and 7pm finishes i can't even appreciate an easy day without thinking something suspect is going on.

i'm SURE this is a freak even. i'm SURE that tomorrow it will all go tits up and continue in that vein for the next 6 months.

until then, tonight Dr Dazed & Confused is smiling if puzzled and may even drag himself out for a pint or two.

[i am listening to the debut from Clap Your Hands Say Yeah - an AWESOME album. i am also going to see the Go Team on Friday night]

Thursday, February 16, 2006

Modernising Medical Careers: A Guide For Current Senior House Officers

here is a circular i received today:

dear doctor

good evening, hello and welcome to your guide to MMC!

now you may have heard a lot about this radical new restructuring of junior doctor training and this letter is to make sure you are fully clued up.

imagine you are a patient! you know... those annoying people who come into the hospital and get in the way of all your paperwork. anyway as you are well aware they perpetually drone on about wanting to see a consultant ie the "specialist" in whatever area they think they have a problem. you are also aware it takes a long long time to become one. that is because being the top of your field doesn't happen overnight does it!? as we write you are probably struggling through postgraduate exams, battling through a difficult rotation in the hope that you can then get onto your 5 year registrar programme and also maybe do a PhD to boot! how long is that going to take? you poor thing, i'd say about another 10 years! A DECADE! Before you're a consultant! Admittedly you'll be really great but a DECADE!

who wants to wait that long? certainly not the patients. so this is where MMC steps in. imagine this. what if we said to you we'd cut out 5 years of your training and took away the need for any research/exams? what if we also said to you that after this truncated training programme we called you junior consultants? you could tell all your non-medical friends (there must be one) that you were a consultant! wouldn't that be cool! and here's the clever bit... we could also tell the public that you were a consultant too! then they would be happy and so would our health secretary and uncle tony too! they'd be really please because Labour pledged to deliver more consultant led services and we would have delivered more consultants in a shorter amount of time! we would satisfy our masters and the public in one fell swoop. they would never know the difference between a junior consultant and a consultant (several years experience) much like no-one know the difference between labour and conservative these days. it'd be our little secret!

of course some people say that if you cut down training then the doctors produced at the end are substandard. Poo poo we say! in MMC you will have to tick boxes on forms every few months to say how well you can communicate with people. because after all, the public are happy if they get a nice friendly doctor to chat to. you don't actually have to make the right diagnosis or treat a problem correctly. we have data to prove this. the breakdown is 5% what you do, 20% how you look and 75% how you say it.

and where exactly do you fit in? there's an incy wincy problem here. we know that there are for the first time in decades plenty out of you out of work currently because woops! we expanded the number of medical school places but not the number of jobs. woops again! MMC really only applies to doctors who graduated last year. so you guys two to four years out of medical school don't really fit in to our plans. but you have a few options (there are always options. smile!):

1. get a registrar position by Aug 2007. that way you can do the old training programme and become a consultant the old way and probably be really good! it's not very modern though. and any of you who thought about taking a break to travel or do something else better not. time's running out for you lot. sorry for ruining any plans you might have had and not telling you this years ago.

2. wait till Aug 2007 and start MMC from scratch. you will of course have to work with doctors 6 years your junior and you will be hopelessly overqualified. but it's new and trendy! plus you will get to do blocks of placements like you did as a student in completely unrelated specialties! that won't help you if you really want to be, say, a gastroenterologist. you might frown and say it would be a waste of time but it'd be fun!

3. stay in your current position forever!!!!!!! the problem with MMC is that the new doctors, by virtue of their reduced training won't be able to do anything and will have to rely on you old school people to, for example, run the hospital at night. so we're hoping a few of you will stay on just to do that. if not we can always get doctors from overseas to do this job because frankly we wouldn't like our homegrown boys to take up slave labour positions with no career prospects.

there you go. please don't worry that you might become part of a lost tribe of doctors (though that too is cool! you'll be like Dr Littlest Hobo - going from place to place in search of work) - as we say on our website:

"In 2007, when the new specialty training will begin, there will be measures in place to ensure the doctors in the current training system are not disadvantaged. "

the funny thing is we haven't planned any of that yet and may not get the time to because of being so busy with the new graduates.

anyways! hope this helps.

all our love

the MMC team

our website

[i am listening to Beth Orton's new album, comfort of strangers]

Sunday, February 12, 2006

i choose hell

Dr P was a miserable man. i first met him in 2000 when i, as a fresh faced medical student, was spending time on a cardiology ward at one of the london teaching hospitals on placement. he was a registrar (not quite consultant), quiet, not up for any bullshit, happy to have a go at you (quietly) if you didn't know your stuff and seemed ever so world weary for someone who must have been about 34 years old. he was of course fiercely intelligent, hardworking and career minded and even then i knew that he would go far. his long fought after consultant post was surely looming.

last night, 6 years on, i receive a transferred patient from the same cardiology department at the same hospital. as i trudged through the dreary reams of photocopied notes imagine my surprise when i see entries from Dr P. the same concise instructions, the same copperplate handwriting, the same aura of tiredness... and yes still in the same position. STILL a registrar after all these years.

i couldn't believe it. i knew he'd been a reg for at least 4 years when i was a student so to date he must have been in the same position for at least 9 years.

he has been slogging his guts out for so long and has moved very far sideways. he was passionate about his subject and keen to please his bosses (they seemed to love him) and where has it got him? nowhere. what kind of job ensures that you do not progress after 9 years service.

i realised that night (in a fred savage wonder years voiceover moment) that tieing myself to hospital medicine (as i am 95% sure i have) is no guarantee of any progression to becoming a specialist in my field, no guarantee of any ascension to the right of some autonomy to research and practice as an expert. i too may flounder despite having years of experience when i am close to 40, hanging on the crazy whims of my superiors whilst around me the rest of life dessicates into a shrivelled world-prune, PURELY because the NHS has no scope to provide a clear career structure and trajectory. how passionate do you have to be to tolerate that? i have chosen a pathway to specialist medicine. i also appear to have chosen a pathway to (my idea of) hell.

"this year Dr D&C you will be doing a year of nights."

[i am listening to will you still love me tomorrow by the shirelles - i am DJing at a wedding in April and though it might be a good slow dance despite the lyrics]

Saturday, February 11, 2006


my fear of total carnage on starting nights in doctor changeover week was confirmed. fortunately the doctor covering before i began my shift is a bit of an old hand and was almost on top of everything but there was still a load of crap to do.

renal medicine is all about pissing. if you piss that makes us happy. in fact a lot of medicine is about pissing. it is guaranteed that very soon into their first job a newly qualified doctor will be called up at an unsocial hour with the (in)famous "you remember Mr Eriksson, the football manager who's had his stomach taken out today? well he hasn't passed any urine for four hours." this is very important because the amount of urine someone passes is a good indicator of how well hydrated they are and whether their kidneys are receiving adequate blood flow. so the appropriate response to that call is to make a full assessment of the patient and their fluid balance. i must add that it is the appropriate response. the reflex response might actually be tempted to say "well doctor here hasn't had time to pass any urine all day but no one gives a shit about him."

so imagine my frustration to be told that the ill looking young guy in the side room, yes the one who's kidneys not only failed years back, but his first transplanted kidney failed and has been admitted cos his second bloody kidney transplant is also failing because of roaring infection, has not passed any urine all day. "i told the doctors during the day" said the nurse "but i'm not sure if they did anything." un-fucking-believable. this is the bloody RENAL unit! the whole bloody point of him being here is so that we can SAVE his transplant. anyway i wasn't happy. though i think i was happier than his melting kidney.

i was also pleased to receive a torrent of abuse at 6am from the guy who was supposed to go to theatre today for his surgery. i was told by the day team "oh yeah, can you check his bloods early in the morning as we want everything to be OK for his op today." yeah sure guys no problem. oh yeah, you might want to actually TELL the patient, nurses, surgeons, anaethetists and theatre staff that he's supposed to be having surgery. does help in my experience. so i got a lot of:

"you fucking cunt, you can't just fucking swan in here to take my bloods and tell me i've got to got for an op when no-one's told me fucking nothing. you're all cunts. i'm sure i've got MRSA from you dirty cunts. i'm gonna fuck you all up"

and so forth. but, by this point, the sun was rising, i could hear the birds singing and i'd spent 40 quid on Amazon buying CDs so i wasn't offended.

[i am listening to Get Free by The Vines who apparently have a new album out soon]

Friday, February 10, 2006

bleary eyes


check out this blog. it is hilariously mad in a "i am delirious" kinda way. i have images of kevin spacey's character from Seven sitting behind a computer.

[i am listening to Float On by Modest Mouse]

not quite dead

no i haven't emigrated (yet) but i have been a little too distracted by other things to refill the blog of late.

i have however managed to travel around the country (taking in wales, hereford and nottingham) and spent a week snowboarding in Italy (i did take a tumble on the dunes and fear that i may have fractured my coccyx.) i have also failed my Part 2 exams (hurrah) but instead of self-flagellating have turned my attention to enjoying myself. in the pipeline i do have another visit from a group of canadians (their band are playing in london in march), tickets to sigur ros, a stag weekend and a week in stockholm. so all is good.

of course this shall be preceded by the ritual week of nights. happy happy joy joy as a tail-less cartoon cat once rejoiced.

furthermore this wednesday heralded the biannual changeover of doctors.

a quick word to you. NEVER EVER EVER be admitted to a british hospital in the first week of february or august. the NHS in all its incredulous wisdom ensures that every single junior doctor in the UK changes positions/hospitals on these two dates.

i haven't changed over for various reasons but our department is amok with new doctors who do not know how to do anything (because they have never worked at my hallowed hospital before) and hence i have had to carry the burden once again. this is not so bad except that i have left work very late the past few days (change the record) but a little disconcerting because, as i am on nights from today, the ward will be left in the hands of doctors who have never done any renal medicine at all.

hence, i apologise for my absence. i am not quite dead but after this week i cannot guarantee the same of the patients.

ciao ciao