Thursday, September 27, 2007

Musings Of A Disheartened Ex-Doctor

well that's not quite true.

however i did resign today.

i'm not quite sure how i feel. come january there will be no more of this nonsense.

the future awaits.

[i am listening to Wilco]

Sunday, August 05, 2007

the MOADD twilight

it's been a while since i've put fingers to keyboard on here.

i blame (in particular order):

1. general tedium with the medical blogosphere - my ranting about Modernising Medical Careers, the general shittiness of the medical profession in the UK and ennui with the lack of control of my career and life is starting to bore even me.

2. Facebook - i thought this would be a fad that would die in a few months but sadly no it is taking up a large part of my internet time.

since the last time i wrote, things have changed and i've done quite a few things.

i went to the amazing Latitude festival in Suffolk. i had a spiritual experience watching the Arcade Fire.

i went to Cornwall and ate well, surfed and lazed around.

i've been getting into the british street art scene and went to a couple of private shows in uber-passe Shoreditch. not tempted to buy anything yet.

i spent about three months not doing any on calls, sitting in outpatient clinics looking after the elderly. a very rewarding and chilled out time. i miss it.

i am also now a Member of the stupid Royal College of Physicians which means nothing to most people and in reality means nothing at all. except that i finally passed some exams and 3 grand simultaneously passed out of pocket. i have a few more letters after my name.

i have left my hospital (where i was for three years) and moved to an even bigger hospital to work in intensive care. it's ok. the doctors however are all posh toffs who don't listen to anything you say. i may as well be invisible.

i am planning to resign in January and go travelling for the rest of the year. this is career suicide as i obtained a training position for 2007-8 unlike thousands of my peers. but frankly i don't really care anymore.

i think that i shall probably delete this blog soon. it hasn't really served the purpose that i felt it would but it was fun while it lasted.

i'm dreaming of far away places. the sun is setting here.

Monday, April 30, 2007

this man is a genius

i have been far too busy to post recently. i am burning the fun candle at both ends as they say. this weekend i have been at All Tomorrow Parties and a jolly good time i had too. anyways i am now a nick cave fanatic and i urge you all to be fanatics too.

[have a guess at what i'm listening to sherlock]

Monday, April 02, 2007

i am honoured to have this man as a friend

i wrote about him a while back. long time readers of MOADD will remember that a year ago current medical students petitioned the government/DOH/MMC people regarding the stupid system they had to use to apply to their first medical jobs after graduation (have a read here - sound familiar?) i at the same time condemned the medical student leadership in this country as being a bunch of sycophantic wankers. hmm... medical student reps... wankers... doctors' leaders... ineffectual pricks... everybody... sold down river... hmm. i feel there may be a connection here.

anyway my buddy orchestrated this petition against the moronic system. it got some press. it got noticed. for his troubles he got asked to join the MMC team to represent students and help make it better. he slowly realised that he was appointed to be used as PR, to silence the protesting masses. as a result he resigned his position in MMC. here are his eloquently polite yet damning letters to the mendacious serpents:


This is my letter of resignation, as sent to Professor Crockard 18/03/07.

Dear Alan,

I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.

When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.

Now as then (when I presented you with a petition signed by 1300 students), I believe:
• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school

Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.

In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.

When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.

I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.

Yours Sincerely,


This is my letter as sent to the CMO 31/03/07:

Dear Professor Sir Liam Donaldson,

I recently resigned as medical student advisor to MMC.

Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.

From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say.
Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.

It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.

Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.

And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”

This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.

If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.

Yours Sincerely,

Alex Liakos


what i love about the letters (apart from beautifully expressing the bigger picture of MMC) is the way they say FUCK YOU CUNT so politely. thinking about my buddy, he is actually the consumate gentlemen, even if he is from southampton.

anyways, he's far too busy with things that are bigger (or littler...) and more important than MMC at present, to which i wish him the best. i'm sure i'll see him soon and there'll be much to celebrate. it's a shame however that i am STILL keeping my pessimistic hat on: i don't think it'll make a difference to this imbecilic process. it is going to continue. at least with the march, the press coverage and letters like these, we can say that the medical profession in the UK, even if it was a bit too much too late, went down guns blazing.

see you soon dude. i've got a pint of guinness and some tea trolley treats waiting for you.

[i am listening to the new Kings of Leon song. they've shaved off their tashes. i'm distraught.]

Thursday, March 15, 2007

without a paddle

MMC steering committee holds urgent meeting to modify the online application process (Prof Alan Crockard, far right)

and so the crisis goes on

this week the department of health announced that the process by which 30000 junior doctors are applying for 22000 jobs is to be urgently reviewed.

the reason for this was that several groups of consultants on interview panels refused to participate in the process on the basis that the entire selection system was moronic.

i have mixed feelings about the actions of these consultants. on the one hand i am glad they spoke out and got a review to take place. on the other hand i pose the question:

where the fuck were you guys nine months ago?

this disheartened doctor has been wingeing about MMC since last year. everybody in the medical profession knew this was going to happen and knew that the implementation was going to be a joke. we knew this from the way the newly graduated doctors had been treated by a similar system. yet the warnings were not heeded. our union, our royal colleges and our bosses sold us down the river with a group shrug of the shoulders and an indifferent "well who knows what's going to happen" whilst all along we were screaming "it's a shit idea, it's going to be shit and it'll fuck up our lives, your lives and those of our patients."

so this review: i'm not convinced. not convinced at all and sadly don't hold the views of my fellow learned bloggers (here and here for example) though i wish i did.

the first round of selections is nearly over. there is talk of the second round being modified to be "fairer."

what this actually means, and we can debate for days about what modifications should be made, is that MMC will continue, we WILL do exactly what we are told to do and we WILL BLOODY WELL LIKE IT. it is marxism at its most literal. you will be allocated and perform the task that we deem you appropriate for.

patricia hewitt and the department of health: why can you not see that our NHS is held together by the altruism of its nurses and doctors. you've already slain the nurses (below inflation pay rise this year most recently) and through MMC you've killed the morale of already demoralised doctors. the boat carrying our altruism is sinking because you've punctured so many holes in the fucking hull. time is running out patricia. how can you not see this?


there is a protest march on saturday. i shall certainly be attending. so shall many of the british medical bloggers. will it make a difference? i doubt it. optimistically it may burgeon public support. realistically the public will probably wonder what all these rich doctors are bitching about, the power-obsessed bastards. pessimistically i think 10% of the doctors who say they are going to attend will actually show up.

for we are the most ineffectual group of lobbyists ever. oh for being a bit more militant and bit less self-serving (like the new zealand junior docs who took strike action last year).

i've been eyeing up the canadian medical board exams. even if i get a job for august, what precedent does the behaviour of the DoH set for working in the NHS in years to come. i personally can't wait for the next set of "reforms" circa 2008. surely better to go somewhere or do something where you are valued as a person with skills to offer society.

i'll report back after the march. i really hope that there will be a sea of angry doctors there, like Sauron's army of orcs and that the british public will be thrusting their fists into the air and willing us to go and give the DoH hell.

but i worry that it will make no difference. i worry it's too late. i worry that come august this will all be done and the protests of the future physicians, surgeons and professors of this country on saturday will become but a whisper in the tragic history of the NHS.

[i am listening to the new Shins album]

ps. this is fucking psychedelic genius:

Saturday, March 03, 2007

the slimiest of slime - something reptile

the HAL9000-esque automated medical job allocation process robot (MTAS) sent me to an interview last week. let me tell you about the moronic sequence of events running up to this interview.

regular readers will know that the Lost Doctor filled in his online application whilst snowboarding in Whistler at the end of january. by doing this i achieved 2 objectives:

1) i managed to avoid everyone at home stressing out immensely about the idiotic questions that needed to be answered
2) being on holiday was a great panacea in reducing my outrage at the idiotic questions

the system crashed due to the sheer number of applicants several times. little space was given for detailing achievements in medicine to date. the details of jobs available were sparse and uninformative. after finally submitting my responses, i was inundated with daily emails informing me how there would be more delays as the system was not getting people's references and that the shortlisting process was taking too long. i overheard one of my consultants two weeks ago saying how she had been couriered hundreds of applications and asked to score them all in a day. she also said how she didn't feel the application form was a particularly good discriminator of good from bad doctors at all and that is was all a "fucking painful joke."

friday (23/2/7) came and i began a weekend of nights. it was a lot of fun because i had the company of the venial sinner (MIA in the blogosphere but very much about in reality) who was also doing nights. at the same time MTAS emailed to say that the shortlist which was supposed to come out that day would only be revealed the following monday. the venial sinner and i decided that after finishing our night shift on monday morning we would go out on a bender to recreate the halcyon student days.

10am monday morning (26/2/7) and tvs and i headed into town for the obligatory caner. at about midday i received a call from vegas who informed me that MTAS had crashed and died again. no-one knew about whether they had been shortlisted for possible employment in medicine in this country for august. tvs and i continued to drink and drink. 2 tycoons (triple sec, apricot schnapps, gin, cointreau, lemonade) and 2 long island ice teas later the eyes were drooping, the gait was ataxic and home and bed beckoned, oblivious to the fact that MTAS was secretly sabotaging the airlock doors.

i woke on tuesday (27/2/7) and went to my outpatient clinic where i checked the website. MTAS said that i had 2 out of 4 interviews. i quickly booked interview times online (gone are the days of someone phoning you) and continued on with a busy clinic.

while awaiting MsD&C's return from work that evening i decided to consult MTAS again (who had by now killed the astronauts in hypersleep) to double check when my interviews were, as in the rush of the clinic i had neglected to note this important detail down. upon accessing his mainframe i found out i had a third interview. attending this interview would require a day off work and a not insignificant train ride. oh yes and it was the following day.

thanks for the notice.

i hurriedly scrabbled together a portfolio with the ridiculous number of things that i had to take there. i also printed out my answers to the questions i had completed one month earlier in canada so i could review them before the interview.

i felt sick.

i read back some of my answers. they were PAINFUL.

when you're writing the twentieth draft of something you become quite dissociated from the content. you're concentrating on grammar and flow.

i was ashamed i could come out with such drivel.

i attended said interview the following day. it was quite funny actually because, finding dry shirts difficult to iron, i said out loud in my flat "fuck this, i'm going to wear the clothes i had on yesterday" and went to the interview smelling of urine and C.difficile.

i hate waiting for anything. being an hour early, i quietly sat in the waiting room drinking water and listening to the five other candidates chat to each other (Dr D&C was ignored probably because he isn't posh enough).

sometimes when you walk into a pub or a bar you can sense an atmosphere of foreboding. in these cases the correct action is to finish your drink and leave quickly without drawing too much attention to yourself. sometimes when you meet someone for the first time you can tell that they are complete utter wankers. in these cases the correct action is to bite your lip and pray they move on to bother someone else.

well these five people were amongst the biggest fucks i've ever met in my entire life.

oh the pain! the continuous, self-serving, droning conversation. the false smiles, the belly laughing, the lack of grounding in any plane of reality. i wished the aliens from war of the worlds would appear and disintegrate them all. i prayed for their unnecessary fountain pens to fly out of their pockets and impale them in their foreheads. everything they talked about was prime, chargrilled bullshit and they were loving it.

and then i realised what it was. i realised what it was about these people that made them all so similarly disgusting examples of our species, and why i was so unfortunate to be breathing the same air as them.

they had all been summoned to this place on the basis of their answers to the stupid questions on the application form, answers that encapsulate their inflated egos and sense of self-importance. i felt like bruce willis at the end of the sixth sense when it dawned on me that i too was one of them. cheapened.

the interview was fine in itself. one of the panels didn't have my application form and so knew nothing about me. the interviewers seemed fair and normal people trying to make the best of a ridiculous situation. at the end of the day it wasn't too dissimilar to any normal job interview. just the getting there, which was marxist to say the least.

and all the way home i couldn't stop thinking about the cunts in that waiting room. this new medical system will roll on because people like them will secure their jobs and then they won't care about their colleagues (if such care ever existed.) there is a protest march on the 17th of this month. do you think any of them will go? course not. they have their interviews. fuck the rest of you.

be warned the UK public. from august your hospitals will have greatly reduced numbers of doctors working at night in an effort to make the NHS balance its books. when you finally do get to see a doctor it won't be someone experienced able to deal with most of your problems. MTAS has ejected these doctors from the cargo hold.

no, what you'll be left with is these five penises, appointed because they are adept in using buzz words such as "motivated" and "empathy" and "nonce." these are the sort of people the NHS of 2007 want to employ. i hope to god i'm not one of them.

people of britain - do not got to hospital after august lest you come across such people in a dimly lit examination cubicle. it is time to stockpile the ibuprofen, turn your kitchen into a operating theatre and find a good VET to look after you when you get ill. medicine in this country has been sold down the river by the government, the royal colleges, our "union" the BMA and our bosses because, as jarvis cocker recently said, cunts are still running the world.

[i am listening to willie nelson]

Thursday, March 01, 2007


this week has seen the biggest culling of junior doctors' career aspirations by a computer system and an ill thought out application form (MMC and MTAS respectively - i've talked about this before). this is probably the biggest change to medical training in the past forty years and within days hundreds of doctors have had their dreams of pursuing a medical specialty shot down. it's like the beginning scenes of saving private ryan. i, unlike many, have survived the initial onslaught of career killing fire and shrapnel. i am currently lying on the normandy beach of possible interviews, unsure of my future. i know a LOT of doctors who've been *BANG* taken out just like that and will have no job to go to in august. some of them (the ones with slightly more experience) will probably never work again as a result. absolutely gutting. absolutely fucking gutting.

the most eloquent explanation of what's been happening is quoted below and taken from the forum. i'll let it speak for itself:

"I feel like crying.

All my life there has been only one thing that I have wanted to do. I worked hard at school to get to medical school, I then worked hard at medical school to give myself the best shot at the jobs I wanted later on. I passed all my exams, won a few prizes along the way and was generally a good all rounder.

I was warned off medicine by my family and friends, they said it was too stressful and the NHS was in trouble; but I found the subject fascinating and it was not a matter of choice for me.

I have worked hard since I qualified and have had good references from all my employers. I have not taken a single day off ill in my first few years of work, and there are days when I have not felt well enough to come into work. I have passed several postgraduate examinations and attended all the relevant courses, as well as having several articles published in scientific journals.

There are many others just like me. Each of us has made numerous sacrifices because we love what we do. Our study budgets and study leave quotas have been cut, meaning we have had to pay for our own training and attend courses in our annual leave. The trust has also stopped properly reimbursing us for our travel expenses and removal costs. However we carried on because we thought that it would all be worth it, if we could have a job at the end of it doing what we loved.

These last few weeks have been the final straw for many of us. We have been subjected to the most unfair and least meritocratic selection process ever seen, MTAS (medical training application service) via MMC (modernizing medical careers). We have had to sum up our years of work and experience in several politically correct short answer questions, on which we are then judged. Examinations, experience and references are all but ignored in the pursuit of vague waffle.

The computer system crashes time and time again, confusion reigns supreme and hundreds of consultants are appalled by the process. Yet it is allowed to proceed. The short listing results are released in dribs and drabs and thousands of juniors tap away on their keyboards in a state of sheer panic, realizing that their future is being decided by the MTAS tombola.

Some of us have been lucky enough to get short listed for the jobs we want, but we shouldn’t have had to be lucky. The process should have been meritocratic, well organized and fair. It was most definitely none of these.

Young doctors such as myself are appalled by what we have had to endure this year. No one should have to go through such a process again. We all know people who are going to have their hopes and dreams crushed by this cruel joke of a system.

Shame on those who are behind this scheme. Many a tear will be shed this week by many brilliant young doctors who have had their hopes and dreams crushed in a quite barbaric fashion. Many of us will emigrate and many of us will leave the profession; I hope those behind the scheme are proud of these achievements.

Of course we do not all expect to be handed our perfect jobs on a plate. However we deserve not be lied to, we deserve not to be treated unfairly and we deserve to be treated with a little more dignity, respect and humanity than we have in 2007."

(Dr Ben Dean)

our union, the grossly ineffectual bunch of sycophants the BMA, have done precisely fuck all about it. i think they may have indulged the architects of MMC in fellatio at some point. they yesterday announced a press release saying that the system was failing.


[i am listening to Johnny Cash]

Tuesday, February 13, 2007

my cup runneth over with honey lager

no the NHS didn't finally kill me.

i've been on holiday for 3 weeks.

Ms D&C and i returned to my spiritual home, vancouver, with a view to collect rent from all the canadians who've been staying at my flat over the past three years.

it was fantastic. with each visit i struggle to answer why i don't move over there. my friend Broseph (who with his lovely wife let us stay for 2 of the 3 weeks) said that if i did go and did a masters degree he'd jack in his job in music production to do one with me. i did remind him that we would probably spend most of the time looking up stuff on youtube and flunk badly. he agreed.

highlights, apart from the copious amounts of red meat and pale ale consumed, were far too many to list.

we visited MsD&C's great aunt and uncle on vancouver island, caught up with Roger Dean Young and the new Tin Cup who played a gig in town, bid farewell to a friend and Tin Cup member moving to Toronto, stayed with another of the Tin Cup in his log cabin on the sunshine coast and gushed at a new baby arrival for two other friends. much of it involved hanging out with people but we were quite outdoorsy too: hiking, cycling around stanley park and finally snowboarding for a week in Whistler with Gnarls Barkley (whose MSF trip appears to have gone tits up) and his latest and greatest girlfriend. he'd come over from Edmonton, Alberta for a "conference" and managed to divert to spend some time imbibing with us.

i think i managed to see pretty much every canadian i know. i've also got a real bug again for snowboarding and am trying to get away again this season. any ideas of good destinations? anyone got a 150 burton board for sale?

i've come back in holiday mode to a much less stressful job and am floating on with memories of good times and fresh air.

i realised when i got back that everyone was incredibly stressed out about MTAS. for the non-medics this is an online application process which (nearly) every doctor who wants to work in august has to complete. it is analysed, processed and then refined into energon fuel which powers a huge robot who then allocates jobs. there has been a lot of worry because it's been poorly implemented, not carefully thought through and there hasn't been much information regarding how many jobs are available and how people will be selected blah blah blah

in short nothing that should surprise you about the NHS.

i did my form when on holiday. very much less worrying when you complete it after spending a day boarding. i also submitted it from the sleepy town of Squamish, British Columbia whilst waiting for a bus. very relaxing as it happens. probably fucked it up anyway.

anyways life is still uncertain, frightening and depressing. at least i know for the next few weeks, until the holiday feeling wears off, i can close my eyes, let all the stress wash around me and daydream of snow and mountains.

[i am listening to Concerning the UFO Sighting Near Highland, Illinois by Sufjan Stevens]