i've decided to sign myself up to this 30 days project. this is all in an attempt to update this blog a bit more than "occasionally".
whether i succeed is another matter.
please join too fellow bloggers! prove to yourself that you are not professional procrastinators!
[i am listening to the zutons]
Wednesday, May 31, 2006
Saturday, May 13, 2006
take your performance feedback and shove it up...
... because my good friend in wales and i have both passed our exams (membership of the royal college of physicians 2: die harder).
i was foolish enough to NOT opt for getting my marks published on the web so i had to wait till today for the stupid envelope.
anyway it is a massive relief for us both (failures the first time round) and so we are kicking back and relaxing this weekend. he is paintballing for a stag weekend and i am going bowling tonight lebowski style.
i nearly stayed in again last night but managed to pull myself off the sofa to go for a few beers with an old friend. it is tragic. i can't drink as much as i used to by any stretch of the imagination and i was almost content to veg on the sofa overnight.
but i pulled myself up and moseyed on out (well just locally) as i think if i become the sort of person who works, eats and sleeps that will be a non-existence.
i have a couple of incidents at work to report to you all. but i shall leave that for the next post as i am too excited and relieved at the moment.
sometimes you hit the bar and sometimes the bar hits you
[i am listening to Romeo and Juliet by Dire Straits]
i was foolish enough to NOT opt for getting my marks published on the web so i had to wait till today for the stupid envelope.
anyway it is a massive relief for us both (failures the first time round) and so we are kicking back and relaxing this weekend. he is paintballing for a stag weekend and i am going bowling tonight lebowski style.
i nearly stayed in again last night but managed to pull myself off the sofa to go for a few beers with an old friend. it is tragic. i can't drink as much as i used to by any stretch of the imagination and i was almost content to veg on the sofa overnight.
but i pulled myself up and moseyed on out (well just locally) as i think if i become the sort of person who works, eats and sleeps that will be a non-existence.
i have a couple of incidents at work to report to you all. but i shall leave that for the next post as i am too excited and relieved at the moment.
sometimes you hit the bar and sometimes the bar hits you
[i am listening to Romeo and Juliet by Dire Straits]
Monday, May 08, 2006
you're a lightweight. you're fired.
dr D&C was skiving on friday.
that's not strictly true. i'm going to be unemployed in august and so i said to the house officers that i would be in at 9.30am because i wanted to hand in a job application at another hospital. i also said to them bleep me if there are any problem because yes ladies and gentlemen my pager not only works in the hospital, it also works at home, it works at my friends' houses, it probably works abroad and when i have left this corporeal existence and ascended to a higher plane of consciousness/the afterlife, i am sure that it'll still be putting through the crash calls at 3am.
anyway i left my friend the bleep/pager switched on and sure enough at about 9.15am it went off. i called the phone number displayed and to my suprise it was the voice of the clinical director that answered.
being called by the clinical director is a rarity. it is also quite frightening. you feel a bit like the generals in that scene on the death star in Star Wars when darth vader announces that the emperor will shortly be arriving. "the emperor is coming here?" reply the assembled generals, terrified faces, poop in their pants.
actually our leader is quite a nice guy. he tutored me as a student and i quite liked him. what on earth could he want though? i briefly scanned my mind of the medical activities i'd been involved in over the past few months. no, i couldn't think of any obvious malpractice.
he asked me if i had a minute. i was buying a coffee so i guess i did. he proceeded to ask me of my thoughts on a radical shake up of the way the hospital works. yes he was asking me about hospital at night.
i won't go into HaN in detail as i have ranted at length about it here. also refer to Dr Crippen for more details. in short the idea is that you only need a skeleton crew to run a hospital overnight and at the moment there are too many doctors doing far too little work.
the wonderful thing about HaN is that it is marketed (in the labour spin world) as something to help us doctors have a smoother time on call. bollocks i say! it is about cost cutting and meeting working time targets. that is what it's about.
at present in my hospital we have two junior doctors covering the wards, splitting the hospital geographically down the middle. what the clinical director was asking was why not get rid of one of the doctors and provide an advanced nurse practitioner with advanced skills (he said advanced twice) instead.
what are advanced skills? i'm not sure really.
bow hunting skills? computer hacking skills?
anyway i said i'd let him know on monday because delight of delights i was to be night shifting across the weekend. and off i scampered into work that night.
the weekend was fine as it happens. people weren't very sick and the stuff i had to do was quite basic... for me. initially i thought about writing back to mr clinical director with "bring on the nurse practitioners and screw you guys i'm going home."
but then in retrospect i thought about the activities i'd got up to overnight. for example prescribing fluids. this is relatively easy but then after three years of medicine i can very quickly assess someone's hydration status, their requirements, factor in their cardiac/renal status, correlate this with their electrolyte results and give them the right fluid at the right speed so that their organs get adequate perfusion and they don't drown in fluid. though it has taken me a long time to get to that level.
so i am a little perturbed at a nurse practitioner rocking up and ploughing 3 litres of gelofusin into a tiny man whose heart has the equivalent pumping function of a small clementine. that could be a disaster.
similarly i had lots of people with chest pain. again you have to worry about the heart. even if you take a careful history and look for (what can be subtle) changes on the ECG it can be a very difficult call. do we want nurse practitioners with no cardiac training to be doing this? i'm not sure (though having said that the CCU nurses i worked with were superb.)
anyway i sent my email back to the big boss saying that i didn't think that we were ready for this scheme. if the nurses had years of medical training and experience (ie were doctors) it would be fine. knowing my hospital they'd do it on the cheap and employ someone who was all talk and no ability.
did he reply? yes he did.
"thanks for the email. take care."
who says i don't make a difference?
[i am listening to the specials]
Wednesday, May 03, 2006
Escapism
a quarter of my patients have cancer of some kind.
i've spent the last few days taking them into quiet rooms, sitting them down, asking the same question over and over.
"what have you been told so far?"
they go on about how they came in with a chest infection/fluid on their lungs/etc and then i have to launch into the splendid bullshit.
"that's right. now that scan we did yesterday. well it's shown alesion/mass/abnormality/cyst/shadow/irregular feature and we need to do a few more tests and speak to a few specialists before we can tell you exactly what it is and act accordingly."
what i want to say is that it looks, smells and tastes like cancer. you have cancer. and the pains we'll put you through to get the sample of tissue to prove this isn't going to change the fact that you have cancer.
of course we're not supposed to say that. in fact i got a telling off as a freshly qualified boy doctor for saying to a patient that although we weren't sure yet what we were concerned about was the possibility that his mass (in his pancreas) may be cancerous.
bad Dr D&C. go and kneel before the GMC with your trousers down.
don't you realise, i was told, that if you even MENTION the "C-word" then it will do more damage than the diagnosis itself.
quoi?
the word will do more damage than the cancer? somehow the word will metastasise and infiltrate all his organs? the word will cause him unbelievable pain and nausea and diabetes in a cruel twist?
no, i was told, we must wait for a tissue diagnosis.
of course said tissue sample took four weeks to get because the procedures (cameras down his to his duodenum and the probing around with a brush in various sphincter) ran into problems each time. anyway, we did finally get the biopsy, we told him he had cancer, he said he had expected that it was going to be cancer and then he died the next day.
but of course it was not the adenocarcinoma that killed him, it was the word.
anyway i must now bite my tongue. i shall wait the time it takes to get Mr K's pleural fluid back from cytology, i shall sit in patience as the lab slices through Mrs G's gastric biopsy and i shall make sure everything is ok after they've had a wash around Mr P's lungs with the bronchoscope. and then, one week on, EVEN THOUGH WE ALL KNOW NOW THESE PEOPLE HAVE CANCER, we shall tell them that they have cancer. in the meantime i shall lie every day to them, through the veil of " we need to do further tests" and "the lab is still processing the sample you poor cancer riddled bastard" before calling in the palliative care team who can start the syringe full of morphine and hasten their discharge to Rose Cottage.
excuse me, i have to go and put on my best used car dealer outfit in preparation for a day full of mendacity.
[i am listening to Primal Scream's new single. i saw this on the web today and it made me very geekily excited]
i've spent the last few days taking them into quiet rooms, sitting them down, asking the same question over and over.
"what have you been told so far?"
they go on about how they came in with a chest infection/fluid on their lungs/etc and then i have to launch into the splendid bullshit.
"that's right. now that scan we did yesterday. well it's shown a
what i want to say is that it looks, smells and tastes like cancer. you have cancer. and the pains we'll put you through to get the sample of tissue to prove this isn't going to change the fact that you have cancer.
of course we're not supposed to say that. in fact i got a telling off as a freshly qualified boy doctor for saying to a patient that although we weren't sure yet what we were concerned about was the possibility that his mass (in his pancreas) may be cancerous.
bad Dr D&C. go and kneel before the GMC with your trousers down.
don't you realise, i was told, that if you even MENTION the "C-word" then it will do more damage than the diagnosis itself.
quoi?
the word will do more damage than the cancer? somehow the word will metastasise and infiltrate all his organs? the word will cause him unbelievable pain and nausea and diabetes in a cruel twist?
no, i was told, we must wait for a tissue diagnosis.
of course said tissue sample took four weeks to get because the procedures (cameras down his to his duodenum and the probing around with a brush in various sphincter) ran into problems each time. anyway, we did finally get the biopsy, we told him he had cancer, he said he had expected that it was going to be cancer and then he died the next day.
but of course it was not the adenocarcinoma that killed him, it was the word.
anyway i must now bite my tongue. i shall wait the time it takes to get Mr K's pleural fluid back from cytology, i shall sit in patience as the lab slices through Mrs G's gastric biopsy and i shall make sure everything is ok after they've had a wash around Mr P's lungs with the bronchoscope. and then, one week on, EVEN THOUGH WE ALL KNOW NOW THESE PEOPLE HAVE CANCER, we shall tell them that they have cancer. in the meantime i shall lie every day to them, through the veil of " we need to do further tests" and "the lab is still processing the sample you poor cancer riddled bastard" before calling in the palliative care team who can start the syringe full of morphine and hasten their discharge to Rose Cottage.
excuse me, i have to go and put on my best used car dealer outfit in preparation for a day full of mendacity.
[i am listening to Primal Scream's new single. i saw this on the web today and it made me very geekily excited]
Sunday, April 30, 2006
do you mind if i do a J?
now i'm never one to preach but i feel that i should for once (halleujia, y'all can be saved ma brothas and sistas.)pete libertines doherty is in the news again this time for allegedly injecting into one of his fans/entourage/groupies. until now i haven't really given a shit about the whole junkie/kate moss bruhaha that the tabloids are so interested in because let's face it most of the country takes a drug of some kind (hash/tobacco/alcohol/ribena/religion) and most importantly because babyshambles are rubbish (NME hat on again) and, as the new dirty pretty things album demonstrates, the libertines were the sum of their parts and when separated are purely mediocre.
but it is starting to piss me off that doherty is getting off every time (and it must be about a million now) when i've worked with/treated enough addicts who've gone to jail for far longer for far less. the even more tragic thing is the misguided doherty obsessionados - you know, the ones who throng outside the courthouse - who rant on about how he is being unfairly persecuted by the police. here me now, oh deluded public school teenagers. persecuted or not, he has actually been in possession each time he's been nicked and it seems that this time he's been so off his face that he's fallen for the "someone wants to take a picture of me" trick AGAIN.
getting off drugs is difficult. i think maybe only one of the many users i've been involved with ever got close to sorting himself out. doherty has the luxury to fly off to arizona to detox at any point if he so wishes. not everyone has that. he can't be arsed and would rather be "playing" gigs wasted. i was really annoyed that the love music hate racism charity were stupid enough to put him on the bill at the trafalgar square gig this weekend. he shouldn't be championing such a cause.
anyway, he'll never get off drugs and he'll never go to jail - not to do a significant period of time like my patients - and this will be to the applause of the white, upper class kentish town teenage girls who love him so much. perhaps it was one of them that he's been photographed injecting. daddy has probably picked her up the following morning anyway. in which case should i really be getting so worked up? after all stupidity (and misery) loves company.
[i am listening to up the bracket and wondering about what might have been]
Thursday, April 20, 2006
i don't want your sympathy; i just want my johnson
the surgeons managed to shit on us today. however it was not us who suffered in the end. it was the patient. who died.
i was hovering on one of the surgical wards where one of my other patients was going a bit nuts when i got a nudge from one of my house officers. he informed me that the surgeons were referring back a patient to our care (even though our boss had not been informed) and oh yes by the way his blood pressure is crashing.
i put on my stroke my beard glove and stifled my need to tell him that we should only see patients that have been officially referred to us and that he should not be accepting patients without running it by a senior. but i held my tongue and wandered over to check out what was going on.
this old man was not a very good advertisement for health (or a very good advertisement for disease depending on whether you're a half empty/full cup person) he was six days out of an operation to remove his right lower leg because of very shit blood vessels not being able to provide his limbs with enough oxygen and nutrients to stay healthy. furthermore amongst his huge list of problems, his heart beats in a rhythm called atrial fibrillation. Dr Crippen has written at length on this topic. whilst it is very common the problem with this rhythm is that blood pools in the heart, forms clots and then there is a risk that these clots fire out of the heart to other parts of the body.
well he was in shit. he had a crap blood pressure, his breathing was awful and his tummy had swollen up and was very tender to touch. he had stopped peeing and was vomiting bile. it didn't take a lot to work out that what had most likely happened was that a clot had fired off into the blood vessels supplying his bowels thereby interrupting the blood flow to his gut. his bowels were now complaining as they slowly died of no oxygen.
myself and the house officer proceeded to resuscitate the patient but the only way to treat this condition is to operate. i called down the on call surgeons, the vascular surgeons who had operated on him in the first place and the high dependency unit. i was bounced from one to the next to the next and then back again. finally after four hours the surgeons decided that they would operate but only after a CT scan.
but by then it was too late and he died.
and no-one was really bothered. no-one would take any responsibility for the patient. except for us and only because we happened to be across the corridor at the right time.
would it have been different if he had gone to HDU? maybe. but there were no beds. so he stayed in the sideroom on the ward vomiting up more and more bile.
another nice happy ending.
[i am listening to black and white by the upper room]
i was hovering on one of the surgical wards where one of my other patients was going a bit nuts when i got a nudge from one of my house officers. he informed me that the surgeons were referring back a patient to our care (even though our boss had not been informed) and oh yes by the way his blood pressure is crashing.
i put on my stroke my beard glove and stifled my need to tell him that we should only see patients that have been officially referred to us and that he should not be accepting patients without running it by a senior. but i held my tongue and wandered over to check out what was going on.
this old man was not a very good advertisement for health (or a very good advertisement for disease depending on whether you're a half empty/full cup person) he was six days out of an operation to remove his right lower leg because of very shit blood vessels not being able to provide his limbs with enough oxygen and nutrients to stay healthy. furthermore amongst his huge list of problems, his heart beats in a rhythm called atrial fibrillation. Dr Crippen has written at length on this topic. whilst it is very common the problem with this rhythm is that blood pools in the heart, forms clots and then there is a risk that these clots fire out of the heart to other parts of the body.
well he was in shit. he had a crap blood pressure, his breathing was awful and his tummy had swollen up and was very tender to touch. he had stopped peeing and was vomiting bile. it didn't take a lot to work out that what had most likely happened was that a clot had fired off into the blood vessels supplying his bowels thereby interrupting the blood flow to his gut. his bowels were now complaining as they slowly died of no oxygen.
myself and the house officer proceeded to resuscitate the patient but the only way to treat this condition is to operate. i called down the on call surgeons, the vascular surgeons who had operated on him in the first place and the high dependency unit. i was bounced from one to the next to the next and then back again. finally after four hours the surgeons decided that they would operate but only after a CT scan.
but by then it was too late and he died.
and no-one was really bothered. no-one would take any responsibility for the patient. except for us and only because we happened to be across the corridor at the right time.
would it have been different if he had gone to HDU? maybe. but there were no beds. so he stayed in the sideroom on the ward vomiting up more and more bile.
another nice happy ending.
[i am listening to black and white by the upper room]
Friday, April 14, 2006
i like the way you do business jackie
i have finally lived a little in the last few weeks, perhaps at the most inopportune of times.
yesterday was the resit of my stupid exams, an exercise in masochism which i am convinced will need to be repeated in a few months time but hey i'm getting used to the idea that i am fundamentally stupid.
anyway much more interesting was firstly turning 27 which was not depressing at all and also my continuing canadian outreach project.
as you may have seen in a previous posting, Roger Dean Young and the Tin Cup finished their UK tour last week and i had the pleasure of three of the lads hanging out and stinking out my flat for a little while.
i met most of the guys through other Vancouverians (Vancouverites, Vancouverers?) over the past few years and have always been struck by how down to earth and well... nice they were. i guess i've spent so much time interacting with wankers that you forget that there are actually "good people" in the world. and they're in the music industry which in my experience in hobnobbing with C-list bands and sometime music journos is a vacuous self-absorbed scene indeed.
i also realised that there are so many talented people in the world that it's quite sobering when compared to your own pathetic achievements. i did find myself tinged with feelings of jealousy at one moment at the last gig. but perhaps it was the staropramen.
it's been a bit of a comedown to see the guys leave. it's difficult when you don't see people that often and your only contact is email. still i shall try to not get too depressed about that. after all that's what postgrad exams are for.
so a year older and a year stupider. i shall now enjoy the holiday weekend (not working) and hell maybe i'll dust down my guitar too.
happy easter
PS. roger was quite troubled by the ALF dream. unfortunately he didn't have any deep meaningful thoughts on the underlying symbology much like everyone else. i'm still waiting.
PPS. i would also like to announce the maiden voyage of my second blog: The Chelsea Rebel. no medicine and a slightly different background to MOADD. please also note the radically different layout.
[i am listening to the Foo Fighters]
yesterday was the resit of my stupid exams, an exercise in masochism which i am convinced will need to be repeated in a few months time but hey i'm getting used to the idea that i am fundamentally stupid.
anyway much more interesting was firstly turning 27 which was not depressing at all and also my continuing canadian outreach project.
as you may have seen in a previous posting, Roger Dean Young and the Tin Cup finished their UK tour last week and i had the pleasure of three of the lads hanging out and stinking out my flat for a little while.
i met most of the guys through other Vancouverians (Vancouverites, Vancouverers?) over the past few years and have always been struck by how down to earth and well... nice they were. i guess i've spent so much time interacting with wankers that you forget that there are actually "good people" in the world. and they're in the music industry which in my experience in hobnobbing with C-list bands and sometime music journos is a vacuous self-absorbed scene indeed.
i also realised that there are so many talented people in the world that it's quite sobering when compared to your own pathetic achievements. i did find myself tinged with feelings of jealousy at one moment at the last gig. but perhaps it was the staropramen.
it's been a bit of a comedown to see the guys leave. it's difficult when you don't see people that often and your only contact is email. still i shall try to not get too depressed about that. after all that's what postgrad exams are for.
so a year older and a year stupider. i shall now enjoy the holiday weekend (not working) and hell maybe i'll dust down my guitar too.
happy easter
PS. roger was quite troubled by the ALF dream. unfortunately he didn't have any deep meaningful thoughts on the underlying symbology much like everyone else. i'm still waiting.
PPS. i would also like to announce the maiden voyage of my second blog: The Chelsea Rebel. no medicine and a slightly different background to MOADD. please also note the radically different layout.
[i am listening to the Foo Fighters]
Tuesday, March 21, 2006
never ceases to amaze
i'm currently entrenched in a set of nights. now that i have transferred to the wonderful world of general internal medicine from renal, the night shifts involved covering A&E which is fine. it's probably the best bit about hospital medicine when you're a junior; you're given the opportunity to see a patient from scratch and try and work out what's wrong with them. proper medicine. no wheeling patients round to X-Ray because no-one else can be fucked too. A&E is generally pretty well organised.
you also carry the "crash" bleep. if someone anywhere in the hospital stops breathing/heart stops the staff on the ward (hopefully) notice, send out an emergency "crash call" and a group of doctors/nurses (normally two doctors, anaesthetist plus others) immediately proceed to the patient who is dying.
so this morning at about 1am, sure enough a crash call comes through directing all and sundry to one of the elderly care wards. having got a good sprint on me i arrive first. there she lies, Mrs X, in her bed, mouth open, pale as someone who's obviously dead for some time. one nurse is doing some half hearted chest compressions, another is fiddling with the defibrillator (the thing that "shocks" people "back to life" on ER) and the doctor looking after the ward is puttin the defibrillator pads on the patient.
"hi," i say "what's happened?" as i take the defib pads off and put them in the correct place on the patient's chest.
silence.
thinking i'm obviously speaking too quietly "can someone tell me what's happened?"
silence. i try to locate a pulse as the defib machine tracing shows that the lady has no heart activity at all.
"that's asystole. continue CPR. does anyone here know anything about the patient?"
"i'm just doing chest compressions" says one of the nurses as i hear the lady's ribs crack.
"get Sharon!" shouts the other one.
i turn to the doctor."are you looking after this lady?" he nods and says nothing. i feel that what should be a very quick and slick resuscitation is going to be painfully slow.
Sharon, one of the other nurses, arrives and informs me that the lady was "fine" an hour ago. given that she is an icicle i stroke my chin.
anyway by the time the anaesthetist has arrived the lady has made no progress at all, she is not breathing, her heart is not pumping and no amount of adrenaline is going to make a difference. after 15 minutes and more rib breaking, we stop.
and that was that. may she rest in peace.
i wonder when i have a cardiac arrest in some horrific hospital somewhere will people be standing around saying "i wasn't looking after D&C" or "he was fine an hour ago" or will i be so dead by the time people realise that something is amiss that it won't matter.
the venial sinner has written in his last blog entry about the transiency of human existence and whether once we leave this world will any imprint of our existence be left? if that's not something to wonder about as you stare forlornly into your pint glass, then the prospect that the actual moment of your death might be so undignified certainly is worth buying a double shot over.
[i am listening to Train In Vain by The Clash]
you also carry the "crash" bleep. if someone anywhere in the hospital stops breathing/heart stops the staff on the ward (hopefully) notice, send out an emergency "crash call" and a group of doctors/nurses (normally two doctors, anaesthetist plus others) immediately proceed to the patient who is dying.
so this morning at about 1am, sure enough a crash call comes through directing all and sundry to one of the elderly care wards. having got a good sprint on me i arrive first. there she lies, Mrs X, in her bed, mouth open, pale as someone who's obviously dead for some time. one nurse is doing some half hearted chest compressions, another is fiddling with the defibrillator (the thing that "shocks" people "back to life" on ER) and the doctor looking after the ward is puttin the defibrillator pads on the patient.
"hi," i say "what's happened?" as i take the defib pads off and put them in the correct place on the patient's chest.
silence.
thinking i'm obviously speaking too quietly "can someone tell me what's happened?"
silence. i try to locate a pulse as the defib machine tracing shows that the lady has no heart activity at all.
"that's asystole. continue CPR. does anyone here know anything about the patient?"
"i'm just doing chest compressions" says one of the nurses as i hear the lady's ribs crack.
"get Sharon!" shouts the other one.
i turn to the doctor."are you looking after this lady?" he nods and says nothing. i feel that what should be a very quick and slick resuscitation is going to be painfully slow.
Sharon, one of the other nurses, arrives and informs me that the lady was "fine" an hour ago. given that she is an icicle i stroke my chin.
anyway by the time the anaesthetist has arrived the lady has made no progress at all, she is not breathing, her heart is not pumping and no amount of adrenaline is going to make a difference. after 15 minutes and more rib breaking, we stop.
and that was that. may she rest in peace.
i wonder when i have a cardiac arrest in some horrific hospital somewhere will people be standing around saying "i wasn't looking after D&C" or "he was fine an hour ago" or will i be so dead by the time people realise that something is amiss that it won't matter.
the venial sinner has written in his last blog entry about the transiency of human existence and whether once we leave this world will any imprint of our existence be left? if that's not something to wonder about as you stare forlornly into your pint glass, then the prospect that the actual moment of your death might be so undignified certainly is worth buying a double shot over.
[i am listening to Train In Vain by The Clash]
Monday, March 20, 2006
wait till you try the pina coladas
as part of my ongoing Canadian Outreach Project, please go and see some buddies of mine on their UK tour this week. i shall of course be plying them with beer (and certainly not lamenting the state of UK healthcare) at their London gig which also happens to coincide with my birthday hurrah.
highly recommended (and i'm not just saying that as they're mates) - there's some tracks on the links below
Roger Dean Young & The Tin Cup
website
Loose records - UK label
Copperspine records
Thursday March 23rd 2006
Brighton, England
Hanbury Ballroom
Phone 01273 325440 for more information
Friday March 24th 2006
Leighton Buzzard, England
The Wheatsheaf
Phone 01525 374611 for more information
www.thewheatie.co.uk
Saturday 25th March 2006
GLASGOW - King Tuts Wah Wah Hut
(08701 690100)
Sunday 26th March 2006
ABERDEEN - The Lemon Tree
(01224 642230)
Monday 27th March 2006
LEEDS - The (New) Roscoe
(0113 246 0778/www.liveinleeds.com/newroscoe.htm)
Tuesday 28th March 2006
NOTTINGHAM - The Maze (Forest Tavern)
(0115 947 5650)
Wednesday 29th March 2006
LEICESTER - The Musician
(0116 283 5533)
Thursday 30th March 2006
LONDON - The Borderline
(0870 0603777)
[i am listening to the Dresden Dolls]
Friday, March 17, 2006
sycophant corner
i thought i would move onwards from my surreal dream-states to a new segment on MOADD - the sycophant corner.
in today's episode i would like to put forward Kirsty Lloyd, chair of the British Medical Association's Medical Student Committee. her job, which i'm sure ensures her a fountain of tea and cakes when she visits the BMA head office, is to be the public face of the thousands of medical students in this country, bringing key issues that affect her colleagues into the limelight.
now to be honest medical students have never had that much to moan about really. until now. at a time when 80+ senior consultants in this country and over 1000 students are protesting about the changes in the way in which candidates are selected for their first medical jobs she has chosen to abandon the undergraduates she represents and instead has openly defended the ridiculous selection criteria/process that her colleagues are publicly rejecting.
i cannot fathom why. i can only assume she is suffering from a severe strain of sycophancy whereby, terrified by the prospect of speaking out, doing her job, representing her fellow students and looking like a "troublemaker", she is under the delusion that by being a sell-out and condemning her peers to a job selection system that is Paddington Bear-ian in its incompetency she will somehow further her career in the future.
little does she realise the system that she is defending will also be the same system that ensures that she winds up without a job anyway. in which case her political fellatio will have been to no avail.
Kirsty Lloyd - Featured Sycophant,
MOADD Sycophant Corner, March 2006
MOADD Sycophant Corner, March 2006
for the record i have no problem with Paddington Bear. in fact i am rather fond of him and have been since childhood. i have no doubt that he would in fact to a better job than Ms Lloyd and i will be the first to suggest him as the next chairbear of the medical student committee . he might, as always happens to him, fail in his ultimate goals but at least he'd TRY TO DO WHAT WAS RIGHT FOR EVERYONE and not himself. go paddington.
[i am listening to Iggy Pop]
Tuesday, March 14, 2006
the decay of my reality
i thought i'd break off from MMC-bashing today and tell you of a dream that i had the other day.
i was john lennon, living in the present day and obviously not shot in New York. i was out somewhere with paul mcartney. i don't remember what we were talking about. anyway it transpires myself, paul, ringo and george (yes all the beatles are alive in my dream) live together in a big mansion somewhere.
anyway paul gets a call on his mobile. "oh god" he says and hangs up. he turns to me and says "something awful has happened" and rushes to the car (i forget what kind.) i'm running behind him. "what is it? what is it?" i say but macca doesn't respond.
we get in the car and speed back to our mansion. it is huge set in beautiful grounds with a long gravel drive. we park at the end of the drive and run up to the front door. i can see a figure lying on the steps, bleeding. it is one of our security guards. he is dead.
the front door is ajar and we burst through, down the long hall. two more security guards lie on the ground. they have been shot. they are also dead.
we do not stop but rush past them to the door at the end of the hall leading to the kitchen. it is a room with a central worktop and cooker. units and appliances line the three walls in front of us. one of the breakfast stools has fallen over. george harrison lies on the floor. he has been shot in the chest. bleeding. my heart is in my mouth. he too is dead. what has happened here?
i hear a moan coming from the other side of the cooker/worktop. macca cradles george's head and sobs. another moan. i move round the worktop.
half on the floor, half propped against a cupboard, bleeding from a gunshot wound to his leg is ALF.
i remember we also share a house with the cuddly Alien Life Form from the eponymous 80s US sitcom.
"John, dude. i'm so sorry..." he says.
"oh alf. what happened..."
"i... i don't know... it was so fast. they shot george. there was.. nothing... nothing i could do."
"i know alf. it's not your fault."
and then i woke up.
what the hell does it mean? from where exactly in the recessess of my brain has ALF emerged from? i did have this dream whilst on holiday in stockholm a few weeks back with Vegas. perhaps he has been spiking my drinks? how fucked up am i? why can't i have normal dreams?
anyways. your thoughts are welcome as always. i'm off to get my depot risperidone injection.
[i am listening to Moby]
i was john lennon, living in the present day and obviously not shot in New York. i was out somewhere with paul mcartney. i don't remember what we were talking about. anyway it transpires myself, paul, ringo and george (yes all the beatles are alive in my dream) live together in a big mansion somewhere.
anyway paul gets a call on his mobile. "oh god" he says and hangs up. he turns to me and says "something awful has happened" and rushes to the car (i forget what kind.) i'm running behind him. "what is it? what is it?" i say but macca doesn't respond.
we get in the car and speed back to our mansion. it is huge set in beautiful grounds with a long gravel drive. we park at the end of the drive and run up to the front door. i can see a figure lying on the steps, bleeding. it is one of our security guards. he is dead.
the front door is ajar and we burst through, down the long hall. two more security guards lie on the ground. they have been shot. they are also dead.
we do not stop but rush past them to the door at the end of the hall leading to the kitchen. it is a room with a central worktop and cooker. units and appliances line the three walls in front of us. one of the breakfast stools has fallen over. george harrison lies on the floor. he has been shot in the chest. bleeding. my heart is in my mouth. he too is dead. what has happened here?
i hear a moan coming from the other side of the cooker/worktop. macca cradles george's head and sobs. another moan. i move round the worktop.
half on the floor, half propped against a cupboard, bleeding from a gunshot wound to his leg is ALF.
i remember we also share a house with the cuddly Alien Life Form from the eponymous 80s US sitcom.
"John, dude. i'm so sorry..." he says.
"oh alf. what happened..."
"i... i don't know... it was so fast. they shot george. there was.. nothing... nothing i could do."
"i know alf. it's not your fault."
and then i woke up.
what the hell does it mean? from where exactly in the recessess of my brain has ALF emerged from? i did have this dream whilst on holiday in stockholm a few weeks back with Vegas. perhaps he has been spiking my drinks? how fucked up am i? why can't i have normal dreams?
anyways. your thoughts are welcome as always. i'm off to get my depot risperidone injection.
[i am listening to Moby]
Monday, March 06, 2006
Modernising Medical Careers: An Update
the shit that is MMC has apparently hit the fan.
you all probably remember me going on about this ad nauseum in previous posts. as a quick summary, this "modernisation of medical careers" came into full effect in august last year.
the official line is that the current system of training for newly qualified doctors is convoluted, overly selective, biased and too old school. hence MMC has restructured the entire post-qualification career progression for the benefit of doctors and their patients. the new structure will speed up the training of doctors to consultant level.
before (or "in my day") doctors would secure jobs on the basis of their performance at medical school in written and clinical examinations and the strength and breadth of their CV coupled with the impression they gave at interview. this is not dissimilar to, well, ANY profession.
now however, final year medical students/newly qualified doctors do not do this. instead they have to fill in a form.
this form consists of 6 sections.
the applicant has to write a 75 word piece on each of these sections extolling their virtues. no more interview. also, each of these sections are equally weighted. so, academic achievements takes the same priority as non-academic and leadership.
this is a bit mad newly qualified doctors rarely need to take a leadership role, not on a regular basis anyway. and yes i would certainly prefer to work with a music afficianado but would be seriously pissed off if he/she could cite the back catalogue of Wilco but was unable to examine someone's chest.
unsurprisingly, medical students are unhappy. one of the reasons is that this application is a bullshitter's dream. you could write anything you wanted and because it is being marked without interview no one would ever know that, despite having put down that you were captain of the uni football team, you have no idea what a striker is and it doesn't matter because you will never ever be asked.
you can read more here about this mess and if so inclined sign a petition put together by disheartened medical students. i really feel for them. having worked so hard for the past five years they have been told that actually maybe they should have spent more time looking at ways to demonstrate their team work skills.
dr D&C demonstrates teamwork skills every weekend. on purchasing a round of drinks that is too numerous for my two hands i shall call on friends to carry said drinks to the table. dr D&C also demonstrates leadership skills by delegating who shall carry what.
"you take the 2 guinessess first because they're for the guys right at the end of the table by the wall. i'll bring our ones over last as we're nearest to the bar. STAT. if there's time i'll sign your appraisal at the end."
the problems are not just with selection either. during the first two years after graduation the new doctors are continually assessed. i am not knocking this for one minute. i think continual assessment is an excellent idea. the issue is WHAT they are being assessed on.
my house officers have to be assessed on taking a history from patients, their clinical examination of them andbasic skills such as taking blood/cannulation.
these are NOT skills that new doctors should need to be assessed on. by bloody finishing medical school people should be proficient in the above. hence it is a phenomenal waste of their and my time. clearly this is designed to weed out the reprobates, the utterly skill-less. i would have hoped that they would not have made it through their primary degree but obviously the department of health does not have this confidence.
lots of important sounding professors seem to agree. 80+ of them wrote this letter to the Times last weekend (accompanying article here).
and the icing is that only the first two years post graduation of the MMC scheme has been formalised. NO-ONE KNOWS what will happen afterwards. years of uncertainty await.
in my opinion this restructuring is not about doing the best for patients or ensuring clear career progression for doctors. it is about money. the NHS has no money. it needs to keep on delivering a consultant led service. the MMC will do this (in name at least) in a shorter time than the current system. the fact that the consultants produced will have several years less experience is immaterial.
[i am still listening to Clap Your Hands Say Yeah]
you all probably remember me going on about this ad nauseum in previous posts. as a quick summary, this "modernisation of medical careers" came into full effect in august last year.
the official line is that the current system of training for newly qualified doctors is convoluted, overly selective, biased and too old school. hence MMC has restructured the entire post-qualification career progression for the benefit of doctors and their patients. the new structure will speed up the training of doctors to consultant level.
before (or "in my day") doctors would secure jobs on the basis of their performance at medical school in written and clinical examinations and the strength and breadth of their CV coupled with the impression they gave at interview. this is not dissimilar to, well, ANY profession.
now however, final year medical students/newly qualified doctors do not do this. instead they have to fill in a form.
this form consists of 6 sections.
- Academic Achievements,
- Non-academic Achievements,
- Reasons for applying for a post,
- Good Medical Practice,
- Teamwork,
- Leadership
the applicant has to write a 75 word piece on each of these sections extolling their virtues. no more interview. also, each of these sections are equally weighted. so, academic achievements takes the same priority as non-academic and leadership.
this is a bit mad newly qualified doctors rarely need to take a leadership role, not on a regular basis anyway. and yes i would certainly prefer to work with a music afficianado but would be seriously pissed off if he/she could cite the back catalogue of Wilco but was unable to examine someone's chest.
unsurprisingly, medical students are unhappy. one of the reasons is that this application is a bullshitter's dream. you could write anything you wanted and because it is being marked without interview no one would ever know that, despite having put down that you were captain of the uni football team, you have no idea what a striker is and it doesn't matter because you will never ever be asked.
you can read more here about this mess and if so inclined sign a petition put together by disheartened medical students. i really feel for them. having worked so hard for the past five years they have been told that actually maybe they should have spent more time looking at ways to demonstrate their team work skills.
dr D&C demonstrates teamwork skills every weekend. on purchasing a round of drinks that is too numerous for my two hands i shall call on friends to carry said drinks to the table. dr D&C also demonstrates leadership skills by delegating who shall carry what.
"you take the 2 guinessess first because they're for the guys right at the end of the table by the wall. i'll bring our ones over last as we're nearest to the bar. STAT. if there's time i'll sign your appraisal at the end."
the problems are not just with selection either. during the first two years after graduation the new doctors are continually assessed. i am not knocking this for one minute. i think continual assessment is an excellent idea. the issue is WHAT they are being assessed on.
my house officers have to be assessed on taking a history from patients, their clinical examination of them andbasic skills such as taking blood/cannulation.
these are NOT skills that new doctors should need to be assessed on. by bloody finishing medical school people should be proficient in the above. hence it is a phenomenal waste of their and my time. clearly this is designed to weed out the reprobates, the utterly skill-less. i would have hoped that they would not have made it through their primary degree but obviously the department of health does not have this confidence.
lots of important sounding professors seem to agree. 80+ of them wrote this letter to the Times last weekend (accompanying article here).
and the icing is that only the first two years post graduation of the MMC scheme has been formalised. NO-ONE KNOWS what will happen afterwards. years of uncertainty await.
in my opinion this restructuring is not about doing the best for patients or ensuring clear career progression for doctors. it is about money. the NHS has no money. it needs to keep on delivering a consultant led service. the MMC will do this (in name at least) in a shorter time than the current system. the fact that the consultants produced will have several years less experience is immaterial.
[i am still listening to Clap Your Hands Say Yeah]
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]
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]
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]
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
shambles
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]
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
http://thismassage.blogspot.com/
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]
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
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
Thursday, January 05, 2006
the most depressing things about the age you live in - the list
leading on from the point before, i suggest we compile this list. please leave your suggestions in comments and i shall collate them at some point. then you can print it out and stick it on your wall, or email it to colleagues. and then maybe it shall be used as soundbite for some talking head on BBC2 or perhaps even get it's own spin-off series on Channel 4. "The Best Worst Things About The Modern Age Ever" - can you imagine?
whilst i'm here please go and see NHS Blog Doctor for a dark, funny, eloquently written weblog by a similarly disheartened doctor (albeit with much more experience. i don't think he has much hope for me - or my patients...)
whilst i'm here please go and see NHS Blog Doctor for a dark, funny, eloquently written weblog by a similarly disheartened doctor (albeit with much more experience. i don't think he has much hope for me - or my patients...)
two thousand and six
happy new year my friends. i hope that you are all dusting off your gym memberships and promising to be a little nicer to your fellow humans in the months to come.
i managed to forget the travails of my special christmas nights on call with a quick sojourn to the countryside (ah how the urban squalor is being knocked out of me as time ticks on) for new year weekend and a meeting of minds with my dear vegas oop north on tuesday. a grand round if you like. i think that, having missed out on any human contact outside of work over the holiday period, this period of post-nights recuperation has been extremely therapeutic for my emotional wellbeing. i shall return to work tomorrow beaming. i do have the weekend to do but let's set that to one side.
vegas and i did not make any headway in the search for life/job satisfaction. there were no answers to be found and we have conceded that four months after starting our blogs we are no better off. we did however discover that rio ferdinand is a waste of space and that jose antonio reyes should perhaps be referred to a local falls assessment programme. we also found out that it is possible to dance without a care in a club filled with less than twenty people if the Arcade Fire are playing and enough Red Stripe/whisky has passed over the bar (the venue happened to a be a local indie nightspot and as such was "filled" with A-level students as comes with the music - how old we felt and looked).
the news has been eyeopening and tearshedding in equal measure over the new year period. there appears to be a glut of horrible things happening to young children. i am never sure if this reflects a Catholic degeneration of our society or whether we are just more aware of such sinister goings on as a result of increased reporting.
incidentally, i did note that the ex-director of NICE (national institute for cost effectiveness) was struck off for perving over kids on the internet. well, grooming teenagers on chatrooms actually. he has since resigned from his position as director of the Institute's Interventional Procedures Programme. suspiciously, a week before that, all catheter ablations were cancelledby an oxfordshire NHS trust. (an interventional procedure whereby the electrical wiring system in the heart is altered to prevent funny unpleasant heart rhythms.) coincidence? i don't think so... you just don't know how deep the conspiracy goes. straight to the president. they knew about it all along, etc etc
i also watch with trepidation at the progress of Ariel Sharon more for what it will mean for the middle east (those three words are now the stock epithet for the Israel-Palestine conflict) which by the way is surely high on the "most depressing things about the age you live in" list. besides if he's on the neurosurgical ward he's probably been left without any fluids and his urinary catheter clamped, whilst the infected bedsore slowly disseminates MRSA to his bloodstream. much like the poor bastard i was referred at 4am on christmas morning ("perhaps you would like to prescribe him some antibiotics that might actually kill the bacteria responsible for his sepsis rather than just give him the shits and make his life even more miserable" was my final suggestion before leaving).
this new year i shall also be keeping a close eye on the activities our dear health secretary who is fast becoming the government's Emperor Palpatine to our pathetic rebel workforce. soon you shall feel the awesome power of her fully operational private health service.
i do, as always, have a theory.
it is my fear her multiple trips across the galaxy via some kind of interdimensional wormhole excavated from beneath the desert in Egypt may have affected her mental health. worse still, i suspecting that she may be currently influenced by some kind of symbiotic all-powerful alien being who, inhabiting her human body and feeding off her very life energy, is hellbent on crushing any decent medical care for this country's people whilst simultaneously strangling the motivation of its doctors. we shall see.
i managed to forget the travails of my special christmas nights on call with a quick sojourn to the countryside (ah how the urban squalor is being knocked out of me as time ticks on) for new year weekend and a meeting of minds with my dear vegas oop north on tuesday. a grand round if you like. i think that, having missed out on any human contact outside of work over the holiday period, this period of post-nights recuperation has been extremely therapeutic for my emotional wellbeing. i shall return to work tomorrow beaming. i do have the weekend to do but let's set that to one side.
vegas and i did not make any headway in the search for life/job satisfaction. there were no answers to be found and we have conceded that four months after starting our blogs we are no better off. we did however discover that rio ferdinand is a waste of space and that jose antonio reyes should perhaps be referred to a local falls assessment programme. we also found out that it is possible to dance without a care in a club filled with less than twenty people if the Arcade Fire are playing and enough Red Stripe/whisky has passed over the bar (the venue happened to a be a local indie nightspot and as such was "filled" with A-level students as comes with the music - how old we felt and looked).
the news has been eyeopening and tearshedding in equal measure over the new year period. there appears to be a glut of horrible things happening to young children. i am never sure if this reflects a Catholic degeneration of our society or whether we are just more aware of such sinister goings on as a result of increased reporting.
incidentally, i did note that the ex-director of NICE (national institute for cost effectiveness) was struck off for perving over kids on the internet. well, grooming teenagers on chatrooms actually. he has since resigned from his position as director of the Institute's Interventional Procedures Programme. suspiciously, a week before that, all catheter ablations were cancelledby an oxfordshire NHS trust. (an interventional procedure whereby the electrical wiring system in the heart is altered to prevent funny unpleasant heart rhythms.) coincidence? i don't think so... you just don't know how deep the conspiracy goes. straight to the president. they knew about it all along, etc etc
i also watch with trepidation at the progress of Ariel Sharon more for what it will mean for the middle east (those three words are now the stock epithet for the Israel-Palestine conflict) which by the way is surely high on the "most depressing things about the age you live in" list. besides if he's on the neurosurgical ward he's probably been left without any fluids and his urinary catheter clamped, whilst the infected bedsore slowly disseminates MRSA to his bloodstream. much like the poor bastard i was referred at 4am on christmas morning ("perhaps you would like to prescribe him some antibiotics that might actually kill the bacteria responsible for his sepsis rather than just give him the shits and make his life even more miserable" was my final suggestion before leaving).
this new year i shall also be keeping a close eye on the activities our dear health secretary who is fast becoming the government's Emperor Palpatine to our pathetic rebel workforce. soon you shall feel the awesome power of her fully operational private health service.
i do, as always, have a theory.
it is my fear her multiple trips across the galaxy via some kind of interdimensional wormhole excavated from beneath the desert in Egypt may have affected her mental health. worse still, i suspecting that she may be currently influenced by some kind of symbiotic all-powerful alien being who, inhabiting her human body and feeding off her very life energy, is hellbent on crushing any decent medical care for this country's people whilst simultaneously strangling the motivation of its doctors. we shall see.
Patricia Hewitt, Health Secretary, pictured above fielding questions from journalists
James Spader, actor, pictured above in "Stargate"
[i am listening to Liezah by The Coral]
[i have just finished reading We Need To Talk About Kevin by Lionel Shriver. absolutely amazing - i did hate the main character for most of the book and then you read the last three chapters. i was blown away. certainly one for your list.]
[i have just finished reading We Need To Talk About Kevin by Lionel Shriver. absolutely amazing - i did hate the main character for most of the book and then you read the last three chapters. i was blown away. certainly one for your list.]
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