Sunday, April 29, 2007
I have just seen in the Sunday papers that wee Nicola (as she portrays herself) might be our next First Minister.
The logic goes that if the SNP are the largest party, but Alex Salmond loses his constituency and doesn't get a list seat, then Nicola Sturgeon (name and face like a fish) will be the Scottish parliament Leader. If the SNP do really well and form a coalition with the Lib Dems or Greens, she will be in pole position to be FM.
I don't know which is worse - 4 more years of Lib/Lab stalemate and PFI, or 4 years of her shreiking from the TV news.
This election is getting very difficult - I don't wamnt four more years of the same, I don;t want Independence, the Tories have no chance, Lib Dems won't be a major coalition partner this time around, so who to vote for?
Friday, April 27, 2007
Thursday, April 26, 2007
3 hours not getting to examine people followed by free lunch and a talk of anti-impotence drugs, and a free sample of drugs (from an anti-histamine company, not from the anti-impotence company!!!!).
Then this afternoon was a trip to see my patient who is subject of my essays - the flat was full of cats and dogs, and the stench ion the stairway up to it was awful. Once in the flat it wasn;t so bad but it was clear that the cats used the stairs as a toilet. Lovely.
Basically my plans have fallen through. I emailed my potential supervisor in February and was told "Yeah. it is fine, we will email you nearer the time"; well we now need to send a form to the Med School Office proving that we have a supervisor etc. This needs to be in by 1st May to give them 8 weeks to check details etc before we start the electives at the end of June. I emailed my erstwhile supervisor on Tuesday and today got a reply from one of his colleagues saying that they already had a student working with them, and I should have made my application earlier than the end of April. So clearly they have had some internal communication issues(!) Maybe I should have pushed earlier, harder etc.
So now I have Friday and Monday to organise a replacement elective, around ******** - can't afford 4 weeks anywhere expensive, since this is viewed as outline the teaching time and thus not eligible for Student Loan / Student Support. Thus I need to be able to keep on my part-time job at weekends / evening as well as being on elective 8-5, since the mortgage and food bills won;t pay themselves.
So I need to find a specialty, supervisor and project within 96 hours, get agreement, get the form filled in and returned to Faculty and all this while writing two 2,000 word essays about community-hospital interactions in the management of a patient i have studied, and revising for the written papers, and the OSCE's.
Ain't life great, excuse me while I go for a long walk off a short pier!
Tuesday, April 24, 2007
Come feedback time, we were all critiqued for not examining every system, not probing harder, not doing a full systemic enquiry - I don;t know if we have become to OSCE oriented that we try to do all histories in 5 minutes, and have parred each examination to the minimum.
We then had a masterclass on Jugular Venous Pulses (JVP)
starting with the normal pulse, and the items we need to describe about each pulse:
- Can you feel the vessel wall?
- Tilt patient's bed backward so they are lying at nearer 30 degrees than the recommended 45 degrees.
- Compare timing of breathing (JVP is higher on expiration)
- Look for bi-phasic nature of pulsation
- Increase pressure my pressing on abdomen over liver
- Check for landmarks - the two heads of sternocleidomastoid, carotid artery, external jugular vein
Monday, April 23, 2007
Looks like its back to the Ceilidh's, cake sales, treasure hunt quiz nights and bank robberies to raise money then.
Saturday, April 21, 2007
Yesterday, 4 women from Plymouth were convicted of encouraging and forcing two toddlers to fight, punch, kick, hit and use weapons against each other. This story has many of the details.
Even accepting the assertion from the defending lawyer, that they were of low education, and had violent upbringings and marriages, with obvious low-grade mental illnesses (suicide attempts, depression), the following quote about the grandmother of the children, seems unreal.
... she saw nothing wrong with what they had done as it would "toughen them up".
We all know that dealing with very young children can be challenging, and their behaviour is not always what we wouls like it to be, but forcing two toddlers to fight each other, using weapons is barbaric.
The judge sentenced them to:
a one-year suspended sentence and ordering them to do 100 hours of community work.
Following our letter to the Times, 4th April, the deputy CMO in charge now of MMC/MTAS requested a meeting, brokered by the PRCP, which seven of us attended together with the Director of NHS Workforce. We reiterated our absolute opposition to the principle of appointments by one-strike-and-your-out interviews. We expressed amazement at the perpetuation of an appointments system after its short-listing stage had been accepted as flawed. We questioned the rigour of medical representation on the Review Body when two College presidents obtained separate arrangements for their UoAs or Specialties, and the other two declared themselves happy with the MTAS appointments within their specialty.
We were told that the apparent intransigence of the Review Body reflected both their desire not to waste interview time already conducted, and feedback from Focus Groups, Deans and SHA Chiefs that the widespread discontent with MTAS evident in the media, marches and polls was incorrect. Surprisingly, it was conceded that neither a staggering of the 1st August start date, nor a selective return to Deanery-specific appointments in a first or second round had been absolutely excluded from consideration by the Review Body.
We explained to the deputy CMO our view that most grief from the one-strike proposal would be felt at ST3/4 level, because of the considerable investment to date in a branch of Medicine, and lack of realistic future in hospital practice if unsuccessful. Whereas a lottery in ST1/2 appointments might onl y be replacing the previous lottery of SHO appointments, this argument was untenable at ST3/4. The risk of failure is particularly severe in high-competition ratio specialties. We therefore proposed an immediate reversion to Deanery-specific appointment for ST3/4 appointments in those specialties not content with MTAS, with a proportion of posts held back for the top 20% or so already interviewed (to avoid unnecessary repeat interviewing). Subsequently, we have also requested that applicants to high-competition-ratio specialties in are given partial equivalence to applicants in the devolved nations, being permitted a backup choice. Before and after our meeting at the RCP we have asked several bodies – England , their Academy, the Review Body – to ballot on this (or other) proposal. The responses, uniformly negative, have been that the questions are too complex t Royal Colleges o ballot, that the Review Body already has feedback, and that complainers on blogs and marches are unrepresentative.
A complete suspension of MTAS is no longer likely or feasible – not least because Deans report plenty of Consultants willing to continue as MTAS executioners in the one-strike process. Since our meeting at the RCP, we have allowed breathing space for the interest professed in our proposal to be taken further. So far, all that has been offered is of more FTSTAs at a second round. This is not acceptable. All the time, August 1st approaches. It is still possible – some might think probable – that MTAS will implode, perhaps because PMETB discovers its responsibilities, or the meaning under English law of the balance of probabilities. Even if everything in the garden had been rosy so far, it is inconceivable that there will be a level playing field for applicants interviewed in rounds 1a vs. 1b.
I keep thinking of the experience of the European constitution as an example of a huge monolith devised by bureaucrats, promoted as unstoppable because of the amount of time spent erecting the monolith, but finally demolished by the late arousal of democratic opposition. Two years later even the bureaucrats can probably not remember why the constitution was so important. MMC seems the same. The new ballot provides the slumbering mass of doctors one last chance. Please visit http://www.cai.cam.ac.uk/people/mjb14/ to answer the yes/no questions regarding alternatives to the Review Body proposal, and register your approval score for the various bodies/persons involved with the MTAS fiasco. Please forward this message (minus the first paragraph) or website address to as many other doctors as possible, of all grades, in your region and specialty.
I have heard the marchers in March dismissed by an influential medic as
unrepresentative complainers about anything and everything. This is preposterous. The ballot will irrefutably document views of MTAS and preferred alternatives according to doctors’ location, grade and specialty. In March a single letter to the BMJ led 2250 to our poll. A similar number this time may be enough to shame the Review Body. A poll of 10,000, with results published widely in the lay and medical press, would be impossible for our inglorious masters to ignore.
Morris Brown Cambridge
This Scotsman.com article is suggesting that there will be a 3-day course in Edinburgh next week which will try to help people choose not to have cancer or anorexia.
The group says it can help people with a range of illnesses, including cancer, and also those with eating disorders, alcohol and drug addiction. Wolter van Verschuer, a Course in Miracles member, said: "We want to change the way that people think about life. It will make you look in a different way at yourself. It has a complete basis on the teachings of Jesus Christ." The organisation's website includes controversial statements suggesting illnesses such as cancer are a person's own choice. It states: "No-one suffers pain except his choice elects this state for him. No-one can grieve, nor fear, nor think him sick unless these are the outcomes that he wants. And no-one dies without his own consent." Mr van Verschuer admitted this was a tough stance, but he invited people with cancer and other diseases to go to the event, adding: "Sickness is a decision that you have made."
This seems a little at odds with most modern evidence based medicine and current western medical opinion. However, some studies have shown that prayer can improve a patients condition and shorten their hospital news (great news for NHS administrators). It is a well respected 'fact' that a positive attitude from the patient and their close family and friends is beneficial to their condition (for a public recent example, look at Jane Tomlinson), the opposite that people who worry about conditions can 'choose' to get them seems a little far fetched.
"Some people do find some help and comfort in their religion, but to say that people choose to have it is ridiculous." "Dementia is an illness and people need help and support to cope with it, not to be taken advantage of by outfits peddling miracle cures."
* For those of you south of the border, although the time interval between donations is 16 weeks in England, it is only 12 weeks in Scotland (and was so even before Devoution in 1999) -so much for the National Health Service.
Friday, April 20, 2007
Scottish power want to see my meter urgently, and indeed have sent me several letters about it. Demanding access on weekdays between 9 and 12. Thankfully their last letter was much nicer and had an email address so I could organise a mutually convenient time for them to visit - if they had done that in the first place.....
The SpR did not speak while the consultant was in the room, and the consultant called him "Mr ...." and indeed asked that we all address him as "Mr ...." which all seemed a little odd, in these days of first name terms around the NHS.
Even during the PBL briefing, he kept moving us along and saying "Well you would have asked for ...." and "The results for the tests were ..." without giving us time to explore which investigations we wanted, or the chance to interpret the results we were given.
We got through everything, but it was a very unusual PBL, though maybe the first of many.
Wednesday, April 18, 2007
The Haemophilia scandal is in the news again today (BBC News) . To my mind as a medical student it is crazy that not only would the NHS not start to scan the imported blood / blood products for the blood borne disease (HIV, Hep C, Hep B) once we were able to in the mid-1980's. The 1980's were also a different ethical era, with patients presuming that the "Doctor knew best" and consent was often seen as an add-on, and informed consent was even rarer. Patients in those days seemed to have just accepted that the anything the 'Doctor' did was in their best interests.
The opening of this 'unofficial' inquiry by the Tainted Blood campaign group (website) will hopefully go someway to establishing the reasons why successive governments did not test the imported blood products, or inform patients that they had been infected for, in some quoted cases, 2 years after the event. I accept that these cases may well be the exception not the norm, and are just used because they make a good new story, but one man's case which was featured on BBC Newsnight (link) showed the perils of this policy. Hew as not informed that he had contracted HIV from infected imported blood products until two years after the diagnosis was noted in his medical note. For those two years he had continued to have unprotected sex with his wife, unaware of the risk to her. She contracted HIV from him. Their children, now in their early twenties, are likely to lose both parents earlier than might be normal, due to the actions of the medical profession in the 1970's & 1980's.
Another worrying fact is that the UK government will not allow a full and public inquiry into this problem - why, what have they to hide? Given the numbers who have died, and the fact that the decisions were made over 20 years ago, when a different government was in power, one can only assume that somewhere along the line there are civil servants who are worried about their decisions being exposed in an inquiry. These people are possibly late on on their careers now, near the top of the tree and maybe even running government departments. There is a second governmental consideration, compensation. If the government is found to be a t fault, the calls for compensation by those infected will grow. However, from the governments point of view, the longer you hold out, the cheaper the compensation bill will be, since a death requires less compensation that a blighted life.
The final thing that worries me is the double standards still applying to UK blood products now. Due to concerns about vCJD transmission through donated blood products is a major worry in the UK, ans thus for all UK donations, the white blood cells are removed to reduce the theorectical risk to patients being transfused. However, for plasma products, we do not use plasma from UK blood donations in case it has the prion protein in it, but we instead buy plasma from the USA. The USA still pays for blood donations - thus often those in desperate need of money will give blood to earn some cash; those in need of money are often IV drug users and prisoners; this was the very pool that gave us the tainted Factor VIII way back in the 1970's and 1980's...........and so the cycle starts over again.
Tuesday, April 17, 2007
Monday, April 16, 2007
The Scottish Parliament elections are now only two weeks away. None of the parties are saying much about the junior doctors or medical schools, but a lot about NHS structure and health in general.
The 4 main parties all seem to be offering shorter waiting lists, more choice and more control over Doctors working conditions - so not much change there. The choice seems to be between a centralised NHS based on main centres, or a local service at your DGH - this in real terms means A+E closures reversed and service downgrading reversed if we have a change in government after May 3rd.
The Greens have a major focus on health, wellbeing, poverty and preventative medicine. This includes community-based care and a focus on mental health. there candidate in my constituency happens to be a Psychiatrist, so apart from the fact that he's very very very unlikely to win, I'd almost vote for him. The Scottish Christian Party haven;t even appeared to publish a manifesto on their website.
Looking forward to getting detailed manifesto's and candidate visits to quiz them...so I can make my mind up before May 3rd. Now just got my local councillor to decide on now.
My local Borders have Gray's Anatomy textbook (a facsimile not the DVD) for the Bargain of £7.99 - its 150 very large pages with lots of text and pictures (b&w line drawings).
I was very impressed and bought it. It looks like a nice read for when I have time.
Bargain Number 2
The second bargain is more related to my hobby as a tech at various charity & christian events. We often need to preview a DVD and have good control of what chapter we play etc. Often this means a separate screen with complex splitting of signals. However at the easter event we did 10 days ago, Someone provided us with a portable DVD player instead - the inbuilt screen gives a preview of the output, and the controls are push buttons on the Unit.
Thus I have spent some of my sunday buy out money from work to buy one for myself - oh and it has the added bonus of letting me watch DVD's on the move.
Saturday, April 14, 2007
Firstly, upon arriving at Hospital for PBL, no one arrived to facilitate. No problem we thought and did our feedback. Since most of us have or have seen a bootleg copy of the Fac notes, this wasn't a problem as we covered all we had to on MS. However, although we knew our new Scenario was on Breast cancer, we didn't have the scenario sheet to do a brainstorm or main issues list from. Someone went to see the sub-dean, but he's off on holiday and his secretary had no idea, so session over after 35 minutes.
Later at work, 3 cashiers were posted missing, so muggins got relocated over to help out for 60% of my shifts (thus doing the rest of my work in the remaining 40%). Then at about 7.15, the card machines failed. No card transactions at all were possible. Cash only. Not only have I not handled so much cash through my till in many a year, but customers were ignoring our large signs and having to go to the cashpoint after passing through the checkouts. High stress levels all round.
We also still have no hot water, no working baler and no working pizza oven at work. One day they will be fixed we are assured. Ok so in a food hygiene environment where we prepare food from raw, we have no hot water for cleaning....that has got to break some food regulations......
Time for my next valium I think!
Thursday, April 12, 2007
However, they would have to pay VAT on each cushion sold, so we invented a plan whereby I would by the cushions and sell them and donate all profit to the organisers to help cover the costs of the free event. I then phoned IKEA in Edinburgh who could only offer us 300 of the IRMA cushions. Since we had some seats, but were expecting another 2-3000 to be standing, we wanted more cushions. We thus phoned IKEA in Braehead, and ordered another 100 cushions from them.
Having spent £300 on my debit card, I was happy when we sold most of the cushions - mainly thanks to my wonderful volunteer sales team (it is amazing what people will do to get a free ticket into a free gig). Thus the pile of money is to go into the bank to cover the initial outlay to buy the cushions. We discovered interesting things, like 300 cushions fills the back of a Renault Megane (ssadly not mine), and Ikea have 525 on each delivery pallet.
I have 64 left if any wants one...or two...or twenty.
After morning surgery, our GP let us go at 1pm, in order to focus on our Community coursework this afternoon, which I failed to start.
Wednesday, April 11, 2007
- Monday was a holiday, and I slept for a lot of it. This did not help my revision.
- A visit to my GP on Tuesday morning meant that I missed Hospital clinical practice, but my neck was really painful and stiff, but as expected I got advised that it would ease up, and to take 'brufen (or Ibuprofen as the rest of the world outside Glasgow calls it).
- In the afternoon, we had out clinical skills session on breast examination - having now had about 15 clinical skills sessions, all of which are examinable in the OSCE I am getting very scared as I can't remember how to do some if not all of them. The session was good because for once we only had about 4 of us per manakin. Thankfully most clinical skills videos are available on the net or DVD.
- Today we had the excitement of our OSCE briefing from a lecturer who thinks he is funny, but sadly isn't. His jokes were very lame and the rest of the talk consisted of telling us the lists of possible topics that could be covered in the OSCE. Since my GP isn't keen on practicing examinations beyond CV and respiratory, I'm very worried about the OSCE, almost as worried as I am about the real exam and especially bones....
- However, tonight someone sent me a list of past exam questions which I can at least practice with. Not sure if they are all from our Uni, but at least it gives me something to practice with.
- Also just remembered that we have coursework due in 2 weeks, so that will be fun. I got BB for the first piece this year, so hoping for a similar result this time.
- Dr Amy my colleague at work, who is in the year below me at Uni has asked to see my project from Year 2 as she has know idea what to write for hers. Due to them being based on different patients, she can't use my info, but I hope the essay helps her, looking at it now, everything in it seems both obvious and complex!! How did I ever understand public policy and sociocultural medicine?
Monday, April 9, 2007
Saturday, April 7, 2007
Ok if you are too young to remember the "Int milk brilliant" adverts (which even Google can't find on the net), then the title will be lost on you, but today I tried using my laptop via my mobile phone's data GPRS modem, and it worked.....First Time...no need to find out passwords, usernames or settings. It was fantastic!!! So I'm posting this traveling at 60ish mph on my First Scotrail train - woohoo!!! Thank you Sony Ericsson and O2. I even get 115kbps which is twice as fast as my old dial up used to be....
Friday, April 6, 2007
Ow I woke up this morning with my head tilted to the right. Any attempt to tilt it to straight or to the left results in amazing pain. However, I can rotate it to the left, albeit at a tilt.
I'm not sure if you can spray deep heat onto your neck to relax the muscle.
Edit - I tried and it didn't help a bit..
Either way I hope it goes away before tomorrow as its all systems Go for two days doing tech stuff at Resurrection 07 at Ingliston - no not the Rave, but Scotland's largest Easter Sunday church service.
Last year's event in the Usher Hall was great and let's hope 2007 is as well.
When are your exams?This question strikes fear into me. The answer of 5 and a bit weeks is very scary. Can I learn 3 years of stuff in 5 and a bit weeks? Can I even learn the clinical skills for the OSCE in 5 and a bit weeks? The exam questions this year look to be in a nicer format than in the past, but as ever you need to know all the points to get the marks, and more importantly you need to know the molecular detail, the chemical interactions, and bones. I hate bones. Bone anatomy makes no sense to me whatsoever! Bones and Blood and Metabolic things and ECG and Respiratory and kidney all worry me, well those plus a few I have probably forgotten.
Wednesday, April 4, 2007
Why is it that the simple lets meet for a pint night outs can turn into some of the best nights out. It was like this for my birthday and also last Friday when a few of us (Little Miss P, Butcher Boy and the Alchie of Ayr)met up after work for a drink and then ended up being out til 3 and having a really good time. At the other end of the scale are the really planned work nights out where everything si kinds not fun and you feel like it was a wasted night (as opposed to a night when you were wasted).
Hmmm maybe there is a link between expectations and results...
And we are getting our Sunday buy out bonus at the end of this month, so that might cushion the 33% drop in pay for a week or two.