About Me

Larbert, Scotland, United Kingdom

Tuesday, July 31, 2007

Illuminated 40ft women outside my bedroom

These were taken at 8pm

No, I haven't been on mind altering drugs (today) but for the past 4-5 months there has been a huge 4-storey advert opposite my flat. It is hung to disguise a building site.

Well tonight they turned floodlights on to illuminate the advert (for FCUK.com). They have been angled towards the poster, but I can still kind of read comfortably in my living room with the blinds open and lights off.

Oh well!!

This was taken at 11pm - look how much brighter it is!

There has also been a planning request to convert the offices on the ground floor of my building into shops. I need to remember to go to the council planning department to check these out and make sure that it doensn't involve major changes to the access to my flat!

Monday, July 30, 2007

If you always come late what does that mean

I have yet again come late to a TV series. I was late to ER, late to Scrubs, totally missed Lost, 24 and Grays Anatomy, and tonight I saw House for the first time. It was much better than I thought but I still can't get over Hugh Lawrie's american accent, which seems to be English but more gravelly than. House does seem to be very good and his character appeals to me in the was the Dr Cox from scrubs and Dr Pratt & Dr Lockheart in ER. Eccentric doctors with crazy personal lives seem to act as some kind of Icon for me - Dr Patch Adams also fits into this category.

It is a strange situation where you want to be like a fictional character in a fictional situation which was written purely for dramatic intent.

Anyway the break is over, so back to the final part of House.

Saturday, July 28, 2007

The Virgin influence...

Today on the Virgin trains I was listening to the onboard radio. They played the video below (well they played the track) its Alfie by lily Allen which i found I liked a load more than I thought I would. I then got home and checked out the rest and I think shes actually quite cool.

Warning. This contains naughty words, for those of you who may be easily offended.

PS. It is on Play.com for only £4.99 - saving £11.

I'm resigned to it

I have decided that I am going to hand in my notice at work to become effective from the end of my leave of absence. It has been a tough call but I think it is for the best. I shall shed a tear of two (inwardly) but will still no doubt meet up with little Miss P, G-star, Sarah, Butcher boy, the Tattooed drinker and others. in fact i may seem them more often since I will have more time in which to be sociable. It will be a sad day after 30 months, but its not the same place it was, and things are not as much fun as they were and I wasn't enjoying it as much.

I guess I better start thinking about a leaving night.....after the exams.

Fun days out!

Today I went on a fun day out to Leeds.

Why Leeds?
a friend who works for an events company needed a box fo stuff taken to leeds to an event, but no couriers could do it.

I started and ended in Glasgow, which is where my sumer elective is. I got a train to Edinburgh (arrived 1030), met guy from the events company to collect the box, then caught the 1105 Virgin train to Oxford. it was quite quiet so i managed to get some work done and was doing Acid-Base and Metabolic Bone disease as my train crossed the border, went down past home and into deepest darkest yorkshire. I arrived (on time) in Leeds at 1415, and had a quick walk round the corner to the hotel, delivered my box to the concierge and then walked back to M&S, bought lunch and got on a train to Carlisle at 1439. This train took in the Settle & Carlisle line which has some great scenery and a cool viaduct 9not as big as the one in the Harry Potter, but nice views anyway). We crawled into Carlisle at 1728, leaving 8 minutes to go over the bridge and catch the train to Glasgow, which was quite busy with screaming children etc. I made it back to Glasgow Central at 1852. then it was just a small matter of heading home from there. 9hours 22 minutes, and about 500 miles of traveling

Tomorrow I plan to stay less than 3 miles from home!

I like having friends which allows you to do mad things. I have dug up Princes St Gardens in Edinburgh, climbed the inside of a big top, bought 400 Ikea cushions, caused traffic chaos in Edinburgh and other such madness. I like it.

Friday, July 27, 2007

Are faculty there to help or hinder?

Ok... the Medical school are confusing me again.

  • Term starts on Monday 27th August
  • My resits are 9-10 August
  • Results are released in week of 20-24 August.
  • My Year 4 could start with an SSM
  • I want to self propose an SSM, so I need to contact a supervisor and sort SSM details.
  • The medical school won't tell me which cohort I am in until the results are released. Thus at the moment they say I cannot plan year 4 until 3 days before it starts!

I emailed the Year 4/5 administrator today, and she has conceded to tell me that I will "start the year with an SSM if I pass" and I "can self-propose but you must inform my supervisor that the SSM is dependent on passing the resit".

Note the nice pessimism in the response from faculty!

But so far the fact that I do start with an SSM means that i now know I am in either chhort C, E, or J. So I have narrowed my choices by 25%.

Elective - days seven and eight

Day 7 - Thursday

Today I was in lower limb orthopaedic surgery. The consultant was very friendly and the SpR with her was the one whom i had been with to do the hip screwing on Wednesday. I did another 3 venflon drip insertions, two of which were successful first time, and one of which wasn't! I also spent a bit of time holding face masks and trying to insert the LMA breathing tubes, which is much trickier than you might think!

The theatre being used today was up in the old part of the hospital and had a huge curved bay at one end with many windows, with a lovely view of the multi-storey car park and the back of the new building at the hospital. The operations were fairly simple, but the consultant surgeon still quizzed me about the nerves of the lower limb whilst he was blocking them with local anaesthetic. I doubt i will ever forget that the sagital nerve invervates the thigh and the femoral nerve innervates the lower leg through its two branches - common peroneal and tibial branches.

The regional anaesthetic idea is a good one, since injecting the anaesthetic into the nerve at the top of the leg gives complete pain relief (but also some loss of feeling a movement) for up to 2 days following the operation. this lessens the need for the patents to be on opiate painkillers, which can make them feel sick.

handily, this list was finished by 2.30pm, so i got an early finish.

Day 8 - Friday

Today I was with one of the SpR's for urology surgery. there were only two cases on the morning list, and the first lady was already anaesthetised when I arrived (on time) at 8.55am. Thus I got to see how the monitoring of her operation was different because she was having a kidney operation, and thus needed to lie on her front (prone). She was quite ill and had many previous operations, so when the surgeons discovered she had pus in her kidney, they decided to abort the planned procedure, give her antibiotics and wait until the infection cleared up before attempting the operation again.

The second man was very anxious. he was only having a spinal anaesthetic, because in the past he has reacted very badly to a general anaesthetic. The operation went off fine, with him feeling no pain. However, as we started to disconnect the monitoring, he complained of chest pain around the bottom of his ribs. His ECG and blood pressure were normal, so we could rule out a heart attack. the surgeons came back to check on his operation, but that was way down in his bladder, so it seems unlikely that it was connected to the pain. The man was also sick and sweating, but his blood sugar level was normal. An Chest X-Ray was inconclusive, and so the SpR ordered some blood tests. We then had a fun tutorial on fluid balance, acid-base balance, heart conditions, and muscle relaxant drugs. the patient had still not improved, so I was sent home as there was no afternoon list, and no obvious 'medical' or 'surgical' cause of the pain, so the man was just on close observation.

Wednesday, July 25, 2007

Elective - days five & six

Day Five - Tuesday

This morning I was in theatre with my supervisor. The first case was a very large lady, on whom there were no veins visible at the wrist or indeed anywhere on the forearms. Thus I git to see a recent development - the use of ultrasound in anaesthesia - to locate the vein before putting the cannula into the vein. All in all it meant that it took about 90 minutes just to anaesthetise the patient and get them onto the operating table. there was also an issue of whether the lady would be too heavy for the operating table.

This gave my supervisor a nice opportunity to give me a tutorial on obesity, its effects on body systems, and the difficulty it causes in operations. We then went on to cover fluid balance and blood products and transfusion.

In the afternoon, I was with another SpR and we were again doing the plastic surgery list. These cases were thankfully more straightforward - some were as short as 30 minutes. The SpR explained a bit about the different types of anaesthetic drugs and also allowed me to do my first venflon.....sticking needles into people is quite scary....and also to put some of the airway tubes in. Apparently my main problem is one common to most students - I was too gentle and didn't push the tube hard enough. My venflon was also too hesitant and I wasn't confident enough pushing it in. I assume this confidence comes with the more that you do.

Day Six - Wednesday

Today I was in the emergency / trauma theatre which deals mainly in orthopaedics. There are two trauma theatres and I got to spend time in both theatres. I spent most of the day with the Duty SHO. Two of the cases today didn't have general anaesthetic (where they are put to sleep) but instead had a local block, which again is done under ultrasound. Both cases involved hand surgery. Thus the anaesthatist had to identify the brachial plexus of nerves in the top of the arm and inject the anaesthetic there to block the impulses coming up from the pain sensors in the hand / arm. I was very surprised at how the patients were so calm, oblivious to the procedures they were undergoing which all looked painful.

The regional block method takes longer than just putting the patient to sleep under a general anaesthetic but had less side effects, and less risk than the general anaesthetic would have.

I also got to see a hip screwing in the emergency orthopaedic theatre, which was a bit more brutal than I was expecting - orthopaedic surgeons do use tools which look too much like my school woodworking workshop.

Sunday, July 22, 2007


Butcher boy is a keen magazine reader. Thus when he saw a careers article "People who help us.... The Doctor" which is a kind of 'day in the life of' series, he kindly leant me a copy to read it. I have scanned it in to see what you all think.

PS. The source of these is Viz.

Click to open in a new window

Good days....

Saturday was a bizarrely good day.

On Friday I fell asleep soon after getting in from Hospital (about 5). I woke up at 1am, feeling rather awake and energised, and pottered about for a bit, then tried to get back to sleep but it wasn't happening.

So I decided to start Uni work at 4am. So i worked 4am-12, had lunch and took a visit up to work to laugh, sorry, see some friends, then went to the Med school where I yet again spent about 4 minutes working out the correct combination of scan card, enter pin and press hash, which makes the door open.

At 4pm I met Butcher boy for a Frappucino in the local Starybucks, he was not impressed with his introduction to icy coffee. I also ate a whole slice of rocky road....without getting chocolate all over my fingers - a first!

I then went back to the Med school, before deciding at 8, that since Little Miss P, g-star, Stefan and Sarah (Stefan and Sarah need nicknames - please help!) were all in curlers, and were texting me, and since I had done about 15 hours work and more than I planned, that I would join them at 8 not 10.

So I went via subway as I was starving, and managed to make a bottle of Magners last about 3 hours. Little Miss p went home tired at 10, when Butcher Boy, the tattooed drinker and Paul arrrived from work.

I left, shattered at 11, and headed home via the chip shop, then fell into bed at half twelve. A 23-hour day is long and exhausting but you can achieve a lot!

My jobs list for Monday (my non-elective day this week) is getting bigger:
  • see adviser of studies at 9.30
  • hair cut
  • go to bank
  • complete list of topics still to be revised
  • food shopping
  • ironing
  • house insurance
  • driving lessons
  • dentist
  • remember to move money to pay mortgage

Saturday, July 21, 2007

Elective - days 3 & 4

Day 3
Today I was in a cardiac theatre where they were replacing a regurgitant aortic valve and doing a bypass graft using the saphenous vein from the leg. It was scheduled to be a 4-5 hour operation. The patient came down to theatre about 8.35am, and was in by about 9am, fully hooked up to all the monitoring machines, this operation was unusual, in that because the surgeon was going to be operating on the heart, they would need to stop the patient's heart and use a heart-lung machine to bypass the lungs.

The operation seemed to go ok - I saw a bit but not all, but the surgeon was very snappy and quite aggressive towards the other staff.

Day 4

Today (well the morning) was spent in ICU - intensive care. It was a kind of whistle-stop tour, where I also met some of the other emd students, who have done a full elective in the ICU. They were showing me what the equipoment does and also how the monitoring is done. I liked the visit to ICU and might consider an SSM at ICU this coming year. one of the other students also gave me some contact details for doing neonatal ICU, which might be a nice alternative.

It was one of the consultant's birthdays, so we had cake and stuff. All in all ICU is much calmer and fun than I had thought it would be, and involves a lot of the kind of detective work of managing patients to dow ith monitoring and correcting their blood results etc. They also seem to have good team working between the SHOs and consultants.

Harry Potter and the endless queue

Well, at midnight I went to see how bad the queues were at Borders, and since it appeared to go all the way up the stairs, round each floor and back down the other side, I decided I'd leave until later today or even Sunday.

Friday, July 20, 2007


On Friday night, should I go to meet up with people from work for a drink, or go and stand in a big queue at Borders for a certain book? Or should I just get up early on Saturday to get the book, or wait toil after my exams by which point lots of people will have told me what the crucial plot twists and ending is.

My current thought is to buy it on Saturday at some point. Or i could go after I have been to the pub. Of course going to the pub in the first place is dependent on when i finish in ICU today, and when I have done some revision and had tea without falling asleep, which has been my fate the last two nights!

Wednesday, July 18, 2007

Elective - day 2 (maternity)

Today was my first ever visit to a labour ward. I was there to see what the anaesthetists do, although I also got to see 2 C-sections as well. It's much more umm, well, eerr, brutal than I thought. However, either way, 2 7lb babies were born fit and healthy so it can't be bad for them.

I don't know if today was a slow baby day, or if it's normally quiet, but there were only 4 ladies required anaesthetic intervention - either for a C-section, or for epidurals, so I got 3 or 4 tutorials on different aspects of anaesthetics. I got to spend time with an SHO, SpR and Consultant and got to see their different styles but also the high degree of teamwork they have.
  1. The difference between a spinal and an epidural anaesthetic.
  2. What the things to look out for when anaesthetising someone who is fit, healthy and awake.
  3. How they manage a patient who has an 'allergy' to one of the commonly used drugs.
The most useful one, long term!!! How to be a good JHO - all about being organised, knowing where things are, what tests to request, how to request them, when to take them down personally and when to just put a card in, remembering to check up on results, knowing how to do all the minor jobs - ECG, venflon, taking blood before you become a JHO etc.

SHO Teaching & careers advice
The SHO I was with for that part of the day was really helpful at explaining why these things are important and why it is good to pick them up as a medical student, and not wait til you are a JHO. She also explained some of the simpler things about anaesthetics and the anatomy of where the different needles go. She also gave some advice on why Anaesthetics is a good choice as a career and also how to manage your FY1 choices and accepting that you are an admin clerk and spend most of your time monitoring things, checking up on things or ordering test fro other departments, She also said about knowing the patients on you ward because more senior staff are off at clinics, research etc, and it is down to you to know who slept well or didn't, whose birthday it is, whose family members are away and haven't been to see them, and things like that which help you to explain things to the consultant. Also getting to know some patient history and circumstances is important.

Seeing tomorrows patients
In the afternoon we were a bit quiet, so the SHO took me over to see the 2 patients who are being operated on and whose anaesthatist I am with tomorrow. Both are having heart surgery, so I had a look in their notes and noted the drugs they were on and went to see them so they would know who i was and why I would be in theatre tomorrow (if they care at that point!). Upon coming home and checking the drugs they are on, one patient is on Clopridogel, which is a drug which aims to prevent your blood clotting (an anti-platelet). The BNF and other textbooks recommend stopping it 7-14 days prior to surgery unless it is needed for anti-platelet reasons. So that case may be a little interesting anyway. When I went to meet that patient, who is having an aortic valve replacement, and potentially a CABG - the consent sheet and referral letter said different things! - I had a listen to her chest and the murmur was really loud and obviously diastolic. Even the SHO said it was one of the best she had heard.

Tuesday, July 17, 2007

Elective - day 1

Phew. Today went well - I found the place, with many police outside, which surprised me at first.
My supervisor is very helpful and helped me find scrubs etc and then get sorted. I got to see 3 operations , mostly plastic surgery today and I get to see a variety of different anaesthetic environments this week - Maternity, cardiac Surgery and ICU.

The SpR I spent a large chunk of the day with was very helpful, explaining what they monitored and how, and why some of the values were still normal, even though in an awake person they would be considered very high. he also explained the 3 main classes of drugs used, and how they affect the body and why they affect you and wear off at different rates. He also guided me through the many tubes and masks that are available and some of the situations in which you would use each one and why.

We also got to see a medical emergency. walking through recovery, one of the patients was gasping for breath and making groaning noises - Stridor - which is when the airway is obstructed or narrowed, and the patient can't get enough air into the lungs. this obviously makes them a bit panicky, since they are only just coming round from the operation anyway. The patient was given an injection of a steroid to reduce any inflammation that was blocking the airway, and also inhaled some adrenaline which would achieve the same effect, tough for a much shorter time. Because the cause of the patient's stridor was not known, he was wheeled back round into an anaesthetic room, and had a fibre-optic probe put down his nose to check that there was no obstruction.

Today I also got my access all areas hospital ID card and discovered that the hospital is truly a maze and that you can get from A to B via C,D or E and that the theatre corridor connects them all.

Elective - Day 0

Hmm night before elective and the nerves are kicking in
  • Can I find it?
I know where I am going - theatre X in building Y.
  • Will he remember?
Well he sent an email confirming the details so i guess it is more about what else may come up tomorrow morning.
  • What do I do with money keys phone etc?
I assume there will be lockers, else stuff it in a rucsac and hope. I could leave the phone and change at home and just take a ten pound note or something
  • What money will I need for lockers?
This goes against the idea of just taking a ten pound note.
  • What hours will I be doing?
  • Where will I be working?
  • Will i have time for revision?
  • What do I need to take with me?
Textbook guide, notebook, pens, ?stethoscope?

Oh well I find out what the world of Anaesthetics is like in 8 hours, and I still haven't sorted most of my to do list from yesterday yet.

City of violence?

I took a wander down to my local Tesco metro, tonight about 9, as you do,, only to find it closed because today was a Monday Holiday, so I thought i would have to try the M&S Simply food at the station since the city-centre Somerfield and Sainsbury's close early (about 7).

As I passed along, and past a few shops, I noticed a crowd of mostly teenage girls standing outside a clothes shop on the other pavement. They looked a bit boistrous, so I adopted the age old look away and keep on walking technique. Then I looked up again about 10 seconds later as i came to cross a lane, and noticed that 3 of the girls were kicking one of the others who was lying on the ground, stretched out, making no attempt to defend herself. They seemed to be really laying into her, and I was about to get my mobile out to call the police, when a shout went up from one of the girls of "Polis".

At this about 30 people turned to look, including some kids who came out from a couple of shop / doorways, to see two policemen in hi-viz jackets as well as the body armour etc come bounding round from by the railway station. The front one started chasing the two main 'kickers' who had done a runner round into a square, and the second one stopped to see the girls who was lying on the floor not moving.

The next thing I knew, another 3 police cars came bombing down the pedistrainised street, slaloming the furniture, and pulled up, disgorging about 10 police officers, who started herding the kids up, whilst a couple took off to support the policeman who had chased the girls. One of the girls fell over some fencing around building work at a bank, and had been tackled by a passing policeman knocking her over.

I was glad the police had turned up, but then a few of the girls standing further away started saying "She's murdered her, She's killed her" which had me worried that the girl was in a bad way and needed medical help. At that point, thankfully an ambulance raced onto the scene.

All this took place in about 3-4 minutes.

Just an everyday event in the city. Unusually this occurred at 9pm on a sunny Monday in the city centre.

Sunday, July 15, 2007

Minor panic

My head is a lovely mess of minor panics today, so as ever, readers, you can help me come up with some answers!

  • My junior elective starts Tuesday morning - I need to buy some more shirts, wash and iron them so I have enough to last a full week
  • I need a hair cut.
  • The library book still hasn't gone back yet. I must remember to drop it in on my way to my elective.
  • I have know idea what hours I will be doing as part of my elective.......which makes planning any more revision tricky.
  • I need to tell my elective supervisor that on the last 2 mornings of the elective I have resit exams, and on the 3rd Wednesday there is a revision session 10-1 that I would like to go to.
  • As well as being on elective at hospital A, I need to visit my advisor of studies over at the main Uni which is next to hospital B - a good 40 minutes away.
  • I am behind on my revision plan to cover the whole course by tomorrow night. Thsi stresses me out a lot.
  • Work have introduced new silly shifts, so I might not be going back once my leave ends as they are so silly it is unreal.
  • I was meant to have started my driving lessons by now to fit with my plan to get a car by mid-October.
  • I also need to resit my theory test as it has expired.
  • A friend is getting married next Saturday back home (over the border) and I'm not sure if I will be in hospital on my elective, or if I have time to go to the wedding, i could only be there for the church bit and the start of the evening bit anyway, before I would need to catch a train back.
And finally, despite visiting tesco yesterday, there is nothing i want to eat in the freezer or fridge. Annoying!

Thursday, July 12, 2007

Oh the Pain.,....

I must have gone mad.

All this revision for resits is causing me to be less active (not at work, fixed to desk, no need to head up to Uni etc) and I have a habit of grazing while working - nuts, fruit gums, polos, yoghurts, carrots, crisps, biscuits - all handy for tidying the cupboards, but it appears to have caused an imbalance in the energy intake = energy expenditure equation, leading to potential weight gain.

Also because I am not burning any energy I get to 1am, and I am wide awake..... I eventually fall asleep at 5 or 6, but then want to sleep to 12 or 1pm...a vicious circle.

So while the rest of the UK is now on Thursday morning, I am on Wednesday night. In an effort to sort the sleep pattern,Ii was up all night - reading, doing some work, and then at 6am i decided to go for a jog.

For those of you not aware, it was raining at 6am. But I pulled on my Edinburgh hoodie, t-shirt shorts n trainers n set off. A 5 minute walk to the nearest park then a 25 minute set of circuits - alternating 5 minutes running with 2 of walking (to keep my heart rate under 1000 and so I could breathe).

I am now sore all the way up my legs, have a stitch an am still sweating crazily an hour later......but I do feel better for it. i may even try it tomorrow, if my knees still work.

Oh well time to have a shower, grab some coffee and start revising again.

Monday, July 9, 2007

MMR & Autism

Does MMR cause Autism?

  • There is no doubt Autism exists.
  • There is no doubt that Autism diagnoses have increase in the past 10-15 years.
  • There is no doubt that MMr was introduced in the mid 1990's.
The connection between children receiving the MMR jab and developing Autism was a temporal one and these are notoriously complex, and often link two unlinked things.

The medical community investigated Dr Wakefield's results very carefully, to double check and see whether a horrendous mistake had been made in the introduction of MMR. However numerous studies, some covering over 30,000 children each, have shown that MMR is not linked to higher incidence of Autism.

Autism diagnoses have increased - possibly due to an increase in the number of cases, but also due to improved diagnostic criteria, more child psychiatry / psychology staff and a different approach to managing children with attention / behaviour disorders.

The Lancet and the GMC inquiry
This week sees the start of a GMC hearing into Dr Wakefield and two of his colleagues behaviour.

The Lancet who published his work have already issued a retraction and apology, as have 10 of the 12 authors of the paper.
The Lancet apology is interesting:
We do not accept Andrew Wakefield and colleagues' interpretation of the letter published in The Lancet on May 2, 1998, which was, in any event, only published 3 months after the original 1998 Lancet paper. This letter was written in response to a letter from Dr A Rouse, published in the same issue. Dr Rouse's letter raised concerns about whether children investigated in the 1998 paper had been referred to the authors by the Society for the Autistically Handicapped, and simply mentioned that his concerns arose out of a fact sheet produced by a firm of solicitors.

Although the letter made it clear that Dr Wakefield “has agreed to help evaluate” some children for the Legal Aid Board, it does not indicate that in fact such work had been commissioned and was being undertaken well before the 1998 paper was published. The natural and ordinary meaning to be drawn from Dr Wakefield's letter at the time was that following the publication of the 1998 paper he had agreed to complete evaluations of children reported in the 1998 paper for the Legal Aid Board. We understood the letter to mean that, although Dr Wakefield agreed to undertake an evaluation for the Legal Aid Board, the evaluation had not taken place before the 1998 paper's publication.

In the light of this, and Dr Wakefield's express statement that no conflict of interest existed, we had no reason to investigate the position further, until the editors were notified for the first time that Dr Wakefield's relationship with the Legal Aid Board predated the publication of the 1998 paper by some considerable time.

Some journalist have done a lot of digging around this issue - see briandeer.com if you want to see the full set of allegations. These might ordinarily be dismissed, except these allegations and investigations seem to be very similar to the charges being placed before the team from the Royal free hospital, led by Dr Wakefield, next Monday at the GMC in London.

The losers
The main losers in this case all along have been two groups of children and parents.
  1. Those who developed Autism and were told that there was a causal link. These parents were told that through giving consent for an immunisation, they had harmed their child for life. the associated guilt and depression has influenced the care that their children received, with an understandable suspicion of medical intervention and treatment.
  2. The children whose parents decided not to give them MMR, and then the child developed measles, mumps or Rubella, and subsequently was injured and developed long-term consequences.
As someone born prior to the MMR introduction, I had both measles and mumps as a small child. I survived. many children did not., the introduction of the immunisation cut the death rate from these childhood disease down to less than 1 in 1,000. With the removal of herd immunity, with less children having MMR, these levels are once again rising.

The other big loser will be public confidence in the medical profession. Dr Wakefield and colleagues have spun the issue as being them sticking up for the truth, and the Medical community covering up. Thus it rings true because it has happened before. However this does not mean it is the case this time.

Pick a job, any job....

Apparently the NHS needs more staff. So they have created a website so schoolkids think the NHS is cool to work for - Step into the NHS.

There are lots of videos, on caring, benefits of working for the NHS, and breaking your wrist.

I decided to do the test which decides what job in the NHS would suit you from the hundreds available. My list of 5 was A+E Doctor, Paediatrician, Paediatric nurse, midwife, Biomedical scientist. So I guess after my course I might be qualified for 40% of the jobs it thinks I suit.
Butcher Boy came out as :
  • Director of finance
  • Information Analyst
  • Medical secretary
  • Chief executive
  • Accountant
The full list is:
Accident and emergency doctor · Accountant · Adult nurse ·· Anatomical pathology technologist · Audiologist Biomedical scientist
Cardiac physiologist · Chef · Chief executive · Children's nurse · Clinical audit assistant · Clinical audit facilitator · Clinical coder · Clinical psychologist · Clinical scientist · Clinical technologist · Communications/PR executive · Community pharmacist Dietitian · Director of finance · Director of operations · District nurse · Dramatherapist Electrician · Emergency care practitioner · Emergency medical dispatcher · Emergency services call handler · Estates officer Forensic psychologist Gardener · General practice doctor Housekeeper · Human resources professional
Information analyst · IT help desk advisor · IT support officer Laundry assistant Maternity support worker · Maxillofacial prosthetist · Medical laboratory assistant · Medical physicist · Medical records clerk · Medical secretary · Midwife Network manager · Non-clinical (counselling) psychologist Occupational therapist · Occupational therapy assistant · Operating department practitioner Paediatrician · Paramedic · Pathologist · Pathology links officer · Personal assistant · Phlebotomist · Physiotherapist · Play worker · Porter · Psychiatrist · Psychotherapist
Radiographer (diagnostic) · Respiratory physiologist Speech and language therapist · Sterile services technician · Surgeon · Systems analyst

I don't know how much this website costs, but ifs clear how the increased NHS funding is not resulting in improvements at hospitals and GP surgeries, when so much is topsliced for this website, MTAS and the NHS Jobs website which seems to be unable to fulfil its function, and which many Trusts do not even use. Will Alan Johnston stop the NHS Corporate Service function using all the budget increases?

Sunday, July 8, 2007


The view out the window....I hate not being able to get to sleep.

Saturday, July 7, 2007

A big Friday night out.

On Friday, after revising til about 9, I met butcher boy for coffee and a milkshake (he had coffee, I had milkshake) - that makes me sound like a small child.....
Anyway, after we went to play Wii sports. I have to say I'm tempted to buy one.................. its soo much fun. Bowling, golf, boxing are all quite easy. tennis and baseball are just ridiculous.

Once I had got my hand in, I won at bowling and golf (though he won the first golf match), and at the boxing i proved quite good. I think it is something to do with the lack of pain felt when you hit the guy on the computer.

Some of the other games for it look quite good too.

If only I had more money than i needed then i could buy a wii.

Random thoughts about Medical terrorism

  • In response to several requests, I have been through the timetable for years 4 & 5, but since it doesn't say if we go to Paisley RAH, I don't know if we get to do the course bomb making 101.
  • It is amusing to note though that the bombs in London failed because NHS syringes, believed to be from Paisley Royal Alexandra Hospital didn't work as the bombers had hoped. Forget about the Nu Labour slogan of 1997 which was "One day to save the NHS", it seems to be becoming "One day the NHS will save you".
  • Since we are on elective break / holidays, I haven't seen any friends who had 3rd year clinical teaching at paisley to find out if they can claim that they were taught by someone that the police have arrested. It would seem unlikely since most 3rd year teaching is Consultant odr SpR led, but you never know.
  • Faculty have sent us n email reminding us to wear ID at all times, and to be ready to state our business to anyone who challenges us.
  • The fact that it seems 8 junior doctors became terrorists is hardly an issue for me - their job wasn't material to their actions. The radicalising of young muslims though does worry me.

Tuesday, July 3, 2007

Feeling better

The other good news from today is that I am feeling better! The bits of my body which had decided to fight with each other since Friday seem to have stopped, except for my thermo-regulator which still has me burning up. Either that or we are having a heatwave!

SSM marks are out

I got my SSM mark back today.

It was a C. (A-D is pass) but so was the other student on the SSM's mark.

So basically neither of us were outstanding, but we went to everything, listened, took part and wrote adequate essays.

If for MMC / FY1 allocations I wanted to be in the top quarter of students at the Medical school, this might bother me, but with two years of resits, this would now be a near impossible task! So I get 2 points for the SSM.

With the new timetable, the method for calculating our positions in the year, and hence which quartile we appear in will have to change anyway.... Under the old system, in years 1 & 2 I had scored 12/28. This year I have 6/24 with just my LCP mark to come.

Year 4/5 timetable

They have moved the exams!!!!

Finals will now be in February/March 2009. This apparently allows time for resits, extra learning and health issues to be cleared up. This is good, since there had been suggestions that resits were to be removed from the final year.

We now also get a "Preparation for Practice" block to learn about FY1 year, assessment etc. However to pay for it, we only get 3 SSM's in years 4/5 before finals, with a further one after the exams.

Each teaching block now starts with a one-day academic day on campus with communication skills and clinical teaching. The idea apparently is to avoid interupting the on-site teaching blocks.

These changes also means that 9apart from resits) our formal programme ends on 22 May 2009, to be followed by 4 weeks of PRHO shadowing and Resits.

So our timetable is now (all blocks are 4 weeks long):
  • 3 Medical blocks
  • 3 Surgery blocks
  • 2 SSM before Finals
  • 1 Psychological medicine
  • 1 Obs / Gyn
  • 1 Child Health
  • 1 GP
  • one week academic week (8-14 December 07)
  • 4 week elective in summer 08
Followed by a 4 week revision / exams period (9 Feb - 13 Mar 09) and then a P for P and an SSM.

In final year we also get a 4 week Christmas holiday, and a 3 week one in 4th year.

The exact order of blocks is laid out in 10 cohorts, each of which has its advantages and its disadvantages in terms of block timings - such as starting with an SSM in September 07; having both SSMs either side of Christmas 07; starting with Obs&Gyn; having GP just before finals in winter 2009; etc.

The faculty listened

Thank you!!!

At last the faculty have listened to teh students (well actually that's what we think they have done). In their words, they have changed the way that we pick our teaching programme for the next two years due to their ongoing process of improvement. Well since we have been campaigning for it for 2 years, i guess we can let them think it is their idea.

You may wonder what this revolution is. It is ranking.

Yes we may have done to get into, and out of, medical school for several years, but now we can do it to choose SSM and cohort booking.
Their email says
Due to the recent problems with the SSM2 booking process for SSMs, we have proposed that the "first-come, first-served" booking systems should be replaced with "ranked preference booking systems."
The "ranked preference approach" is preferred, and is fair in that:
  • no student is disadvantaged by not being able to access a terminal at a particular point in time.
  • a real-time indication can be given of how people are making first choices to assist in the process.
  • there is a short cooling off period (1 week) where students can change their preferences (until booking is closed)
  • all matching of requests to places is done using the same standard advanced matching algorithm.
When applied to the recent SSM2, over 75% of students got first or second choice.
So basically the old system failed and the computer lost all the results so we have adopted the idea that the students suggested in 2004, and which is in fact the one we used until 2003, using bits of paper.

Investment and return

In September last year, I gave the BMA £24 annual subscriptions. yesterday they sent me a letter offering me £1500 (a 6250% return).

To be fair I gave them the same amount last year and got nothing back, and I might not get anything next year! It is to pay my tuition fees etc this coming year and came from the BMA charities wing, which has a trust to provide support for Medical students.

So I guess I owe thanks to two groups of people - my two referees; and all the BMA members who contribute to the charities fund each year which allowed them to grant me this money.

My LEA have calculated me as not having to pay fees next year because (yet again) they have forgotten to factor in that this is my second degree and thus I have to pay full UK Fees.

How does my computer count?

This video shows how a computer (32 bit) counts. Its actually much simpler than I thought and binary kinda makes sense this way.

Who would have thought that they could make geekiness interesting.

Monday, July 2, 2007

New PM, New NHS?

BBC Five Live are having an NHSS day and asking people to fill in their experiences of the NHS today - be it as a patient - GP, Dentist, optician, A&E or outpatient; or staff member - consultant, staff grade doctor, foundation year doctor, medical student, nurse, physio, OT, SLT, cleaner, ambulance-person, manager clerk etc.

Five Live then plan to send these collected experiences in a dossier to Alan Johnson, the new English health secretary, to help inform his decisions.

Many of the contributions are the classic stories of the NHS being there in times of emergency:
I was taken ill on a Sunday a few weeks ago. I rang my Doctor’s number and was put through to an emergency number. The person on the end of the line took all details and told me a nurse would ring me back. The nurse advised me to go to Southmead Primary Care Unit, where I was examined by a doctor. He told me to go to C Ward in Southmead Hospital. I was immediately seen by a nurse who took my blood pressure etc. I then saw a doctor who gave me a thorough examination. She sent me for an X-Ray. Eventually I saw a Consultant who told me I had pneumonia. I was allowed to go home with antibiotics.
or failing in out of hours cases.
My mother suffered abdominal severe pain on Christmas Eve 2004 and through a misdiagnosis at her GP out of hours surgery in Cheshire and a failure to manage her properly she was sent home and later passed away in pain on Christmas Day. All three triage nurses we spoke to on the phone over a 24 hour period were later criticised for having weak skills while several medical staff visited her but left her in pain not taking responsibility for her
The stories from staff of long hours,
We can run a 24 hour service, but there is no 24 hour support - no CT scans, physio, OT, Echocardiograms etc out of hours unless we are talking a dire emergency. Clearly these things shouldn't be done at 2am, but I don't see 7pm as a problem. So we enter a game of negotiation with these clinical areas, trying to get our patients through quicker, while the departments have to prioritise the requests. It takes up an awful lot of time which doesn't truly contribute to patient care.

Everyday I'll stay till about 7pm, and there is always something still not done. Handover is tough as Working Time laws mean people are available and unavailable at random times - I fear for next year with the 48 hour working week because it may be that patients rarely have the same team looking after them. That can't help a sick and scared patient.

I like my job - because I know my patients, because I feel involved, because it is interesting and challenging & I am privileged to play a part in peoples lives. But I am increasingly fatigued, by the moaning in the press, by the moaning on the wards, by the governmental attacks on the profession. I do this job to be a doctor - and know for cetain politicians cannot tell me how to do this.

and the relentless demand for change:
PLease stop CHANGING things. GB said this word 8 times in his first speech. We are sick of changes all the time, moving goalposts and targets. How can we hope to build a stble forward thinking service for our patients with this constant meddling. Leave doctoring to us doctors and stop criticising consultants. We work bloody hard, above our paid hours to serve our patients. Considering it took 13 years of hard work working through nights, doing untold exams, self funding my own training for the essential courses and neglecting family life to get to where I am, I think you are getting us at a bargain price. Especially when you consider the incredibly stressful and skilled work that we do on a daily basis. Leave us alone to get on with it..
The laundry gets a mention as well:
Much has been said and written about infection control in hospitals and much importance has been put on good practice such as hand-washing. However, one vital aspect of infection control is virtually overlooked. This is infected laundry. Hospital laundries are very much 'out of sight, out of mind' and a common misconception is that everything that comes out of a washing machine is clean. Nothing could be further from the truth - infected laundry must be thoroughly disinfected. A long-standing official NHS guideline advises hospitals to disinfect infected laundry by washing at high temperatures.
and the cleaning;
A sufferer of Bowel and Liver Cancer and now very sadly died, he made an unfortunate mess of the toilet bowl and seat which I cleaned up as best as I was able with tissue.
Once I had him back in bed I reported the state of the toilet to a Staff Nurse and advised that it required disinfecting.
In the two and a half hours that my sister and I were present, no attempt was made to clean the toilet despite the assurances that it would be done.

So basically the answer seems to be that the NHS is great in life-threatening emergencies but fiddling around with the staffing structure (MTAS, MMC, Working time Directive), management (more managers, privatised hospitals and ancillary services), and targets seems to have caused the system to once again appear on the brink of collapse.

We should remember however that Alan Johnson is no fool -
...then on to the Education department as higher education minister. He proved a cunning, persuasive and, above all, successful campaigner in the battle to get the back benches to support "top up" university tuition fees. The measure was carried by just five votes, and beforehand the whips were so unsure of victory that Blair discussed the terms of the motion of confidence that would have followed such a major defeat. The orphaned grammar school boy without an O-level to his name cut a more convincing figure among old Labour stalwarts than Charles Clarke, his hectoring, public-school-educated boss. "I was part of the charm offensive with Charles Clarke," Johnson said recently. "I did the charming and he was offensive."
Of course, up here in devolved Scotland things are very different, with only some of the NHS decisions from London actually affecting us.

The NHS up here is now run by Nicola Sturgeon, who has already made an interesting start to the new Executive / Government's programme by reversing hospital re-organisations in Lanarkshire and Ayr, but supporting the previous executive's decisions elsewhere.

The SNP minority government are also opposed to PFI, so we shall have to see if the rate of investment up here is maintained, or whether the NHS is allowed to settle before more upheaval is foisted upon it.

Sunday, July 1, 2007

Leave of their senses.

On Tuesday, I handed in a nice letter to work asking for 5 weeks Leave of absence from next Sunday morning. In my letter, I even included the dates of the start and end of the leave.

went into work yesterday evening for a backshift and discovered that they had my leave starting this morning, so on the plus side i get an extra week off to study and on the down side i get paid for one week less.


Today I feel ill.

Shivery, sore stomach etc.