How long have I got?

Leaving aside any politics or debates about the pro's and con's of our welfare state, and pension system (which in fact predates the welfare state - the random facts you get from watching BBC4 documentaries, or was it QI?) , this makes interesting reading. If we lay all the economics and social policy stuff about pension pot, and actuarial scales...something I don't even profess to comprehend let alone understand, one table hit me:

Lowest Life expectancy at age 65
432	Glasgow City	Scotland	13.8
431	Inverclyde	Scotland	14.9
430	North Lanarkshire	Scotland	14.9
429	West Dunbartonshire	Scotland	14.9
428	Renfrewshire	Scotland	15.0
427	Knowsley	North West	15.3
426	Manchester	North West	15.3
425	Liverpool	North West	15.3
424	Hartlepool	North East	15.4
423	Cannock Chase	West Midlands	15.4

Copy and paste directly from BBC Website on 30th September 2008

Note how the bottom 5 are all in the area covered by my beloved Medical school. One factor that those of you not familiar with the West of Scotland can be seen in this map
Sitting squarely between Glasgow City and North Lanarkshire, and adjoining West Dumbartonshire is East Dumbartonshire, and area which one might except to have a similarly poor life expectancy for its 65 year old residents. Except that it does not. If we look at other statistics in teh full report (here) we see that East Ayrshire adnd Clackmannanshire also have poor life expectancy figures. And yet, East Renfrewshire does not.

There seems to hjave been some nice games played when the old Strathclyde region was divvied up in the 1990's, to create the unitary authorities you see on the map above. The two areas I identified, East Dumbartonshire and East Renfrewshire also have very high (for West of Scotland):

• school exam results,
  
• owner occupier,
  
• car ownership,
  
• house prices,
  
• health indicators
• incomes.

It seems that there was a plan to create these areas of middle-upper class suburbia perhaps by civil servants who wanted to create areas for people like us? Note how there is a real U shape in the top of Glasgow to shoehorn East Dumbartonshire (Milngavie & Bearsden) between Maryhill and Drumchapel housing schemes which stay in Glasgow City. They also have lower council tax, and allegedly better services. And who lives in these areas? Well there are a fair few Consultants, Civil Servants, Teachers, University Lecturers, professional people and accountants/Lawyers. They get the benefits of city life, with the benefits of suburban council taxes. Now Greater Glasgow maybe too big for one council to run it, but there are other options to divide the area.....

The local health profiles designed by the ISD of NHS Scotland are interesting reading (unless you are a Glasgow First Year Medical Student doing Block3/4 Community Diagnosis coursework, or year 2 Family Project coursework). Similar are available in England. They also offer tobacco atlases! I can't stand doing statistics but I like graphs and maps... Maybe epidemiology is worth understand after all, but I still don't think I could deal with a career in public health.

Seaside hospital and the health form

Seaside hospital does seem a little odd though. Over the past 4 years, I have been to 10 different hospitals, and in none have I been asked about my health. The Uni did the HEAF test at the start of Year 1 Hep B and Rubella status tests before Year 2 but no more. However, seaside hospital wanted us to complete a full Occupational Health form, demanding details of medical history (thankfully brief), alcohol consumption(!), and immunisations - the full list of immunisations to give details on was:

• Tetanus (date of last immunisation only)
• Polio (as above)
• Diptheria (as above)
• Thyphoid (as above)
• Rubella - Date of last immunisation, date of immunity test, result of immunity test; Have you ever had an MMR?; Have you ever been diagnosed with mumps?
• Hepatitis B - doses, date of last dose, date of last blood test, titre level, date of next booster

This sent me rushing to Uni Health Service (for BCG, Hep B and Rubella data) and to my GP surgery for the others. At the surgery the receptionists showed me my medical notes based on my confirming my address and D.o.B, only for me to discover that the only things in my GP medical notes are the list of immunisations I have received!

At least I now have a composite list of my immunisations though.

interestingly, the university had not informed the GP of the result of the HEAF test, and the GP practice had not recorded the titre level for Rubella or Hep B, merely recorded that they were acceptable as an indication of immunisation.

Still I have now sent the form off, and hope that it is acceptable.

Introducing Suburban Seaside Hospital

This weekend is the Monday Holiday in the Health Board where i am currently on placement, so a 4 days weekend!

I utilised today by a period of meditative activity (i.e. a long lie) then started to scout out my next placement location. From Depcat Hell, I will be at the Suburban seaside hospital. Well it's not on the prom, but its a darn sight closer than my flat is.

I decided to find someone with some knowledge of the area I'd be going to, and indeed who knows the road very well. Step forward the ubiquitous Butcher Boy. the tattooed drinker also knows the area well, but he had films to see and drink to drink. We set off shortly after lunch and had a good journey down, despite the obsessive changing of the speed limit every 5-10 miles, The trip takes about 50 minutes, so is almost commutable - although we do get accommodation at the hospital if we choose to use it.

The biggest surprise was the fact that there's no two ways about it, the hospital is bright yellow. Most around here are Concrete or Stone. This one is yellow brick and looks both quite nice and quite odd at the same time.

We then went for a rather nice lunch in the Boot of the old town, near the courthouse and beach, before heading for the 'burbs, where I dropped butcher Boy at his parents house and he did some carjacking, and I drove back up to the big smoke.

Who said public holidays were restful?

I can survive 38 seconds.............

I could survive for 38 seconds chained to a bunk bed with a velociraptor

Lost in the post

While posting my sleep rant, I found this saved draft which I had forgotten to publish, so here goes.
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The other week I bought a jumper, on which the sleeves were too long (stop laughing) because although my body is normal size, it would seem that my shortness is due to short limbs (allegedly). Anyway, being useless with such things, I left the jumper with Mum & Dad, and Mum took it to a place near home to have the sleeves altered. Mum expressed herse;f very pleased and said you would hardly notice that it had been altered. Because they were going away on holiday, and I wasn't sure when I would next be down there, Mum posted it up to me, certificated and everything.....

3 weeks later it is still not here. Nor are the books I ordered lastweek.

I know the post office is busy, but it seems that only my bills get through. And there isn't even a scuccession of red cards telling me to go and collect a parcel because it is too big / needs signing for.

The one advantage of the courrier companies is that with internet tracking, I can at least track my parcel then take a print out from the website along with passport and untility ill to an industrial estate between Cambuslang and the middle of nowhere and claim back my parcels.

The problem then is that they take my intrnet print out off me and I have toi navigate out of the industrial estate again....and of course they are all new builds, so don't show on the SatNav......

It;s 3am, for goodness sake.

Ok I'm annoyed, It is now 3.25am, and the builders / contractors working on the building opposite my flat have been working sicne midnight to a) change the advert poster on the front of the bulding and b) remove / replace / maintain the LED video wall on the corner of teh facade retention metalwork.

I appreciate that in order to do this they need to block the road outside my flat and 2 of the 3 lanes of the road around the corner, and thus they cannot do it between 8am & 5pm. But, had they started at 8pm, there would be a chance that they would be finished by now, allowing me some sleep. Instead, they brough their triucks, cranes and cherry pickers about 10.30pm, and took an hour or so to set up the cranes, cones, road signs etc then started work about midnight.

I may therefore be tired and grumpy on Tuesday!

More weddingness

On Friday I was at another wedding - one I didn't think I'd be at....you see on thurs-Friday in uni we had a "Managing sick patients" course which was very useful but also scheduled 9-4 on Friday. The wedding was supposed to be over in the capital at 1, so a good 1hrs drive.....so inreply to teh invitation, I had said that i would not be at the ceremony or reception, but would be tehre for the evening.

Well anyway, come Friday morning, and 2 of my coursemates droopped me in it, telling the course trainers (both resus officers) that I was supposed to be at a wedding. They both told me to stop being silly and to miss the course and go to the wedding. thus I found myself at 11.45 at the church, in time to familiarise myself with the PA rig and do the sound for the wedding, which seemed to go ok.

I then filled my afternoon with a pleasant lunch, and then a trip out to Livingston where I sat drinking eta in a cafe in teh shopping centre and reading a textbook, until it was time to head to the hotel for the evening reception, where betweeen 4 of us we set everything up for the disco.

Then I spent my evening assisting PhilT with his DJ set, which started slow, but really had then packing out the dancefloor by the end. This was followed by the derig and a drive back to Glasgow.....all in all a long, but enjoyable day.

Life in DepCat hell

One thing I have learned on my first Surgical block is that DepCat matters... Given that they invented Carstairs Indices6 & 7 for Scotland, and Indices 7 for the area I am in at the moment in particular.

This informs the patients we see...

• Pancreatitis (West of Scotland favourite)
• Cancer - bucket loads of it, of almost all known organs - oropharyngeal, gastric, colorectal, pancreatic, prostatic, bony met's....
• Obesity
• Traumatic orthopaedics

Being a surgical block, we haven't seen much respiratory stuff, since most are to far gone for any curative or palliative surgery. Many of the operations are not curative, and the people accept this as normal.

Many of the population in the area served by the DGH moved from the East end of Glasgow in the 1970's-80's and brought their health with them. You may remember the East End from the recent by-election and news headlines (see here, here, here, ad infinitum).

It seems that down in the lower indices, where deprivation is at a level which is hardly ever seen and which some in the UK would like to pretend does not exist, then you can expect to die young and they accept this. They view their lot as a poor one, and aim to make the best of it, but the vices of the poor are generally alcohol, food and tobacco - who can forget a local MP's comments in 2004.

Lest you think that it is all depression and gloom....the sick man of Europe as its uses as a Medical student, and since we cannot change the health we are presented with in the here and now, it gives many great opportunities for understand behaviours, trendsm, and also to see lots of pathology and cases in a relatively short block.

On a related note, I am writing up my first portfolio case and discovering
a) I forgot to ask about half the information I ened
b) I forgot to look in the notes for the other half
c) I have no idea why the patient is on some drugs
d) I have no idea what the 7 GMC themes are
e) I am now worried due to the above....any support anyone - the email link should work :)