And so it begins...

**Ring Ring **Ring Ring **Ring Ring **Ring Ring

- Hello, Occupational Health - Margaret speaking
- Good afternoon Margaret, my name is Michael, I’m one of the doctors due to start work at your hospital next week.
- Hello Michael, how can I help you?
- I received a letter from you asking me to call you. Something about missing information
- O.K., let me check my records can I have your full name and date of birth please?

I hear the tap-tap-tap of fingers on a computer keyboard and I try to visualise what Margaret looks like. In my head, I see a shortish woman in her late fifties with short, curly brown hair that is flecked with grey and a pair of large rimmed glasses that hang around her neck on a piece of string.

- Right, I’ve found you Dr Michael Anderson.
- That’s me
- Yes, I see what the problem is. We need some evidence that you are immune to T.B.

At one point I had a letter from an occupational health nurse confirming my TB immunity, but to be honest I have no idea where that letter is anymore. Probably among the many treeloads of paper that I’ve accumulated from “Induction Days” at previous hospitals

- I don’t think I’ve actually got any documents that say that
- I’m sorry doctor, but I can’t issue you with a “Fit to Practice” certificate unless I have some evidence that you are immune and you won’t be able to work without one.

My heart sinks a little at the thought of having to rifle through all the crap that’s currently in the “I Need To Sort All This Stuff Out At Some Point” box(es) under my bed. But then a thought hits me.

- I have a B.C.G. scar, I pipe up. - Is that evidence enough?
- Yes, that would be good enough, but obviously neither I nor any of my staff have seen your scar. Do you think you’d be able to pop in and show us?
- I live in NewCity! I can’t “pop in” because it’s about a two-hour round trip to your hospital. I do actually have an afternoon off this week but I don’t particularly want to spend it coming to show you my arm. Can’t I just come to the department to show you on Induction Day?
- Well, I suppose you could, depending on how many people we have to see that day, there may be a delay in issuing you with your certificate. You might have to wait a day or so.

I’ve already spoken to the anaesthetics office and it doesn’t look like I’ll be doing much actual clinical work in the first couple of days of the new job, so waiting a couple of days for occupational health clearance is unlikely to be a huge problem.

- O.K., well that’s fine with me. I’ll come in on induction day, and hopefully we can get it sorted then.
- Well, we shall see you then Dr Anderson
- Thank you. Bye for now
- Goodbye

**Click.

I hate Induction Day and it seems this time round, it’s starting even earlier than normal.

Another one leaves the flock

So, Dr Holly Branson has quit working as a junior doctor to work for her Dad instead.

I can’t say I blame her. In fact, I’m actually surprised that she’s remained in medicine for as long as she has. Why on earth would anyone want to work as a junior hospital doctor (for £21k p.a.) when their father is one of the richest men in the world? It seems that Holly has seen sense and has got out.

I wish her all the best (though I very much doubt she’ll need my good wishes).

Winding down...

After having a fantastic couple of weeks off, I’m back at work again. I think I’d gotten to the point where I needed a holiday. Getting out of bed had started to become even more of a chore than normal and I really wasn’t “throwing myself into it” as much as I normally did. Now I feel much more invigorated and am back to being super-keen again.

We junior doctors change jobs on the 6th of August. We move on to new positions, often in new hospitals and this is also the day that the brand new FY1 doctors start their first jobs. Lots of my fellow junior doctors appear to be on a “wind-down,” people are talking about where their next jobs are and what they’ll be doing there. Personally, I’m going to another District General Hospital and I hope to do quite a lot of work on the delivery suite.

Lots of the consultant anaesthetists and consultant surgeons are away on holiday at the moment, so there’s not as much work to do as normal and this adds to the “rest and relaxation” mood among the medical staff. It’s actually quite nice.

Some of the house officers are arranging a hospital ball on Friday, and I’m really looking forward to it. It’ll be a chance to get dressed up, a chance to share a drink or three with my colleagues, and also an opportunity to say goodbye.

Summer Holiday

Woohoo!

No more workin' for a week or two....

Life-long learning 2

As I’ve said before, doctors should be committed to learning for the rest of our lives and the people we actually learn most from are the patients we look after.

Here are five things that I learned from my patients today:

1. Sea levels have been rising for the last 10000 years and are not rising any faster now than they were thousands of years ago, despite what the media say.

2. The needle didn’t hurt as much as she thought it would.

3. Christiano Ronaldo is a much better player than George Best ever was.

4. I look much younger than I am.

5. Just 2mg of midazolam can make a young man stop breathing completely.

Be careful what you wish for...

If you believe what’s said in the media, you’d probably conclude that our NHS is on its knees and on the verge of a meltdown. You’d think that primary care (GPs and A&E) is a complete disaster in this country and that it’s only a matter of time before the whole house of cards comes crashing down round our ears.

Despite this "obvious truth," it seems that people in other countries see what we have here in the UK as a good thing and are actually quite envious of our health service.

Funny that…

Free access to GP services is what I believe needs to happen. Then, and only then, will those on low incomes be able to take control of their health. Sure, it'll cost a hell of a lot of money. But if people could afford to go to their GP to get their cholesterol checked, to have their blood pressure measured, to talk about giving up the fags, then we could potentially claw back a significant amount of the money, while at the same time improving the nation's health.

But when you have the choice between paying 60 euro to have your BMI measured, or buy the tin of baby formula that your nipper needs, I know which most people would choose.

The full article is over here.

Am I a hypocrite?

I used to go running quite regularly, it was something that I really enjoyed doing. But, between studying and working and having a girlfriend, I hadn’t been for ages.

I went for a run last night and it was great. The sun was shining, but it wasn’t too hot and there was a slight breeze to cool me down as I ran. This country looks beautifully green at the moment and the people I passed seemed happy as they enjoyed the summer evening.

If I’m being honest with you though, I’d say that the real reason I went running was because I stepped on a set of scales the other day and discovered that I’m almost a stone and a half (9.5kg) heavier now than I was this time last year. On the BMI charts, I’ve slipped across the line from the Healthy Green to the Overweight Yellow. More tellingly, trousers that I bought because they were baggy are now looking distinctly “fitted.”

I’m not overly concerned though, nobody who knows me would describe me as “fat” and I’m sure the extra pounds will come off again, but it got me thinking about things I’ve said to patients about losing weight.

On many occasions, I’ve advised people that they need to lose some weight, that their size is damaging their health and on many occasions I’ve been exasperated when they “refuse” to do so.

“How hard can it be?” I’d whinge to my colleagues. “All they have to do is eat less and do a bit of exercise and then they would be in the hospital in the first place?”

But now, I’m officially overweight myself. So, do I have any right to tell another overweight person to lose some weight?

The question I’m asking is “Am I a hypocrite?”

And the honest answer has to be, “Yes, I am.”

I’m far from being alone in this though. In fact, I believe that the vast majority of doctors across the world have given advice to their patients that they, themselves flagrantly ignore.

I used to work with a consultant vascular surgeon who, every week for the majority of his working life would amputate people’s legs because their smoking had clogged their arteries, causing their leg(s) to rot. And every week, at the end of his list, he’d take himself off to the smoking room to have a few fags before reviewing the post-op patients.

Drunk people are so annoying in the A&E department. Not only because they can be loud, rude and aggressive, but because the effects of alcohol itself mimics the symptoms of severe disease (dizziness, drowsiness, slurred speech, vomiting etc…) and makes it much harder to exclude potentially serious problems. I used to bemoan having to clerk in drunk people on a Saturday Night but I knew that, had I not had to work, I would probably have been in the same bar, dancing like a tool and being almost as pissed as they are.

I know doctors that regularly take recreational drugs, even though they of all people know the harm these substances can cause.

What I’m saying is that there is a large amount of hypocrisy running through medicine and a large amount of the “Do as I say, not as I do” attitude that comes with it.

However, on the flip side of this, being a doctor certainly gives a different perspective of life and health. We’ve all seen people die in front of us in horrible, but avoidable ways and, as a result, we are morally and duty bound to try and help the person in front of us from doing the same.

I suppose what it comes down to is this. We are no angels, we never said that we were. I guess that our hypocrisy stems from wanting our patients to have as good a life as possible and from trying to get them to avoid the suffering that lies further down the path that they’re on.

We’ll continue to do this, even if we can’t take that advice ourselves.

Married to the job

Six Months ago...

I’m in the changing rooms, getting into my scrubs at the start of the day and I’m chatting with Jeremy, one of the other novice anaesthetists.

“I’ve started seeing someone,” I say

“Oh yeah?” Jeremy raises his eyebrow at me, “Who is she? Tell me more.”

“I’ve actually known her for a little while now, but things are just starting to get more serious. She’s fantastic though, and you know me, I don’t say that lightly.”

“What’s her name? Is she another medic?”

This is what you find in medicine. There’s the tacit implication that doctors only go out with other doctors and it’s almost as if you’re breaking the rules if you go out with someone totally non-medical.

“No, she’s not. She works in fashion, she’s called FashionGirl.”

“Oh that’s cool, so how did you meet?”

The conversation goes on along this vein for a few more minutes and then Jeremy leans into towards me and asks.

“Does she understand?”

“What do you mean?” I query.

“You’re planning to sit your primary exam this year aren’t you? Does she understand about the time you’ll need to study as well as spending so much time in this place?”

“Yeah, I’ve explained that to her.” I avoid his gaze as I say this because even in my own head, I’m not sure that FashionGirl really understands what lies in the few months ahead. I’m not going to be there a lot of the time. In the run up to my exams, I’m going to be married to my text books and there are going to be times when I’ll be so tired after work that I won’t want to speak to anybody at all.

“I’m sure it’ll be OK,” I continue, hoping that what I say will turn out to be true.

------------------------------------------------------

Last Friday Night...

FashionGirl and I are sitting having dinner and sharing a bottle of wine. I’d really been looking forward to seeing her because it felt like I hadn’t seen her in ages.

“You know, Michael” she says as she takes a sip and fixes me with her blue eyes, “I was really pissed off with you the other weekend.”

“When I said that I wasn’t going to come to Emma’s birthday do?”

“Yes. It’s not that you didn’t come, it’s that you said you would and then changed your mind the day before.”

“I know, but I’d just done a week of long shifts and I just wanted a night in.”

“I know that babe, but…” her voice tails off.

“But?”

“I don’t think it’s very fair that’s all. It’s just that sometimes it seems like I’m the one making all the effort. I’m always the one that comes over to see you. I know that you’ve had your exams and everything, but I feel that I’ve been really supportive over that whole period.”

“You have!” I interject as I recall her sitting in bed with me, quizzing me about the Gas Laws. “Very much so.”

“But, it seems to me that now you’ve got this free time that you could be making an effort too.”

“FashionGirl,” I say. “Remember that was my first free Saturday in weeks and I’ve been over to see you loads in the last couple of weeks.”

“I suppose that’s true.”

“And besides, I don’t think I would have been a whole lot of fun that night and, had I gone out with you guys, I reckon I would have spent most of the evening asking you to come home with me. I was in bed by 8 that night!”

“Actually, I’ve been meaning to have this chat with you for a little while now.” I continue. “There will be times where I won’t be able to do things that I said I would. There will be times when I miss doing something with you because of my job and there’ll be time where I really just want to be left alone and just sit in a dark room for a while. But please remember that all of that is just because of the job I do. It doesn’t mean that I care about you less, because I care about you loads, you know that.

“I remember in my first year after graduating, after a real nightmare shift, I called up my Mum and Dad and ranted and raved about how I was spending all my time at the hospital and it seemed I never got to do anything else.

“They said to me, ‘Son, it’ll only be for the first couple of years you know. As you move up the ladder, you’ll have to do less work and you’ll have more free time in a couple of years’ time.’

“But that’s not true, FashionGirl. It’s really not true at all. The higher I get up the medical career ladder, the greater my responsibilities get and I’ll be doing more work and have more commitments - not less. And that means that going into the future, this problem is just going to get worse.

“What I mean to say is that I do really care about you, you know I do, but there will be times when I let you down. All I can say to you is, when the choice is in my hands, I promise I’ll put you first. It’s the best I can do.”

The Crash Team

When somebody dies on a hospital ward, a “crash call” gets put out by a member of the ward staff. This comes through to the pagers of the members of the “crash team” who have only a couple of minutes or so to get to the ward and attempt to literally bring the dead person back to life again.

There is a definite order in which the various members of the crash team arrive at a cardiac arrest.

First there are the nurses due to the fact that they are actually on the ward when the person died and are often the people who put the crash call out in the first place. There’s usually two or three nurses there performing Basic Life Support (CPR) before the crash team arrives.

The first member of the crash team to get there is the Medical SHO. The Medical SHO is usually younger, quicker and keener than the other members and will try her best to organise a working airway, IV access, a heart monitor and give some emergency drugs.

The Medical SHO is quickly followed by the Medical FY1, who is even younger and fitter that the SHO, and would have been there first apart from the fact that he doesn’t want to get there, get scared by the situation and freeze with everyone looking at him and asking “What shall we do now, doctor?”

It takes about a minute or so for Advanced Life Support to get properly underway, and this is the moment when the Medical Registrar pitches up. The Medical Registrar is the leader of the crash team and she’ll have seen literally hundreds of these in her time. She’s got the knack of arriving early enough to potentially make a difference to the patient but late enough to allow the initial panic to die down and for everyone to slot into their roles so she can take over the overall running of the crash call.

Last to turn up is the anaesthetist. It seems that the anaesthetist’s role at a cardiac arrest is to turn up, sneer, suggest to the Medical Registrar that we should all stop now and then saunter off again. I used to think that this was because anaesthetists were lazy, but now I know that the reason we turn up last is because most of the time, cardiac arrests happen on general medical wards and in most hospitals, the general medical wards are nowhere near the operating theatres, which is where the anaesthetists hang out. The other reason is that the medics are perfectly capable of running the arrest without us, so we don’t bother making the long sprint from theatres to the medical ward (up to half a mile in some hospitals) and settle for a slow jog instead.