Thursday, September 29, 2005

Thank god for locums

I went to my GP yesterday who actually was sick, so I saw another (very nice) medic who graduated the year before me and so understood the hell of being an SHO and understood that I wanted to be a registrar but wasn't sure if I was capable of passing the exams and that I was very stressed at work and didn't know how to cope. In fact I think I walked in and sounded fairly desperate because she took me fairly seriously. She agreed to give me 5 nights worth of sleepers, and I'm only allowed to take them at night (i.e. not to get rest during the day when on a night shift) and not continuous nights (standard procedure) and I have to go back and see her next week as she is a locum at the practice and will therefore be around for a few months. She said that I don't have to see occupational health at this moment in time but would like me to consider the idea of some form of psychological therapies to help me be prepared for any possible setbacks I may hit. All sound advice really.

Another locum who arrived yesterday was the locum registrar who is taking the position of the one who sauntered off to another trust and he seems exceptionally pleasant and wants to help all the SHOs/PRHOs along the way, which makes a change. Usually registrars just want to become senior registrars and consultants and don't give a damn about who they tread on along the way.

Found myself being a bit of a counsellor yesterday afternoon to a PRHO who I know has been having some problems. She's currently on her 6 month surgical rotation within MAAU and is therefore responsible for a hell of a lot of suturing and overseeing patient transfers to surgical wards. I knew a bit of her persoanl history, her mum was diagnosed with cancer during her finals and unfortunately it appears to be terminal so she is just waiting in essence which has been having an impact on her work. Yesterday she tried to suture up a fairly simple head wound and just could not do it, in fact she was having difficulty injecting the local into the area and ended up asking me to do it for her. I suggested that another surgical PRHO did it (they need the practice and I've never been a very good seamstress) and we went off to the staff room for a little chat. I told her that we all find things hard at times, and she admitted that she had never really grasped how to suture so together we spent about 1 hour injecting oranges and suturing up banana skins, I have to say I think we are both better off for the practice! I really feel an attachment with the girl, as I know I found my PRHO year tough due to one thing or another but am loathed to take her under my wing too much as present due to all the stuff I've got going on and also I know her mentor/consultant is an ogre and I don't want to be accused of being overly emotionally involved with her.

That's bureaucracy for you these days... you are willing to hold back from helping someone in need for fear of the reprimands, and it's not just colleagues, I know it happens in the ambulance service/A&E too.

Well I'm off to go and do one of my A&E liaison/crash course learning shifts now which should be slightly more thrilling than MAAU.

Tuesday, September 27, 2005

I think I'm semi-famous

Hello... it's me... that random person who should be writing this blog but has in fact been snowed under at work due to a registrar's decision to move NHS trusts. Great. Thanks. A lot.

Well I have to start studying for my advanced exams to let me become a registrar which means I am also getting to spend a couple of shifts a week in A&E doing 'liaison work' which in effect means I am an extra pair of hands that they don't have to worry about the pay or supervision of, it's nice to be wanted for a change. This registrar post means a lot to me and would be proof that I can actually achieve rather than just plod along and float through my medical career but it's going to involve a lot of hard work and time and I am so tired at present that I don't know if I can face it.

I was very naughty the other day and asked my fiancé (also a medic) to prescribe me some sleepers so I could get some rest, luckily for myself, my career and my reputation he refused but he bullied me into seeing my GP about everything (he thinks I have never really got over all my 'mental' stuff and am shoving it away, never to be dealt with) and so I have half a morning off work tomorrow to see him. Now I don't particularly get on with my GP, I don't know if it is the same for all health professionals but my GP seems to not be very keen on me as he always assumes I know what is wrong with me and what I need to be prescribed. I guess he thinks that in my eyes all he is is a signature on a prescription as I can't prescribe my own drugs, which isn't true. I see GPs as the 'gateway' to all NHS services and view my GP accordingly. Anyway, I know that depending on the result of the consultation there may be a visit to occupational health which means more explaining, but I know I am not coping well with the stress of everything at the minute and I want to stave off any impending doom than give into it.

Finally for the subject title of this post. I have since discovered that I have been mentioned on Mental Nurse's Blog which is a great privilege as I first read about their blog in The Observer a while back and have to say that they were some of the inspiration in creating my own blog. I feel deeply honoured.

Wednesday, September 07, 2005

Job opportunities

I seem to have neglected my blogging so on my day off I thought I'd write an update, although I sense I do not have a lot to write.

So finally I have a day off and then tomorrow I start back doing day shifts which tend to be terminally boring. Everything on a night shift seems to happen at double speed and because it is dark I can't see my awful surroundings that much (most of the time I can't actually see what I am doing either) yet on a day shift the hours seem to drag by.

I cannot complain though, at least I have a job when there are so many newly qualified doctors seeking jobs. It seems ludicrous to me that you apply for medical school and then train at university for 6 years and then not being guaranteed a job after your PRHO year. This year is usually spent in the same (or surrounding) NHS Trust as the one your university was located in, or used for the clinical placements and you are guaranteed a job for this year. When this year comes to an end you have to look for a post as an SHO in the speciality you want to work in. Unfortunately this is the difficult part as there are only so many allocated training posts in the UK. If you have been lucky in your PRHO year you will have already decided to train in a certain speciality and you will therefore remain in one NHS Trust doing rotations within that speciality, the most obvious one of these is psychiatry where you would gain knowledge in all aspects e.g. acute, elderly, mother & baby, crisis, liaison and outpatient and you will therefore always be able to find a post. However, for the rest of us mere medics the search goes on for a post and this happens every 6 months (in February and August). The problem is there are always popular posts (A&E for example) and these fill up quickly leaving the medics wanting to practise in A&E probably in oncology or something similar, basically where they didn't want to be.

Can you see why so there are so many medics who do not appear happy in their current positions and resent their colleagues who happen to work in the department they wanted to spend this 6 months in?

Rant over... I promise. Until next time.

Saturday, September 03, 2005

Friday night is "why oh why did I choose this job?" night

I sat for most of last night wondering why I left the stressful yet fast-moving rotation of A&E behind to enter the equally stressful yet slower pace, and lower pay, of MAAU. To me it seems it is the same job, except we retain patients for longer than 4 hours and therefore tend to get them whinge at us more frequently, and we also have fewer doctors on duty at the same time. Usually we have a Registrar on-call (but never actually to hand), an SHO and a couple of PRHOs which sounds adequate to cover a 4 bay ward with 6 beds in each ward. We also have an excellent team of nurses and health care assistants who are more than happy to help an ailing, zombie-like doctor in their quest to cure a patient before the consultant does ward-rounds the next day but I always seem to spend my entire life running around like a headless chicken from one bay to another whilst having the PRHOs follow me round as if they were still med students. This is probably a little harsh as they were med students until a couple of months ago and are therefore well trained in the art of traipsing behind an ego-centric consultant and his/her medical team (i.e. registrars, SHOs & PRHOs) to look at all the 'interesting' cases/patients. What they have to realise now is that they are no longer required to follow the more senior doctor around and at 3am I would much prefer it if they left me in peace. Oh for the day when I can become a registrar and go on-call whilst refusing to answer my bleeper to anything less than a cardiac arrest!

So instead, dear reader, of giving you a breakdown of some of my patients last night (mainly drunks who needed sobering up, assault victims due to alcohol, a couple of overdoses and some nasty broken bones requiring surgery) I thought I'd give you an insight into my consultant here on MAAU and the guy who is my mentor.

My consultant seems as if he has been a doctor since Hippocrates wrote the oath in pen and ink yet has in fact probably only been qualified for less than 30 years and is a whizz on all things weird and wonderful after doing a short time in infectious diseases before deciding to embark on the general public's misfortunes in MAAU. He is a rather short, stout man who appears to think that women should be left to running a nurse's station rather than filling in ward-rounds. Nonetheless, he is a fairly decent bloke who is always willing to help you out if you encounter a problem (so long as it is between the hours of 9am and 5pm) and is wonderful to bitch about the PRHOs/med students to in the staff room. I am very lucky in this rotation to have such an approachable consultant, especially as it will be him who will be writing my reference for a registrar post in Febraury.

That's right fellow-bloggers, yours truly has decided to try and become an emergency medicine registrar after I do my (hopefully) final SHO rotation from February - August 2006. If not, well then I guess I could always try and become one of the few doctors who is still an SHO in their 30s but there's a long way to go until I hit the big three zero.

Friday, September 02, 2005

Day One of Bloglife

As this is a personal blog about my job and my life I should start by telling you about my day. Today actually started at about 2pm for me as that is when I woke up and it was September 2nd. I did a night shift last night on MAAU and although Thursday isn't usually a bad day this one had it's exceptions. A&E was bursting at the seams by approx. 10pm so all urgent, yet not life-threatening cases were diverted to another admissions unit, at a different hospital to the one I work in. We got all the patients who had been kicked out of A&E, often without treatment or the appropriate tests/examinations just so the patient didn't breach the 4 hour government guideline and of course our unit doesn't have guidelines or deadlines to keep to so as long as we have the bed space, the patients keep coming.

So of the best patients I had the pleasure of treating last night included a 57-year-old male who had suffered a suspected myocardial infarction and had been taken to A&E by ambulance. Once there he had received treatment including 'clot busting' meds and an ECG all of which had pointed to the above diagnosis and eased his symptoms. He was transferred to us by ambulance yet on arrival his ECG results and entire A&E notes had disappeared. Cue another ECG and long telephone calls to A&E to ascertain quantity and strength of drugs. Not a pleasant experience when A&E receptionists put you on hold because they cannot find a doctor to talk to you, despite the fact that they, or a nurse, could access the information perfectly easily and give you the required information. All of which would save a lot of time and energy because let's face it, who wants to bother to talk to an incompetent medic in a different hospital who has lost some medical notes when you already have far too many patients in your care and not enough time to grab a cup of coffee at 11pm when you've been working flat out for gods-knows how many hours? Not me, that's for starters. The patient is stable and has been transferred to Coronary Care where he'll be a lot better off.

Another wonderful character I had the pleasure of meeting last night was a 23-year-old female with multiple injuries to her face due to assault. She was in MAAU for observation after a head injury and had a suspected skull fracture which couldn't be diagnosed in A&E because the radiographer had gone home (never need a CT scan after 6pm on weekdays, or at all at weekends) and had been transferred to us in the meantime. Unfortunately she came with a couple of police officers who wanted to question her in relation to the assault and her response to everyone was to "fuck off, I don't need your help". The patient was also a drug addict and therefore had atrocious veinous access so trying to place a cannula in her arm in case we needed an emergency line was impossible. On the fourth attempt (this time in her foot) she kicked out in pain and told me to find a qualified person to put the line in (or similar words to that effect). Unfortunately I was the only SHO on duty last night and I had a Pre-Registration House Officer (PRHO) on duty with me. Basically a fresh-faced lad who only graduated and stepped into the big wide world of non-student medicine a month ago, or I had the Registrar (SpR) on-call. The SpR would have been my first port of call except I learnt the hard way in my first couple of years that a senior doctor does not like to be bleeped in the middle of the night for a cardiac arrest, let alone something as simple as a cannula). Out of kindness I let the PRHO try and to my annoyance he managed to find a perfectly suitable vein first time, just shows that a month as a PRHO where your sole job appears to be cannulas when you start pays off, he'll be a whizz when he leaves us in 5 months time. I'll have to ask him more often and save myself the sheer embarrassment.

Embarrassment... a word that is usually, ironically, reserved for PRHOs!