Stolen from Mental Nurse

Your Score: Commander - ESTP

60% Extraversion, 40% Intuition, 73% Thinking, 46% Judging

It's all about action with you, isn't it? You're outgoing and right to the point. Fast moving, fast talking and often fast spending. Your motto is "Just DO it."

Wow. You move faster than the Flash on a treadmill. (Yes. I could have thought up something cleverer than that. But honestly, you're just not worth my time.)

To carry on the superhero theme, you're comparable to the Hulk. Except you're uglier. And you're slightly more intimidating. People flinch when you're around for fear you might exert your dominance and order them to do 50 press-ups.

Perhaps if you calmed down a little, people wouldn't be so scared of you. Of course, something would have to be done about your face. Is plastic surgery an option?

This insatiable appetite for action means that you're not exactly into long term commitments. You get bored incredibly quickly and tend to jump in and out of relationships like the Energiser Bunny.

Eventually you're going to run out of people to bounce to, and you will end up a very lonely and hated individual.

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If you want to learn more about your personality type in a slightly less negative way, check out this.

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The other personality types are as follows...

Loner - Introverted Sensing Feeling Perceiving
Pushover - Introverted Sensing Feeling Judging
Criminal - Introverted Sensing Thinking Perceiving
Borefest - Introverted Sensing Thinking Judging
Almost Perfect - Introverted iNtuitive Feeling Perceiving
Freak - Introverted iNtuitive Feeling Judging
Loser - Introverted iNtuitive Thinking Perceiving
Crackpot - Introverted iNtuitive Thinking Judging
Clown - Extraverted Sensing Feeling Perceiving
Sap - Extraverted Sensing Feeling Judging
Do Gooder - Extraverted Sensing Thinking Judging
Scumbag - Extraverted iNtuitive Feeling Perceiving
Busybody - Extraverted iNtuitive Feeling Judging
Prick - Extraverted iNtuitive Thinking Perceiving
Dictator - Extraverted iNtuitive Thinking Judging

Link: The Brutally Honest Personality Test written by UltimateMaster on OkCupid Free Online Dating, home of the The Dating Persona Test

Off work on the sick

I have been off work sick for just over a week now. The ugly, black monster that is depression, self-harm, suicidal thoughts and general don't care lethargy has washed over me again. It's a shame really because I was rather being to enjoy my new job at the new hospital.

Work have been great about it though. They've been really understanding and my consultant has told me not to come back until I feel ready to work, not when I think I should come back. I still feel guilty though, I should be out there helping people, not wallowing in my own self-pity like some emo-esque teenager.

My new GP is an absolute love too. I am back on the anti-depressants, back on the mood stabiliser, back on the sleeping tablets, back on all the tablets I stopped taking many years ago in the great belief that I was absolutely fine and didn't need pharmacological intervention. Now I am wishing that pharmacology worked faster on the body.

I am holed up in my little room, crying, listening to maudling music and planning ways to escape my life for a few hours. I wouldn't say I was actively suicidal, not like sometimes, but I am thinking about it strongly. It's a thought that is always in my head and pops up at the most inconvenient of times. I have been cutting myself again, quite badly, and it's only because I am an A&E doctor that I haven't had to get treatment for it.

My GP is worried about me, my parents are worried about me, work is worried about me. In fact the only person who doesn't seem to be worried about me, is me, and that's only because I haven't got the energy to think anymore.

It doesn't matter where you are in the country...

Bank Holidays working in A&E are on the whole always the same. Full of DIY accidents, sporting accidents, drunks, people who have had accidents whilst drunk, overprotective parents bringing their kids in 'cause they can't get to see a GP and all the time people telling you to hurry up because it's a Bank Holiday and they don't want to spend all day in A&E.

Well, guess what? It wasn't my first choice of location to spend August Bank Holiday either, but I had no choice in the matter, unlike the majority of the patients I saw who could have waited until they got a GP appointment in the morning. So don't moan at me, because the mood I was in today, I was highly likely to moan back at you and the general public doesn't like that!

Got a day off tomorrow and then start a week of nights on Wednesday. I haven't done a whole week of nights in my new job yet. I've done a couple here and one there but not a whole week of working 8pm until 8am. I guess I'm a little scared as it's new territory for me, and I was scared starting at this hospital with the usual self-confidence doubts, but I've had good feedback from the rest of the staff, so I just have to let the positives prevail and push the negatives away. Sounds easy on paper!

But how strange the change, from major to minor

I spent most of the day in the minors department today, as opposed to the rest of the week where I was in majors. Now unlike most of my colleagues, I don't actually mind working in minors, I believe it is part of my job and I tend to get annoyed with people who work in A&E for all the adrenaline rush of a Casualty episode, and sometimes minors can be as interesting as majors.

I do however, get annoyed wth Emergency Nurse Practitioners (ENPs) telling me how to do my job in the minors department. Unfortunately minors seems to be overrun with ENPs, apparently it speeds things up and allows for more patients to be seen, in essence though it slows things down and means that I cannot get on with whatever I am attending to. Today I was told by an ENP how to check for concussion and that the patient that has arrived in minors didn't need a CT scan to rule anything out as "minors don't refer to CT, if triage think they need a CT then they get sent to majors" and "they've only had a minor bump on the head". Just a minor bump on the head that left them forgetting all of yesterday evening and meant that their left pupil wasn't reacting at the same speed as their right one today.

The same ENP then called me away from my patients 8 times in the space of 4 hours to ask me my opinion on her patients. I have no problem with people requesting a second opinion, in fact I'd rather have an ENP ask me my opinion on a case than assume they can deal with it and miss something dangerous. The department has quite a lot of ENPs in minors though and if everyone of them asked for my opinion (or another doctor's) twice an hour then the doctors wouldn't get round to seeing any patients.

ENPs are meant to be able to see patients alongside doctors and therefore clear the minors waiting area in half the time, but if this particular ENP was anything to go by then the waiting area would clog up and go twice as slowly. I'm sure they do a very valued job and I'm probably being unreasonably unfair but when I start to assess or treat a patient, I quite like to complete the treatment without that many interruptions (within due reason) and I don't like being interrupted by the same person so often. Maybe she saw me as a soft touch, or maybe Friday was just my turn to be her oracle. I guess I'll never know.

Success!

For those of you who are interested, and those who are not, I finally found out what the backing music to the TfL "You're Better Off By Bike" advert is.

Straight Lines by Dawn Landes.

Hallelujah!!! It's been driving me mad for weeks.

Long time, no see, and all that jazz

Gosh, it's been a while. I don't really know where to start. I'll start by saying that I was one of the lucky ones, I have a training post in London, in Emergency Medicine. It's in a busy hospital and isn't one I'd come across before (I studied in London) although I did know of it. They are also encouraging me to sit my MCEM exams which is good as I have said before that my previous workplaces weren't that bothered about my post-grad credentials and thus led me to believe that I wasn't worthwhile when it came to exams etc.

The fiance and I are no longer. He is working in Birmingham at the Defence Medical Centre and in the last few months had become so obsessed with his job, and possible promotion, and trying to get sent back out to active service (something I coudn't understand) that we barely spoke to each other either by text, phone or email, let alone saw each other. We decided that a long distance relationship wasn't going to work out and he seemed more concerned with his career than he did with the idea of marriage so we called it a day. I did all the screaming, crying, sulking malarky and am now feeling quite relieved and free. I quite like being single again, sometimes it's nice to go into a bar and flirt with people and tease them a little, whilst having absolutely no intention of taking it any further. Oh dear, I've just realised that could make me sound like a slutty, bitchy tart, which of course I'm not, I just haven't been single for oh such a long time.

I am refreshed to say that I am slightly more enlightened with being a doctor than I was 3 months ago. I think most doctors can say that now. I know a couple of people who have emigrated to find a job, a few who were unsuccessful in finding a training post, one guy who has had a change of career entirely and has decided to become a teacher and one girl who gave birth to a baby girl earlier this week so doesn't care about her career at present. It's been a rough time for the medical profession and I am alarmed to say that the majority of Joe Public has had absolutely no idea what it is like. I have had comments of "it's healthy competition, you get it in every job" and "it's only bringing medicine in line with the rest of the employment system" thrown at me over the period that MMC was in crisis. Let me say that I know what the rest of the world is like and I know that job-hunting is tough, but I don't think you can assess doctors on their ability to write creative answers to stupid, inanane questions without looking at their qualifications, experience and medical abilities. I just hope the government has learnt from this mistake, although I get the impression that because the NHS hasn't ground to a halt this month they probably think that it was a successful process!

I did however, have a horrible incident in the department yesterday. One I have never experienced before, and hope not to again. It was an anti-semitic attack against me. I have worked in lots of hospitals and no one has cared about my religion. My surname is very stereotypically Jewish and when I went to treat the man yesterday he spat in my face and told me he wasn't going to be treated by a hook-nosed terrorist like myself. Charming. The hospital have barred him from the department on racial discrimination grounds but it scared me. Anti-semitism is becoming amazingly more common of late and that scares me too. The Jewish cemetery near where I live had been vandalised, my aunt's house has had graffiti sprayed on it, I know my cousins have been subjected to abuse on their way to school and the local synagogue is running at a much higher security level than ever before.

In other news, can anyone in the London area please tell me what the backing music to the Transport for London "You're Better Off By Bike" TV advert is? It's driving me mad. All help mucho appreciated, ta!

I am not dead...

But I can't honestly say that I feel alive.

MMC and MTAS still stink, the fiance is back from Iraq and is looking forward to working in Birmingham without any consideration for the fact that if I get a job I won't be anywhere near Birmingham, I am trying to calm myself down over the one interview I have and am trying to resist the urge to run away and quit this profession. Oh, and I'm trying to stop bursting into tears on ward rounds or when in ICU or Theatre, I wish I was back in A&E but then I don't, then I sometimes wish I wasn't anywhere.

So if you were wondering where the posts had gone it's because frankly I can't see the point in posting, I can't see the good or positive side to medicine anymore and I don't want to bore people with my pathetic whinging, but thanks for the concern about my lack of posts, that means a lot to me, it really does.

Auf Wiedersen, A Bientot!

Although, unlike in the great film Cabaret, the end of this post will most certainly not end with

Where are your problems now? Forgotten? I told you so. We have no troubles here! Here life is beautiful... The girls are beautiful...Even the orchestra is beautiful!

Is it a fact that MMC/MTAS is not beautiful.

I have been shortlisted for one interview. In ACCS (Emergency Medicine) and have been rejected from CMT and ACCS (Acute Medicine), which I am not that unhappy about. The interview is for London. The fiance has only been shortlisted for one interview in West Midlands deanery (as he is a military applicant all his applications were handled by West Midlands deanery). Trouble is, I got rejected from West Midlands deanery.

The fiance is highly likely to be working at the Royal Centre for Defence Medicine, and this is what he wants to do, which is in Birmingham. I am going to be working in London (if I get a place). I know this is going to wreck our relationship.

I know I have been lucky. I have an interview, I have an interview for the deanery/UoA I wanted. But still I don't feel happy. And now I feel selfish because of this.

Rule number one of blogging

Never post when slightly drunk.

I have to admit that my last post (on the shambles that is MMC/MTAS) was posted when I was drowning my sorrows over finding out the deadline had been extended with a bottle of nice chilled white wine. This may account for the slightly melodramatic, 14-year-old, style of writing.

However, despite being slightly inebriated when writing it, my thoughts on the matter are still the same. Although in the cold, sober, light of day I am probably slightly less likely to swear and sulk about it so much. But the general point still stands. I doubt I will be shortlisted and I will be out of a job with no other skills/experience to do anything else and I will, obviously, not be a very happy bunny.

In my personal life I have discovered that the fiancé is back from Iraq in a bit (week on Monday) for a week's leave. I can't believe how he is coping with all the MMC/MTAS stress and having to operate as a medic in a war zone. Kind of puts things into perspective a little.

My true thoughts on MMC

Oh how I hate MMC, how I hate MTAS, how I hate being a doctor right now and how I hate being me.

I probably have 6 months left of being a doctor, after all, who on earth is going to shortlist me? And even if they do I now have to wait even longer to find out because of the fecking eejits. Of these 6 months I have spending half of this time in anaesthetics, a worthy cause but not the speciality I love. That is Emergency Medicine (of which I know anaesthetics is a part but hey...) and I only get to spend 3 months there.

I admit, I haven't tried hard enough as a medic. I never strived to sit memberships exams for the various colleges out there, I was always perfectly happy being a Senior SHO, or even just an SHO. I didn't become a doctor for the letters after my name and the experience of being a college member. I became a medic to do what I am doing now, helping people, making people better, easing their pain and suffering and enhancing my diagnostic skills.

Unfortunately this counts for jack-shit with MMC. Letters after the name is what they're looking for. Career minded medics is what they want. People dedicated to the furtherance of the NHS, not their patients.

Well fuck that, they got me and I may not be any of those things but I know that when I am on good form I am a damn good and empathetic doctor and that is what I care about, not being what MMC wants me to be.

So I may be unemployed in August and yes, I'll act all non-chalent and pretend I don't care. But between you, me and the gatepost... it's going to hit me fucking hard and I don't know how I'll cope. After all the stress of university didn't agree with me very well so fuck knows how I'll take being unemployed and not having the qualifications or life skills to do anything else.

But no one will care anyway because the government will have filled it's quota of junior doctors with the people they wanted and no one will give a toss about those left out to rot with the rubbish.

Seconded

I have been seconded to anaesthetics for 3 months. Whilst this is somewhat bad (as it means I have to leave the beloved A&E department and all the hilarity that involves) it is also good as I am now working a daily shift pattern that will see me working either early (8am - 5pm), late (3pm - midnight) or a night shift (11pm - 9am the following morning). This is of course good news as it means shorter days. However, being a anaesthetics SHO means I have to go back to doing on-call work, which is bad.

On the whole, so far anaesthetics looks good and I'm managing to incorporate some ICU work into the secondment too. Apparently the trust thought I needed to "spread my wings" and although I have completed a lot of the other necessary rotations related to A&E (paediatrics, general surgery, critical care etc) I have never been attached to an anaesthetics firm so it is all a learning curve. Let's just hope it's a good learning curve.

Friday evening

It was a weird and wonderful shift last night and quite harrowing at times. I arrived just before I started to a waiting room full of patients, which is never a good sign as it invariably means there are a lot of frustrated people as they have been waiting a fair while and last night was no exception.

The first patient I saw was a 12 year old girl with a suspected fractured wrist which she had sustained from falling off a kerb whilst wearing those wheelie shoes. Her father who was accompanying her was rude and aggressive and kept telling me that they had been waiting for nearly 3 hours before they were seen whilst people who had arrived after them had been seen first. I tried to explain that the department was very busy and that his daughter would have been assigned to a triage category reflecting her injury and that patients are seen not in order of time of arrival but in order of clinical need and seriousness of illness and/or injury. The father then blew up in my face and accused me of not caring about his daughter’s wellbeing and suggesting that her injury was trivial. I bit my tongue and said that the girl needed to have an x-ray to see whether her wrist was fractured or not and gave him the x-ray form and told him to make his way there. It turns out that she probably has a scaphoid fracture, but these being notorious to not show up in initial x-rays and not wanting to send her home merely with a tubigrip, when she was exhibiting all the signs of a bone injury not a muscular injury, I have referred her to be reassessed by the fracture clinic next week where they will re-examine her wrist and take another x-ray, by which time if it is a scaphoid fracture the break will show up and I gt her wrist put in a cast as a precaution. I also gave the father and daughter some social advice on the use of ‘Heelys’, in relation to this incident.

The next patient was a more harrowing case. A 24 year old male who arrived on foot with his girlfriend after having a severe headache at the back of his head for a few hours which came on suddenly and was worse than any other headache he had ever suffered before. Now that sentence rings alarm bells at any doctor for a diagnosis of subarachnoid haemorrhage and sure enough he was exhibiting other symptoms; he was nauseated, had vomited, had photophobia (dislike of bright lights), neck stiffness and was becoming sleepy. I sent him off to have a CT scan to confirm the diagnosis, which it did – subarachnoid haemorrhage as a result of a burst berry aneurysum, and on his return put him in resus just in case he lapsed into unconsciousness and made a referral to the neurosurgeon (at a different hospital). The ambulance arrived to transfer him to the neurosurgery department and I discovered a few hours later when I rang to see how he was getting on that he died on transfer to the hospital, probably from the aneurysum rebleeding. Now I know that I couldn’t have predicted this and I did my best but I hate it when things like that happen. Subarachnoid haemorrhages are one of the things about emergency medicine I hate. They are very rare, thank goodness, but tend to affect young normally fit and healthy people and unfortunately there isn’t really any way of knowing who will survive and who won’t.

After that there were the usual Friday evening cases of alcohol related injuries, people having got into fights, the odd depressed patient attending A&E because they felt they couldn’t cope over the weekend and their CPN had gone off duty at 5pm so could they access the duty psychiatrist/crisis team and a few domestic violence cases, one serious and three non-life threatening, all with police attendance.

Then my last patient of the evening was totally bizarre. I would like to say that I thought I had seen most things in emergency medicine and the nurse who assessed this patient had told her “not to worry because we’ve all seen everything before”. Thing is, I had heard of patients like this, I have had colleagues deal with them but I had never treated one. She was referred to me by a male colleague as she was insistent on a female medic, and after discovering her problem I could understand why. She told me that she had been feeling upset and lonely and so had decided to have ‘a play’. Unfortunately she decided that as she was lacking in a vibrator or dildo that she would use a carrot. Trouble was she had got a little bit too excited and the carrot had snapped and whilst she had been able to retrieve half or it the other half was left inside. Normally I would have had a little snigger to myself over this (and don’t berate me for it because I’d like to know anyone who wouldn’t) but she sounded so embarrassed and upset and thought that I’d judge her (she was 58 and clearly thought that I would think that 58 year old women shouldn’t have sexual urges) that I couldn’t even find it that funny at the time, however typing it now I am smiling. Anyway, once I’d treated her and when she asked me my advice (which was to possibly expend some money in Ann Summers) and I’d given her a script for some generic antibiotics (carrots are not the cleanest items) she left, thanking me profusely. In fact as I left my shift she was still sitting outside the department waiting for me to thank me again and she tried to give me £10 as a way of a thank you present but I obviously had to refuse. She also praised the way I’d handled the situation and said the department was brilliant because no one had laughed at her or been cruel about her. I just smiled and walked off, feeling awful because I know the gossip that was going round the staff room in relation to her (that I didn’t partake in) and felt quite appalled that I could laugh about it with colleagues when the patient thought I had acted so professionally.

Another night shift tonight, except it’s a full 12 hour one, let’s hope Saturday night isn’t quite as eventful as Friday evening.

Stressed

So I am trying to complete my MMC application before I go to work but the bastard computer is not letting me access MTAS and my hard drive seems to be in melt down. *screams quietly to herself*

I start work at 5pm and am only on shift until 11pm (short shift woohoo). Am praying for a quiet evening so I can calm down slightly and try and take my mind off MMC.

Doubt it will happen though, after all it is a Friday evening and I doubt I'll manage to get away at 11 on the dot. Still at least it's only a half shift.

I've discovered recently that thanks to MTAS and MMC you have to be thankful for the small mercies in life.

I Hate MMC

AAAAAAAAAAARRRRRRRRRRRGGGGGGGGHHHHHH!!!

That just about vents my anger over MMC. I am offically useless and am going to be unemployed.

Why? Because I am not experienced/qualified enough for ST3 training in Emergency Medicine as I don't hold Part A of MCEM or equivalent. So am stuck with ST2 places in ACCS - Emergency Medicine and ACCS - Acute Medicine and 2 CTM specialities.

I'm just a useless doctor and because I haven't pushed enough to further my career I'm now screwed. Plus I'm opting for the 2 speciality/2 UoA option.

Just hope the fiance has more luck with his application as he can only choose 2 specialities and his application is being processed by one UoA - West Midlands deanery - on behalf of the Defence deanery.

This is such a cock up.

London... home sweet home

I have got a few days off now (including today) and I decided to treat myself. So today saw me tootling off on a train into London, which reminded me of the joys of being back in the South (reaching London within 60 minutes - joy) and then reminded me of the pain of being back in the South (old trains, annoying timetables, overcrowding - not so fun).

Anyway, I am a Londoner at heart. I was born in the City, grew up there, went to school there, went to uni there and did my house officer years there. Then I moved 'oop North' and came back down again because the fiance's job moved him to the South East (though not London, unfortunately). I feel as if I have an affinity wih the place and I had a really nice day.

In the morning I saw the parents, who haven't seen me for a while and we had a nice coffee and chat. Apart from a few awkward questions like "when are you going to get married?" and "when are you going to become a registrar?" and "why did you become a medic when you could be earning so much more in the financial services and with much less hassle?" it was a success. They don't seem too keen on the emergency medicine life of things but then again I think they've been watching too many shows like Panorama and Tonight with Trevor MacDonald with the lead story being 'A&E staff suffering more abuse and violence from patients', oh and knowing my mother, probably reading the Daily (Hate) Mail as well.

This afternoon I saw an old friend from uni. We were in the same year at med school together except he dropped out after the 4th year, graduated with an MSc in Medical Sciences and is now working as a medical journalist earning about 3 times what I do whilst I stuck the course. Sometimes life isn't fair. We met for lunch and then we did a bit of shopping, well I did some shopping and dragged him with me.

Some things I noticed on my excursion were the reason I love London so much:
The Tube
The ability to get on a bus when you want to
Krispy Kreme doughnuts available pretty much everywhere, rather than having to hunt for them
Oyster cards, thus proving the world can go paperless
Busy shopping streets like Oxford Street with the ability to nip down a side street and feel like you stepped into a parallel universe because it's so quiet
Shops, that are big, and actually stock stuff
Free museums, that you might actually want to go into
Decent buskers on Tube stations.

However, there is one thing I resent about London (well, Oxford Street in particular). I do not want to be accosted whilst I am shopping by a guy with a megaphone asking me what I have done to redeem my sins in the name of Jesus Christ and then stopping to ask me what job I did and telling me that I should let nature run it's course and people are meant to die when God wants them to. Meaning that the job I attempt to do everyday is pointless.

Now I know medicine has a low success rate ultimately (everyone is going to die) but I like to think that we (medics) try and stop people dying prematurely, or from curable conditions or in pain and discomfort. Or as a colleague I had who worked in cardiology once told me "my job is delaying the inevitable because in the end heart failure ultimately gets every one of us". She has a point.

Tomorrow sees me cleaning the house, what fun!

Meme

Stolen from Patient Anonymous:
The medical specialty for you is.... Internal Medicine

Internal medicine is better than any of the specialties. When a patient comes in for a check-up, you can send them home with a clean bill of health. And when a patient comes in with high blood pressure, you can prescribe one of a wide variety of drugs, including beta-blockers, diuretics, and ACE inhibitors. And when a patient comes in with some other problem, you will be able to refer them to one of a long list of your colleagues.

To find out what specialty best fits your unique personality, go to:

What Medical Specialty Is For You?

Burns Victim

General rule in life that should always be followed. When cooking on a gas hob, never leave the ring lit without a saucepan/frying pan on it as someone may reach over it and burn themselves thus ensuring a trip to A&E to get burn dressed and nylon jumper removed from burn.

Even more obvious rule, never do this if you are a junior doctor and the A&E department you will end up in is the one you work in and the staff treating you will be your colleagues.

Needless to say I have been the butt of many jokes these last few days, especially when people suggest that doctors are 'intelligent' or 'sensible'. The chorus of "oh no, look at MJ, she burnt her arm by leaning over a lit gas ring and she's a doctor" rings from all corners of the department.

I think me and my slightly poorly arm will retreat away from the world of humiliation and sarcasm and try and get some sympathy now, and give up on cooking, after all that's why instant microwave meals were invented.

Flattered...

Firstly, thanks to all the people who posted comments in relation to my last post and my new additions to my blogroll. It is very flattering to think that there are medical students and medics out there who enjoy my writing and can relate to it. It makes me think that this blog is worthwhile and it is not just me who is going through this crap of Mucking-Up Medical Careers (oh, sorry that meant to read Modernising Medical Careers - what a silly mistake).

I don't really have a lot to say. There have been a lot of minor incidents in the department, a few major ones and a few I'd rather forget. There have been a lot of people screaming at me, a fair few vomiting over me and a few discharging themselves only to be brought back in by an ambulance crew 10 minutes later because they were found collapsed at the hospital entrance.

The most exciting thing to be happening in my work life at the moment is that we have acquired two groups of 4th year medical students in the department doing their Student Selected Choices (SSCs). They are like chalk and cheese. One group wants to work extremely hard and they offer to do anything (including tasks that they aren't allowed to do) and the other group saunter in late and spend most of their time sitting at the workstation drinking coffee and trying to chat up nurses and ambulance staff. I even caught one girl trying to chat up a severely ill patient yesterday!

It must be incredibly boring being a student on your SSC in A&E. When I look at other specialities that I have worked in and look at the students doing placements in things like paeds and hepatics and then compare them with the students in A&E then the A&E lot aren't allowed to do anything. In fact the student nurses complete more hands on experience than the med students will. They are there to observe how an A&E department works, and I think to learn that emergency medicine is not like ER or Casualty, but although that by their 4th year they will have learnt plenty of clinical skills that they could put into practice (or supposedly will have learnt the skills) due to health & safety and the fact that an A&E department really isn't the place to continuously mess up (not that all students do, in fact some of the students are amazing) they cannot practice most of their newly acquired skills.

They are left to deal with the paperwork (which is good as no one else round here does their paperwork), take histories, take blood samples, cannulate patients, help interpret ECGs & X-rays, run up to the lab and try and bully the bioscientists into getting the sample results faster, administering activated charcoal, acting as mental health liaison by sitting with patients on DSH/suicide watch when the mental health nurse cannot be bothered to tear themselves away from their tea break and if they have a nice mentor, possibly even attempt an ABG or steri-stripping (although they are not allowed to suture).

So I warn you potential med students and med students alike. If you consider completing a placement in A&E during your time at med school, then reconsider because it is by far one of the most boring and non-productive placements, in my opinion, that you will complete. And I am passionate about emergency medicine.

New additions

You may have noticed that I have made some new additions to my blog roll. All of their blogs are absolutely fantastic.

For a look at the stresses and strains of being a medical student in today's world may I suggest that you check out Angry Medic who is currently at Cambridge University (and by the sounds of things wishing they weren't) and Of Short White Coats who is studying at a London Medical School, and urges you not to guess which one as she won't tell you.

I have been reading Diagnosis? NFI's blog for quite a while but never got up to sticking a link up to it. They are an ECP working in East Anglia who blog very eloquently on how the ambulance service (like all other areas of the NHS) is in turmoil.

FtM Doctor and Dr. Grumble show the viewpoints of hospital doctors currently working in the NHS. FtM Doctor is currently in Obs & Gynae, and a transsexual although his blog is about much more than just this, and Dr. Grumble in Cardiology. Both are excellent reads.

Just thought I'd share my finds!

Urgent plea

This is a plea from the deepest darkest depths of the Home Counties and all the areas within the M25...

Could all you yummy-mummy's (and you know who you are - you shop in Waitrose, buy your kids ready prepared packed lunches because making lunch isn't in the nanny's job description, drive Chelsea tractors and send your kids to independent prep schools) stop bringing your kids into A&E departments just because you cannot get to see a GP.

Your child is highly unlikely to have meningitis just because he has a headache and a temperature... how do I know this? Well their runny nose, hacking cough and croaking voice all scream "viral infection" at me as soon as they walk in the door, and if that isn't enough, I know because one of your snotty nosed brats has passed said hacking cough onto yours truly.

Your child is also unlikely to have irritable bowel syndrome just because they have stomach ache and diarrhoea (and I don't care if you've suffered from it for years)... how do I know this? Because I happened to walk past the waiting room whilst you were feeding them packet loads of crisps and bars of chocolate. They are more likely to have overeaten, or possibly have anxiety due to the pressure placed on them to pass school selection tests at 11, and how do I know this? Because when you weren't feeding them junk food you had them working from revision books for their SATs and reciting pieces of information for the private school exam.

Plus an A&E department will not give you the advice of a consultant paediatrician just because you turn up at triage with a child, you will get an SHO, if you are lucky an SHO who is specialising in paediatrics.

And do not be surprised when you get a cold emotional response to your pleas from doctors and nurses when you have just exclaimed loudly in the middle of the department that if you do not get to see said consultant then you will resort to BUPA or PPP or whichever medical insurer you use.

Plus I do not care if your husband works for an important company or you have friends in high places or you could get media coverage of the hospital being medically irresponsible.

I am trying to do my job and I am not a paediatrician, nor am I a consultant. I am an SHO who is working very hard to earn a living and to get her career to progress. I have my own worries about my fiance being in Iraq and I could do without your abuse whilst I am trying to complete my job.

Is that understood?

Happy New Year

Although it is a little late.

I seem to have neglected blogging for far too long and yet I am not quite sure why. Maybe the current post I have is more demanding than the last, that is of course a very plausible reason as there are fewer staff in this department than in the last department I worked in. Or maybe I just haven't had anything interesting to say.

To be honest, I don't think anyone really reads this blog anymore. I am not as critically acclaimed or as witty as Dr. Crippen (NHS Blog Doctor) or any of the other medical related blogs out there. But I will endeavour to keep blogging, if only for my own sense of achievement.

The fiance is now in Iraq, doing his duty as an army medic whilst I am left here in the A&E department I am currently working in. I am becoming disillusioned with emergency medicine in my current post. This time last year I was working in a big city, now I am working in a town, not that it should make any difference. I quite enjoyed doing the menial A&E jobs such as simple suturing, removing splinters and other such tasks, but now I am apparently 'above' these jobs as I am a doctor, not a nurse practitioner. Granted some nurse practitioners do a splendid job, just not the work of one I saw yesterday.

Lee is a 20 year old lad who had got quite drunk on Tuesday night and had decided to jump off a wall whilst holding his bottle of beer. Now, as any normal person could have predicted, Lee didn't land smoothly and landed on the bottle of beer which lacerated his leg and arm. Luckily he was wearing jeans so the glass didn't go into his leg, or so he thought, but he did have some nasty cuts so he went to A&E. When he got there he was assessed by a nurse practitioner who cleaned the wounds and sutured them up and sent home with the instructions to get the sutures removed in 10 to 14 days. Lee presented at A&E again yesterday where I saw him. The sutures in his leg were extremely red and swollen, clearly infected, although they were undoubtedly very, very neat, much neater than I suture. I questioned him to see what treatment he had received and was shocked to hear that his wounds hadn't been X-rayed to see if any glss was in the wounds. I sent him down to X-ray and lo and behold he had 3 small shards of glass in the wound. I took out the old stitches and under local anaesthetic explored the wound to find the glass, which I did, I then sent him back to X-ray to ensure I had removed all the glass and resutured his wound, with the aid of steri-strips as the skin wasn't holding after being previously sutured.

This took extra time, but should have been done in the first place. One of the first rules of A&E medicine that I learnt was that if a penetrating or lacerating injury had been made with broken glass then the wound had to be X-rayed to ensure there was no glass left under the skin. Clearly this pearl of wisdom hasn't been passed onto our dear nurse practitioners.