Wednesday, January 31, 2007
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 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!
Tuesday, January 30, 2007
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:
Sunday, January 28, 2007
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.
Tuesday, January 23, 2007
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.
Sunday, January 07, 2007
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!
Saturday, January 06, 2007
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?
Friday, January 05, 2007
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.