Moving on

5 04 2012

Another 4 months has flown by, and I’m onto the last job of my FY1 year.

Started work in August on a ridiculously busy medical job, where I felt I never left the hospital, and certainly never separated from it mentally. But I worked with some great people, noone in the hospital is ever as good a friend to you as “med reg”, especially when they’re your own. Even after I finished on medicine, those links were what saw me through much of job number 2. I learnt loads, had to make decisions, and am definitely a better doctor (if not person!) because of my experiences.

Fast forward to Christmas and started on surgery with a little bit of apprehension. Lets face it, I’m not exactly typical surgery fodder, rarely cope well with *ahem* aggressive personalities, and whilst theatre is often hilarious, I’ve never really been into being the one actually cutting people up. But seems I lucked out. Fab bosses, hilarious registrars, great SHOs, and a wonderful bunch of assorted others. Life got left a bit by the wayside somewhere along the way, and suspect I have quite a bit of making up to do with the boy in the coming months. When the job was good, it was incredible. When it was bad… well…. I’m just glad the people around me provided the compassion, support and/or giggles neccessary to get through.

So now I’m just starting psychiatry. I’ve always had a bit of a soft spot for the subject, even ran a book club for a while with a strong psychiatric focus to the books we chose, and was quite keen for an F1 job involving it. 2 days of induction was gruelling though, so looking forward to getting stuck in for real after a wonderfully work-free weekend!

J

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New year, new job

31 01 2012

So, started a new job at the tail end of the year, and found my feet at last…. and I’m *loving* it! Great bosses, fabbier contemporaries, and the middle grades just make coming to work hilarious. Add to that a great bunch of patients, and it’s a winning combination. Get my arse handed to me most days, but am enjoying trying to keep up. Coming up with the list of #rulesforsurgicalhouseofficers slowly but surely.

  1. The boss is always right
  2. As per 1. Even if they’re wrong. In fact, especially if they’re wrong.
  3. CALL FOR HELP. Early and often.
  4. Leave work. Eventually you’ll have to. You might as well get a good night’s rest before rinsing and repeating. On call is there for a reason.
  5. It’s ok to feel lonely and/or terrified in this job. And to admit to it. Even the occasional senior does (but only at 3am).
  6. Your team can be your lifeline. Look after them, they’re already looking after you. (And yes, pilfering sandwiches from a lunchtime meeting when the boss is stuck in clinic or theatre counts).
  7. Nurses are AMAZING. Tell them.
  8. KY jelly sachets. Always carry some in your work bag. Makes you look like a freak, but saves time on endless ward rounds.
  9. If they stop kicking your arse when you mess up, it means they’ve given up on you. Try to remember this.

…to be added to as the job continues.

Jxx





Keep calm and drink tea!

24 04 2011

So…

Finals start this week, but at least all will be over in a little over a week and a half! (Until resits…)

Cannot wait for lazy days, BBQ days, sand-between-the-toes beach days, pamper days, and learning to snowboard days. And I’m very excited that I seem to have bagged an interesting, relevant audit to do with a new friend, and a great placement with a truly fascinating department for some of my  post-exams private study time!

But until then, at least I’ve got these adorable “keep calm and…” badges to kep me smiling. That and a very full belly from the post-Easter-Sunday-pub-roast chocolate binge!

See you on the other side…

Jx





SBAR and me

3 02 2011

For those of you who don’t know about it, SBAR is a handy acronym used in the NHS (because if there’s one thing the NHS needs, it’s more acronyms </sarcasm>) that can be used communicating information. Now, I’d not stumbled on this little piece of of the interwebs before, and none of the hosptials I’d been placed in had used it. Until this year.

It’s now a month since I first heard about it, and thought it was time to reflect a little on my experience.

At a first glance, it seems kind of intuitive. Thie pieces of SBAR are:

S – Situation. Describing the current status/problem succinctly

B – Background. What has lead up to this? What are the salient points from the history?

A – Assessement. What have you done? What have you found? What does this tell you about what might be going on?

and finally

R – Reccomendations. SBAR as I’ve seen it has been used in handovers, so this is what the team handing over care recommend that the team taking over care should do.

There is a lot about this that I really get on with. It seems like a nice idea to begin with the key issue, sets the tone, allows the person you’re talking to to get a snapshot idea of what’s going on, particularly important in where patients have more complex histories or care issues. Often as I’ve come across patients being presented to colleages in the past, the order of the current situation and background may be flipped (as in “This is a x year old lady with a background of y and z, presenting with a”), so this has taken a little getting used to for me.

Another excellent aspect of the SBAR format is that it positively encourages doctors (in particular more juniour doctors) to engage in patient’s care more directly, by allowing them the opportunity (in fact, the format demands it) to make a management plan and vocalise it to others (the recommendation).

As well as handover, I have also been encouraged to use the format during an adrenaline fuelled simulation session, trying to get a registrar to come and see my increasingly sick (pretend) patient. Knowing that I was supposed to be using SBAR, and so was allowed to make firm recomendations to my senior (in this case, something along the lines of “drop what you’re doing and come help me NOW!!!!”) was very empowering!

However, even after amonth, something hasn’t quite gelled. I love the narrative of medicine. I love the descriptions patients use. I love engaging with people, and find it difficult to distill human interaction into a one line “neurology advised x”. Perhaps this is why I’ve always felt more of an affinity with the more narrative-based specialties (GP, psychiatry…) over the more ‘snapshot’ specialties. Without begining at the begining and working my way through, I know that I find it difficult to remember things. So SBAR can be something of a challenge.

In real life, we often come across several problems, and will solve some whilst still turning up new issues to be considered. This ‘disordering’, this natural chaos, is the environment my brain has learnt to cope with. To suddenly impose rigid barriers between the synthesising and exploration of theories feels artificial.

This is even more so in pressured situations. What I found with the simulated session was that my ability to synthesise the narrative of what was happening into an SBAR format felt nigh on impossible. Details bled away, my mind felt scrambled, and all I had to hang on to was “oh, I need to give my assessment now” rather than actually thinking about what information needed to be got across, what problems we’d encountered, and what steps we’d already taken to help the situation.

I am sure this is a tool that I will discover when it can be used well. I am sure I will also learn to use it at times I currently find difficult. But not today.

Jx





“no decision about me without me” part the first

14 07 2010

“No decision about me without me.” Liberating the NHS.

Some of you might have heard that – buried between an international footballing tournament and second by second updates on a gunman in Northumberland – the government has released their plans for a total upheaval within the NHS.

Now, whether you’ve been sat in a waiting room for 2 hours, or had the misfortune to go to a party with a ‘medical bore’, it would be difficult to escape the relentless manager-bashing that has grown over the past few years. When things don’t work as they should in hospitals, a mere reference to the problems being all because of “too many managers” explains the whole thing away. Health professionals and patients alike bemoan the powers granted to these people who – as far as we can see – often have little experience with healthcare, and maybe applying a business model to the lives and health of individuals feels a little… well, icky.

Well, it turns out some govenrment bod has listened to this common doctors’ gripe, and turned round to the PM and gone “y’know what, lets give them what they say they want”.

My understanging of the report – and I’m still digesting it, so expect an update over the coming days – has it boiled down to a few key points.

  1. The NHS is great – the government loves what it sets out to achieve and wants it to be even better.
  2. Patient choice should be in the forefront of everyone’s minds for the future of the NHS.
  3. “Targets” are to be replaced by “clinically credible and evidence based outcome measures”.
  4. The relationship between the government and drug developers may become interesting, and a fund will be set up to pay for those oh so expensive cancer drugs.
  5. The roles of the current commissioners (i.e. people who decide what the limitted pot of money should be spent on and wwhere provides services) with be taken over by groups of GPs who will be in charge of commissioning most of what their patients need, apart from the primary care bits, which will be looked at by another group (The NHS Commissioning Board).

This is potentially a massive change in how the NHS works. All I want to say for now is that I love our National Health Service. I am passionate about how fantastic it is. Sure, things could be better, but what we have in the UK is an example to the rest of the world. I look to see how this document will translate in practice with great interest.

Jx





Syphilis

29 03 2010

Ok, ok, I’m starting to become obsessed! Just wanted to use the current discussions (/fiasco)on t’internet as a platform for telling you about syphilis.

As a med student, syphilis is one of those ‘go to’ conditions. It literally seems to cause everything! It is refered to amongst doctors as one of the “Great imitators” – a disease that can trick health professionals into thinking they are something else. But what actually is it?

Well, it’s part of a groovy subgroup of bacteria [edit:just for dom] called spirocaetes, that is mostly passed on through sexual contact. Wikipedia amusingly notes  that syphilis “had been called the “French disease” in Italy and Germany, and the “Italian disease” in France. In addition, the Dutch called it the “Spanish disease”, the Russians called it the “Polish disease”, the Turks called it the “Christian disease” or “Frank disease” (frengi) and the Tahitians called it the “British disease”.” Doesn’t that make you proud, fellow Brits?!

So what does it do to you?

Well the first stage (primary syphilis) is probably what you’d think of as being syphilis. Painless lesions develop, which ulcerate to form ‘syphilitic chancres’, which normally heal after a few weeks. They are highly infectious sores that normally appear around genitals.

Secondary symptoms, such as a fever, skin rash and sore throat, then develop, despite the body already having mounted an immune response to the disease! 

Tertiary syphilis. At this stage, it can cause serious damage to the body. It affects many tissues of the body, such as the bone, skin and mucosal surfaces, and can go on to affect important body systems like nerves and the heart.

But for such a potentially destructive disease, treatment couldn’t be more straight forward. Penicillin. An antibiotic we’ve known about for the best part of 100 years.

Syphilis is still in relatively small numbers in the UK, although the recent news reports suggest that this may be changing. Still, if you’re worried that you might have this, or any other sexually transmitted disease (STD), please got to your local GUM clinic, or have a chat to your doctor. Remember that some STDs may not have any symptoms.

But it’s not all doom and gloom! Many diseases can be tested for with simple, painless tests, and treated effectively.

J x





Birmingham Mail jumps on Syphilis bandwagon

25 03 2010

Oh dear.

Heard via Twitter that my local paper, the Birmingham Mail, had added a local spin on the Syphilis story [edit 26/3: story removed following request from Birmingham University] we are all watching with bated breath. In it, was information from an outreach officer at Birmingham. This time, it was one teensy, seeminlg innocuous statement which raised a few questions:

“In Birmingham, Ms Hyland said a 2,000 per cent increase in reports of syphilis had been logged in 2007, according to figures from the Heartlands Clinic.”

Now, not one to let things like this slip by, I dropped My Hyland an email. I had an incredibly swift response from her.

It seems she had nothing to do with the figures reported, and is trying to contact the paper and clarify the situation at the moment. She said she was upset by it all, and said that “I never said I was an expert and the figures are nowhere near what have been published! Figures can be obtained from the Health Protection Agency, and the rise of syphilis is nowhere near that of say, herpes or warts. ”

She let me know that she had been told by a masters student who had worked in a Birmingham GU clinic that ” there was a massive increase in syphilis and that babies were being born with the condition, that the disease was becoming resistant to antibiotics so their figures may well be above average the UK average.”

So where did the data come from? A two thousand percent increase is surly not just plucked from thin air…?

Update (14.55.):: Just heard the following from Ms Hyland “I (julia hyland) did not claim to be an expert in this field and the figures quoted did not come from me, I have called the Evening Mail they told me their figures came from Heartlands.”