Dr Nick- An NHS Hospital Doctor writes!

donate

2010-02-12T19:13:00.001+01:00

Why don't doctors explain much!

2008-11-29T19:15:00.003+01:00

Personally, I enjoy talking to my patients & finding out more about their lives. However, the reality is there simply isn't enough time.

Last week, in clinic there was a patient that had 3 previous heart attacks. His cholesterol was sky-high & he was refusing medication (statins) to bring this down. He explained,"I read on a website that statins are bad for you doc". I spent a good 45 minutes with him explaining the benefits of statins versus their disdvantages. I explained that on average, patients live longer & are less likely to have another heart attack.

In the end, he decided to agree to take statins & walked out a happy man. "Thanks for explaining everything doc. I wished my GP had gone through this with me."

When he walked out the door, I saw how many patients had accumulated in the waiting room I ended up going home an hour late that day. Every other patient who came in after me was either complaining or grumpy.

Serves me right for trying to do the right thing. What should I have done? What would you do in my place?

Do Not Resuscitate!

2007-04-02T02:02:00.000+02:00

First, the withdrawl of the JDC from the review body followed by the resignation of Professor Crockard. Now, the latest news that Remedy UK is mounting a legal challenge.

Isn't it time we gave the DNR order on MMC & MTAS? It would be the kindest thing to do!

What a load of Crock!!

2007-03-31T01:57:00.000+02:00

"This coming year is the best year to be an SHO"
Professor Alan Crockard, now resigned from the board of Modernising Medical Careers

Can't believe he actually said that? Well watch the video, "Where do SHO's fit in?"

March against MTAS!

2007-03-17T01:27:00.000+01:00

March 17- The UK's doctors will march against MTAS, the bungled job application system!

Doctors are marching for a fair job application system. So far, MTAS has been riddled with delays, mistakes, & a lack of transparency.

See you at the protest march today!

Remedy UK

Christmas without the "Christ"

2006-12-29T21:24:00.001+01:00

I know its post-Christmas, but here's something that's too good to wait for another year.

Its was the hospital's annual Christmas Tree competition. A circular from hospital management (high up in their glass tower) detailed the criteria by which the best Christmas Tree would be selected:

1.) Religiously non-offensive Christmas Tree!

2.) Compliance with Infection Control policy

3.) Cost-effectiveness

Religiously non-offensive- Christmas is a religious festival celebrating the birth of Jesus, the "messiah" to Christians. How can you make it non-religious??!! It would be like asking Jeremy Clarkson to present "Top Gear" but without any cars in it!

Infection Control- Well, the best tree from an infection control point of view would be no tree. Since we are dispensing with a tree, why not get rid of flowers or cards by patient's bedsides, telephones, curtains or television sets?!

Cost-effectiveness?- Shows how single-track our hospital management are!

To the managers who made these ridiculous rules, thanks for the laughter! We on the wards have had our share & wish you a non-religious Christmas & a target-driven New Year!

Christmas Weekend- The Killing Season

2006-12-23T13:58:00.000+01:00

The staff on the wards are edgy knowing that something is afoot & approaching. Its Friday, the last working day before the long Christmas weekend.

During these 4 days, everything routine will grind to a halt. No blood tests, no X-rays, no specialist consultations, no operations, no procedures, NOTHING!. The hospital enters a state of "emergency" where only urgent problems will be dealt with.

In fact, most patients in hospital, will not be seen by a doctor for 4 days unless an problem or emergency develops. They’ll lie languishing in a hospital bed, waiting to catch pneumonia, a bed sore or MRSA.

“People will die! Its like this every year” quipped a senior doctor during our special Christmas lunch in the doctor’s “mess” (staff room).

Instead, the hospital will be manned by a skeleton crew of nurses & doctors. This will is a testing time for any young doctor as they’ll be overstreched on the wards managing crisis after crisis.

I have spent the last 3 Christmases working in hospital & it has always been a harrowing & depressing time. Many relatives visiting Mum or Nan on the ward will be horrified to see their loved one in pain or ignored for days & will understandably demand to see a doctor.

“What’s going on with my Nan? She’s been crying out in agony for hours but no one has seen her!” No doubt this outburst has been partially fuelled by the guilt of a weekend of merriment & a sumptuous Christmas brunch.

The doctor will struggle to explain what’s going with Nan after all, he doesn’t know the patient & doesn’t normally care for them. He’s only covering emergencies & his pager keeps going off! The best he can do is prescribe pain killers & make a hasty retreat!

But these are the lucky patients. There will be many patients who lie in bed with no visitors or loved ones all weekend as they have always done for the past few weeks or month. These are the patients who will die if they run into problems as there will be no one to act as their minder or advocate. What about the nurses you ask? Surely they see their patients’ everyday? Let me just say that nursing care on the wards can be highly variable & I’ve seen nurses who will not call the doctor until the patient has one foot in death’s door!

So why not get extra doctors to work for a few days during this period? After all, we know that this is bound to happen at least once a year! The bottom line is money! There isn’t enough of it to hire extra doctors. Our hospital like many hospitals around the country is broke & the Department of Health (bless their cotton socks!) is treating hospitals like a private business. If there isn't enough money, tough!

So, on my last day at work yesterday, I was asked to represent the doctors & join the carollers singing Christmas songs in the hospital lobby. With my consultant playing the piano & the patients singing along to the tune of “Silent Night”, the scene was surreal. It was a scene akin to one in “Titanic” where the band continued to play & the passengers danced along as the ship was slowly sinking!

I’m off work this year! Merry Christmas!

2006-12-22T01:18:00.000+01:00

"My father wants to go home!" announced Ms. Payne the daughter of one of our patients, Mr Payne who had come in after a heart attack.

"But its Christmas weekend & your father is actually too unwell to go home. If he were to go home so soon, he could have another heart attack", I explain.

"Well, he still wans to discharge himself".

"Right! I thought to myself, "what a right pain in the arse. At this hour, just 1 hour before I go home! "

"alRIGHT MRs Payne, I'll speak to your father."

"When? The parking meter is running & I have a schedule".

Yeah, like I have nothing better to do than pander to your beck & call, I thought to myself. Doesn't she realise that I have 30 other patients? By wasting my time in this way, I can't care for the other patients".

"I'll try to see him as soon as I can", with my best sugar-sweet smile, hiding a very sour face,

I walked up to My Payne who was at his bed, his daughter sitting next to him.
Mr Payne, your daughter tells me that you want to go home today.

"I Do?" answers Mr Payne with a bewildered expression. His daughter then nudges him, which prompts him, "oh yes, of course I do".

Mrs Payne, could I speak to your father alone please.

"I'd rather like to stay please."

"Big pain in the arse! this one!", I thought to myself, I should have just gone home early! Why, Oh! why did I stay behind to do that paperwork!

"Well I have to insist, I want to make sure that Mr Payne is making this decision out of his own free will."

Mrs Payne replied, "Well, go ahead & ask him, I will just sit here."

Ok, no more Mr nice guy, "I can't speak to him like this, please leave or I'll call security"

Mrs Payne storms off in a huff. I'm glad to be rid of this tarantula of a relative.

Mr Payne, what do you want to do?

"Huh? What do you mean?", asks Mr Payne

Do you want to go home & discharge youself then?

"Well, I'm perfectly happy to stay here!"

Fine! So what the hell was that all about? I think to myself

I say to Mr Payne, "Its a shame you're not well enough yet. I suppose your daugther is desperate to get you home so you can be with the family for Christmas."

"Hardly! I'll be alone for Christmas. My daughter is flying off to Dubai for the week. I'll be on my own!"

I feel a twinge a sadness for Mr Payne

Guess the diagnosis

2006-12-03T02:02:00.000+01:00

A 27 year old male presents with a 4 week history of lethargy, listlessness & malaise. This is accompanied with complete anhedonia, early morning wakening.

He has a Mini Mental Acore of 6 out of 10. Other than a glazed expression,

He also complains of ternderness over the right wrist region.

What is the diagnosis.

I don't even know what day of the week it is, but I can tell you which antibody you get with cerebellar para-neoplastic syndrome. I probably have a Mental Score of 6/10.

Guess the diagnosis?

MRCP sydrome!

Thallium Poisoning!- Everything a Russian spy needs to know about Thallium

2006-11-19T22:23:00.000+01:00

The alleged poisioning of KGB spy, Alexander Litvinenko with Thallium has prompted me to write this handy guide for spies on Thallium poisioning & what to do if you think you've had it.

Thallium is actually an ideal murder weapon as it is odourless & tasteless. Best of all, it decays after the victim has died. And unless you look specifically for it, its not something that's routinely tested for in hospitals or at post-mortems. Its effects are delayed & the victim can take weeks to die, thus making it hard to pinpoint a specific event or time of poisoning.

It has long been a way of getting rid of spies, political figures & dissidents particularly among the former Soviet bloc nations. It was even rumoured that there was a plot to poison Nelson Mandela with Thallium by South African agents when he was deemed a dangerous political prisoner.

Thallium salts irritate the stomach and intestines causing symptoms like abdominal colic, nausea, vomiting & diarrhoea. Then, numbness & tingling in the hands & legs develop. An intense pain which starts in the toes gradually spreads across the entire body. Your vision then starts being affected & a late sign is your hair falling out. By then, it might be too late!

The treatment is to vomit out the Thallium & to give yourself the antidote Prussian Blue which I promise you, is not avalilable over the counter! So you'd better turn up to your nearest casualty department pronto! Having said that, if you were to turn up to your local A&E saying you have been poisoned by spies, your're much more likely to get seen by the psychiatrist instead!!

But of course, should you need any help anonymously, the NHS Direct website is useful.... NOT! And NICE are yet to publish any guidance on the use of any antidote for Thallium.

Click here from a Russian version of this article

2006-11-19T01:03:00.000+01:00

"I'm not certain of the answer to this question, let me think for a second". It was the first day of the MRCP course & it was one of the rare moments when our esteemed and knowledgeable lecturer was caught out.The silence was broken by a member of the audience, "I can tell you the answer!". Mr Egghead in the front row who proceeded to enlighten us in his thick Indian accent.

The rest of us stared open-mouthed in amazement. As Mr Egghead & our lecturer started a discourse which most of us couldn't follow, it was a very somber moment for the rest of the audience who hadn't done enough revision. Our exam was only 3 weeks away!

We had a mock test, at least I scored above average! The depressing thing was when I walked out after we finished at 7pm, I saw so many young people outside dressed nicely in their best night out clothes. I had forgotten it was a Saturday night. It was time to go home & drown my sorrows!

The True Cost of the MRCP

2006-10-22T21:55:00.000+02:00

I'm preparing once again for the MRCP (round 2!). The MRCP is a post-graduate medical exam that needs to be complete before a aspiring physician doctor can proceed to specialist training.

How much does it cost to get an MRCP? Have a guess! I bet you won't come close. Scroll down for the answer.

P.S. Include all costs in your calculations from Part 1 to PACES.

Total cost of the MRCP = £6,070!

Don't believe it? Neither did I initially & I had to double check my figures. Here is the breakdown of the numbers in detail.

Part 1
Exam Fee- £350
Pastest Revision Course- £850
Onexamination- £90
Books- £125

Part 1 Resit
(The average candidate will resit Part 1 as the pass rate is betweeen 30-40%. Source- BMJ)
Exam Fee- £350
Onexamination- £90

Part 2- Written
Exam Fee- £330
Medibyte Course- £975
Onexamination- £90
Books- £90

Part 2- PACES
Exam Fee- £520
Pastest Course (4 days)- £1450
Books- £80

Part 2- PACES Resit
(Once again, the average pass rate is lower than 50% therefore your average candidate will resit at least once. Souce: Postgraduate Medical Journal)

Exam Fee- £520

MRCP Diploma
£200
(That's right! They have the cheek of charging you a further 200 for a certificate on a wall!)

Total Cost £6070

So, everday after an exhausting day's work, I head to the library to hit the books. I stare at scars on my forearms, the result from numerous intravenous caffeine drips. Friends & family complain I never go out anymore.

Although my partner hardly complains, she's missing me & this only adds to the strain in our relationship. The clock is ticking, I've got 6 weeks left! I wonder, why do I do this to myself? Its probably the masochist in me!

The true cost of MRCP cannot be just about money or numbers, but time away from family & friends.

2006-10-02T20:47:00.000+02:00

"to teach them this art - if they desire to learn it - without fee and covenant"

This phrase comes from the original Hippocratic Oath. Dr Nick will be sitting exams again soon & nearly got a heart attack at the exorbitant costs of these revision courses. Some courses exceeded £900!

My initial reaction was that these organisers were greedy, money-grabbers with prices bordering on exploitation. But on second though, there is nothing worse than going to a "free" teaching session with a disinterested, unprepared tutor. At least with a paid course, you can be assured the teacher is motivated and prepared.

The reality is that these course are filling a need that training roatations throughout the NHS are missing. But on the bright side, I have a study allowance!!

The Cycle of Life & Death

2006-09-17T23:03:00.000+02:00

"Not much to handover tonight, just check this patient's potassium level later. The name of the patient is Maria". It was 8pm & I was starting my night shift. Between 8pm till 8am, I was responsible for all medical patients in the entire hospital & my colleague Sam was just coming off duty & letting me know about the tasks I had for the night.

I decided that a nice cup of coffee & a newspaper in the mess would sort me out before starting some work. Halfway through the sports section of The Times, my bleep went off. The damn thing! It was my registrar, she needed a hand. Maria, the patient I was told about was vomiting blood. She was bleeding internally and blood was pouring out of her ass fast!

When I reached, the ward, I saw Maria, a 47 year-old Hispanic woman semi-comatose on the floor, lying in a puddle of her own blood. She had collapsed while going to the loo. With the help of 2 nurses, we unelegantly hauled her back on to the bed.

Within minutes, we managed to squeeze enough fluid & blood back into her veins for her blood pressure to improve. But Maria was still in a real state, she was barely conscious, pale, clammy and looked like she was at death's door.

While I was dealing with Maria, my registrar called the Intensive Care Unit in the attempt to transfer her there. But when the Intensive Care Specialist turned up to the ward, he was having none of it. He felt that Maria didn't need to go to ITU on the basis that Maria could be cared for on the ward and that the patient was "currently haemodynamically stable".

My registrar & I were stunned out of disbelief. Was the Intensive Care Specialist pulling our leg? Couldn't the numbskull smell the malena (blood)? Couldn't he see that despite 8 pints of blood, her blood pressure was lower than the dead sea?

Fifteen minutes later, this "stable patient" wasn't responding to us & her heart stopped beating. While I was performing chest compressions, I looked up to see Maria's son & daughter standing by the foot of the bed. They were shocked in disbelief. At this point, Maria's daughter cried, "Mummy, mummy speak to us, oh mummy!". With great difficulty, Maria's daughter had to be ushered into the relatives room while we persisted in our resuscitation efforts.

With plenty of adrenaline, atropine & vigorous chest compressions, Maria's heart soon restarted. Alas, our success was short-lived and her heart faded away and stopped beating soon. Again, we manged to restart her heart and again, it would start fading, beating weaker and weaker before stopping completely. For 50 minutes we carried on this desperate cycle of death & life. With each passing minute, our chances of success were fading fast. By the time we hit the hour mark, I knew that we had lost Maria & pretty soon, all efforts were stopped.

When the bad news was broken to Maria's daughter, she was hysterical, "You didn't let me speak to her! Why?!!" It was a horrible feeling, for the guilt I felt. But I seriously doubted we could have resuscitated Maria with her family around.

The rest of the night went by in a blur. When Sam turned up the next morning at 8 am, the first thing I said was, "Sam, I'm sorry, I never did get round to checking that potssium".

A sense of Deja Vu

2006-08-26T02:07:00.000+02:00

"Doctor, I'm worried about this patient", blurted the nurse. The patient was Mr C, an elderly gentleman who had been admitted to hospital the day before for a severe chest infection. Mr C was now unresponsive & was gasping for air. This was a very, very sick man & he was going to die unless we acted fast.

My initial reaction was annoyance at the nurse for informing me of Mr C's condition so late. But the nurses HAD already informed one of the junior doctors. The "House Officer", the most junior doctor on the team had seen Mr C only minutes ago. In neat handwriting, I could read her assesment of Mr C & her management plan.

It was apparent from her notes that the House Officer hadn't appreciated the severity of his condition & had barely done anything. This man needed aggressive treatment & he needed to be transferred to the intensive care unit now! I summoned the assistance of my senior & arranged an urgent transfer.

While I was explaining to the patient's family of his condition, the "cardiac arrest" call came out on my bleep. Mr C had gone into cardiac arrest & soon the full arrest team turned up. Despite several cycles of chest compressions & lots of adrenaline, we were unable to revive Mr C & he was pronounced dead.

After the urgency of the arrest call had passed, I spotted the "House Officer" who had reviewed Mr C less than an hour ago. She was standing at the foot of the bed looking aghast. Her face was pale & her expression was that of shock.

I knew how she felt. I made the same terrible mistake as a House Officer 2 years ago.

Perfect for Care of the Elderly!

2006-08-15T04:46:00.000+02:00

Dr Nick has moved to a new Hospital & new job.
I'm now a Care Of The Elderly SHO in London!

To commemerate this move, I've bought myself a "Racing Granny"!! Just wind them up & watch them race across the floor! If only the poor dears on my ward could move so fast! It certainly has given the ward staff the chuckles!

The first few days in Care Of the Elderly have been spent on long, "ALL-DAY" ward rounds. It was difficult at first but I've realised that a geriatric ward round is more of a marathon than a sprint. I sneak off regularly for a short, frequent tea breaks while my consultant gives us his long-winded tales of his medical brilliance!

Note to myself: I'd better not let my consultant catch sight of this toy!

Acopia!- I'm all for it!

2006-07-29T19:40:00.000+02:00

Acopia! The fastest way to get a Care of the Eldery Consultant fuming is to use the term "acopia" when presenting a patient in the "post-take" ward round.

Dr Nick is all for the use of the term acopia! My arguments for acopia being a proper medical term are as follows:

1. Acopia is a proper illness. According to the WHO's definition, health encompasses physical, mental & social well-being. In acopia, the main reason for admission is a lack of function & social support at home. By definition, that is an ilness!

2. Acopia sumarises everything in just 3 syllables! No long latin words required. Terms like "off-legs" & "failed OT assesment" are lengthier & don't roll off the tongue as easily!

3. Acopia is a very common illness in the elderly population & accounts for a very large proportion of hospital admissions as any hospital doctor is aware. Acopia is also a relative contraindication to many procedures like major surgery, ITU admission or even resuscitation attempts.

4. The argument against acopia is that it "hides" the reason for their loss of function. Geriatricians argue that it takes a "hit" like a urine infection or a stroke to bring a patient down & we'll be missing such problems if the term acopia is used.

Dr Nick complelety agrees that its essential to search for such contributing factors. That doesn't mean acopia can't be used. For example, the term "exacerbation of COPD" is used, and of course there mey be contributing factors like poor compliance, smoking, infection. Neverthless, "exacerbation of COPD" is generally considered a valid term.

5. Last but not least, acopia can be the only problem. There! I've said it! Now every Geriatrician in the NHS will be trying to get me "struck off" the GMC register! As we age, its accepted that most of our capabilities deteriorate inluding lung function, cognitive abilities, muscle mass, renal function etc. Its therefore completely conceivable that acopia is simply the end-result of getting old.

Agree or disagree? Feel free to comment
NB. Dr Nick is not using Acopia in a derogatory context!

Which Hospitals Overworks Junior Doctors The Most?

2006-07-25T00:33:00.000+02:00

Its official! In a national survey, the NHS Trust with the highest proportion of overworked junior doctors was....... (drum roll)...... Milton Keynes General Hospital!! Source: Healthcare Commission Staff Survey 2003/2004)

The survey showed that 41% of junior doctors questioned at Milton Keynes said that they worked longer than their contracted hours.

But Milton Keynes is not only the only NHS Trust that deserves to be named & shamed!

North-West London Hospitals, Surrey & Sussex Healthcare, Queen Elizabeth Hospital, Ashford & St Peter's Hospitals & Northampton General Hospital.

All the above-named NHS Trusts had among the lowest proportion of junior doctors complying with their contracted hours according to the survey. The results showed that over 30% junior doctors who responded in these NHS Trusts felt overworked! Read the survey results online!

Wouldn't it be great if there was a way to find out about the working conditions in hospitals we were going to work in or thinking of applying to?

Well Dr Nick Riviera says, dream no more! Such a site does exist! The Healthcare commission is an independent, organisation funded by the Department of Health. Its annual staff survey covers hundreds of NHS Trusts with thousands of staff surveyed.

The survey covers areas including job satisfaction, job pressure, bullying from seniors, teamwork, training & life-work balance. You can read the results for doctors in each NHS Trust across the country. Best of all, its free & public access!

I also recommend reading the Clinical Governance Review for individual NHS Trusts as they provide very revealing information. For example, here are some excerpts from the Clinical Governance Review for Ashford & St Peter's NHS Trust (2001):

"The trust is having difficulties in achieving the New Deal for junior medical staff (SHO), and state they are 68% compliant."

"There were a number of concerns raised regarding consultant support and supervision of junior medical staff. We were told on a number of occasions of a lack of support, both during the day and when problems arise on call."

" Some junior doctors reported difficulties in accessing training at this time due to the pressure of work."

Dr Nick feels that the Healthcare Commission website is very much underused by junior doctors. And its quite obvious why some hospitals are not too keen on doctors reading this kind of incriminating material!

Read individual reports of NHS Trusts! Instructions: Select the NHS Trust you want then click on Staff Survey or Clinical Governance Review.

Get Away From Ward Rounds!

2006-07-21T22:42:00.000+02:00

Have you, in the middle of an endless ward round wished you could do something far more exciting at work? Combining expedition work & clinical medicine is a possibilty for those who are willing to make the sacrifices. Here is the story of one doctor who managed such a career.

Sir Ranulph Fiennes, the British explorer is famous for his unsupported crossing of Antarctica. Less well-known is Dr Mike Stroud who accomapanied him. Together, they made the longest unsupported walk in history. Their epic journey involved dragging a 485 lbs sledge each across the Antarctic ice shelf consuming up to 10,000 calories a day (far more than the human intestinal tract is capable of absorbing!)

Prior to this, the pair of them made several attempts at reaching the North Pole from Arctic Canada & Siberia unsupported. In the process they broke a world-record & raised £2 million for charity.

It doesn't end there! He led the first UK team in the "Marathon of the Sands", a 7 day run across the Sahara. Recently in 2002, he made the first unsupported crossing of the Qatar dessert, covering 200km in 3 days!

In 2003, Sir Ranulph Fiennes suffered a heart attack, requiring an emergency bypass operation. 3 months after this, Dr Stroud, with a defibrillator packed, accompanied him as they ran seven Marathons in seven continents in seven days!! Not something most Cardiologists would recommend!

While on his expedition, Dr Stroud has managed to collect data for research, acting as his own guinea pig, collecting his own blood & urine samples. This data has contributed to our understanding of the human survival in extreme conditions & human endurance.

Dr Stroud has managed to achieve what many medics only dream of, an adventurous lifestlye, research & clinical work. Dr Stoud is currently a Consultant Gastroenterologist at Southampton Hospital.

I haven't had the chance to read his book, "Survival of the fittest" but I'm sure it'll make fascinating reading. I'm already inspired to do an expedition medicine course & you'll here more on this theme in the future!

Anybody out there with expediton medicine experience, please feel free to comment!

Heatwave! Clothes & Roads Melt!

2006-07-18T16:12:00.000+02:00

Today's maximum temperature was 33 degrees Celsius in the shade! Gritting trucks were out in force today spreading crushed rock onto melting tarmac!

Some schools have closed early for health & safety reasons. Unions are calling for informal wear to be allowed to ease working conditions.

The Department of Health today, issued a "Level 3" Heatwave Alert.

How many doctors or nurses are aware of this Heatwave alert?And what does a "Level 3 Heatwave actually entail?

The Heatwave Plan is published in a glossy document crammed with the usual buzz words of "awareness", "review", "surveillance" & "escalation plan".

It goes on to say that, health professionals should ensure that, ".......people at risk are not discharged to unsuitable accommodation or reduced care during a heatwave."

I wonder how impressed the discharge manager would be if I used this as a reason not to discharge my elderly patients back to sheltered accomodation?

Dr Nick is a simple guy & to him, this Heatwave Plan contains a lot of words with little meaningful content.

There is talk of increasing "daily visits" & "commissioning" additional social & community support by involving informal carers, volunteers and care workers. In reality, this means relatives are reminded not to forget nan at home & visit her more often.

I doubt if social services have much reserve capacity & stepping up visits to the vulnerable, is akin to Hitler ordering armies which no longer existed when Berlin was completely surrounded in the dying stages of the World War. You can read the Heatwave Plan here.

Don't get me wrong, this heatwave is a serious health risk. But producing this plan is is a waste of taxpayer's money. For the public, NHS Direct has got simple but effective advice.

The worst is yet to come however, as Wednesday is forecasted to be worse at 35 degrees according to BBC Weather & could become Britain's hottest day ever! We could even "escalate" to Heatwave Level 4. Don't get me started now!!

The Killing Season approaches- Black August

2006-07-15T21:29:00.000+02:00

August approaches & we come closer to the period nicknamed the "killing season" or "Black August". It is rumoured that even GP's are reluctant to send patients to hospital during this period & referrals plummet!

The new House Officer (Foundation Year 1) starts work in August!

But not to worry for the new doctors out there. Here is some advice to get through those few early weeks.

1. Learn to suck up!
If you're going to get anywhere in Medicine, you're have to suck up to the people that matter..... the nurses & ward clerks. If you get them on your side, they can make your life that much better.

Don't worry too much about your consultant! In the new FY2 job application process, your consultant's reference counts for very little.

You're better off doing audits & presentations to get points in the application scoring system!

2. Hit the stairmaster, hard!
Ward rounds can be physically gruelling, especially surgical rounds that go at the speed of lightning. Circuit training is very good at simulating a ward round, as you bound from bed to bed, ward to ward with an armful of hospital notes.

3.Join a speed-typing course
"TTA's" or discharge summaries are usually typed nowadays and this skill can indefinitely speed up the time you plough through a pile of TTA's.

Especially after a ward round when your consultant is in discharge mode!

4. Learn how to fax
The second most important piece of equipment after the computer! All those referrals have to go somewhere!

5. Beef up! Do some bench presses
Arm strength is essential for the FY1/ PRHO, especially in Care of The Elderly. Some patients' notes dwarf London's telephone directories & can weigh over 5 kg each.

Lifting patients, helping them to stand or sit-up also takes strength. Don't hurt your back, ask your gym instructor to show you good lifting technique.

6. The most important piece of advice!
Ignore all the above advice! Did you really take me seriously? Are you going to listen to someone who names himself after a cartoon character in the Simpsons?!!

Relax! Black August is an urban legend. For the new doctors out there, the first few weeks will be challenging & at times difficult. But you'll soon the hang of things, I promise!

For proper advice I recommend "The Oxford Handbook For The Foundation Year" which is crammed with practical advice for the first 2 years.

Working at Mc Donald's!

2006-07-13T00:22:00.000+02:00

Work as a Mc Donald's manager & you'll get treated better than a junior doctor in NHS (or at least have more work benefits!).

I've made a comparison between a Mc Donald's Operations Manager & a year 2 Senior House Officer, just to prove my point. Both jobs are realistically achievable a few years after graduation.

Annual Salary
Mc Donald's: £35K- £55K
NHS Doctor: £39K- £55K (Banding 2B)

Hours Worked per Week
Mc Donald's: 43-45 hours
NHS Doctor: 48-56 hours (theoretically!!)

Annual Leave
Mc Donald's: 6 weeks
NHS Doctor: 5 weeks

Life Insurance
Mc Donald's: Full cover provided
NHS Doctor: Don't be silly now!

Annual Bonus
Mc Donald's- Performance-related bonus
NHS Doctor- £5 Christmas voucher at hospital canteen

Company Car
Mc Donald's- Car provided or cash alternative
NHS Doctor- Ha Ha!

Private Health Care
Mc Donald's:Covers yourself, spouse and children
NHS Doctor: Nil but at least you can have your colleagues prod you!

Home Telephone Bills
Mc Donald's: Monthly charge paid & 50% of all calls
NHS Doctor: Continue dreaming!

Meals
Mc Donald's: Free Mc Donald's food
NHS Doctor: Hey, you get 10% off in the canteen!

Don't believe this? Visit the Mc Donald's site for yourself.

Always on the move.

2006-07-11T00:20:00.000+02:00

Its coming to the time of the year when we have to change jobs again. I've moved to so many different places I forget where home is sometimes. I feel like a travelling salesman at times! When I fill in my CRB (criminal records bureau) application, they ask for address of ALL the places I have lived in the last 5 years. My heart sinks, I'll need a few extra sheets of paper please!

Why do we get moved around so much? Is it a perverse wish of the NHS to keep us confused & disorientated. That way, we won't get to know a particular hospital & its staff too well. We'll then remain strangers to the other staff there.

We'll constantly wander around the hospital corridors lost for the first month or so and just when we've made friends & become familiar with the place, we move on. :( I've made so many friends, doctors & nurses alike, & although you try to keep in touch, its not so easy once you've left.

This must be some conspiracy to keep the professional moving companies in business! But in all seriousness, this causes some real problems for us. Having no fixed area of work makes it difficult for us to settle down and get a home. Nobody wants to pay rent forever and move from one cardboard box to another!

Zidane Headbut!

What a butt-head! Watch the video-clip.

Spent all evening yesterday with a group of screaming Italians & French guys watching the final yesterday. I've got a few decibels of hearing loss after the two sides tried outdoing each other in a shouting match! All the same, great final! Congrats to the Italians. I-ta-lia! I-ta-lia!

2006-07-08T16:40:00.000+02:00

The Nightmare of "Nights"
Saturday, my first day off after 12 days working in a row. In the last 7 days, I have worked a total of 84 hours, and the European Working Time Directive feels like a work of fiction. After a week of being in the the "twilight zone", being neither awake or asleep, it feels like life has returned into this aching body. But the "nights" still has its grip on me, for I remain restless at night & listless during the day.

Today, I've bought a new pair of comfy work shoes. After a week of nights, my feet ache more than any part of my body. It feels like I've climbed Mt Everest & back! To the amusement of shoppers, I stomp around the shop, jump on the spot and bound up and down the stairs to see if my new shoes will stand up to the rigors of my consultant's lightning ward round. Me thinks this pair will be worn out in a few months!

Feature of the day

Behold! A "wrist-worn" computer by Seiko in 1984. Good thing times have moved on! LOL! Read more here.

Отравление Таллия! - Все русская, котор шпионка знать о таллии

2000-11-19T22:49:00.000+01:00

Отравление Таллия! - Все русская, котор шпионка знать о таллии Alleged poisioning шпионки KGB, Александра Litvinenko с таллием пробудил меня написать этот сподручный направляющий выступ для шпионок на таллии poisioning &, котор нужно сделать если вы думаете, то вас имейте его. Таллий будет фактическ идеально оружием убийства по мере того как он непахуч & безвкусен. Наиболее наилучшим образом всех, он распадается после того как жертва умирала. И если вы не посмотреть специфически для их, свое не что-то которое по заведенному порядку испытано для в стационаров или на stolbe-mortems. Соли таллия раздражают живот и intestines причиняя симптомы как подбрюшные колика, тошнота, тошнить & понос. После этого, цепенение & tingling в руках & ноги превращаются. Интенсивная боль начинает в пальцах ноги постепенно распространяет через все тело. Вашими будучи влиянными на стартами зрения после этого & последним знаком будут ваши волосы падая вне. By then, он могли быть слишком последними! Обработка должна затошнить из таллия & дать противоядие прусская синь я обещаю вам, не avalilable над счетчиком! Так вы улучшали бы поворот до вашего самого близкого pronto отдела casualty! Говорящ то, если вы должны были повернуть до вашего местного A&E говоря, то вы были отравлены шпионками, your're очень вероятее для того чтобы получить увиденными psychiatrist вместо!!