Acopia!- I'm all for it!

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?

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!

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!

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

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!

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.

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!

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.