Graduating from Medical School and Hightailing it to New Zealand.

I’ve recently been looking towards the future and have come to the conclusion that as much as I love the UK I will want a change of scenery by the time I graduate. Hell, I’d be happy for a change of scenery right now.

It’s a long way off, and I imagine I will complete my foundation years here in the UK to allow me to return should I want to but I am sorely tempted to head off to NZ once I graduate.
I have looked into the USA and Canada but from things I’ve heard it seems incredibly difficult to get a training post out there. In NZ things are apparently easier and to be perfectly honest who wouldn’t want to live in a country that seems to have its work-life balance way more sorted than most other places.

Obviously this may be subject to change as I may meet someone and decide to settle down here in the UK, but I can’t help but be tempted by the more peaceful, less crowded and frankly beautiful country that is New Zealand.

It’s a dream and probably a wild one which will never happen but at the moment it is something that I’m really considering. If anyone has done this, what was it like? How did you find the process? I’m struggling to find clear, concise information about the requirements and how to go about moving over. It would be wonderful to hear from someone who has done this and who could shed some light.

Enough daydreaming for one day. I should really hit the books to make sure I get to graduation let alone to NZ!

Another Professionalism Debate

Professionalism is something that I personally reflect on a lot. I want nothing more in my medical career than to do no harm and to be professional so that I provide the best for my patients.
At medical school I always seem to be coming across situations in which I question the professionalism of the doctor/healthcare professional I am working with. I understand that in stressful situations when there is a lot to do and think about sometimes common courtesies get missed, but there are times when I see things that make me question professionalism and how we come across as medical professionals.

The case that got me thinking about this issue again this time was on our hospital placement. Each fortnight we go around the wards and practice on unsuspecting patients our history taking and examination skills. For patients this must be a really daunting prospect anyway. Our hospital tutor goes to the patients and asks them if they would be willing to talk to, and get prodded by the medical students in advance of our session and  if they say yes in we go. There are six of us and you can see the shock and mild panic at the number of students on every patients face as we file into the bay and crowd round them, hemmed in by the curtain. And then our hospital tutor introduces them and we take a history/do our examination. The poor patient has to sit there whilst 6 of us go through the motions one after the other. Nothing we are subjecting them to is painful and I think some of them enjoy it as a way to pass the time but there are occasions when we go in and it is clear that the patient wants to go back on their previous ‘yes’ to being a guinea pig. For example there are occasions in which the patients family are there and they clearly want to spend this time talking to their family member and not to us.
In this situation though what is the right thing to do? Should we be quick (this is often the option that our hospital tutor goes for, allowing only a couple of us to do the examination or taking a rapid fire history himself) or should we recognise that the patient doesn’t want to be examined right now and leave them be. I personally would prefer the latter. Whilst it is important for us to be able to practise examinations, none of these patients actually have signs, we are more just looking at normal at the minute so we can practice on ourselves. I don’t see that there is any need to disturb them when they clearly don’t want to be disturbed. I wonder how we come across if we don’t pick up on these signs and act accordingly and I worry that we come across as rude to the patient.

There was a specific situation during our hospital placement that made me particularly uncomfortable and after discussing it with my colleagues it was clear that they felt the same. There was a patient on the neurology ward who we went to see to practice respiratory examinations. When we entered his bay it as clear that it would be difficult to take the respiratory examination as he had his arm in a sling and a neck brace on and we were informed that we shouldn’t sit him forward. He also had external fixation on one of his legs and it was difficult to get in close to him. I was expecting our hospital tutor to leave him be and not let us examine him because none of use wanted to risk hurting him but he pressed on and let one of my colleagues have a go. As soon as we entered the bay it was clear that the patient wanted to chat, he was talking in confused sentences but appeared to believe wholly that he was getting his point across. What made me uncomfortable was that our consultant completely ignored him and talked only to us. All the time that he was talking the patient was trying to get his attention to tell him his story, from what I could gather, but our consultant continued to ignore him.

This made me uncomfortable. Understandably though we were rushed for time and I know he was trying to get the best for us from an educational point of view. I would have felt much more at ease if our consultant had spoken to him a little, even just said yes at the end of a few of his sentences to appear as though he was listening. This type of thing makes me question how we come across. In my mind that made him less professional but the patient, who was admittedly very confused, didn’t seem hugely fazed. Our consultant redeemed himself by talking to the patient very well after my colleague had finished her examination but it still grated on me that he had ignored him until that point.

It also makes me wonder about a larger problem. The NHS and medical care in general is supposed to put patients first and yet we as trainee doctors are constantly doing procedures which our seniors could perform better than us. How is that putting patients first? It is putting our medical education first surely? Of course new doctors have to be trained for the future well-being of patients and I suppose that finding the balance is the key.

Anyway enough reflection. I need my bed to have a productive day of revision tomorrow!

Our Future Specialty: Getting ahead of the game in medical school?

What specialty we will practice for the rest of our careers is a discussion that frequently crops up amongst my peers at medical school. We have even decided it will be quite amusing and interesting to write down the specialty that we see ourselves in and the specialty that we see each other in and open them in 6 or 7 years time to see how they match up. Could be entertaining. I honestly have no real idea what I would like to put down at the moment though.

Currently, I’ve just picked my area of interest for my BMedSci intercalated degree and have decided to do a project in something related to surgery. I’m currently in the process of chatting to supervisors and coming up with a specific project. Surgery appeals to me because of the idea of fixing the problem that is in front of you, as you see it. I have my misgivings about surgery mostly because of the sexism that still unfortunately exists around this career choice but I cannot deny my fascination with it, and no not just because of Grey’s Anatomy (though I absolutely love love love Grey’s on another note!). I hope that by conducting my research project in this area I can gain more insight into surgery and the demands of this career, because undoubtedly it will be a tough road should I choose to go down it.

It is extremely difficult whilst at medical school to know how to go about gaining the necessary evidence to show your investment in a particular specialty. These days we are told that because competition is fierce we should get ahead of the game and start getting some relevant experience and go to relevant conferences. On the other hand though you can’t go to conferences for every subject and specialty and I don’t want to narrow down just yet. Interestingly a lot of people in their foundation years who I have spoken to have said not to worry about it too much at medical school and just to try and get exposure to specialties that you feel you would be interested in. But then again, having experience such as a publication in your future specialty must surely be a boost?

I recently (I say recently, I literally just) read this article in the student BMJ about what some people had said they would have done differently to smooth out their career paths with hindsight.

Here’s the link:
http://student.bmj.com/student/view-article.html?id=sbmj.g7554&locale=en_GB

(You may have to register for free to be able to read the full article, but if you are interested I’d recommend a read.)

For me at the moment I think the most relevant points are to:

– Take more opportunities to experience different specialties

– Ask more questions about different specialties 

So I will take that into my project and my chats with supervisors to try and gain some experience to see if surgery really is for me and if it’s not then I’ll take a look at some other specialties.

I think that for the most part that is the most important thing we can do in medical school, ensure that we really want to do said specialty for the rest of our careers. By all means if you are certain that being a GP is your calling then gaining relevant experience and publications/presentations in primary healthcare will help you no end but for the rest of us just working out exactly what we want to do is the first, and most important hurdle.

Anyone else reading who is currently in medical school, what are your thoughts on getting ahead of the game?

The Theory of Everything

There was no better way to see in the New Year today than by watching the wonderful movie that is ‘The Theory of Everything’. For those of you unsure, this is the new film about the life of Steven Hawking and his progressive journey through life with Motor Neuron disease. He was given approximately two years to live but he is still with us today. As a future medic I found this film extremely thought provoking. One line particularly caught my attention,

‘Your thoughts won’t change, it is just that soon people won’t know about them’. 

This quote, I think,  profoundly sums up the suffering of those with motor neuron disease. To be totally aware of your decline, to have your thoughts as intact as they were from the days when you can still walk to the days where you require constant assistance must be torturous.

This movie has captured that struggle immensely well and I cannot commend Eddie Redmayne enough for his highly considered performance. I am so glad I watched this film as I think I understand this suffering to a greater level now.

I have a new found respect for Steven Hawking and the incredible hurdles he has overcome, both personal and professional. He is one of the greatest minds of our time and he has not let his MND sway him from his work. He is an inspiration.

I’ll leave you with this quote which contains a mentality I wish to adopt for the New Year:

‘However difficult life may seem, there is always something you can do and succeed at.’

Thank you, and Happy New Year!

Christmas is Nearing!

I have a bit of a love/hate relationship with the Christmas holidays, on the one hand, the tinsel covered festive hand, I love Christmas because I get to spend time with my family and eat nice home cooked meals for once. On the other, pen covered hand, shrewn with paper cuts it is the time of revision and more revision in prep for January exams.

I’m sure most people with January exams will agree that it is really hard to enjoy Christmas to its full extent due to the never ending feeling of guilt that follows you everywhere when you aren’t working. Even on Christmas day I fell guilty which is ludicrous, and have been known to ram in a little bit of revision on Christmas day itself in the mornings whilst waiting for my teenage brother to surface from his duvet cocoon.

This year though it’s sure to be even worse because coming up in Jan are the exams that are notoriously the ones that people at my medical school are most likely to fail simply because of the volume of neuroanatomy we are expected to know. I have been trying to start revision now but with all the secret santas to organise and the shows I’m directing/am in and auditions coming up I just have no time.

Lets hope I get the balance right! Good luck to everyone else starting your revision – you’re not alone in your pain!

And Merry Advent!

(Still need to get myself an advent calender – the picture of organisation as ever.)

Professionalism

It’s a funny word.

A word that is completely drilled into us over and over at medical school. Even before we get here we are told that from now on we must behave in a professional manner, not do anything that could compromise our fitness to practice and stay on the straight and narrow.

Yet there isn’t actually an accepted definition.

It’s a very difficult word to define because it means different things to different people and relies heavily on context.

I generally judge professionalism by looking back on things that I or others have done and to think if there was a way to do that that would have respected the dignity of the patient more, that would have been less painful for the patient or that would have been easier on my colleagues?

But still it’s hard to know if I’m hitting at the right ball park. For example last week when I was on my HCA shift – this is a thing that the medical school are making us do at the weekends now, it’s an annoying amount of time to lose from studying and other stuff that I want to be doing but I think I’m learning, though how relevant that learning is, is another matter.
So anyway, I was on my HCA shift on an elderly care ward. I love this ward because although a lot of the patients are confused there are patients with some wonderful stories who’ve been in hospital for a while and want nothing better than to sit there and recount all their travels to you – it’s lovely. I was in a bay this time with a few distressed and sometimes aggressive patients I had been warned.

I had another HCA and a staff nurse working with me. One of the patients was on a mattress on the floor as they had no more low profile beds and he was a falls risk. He was due to be moved but I also questioned that – is it better for him to be on the floor, what about infection risk? Or do we risk putting him in a normal bed and him falling? What’s the right thing to do here? In light of the following events I’m glad he was in a mattress on the floor but I remember questioning it at the time. We got on with the morning work and at one stage I was in the bay alone. This man had been distressed all morning and tossing and turning trying to get up and out of bed despite being unable to stand. I turned my back for a minute and heard him cry out. I spun round and he was half way across the bay on his front with blood all down the front of his hospital gown. Turns out he had pulled his catheter out and was running away in the only way he knew how because he was disorientated and felt like he wasn’t safe. I yelled for help and got down beside him to reassure him and calm him down. I took his hand, looked him in the face and spoke to him calmly and he did begin to calm down. However then the nurse and HCA arrived and he riled up again.
Both this nurse and HCA were incredibly professional all morning, maintaining brilliant dignity when bed bathing patients and talking to them well but I think the nurse at this stage was frustrated with this patient. He had been distressed all morning and we had kept going back to calm him down. He had already pulled out cannulae and catheters before all of which had to be replaced and by this point I think the nurse was done being calm with him. THe nurse didn’t snap but was quite short with the patient and was just generally portraying a frustrated exterior – now this meant that calming the patient down took a lot longer because he picked up on the frustration and amplified it in himself.

Was the nurse being un-professional to outwardly direct his frustrations at the patient?

I don’t know, I know it didn’t sit right with me and I preferred to personally take the calm exterior approach however frustrated I was internally. But I can understand the reason for his frustration. The patient eventually calmed down, the catheter was re-fitted and he was calm for the rest of my shift even as he was hoisted and moved to a low profile bed. So the nurse getting frustrated had no repercussions – so was it unprofessional?

I can’t give you the answer and I don’t think most people can either, its more down to personal opinion. Professionalism is subjective and the most important opinion on whether or not you are being professional is that surely of your patients and your colleagues. If they perceive to be professional then you are, aren’t you? Even if not so much in your personal life?

Well that’s another debate right there. I’ll leave you with this thought:

‘Medicine is, in essence, a moral enterprise, and its professional associations should
therefore be built on ethically sound foundations. At the very least, when physicians
form associations, such occasions should promote the interests of those they serve.
This, sadly, has not always been the case, when economic, commercial, and political
agendas so often take precedence over ethical obligations. The history of professional
medical associations reflects a constant tension between self-interest and ethical ideals
that has never been resolved’

Thank you.

Why We Shouldn’t Complain about the NHS…

I’ll admit that I’ve done it, and I’m sure we all have at some point. Admittedly when you are sitting in A&E, nursing a concussion only to look at the clock and realise you’ve already been here for 3 hours it is hard to see the rosy side of our healthcare system with it’s long waiting times and ever decreasing availability of services. However we shouldn’t be so fast to complain.

I learnt a couple of days ago that someone I know from America is dying. He has a congenital heart defect and requires a new pacemaker as well as a follow up surgery to try and reduce the defect. Unfortunately he cannot afford either of these things.
And that’s that.
The American healthcare system just watches whilst he dies from something completely preventable.

Now, the American system is fine for those people with insurance and it tries to help those who are the poorest and can’t afford healthcare but it misses a chunk of people in the middle. Unfortunately for my friend no insurance company will cover him with reasonable premiums because he has a congenital disease. So he can’t afford to pay the premiums, and certainly can’t afford to pay upfront for the surgery despite hardly missing a day of work in his life.

His family are very strong and are glad that they’ve had the time that they’ve had. They have accepted that at any day they could wake up and he could not be with them anymore but we have to ask ourselves why they should have to accept this? Both him and his wife work extremely hard, they are pillars of the community and yet because they don’t have the monetary means the healthcare system leaves them by the wayside.

Healthcare is there to alleviate suffering. My friend is suffering because he can’t afford care and his family are suffering with the knowledge that they can’t do anything and will suffer more when he eventually passes away. It’s pretty ironic don’t you think that it is a healthcare system which has caused this suffering?

I had strong and mixed emotions when I heard about this, I was mad that this is happening to such a young man and wonderful family, I was sad for them and then I was extremely grateful. The horrifying truth is that in the UK my friend wouldn’t be dying because we have a healthcare system that is free at the point of access and that does not discriminate based on economic standing.

So yes we may have to wait 4 hours in A&E or 6 weeks for our knee op and that’s annoying, but at least we get care and we don’t have to worry that we can’t afford it.
I have a new found respect for the NHS and the values it upholds and if anyone catches me moaning about it again, feel free to give me a slap!