Calpol

"I'm not going to take Paracetamol" stated one alpha male to the Fuddled Medic as the last outbreak of swine flu takes place. "I dont believe in take tablets for simple things like colds, etc."

Ok, your an adult, its your decision. If you want to spend 3-7 days with a cold/flu with a raging headache and fever thats fine, I'd rather spend 3-7 days when I havea cold/flu with a reduced hedache/fever and general feeling of shittiness.

Unfortunately children who suffere colds/fevers etc are not adults and have to rely on mum and dad to dish out calpol. Colleages have shocked me with tales of parents bringing in kids to Children A & E who refuse to administer Calpol.

Why? Its safe and effective and despite evidence to the contrary it probably doesn't raise the asthma/eczema risk. Buying ice scream is linked to increase risk of drowning, doesn't mean one causes the other.

I am starting paediatrics after christmas, there will probably be an increase in posts where I feel sorry for poorly kids whose parents seem to think immunisations are tantamount to murder, or that steroid inhalers are a bad things

Dr Zorro

Thank you very much for your last comment, have spent half an hour in between peeling sprouts reading Newsthump. Much Appreciated

Here's one for you all to enjoy

Tesco

I am writing about something outside of medicine(shock horror!), earlier today I saw a report where everyone was whinging about the expansion of the big supermarkets.

Why?

My parents complain about the rise of the supermarkets but they never go to the local Butcher (except at christmas) and use Tescos regularly.

One of my favourite episodes of Southpark is where the kids go in search of the "heart" of Wal Mart. This turns out to be simply a mirror, reflecting the fact that without us the supermarkets would not be able to expand in the first place

Worried

"I'm really worried about Bob,aged 10. He wont get up till ten thirty in a morning."

"What time does he go to bed?" asked a cynical Fuddled Medic

"About half twelve, perhaps thats why he gets up late?"

Treadmill

"I want to get you enthusiastic again," stated the next consultant to try and aid the Fuddled Medic's education. "Some of you may feel like you've been running on a treadmill getting bored and run down."

Whats this? Its ok to have these feeling? Even better was still to come - "You may even have become disillusioned with medicine, I want to change that."

Oh my god, someone who has made an attempt to understand that medical students are human beings to and can get disheartened?

In other news, the above has happened to me, I need a holiday. I hope that I feel refreshed and eager to go again in the new year

Registered

Professionalism is a big word branded around to medical students and the need to act in a professional way. To ensure we do so perhaps we should be registered with the GMC during our time in medical school?

And if so, from what stage? Day 1? Some people have suggested from clinical years but in a significant number of medical schools this would not be practical.

Personally the FM is against the idea. Medical students are taught (and hopefully looked after) by the medical school. Therefore the FM believes medical schools should have the responsbility of deciding if someone has acted unprofessionally and if so what action should be taken.

My Friend

I got into Medical school, I got the required grades. I went to a school where I was pushed to exceed my own expectations. My friend did not, at her school the vast majority of students did not want to learn. It meant his own grades suffered and she did not get into medical school.

To a certain extent its dumb luck that I'm here writing this blog, whereas my friend has tried (and unfortunately failed) to to get into graduate entry medicine. She has decided not to reapply and do something else for a bit.

ASD/PID

Atrial Septal defect or Austistic spectrum disorder?
Pelvic inflammatory disease or Prolapsed intervertebral disc?

Best not to get them confused

In the Neck

I get slightly annoyed at GP bashing, although I suppose I am slightly hypercritical as I regularly take the mickey out of other specialities. Although its always obvious that I still respect the job they do.

But for some reason it goes to far with GPs, one colleague told me she didn't want to be a GP as she wanted to do a job that needed a medical degree.

However, indirectly everything we do at medical school is geared to preparing us for being a GP (50% of us will be GPs afterwards), in psychiatry we are taught to quickly perform a risk assessment on someone with depression, in ENT when to refer someone with hearing loss and when not to.

Is it down to jealousy? Probably.

In my experience GPs are some of the best teachers out there, I learnt how to take a history from a GP and I still remember that lecture.

They do a good job well, why are'nt they appreciated?

Resting Heart Rate

Today I was informed by a first year medical student that my resting pulse rate was 68 beats per minute. Five years ago it was 62 beats per minute. Does this mean I'm slightly less fit physically then I was back then? You can't really tell by resting heart rate but its nice to know that I'm on the healthier side.

But what is not helping to keep my heart rate down is an exam induced tachycardia. Note to the examiners, if you are going to have a question asking "identify the abnormality in the ECG at question 10," then please make sure there is actually an ECG reading at question 10, as opposed to a series of True/False questions on Congestive Cardiac Failure

Irked

At school I was taught creationism before being taught about the big bang. I remember opening a science book and learning about how we all really came about. I was a bit miffed by this, I had effectively been lied to by teachers at my primary school who took it on themselves to ignore all scientific evidence in favour of some superstitious nancy pansy.

Religion is bad for children. Today I spoke to a consultant about one case she saw of a child with Austism who was home schooled because her parents were devout christians.

Is this wrong? Kids deserve to be taught stuff backed up by evidence before stuff that isn't.

On a similar theme, another consultant then mentioned how she got in trouble with other parents over santa clause. Her children knew that jolly Nick wasn't really and at christmas they always used to pretend to leave stuff out for him. Is that taking rationalism to far? I dont think so, although I don't think with father christmas its imporant either way, as those kids will still have a wonderful time at christmas.

In other news examsare looming, so expect nothing at all for a bit or a rant at how medical school get people to become very good at passing exams, rather then being doctors.

Comforting and yet Scary

Medical Studentscan be spotted a mile of, usually, as those people onthe ward trying there best to make themselves seem small and insignificant. To be honest this is a good skill to master, it can be useful when you desperately want to avoid being picked on to do something during ward based teaching.

The alternative tactic is to stand out by being really confident. If you look like you know the answer then the teaching fellow/consultant/bored FY1 who is bemused to have four/five/six medical students following him.

Anyway I digress, the point of this post is to highlight two situations showing that I am at least making progress

1)Shadowing a registrar on AMU last week when I was mistaken by an FY2 as the reg, he had assumed that the actual reg was an FY1 shadowing me

2)Mistaken as a GP trainee by one of the nurses

Progress? Am I somehow walking/talking differently to how I did last year?

Teaching

All doctors (or potential doctors) should be able to teach there subject to medical students or to other doctors. Myself and some colleagues have actually already discussed how we might be considered when we do this. Most of the girls want to be seen as kind and caring. Others are tempted to be horrible to every other student/group and nice to the rest to mess everyone around.

Informally medical students teach already. We discuss cases with our peers and go over stuff with them for exams on topics we feel confident about.

Sometimes you get the opportunity to teach clinical skills to the first/second years. Which is what I did earlier this week, on the whole it was pretty fun and it was good to see I was getting better for every session I did.

This post is just an opportunity to share an anecdote with you. Twenty odd years ago, or something like that, temperature was generally measured by use of an oral thermometer. Occasionally the tea lady would give all the patients a coffee beforehand. Poor nurse would then report that all the patients have a fever

Enjoy the weekend!

Why

What makes a good blog? Is number of followers or comments received a good indicator of how good a particular blog is? I have been looking back at my blogposts over the last nine months and wondering what is it all for? My posts seemed to be slightly longer back then, but I am unsure as to if the quality of posts has suffered as the blog ages. I started off with lots to say, but I get the feeling I ran out of things to say or ran out of steam. Although even now, I take some pride out of this blog.

I set up this blog just because I could. I enjoyed reading medical and non-medical blogs and decided to give it a go. Then people started to read it and hopefully like it. I hope you all got something out of it.

So what is the point of this blog now? Are people expecting a funny story everynow and again, is its just one more blog to check on the list? Perhaps I should start telling stories of heroism that I have performed, rescuing twenty patients from a burning hospital? And what is the point of the wider medical blogosphere? Is it to make people laugh or think? Or is it to preach to the converted about how shit governments are and illustrate the inepitudes of managers in the NHS?

Have we made a difference? Is it our job to try and change stuff? Or is it just another hobby?

Lightning

If you are asked as to what can cause a particular condition, such as cataracts, the best solution is to say two common causes and then say something obscure. Hopefully said consultant or registrar will have a sense of humour.

Here are mine for causes of cataracts . . .

1)Age-related
2)Steroids
3)Being struck by lightning

Getting Sued

If you dont want to get sued, go and work in Intensive Care. This is because everyone expects the person to die anyway. I was unaware that research had been done into which speciality faced the most litigation.

A, B and not to Bad

The Fuddled Medic is now based at hospital A, which is a ten minute walk from his house. This is a good thing, previously I was sent to hospital B which was an hours drive away. Hopefully this means that the chap who was based at hospital A, but lived next to Hospital B can enjoy a lie in to and two less cars will be on the road.

In other news my latest attachment seems quite nice. The conversation with the guy I'm working with went like this

"So, you've got exams in a few weeks haven't you?"

"Yes" replied the FM

"Well, dont stress out to much about this placement, make sure you leave yourself plenty of reading time to revise for those exams. Dont worry, we're quite chilled out here, do as much or as little as you want."

You are a legend

Three . . .

. . day weekend!

Our latest consultant has brought some assessments forward to tommorow and told us we can have Friday off. Yay!

See one, do one, teach one

There are lots of wise saying in medicine, another one to that given in the title is "If you dont put your finger in, you may put your foot in it." Yesterday I saw a grommet being inserted, last week a cataract operation (seeing one was pretty cool, the fourth wasn't such fun). Both times the surgeon turned to me and joked "See one, do one, teach one - so now its your turn." I asked if i could see them do it on the right ear-eye first before I tried

Tricky Question

"So are you interested in this field of medicine?" asks the doctor at the latest clinic that the Fuddled Medic attended. This is a tricky question, say that you are and the guy will look delighted and either pelt you with careers advice you grill you on the latest research. Saying "not particularly" may be the truth but not really diplomatic.

Instead yours truly chickened out and stated he didn't really know much about this speciality to make an informed decision.

In other news medicine continues to take over my life, it seems an evening in the library may be called for to lift the fog of ignorance that penetrates my brain.

Take care readers

For the Heart

Today a consultant told me he drank "enough red wine" and that it "was for the heart." Taking inspiration from this I entered Lidle which is opposite the hospital I am based at. I purchased a decent bottle of Shiraz. I was ID. The lady at the checkout apologised, as I was blatantly a medical student but she had to do her job. I asked if many medical students brought a bottle on a friday. She said yes, also on Monday, Tuesday, Wednesday, Thursday to.

I am off to finish said bottle and play monopoly. Thank goodness its the weekend. Another case of tinnitus or weighing up the pro's or cons of performing a tonsillectomy would have driven me mad.

Lithium

Yesterday my Psychiatry consultant told me I needed to know about Lithium. This is a good idea. As a result of my ignorance on the use of Lithium being uncovered I will present what I have researched/copied from a book here.

Lithium

• Mode of action is unkown
• Usually given as lithium carbonate, it is most useful in preventing mania. Needs to be given for 18 months for the benefits to be clear.
• At therapeutic levels the side effects are fine tremor, metallic taste, dry mouth, thirst, mild polyura, nausea, weight gain and hypothyroidism in 20% of women who take it - this is rarer in men, Renal impairment can occur after prolonged use
• Above 2.5 mmol/L you get coarse tremor, agitation, twitching, thirst and polyura, At higher levels renal failure, seizure, coma and death. Toxic levels can arise from dehydration or with a low salt diet
• Before starting perfom an ECG, electrolyte balance, creatinine clearancem TFTs.
• Measure lithium levels weekly, then every 3 months when stable
• Test thyroid function and renal function every 6 months to avoid rebound mania
• Withdraw gradually so that you avoid rebound mania
• Avoid in patients where adherence will ne an issue and avoid in renal failure and pregnancy. Best not to combine with diuretics, ACE inhibitors etc.

If you would like to contribute to my education and feel I need to know more then please let me know

Clinic

What makes a good clinic?

Finishing on time and having consultants/registrars who are willing to chat/teach comes close. But the clincher is having a cup of tea or coffee made for you by one of the nurses.

Thank you!

Dermatoscopy

The art of examining some skin using a dermatoscope. All GP's in Fuddled Medic Land had one brought for them by the PCT. In constrast the hospital in Fuddled Medic Land had to raise money via the hospital league of friends so that the Dermatologists had some to use

Compliance

Astham patients took 50% of the amount of their inhaler 50% of the time.

Another example of poor adherance being a problem is when doctors prescribe a medication to someone newly admitted to hospital who says there taking an ACE Inhibitor. There not actually taking it but they are supposed to. Then, said patients gets severe postural hypotension, falls over and breaks knee

Acne and Isotretinoin

Does Isotretinoin therapy cause depression? Maybe, maybe not - all depends on who you speak to.

The argument against Isotretinoin therapy causing depression is that its used for severe acne. Having severe acne could probably cause depression anyway. Well, thats what the latest psychiatrist to take a mild interest in the Fuddled Medics education said. According to wikipedia though, Isotretinoin has produced behaviour of dperession in rars though.

Another example of how you can argue anything you want in medicine if you think about it (althoug some things are set in stone).

The above point also illustrates how psychiatry is linked to the rest of medicine, depression arises due to a severe, disabling skin condition. Another one is that 10% of hospital patients will get delirium, something that can be quite hard (in practice, not in theory) to distinguish from dementia.

And with regards to dementia, is it due an underlying organic cause? Or are they quiete and unresponsive due a care home induced depression?

Dermatology is often seen as a bit of a joke subject by student, if you have a patient with a rash in front of you just flick though a book until you find the right picture. This can't really be done, textbooks show pictures of the "classical" disease, not the shades of grey in between.

What also isolates this speciality is that there is no dermatology wards, 99% of dermatologists deal with outpatients and dont do ward rounds.

Ashworth, Rampton and Broadmoor

Today I visited one of the above places, a high security psychiatric hospital. Broadmoor is the most high profile, but they are all pretty much the same. It was a bit scary at first, being searched, going though four/five locked soors. The gentleman giving the tour pointed out that forgetting to lock a door behind you was a disciplinary matter.

In 1998 the Fallon report was published as a result of children being groomed by residents at Ashworth in 1998. What happened was that the patients with Personality Disorder were running the ward. Sticking a buch of people who are highly manipulative is not usually a good idea. Patients were able to take advantage of low staff morale who did not feel they could turn for management for help. From what I can gather these concerns were first raised by one of the patients who was ignored.

One surprise to me was the idea that patients would often want to be in prison as opposed to "hospital." The theory being that in prison you have access to drugs and there can be a hiearchy of power. Whilst in a secure psychiatric hospital you cant smuggled stuff in by bribing staff.

So are these places necessary? Or a throwback to a bygone era? Some of the people in these places have commited no crimes, society has acted pre-emptively. Others have been deemed "safe" by doctors but the Home secretary got the jitters and overuled them. Any after speaking to a patient intense debate was given when we were asked whether or not she should be released back into society

Respect

Some of you who read this blog may have gathered that I am not a fan of religion. Therefore I am going to do a taoken post on the popes visit.

Today his holiness has been ranting about how religion has been marginalised. Tough bloody luck. If you had not persecuted non-believers and people who disagreed with you down the ages and you kept your crazy views about wine turning to blood then I might feel sorry for you. I dont, I feel anger towards you, you brought on the attacks on religion yourselves by poking your noses into other peoples businesses and fostering your views on others.

Religion deserves all the criticism it gets

Idiots

I sometimes dont know what is more scary, meeting someone who is actually a bad/evil person. Or a good person who genuinely believes in something stupid.

Tennis and Saturdays

On Monday I shall be found in the pub, hopefully watching a Federer-Nadal final. But today will be spent lying on the sofa watching cricket highlights after an exhausting two hour tennis match.

Anyhow, hope all my readers are enjoying the sunshine, I certainly am. it means my washing will be dried sometime today

Socks, Simpsons and Trouble

Today I was on the Ward when one of the Patients decided to have a go at Doctors, Nurses and Students. This involved shouting at how unprofessional we all were. One doctor came under criticism for having unruly hair, another for sitting on the table. Yours truly, the Fuddled Medic came in for criticism for wearing inappropriate socks.

Should medical students or any other healthcare professionals refrain from wearing comedy socks on the Ward?

I shall be wearing my Simpsons socks in the future

Witzelsucht

It is likely that i have an orbitofrontal cortex lesion which is relatively small. This is because I sometimes tell boring and irrelevant stories that dont lead anywhere, as well as making bad puns. Thanks to wikipedia I have a diagnosis.

Thinkers, Workers and jealousy

According to the latest consultant that I chatted to medical students and doctors can be classified into two categories (although there is some overlap)

The first group is the thinkers, they sailed through A-levels getting three A's by default. They automatically know everything by instinctively picking it up during the day and applying the underlying theory/philosophy.

The second group are the workers, they struggled to get the 3A's and had to work hard. They have an incredible work ethic which they bring to medical school. Nothing comes easy and they have to work throughout the term and still do lots of revision for exams.

The workers are jealous of the thinkers, bloody know it alls who do sod all during the year and still get 90% in exams. Am sure you all know someone like that. Although as I mentioned earlier there is some overlap between the groups. Even the thinkers will at one stage have to sit down and do some work, something which may not come naturally to them.

I am a worker, nothing comes easily and I have to constantly run in order to at least stand still (oxymoron alert).

The enxt part of the conversation turned to people and there personalities. Medical students and doctors either overestimate there abilities which has the potential to cause harm to patients or they underestimate themselves.

Is this a bad thing? If you constantly question your abilities you are likely to always ensure you seek senior help when its required. However you may be struck down by fear and question yourself at the wrong time, when you should have acted straight away?

Careers, Sleep and the Weather

As my lovely readers will be of aware the FM is interested in psychiatry and was seriously considering it as a career. This took a bit of a battering due to the FM feeling drained and tired of dealing with patients with mental health problems and the issues that arose.

My consultant took my arguments on board and then calmly pointed out that I am relatively young, in two or three years times I will deal with emotions differently, I will have more clinical (and life experience) and perhaps I shall be better placed to cope with stuff better.

Maybe, are you a different person when your 23/24 as opposed to 20/21?

The weather in Fuddled Medic land has been hot and sunny. This is good, not so good is being stuck in clinics, sitting in a nice comfy chair and having the patients smiling at you and asking if your ok as you drift in and out of consciousness.

Thankfully the lovely receptionist came riding to the rescue and offered me a cup of coffee. Brilliant, thank you!

Until

I shall leave you with this, untill my writers block goes

The Ashes

Today and Yesterday something magical happened, England are completely battering Pakistan and it is a joy to watch. The FM does a significant amount of work whilst listening to the cricket, usually as Test cricket is sedate and therefore alot of work is done. However today the FM gave up and just watched it for a couple of hours. Absolute joy to watch. And listenening to Mr Swann arguing that he should stay as englands number eight due to his cool headeness, brilliant.

So are we going to win the Ashes? Probably not, hopefully it will be competitive though.

On Monday it is a Bank holiday, which means a three day weekend and more importantly a four day week afterward. The FM has become rather boring and now lives for routine, or more accurately the weekend.

"Did you have a good weekend FM?"

"Yes thank you, I got lots of sleep and had a nice relaxing time."

The FY1 who was talking to laughed and pointed out that by the end of the day I would be feeling terrible and tired and would be counting down to the next weekend. Indeed I was.

Afraid the FM has been suffering from writers block and therefore has nothing constructive to say, as a result this rambling post was born. Maybe the FM should give herself two weeks of from blogging and have a break from it? Maybe, lets hope my imagination and ability to say something sensible returns shortly

Psychiatry

So here is a review of my psychiatry placement, on the whole its fun and I have enjoyed bits of it but I dont think its for me.

One good point is the ward rounds, or lack of ward rounds. I could very easily get used to the equivalent "ward review" where you get used to patients coming to you, sitting on nice comfy chairs with tea, biscuits etc

ECT was a good eperience. I had mixed feeling before I saw it, having images of people I have seen with epilepsy in my head had made me think it was quite barbaric. But it has been proven to be safe and effective. And after talking to the consultant in charge I can say that I am definitely in favour of ECT, its no more barbaric than half the drugs doctors give to patients or the trauma of surgery.

However psychiatry is far more emotionally draining then either medicine or surgery. After sitting in on clinics my emotions are all over the place. In medicine its important to switch off mentally at the end of the day and with psychiatry I find it harder to do so. Is this me, or is that what working with patients with mental health problems does to you?

In General

GPs are often portrayed as the last of the generalists, from what I have seen this week I would like to respectfully disagree. Well not disagree entirely but present another job that deals with general medicine.

Decided to do something different yesterday and attend a clinic for members of the older generation. I am yet to learn the Politically Correct way of saying geriatric medicine, apparently this is insulting in some way.

What struck me was how similar it was to being a GP, you never knew what would be next, as opposed to a Respiratory clinic (Ah, another case of obstructrive sleep apnea).

Another similarity was dealing with patients who had multiple problems and then trying to prioritise which problem to deal with first. Unlike the rest of this year, this will be the closest I get to "bread and butter medicine" so its all good revision and I hope to make the most of it.

And in the next post I shall be talking about the current attachment and how I'm getting along in Psychiatry . . . . . . .

Personal Responsibility

I have just read this article, a nice thing to do on a Sunday especially in combination to listening to TMS.

One thing that annoyed me though was this paragraph,

But Tam Fry, National Obesity Forum spokesman, suggested Field was being naïve. "If Professor Field wants a world where everyone assumes personal responsibility, he is living a dream. He appears to have forgotten the 35-40% of our population who live in the same obesogenic environment as he does but simply can't cope with it or have long since given up the unequal struggle. They are the people who are quite unequipped to resist the 24/24 battering of junk food promotion and are easy prey for the marketing men."

I am perhaps being a little hard but I think its a little patronising. It implies that 35-40% of our population are incapable of taking personal responsibility. Sorry your too stupid to take resposibility for the fact that you eat to much. Basically me and you can resist the tempatation to go for McDonalds for the masses cant.

Logbook

This post is an apology to all the consultants out there who have signed off Logbooks for Medical students. We ask you questions about your career, your work, your patients and your delighted that we seem to have a genuine interest in your speciality.

But then we bring the conversation to the end by saying "Can you just sign our logbooks please?" Your smile fades as you realise that the students are just making sure they tick the boxes.

Keep an open mind . . . . . .

. . . . . . but not so open that your brain falls out.

A lovely little quote, who originally coined it is open to some debate. The FM has often been accused of being close minded as a result of her opposition to homeopathy. Unfortunately it is not the only situation that she has been accused of being close minded.

People seem to be annoyed when the FM criticised this person.

The FM just hates it when people are taken advantage of, or are led to believe that something is true when it isn't. For instance, its not nice to have the process of grief disrupted by a charlatan.
Hopefully someone wont sue me for saying this

A fine line

Spoke to someone today who was a patient at a mental health hospital who believed he had a cure for type 2 Diabetes, three days later talked to a member of staff who believed that september 11th was caused by the US government and that all the worlds government are really controlled by someone else.

In each case I gently challenged these views, in a nice and diplomatic way like what we have been taught.

Fat, not Obese

The FM used to work at a care home, where various members of staff wanted to lose weight. Or more accurately they wanted to talk about losing weight. This is easier then actually getting off your backside and going for a run/swim/cycle/walk.

It would be quite common for the FM join the rest of the staff when they had a fag break. The FM was amused at one time to see the Deputy Manager marching up and down on the spot. This was the latest craze to get fit and into shape. This is unlikely to constitute a sufficient enough lifestyle change needed to lose weight.

People were often annoyed at the FMs response to “How to avoid getting fat, you always eat more than us!” The response usually involved a list that included three hours of doing karate a week, going for a jog, family walks and going to the gym and playing tennis when people were free.

Perhaps the FM is being too harsh, but at the end of the day fat people get fat because they eat too much. Maybe if the FM was not blessed with her particular genetic makeup she would think differently.

NHS should use term fat instead of obese, says minister, but then should HCPs be worried about causing offense to people? Certainly medical students have had to walk a fine line when presenting a patient to a consultant (in front of the patient) who is seriously overweight. Being asked what are the risk factors for having an MI by a consultant is not nice , especially when you then go and state diet and obesity in front of a seriously overweight patient.

Perhaps we are too nice as a society? With regards to the earlier situation presented in this blog it took some self-discipline for the FM to remain quiet and not say something along the lines of “Stop bloody talking about it, replace that Mars Bar you have with an apple and instead of spending all evening watching neighbours, home and away, emmerdale, coronation street and eastenders go for a fucking run.”

Just Silly

"Oh, I'm just a medical student," replied the FM when asked who she was. "Just a medical student!" roared the person chairing the meeting I was attending, "Why do you put yourself down by using the word Just?"

"I'm now going to have a little listen to your heart," said one of the FM's friends whilst examining a patient. "Why do medical students say "a little listen?" asked our consultant, it does seem a little patronising to the patient.

Two bad habits medical students often get into when wondering around

Making a Recording

Some of the FM lecturers decide to record there lectures online and make them available as a podcast. Thank you very much, much appreciated.

What do others think of this? Any other medical students get lectures recorder? Any lecturers out there who record what they say maybe?

Some of my lectures are exclusively online, the FM access them online and listens to them at home. Is this a good thing? Perhaps in a few years lecture halls will become extinct as students stay at home and listen to the lecture on glycolysis from four years ago?

The post on religion

It has been coming for a while, a post where I basically slag off religion in all its forms. However as this has already been done by people far cleverer then me I shall do something different instead.

What is a delusion?


"The most recent Diagnostic and Statistical Manual of Mental Disorders defines a delusion as:

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture."

If the last sentence had not been put in then the vast majority of the worlds population would be deemed to suffer from delusions.

Let us accept for the time being that people brought up and taught religion in a religious environment are not suffering from delusions, what I am curious is when people swop from one religion to another or from atheism.

If a friend of yours was to suddenly start giving lots of money to scientologists would you be concerned? What if they suddenly became a born again christian and started to spread the message that homosexuality was a sin?

Do they need psychiatric help?

In my posts the views expressed are my own, in this please note I am playing devils advocate with myself. I am not sure what to think.

Surgery

I am pretty sure that I do not want to be a surgeon, standing for three/four hours nearly killed me. However it was pretty fun at time, but I know its not for me. I can understand why people like it though. One consultant said to me that surgery appealed to him as everyone is equally important, especially as everyone wears the same.



Being an anaesthetist could be fun though. It was quite bizarre to be asked for suggestions for "Level of command (7)."

Today not having broadband makes people feel deprived," said Steve Robertson

Should this be the case? Even if we dont have broadband at home don't we all have acess to broadband at public libraries? Is it really the governments job to use its money (I mean "taxpayers" money) to prod and poke private companies into trying to get broadband into every home?

15%

Looking at statistics in a different way can often alter our perceptions of things. A significant portion of people have a mental image of old people generally being down and depressed as a result of being old. It is thought at 5-15% of the elderly population do indeed suffer from depression.

However this means that 85-95% of older people are not suffering from depression and therefore it is normal for them to be perfectly happy and mentally well.

After making this poin the lecturer then moved on to consider the differences between depression in younger people compared to an older person. Perhaps I shall see this in practice but apparently in older people the symptoms tend to be more biological (altered sleep and appetite for instance).

Also discussed pseudodementia, where someone is diagnosed with dementia but actually are suffering from a psychiatric illness. Is there any information out there I wonder on how many people have been diagnosed with dementia when they are actually suffering from a condition that could be treated relatively better then dementia with the possibility of a recovery?

Neurology and Cowards

Headaches are common, therefore the Fuddled Medic is required to know a little bit about them. Indeed a mock exam paper asked the FM to state which type of headache best fits this description. . . .

"A woman describes to her GP a band like pain across her forehead that slowly develops during the working day and is relieved by weekends."

More interesting are migraines, untill the FM started Medical school she was unaware that most migraines dont have an aura and generally aren't caused by cheese, red wine, chocolate etc. This is important to the FM as family members suffer from migraines and as a result have probably given up cheese, chocolate etc for no real reason.

The word Coward is in this post as a result of seeing this article.

Today, I learnt something

I learnt something today, that you don't appreciate what you have untill its gone. To be honest I could not help but learn this as I sat through the latest Shrek film and had this particular message rammed down my throat. A terrible, terrible film that was punctuated by bits of sheer brilliance every ten minutes or so.

In other news I passed some exams and can now proceed to the next part of medical training

Another sensible suggestion?

Yes, Michael Gove is right that it would be best to return to the more tradition A-level system where students take their exams at the end of upper sixth, as opposed to throughout the two year a-level course.
This is a good thing, lower sixth should be a time to relax and develop your interests in the subject and not focusing on exams. For A-level chemistry I sat six different papers, to revise for this I did every past paper available for each paper. As there were approximately 10 past papers per difference module I did about 60 past papers per subject. As a result when I took the real things there weren’t that many questions that I had not seen in one form or the other.
Is this a good thing? Is this what A-levels are for, to prepare you to jump through hoops? Suppose you could argue that life is generally becoming more and more a game to get through. Got an OSCE coming up? No problem just polish up on your act and memorise statements such as “to complete my examination I would look at the observation chart, check the sputum pot and see a CXR.”
Don’t bother about learning stuff properly; just remember to rehearse various answers.

Another Joke

"An Alcoholic is someone who drinks as much as his GP." The deaths of cirrhosis amongst doctors is higher than that of the general population. Scary, in practical terms there is a good chance that I or someone who I'm friends with at medical school will get addicted to alcohol.

I can totally understand the articles point of doctors being unwilling to seek help when they need it. Alcoholics are stigmatised by the medical profession, so knowing this and seeing it first hand, why on earth would you own up to it?

Something sensible?

There are two ways of thinking about the coalition government.

1)Get annoyed at everything stupid that they do
2)Accept that all governments do silly things so its not really worth worrying about

If you follow point 2 then occasionally some optimism can light up your head. This has happened to the FM whilst reading about a speech given by David Willets who was talking about teenagers who were put at a disadvantage at applying to medical school as they did not have the option of taking individual sciences at GCSE.

Its an absolute disgrace that some students dont even have the opportunity to take the individual sciences at GCSE, certainly the FM would have struggled at A-level if she had not had the opportunity denied to pupils all over the country

A Joke

The neurologist knows everything but does nothing
The surgeon knows nothing but does everything
The psychiatrist knows nothing and does nothing
The pathologist knows everything and does everything, but too late

And now for the punchline . . . . .

And the anesthesiologist sits on a stool all day long and passes gas.

So is this friendly, harmless banter? Or does it undermine different specialities and the patients who come under there care? In a few weeks I will be doing some psychiatry, if I enjoy it then I will probably aim to become a psychiatrist. If this happens I would not be considered a "proper doctor" by a significant proportion of the medical team. Some people consider psychiatric treatment to be quackery, dangerous and generally unhelpful.

Perhaps this says more about us? Perhaps psychiatrists are'nt seen as "proper doctors" as society as a whole does not consider mental illness as a "proper disease."

Things that annoy me

Earlier in the month I posted about the bloated BBC and was accused of being grumpy! Afraid this is a grumpy post as well.

Workshops are amazing, this is where patients with a particular condition volunteer to be examined by groups of medical students (usually about 3-7). This is overseen by a consultant or registrar who points out what we've missed.

Anyway, had one of these today and the turnout by medical students was poor. I know we have exams but its no excuse, people have given up there time for us and people cant even be bothered to turn up. On the brightside I was in a group of two, as opposed to five/six meaning we both got more attention and learnt more.

Bloody Hell

NHS Blog Doctor, Jobbing doctor and Dr Grumble. Only one remains. Both Crippen and JD have taken down all of the posts on their blog. A big shame

Now that JD has gone the medical blogosphere seems a heck of a lot smaller

The C and the P's

Causes of Hepatomegaly can be remembered by stuff that works with C, such as cirrhosis, CCF, Cancer and then chronic hepatitis and cysts.

Ascites can be rembered by words that start with P, such as Portal Hypertension, protein loosing states, pancreatitis, pericarditis (constrictive) and something else which I can't post here as I cant read my handwriting on the piece of paper I scrawled it down on.

Hope this post counts for revision. Am going to revise for another half hour and then go for a run

Looming

Eight day untill the exam, eleven days till the "practical exam." Postins will be non existent/short untill after this time.

Headaches

I try not to put myself under to much pressure, if i do then i am likely to get stress induced headaches. However if i dont put myself under pressure then I am liable to be a lazy bum and do very little.

Currently this evening i have been doing some pharmacology revision, but started off by going over Pulmonary Embolisms. Partly because its quite common and common stuff get tested in exams, uncommon stuff does not, but also because consultant sydrome set in when being asked some fairly routine stuff on it ealier today.

The best teaching is generallly when we clerk someone beforehand and present back to a consultant/whover. This what happened to me today. Perhaps medical students should have no teaching sessions at all, except on how to take a history in the first week of medical school. After six months they could then be taught how to do some basic examinations. Alot of consultants think that medical students shouldn't even consider how to treat stuff until they have spent a significant amount of time taking histories/examining.

First exam is in two weeks. People who know me tell me I'm going to be fine if I just keep at it and cant understand my concer. I wish i had the same confidence in myself that they do in me.

Like alot of my posts this one has no real point to it. I feel that if I took the time to rewrite it, it could be amazing. Instead I have banged this out because I am tired, been on the wards/teaching for eight hours and then done some more work in the evening. I want to sleep but I know that as soon as I go to bed in half an hour that coffee I had at four to keep me awake during teaching will kick in. So instead of going to sleep I shall reluctantly get up and read Bill Bryson

Goodnight

Surviveing an Exam

Exams are looming, one of these is a particularly nasty exam that involves a random discussion with a consultant/registrar about anything of there choice. From what I have gathered this is easier to fail then the MCQ type of exam medical students must also jump through.

Thus tips on how to survive

1) ABCDE, this will get you a mark and if your really stuck then go on an hours discussion explaining what each one means.Downside is a good chance of pissing said examiner off
2) Dont say the first thing that comes into your head, knowing that snake venom can cause pancreatitis is nice, not so good is being asked to name said snake, where it comes from etc
3)"As per BNF guidelines," may work or at the least raise a smile if the examiner has a sense of humour. Easier when asked to say what antibiotics you would use, there are local, national guidelines and a conversation can be furthered by pointing this out
4) Have some structure, anyone can blurt out one or two complications of surgery. Whats more impressive and will get you more marks is to say how you would classify them before you give some examples.

This type of examination is dying out, from what i've gathered its the best way of preparing you for being being an FY1 when your consultant decides to grill you in between patients.

Bloated BBC

Absolutely love the BBC, but they do annoy me at times especially as we are all having to tighten our belts.

1) I Player, amazing, but why do they have to change the format on its website - it was fine how it was. If it aint broke, dont fix it

2)Watched Dr Who Confidential, saw that they went on a tour of the UK in a special bus to promote the new series. Why?

3) Can they stop changing the BBC logo they use for each channel in between programs

No excuse for all of the above. Completely uncalled for.

Things that upset the Fuddled Medic

Am usually able to control my emotions, was unable to do so in these situations
1. Seeing a severely ill person whose partner had been raped four days earlier, who was unable to go home and see them
2. Seeing a sixty something chap who had suffered a suspected stroke – had to wear incontinence pads
3. Talking to an eighty years old woman whose only daughter had died of breast cancer, with liver metastasis six days earlier

Very Sad

Teaching and Politics

Teaching session involved the FM presenting a patient she had clerked to a consultant. It was a relatively simple case. As a result people got easily sidetracked and the meeting descending in a spirited debate about the role of the private sector in the NHS. The consultant looked bemused and when someone apologised for the fact that our firm were now engaged in a passionate discussion he replied that it was good we were doing this. In his view medical students did not get enough time or encouragement to discuss how they wanted healthcare to be provided. Should it be the case that a few seminars/tutorials be held so that we can discuss all of this? As he said we’re the ones who are going to have to work in whatever system for the next forty odd years

Dr McCoy, Mental and Looking Back

My favourite star Trek film is “The Voyage Home,” which you may or may not know is the one where they go back in time to find some whales.





Some very good scenes involved Dr McCoy being absolutely disgusted at today’s medical practices – my favourite being the good doctor giving an old woman who was awaiting a kidney transplant a tablet so her kidney grew back. Miraculous.


I remembered this film last night when watch “Mental-A History of the Madhouse.” Back then they used to give Insulin Shock Therapy to patients. It was thought that giving people suffering a Schizophrenic Coma an insulin induced coma on a regular basis was a good idea. Absolutely horrible, but back then they thought it was revolutionary.

But when we look back in sixty years time, what do we think will be considered barbaric about today’s health treatment?

Pathology and Stereotypes

“So we’re going to take the object with the biggest negative entropy in the entire universe and cut it into bits.” These were the words of one pathologist as he started to cut up the brain whilst doing a PM. If you really want to study the brain of someone who has died the best thing to do is to stick it in formaldehyde for a while, but this isn’t usually practically or necessary. This means the pathologist usually cuts it up into slices and quickly looks for any major abnormalities.

“Are there many female pathologists?” More than you would expect, said our chap - apparently it has relatively friendly hours. This appeal’s to the FM, who loves dealing with patients but dreads the idea of spending the best years of life stuck doing continuous night shifts, working days where you start at four in the morning and then finish at six/severn/eight/nine at night.
However pathologists, according to one respiratory consultant have the highest rates of suicide within the medical profession.

The FM does not know if this is true- the reasoning behind this consultants statement is that pathologist spend a lot of time isolated in basement offices, surrounded by bits of bodies. Maybe this is an unfair stereotype. One pathologist sarcastically said that people impression of them is “that of a guy with a beard who sits staring at stuff under a microscope all day, with a rotting heart and lung sitting next to them, who perhaps gets up to have shave after three weeks.”

Anyway the other reason supposedly is that they get very worked up when they can’t decide what’s going on when they see a slide under a microscope. Is it really dysplastic tissue that is being seen? Or perhaps it’s just inflammation making them look dysplastic?

Most medical students and doctors think the FM is mad when she says she is interested in pathology, why is this the case? Have the stereotypes presented above gone too far? Is it ok to pick on pathologists? Are they really “proper” doctors is a common question. Is it acceptable for medical students to say there interested in it and are considering it as a career?

Shall I become a GP?

The GP who I am attached to is absolutely lovely; sometimes he will pop out to the local shop to get some biscuits and chocolates for the secretaries. Occasionally whilst we’re walking back we will see the next patient on the list across the road.

It’s a nice feeling giving patients a wave and smile in the morning.
I don’t think that I’m likely to become a GP (but time will tell), but I can understand the appeal. Sitting in on a GP surgery is more interesting than seeing 15 cases of ulcerative colitis or crohn’s disease at a hospital clinic.

Consultant Syndrome

The FM did not come up with the term, but she shall tentatively offer a definition.It is the “Inability of a medical student to say anything rational or sensible when questioned by a consultant.” This is something that the FM suffers from.

This happened last week to the FM when she was asked about Meckel’s Diverticulum. This was something that had been read about in Kumar and Clark, so with confidence she shouted out “Rules of two!” Unfortunately consultant syndrome kicked in and this is the only thing to have left the FMs mouth.

So revisions for the weekend, finding out what these rules of two are, they include
1)2incheslong 2)2 feet from the ileocecal valve 3)2% of the population have it 2)Males are twice as likely to get it.

Unfortunately now this knowledge has been learnt (again) it is unlikely that the FM will be questioned about it in the future, thus will not be able to show off.

This condition particularly affects the FM when examining patients in front of six other students and a consultant/registrar. She is quite confident doing the basic examinations on her own (or even when being assessed-the FM passed comfortably when being watched by one examiner last week). The FM is able to progress from one stage to another, looking for any pathology. But when asked to do in front of other people she falls apart, always wondering whats she's going to miss out next (liver flap, chest expansion etc)

Any wacky cures out there?

Hangovers

Drinking has a much bigger effect on me than it used to, definitely cant drink as much as I could two years ago. Any rationale behind this, I am only twenty two years old. What has happened to me?
Any RCTs out there giving an indicator as to the best hangover cure?

Voted

Probably posted it to late, but earlier today I posted my vote.

Sigh

FM attempts to take a Past Medical History, she thinks she gets everything. Looks in the notes and sees that patient has had four heart attacks.
On someone else FM sees that a patient has a lanz incision or other surgical scar, asks if patient has had any operations. "No" is the answer. Later on examination FM politely asks what those scars are from, "Well from my operations of course!"
FM feels stupid, especially when presenting back to the FY1 who informs her that said patient is epileptic, despite FM asking on SE if they had had any fits or seizures.
All good fun!

Litter Picks

Previously I have blogged on employment and unemployment previously before. I am revisiting this pattern of though because of a Lord Digby who believes that the unemployed should be made to do litter picks before they can pick up there benefits. Is this a good idea?

Personally I think it is, but I am biased. I have spent my holidays doing various jobs because I needed money. After wiping bottoms in one job and looking after teenagers in another I am constantly annoyed when I hear people saying they can't find work. Am I judging them? Yes, I am wrong to do so and I am annoyed at myself that I am judging people.

But I just cant help but get annoyed. The home I worked at had vacancies that were well advertised in an area of some unemployment. But no one wanted to do it, perhaps they think it is beneath them? I didn't think it was beneath me and I learnt alot from working there.

The other job was only for four week, it was all students who were doing the jobs - this compancy still had vacancies going. It was not advertised exclusively on student websites, I found it on the jobcentre website. But why only students doing it? Are we not all useless bum who do sod all?

GET SMASHED!

Apologies to people who have seen the header and thought I had gone off the rails or something. This is a memory tool to help memorise the causes of pancreatitis (G-Gallstones,E-Ethanol,T-Trauma,S-Steroids,M-Mumps,A-Autoimmune,S-Scorpion and Snake Venom,H-Hypocalcaemia,E-ECPR,D-drugs

This was found on wikipedia when the FM was unable to list more than two cause of pancreatitis when being questioned by an FY1.

This is what medicine does to you, it reduces you to learning lots of mnemonics. Maybe I am starting to sympathise with a consultant who argued that the tragedy of medical school is that it turns bright teenagers into robots. Am I going to be a robot? Maybe this is a good thing, people make mistakes and being a robot means you will always be able to fall back onto a routine, a safety net as such.
Are we all going to be robotised, like most things in life everything seems to be becoming a tick-box routine?

Who to Vote for?

The Fuddled Medic is slightly confused. At the last election things were simply, the FM was not allowed to vote. The FM stilled followed politics and was relatively right wing and wanted a conservative government. That did not happen, if it did the NHS would have been carved up even more and we would have had silly expensive things like the "Patients Passport" idea.

This time the FM can vote and has a postal vote. His vote will be slightly irrelevant as he lives in the countryside and a safe Tory Seat. Do not get me wrong, First pass the post is not perfect but I think its the best out of the lot and does not want to change it.

Anyway, assuming my vote determined who was to win the election? Who should I vote for? I disagree with Labours tendancy to micromanage everything and am appalled at the lack of respect they treat the private sector with. Although not as right wing as a few years ago I do tend towards the idea that the state should leave things alone unless it really, really has to. I have been described as a libertarian in the past, maybe I am.

The Markets are a wonderful thing, but not for everything. This includes the NHS, you simply cannot make money from running and A and E department. The private sector is only interested in simple cases that it can make money for. Unfortunately the conservatives disagree with me, as I now have a "professional" interest in the NHS I am unsure whether or not I can vote for them or not.

I hope I have not made a mistake with this post. I tend to keep my political views to myself (or try to, often failing miserably when provoked over issues like the Iraq war and the Euro), but I hope my dilemma may be of some interest to my half dozen readers

Vote Tory, die of breast cancer

Vote for the Conservatives and if a relative dies of Cancer, we told you so, seems to be the Labour Parties latest pathetic attempt to close the gap on the Conservative Party.

Answers on a Postcard

Medical Students can be very sill at times, including myself. Here is a list of silly things done this week by various people. One of these was done by the Fuddled Medic. Can you guess which one?

1) Suggesting Pelvic Inflammatory Disease as a diagnosis in a 40 year old man
2)Pointing to a hysterectomy scar and confidently stating it was a Masectomy Scar
3)Succesfully taking blood of a patient, then realising your efforts were in vain as you had used the wrong coloured bottless (unfair on the patient, as they needed to be redone)

A very good Idea

Please check this out, its an amazing resource for us all.
Thank you Julie

Hoops

There is a lot of stuff in medicine to learn, no one will ever be able to learn everything. The Fuddled Medic has a reasonably big book ok objectives to get through, some are quite specific, such as "Assess a patient's level of consciousness using the GCS." Others are not - "Describe the pathology of Parkinsons Disease"

The second objective could be answered briefly in three or four lines, alternatively a 1000 word essay could be written. What I need to know is somewhere in the middle. Increasingly the Fuddled Medic is looking through books and thinking "Do I need to know this?" I hate it when I do this but sometimes you have to

As the FM goes through these objectives he hopes that he's finding the right place to stop and draw the line, but comes exams at the end of the term he may be in for a bit of a shock. I hope I have got the balance right.

I suppose my point is that medicine should not be like this, medicine is more then jumping through hoops. And I hate having to jump through a hoop but this is what I've got to do and accept.

Blood

Today I took blood, using the vacutainer system. I have taken blood before but today was the first time from a "real patient," as opposed to in the clinical skills centre practicing on someone with biggest veins around.

I was able to do it on two patients in the end (out of three - my colleague who is more sophisticated then the fuddled medic used a syringe in the end). I consider this to be a success.


The afternoon was spent watching an FY1 doing Intravenous cannulation on a patient, followed by them teaching us how to do it on each other (before this we had just practiced on a mannequin), with a bit of luck I was able to do this on my friend relatively easily - although tbh it was a bit of dumb luck that I was able to manage it.

In the meantime I have been set a challenge of finding out the scientific evidence for why doctors should wear there sleeves rolled up - to me it makes sense insticitively to wear short sleeve shirts, elbows and below exposed, but is there any evidence?

Where are you?

Earlier today I was procrastinating and I discovered that the manchester medics blog had disappeared. Where of where has he gone?

My week

I was tempted to do a day by day diary of my week, but eventually decided against it. Instead I'm going to summarise my week.

This Chart show the relative importance of three things in making a diagnosis. These are taking a history, examination and tests.
The original work can be found here. I have wanted to put this in for a while now but could not find a reason to. I have put it here because it is a reasonably indicator of what I've done this week.

Most of my time is spent chatting to patients on the wards and taking histories. If an F1/F2 is around and feeling nice they often get us to take a history and practice presenting to them. In clinics we often present to the consultant before he see's the patient. Most of the years above have told me that the main thing to get out of this attachment is to simply get good at taking histories and presenting back to people. After all this is the major thing in finding out whats wrong. Expensive tests usually confirm what we often know from the history.

A smaller amount of time is spent examining patients or looking/trying to interpret there test results.

Other time is spent in teaching, such as seminars and lectures. This week we have discussed colorectal cancer, practicing PRs, other sessions included going over the abdominal examination and discussing why we palpated for various bits and bobs.

This week was very similar to last week, thankfully it seemed a little easier and although I still feel completely out of my depth and very stupid I do sometimes get the feeling that a little bit more is slotting into place.

Weeked Homework- Pathology and Radiology teaching, immunology lecture to listen to, reivse anatomy of femoral/inguinal hernia's and make notes of cycstic fibrosis. Also to gut room and do some laundry

RCTs

The fuddled medic believes that if we should use evidence to support why we use something or believes something.

In poorly understood areas the best way to find out what works and what doesn't is to do a Randomised controlled study. It is thanks to RCTs that we know that women on HRT are at a higher risk of strokes, heart disease and breast cancers.

I have written the above because this made me laugh and i wanted to share it.

ABC

Our group have now met all three of the consultants who will be giving us teaching over the next six weeks, two are lovely - one is not.

Consultant A did some bedside teaching, this involved 7 of us crowding round a patient-the purpose was to go over assesing the ABCs(D and E) to. This consultant was very nice, telling us there was no such thing as a stupid question and smiling briefly whenever we said something stupid

Consultant B was the complete opposite, he told us the plan for the next two weeks and put the fear of God into us, warning that he would not be to kind if we did not know our anatomy. Our homework is to go away and learn the blood vessels of the body so we can draw them on the whiteboard

Consultant C was lovely, we met him on the ward but we quickly ended up in the Cafe having tea and biscuits. He asked us what we wanted to do (next week abdo examination, next week histoy taking and presenting) and then just talked a bit about his job, when he was a medical student etc

Medical students are often overwhelmed when they start being on wards full time, its kind of nice that most of the consultants seem to appreciate this.

Reassurance

Was at clinic today and whilst the consultant was having a cup of tea we all had a bit of a chat. He told he only expected one thing from medical students. This was just to turn up - thankfully even I can manage that!

Seven hours and fifty minutes

That is a rough indicator of how much sleep I need, if I fall asleep at around eleven I will wake up just before seven. And no I am not worried about loosing my marbles because I dont get exactly eight hours of sleep every night - you only need enough so that you feel refreshed when you wake up. There have been case reports of people who only needed to sleep for two hours a day - it was reported that they felt that most people wasted there lives in bed!

Where is this going? Is this going to be a biology related post? Have'nt done one of them for a while

Nope, this post is because of this.

Should a charity really have to do this? When I was younger my parents told me why sleep was important. Anyway should sleep and the reasons behind it be discussed in biology anyway?

I'm probably going to get shouted down for saying this but surely its down to the students themselves? During the school week if I noticed I was tired I would make sure I went to bed early, is to much to ask of people? You would not be happy if a lecturer or a teacher fell asleep during a lesson - they manage to stay awake

A new way of learning

The course I am is becoming more and more clinical (very rapidly in fact), so whereas learning before was just a case of learning lecture slides (give or take some extra reading) things have changed.

Now its more a case if you see a patient with a certain disease, you just go away and read about it in a book. Because of this I have obtained a copy of Kumar and Clarkes clinical medicine. It feels liberating to read a textbook aimed for clinical medicine as opposed to a book relating to physiology or pharmacology.

However the best book I have purchased in the Oxford Clinical Handbook of Medicine - perfect for taking a sneaky look as the consultant chooses who to pick on.

Autonomy

Had a lecture of pallitative care and euthanasia today, wasn't a lecture in the traditional sense - more a couple of videos to try and get us thinking about the issue.

With regards to voluntary euthanasia I am in favour. Everyone accepts that we have a right to life, therefore we all have a right to die when we choose to. One of the physicians duty is to take into account patients wishes and there right to decide on a particular treatment/course of action.

From this I think it is logical to accept voluntary euthanasia is fully justified and morally ok, unfortunately the law in this country seems to need to catch up with what is right.

Alice in Underland

Saw Tim Burtons Alice in Wonderland last night, a very silly, pointless film that did not pretend to be anything other then entertainment and a bit of fun. Despite thinking to myself this is terrible I could not help but enjoy it

Probably because I enjoy fantasy worlds, being able to escape somewhere new (even if its only for half an hour in doctor who) is good, particulary if your course places heavy demands on you.

Anyhow this brings me on to reading, I particularly enjoyed Harry Potter and also Artemis Fowl. At my Birmingham interview I was asked what book I had last ready and why. I answered truthfully and said Artmeis Fowl. This was followed by bemused/amused looks between the interviewers as I attempted to explain what the book was about!(Magic, Fairy creatures, an evil Pixie and a secret world underneath ours)

Back to the real world, the next hour is going to be a futile attempt trying to teach myself anatomy (again).

Reference Ranges

What is normal? What is healthy? When it comes to test results (such as electrolytes, glucose levels) normals means within a certain range. Normals is above the first 2.5% of the lower range and lower then the highest 2.5%. This means they include 95% of values from a healthy reference population.

Subsequently there is a chance that what could be normal for one person is marked up as abnormals - it is outside a certain range. And vice versa - what is abnormal for one person could be within the reference range

Which one should be worry about more? (based on these results, yes I know you would take a full history but its just to illustrate a point)

1) A fit guy in his early forties with a creatinine count of 135 in 200 and 132 in 2009
or
2) A little old lady with hypertension and diabetes whose cretinine levels was 68 in 2008 and 98 eighteen months later?
(normal range, 60-120 umol/L)

Mr Spock and Drug Reactions

Mr Spock had green blood, humans have a completely different physiology to Vulcans and normally have red blood. Unless we suffer a very rare adverse drug reaction when taking Sumatriptan.

This can cause sulfhemoglobinemia, which is when blood changes to green as a result of sulphur integrating itself within the haemoglobin molecule

Because this is a very rare condition I shall remember it.


But moving on, this blog is not here so that I can disover how my mind works.

When is 1500 deaths more important than 200o death? It is likely that these figures are wrong, but the point I want to make is that more people die from adverse drug reactions in the Uk then from MRSA. However because you can take pictures of doctors not washing there hands and it can give simpler headlines more resources are given to preventing MRSa then adverse drug reactions

Cricket 2

England are on tour at the moment in Bangladesh. I am unable to feel as excited about this tour as I did about the South African one. England should not loose this, and because I feel like this I am just expecting a whitewash and that anything less would be a disapointment

The day the Immigrants left

I am a big fan of evan davies, I think he's an absolutely brilliant presenter. I therefore watched his latest program, "The Day the Immigrants Left." It was quite well done and it reaffirmed my view that if people want to live in the UK, then thats brilliant.

This annoyed me though

"I won't do a job that I don't find very interesting," said 26-year-old Lewis, who has been unemployed for five years and was supposed to go to a potato factory. "I do feel a little bit pressurised to get a job, but it's not to the point that I can just take any job that comes."

Am I being harsh at getting annoyed at this guy?

Evidence

There is no evidence that rubbing oil on your head will cure cancer, therefore it is not paid for on the NHS. Similarly there is no evidence that Homeopathy works, therefore it should not be paid for on the NHS, unfortunately it is.

Homeopathy has been proven not to work, if it did a whole new force would have been discovered, not just in medicine but in physics. The person who discovered this force would have won a Noebel prize. Unfortunately it has been proven not to work. End of story

Whats more relevant and interesting is discussing whether or not doctors should be able to prescibe a placebo. There is some cognitive dissonace on the topic within the medical professions. One one hand we are against it (we would be deceiving patients, they would not be fully informed) but there again somedoctors are quite happy with there patients trying out alternative medicines and not telling them about the placebo effect.

A nice letter from the BMA

Can you tell me what the GMC and the BMA do, is a typical question asked as medical interviews. The person being interviewed then says something like "The GMC is the regulatory body whereas the BMA acts as the doctors trade union." The interviewer can then be nice and move on to another stabdard question or be mean and ask something like "What else do they do" or "Why have they been in the News recently?"

One thing that could be talked about is the BMA attempting to campaign against the use of the private sector in the NHS. I have a letter in from of me from the BMA, they are against it.


One function of the NHS is to train the next generation. The BMA have kindly pointed out how reforms may affect me here.

Another point the BMA have considered for me is the training fo medical students. This is expensive and therefore not really of any significance to private companies. Having medical students running around in a private hospital is bad, why would they want us there to watch hip operations and cataracts. We are bad news for them.

A-levels and University

When doing my Physics A-level our teacher would often go into more depth and detail on a particular topic then was necessary. When he did this I would switch off, I had a copy of the syllabus so that I knew what (and only) I needed to learn. This meant that I was able to get the required grades but that I was a poorer physicist (and therefore scientist).

This was the same with the other subjects, although as Biology was more my thing I read several Biology-related books.

This is in complete contrast to University, where you are expected to read around the subject to get higher marks (or to pass the exam in the first place). When revising inflammation and other pathology lectures for instance, you would not only go over the lecture slides, but find a pathology textbooks (Robbins, Underwood, Stevens and Lowe) and make notes based on what they had to say.

One of the problems with the current A-level system is that doing extra reading will not get you extra marks on the exam - sticking to the revision guide will. What we need are A-levels that encourage learning for the fun of it. One of my favourite books is "A Devil's Chaplain" by Richard Dawkins. In one chapter he talks about a headmaster called Sanderson, at a school called Oundle.

This was a guy who would leave the school laboratories unlocked so that the students could go and run there own experiments whenever they wanted to. I doubt that this would be allowed ever again.

Although setting an exam with open ended questions in the sciences would be easy to do, thus allowing students who have taken a genuine interest in a subject to excel and show how much they know and love what there studying

Exam

I have an exam tommorow, thankfully its in the early afternoon, so I can spend the morning cramming as opposed to tonight. So the post I thinking of writing on, such as voting reforms, election night, shane warne trying to stir things up again will have to wait.

One thing I want to say and I'll probably expand on this in the future, is that at sixth form I thought I knew how I studied best - Not only was I wrong but I am forced to accept that A-levels (as I did them) simply did not prepare me for studying at University

Rod of Asclepius; An interesting Idea

My last couples of posts have been either rants, or I've been trying to make a point (to varying degrees of success). So this posting is here just to be different. It is merely a repeat of something one of our lecterers told us.


The medina worm is a well documented human parasite that has no drugs to cure it or vccination to prvent it. The only treatment is to wrap the live worm around a stick (once it emerges from the body) and eventually get it out. This method was used 1500 odd years BC.



According to the lecturer this was an alternative theory as to the origicin of the Rod of Asclepius, the rod represents the treatment used for this parasite. Although its unliley, as in most representations it is obvious that it is a snake wrapped round the rod and not a worm.




When the worm emerges it causes a burning sensation, which some people have claimed could refer to the "fiery serpent," mentioned in the Bible, that were sent to plague the Israelites.


A horrible disease, that affects many people, such as in Sudan. Apparently though its supposed to be the next disease to be eradicated (after smallpox).

Why I dislike Tom Cruise

Whilst watching TV with my housemates I saw Tom Cruise, this made me angry. As a result I started to rant to the bemusement of my housemates. I present a more polished version here

I dislike him because he is a scientologist, an evil organisation that dares to use the word science in its title to give itself some credibility. Anyway the main reason I dislike it is because of its attitudes towards psychiatry. I dont know why this speciality appeals to me, maybe because I am annoyed that the stigma towards mental health is still around.

Tom Cruise (with no science background or education) believes that he know how to cure depression, hence his attacks on brooke Shields for using Paxil. Apparently chemical imbalances in the brain are a myth (they do exist or anti-depressants/anti-epipleptic drugs would not have got through the clinical trial stage)

Why has'nt he been challenged more about this? Every time he goes on TV he should grilled about this issue.

How come Psychiatry is seen as something different to other medical specialities? If I become a cardiologist or infective disease consultant I will not have to worry about cults going around telling everyone that my speciality is a Nazi Science.

Whats it like to be Old?

Spoke to a lovely lady on the train a few day ago on the train back home. She saw my notes and books and asked if I was a medical student. I replied yes and we started to talk. She was a retired social worker and during our discussion she asked "If I ever thought about getting older."

I told her its not something I've really thought about in any great detail, its something I've accepted but I'm quite happy in the knowledge that my best years are still ahead of me

Anyway the discussion turned to the fact that we have an ageing population, bring a whole host of problems. A big one is money. Money means that our elderly are going to spend there last few years stuck in privately run care homes. The majority of the staff who work there will be on minimum wage. Are you going to get the best carers who are happy with there pay for £5.72 an hour? Are you going to get low staff turnover?Especially when people realise that liddle will pay them more?

Why is it acceptable to argue that bankers should be highly paid to get the best people for the job? Using this arguments carers should be paid a whole lot more. Expanding this argument shouldn't carers also get plenty more holidays and bonuses to?

What does it say about us as a society when we ship off our elderly to a care home where success is measured by profit margins and not by the levels of care provided?

The MMR Vaccine

I was thinking of posting about this issue, but anything i would say is done here, and in a far superior way to anything I would write

Iraq

I supported the war in 2003 and I still do. Imagine if we did not go to war in 2003 and two years later Saddam decided to gas 10,000 people somewhere in Kurdistan in 2006? What if we had known he was going to do it in 2005 and did nothing? Would that have been right?

At the end of the day Saddam Hussein was a nasty piece of work who wanted to develop weapons of mass distruction and would have tried to do some if we had left him alone.

No matter what the Chilcott inquiry finds people have already made there minds up with regards to the war with Iraq. Unfortunately I dont think that Iraw as an issue will settle down. Whats more important is to concentrate on the worsening situation in Afganistan

Tennis and Books

Tommorow I am going home and coming back to university life on sunday. This means I shall be able to see the parents, revise in the kitchen with copious amounts of tea, coffee, hot chocolate, biscuits, sandwiches etc. I will be able to go to karate on the Friday night (am very rusty, but still find it fun).

On the train I will get some quiet time and finish off the book I'm reading and hopefully start on Bill Bryson.

And Sunday morning will be spent watching Andy Murray (hopefully) win the Australian Open

Tip Top

The day after antibiotics stop working

Just had a lecture on resistance to antibiotics. This photo was taken from the 1930s and shows how TB was treated back then (without antibiotics). Basically if you had TB you were treated with plenty of fresh air and then you had to hope for the best.

Hopefully the situation shown in this photo wont be repeated. Not over using antibiotics and other precautions are useful and necesarry but what we could do with really are some brand spanking new antibiotics.

When antibiotics were first discovered there was a sudden explosion in the number of antibiotics being found or made(usually a slight modification of an old one). This then tailed of to zero until the late 1990s when the oxazolididones were produced. More new classes of antibiotics from Big Pharma would be much appreciated.

The market though does not give a good incentive for companies to produce new antibiotics, for reasons given

1)Antibiotics are taken for 7-14 days, drugs for diabetes or hypertension are taken for years
2)Big Pharma makes a new antibiotic that then becomes obsolete within five - ten years due to resistance
3)Drug companies make a wonderful new antibiotic, this drug is loved by everyone. So Health Authorities decide to keep it for later and restict the use of it to try and stave off resistance developing. Therefore companies makes no money off it

I am a little scared that when/if I qualify as a doctor I am going to be facing infections that the generation before me could have treated but that I wont

Bugger

Ethics, how to think it all through

Medical students are (hopefully) taught to think logically and in a systematic way. This is useful, consider chest pain and its causes. Thinking in the way described above allows us to break down the problem - Is it a cardiovascular, respiratory or musculoskeletal cause?

This also applies to ethics. Potential medics are often faced with an "ethics" question at interview. A classic is whether or not Patient A or Patient B should get a liver transplant. The decision is made more complicated for the student when the interviewer drops into conversation that patient A is an alcoholic and has been for the last five years. Then student then says patient B should get the transplant. The other interviewer then chirps in and says patient B is unlikely to survive the operation due to a previous illnesses.

Thankfully ethical decision making is made a little easier when students are taught the four ethical principles. These were thought out to help ethical decision making in a more secular world. They are as followed

1)Autonomy - Patients should be allowed to make there own decisions
2) Non-maleficience - Doc should do no harm
3)Beneficience - Do whats best for the patients
4) Justice - How does your decision impact on the wider world? (a very rough definition)

At an ethics OSCE station i was given the following senario

A patient was diagnosed by his GP as having a viral cold. The patients was worried about an upcoming exam and wanted antibiotics (his friend had told him he should be on antibiotics). The GP reassured the patient that it was probably due to a virus, would hopefully disappear within a few days and antibiotics would be useless. Despite protests from the patient his GP refused to prescribe any antibiotics

I was asked "Using the ethical principles explain why the GP did not respect the patients right to autonomy"

Books

I have a few days off before I start working again, which means I have been able to go into town and buy some books. Having read several bill Bryson books (Notes from a small country, a walk in a woods) I brought two more – one about his travels to Australia, the other to Europe. I also purchase More Blood, More Sweat and another cup of tea by Tom Reynolds, a book describing life as an ambulance driver in London.

Despite only being 100 odd pages into the book I am a bit depressed at how nasty some people can be. Already people have put graffiti on an ambulance and stolen another’s sat nav. Other depressing bits mentioned how much time is wasted due to idiots consuming to much alcohol.

Its a good book and it does have some funny and heart-warming bits in. Although I will be happier when I’ve finished it and can move on to Bill Bryson, simply because it’s an easier read and it’ll be more relaxing.

Buses, Taxis and the NHS

Medical School Interviews are inevitably scary; one common question is to ask about the makeup of the NHS, which sometimes lead to a discussion about the future of the NHS and the involvement of the private sector. This can be tricky for people, you need to weigh up the pros and cons of the private sector in medicine and avoid pissing off the consultant who is interviewing you - they might get a significant portion of their income via private patients.



One analogy to start with is the bus and taxi scenario. Queues of people are waiting for a bus, but there are too many people for the bus pending. A few people in the queue get together and pay for a taxi. Everybody wins! The people who get the taxi get to their destination on time and the rest of the people in the queue get to travel by bus. Except the bus driver then decided to go and work as a taxi driver

It seems that patients who need the NHS are becoming like the people waiting for a bus, where the driver has gone over and become a taxi driver. At the moment the private sector is getting the better deal over the NHS

Now it seems medical students may need to learn the pros and cons of franchises. Hinchingbrooke hospital is being lined up to be run by one of five private companies. The aim of a private company is to make a profit to give to shareholders etc. The bottom line when talking about the private sector is that any money a private company does not have to be spent on patients is seen as a good thing, whereas in the NHS any money left over can be used to improve treatment or pay for more nurses etc (or at least in theory)

Calor, Dolor, Rubor, Tumor

These are the signs of acute inflammation as described by A C Celsus about 2000 years ago. He is best known for the medical work De Medicina. Some of the the titles for the different parts include history of medicine, general pathology (modern pathology textbooks are commonly slit into general and systematic pathology), parts of the body, pharmacology etc.

One thing that strikes me is the blurring between the amateur and the professional when it comes to practicing medicine. Celus is credited with being the father of pathology, but you can argue either way whether he was a "professional." You can argue he must be due to the amount of knowledge shown means he must be, but others argue bits are a little superficial. Also most household heads would know some medicine (it was easy to pick up the relevant knowledge being an educated lay person), as it would be useful when running a large family with copious amounts of slaves etc

Also thanks to celsus we use the term cancer today. He translated it from the greek carcionos. Both terms mean crab and apparently refer to the fact that dissected malignant tumours were perceived to have pincer like growths into other tissues.

Tea and Mars Bars

In one part of the hospital that I am based at, one obscure little cafe, based in the researchy ara of the hospital, provides a cup of tea for 40p and a mars bar for 35p. At the front entrance to this hospital, where all the patients walk in and out (its also next to the main reception), another cafe owned by a big company provides a cup of tea for £1 and a mars bar for 55p.

Bit unfair dont you think?

Diet and the Big Brother State

This graph shows how much money is spent by the government telling us what to eat when compared to the food industry.

Not that we're influenced in anyway by advertisement when it comes to deciding what to eat. As responsible people we just use it all to come to an informed decision

Anyway I am pleased to annouce that afert a week of 2010 I have still stuck to my resolution of eating five (or more) portions of fruit and veg and a day. And have ignored the chip shop that is a five minute walk from my house

Nothing to get your hopes up about

Medical students are taught to be rather sceptical when evaluating new treatments (or anything else for that matter). This has served me well, especially when I am "Home, Home" and I glance the Daily Mail as read so by my parents. Apparently Alzheimers disease can be prevented and reversed by using mobile phones.



This was based on just one study on 96 mice, to me this signifies nothing, except maybe as an indicator as to where future research should be directed.



A quick google search will find this article, that didn't seem to worry or affect us then