I'm a coward

Time to call it a day, I started blogging with Dr Grumble, Rant, Crippen etc. Now they have gone, whether by choice or force.

I have done this blog for nearly two years, it has been a pleasure to do so. But I have lost my enthusiasm for it. I look back at posts I've written over the last few months and the blog is not what is was.

Blogging isn't fun for me anymore, especially as I'm young and dont really want to be noticed by anyone.

Time to call it a day

Stereotypes

A woman from pakistan who runs a shop with respiratory symptoms = TB

A gentleman goest to spain and gets some symptoms = Legionella

A 21 year old woman with lower abdominal pain = ectopic pregnancy

A middle aged woman wo seems quite irritable with muscle pain = fibromyagia

Anything else? Pretty sure I can pass any remainding exams if I just learn all the steroetypes

Thinking

The FM is gearing up for exams, especially the OSCE where she/he will be forced to go round 12 lots of stations examining patients, discussing ethics or looking at radiology stuff. Or pretending a dummy has anaphylactic shock with the words "rash" written on its chest.

But the problem is these exams are nerve wracking and yet at the same time encourage people to make up markschemes and learn them by rote. They do not encourage thinking.

Take the abdominal station, if I see someone who is well (i.e. stable) in an OSCE, I can deduce that they will have bowel sounds and are very unlikely to have a uraemic/liver/CO2 retention flap.

But he/she still has to go through the motions of listening to bowel sounds etc.

Is this a bad thing? Routine is go isn't it? Aren't you less likely to make mistakes if you follow the same patter?

My time

The time is coming where the FM will sit the exams to end all exams (at medical school at least), will she have learnt enough?

Yep, its here, finals are 14 weeks away. Panic is starting to kick in.

But I've got this far?

Cheers..

..Ben Goldacre for pointing this out to the FM. Can someone please give a definition of the term "temporary dementia." Perhaps it refers to when the FM has had alot to drink (in her case just three pints will do)?

Silly and Justice

There are the so called four ethical principles, autonomy, beneficience, non maleficience and justice (aka how does it fit into the wider community).

There is some silly notion going around that women should be free to pick and choose if they have a caesarean or not.

By this logic I should be free to decide if I want antibiotics for a runny nose, etc

Oh Dear

I'm afraid to say I've seen most of what Lily desribes over in Scrubs and Pubs. I have already blogged about the high proportion of unpleasant people within medicine and now I'm going to have to etend this to medical students to.

Indeed I have heard quite a few of my colleagues criticising FY1 for "only" being a year ahead of them. A year is a long time, particularly when the FM looks back on where she was last year. Plus we have not passed finals.

So why are we like this?

Is it because some of us were forced into medicine by pushy parents and various private schools?

Or because people came into medicine just wanting money? A very silly thing to do, there are far easier ways. But as mentioned before the FM gets annoyed and upset when hearing people boast about how much private work they want to do.

But a friend summarised it to me best, medical students quickly forget how lucky they are to be here in the first place

Rant over

Submit

Form submitted, time to get my life back . .

There must be a better way

The Fuddled Medic is anxious, she is applying for jobs.

This involves answering question such as "think of a situation that you found yourself in where you were standing upside down on a ward round. How did you manage this situation, what were your priorities? How might you share what you have learnt with your colleagues, who like yourself often find themselves doing this? Now for a poorly written statement thats long winded that you cant really understand with a token bit of jargon in."

Yes MTAS is here.

This depresses the FM, she wants to be spending her evening learning about medicine, practicing examination skills, revising physiology, perhaps even looking up how to manage and deal with stuff that can KILL patients.

But no, its answering poorly written questions. Even spell checker hated it

Ten days...

..since I last posted. This is because the FM is getting stressed. Finals are in Febuary, people are starting to loose there heads.

Am hoping to keep plodding along, doing a little and often.

In other news a patient told me she was going to send a postcard to her relatives as she was in hospital. This was because most partcards are sent to annoy people - hahaha i'm in a nice warm place whereas your stuck in a place where its raining.

Here argument was that this could be reversed - her relatives would get a postcard pointing out how luck there were not to be in a place that was prett shit

Radio 4

The Fuddled Medic likes Radio 4, in particular she likes listening to some of the comedy programs whilst doing some work. Yesterday she started to to learn/revise about gout and other interesting things whilst listening to the News quiz. Other gems include Just a minute and Test match special.

Whilst listening to the News quiz the NHS bill came up for discussion/mocking. One of the panellist issued a challeng to anyone from a private health company.

Go to Accident and Emergency at three o clock in the morning and volunteer to do a better job

Theatre and Gravity

Chatted to someone in theatre today who was more junior then I was. Asked her if she knew any complications of theatre. She did - falling of the bed.

Students and Reforms

I seem to be in the minority of medical students when I state I'm against the NHS reforms. Thats not true actually, most dont care. I should care more but I am not perfect, like most other students I care more about passing exams and finding patients with mitral regurgitation etc so that I can pass OSCEs as well.

Although unlike most of my college I also try very hard to have a life outside of medicine - it gets harder and harder.

But onto NHS reforms, its very hard to argue with fellow students when they point out the nice shiny building there sitting in built due to the PFI is a lot nicer for them and patients then the old, crumbling hospital building. And being cynical I think a huge proportion of them are looking to how much more money they could potentially earn under a future change- very shortsighted.

I have also found that people in favour of privatisation tend to be those people that can afford it.

A Resolution

To never ever refer to any other student as a "non-medic". The FM would hate to be referred to as the "non-historian" or the "non-midwife," so saying this ends here.

Home

The FM has left the placed she has trained to go home for the weekend

Paradise.

Apologies for the distinct lack of posting but the FM has recently finished one placement and started another. She is now based in a place where there is little/no internet.

Anyway, here is something to keep you going, what is the Triple T ratio about? More commonly used in A&E

What a week

Some of you may have heard of newsthumps, a spoof newswebsite introduced to me by Dr Zorro. Thank you.

The best article there this week was one saying how youths were so bored that they had turned to reading books.

The FM was going to go out this week. She did not as a result of the rioting.

There is no excuse for the violence. I sometimes think it is more disturbing seeing people excusing the rioting as there are not enough youth services.

If you dont laugh . . .

you'll cry

2N

"The patient was nauseous"

"Hang on" said FMs latest consultant, "Do you mean the patient was nauseated, or that the patient made you feel sick."

Bloody hell, not just the spelling that the FM has to watch out for

Unnecessary

Today the FM went to a clinic where her consultant went to see someone with a hydrocele. But said consultant does not deal with hydroceles and this patient should not have been sent to her clinic.

But no need to worry, surely said consultant should be able to refer this patient directly to a relevant consultant and clinic?

No, instead a letter was written to the GP making a recommendation and said patient was to make an apointment with the GP to be told they were going to referred elsewhere

Very silly.

MTAS

Oh dear, where do I begin.

In summary my career might depend on my abiity to answere a couple of questions using the right jargon (apologies - keywords).

Anyway, 10% of these answers will be audited, i.e. some poor sod will be asked to prove his/her answers.

But what counts as evidence? Everything seems to be mixed. Some say emailing your consultant (possibe a year after the example used occured), others say write down a reflection and get another medical student to sign it, others say it has to be a student on your firm.

Its annoying

ps - will be sending his/hers answers of to someone to have the SPAG checked

Teaching

What makes a good teacher? The problem is you dont know what makes a good teacher until further down the line.

Yesterday the FM went to a tutorial on bowel obstruction. As in most tutorials the FM was asked a question. Unlike most tutorials FM was able to answer said question and answer it well with a nice structure. Structure is good, as the examiner will hopefully be impressed by your thought process

And this is all because of teaching received twenty months ago by somebody she didn't know at all. The teaching came flooding back and the FM was able to regurgitate it back. This was because said teacher actually looked like he wanted to be there and simpified everything into a nice, simple way.

So what does make a good teacher?

Structure and enthusiasm.

Fail

A significant proportion of doctors I have spoken to this week are in renal failure of some sort, due to a proonged period of anuria

Medical School

Initial thoughts

Aim - to take bright, eager students and turn them into decent doctors

Reality - Take the most competitive A-level students and make them even more so

Moaning and Monopoly

Monopoly is a board game that either be incredibly dull or incredibly fun, unfortunately you don’t know which one it’s going to be until an hour into the game. It’s also used to describe a situation where somebody or something owns/controls the vast majority of a particular market/substance.

For some reasons Medics seem to think that they have a monopoly on “working hard,” in the mistaken belief that only medical students do any work whilst at Uni. This is partly due to the fact that medics become isolated from other students and get a warped view of themselves. Indeed medics do work hard but the FM knows plenty of engineers who work much harder and give up there holidays to do unpaid internships.

Does it really matter if we have this view of ourselves? Yes, especially as some medics seem to think there better then what they are.

Well we don’t have a monopoly on working and compared to some other students (student nurses/midwifes) we have it pretty easy when it comes to shifts – unlike these professions we don’t have to do weekends or evenings or night shifts.

So why this mini rant? Because it’s an unnecessary wall that we put up between us and everybody else. Sure, we are stressed and we have lots of exams but that’s no reasons to think we’re different to everyone else. Plus it makes us incredibly dull at times. There we go – tenuous link to the start of this post.

Interesting

If you’re a patient in teaching hospital I wouldn’t know what’s worse, being deemed “interesting” by a consultant and having a large, angry looking consultant (whose annoyed that they’ve got to do some teaching) followed by eight medical students. Knowing that they are walking towards YOU with the intent of prodding and poking you, or walking past you because you’re a boring, simple case - not worthy of any attention at all.

Frogs

Today I went for a walk which included going past a largish pond. The ground next to it was swarming with little frogs. It was only just a few weeks ago that on the same walk I saw hundreds of tadpoles swimming around.

Happy Days

Tomorrow’s Doctor’s

The GMC published something called tomorrow’s Doctor’s, which tell medical schools what they need to teach us as students. The FM is not really impressed by it as a document; one example is that it only mentions children three times in the entire document. Unfortunately the GMC is the only body that can shut medical schools down and therefore the wants and wishes of other stakeholders in medical education are being ignored or sidelined just to keep the GMC happy.

The Fuddled Medic has noticed that consultants of various different specialties are annoyed that they don’t have time to “sell” there specialities, there passion to students and instead have to teach to a well defined syllabus.

This is a bad thing; it does not prepare students for the “real word” and reflects what is happening in secondary education where students are taught to pass exams to keep Ofsted happy as opposed to allowing teachers to let their passion shine through.

Water

Today the FM went shopping. Whilst doing so she noticed some sainsburies basic mineral water. Who on earth decides that they need to cut back on costs and replace Buxtons or Evian with Basics mineral water?

Sift and Services

Like many Medical schools, the one attended by the Fuddled Medic sends students all over the place to different hospitals of different trusts so that we can be trained to become doctors. In theory the teaching provided at hospital A should be the same as those provided by hospitals B, C and D. However this is simply not the case. One hospital provides three hours of teaching on ECGs, the rest provide one hour.

How is this fair?

The Fuddled Medic is aware that students are becoming more “militant” and are demanding better value for money, especially with impending tuition fee rises on the horizon. In the future medical faculties can probably expect a bay of students sitting outside demanding the same level of teaching that their peers receive.

A few weeks ago the FM posted about teaching being cancelled; don’t be surprised if in a year or so medical students turn around and demand that it be rearranged. Indeed colleague of mine would probably have been quite rude and argued that they were being paid to teach and therefore cancelled teaching due to bank holidays was simply not good enough.

Exams

So the FM passes through some hoops that were put in front of her. Yet she does not feel that pleased. You see her results were all below (bar one) that of the mean and median for the year.

The FM does not like feeling like a slightly below average. Especially as one of the specialities was something that the FM is considering specialising in.

At least the FM passed, that is the main thing

Tennis and Fuddled

The Fuddled Medic is a tennis fan who enjoys playing and watching (all of the grand slams, not just wimbledon) tennis. She has just watched another news report on why there aren't many top British players.

Here is my moneys worth on why we have a problem

The Fuddled Medic wants to go swimming, £2.50. The FM wants to go to the gym, £3.00.
Going to play tennis at my local tennis courts, £7.50 per hour - even when none of the eight courts are being used. Indoor courts are £13.00 per hour.

Brilliant

Hope the chap doesn't get into trouble with any managers though. . .

Southern Cross

Why is the department of health getting involved? Isn't it a matter for the private sector? Esepcially as the current government loves the private sector so much? The thing with the private sector is that if a business is going to go bust - you let it go bust. That is the nature of competition and capitalism.

Ahh, but this is different, the department of health has to get involved to stop dear old Aunt Muriel find herself on the street wehn Southern Cross goes bankrupt.

Fair enough, but the whole point of the private sector is carrot and stick (failure), it has to have both.

And what happens in the future if private companies running bits and pieces of the NHS goes bankrupt? Do fancy new buildings used for patient care get sold off to pay debts? Do endoscopy lists that take place in a private hospital for NHS patients still get done?

etc etc

Ridiculous

The FM is referring to this article. Am pretty sure midwives know that alcohol is not the best of ideas during pregnancy, its as if people don't realise they are highly trained professionals.

Poor Kids

A Kid in Manchester will have a life expectancy of seven years less than that of a child in Barnet. Before the FM started medicine she did not give health inequality or the gap between rich and poor much though – she has given more thought to it since.

So why does it matter if a child grows up below the poverty line? Because there are higher chances of infections, anaemia, middle ear infection amongst many, many more.

Currently the FM is watching the BBC documentary, Poor Kids. Watching it is heartbreaking, currently at the bit where the girl in the flat in Glasgow where she shows us the damp. When clerking children in hospital it is important to do a proper social history, including to ask about any problems with damp at home.

The fact that 85% of children who live in damp suffer from breathing problems has popped onto my screen.

Let us assume the FM becomes a paediatrician. Will she do any good? Is there anything the FM could do about what she is watching? Or should she have gone into politics and tried to decrease the gap between rich and poor?

Bastards and Gunners

The Fuddled Medic is going to join a profession that include a whole lot of bastards. In one of the first lectures the FM attended the lecturer stated doctors have a higher than average amount of
· Racists
· Sexist
· Homophobes

As a profession we have a higher amount of bullies to. And this is something that is not just experienced by medical students but by junior doctors as well. Most students work on confidence, after a few weeks of things going well students start to believe that they might have what it takes to be a doctor. All it takes is for one bit of humiliation in front of eight other medical students for this to go, with poor student going backwards.

Buts what’s worse that this?

Gunners, the term given to overly (usually downright rude) competitive medical students. These are far worse in the FM’s mind. An arrogant consultant can be easily ignored, or thought off as old fashioned and ignorant. A Gunner will find it easier to sow doubts in minds. Are you doing enough work? Why can they answer questions that you can’t?

Unfortunately MTAS has made it much worse. In the good old days it was a case of pass or fail. Now it pays to be in the top 25 or 50% of year. This is wrong, either you are competent or you are not.

Privilege

One thing that annoys the Fuddled medic is people who don’t appreciate how lucky they are. At some stage (or quite regularly) medical students will get bored sitting in clinics staring at the back of the ophthalmologists head or standing in theatre. All medical students should be acutely aware that if they don’t really want to be there, many hundreds of other students would jump to have that opportunity.

Perhaps this is why the Fuddled Medic gets annoyed when she see’s other students skipping stuff. The time you skip a nursing shift or a clinic is a time that could be given to someone else. On a personal note there are clinics that were inspiring but the FM could only go to one due to other students being roistered in. The FM could have gone twice if she had known other students weren’t going to turn up.

So why the title of this blog post? One problem is that a significant proportion of people who got medical school come from a background where they have everything handed to them on a plate. How can you appreciate medical school when you have had to do relatively little work to get in? If you’ve been told what’s going to appear in exams, you’ve been coached in ethics, you’ve had lectures put on for you by the school, you’ve been coached on how to answer interview questions?

Does this post make me bitter? Or is it a valid observation? Certainly I don’t want a class war. And the Fuddled Medic has many good friends who went to private school, the difference being they appreciate how lucky they are.

Culture

The FM has been reading about the Panorama program about abuse at Winterbourne House. After reading about it and watching some of the clips she doesn’t think she could watch the program - it would be too much. But unfortunately the FM is not surprised. This type of thing is common and the FM believes part of it is due to the private sector being involved in the providing of care to vulnerable adults.

The FM has briefly blogged on this before. A significant part of it is due to staff being on minimum wage and a high staff turnover. And my next statement may seem judgemental, but if you pay minimum wage and as a society give the impression that care work is not worthwhile then you will attract the “wrong” type of people for the job.

Private care homes are very good at telling the regulatory bodies what they want to hear. The only way to reduce the amount of abuse is to have inspections that are completely unannounced and at random times.

But that won’t be enough, let’s face it the vast majority of people don’t give a dam about people with profound learning disability or mental health problems. We simply don’t consider them a worthy part of the population. We are more than happy for an important job such as being a care or support worker to be done by people who have relatively few qualifications and a poor educational background to do this job for pittance.

Coupled with the fact we are happy for private companies to provide the relevant training. And what will they do? Do it as cheaply as possible

Apologies

The blog has been neglected of late with shoddy posts at best. I am therefore going to take three weeks off from posting. Hopefully when I decided to start postings again my head will be full of fun, innovative though thought provoking posts that you usally get on other blogs.

Given . .

. . .the game away

Three days

Three days left to learn these bad boys, pretty much by heart.

Pens and Pencils

Apparently the Americans spent $20,000 on developing a pen that could work in space. Whilst the Russians just made do with pencils. Amazing!

Postcard time!

The FM is now revising for his exams, a common practice is to rote learn answers to MCQs. You give us hoops, we'll jump through them. Here are som for you, the readers to do!

Pre-menstrual Syndrome . . . . . . . . . . .

a. is due to lack of progesterone.
b. is a diagnosis beneath contempt.
c. may respond to removal of ovaries.
d. may respond to an LH-RH analogue and transdermal oestrogen patches.
e. may respond to cyclical selective serotonin reuptake inhibitors.
f. vitamin B6 is of proven efficacy.
g. progesterone drugs are of proven efficacy.
h. danazol may be effective.
i. may respond to pre-menstrual oestrogen.
j. is 'all in the mind'.

True, false or abstain!

Emotional

Not really a royalist, but not a Republican either. But today emotions got the better of me and as I revised APH and the causes of male infertility I did well up and nearly cried as I put down my pen to watch the wedding vows on TV.

Got I'm pathetic at times

Brick Wall

I took half of yesterday off to play tennis and catch up with old friends. I went down to the library this morning and did a few hours of work. Then I did nothing this afternoon, having decided to fit in a cheeky gym session.

Meant to work this evening but cant, have hit a complete mental wall. Going to procrastinate for the rest of the day, watch some tele and hope I can start again tommorow.

Bloody Hell

Bank Holiday

Next Monday is a bank holiday, which means a cancelled tutorial given by his current consultant. The FM being an enthusiastic chap asked politely if this tutorial would be rearranged? The answer was no and said consultant seemed a little annoyed at being asked this. Was the FM being rude, or was it a pefectly reasonable request?

Violins and Easter

You wake up in the morning and find yourself back to back in bed with an unconscious violinist. A famous unconscious violinist. He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist's circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. If he is unplugged from you now, he will die; but in nine months he will have recovered from his ailment, and can safely be unplugged from you.

On wednesday the Fuddled Medic had a tutorial on ethics, he had forgotten how much fun ethics could be.

Have a good easter, postings will restart next week.

Screening and Cake

The Fuddled Medic's Housemate has just shown me this video . . .

Anyway, much appreciated as was the delicious chocolate cake that she baked.

On to screening. Its completely different to most of medicine. Normally people go to see a doctor because they are ill and hopefully we make them better, useing the best available evidence to us.

Whereas with screening we take perfectly health people off the street, subject them to tests, scare the daylights out of them and then state that they may or may not be at increased risk of a disease. Wilson-Junger criteria is used to assess if screening is worthwhile. D

oes screening for Downs Syndrome meet this criteria? I am now not sure. Does a TOP count as treatment?

And are patients explained adequately what the screening involves? Apologies, its a bit old and from the mail but it highlights the point.

And after reading this article am a bit annoyed, is reduced fetal movement a classic sign of Down's syndrome? Bloody hell, pretty sure its a non-specific sign. Hope its not a T/F/A question in an exam.

Music

Can you revise effectively whilst listening to music? The FM has been involved in a debate with a friend over the ebst ways of revising. Can you learn whilst listening to Happy Potter on Audiobook. If you have a day off, so no clinics or ward rounds, how many hours of revision can you effectively do in a day? Six, eight, more? Exams are approaching and the Fuddled Medic is get edgy, has she done enough work throughout this term? Will she be dragged to see yet another hysterectomy four days before exams by her consultant? And does anyone know any good revision sites for Obs and Gynae and Paediatrics? Preferably one with lots of MCQs?

Crap

Today the FM was grilled by a consultant and not in a nice way. Any confidence that has been built up over her time studying medicine, feeling that she's good at this is, is starting to fade away. Bloody Hell

A week

A week is a long time in blogging as the old saying goes, so apologies for the lack of a post this week. All I can say is that not much is happening at the moment, but exams are looming (five weeks) and the FM has one eye looking tentatively as they approach on the Horizon. Today the FM is meeting up with some old friends who graduated last year. And then exscuses will be thrown out, from tommorow the FM will be spending alot more time in the library

Honesty

Yesterday the Fuddled Medic saw something that pissed him off. A colleague turned up for a tutorial/lecture signed in and then left after forty minutes despite another hour and a half to go. The FM does not mind if people miss lectures, its up to them how they learn and he can understand why some people thing they get more done spending an hour in the library then an hour falling asleep in a hot lecture room. But the above is dishonest. And its not the first time the above student has done this, indeed one group of medics didn't even realise she was in the group till about half way through the semester. Another colleague reckons this student should be reported to the faculty, indeed signing up for stuff when your not there is considered to be a serious event.

Privileged

Today I got to scrub up for a Caesarean section, absolutely amazing experience! Afterwards the mum thanked me, thinking that by occasionally holding retracters open that i had donse some useful. Its thinks like this that remind me why I love medicine, how lucky am I to do a course where I get to do something as amazing as seeing a birth.

Two

Two anectdotes to mention on this lovely Friday afternoon

Today the Fuddled Medic went to see the Dentist, this is something that scares the living daylights out of her. Whilst being prodded and poked the FM was asked what she thought of the NHS reforms. Unable to answer the Dentist proceeded to state that as well as medicine he recommended medical students do another degree in business studies due to how things are proceeding. The FM wants to be a doctor, not a businessman.

Yesterday the FM asked the consult she was shadowing if they were on the health care of the elderly ward. The consultant whispered in my ear that all medical wards eventually become geriatric wards.

The FM isn't a business person but she knows that caring for the elderly is expensive business, and judging by how a considerable quantity of private care homes are run making profit and high quality health care of the elderly wards probably aren't hand in hand

Elective

In 369 days the elective period starts, the FM wants to be a paediatrician and want to do this during her elective. Somewhere warm would be nice, english speaking perhaps. The FM is not very good at languages. The FM should probably have started to think about electives earlier and is reading through past elective reports.

Any suggestion from readers out there? Or just a place to start

LOC

Earlier on this blogs historyI posted about acronyms, here is another one.
What can LOC stabd for?

Different

As part of my training the FM gets sent to different hospital sites, who do things differently to one another.

At hospital B everything is timetabled, you rock up on your first day and they give you a timetable with all the clinics assigned to you, times of lectures, days with other specialities etc. If a clinic you were down to attend gets cancelled you tell the administrator and they rearrange another one for you. They seem to take pride in how organised they are and how much they do for the students.

At hospital C you turn up and are given a list of phone numbers and told which consultants you are assigned to. It is then up to you to find out when clinics are on and to sign up to things.

I accept that medical students should be quite proactive in doing things for themselves, but I am sceptical as to how one hospital is able to provide more timetables and look after you better then another.

Annoyed

Can you make training tommorow Fuddled?



Fuddled Medic quickly consults timetable and see's that he has a lecture at four, which is due to finish as five. Indeed the FM can turn up, or so he thought. Bloody lecture runs over by half an hour, so is unable to get back in time to attend.



I hate it when this happens, making a commitment and then having to break it

Sad and Mad

Few things make the FM Sad and/or Mad, the FM like to keep non-judgmental and not let things affect him. Here I make an exception.

On the way to clinic this morning I saw a woman driving who was smoking at the same time. Then I saw a child sitting in the back seat.

Bloody Hell

Surely Not

One thing that medical school has done to the Fuddled Medic is to make him very good at passing exams. Thankfully I have not yet failed one, although I admit I have come close.

Today I found out I have passed another one. Only two more sets of exams stand between me and being an FY1. Scary.

And yet I still feel like I know nothing, I know enough to pass tests, but enough to be a doctor?

PR

I have only seen a little bit of "Junior Doctor - Your life in their hands." What little I saw annoyed me, why on earth anyone would want to be shadowed by a camera crew whilst doing this job is beyond me.

Plus the music irritated me, seemed to make the job glamorous which it certainly is not.

Apparently though (I did not see this bit), one doctor had not performed a PR whilst in medical school, (The FM has done one). I thought this was something you had to get signed off to say you were competant to do?

Off

I have a day off, hooray. Its already been spent playing tennis and recovering from hangover and the rest of it will be spent in front of the laptop watching cricket highlights

Food

The Fuddled Medic likes food, especially when coming back from a tiring day clerking patients or playing sport to find his housemate has cooked a wonderful dinner. A decent meal will make you feel refreshed and energise.

Feeling refreshed and energised might seem like a good think? Unfortunately patients wont feel like this on the wards in a huge proportion of hospitals.

What scared the FM most was the government response. It was all about GPs and the new changes. Readers may know that the FM is sceptical of these NHS reforms. From what has been said on the dispatches program it seems that any criticisms of the NHS will be met by this . . . .

"We are giving GPs all these powers, so that the public can themselves raise standars and GPs will be able to say what they want doing."

But without significant resources GPs wont be able to make a difference and the FM feels that these reforms are in place so the government can devolve blame to the GP.

But the FM is a bit of a cynic

Goodbye

Had my last day in paediatrics yesterday. Very sad, until now I have not had a placement which instantly caught my interest. If I want to do it again (i.e. as an FY1 doctor) then it means at least 18 months of not doing paediatrics.

Surgery

I have now been told twice in one week that I come across as a surgeoun, why?

Incident 1 - Saying to a colleague, he'll live whilst practicing cannulation on each other - this wasn't in response to a failed attempt on my part

Incident 2 - Discussing 1st year male medical students and how immature they are. This was whilst helping out in a teaching session they were going through. I commented that any immaturity they had would quickly be knocked out of them when they started out on the wards and someone started shouting at them for it

Confidence

I am a much better medical student i.e. presenting/taking histories and examining, answering questions when I am surrounded by other students who at least pretend to give me some respect. When working with the type of person who would sell there own grandma to proceed up the ladder and makes it plain they conisder you to be inferior, then I simply fall apart.

Bugger

Differential diagnosis

Its important to know the differential diagnosis of various diseases. The Fuddled Medic has just had a lecture about epilepsy. Or rather a talk on "what else could it be?"

The FM was solemnly taught that epilepsy itself is boring, everyone will probably end up on Valproate if its not contraindicated.

So what else could it be?

1. Bening myoclonic jerks
2. Benign paroxysmal vertigo
3. Obstructive sleep apnoea
4. Night Terrors
5. Adolescent stretch syncope
6. Other types of syncope
7. Sandifer's Syndrome
8. Daydreaming
9.Infantile Gratification
10. Reflec anoxic seizures
11. Head Banging

Anymore out there? Please let me know

Lucky and Education

I was lucky to go to a state Grammar School. As a result I got pushed and did the best to my ability at GCSE and A-level and went on to study medicine at University. After watching Andrew Neil chatting about social mobility it would be fair to say it has stalled.

This is probably due to the decline in Grammar Schools. Children who went to a Grammar were able to compete with children who were sent to a private school. As a result the top jobs in business and politics were opened up to people outside the upper classes.

Perhaps this is why politicians dislike grammar school? They know that there success meant the end of "jobs for the boys."

All I know is that I was very lucky to go to a Grammar School and I wouldn't be writing this blog if I hadn't gone

A Twat

"We don't get the results we should compared with other European countries; if we did we would save thousands of lives," he told the Andrew Marr Show.

This was another pearl of wisdom from Andrew Lansley, a lovely chap who accepts money from the private sector. Probably get sued for saying that.

His above comment seems to suggest that if you oppose his plans then you dont really care about saving thousands of lives. We dont get the same results as other countries, perhaps this is because we smoke and drink more and on the whole as a nation we're quite fat? (and lazy?)

I have yet to meet a medical student who is happy with these plans, indifference or a sense of "oh shit," seem to be prevailing themes

Pressure

The fuddled medic enjoys cricket, particularly working whilst listening to Test Match Special. Indeed the FM shall be up early and doing some Cardiology while hoping England can beat Australia in the 3rd ODI.

But something I want to discuss is based on a comment by ex england captain Michael Vaughan. He argued that as professionals players should be given freedom to train, relax and rest when they want. And that they are in an environment where they are always under pressure, so everyone needs to back off and leave them to it.

Should the same apply to medical student? I resent always having stuff timetable all the time with no flexibility. On Friday I turned up a few minutes late to the lecture due to ward work running over. I did not have the register passed to me, and half an hour later I ran to the office and pleaded to be allowed to be sign in.

It is sad that the medical school and the University dont trust us to learn the stuff we need to learn and lest us get on with it.

And medical school is always full of pointless stuff that makes things more difficult then they need to be. Recently I have completed a one thousand word essay, with a subsequent presentation. Everyone knows its a load of bollocks, but its one more bloody hoop to pass through. Perhaps you believe I have learnt from doing said essay? Well a little, but most of the essay writing was making sure it corresponded with the markscheme and making it easy for the examiner to pass me.



And so my precious time has been wasted, I would have learnt more going to the wards or taking Kumar and Clark to the library and doing some reading.

The vast majority of medical students dont need someone dictating to them how to learn. We are capable of looking at all the different ways of learning and choosing whats best for us.

Please . . .

. . . go and see The King's Speech. I am usually quite generous with my markings when I see a film, but this was a genuinely good 10/10 film.

That is all

Layers

I have seen nothing by David Cameron that fills me with confidence about the future NHS reforms.

But enough of what I think, here I copy and paste some readers comment that I agree with as I cant be bothered to say anthing original about the topic

"This is a gamble because he expects there to be no unfortunate mistakes - embarrassing anomalies etc when the conservatives are transferring 80bn of expenditure in a very short period of time, to multiple consortia. Any decent management consultant will tell you mistakes will be made."

And think of all the paperwork, logo etc that will be generated.

"Now the tories want to replace 150 PCTs with up to 500-600 GP run consortiums. Unless you want your GP spending all day with their head down over a budget spreadsheet or typing up a service level agreement then each one of these will need it's own army of bureaucrats."

Consultants

I have heard stories of some NHS consultants who do the bare minimum NHS work that they can so they can maximise earnings working in the private sector. I am neither for or against this, with regards to private medicine and people working for it, its there choice.

As pointed out by other blog comments on this issue if consultants pay is attacked, then more of them will do this and the NHS will loose out.

Lunch

Yesterday I had a day with the GP, sitting in on surgery and going on home visits. After two visits the GP drove into a pub carpark. Thinking that this was a strange place for a home visit, I got out of the car and walked into the pub.

I think we'll have lunch hear, stated the GP. "Dont't worry its on me."

"Thank you" I erred.

I had a very nice lunch, am glad to think that I made a good impression. Not so this morning at clinic.

"Would you like a cup of tea doctor?" asked a nurse. The doctor said yes and I tried frantically to catch the nurses eye but she was gone. Obviously made a social blunder somewhere. I try whever I can to consume tea, it is a necessary fact of Fuddled Medics Law, which states that. . . .

"the number of cups of tea conusmed in a day is inversely proportional to the size of the stress headache at the end of the day."

Four

Medicine is full of people slagging of other specialities and trying to encourage people to join their discipline. One I heard today was about paediatrics and was that you only saw four types of patients - "Shitters, Pissers, Fitters and Wheezers."

Australians are legendary

Thank you for this Australia

Optimum Age?

This post originates from a paragraph in this post, written by Dr Grumble. What is the best age? Twenties, thirties, forties? With age comes wisdom, or from my experience cynicism. Don’t get me wrong though, I know a lot of older people out there who are optimistic and can still past on their cumulative knowledge to the younger generation.

So when will I peak? Physically I’m in my prime, playing sports has never been easier for me. At school I was terrible at PE. But Karate changed that.

Mentally? Certainly I am no cleverer then what I was during my A-levels, but I am certainly better at working, am more disciplined and organised with myself.

Life experience? Would say I’m getting there. Compared to other students, being a medic means you are generally exposed to more of life’s ups and downs then other courses. But I still struggle to adapt to new placements, situations, etc, some of the time. Assuming you get better as you get older.

Themes and Work

Tonight I shall do an hour or so of work. However unlike the last time I did some work I shall actually enjoy myself as I dont need to worry about exams and the question of "Will this come up in exams?" won't be a problem.

In other news, its 2011. Already I have, out of habit, put the date down as 2010. Sigh.

So what are your new years resolutions then Fuddled Medic? I hea you cry!

Dont have any, but are some non-specific goals for 2011.

1)Work Smarter, I have a system that works for me, I set myself a goat of working say, 2.5 hours withing a 3 hour timeslot. When exams are coming up I plan my revision day to the tilt. If I can do this a bit more whilst generally working during the term I should have more saved time.

2) Do roughly the same amount of exercise as I did last year but try and eat a bit more fruit and veg. Or just go home more and let the parents cook lovely food for me.

3) Stop Swearing. From Monday next week I shall donate a small sum of money to charity everytime I swear.

Take care dear readers

Medical students act like students, shock horror

Medical Students, like most students enjoy having a good time. After reading this pathetic attempt at an article from the Daily Mail my mind says, so what?

Although the FM would not party quite as hard as some students, the FM certainly drinks some alcohol. Indeed a wonderful night on Friday involved wine, port and beer and trying to pick up an after eight mint from the floor without using hands or knees. It was fun, it was silly, but its what we do.

But at the end of the day, 99.9% of us know that being under the influence of alcohol when dealing with patients or turning up to the wards hungover is unacceptable.

And as one wise daily mail reader pointed out, students have been doing this for a long, long time and will continue to do so.