Thank you...

to all the nursing staff who

1)didn't bleep me to come and prescribe paracetamol when it was already prescribed PRN
2)looked at all the drug charts to see if the fluids had been prescribed there before bleeping the Fuddled Medic
3)wondered if the FM had gone into AKI during her shift and made her a cup of tea
4)had an ECG done, taken some bloods whilst the FM was on her way to see the patient with chest pain
5)didn't get annoyed when the FM asked why a patient needed fluids or when she took five minutes to look at the U&Es
6)who bleeped the cannula nurse instead of me (as opposed to the FM asking down the phone if they had bleeped the cannula nurse)
7)who thought my request to await for a patients INR to come back before I prescribed warfarin was reasonable, as opposed to me "being funny."

Weekend

The Fuddled Medic agrees with the Medical Registrar on call that it would have been nice for his registrar to review the patient before calling the Med Reg, but is confused as to how useful the trauma and orthopaedic registrar would be in dealing with an acute stroke. Besides he was in theatre and wasn't answering his bleep

On call

How to survive an on call

1) Have a good nights sleep beforehand. Be tucked up in bed with a nice hot chocolate by 11:00pm.

2) Have a good breakfast, preferably involving kippers or bacon. It may be the last time you eat that day.

3) Keep a copy of the oxford handbook in the one ward you cover and the foundation programme in the over.

4) Buy the nurses chocolate, it really does work.

5)When calling the med reg be very clear what you want him/her to do. When on the phone they will be coming up with questions in the hope you don't know the answer to so they can tell you to go away and come back when you do know the answer.

6) When/if the med reg comes worship him. And have two pieces (at least) of clerking paper ready for him.

7) If you can, find the sho's/cts in anaesthesiae and butter them up so that they'l come and do a cannula for you.

8)When the cannula nurse agrees to help you with bloods, cannula's etc, have stuff ready for you. They'll remember it.

9) have something to EAT AND DRINK. At least so you don't have the irony have treating somebodies AKI when your technically in it to.

Cynical?

Am I right to be a bit annoyed and cynical about a colleague who was seen in a nightclub last night very drunk last night who did not turn up for work today? Especially as it doubled the workload for one of my colleagues.

Confidence and Careers

Starting work has been stressful, mistakes have been made on the whole (I hope) myself and my new colleagues seem to have done ok.

On call have been stressful and then the doubt starts to come in. Should I have reviewed Mrs X who track triggered or Mrs B who seemed just as sick first?

Did I do the right thing? Should I have seen this happening earlier? Did I miss something?

An FY2 colleague said to me - "Your doing fine. Everybody ended the shift hemodynamically  stable and those who weren't, you got a senior to come along."

Apparently this gets easier and you start to relax. Hope it starts soon

Radiology

Consultant Radiologist 1 - Asked me why I wanted a CTPA. I explained that we wanted to rule out a PE on a patient as he was tachycardic, respiratory rate of 25, desaturations to 85% and had spoke to the med reg who agreed a CTPA was necessary. Agreed to do it.

Consultant Radiologist 2 - Exact same picture as before. Told me that an FY1 should not be requesting CTPAs, shouted a bit, ordered me to speak to the Med Reg and get him to speak to him directly. Resulting in me wasting time getting someone more senior than me to speak with a radiologist to tell them exactly the same as what I did

ECG and orthopaedics

The Fuddled Medic is working (blundering through) as an FY1 in trauma and orthopaedics. This involves conversations like this.

My Consultant - How is the patient?

Me - Well they went into retention last night so we catheterised them. Also there kidney functions don't look so good so I've reviewed and increased there IV fluids and ordered a renal US. They also suffered a morphine overdose on return from theatre, so we reversed this with narloxone and this brought there respiratory rate back up.

My Consultant - I meant, how is the knee I operated on?

Or something along those lines.

I have survived a weekend on call, an evening on call and am cautiously optimistic. On the other hand I have forgotten how to read ECGs and am grateful to the passing Med Reg who kindly agreed to review one for me. As a result this weekend has been spent reading "ECGs made easy."

And as a result of becoming a doctor, I've only gone and joined the National Trust - how middle class can you get

Day two

I have survived two days of being an FY1 doctor! And on both days I got home by quarter past five. I am cautiously optimistic to about how they have gone. Although I do not want to curse it.

Another day to get through and then its the weekend

Scientology

Isn't religion or a cult scary? What's the difference? In one the guy who made it up is dead, in the other they are still alive.

I'm bringing this up because of Tom Cruise, a nasty piece of work who thankfully won't be able to brainwash his daughter.

It seems sad though that the enlightenment appears to be fading.

Anyway, if you get the chance watch this

http://www.youtube.com/watch?v=Cr2BijIprqg

Shadowing

The FM is hungover (but not by much - thanks to four cups of tea that were drunk before I went to bed) and is going to spend the day watching england v west indies.

In other news she is shadowing at the moment. She starts on Trauma and Orthopaedics. Unfortunately the hospital have put on so many bloody lectures that she's only had one full day of shadowing. Most of my colleagues seem nice to, although one is perhaps a little mad by stating that the earth is on six thousand years old.

Bloody Politics

Whats the point of having a ranking system if your not going to follow it?
http://www.telegraph.co.uk/sport/olympics/taekwondo/9313866/London-2012-Olympics-Aaron-Cook-writes-to-minister-over-Team-GB-taekwondo-selection-concerns.html

C-section

According to this from the BBC News website if your child is born by  Normal Vagina Delivery there less likely to become fat. Problem is that a risk factor for needing a C section is a big baby, diabetic mother etc, which are also risk factors for having an obese child.

The only true way to find out if having a C section would be a risk of causing obesity in itself would be to conduct a randomised controlled trial. Get one thousand pregnant women and randomly allocate them to NVD or to C section. Then follow up the kids in ten years time and see if they are fat or not.

Rhymes with "Clucking Bell."

Thank you JD for highlighting this. This idea is the most stupid one I have seen.

"The announcement has been broadly welcomed by doctors leaders and NHS managers."


What the hell! Who would be idiotic enough to support this proposal? Or is it simply "support" in the same way professionals supported the health care bill?


All this will do is make GPs in middle class areas look good and GPs who work in deprived areas  look bad.

This simply isn't feasible to do. 

Orchestra and Epilepsy

The brain is like an orchestra, with everything running smoothly and in harmony with one another. An orchestra is usually playing together to play something nice. However every now and again a Lady Gaga appears and disrupts the whole bloody thing.

That is how you explain epilepsy to an eight year old

Ward 401

Not a very enticing name for a medical documentary about life on the geriatric wards. We have plenty of programs dealing with sick kids who people can very easy feel sorry for and go "oh, isn't she sweet," or "what a brave little soldier he is," etc etc.

How about a program about life on the stroke unit or the geriatric ward?

 (SHIT! I MEAN HEALTH CARE OF THE ELDERLY WARD - WHAT? THATS POLITICALLY INCORRECT TO NOW? SORRY - HEALTH CARE OF THE OLDER PERSON WARD).

Ahh, I see. Talking about Mrs Jones who has dementia, cant wipe her own bottom and has come in because she has had a fall doesn't make very good television.

OSCE or SSCE?

Is it an Objective Structured Clinical Examination or a  Subjective Structured Clinical Examination?

On paper is should be objective but in real life its down to whether or not the examiner takes an instant like or dislike to you.

The FM passed a resit OSCE yesterday. On her first sitting she got 31/32 for the head and neck station. Second time round she failed this station, despite her examination being exactly the same, a neck lump in exactly the same place and her suggested differentials being the same.

This time round she got full marks in the lower Peripheral NS and Breast station, despite failing them first time round. Her examinations were exactly the same, down to the same way she introduced herself and held the tendon hammer. This time round the OSCE gods were smiling.

There is also the fact that OSCEs are a game. First time round she passed the critical care station but dropped a couple of marks. After getting feedback she realised there was a mark for commenting on the values of observations given to her in the station. Second time round she scored much highly for saying things like this...

"This blood pressure of 80/40 is low, I am concerned by it."

Repeat above statement but for pulse rate, respiratory rate, oxygen saturation etc.

A similar example is in the radiology station. Two bloody marks for simply stating that this is a "PA chest radiograph."

Is this really the best way we have to decide who is suitable to be a doctor or not?

On another note she got 29/30 for her abdomen examination (on both times), saying to the examiner that she would admit this patient who had an ileostomy two months and was in an incredible amount of pain, was probably the right thing to say.

IS THERE

The Fuddled Medic is now DR FUDDLED MEDIC. You heard me - A DOCTOR!

Assuming she does not have any outstanding library fines that could prevent graduation!

Weekly review

The FM has been stuck in a district hospital for a revision week. She thought they would bring patient in with signs for us to examine. Nope, mainly practicing on each other and answering questions such as "what are the causes of clubbing?"

Here is another video from the chasers for you to enjoy

Back in the UK

Where has the FM been? Here is a clue..

But anyway, back where money isn't water proof. And back to the grind, today she is going to have a fried breakfast, then she's going to the gym. Having lunch with a friend and then doing OSCE practice.

In other news she is no longer going to do four months as an FY2 in opthalmology -  its been changed to ENT.

Max and Spartacus

I've met Max Pemberton, he's a top notch bloke and I agree with his views on the NHS. I also agree that virgin trains are a pile of poo (thankfully the FM has a car and doesn't have to rely on the choice provided by railway companies).

Is the telegraph going to be sued? According to twitter, NO.

But his article is still worth a read

Update

Just a quick post stating I'm somewhere warm and where the money is waterproof(thankfully). Resit twenty days away. Time to hit the radiology books

Being Nice

"Why should we be nice to patients Fuddled?"

Because it helps them engage with the medical professionals and gives them a better experience?

"There's that, but also patients don't put in complaint's about people they like."

Professionalism

"You doctors are shit from taking blood from me," stated one patient. When this happens we smile and apologise profusely. Perhaps we should put our public health into practice and simply state it because your fat?

Thanks

for the comments, it is appreciated. Life continues.

Resit is on the second of May. The FM got 68% in the OSCE, this time it shall be 80%. That is her latest goal. The pass mark was 50% - just dumb luck in one or two station. But she has got feedback, she will improve.

As a result of the above her elective in Australia has been cut short by three weeks. However she has some time free from May 7 onwards, for three weeks. Am planning to do a mini elective in this country to do with paediatrics. Any thoughts/ideas/contacts would be appreciated.

In other news a patient was categorised today as a "recurrent faller." Probably will never be able to get rid of that tag

FINALS!

The FM is drunk, therefore this post will probably not be coherent. She has Failed Finals. She passed two out of three exams. In the one she failed she failed three OSCE station, you are allowed to fail two. If she had got 15/30 on the radiology station and not 14/30 she would be DR FUDDLED MEDIC. Shit

And some people managed to pass finals without even picking up a patient into anaphylactic shock. The FM failse because she could not quite tell the difference between a massive pleural effusion and consolidation and then started to stutter.

Hopefully a post coming up soon with some REFLECTION, that indicate REFLECTIVE PRACTICE is going on

The Apprentice

is what the FM is doing at the moment whilst she anxiously awaits the release of results for FINALS! CAPITAL LETTERS TO HIGHLIGHT HOW IMPORTANT THIS IS!!!

So she is shadowing an FY1 on a stroke rehabilitation ward (or as the logbook would rather me say - "be an integrated and valued member of the healthcare professional team/ more bullshit.") So she is shadowing and realising how little she knows, the FM success rate for taking bloods and putting in cannulas etc has taken a bit of a nose dive. But come August, she will be it! No more running, crying to the FY1 asking for help, because that WILL BE MORE (more capital letters).

The FM is supposed to do a reflection on the week that has just gone past. Perhaps pointing out that one FY1 to look at 16 patients (who despite it being a rehab ward, are all sick developing sepsis, pleural effusions, randomly dropping platelets to 31, get UTI's, have falling haemoglobins etc), is just plain DANGEROUS!.

Or perhaps a statement that she is shit scared?

FINALS!

Are over!....

Time to play Korfball and then get ridiculously smashed!

GPs

Apparently there was a meeting today. People invited were those who would benefit from a change in policy (surgouns - who do private work), whereas people who would implement the change were not invited (GPs)

The FM is not the brightest spark in the box, but even she thinks it a bit weird

UKFPO

This blog post is going to be a rant post, so if yor expecting a post about the FM enjoying playing with kittens whilst awaiting his doom in the upcoming OSCE, sorry.

The FM has found out what jobs she will be doing, she is not a happy Bunny. No Paediatric jobs, and working in a hospital three hours from home and miles away from all her friends.

The FM spent time on the wards learning HOW TO BE A DOCTOR! Learning how to take bloods, cannulate, do shitty bits of paper work etc. She should not have bothered, instead she should have spent her time in the library learning how to pass exams well.

Perhaps if she had did this she would have got six more MTAS points which would have been a significant help.

The FM mood is not helped when she see's people who are arrogant wankers wo cant cannulate for shit and upset patients, declaring they've got there dream jobs.

Apologies for the RANT but the FM is feeling quite bitter and pissed off. But these feelings will pass

Funny

Due to exams being in less than 48 HOURS TIME, I don't have anything interesting to say so I though I would copy and paste what I heard to medical student from the lower years say to one another.

Medical Student 1 - "Do you think he'd forgive me if I let him have anal?"

Medical Student 2 - "Well, it can't hurt."

Five days..

..and counting.

Any last minute advice.

In other news, I have a date!

With the library!

In other news Australia is less than six weeks away, but unfortunately four weeks of apprentishipness on a stroke ward awaits.

SNOW!

Going outside and seeing everyone making snowmen and having snowball fights is fun, realising getting to the library tomorrow will also be "fun" to

When to lie..

..to patients?

"When your anaethetising them, just before you attempt to repain a ruptured triple A."

Silence from the group

Bastards

One thing about finals fast coming up is that people's true personalies tend to shine through. Medics are notoriously competitive and in a significant proportion of cases just plain nasty.

Wards are full of interesting patiens with aortic stenosis ad interstital lung disease causing fine inspiratory crackles. And there are some students who after finding these patients will tell everyone else so they can benefit. And there are those who will keep it to themeselves.

Tea and Coffee

Going to the local library equals librarians bringing you big steaming cups of tea or coffee. Priceless.

Statistically the FM will pass the written paper.

Just three more weeks, then Australia (elective time)

I'm BACK!

You heard!

The fuddled medic is back, mainly due to being unable to do any work this afternoon and decided to restart the blog.

This is bad news, because finals, yes FINALS are in three weeks, three weeks on Monday in fact.

Generic, oh no FM, thats terrible news! Well yes it is. And any kind words of encouragement would be appreciated.

But anyway, besides going to extra revision sessions and the clinical skills centre to practice ABPIs amongst other things she's still managing two and a bit hours of exercise a week and hopefully, finding time to write.

This will probably involve posts such as "A Day in the Library," or "An evening of learning of interstitial lung disease."

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