Platelets

One problem with hospital medicine is the increasing specialisation. This means that we know more and more about less and less.

Sometimes there will be a situation when juniors in a particular speciality know more about a particular problem then the registrar/consultant.

Hence when I am asked to ring the haematologist to discuss a platelet count of 700 in a person when they had an operation one week ago I roll my eyes in disbelief.

For the tenth time I ring haematology to be told the answer I got last week. They have had an operation and are therefore in a pro inflammatory state. Thus, this is normal. Please don't call us unless it goes above 1000.

But I am an FY2 so if I say this I am ignored.

Wasted

No I am NOT WASTED!!!

But I am going to start writing again. I mean if Max over at the telegraph can write a few letters and then get a job publishing articles then surely I can do it to?

I mean I even once got mentioned, inadvertently in the guardian!

So newspapers around the globe, I am happy for YOU to employ me.

Anyway, better write an article first.

I am going into GP training, that is if I manage to fill in all the paperwork that needs to be generated and pass my ARCP.

I am going into GP because I consider myself a generalist. People ask each other if there "more medical," or which speciality they are. I do not want to be that. I am a DOCTOR and I look after patients, not there ears or eyes, or bowels or mental state, but the patient.

Right, that'll do for now!

Why

is it that manager who used to be nurses try to sort out staffing problems by getting bank/agency nurses in at five minutes noticed or who take nursing staff away from one ward do this? Surely it would be more effective if they did the shift themselves? (and more cost effective?)

Why is it that doctors who are now managers continue to tell the people on the shop floor what to do, as opposed to working next us?

Dear

annoying medical student.

Please don't sound surprised when I say I don't have time to teach you when you earlier stated you don't have time to help me with bloods

Regards

Fuddled Medic

Dear

Respiratory nurse.

Please do not demand I drop everything to run and do an ABG on a patient with infective exacerbation of COPD, who the respiratory consultant has stated is doing absolutely fine, so that you can have a look at the results before you have to go for lunch instead of afterwards.

Regards

Fuddled Medic

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.