The Leodisian Life...

[yeliab_cram]

Oh dear, im not very good at this regular bloggin lark am i?

Never mind. Time for a bit of catch up time. I am have returned to Leeds with avengence and whilst we all thought 4th year was hard (and it was) 5th year is even worse. Its just very busy indeed. Not a lot of time for eating, sleeping, socialising, blogging or even working most of the time.

Anyway, i am currently doing elderly medicine in pinderfields, officially the worst hospital in the UK. Built as a temporary military hospital some time towards the dawn of time, the porta cabin metropolis is still going strong, although they are finally building a new version. Despite appearances, pinders is always rather welcoming and the elderly medicine lot are lovely. although it can be hard to tell the consultants apart from the patients.

I dont have a lot to say about elderly medicine, except that everyone tends to be old and fall over, very grateful to the staff and deaf as a post. I did just read this though, which i quite liked "sucess is often impossible - there are just too many grey areas, but if you can stumble from one ambiguity to another without being too disenheartened then that is good enough"

Far more interesting was the previous four weeks doing general surgery in Bradford. Now, as avid readers will be aware, i like a bit of slicing and dicing. However, have never actually done any proper hard core poo-related surgery. Unfortunately, straight back from the elective, 2 years plus since doing any general medicine whatsoever is probably not the best time to meet the old-school surgeons from hell. They are infamous.

The placement didnt start on the right food when a certain Dr M gave 8 of us a tutorial on jaundice. Well it was kind of on jaundice, but was also on being completely retarded at the start of 5th year, answering all questions like a surgeon and being made to cry. I think they call it didactic teaching. I developed rabbit-in-headlights syndrome, and couln't look away, despite all the knowledge draining from my ears. It was not pretty. who knows about auto-immune hepatitis anyway.

This, however was nothing compared to our first theatre list with the surgeons. Mr A, the at least 70 year old big boss, who believes diathermy to be the tool of the devil and Mr G, his particularly infamous for being a complete bastard, younger protege. Me and my colleague were supposed to be in with Mr A for a morning list. We had been all productive and already and seen both the patients on the list. A guy with a probably rectal cancer and a lady having a subtotal colectomy (i forget why, i didnt see that one).

Heads held high we said good morning to the big boss:

Mr A: Morning boys
Me: Is it alright if we join you in theatre this morning?
Mr A: Well you can, but there's no ****ing point. they've cancelled half my list.
Me: ah
Mr A: quite, go in with Mr G.
Me: (shite)

We slipped in to the theatre next door where Mr G was already operating, well, he wasnt quite operating but he did have his hand a long way up a lady's arse. Dont worry she was sleeping... not like that. never mind.

Mr G: So what can you tell me about this lady
Me: (shit... bugger all, i saw Mr A's case) erm... not a lot i'm afraid.
Mr G: what do you mean not a lot, are you a retard?
Me: no, but I was supposed to be with Mr A this morning, but they've cancelled his list.
Mr G: so what, as soon as you were put on my list you should have got off your arse and seen the patients.
Me: [undignified silence]

At this point i should probably tell you a bit more about Mr G. So he is renowned for being a bastard to students. He is built like a brick shit house and looks like he would be more comfortable in a tracksuit and whistle on a games field screaming "run faster boy, run" not in an operating theatre with his hand up someone's arse.

He proceeded to grill us on fistulas for the next hour or so. Unrelentingly. It went a bit like this:

Mr G: what's Goodsall's law?
Me: something to do with anal fistulas (trying hard to remember)
Mr G: [shoots evil look through mask] what about anal fistulas.
Me: (partially bulshitting) isn't it that anterior fistulas drain directly into the anus but posterior ones curve round to the midline?!
Mr G: NO, well, yes, but why does it happen?
Me: I have no idea.
Mr G: Ha, well you will. By 8am tomorrow morning i want a hand written account of why Goodsall's law applies on my desk - non of this copying and pasting from the internet crap either.

What a bastard.

At this point, Mr A came in. "come with me boys" he said invitingly. Phew, i thought, we are saved. Go the old school surgical cavalry.

no, no, wrong again.

After shoving my entire hand up a little old man's arse (strangely not that wired after doing obs and gynae... anyway) he decided to quiz us on rectal cancer.

i dont know very much about rectal cancer.

Mr A: well go back to basics then... what's the lymphatic drainage of the anal canal?
Me: (oh shit)
Medic 2: erm, para-aortic
Mr A: Para-****ing-aortic, don't they teach you ****ing anatomy???
Me: (i really hope he doesnt ever find out that the two of us have a degree in anatomy)
Mr A: well?
Me: erm...
Mr A: (shouting) INGUINAL, bloody INGUINAL. You're a bit ****ing dense aren't you boys.

At that point we left, and wen't back to grilling with Mr G. Mr A came with and they tagteamed. It was not pretty. In fact, it was like watching a slow car crash, rewinding and watching again, and again, and again, and again, and again. Until the tape broke.

I hate poo.

[yeliab_cram]

Happy New Year everyone. Apparently, 5th year is not conducive with time wasting rants. Although, in the words of a certain Mr John Lennon, Time you enjoy wasting is not wasted time. Profound.

Perspective is an interesting thing. I always think at Christmas and at the start of a new year, it is important to have a bit of perspective on life...

The other week i had to take my car in for its yearly service. Its a not-too-old honda and wanting to keep the manufacturer service history going, it went to the local honda garage. Sensible, i think you will agree. I think it is reasonable to expect the best service from the manufacturers themselves. Anyway, seeing as it was near christmas, nobody was free to give me a lift, so i waited with the car, drank lots of free coffee and watched an hour or so of that god awful prgramme that isnt Kilroy, but may as well be... you know the one i mean.

Anyway, after a few gallons of free coffee scented water had been consumed, the service man came over to find me. I have done enough PPD breaking bad news sessions to know that something was amiss. This was confirmed by his warning shot "i think you should come into my office" (i immediately assumed either i, or the car had cancer, possibly both). He then proceeded to tell me how much he was going to charge me for the service (a lot) but he still had this look of doom. What is it? i thought, has he found illegal immigrants in my boot or something? am i going to be arrested?

No. Apparrently, despite him driving and fixing the same type of car all day, every day, the bloke in the workshop had managed to reverse my car into the workshop door and was therefore a moron. In the process of this bit of destruction derby driving, the rear bumper and basically the whole back pannel had been buggered. What a twat.

Now, if i was in my usual, non chistmassy mood there would have been shouting, swearing and possibly some violence. However, on this occasion i remained calm and composed. I explained i understood that shit did occasionally happen, and that i understood people somtimes did silly things. So long as they fixed it by the end of the week, and paid for it all and were very nice, then there was no real harm done, was there.

Whilst some shouting and ranting at the poor man may have been theraputic, on this particular day, i had a certain sense of perspective, and realised the following. People **** up. I certainly **** up from time to time, and in less than a year, i will be working as a junior doctor. If i **** up, people may die. Thats bad. ****ed up car bumper is not so bad. I only hope people will understand if and when i **** up, and am now hoping that my good humour will act as some form of karma.

In other news, i have just finished doing Neurology and Elderly Medicine at Pinderfields. Pinders is a great place, i do not think you had the joys of the stories from my third year time there, but it has a fond place in my heart, mainly because in the accomodation the TV colour is ****ed, and George Aligiyah is purple, and the Simpsons are green. Legendary.

I only have two things to say about my time there this year. 1) Neurology is simply intelectual masturbation - whoever first said that could not have been more right. 6 patients on the ward, no solid diagnosis for any of them, except the lady who is clearly making it all up and is being turfed to psyc. and 2) the elderly medicine consultant WAS Micheal Stipe (the lead singer of REM for those who cannot place the name). Not just in looks, but also in persona. Humming Losing My Religion and Man on the Moon during ward rounds did not result in him revealing his identity. I have informed the next group based there that he must crack eventually. They have agreed to casually slip REM lyrics into conversation. The quest continues.

[yeliab_cram]

Avid readers will probably notice i have ranted on the subject of MMC a number of times before. But now that the press has finally started to cotton on to the big ****ing balls up that is MMC and on the day that Took published his final recommendations, it feels time to see how things have progressed.

I have had the same debate on a number of boards on NMM recently about this topic. There seem to be some significant misunderstandings amongst the populus. Medical training has always been very very competetive. Always. It has always involved sacrafice and grind, and it is well known that not all will make it to their initially chosen destination. Notwithstanding that however, most will remain within the profession somewhere.

Last year saw the first realisation that MMC was a big ****-up. A knee jerk reaction to the introduction of the EWTD in Britain. Junior doctors had their hours cut from 100 per week to 56 and ultimately 48 per week. This meant that to safely staff the ward, roughly twice the number of house officers would be needed. This has been provided by the 56% increase in medical students over the last 6 years.

Thus the first disaster was avoided. But as with much of new labour, the unforseen consequences of short term solutions are going to be massive. Not only our the medical courses of the 21st century watered down, but the consultant firms are being withered away and the experience of doctors dramatically reduced.

To add insult to serious injury, it has now become apparent that whilst there is enough cash to pay for twice the number of house officers, there is not enough cash or rescources to fund specialist training posts for them all. And rather than get stuck as "lost" SHOs, they are going to be forced out of the profession - what with GP requiring its own ST programme and being highly competetive now, due to the massive wages and no on-call.

Last year roughly 10,000 doctors were set to be laid off. There was controversy amongst the medical profession, 40,000 docs took to the streets of london, everyone was angry, and the press largely ignored it. However, it never really came to pass. There was no mass lay off in august. Why.

The answer is simply (and typically new labour) a quick fix. FTSTA posts are one year appointments outside of the training scheme which essentially mop up those who dont get ST jobs. Problem is, they were only supposed to represent about 10% of the workforce. Instead some specialities report 60% of their doctors are on FTSTA contracts.

This year, this means that all those FTSTA doctors, plus the next round of applicants, who massively outnumber the jobs available are competing for the same jobs. If the figures for last year were bad, this year it beggers belief. Around 26,000 doctors applying for around 8,000 jobs.

FTSTA posts are not a solution, merely a stalling tactic.

The fundamental problem was the knee jerk reaction to the EWTD coupled with the introduction of specialist training. The worst part, is that there is no solution on the horizon. Even if the powers that be take the plunge and lay off 18,000 doctors to purge the excess and get things back onto an even keel, in two years it will happen again.

The only solution is to reduce medical school intake again, and find a way to allow house officers to work more than 48 hour weeks without being subjected to the horrific 150 hour weeks of the past. That is going to be far more cost-effective than spending £4.5 billion to train a small football stadium full of doctors you are simply going to lay off.

I am glad to see Tooke suggests the introduction of an NHS board of directors who would oversee NHS management and prevent the political ping pong match that results in only short term plans being made.

Right now we need one thing more than anything else - long term planning and with it, stability. Only then can we start to undo the massive damage that has been done.

[yeliab_cram]

Ladies and Gentlemen, hello.

I do apologise. I have been absent for far far too long. Alas i have been making preperations to jump through that one last medical school hoop. Unfortunately this one is too small, set at rather an jaunty angle and is aflame. What with all the reading and seeing of patients, there was less time for blogging. However, as with all good articles, the best are written in retrospect anyway - it allows for proper reflection (as opposed to artificial medical school pseudo-reflective bullshit).

So finals. I worked very hard indeed, and can tell you all sorts, from how to diagnose acromegaly to the biochemistry findings in acute cholecystitis and ascending cholangitis. Why a patient may want an EVAR, why they may want an ERCP and all the complications that come with endoscopy, colonscopy, bronchoscopy and any other form of light emmiting tube inserting fun and games. However absolutely none of it came up.

Despite being told over and over again that finals would be on core medical topics and acute management of emergency conditions that we will be expected to deal with as an F1, i was astounded that i could have probably done just as well in finals knowing no cardiology, respiratory, gastro or neuro. I was never asked about acute management of MIs or acute asthma or acute exacerbations of COPD. In fact i wasn't really asked about anything at all. If i had to tell you what my medical finals were on, i honestly couldnt. I would just melt into a pile of goo saying things like "vague" and "impotent" over and over again.

So rather than bitch about my exams, i thought i would take a look back over the personalities that made up my year. After all, they are what i will remember.

So first was bradford, where i got to hang out with a house officer who is a friend of mine, and met the archetypal surgical bastards. It was quite amazing to see one of my peers having evolved from fairly cute blonde medical student into surprisingly efficient and confident young doctor. The gulf seemed immense.

Second was pinderfields, where my consultant was the spitting image of micheal stipe, and was a tad surreal. He knew where i lived and was able to have a twilight zone style conversation with me about the national federation of fish friers (est 1914) HQ which is located on my road.

Third was dewsbury and respiratory medicine - mmm phlegm. There i met a charming consultant who in the first week felt i was invading his personal space in clinic, so went on to map out his personal space for me in case i was confused. It turned around in the end though, when he told me a had a gift for medical writing.

Fourth was GP, again in bradford, so again i got to play with my house officer friend during our teaching at the hospital. It was largely a dull experience, and i learnt that basically the problem with the people of greengates is not so much that they are ill, more they have shitty social circumstances which lead them to be depressed which lead them to somatosize. oh well.

and finally, the LGI, back on home territory. However, we had been away so long it seemed like an alien world. There we met, quite possibly the nicest consultant alive, and i met yet another vascular surgeon who inspired me further along the path to that career.

and thats it. The final run in is done. All we have to do now is 5 weeks of shaddowing, and then pray that the crazy exams were not too crazy for us to be ****ed.

Hopefully more colourful ranting will follow in the coming weeks.