Just a quick note...

...to say a huge thank you to the three men who helped push my car out of the hospital ice-rink car park this evening.

I truly am very, very grateful.

I'm dreaming of a white Christmas

I was in a bit of a grump yesterday (it was a long day). I feel much better now. There's nothing I can do about the weather, so what will be will be. The good thing about Britain in the snow is that everywhere looks really beautiful and magical. Even the Kebab shop round the corner looked pretty.

I feel much cheerier now so here's a few pictures of this winter and my favourite Christmas song. Sing along if you know the words (I'm not sure Shane does).

Happy Christmas to everyone!

I’m not dreaming of a white Christmas.

At the end October, all the junior anaesthetists in my hospital were given the on-call rota for November to February. The first thing we all looked at was who had to work Christmas and who had to work New Year’s Eve.

This year, I’m lucky enough not to be working Christmas Day and I’m really happy about that. Spending Christmas Day in hospital on-call must be one of the most miserable and depressing experiences known.

Christmas Eve, however is a normal working day in my hospital and I have the misfortune to be doing a theatre list that’s notorious for running over time. (Was I naïve in thinking that in this brave new world of “patient choice,” that patients would “choose” not to have their elective major surgery on Christmas Eve and would choose to have it in the new year instead. Apparently so). I envisage that I’ll leave work at about 7pm on Christmas Eve and my plan is to drive the couple of hundred or so miles to my parent’s home after work that day. With a bit of luck, I’ll get there just in time to hear the bells ring out for Christmas Day.

However, hearing about all the travel dramas because of the weather has me quite worried. I’m just praying that the icy freeze that’s currently enveloping the country has loosened its grip by then because otherwise there’s the distinct possibility I could be spending Christmas stuck at work or worse, stranded in some motorway service station.

My Christmas “holiday” is short lived though, I’ve got to brave the roads again on Sunday evening for my on-call shift on Monday and then it’s back to work for business as usual for the elective operations on Tuesday.

I’m not the only one who has to do this; Dr. Grumble is also rather miffed by the situation.

I know there’ll be people reading this who’ll be thinking “junior doctors these days don’t know they’re born. They only work 48hr weeks whereas when I was a lad we worked 128hr weeks etc… etc… etc…”

But, as Dr Grumble also points out, working in hospital over Christmas used to be fun. Believe me, it really no fun being on call for intensive care over the holiday period. I think this Christmas, I’ll be mostly knackered.

But at least I’m not working Christmas Day his year.

Two things that made me smile today

The sight of two of our recovery nurses - one Iranian, one Australian - laughing and dancing arm-in-arm outside as the snow came down.

The fact that Rage Against the Machine are Christmas number one. Power to the people!

Raising doctors, the "beta" version

I've just read this brilliant post by Dr Edwin Leap MD. It's the text of a lecture he gave to new doctors starting at his hospital in America. It's more about life in general than it is about medicine. It's long, but it's well worth the read so, give yourself ten minutes, make yourself a nice hot cup of tea, sit back and enjoy his words.

Raising doctors, the "beta" version

Who is a doctor?

Beep Beep… Beep Beep…

My mobile phone shrills and I casually reach over and pick it up to read the incoming text message.

You have an appointment with Dr Kavelidis at 16:00 on 17/12/09. Please allow time for parking.

I furrow my brow in confusion. I haven’t made an appointment with my G.P. in fact I haven’t needed to see him in over a year. Besides, I don’t have a clue who “Dr Kavelidis” is, perhaps he’s a new G.P. at the practice. But it still doesn’t make sense I’m sure the GPs at my surgery are busy enough without having to randomly text people on their practice lists to trawl for business. Was this some sort of new QOF thing? Seems unlikely, I’m a healthy young man. Maybe FashionGirl has the answer.

“Darling,” I say and she looks up at me from the magazine that she’s engrossed in. “Did you make me an appointment at the doctors? I’ve just had a text telling me I’ve got an appointment in a couple of days and I never made one.”

She shakes her head at me and says, “No, I didn’t. Let me see that.” She has a look at my phone and says, “It’s odd isn’t it? Especially as there’s no “from” number.”

None the wiser, I delete the message and continue watching the telly. Last time I went to the GP, I did get a reminder text beforehand, so I assumed there’s been a mix up and I’ve go the text by mistake.

Two hours later, it hits me. I do have an appointment on Thursday, but not with the doctor, with the dentist.

I go over to the fridge where I’ve stuck the appointment card and have a look at the names. Sure enough Dr. Kavelidis’ name is on the card, just below "Dr. Chang" and just above, ironically enough, “Dr Anderson.”

So, it does beg the question, “Are dentists ‘doctors?’” On this evidence, apparently they are. It just seems a bit odd to me. Dentistry is incredibly competitive to get into. Like medicine, you need straight As at A-level and then you have to spend five years studying at dental school before you’ve earned the right to call yourself a “dentist.” So why on earth, after all that, would you want to call yourself “doctor”?

It’s not just dentists that are “doctors.” Apparently, these days psychologists are “doctors,” chiropractors are “doctors”, and even nutritionists are “doctors.”

Slag me off if you want, but I spent five years at doctor school to earn the right to call myself “doctor” when I treat patients and I find it rather annoying (and inappropriate) that people with no medical qualifications get to call themselves “doctor” when treating patients.

I know there’s a feeling in the modern NHS that “anyone can do a doctor’s job,” but it’s simply not true. The way I see it, if you think you can be a real doctor, go to medical school and graduate. That way, you’ll see for yourself how “easy” it is.

Now, I totally agree that a PhD is hardly a walk in the park either, and neither is a dentistry degree and I can see that people who’ve worked hard for years at these should have a title to show their achievement.

The solution, I think is to use a system like the do in the USA whereby medical doctors have the suffix MD after their names. I know that MD means something different in the UK, but now dentists, nurses, psychologists, chiropractors and nutritionists are “doctors,” sooner or later, every man jack is going to be a “doctor” and the term will be meaningless.

Dr. Michael Anderson MD

I like the sound of that.

In which we save money for the NHS

I’m on a morning ward round in the Intensive Care Unit and we’re discussing a patient I’d admitted the day before. Mrs Patel is a lady in her sixties with really bad respiratory failure due to a particularly nasty pneumonia. The previous afternoon I thought that if we gave her non-invasive ventilation (NIV) and adequate intravenous fluids, she may just turn the corner and start to get better.

Unfortunately, I was wrong. She continued to deteriorate and quite soon after she arrives on the ICU, her oxygen levels were still dangerously low despite the NIV so in order to prevent her from dying then and there I had to put her into a medically-induced coma, intubate and put her on a ventilator.

So there I was the next day, recalling this story to the ICU consultant, SHO, ward sister and staff nurse. We look at her blood test results, ABGs, chest X-rays etc… and it’s apparent to all of us that whilst this lady will probably get better, it’s going to take a while and she will need to stay on the ventilator for at least a couple of days.

I turn to Richard, the SHO, and say “Could you change her sedation to midazolam & morphine.”

“Sure,” he says as he picks up the drug chart. He crosses off the propofol & alfentanil and writes up what I requested.

(Basically I’ve asked him to change the drugs that are keeping Mrs Patel in a coma. Propofol & alfentanil are shorter acting, but much more expensive. Because we were going to keep her in a coma for a few days, I changed to the longer-acting but much cheaper midazolam & morphine.)

After scrawling the new prescription (it’s so true what they say about doctor’s handwriting) Richard says, “It won’t make any difference, you know.”

I raise an eyebrow. “What do you mean?”

“I mean, it doesn’t matter how much money we save by doing stuff like this, they’re still going to cut our pay.”

“True enough,” I concede.

“Well, if the other lot get in, they’ll dock our pay even more!” pipes up Julie, the ICU ward sister

“Could we please save the politics for the coffee room,” comes the irritated voice of our consultant. “Now, could someone find the result of this woman’s most recent ECHO?”

Suitably chided, we get back on with the job in hand.

Casualty

I’m not working this weekend, so I’ve been sitting in front of the telly with a can of beer (Grolsch is my tipple of choice at the moment). Disappointingly, there was nothing I particularly wanted to see on the box. Come Dine With Me didn’t appeal, and I detest the X Factor so much that I won’t even entertain the thought of having it on anymore (I’m seriously considering buying Killing In The Name Of…).

I flicked over to the Beeb and was greeted by the Casualty* theme. I can’t listen to that tune without wanting to say “Will everyone stop getting shot!” in a really bad cockney accent. Previously, I’ve said that I was no fan of medical dramas, but for some reason, I thought I’d give it a go. Maybe it’s because I had nothing else in particular to do or maybe it’s because I’ve just spent a month watching seven series of Scrubs, but I thought I’d see if Casualty had gotten any better since the last time I watched it.

I think it’s definitely improved. I was quite pleasantly surprised and even moderately entertained. Back in the day, Casualty always used to be about “guess the really predictable disaster” and tonight’s episode remained true to those roots. I can sum it up with: Man unscrews valve on bus/fluid starts leaking out/bus goes downhill on narrow country lanes/brakes fail/bus goes over cliff. I don’t think it’ll Casualty will ever top the classic “man in field/combine harvester” episode, but it’s good to see the producers continue to try.

It’s also good to see that at long last, the show has recognised the existence of us junior doctors. I’ve spent more time than I care to remember trying to explain to people that “junior doctor” and “medical student” are not the same thing and then explaining what we junior docs actually do all day. I think having us on telly will help a little bit. The juniors on the show all seem to be very attractive, much more attractive than any group of doctors that I’ve ever worked with, if a bit on the numptyish side.

All in all though, it kept me amused for three quarters of an hour or so, so it’s definitely a big step up on the last time I watched a medical drama on the BBC. I might even consider watching it again next week.

If anyone reading this and thinks that I really need to get a life and get out more, I totally agree - Big Ed has just texted me and now I’m off out dancing…

* “Casualty” is such an old-fashioned name isn’t it? I’d be interested to know if it’s still called “Casualty” any hospital in the UK today (I must see photographic evidence) because, as far as I was aware, they all changed their name to “Accident & Emergency” years ago.

Interestingly, more changes are afoot because it’s been decided that “Accident & Emergency” is now not a good enough name, so it’s going to become the “Emergency Department.”

In about 10 years’ time they’ll probably all go back to being called “Casualty” again. Who makes these decisions? What a waste of time and effort.

Scrubs

Almost exactly a month ago, one of my colleagues lent me the DVD box-sets of Scrubs Series 1-7.

I remember when Scrubs first started. I was still in medical school and at the time, loads of my fellow medical students were raving about how good it was.

I never really got into it though, mainly because, as far as I can recall, it’s never been on terrestrial TV in the UK (correct me if I’m wrong). I watched the occasional episode at mate’s places but would never have said I was a fan of the show.

Until now.

I think the show is absolutely fantastic, and it’s made me laugh out loud more times than I can remember. For those who don’t know, the series basically follows three American doctors as they progress through their training from their intern year through to becoming attending physicians and beyond.

I’ve heard people say that it’s “really realistic.” I wouldn’t go so far as to say that the show bears much resemblance to every day hospital life, but it does have moments that I really recognise. Bricking it at your first cardiac arrest call, trying to make a relationship work despite the demands of the job, the frustration you feel at the patients who just won’t help themselves as well as those who you feel you’ve made a real difference to are all shown at various points.

I realise this is rapidly turning into an advert, so I’ll stop. Anyway, the DVD is calling, I’m half way through series 7 now, so I guess my normal blogging will resume shortly.