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.

In which I ask for help

One of my old posts keeps getting Japanese spam from a different commentor every time.

Do any of you know how I can stop this happenning without resorting to banning all comments?

Thanks

Sleeping is Cheating

My time working in Intensive Care is drawing to an end. I’ve been working here for three months now and I have only one more shift to go. It’s been really hard work and at times really stressful and emotional, but I think I’ve got a lot out of my placement here. I’ve learned loads of stuff and I think that when it comes to procedures such as central lines, I’ve gone from being “competent” at them to being “good” at them. I think the best thing I've got out of this placement is that I have now answered the question of whether or not I want to be an Intensive Care Physician as a consultant.

As I sit here typing, I think of a weekend I spent with friends earlier in the summer. One of my best friends had his stag do up in Newcastle and we all went up there for a rather debaucherous couple of nights of drinking far too much and abusing the stag. We had several rules to observe on said weekend and one of them was “Sleeping Is Cheating.” This meant that nobody was allowed to sleep during daylight hours and anyone caught doing so was suitably punished.
The reason I’m telling you about this is not because I particularly want to share what a group of mates got up to in a Northern city but that tonight I face a similar situation.

I start work tonight at 8pm in one hospital in one city. I finish my shift at 9am tomorrow morning. However, tomorrow morning at 8am I am expected to start work in my new hospital in a totally different town and work through to 5pm there.

How can this be fair? I’m pretty good at some things but my talents don’t extend to being in two places at the same time. I called my new hospital and was told that I absolutely could NOT have the day off to sleep, and that I MUST come to work as they are all expecting me. They are VERY DISAPPOINTED that I won’t be there at 8am and I should MAKE EVERY EFFORT to get to the hospital as soon as I possibly can.

So, it looks like I won’t be sleeping for a while, but then again, sleeping is cheating isn’t it?

Fuck the BNP

I’m not usually political on this blog, but the appearance of the BNP’s Nick Griffen on Question Time and the subsequent domination of the media by this fascist’s agenda has me absolutely fuming.

I don’t pay my licence fee for fascists and their followers to come onto political shows on one of the UKs great institutions and spout their hate-filled racist drivel.

Let’s recap some of the BNP’s policies (words in italics are my own comments).

· The forced deportation of 2,000,000 people (or 1 in 30) from the UK. Let’s not forget these will be British passport holders or working here with valid visas. These people will be stripped of their assets including homes and cars on the basis of skin colour.
· Millions of other Brits “of foreign descent” will be “encouraged” to return to their “country of origin.” Exactly what form this “encouragement” will take, I can only shudder to think.

I could keep going with a whole list of thing that these evil fuckers want to do, but I won’t because this post will get too long and I think you get the point already.

And yet, we have so many people who think that the BNP should be given a voice. I had to walk out of the ICU coffee room on Friday because I was so mad with one of the consultants who thought it was right that the BNP should be on Question Time. Fellow bloggers such as The Jobbing Doctor think it’s OK for people to say stuff like “Islam is wicked,” and “There’s no such thing as a Black Englishman” on national television. People who defend the BNP’s right to hate speech seem to have no regard for the targets of the BNP’s vitriol. They have no regard for their fellow citizens, instead they prefer to stand behind the right of the racists even though the very things the racists are saying would deny rights to some of their fellow countrymen based on skin colour.

Why do people in the country find it so hard to say “No.”?

What happened to the British backbone? Why can’t we stand up to these evil people and say, “This is WRONG. You are WRONG. What you are saying is WRONG and we shall have no part of it.”?

This whole episode is deeply shaming on us as a nation and a lot of people need to take a good look at themselves and be honest about what their values really are.

Fuck the BNP.

Thinking about this is getting me angry again, so I’m going to leave you with the words of a Mr Richard Reynish whose letter was published in The Guardian on Friday.

"As Britain debates the BNP’s appearance on Question Time, it would be a good idea to learn from developments elsewhere, before it’s too late. Here in Denmark, where I have lived for 30 years, we have witnessed the systemic hijacking of a progressive and tolerant culture by the far right dressed in “respectable” sheep’s clothing. In 10 years, Denmark has been transformed into a country where racism is in the mainstream.

Free speech has protected hate speech, and opponents of censorship have consistently defended the rights of unscrupulous populists and incendiarists. When the media take this line, a very wicked circle is started: the inflammatory accusations of racists become self-fulfilling prophecies, as minorities are increasingly marginalised and excluded. Mainstream political parties, attempting to win back voters from the far right, make an endless series of concessions, attempting in vain to demonstrate understanding of the concerns of voters tempted by simple xenophobic policies. But the far right will always have a more extreme policy, and a new provocative proposal, which keeps them permanently centre stage in the media.

The “debate” about immigration – in reality a platform for populist racism – dominates politics, poisons serious dialogue an guarantees one thing: racist dominance of the media and the political agenda. "

Richard Reynish
Copenhagen, Denmark.