How Different Specialities React

I'm busy this weekend, so I thought I'd leave this for my faithful ardent readers (all three of you. Three and a half if my neighbour brings his dog, who doesn't really read but will at least stare at the screen if you scratch his butt --Editor) to giggle over. This is a clever bit of wordplay on how different medical specialities react to changes.

The British Medical Association has weighed in on Prime Minister David Cameron's health care proposals:

The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.

The Gastroenterologists had a sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve.

The Obstetricians felt they were all labouring under a misconception. Ophthalmologists considered the idea short-sighted.

Pathologists yelled, "Over my dead body!" while the Paediatricians said, "Oh, Grow up!"

The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.

The Surgeons were fed up with the cuts and decided to wash their hands of the whole thing.

The ENT specialists didn't swallow it, and just wouldnt hear of it. The Pharmacologists thought it was a bitter pill to swallow, and the

Plastic Surgeons said, "This puts a whole new face on the matter...."

The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.

The Anaesthetists thought the whole idea was a gas, but the Cardiologists didn't have the heart to say no.

In the end, the Proctologists won out, leaving the entire decision up to the arseholes in London.

Found via Dr Zorro's blog. Now don't cry, dear readers, I'll be back again real soon. I know loads and loads of you wait with anticipation every day just to see what else I've writte--

Dammit.

If you liked/close to liked/maybe smiled a little at this post, consider liking my Facebook page. You know Justin Bieber fanpages on Facebook who have more likes than me. Is that fair? Ask yourself honestly. The truth is out there*.

(*the truth is you should like my Facebook page)

Stuff They Don't Teach You In Medical School: Who's The Boss

I have always believed in helping my fellow medical students. That's even why I set up this blog: so that I could share experiences and insights about the illuminating journey that is medical schoo-- ah screw it, okay fine I set up this blog because life hates me and I figured, I should at least share my misery and make people laugh. There.

Anyway as part of my effort to warn educate other medical students and members of the public, now that I'm a real doctor (I SEE YOU LAUGHING! STOP THAT! -- Editor) I thought I'd start a little series on the real-life stuff you find out as a doctor that you wish those bastar-- uh, loving lecturers had remembered to teach you in medical school.

So for our first lesson, children, I'm going to ask you a simple multiple-choice question. A simple one, but bloody hell is it an important one for doctors, students, and any poor fool who has to visit a hospital actually. Ready? Here it comes:

FROM AMONG THE FOLLOWING STAFF ON THE WARD, WHICH ONE IS THE BOSS?

Click to enlarge. Go on, it's worth it. I slaved five hours to make this! 

(OK so I suck at Photoshop. Leave me alone.)

Choose from among the following answers:

1. House Officers/Interns/Slaves - the lowest on the food chain, even lower than medical students (YES FOLKS! You think you're getting a PROMOTION when you graduate and become a real doctor? HAHAHAHAHA-- wait, you're being serious. --Ed.) and responsible for doing all the crap that other doctors don't want to do.

2. Registrars/Residents/Medical Officers (MO) - senior doctors with years of experience, one step down the food chain from big boss. They run the ward when no boss doctors are around, and are generally the source of both great teaching and great misery for junior doctors.

3. Head of Department (HOD)/Chief of Medicine/Chief of Surgery - the biggest, baddest, most experienced doctor around. Top of the ward food chain and has doctors fleeing before him in terror. House officers have been known to kiss the ground they walk on.

4. Nurses - The front line of medical care to the patients. They do the stuff even junior doctors won't/aren't allowed to do. Run things on the ward when doctors aren't around.

5. Patients - The point of the whole health service actually. Known to be either really nice or complete freakshows. If patient also happens to be a doctor, you're REALLY screwed.

Choose one. Done? Okay what did you answer? Check your number below:

IF YOU ANSWERED

1. - HAHAHAHAHAHAHAHAHA. Nice one. Seriously, I needed a laugh. Thanks.

2. - Not as ridiculous as the previous answer, but still no. Sometimes they are the boss, especially when it's 4am, the boss doctor who usually protects you is asleep, none of your friends are around, and the registrar/resident/MO remembers you as the funny-looking junior who insulted his hairstyle behind his back when you thought he wasn't listening. Oh yes.

3. - If you chose this, congratulations! You have a working brain! 90% of readers chose this option.

It is however, FALSE. Gasp! Why, you ask? Has Angry Medic lost his mind? (He has, but that's a story for another time.) I'll explain in a bit.

5. - Well...this is a tough one to explain. Patients SHOULD be in charge, especially with all this touchy-feely 'patient-centered care' crap that they pound into medical students' heads from day one. But sadly, they are not.

This leaves:

4. Nurses - That's right folks!

And don't you forget it.

A very, VERY important part of life on the wards that they don't teach you in med school (but surprisingly do in Grey's Anatomy. See Mom? And you scolded me for spending more time watching that crap than actually studying. HAH. --Ed.) is that nurses are REALLY in charge of the ward. Piss them off, and they can make life a LIVING. HELL. Treat them nicely and they'll help you put that central line in, tell you which doctors are nice and which doctors to avoid like a Justin Bieber album, and warn you wayyy ahead of time when Mr No-I'm-Just-Going-Down-For-A-Walk is actually smoking at the hospital entrance and is about to set his face on fire.

See, who says reading my blog isn't a waste of time?

*Thanks to Mother Jones RN of Nurse Ratched's Place for inspiring this post. Sort of.

Cambridge Medics Get Their MTAS Kicked

Patricia Hewitt, Secretary of State for Health, kicks me in the MT-ASS
(Yes, that's my sad face. Yes, I forgot to put make-up on, okay?)

I haven't blogged in a while*, and whilst I'd like to say that this is actually because I've been acting like a proper Cambridge medic and making love to Biochemistry textbooks in my college library, it's actually because I've been plain lazy. And just today I read another profound blog post that made me realise just why I'm being so lazy, but I'll save that for the next post, which will be a Hollywood-esque jam-packed tale of ambition, success, failure, and Donald Trump. (No, it's not going to be an Apprentice review, though good guess! These guys do a much better job than I could. --Editor)

Anyhoo, more MTAS bad news! All that I know about MTAS comes from the medblogs out there that do a terrific job of covering the madness it's unleashed on the wards. But it turns out that there's more to MTAS than just the nonsense affecting junior doctors. The geniuses behind it all, not content with culling working doctors, decided to get right to the root of the problem - medical schools.

As I learnt from the Cambridge representative to the BMA Medical School Conference, in addition to the questionnaire part and the reference part, there's an academic part for medical students to be ranked by their medical schools upon graduation. Once the students are ranked academically, they are divided into 4 quartiles.

Oxford and Cambridge reps to the Conference argued that this system is intrinsically biased against universities with more stringent admissions criteria and tougher exams, like themselves. This is because students at these universities would have to put in more work and sit for tougher exams than students at other universities ranked in the same quartile. Similar motions were put forward by both reps, but they failed to pass because, in the rep's words, "as you must understand the other British medical school representatives at the BMA were not very sympathetic with this idea".

Whoa whoa wait! Before you start lobbing rotten vegetables (and certain forms of animal excrement, for those of you who used up all your rotten vegetables after my last post --Ed) at me for being an arrogant arse, let me say that I do not actually know if Oxford and Cambridge have tougher exams than other universities. Certainly some people seem to think so. But from what I've seen of other universities' courses (and I've been to quite a few other unis - time away from Cambridge is like a drug holiday for an antidepressant user suffering sexual dysfunction --Ed) the only difference that I noticed was that courses elsewhere seemed more...enjoyable. To my clinical-starved self, at least.

So what does this mean? Does it matter? Will it make a difference in four years when we graduate and get spat out into the workforce? I don't know. Should I be bothered? Probably. But not right now, because it's almost 9am and I hear my supervisor coming. If anyone asks, I've been in the library all night.

*yes, I'm going to pretend that some of you out there actually care. I'm young, okay. Let me dream! --Ed.

MMC Big Daddy Resigns

Professor Crockard, National Director of MMC, marches out of the MMC bunker for good

I was online at FrontPoint Systems (yes, so I was procrastinating again. What's it to you? YOU AIN'T THE BOSS O' ME!* --Editor) when he broke the news that Professor Alan Crockard, the National Director of Moderning Medical Careers (MMC) has resigned. Read his full story here, and the full letter of resignation at Dr Rant here. (Link not safe for kids. Don't bother with noisy grown-ups arguing, li'l tykes, go play a Teletubbies game or something. --Ed)

Let's take a break from revision together, folks, and take a look at ol' Crocky's letter. In it he simultaneously plays both hero AND villain (a feat previously only managed by President Bush --Ed). He says "The principles of MMC are laudable and I stand by them. More patients should be treated by trained doctors, rather than doctors in training."

Forgive me, for I am but a humble overworked medic, not blessed by the abundance of brain cells required for a position of such great responsibility, but I fail to see how exactly we are supposed to GET trained doctors unless we LET doctors-in-training treat patients.

However towards the end he nicely states "But the overriding message coming back from the profession is that it has lost confidence in the current recruitment system." There we go. At least he's acknowledged that doctors don't bloody like MMC, without resorting to the whole ignore-doctors-won't-apologise-lalala-I-can't-hear-you stance of the Department of Health. If he stepped down in genuine protest at how the system is treating doctors in such a haphazard manner, and if he is not a traitor like the complaint lodged against him suggests, then he is truly worthy of applause.

So c'mon, folks, join me in celebrating by putting this on repeat on your playlist, courtesy of the brilliant DogHorse. Turn the volume up real loud - it's great for accompanying revision!

* unless you're my Director of Studies/Senior Tutor/supervisor, in which case, sorry, sir. I'm heading back to the library now, sir. Honest.

The Empire Is Struck Back Against, Part II

Aboard the MTAS Death Star, Emperor Blair and Darth Hewitt try to get themselves out of hot soup

After last Saturday's widely-publicised march in London by junior doctors protesting against MTAS, Patricia Hewitt has gone into hiding and left behind her henchman Lord Hunt, the Health Minister, to face the music and gibber incoherently. Dr Crippen wonders where she's gone; I suspect she's hiding on the MTAS Death Star.

And since my last post on the MTAS debacle (which was picked up in last week's BritMeds due to my use of the word 'wankpile' to categorise it; I don't think that's weird at all, do you? --Editor) Opposition Leader David Cameron has finally got it through his thick head that hey, thousands of doctors protesting could actually be a good time to campaign for votes:

David Cameron gets a clue

But you have to admit, his speech was stirring. It made doctors feel something they haven't felt in a long time -- like they were valued. You can watch it here.

Comments under the original post here please.

The Empire Is Struck Back Against

Aboard the MTAS Death Star, Emperor Blair and Darth Hewitt find that the Force is no longer with them

The doctors have begun to strike back against the injustice that is MTAS.

Earlier last week they turned to David Cameron, Opposition Leader. They looked to him as a saviour, someone who would use the huge political stick that is the MTAS fiasco to beat Tony Blair on the head and secure several thousand votes. So great was the call that MTAS became the top question on Cameron's Open Blog, where the Conservative leader responds to the top 5 posts every week.

Sadly he has let them down. His response, viewable here, saw him sidestepping the issue like a Labour politician. This idiotic political move is already costing him votes, as an be seen from the responses on his blog.

Doctors wait in vain for David Cameron to save them

But the doctors aren't done in yet! What do good, honest UK citizens do when civil rights are threatened and evil greedy government types screw them over? Why, march, of course. This Saturday's 'March in March' is hoped to raise more media pressure on the government to fix the situation.

The deaneries themselves have spoken out. Some have resigned in disgust. The Royal Colleges have condemned it. In fact, several of the UK's leading doctors have spoken out against it, including, I am proud to add, several of my lecturers here at Cambridge.

Dudes who have spoken out against MTAS

But all this is above my humble medical student head. All I know is that the future suddenly looks a lot bleaker, and unless all these angry people in white coats can convince this woman to change her mind, I'd better start looking for jobs in Australia.

So what can I do? Several things. Firstly, I've done my part to educate the international community on what is happening here in the UK by writing a post on it for Medscape. Do check it out and leave a comment or two, if only to confirm what's happening, as the editor left out the BBC news links I gave her (either that or she thinks I'm a loon, which isn't too far from the truth. --Editor).

I also blogged here about the tragic passing of Laura Case, a former medical student at Cambridge who was killed whilst delivering medical aid in Uganda. Her father has written to me with a heartfelt letter that he has sent to The Times, saying how Laura disagreed with the current system of training junior doctors:

My daughter, Laura Case, was a medical student who was killed in Uganda while working there in a hospital as part of her final year training. (Times 20 February).

Like most medical students, she was committed, but not particularly idealistic. Nor was she political. She was, though, angry about the failings in the training and selection of junior doctors. Admittedly her experience was only her own hospital area, but she thought the central organisation and supervision of her training poor, and when on six weekly rotations round various hospitals and GP practices found, with some notable exceptions, that students’ training was often chaotically organised, and students tolerated rather than involved. The view of senior doctors seemed to be that it was better now than when they were young, so ‘get used to it’

She found the failure of government to plan effectively for the requirement for doctors dispiriting, as it lurched from creating new medical colleges, and then in the face of ‘overcapacity’ ditching non EU doctors that had been encouraged to train here, and now admitting an oversupply of newly trained doctors due to ‘changes in the system’. The actual selection process, which has been marginally improved from last year when humans were more or less replaced by computers in selecting junior doctors for posts, is still so useless that a group of consultants recently refused to conduct job interviews on the grounds that the process was unfair. (Times 6 March).

The Department of Health and Downing Street both defend the position with weasel words, but junior doctors, not usually a militant bunch, are so incensed that they will stage a march on March 17^th to protest at the position. (www.remedyuk.org). My daughter was well aware of the cost of her training both in terms of taxpayer money and her six years of study; let’s hope many more join the thousands of young doctors planning to march to highlight this cavalier handling of investment and talent, and the government’s inadequate response to the problem.

The medical profession has spoken. We will not stand for dictatorial high-handedness with a policy that looks like it was dreamt up by a bunch of baboons in a doughnut shop with John Prescott. Like this comment says from a friend of Laura's:

Compassion is fine but Laura would have wanted you to fight. Stick a card in front of the complacent - 'Laura Case died because she cared enough to be a doctor.'

The Angry Medic Finally Gets MMC & MTAS

Wheel of Fortune: Doctors' Edition

Remember Wheel of Fortune? That game show where, given a hint, you had to spin a large wheel and win money by correctly guessing letters illuminated on a giant board by an inexplicably lovely assistant who was the subject of wet dreams and midnight fantasies everywhere?

Well the UK Government, capitalising on the gameshow's popularity and deciding that doctors' lives are too bloody bland and boring, has decided to introduce its own version for doctors in an attempt to spice up their lives a little (and get their lazy arses off those plush taxpayer-funded chairs --Editor). And they've called it MMC.

Go ahead. Look at the picture above. See if you can fill in the last letter for the win.

Before today, I had no concept of the horror of MMC and MTAS. Oh, I read about it all right. Any half-brained drooling numbskull looking at the blogs out there could tell it was horrible. HospitalPhoenix, a good competent surgeon who genuinely cares about his profession, lost sleep over it. SHP, the very sort of doctor keeping the NHS afloat, has lost hope. Even her partner has not been to work for fear of her breaking down. Dr Rant, being his usual self, has been mouthing off about it.

But I, being a mere medical student cosied up in his snug ivory tower, buried under piles of drug name sheets and obscure biochemistry named-after-car-license-plate molecules to remember, didn't understand. All I could do was pat them on the shoulder, drop a nice comment on their blogs, and hope that things would be better.

Until now.

Dr Crippen has finally put it in language I can understand. Here he posts sample questions with sample answers from an unsuccessful candidate who now has to emigrate to find work. And here are more example questions with sample answers from a more fortunate candidate.

I read the questions. I read the answers. And then it hit me. Because I had seen some of the questions before. Also on an arbitrarily marked, wishy-washy-waffle-requiring exam known as Preparing For Patients (PfP).

I have blogged about PfP before. The questions asked are rather arbitrary, marked not by doctors but by "communication skills experts". No one knows if they will pass or fail; I know gifted medics who spent hours slaving over their PfP reports, only to be told that they couldn't progress to the next year because they had failed this minor subject (because they didn't dot an I or misspelt a few words. No, seriously --Ed). Conversely, everyone knows someone who spent two hours on the last day typing up some crap, handing it in 15 minutes before the deadline and passing. (Not that I'd know anything about that. Ahem. --Ed)

In many ways, it is a lottery. Compare the questions from MTAS and from PfP:

MTAS: Describe a recent example from your surgical experience of a time when you found it difficult to make an effective judgement in a challenging situation. How did you overcome this difficulty, and how has this experience informed your subsequent practice?

PfP: Give examples from an interview you conducted with a patient to illustrate what you did that helped and hindered making the interview successful
a) From the viewpoint of the patient
b) From your viewpoint in terms of gathering information about the symptoms
c) From your viewpoint in terms of gathering information about the illness (the patient's perspective)

See the similarity? Both questions require wishy-washy bullcrap (or require you to become John friggin' Steinbeck). In fact, the PfP question stops just short of requiring you to bloody read the patient's mind. There are no correct answers; whether you pass or fail depends on whether the course organiser thinks you maintained enough eye contact or said "hmm" and "uh-huh" enough times in your patient interview. I have known students who, having run out of ideas, put down "I smiled at the patient" and "I patted his arm".

But PfP serves a purpose. I'm not complaining, because it gave me the opportunity to finally go to hospital and see real patients. And if you fail it, you can always resit it, and almost always pass the second time (unless you do something really stupid, like turn your patient's respirator off for kicks --Ed).

Look at the final paragraph of the successful MTAS candidate's answer to the above question:

On reflection, I realised the value of my clinical judgement, prioritisation, teamwork and communication. The experience increased my confidence in adopting leadership roles.

I know exactly what that is. Any medical student who has done PfP, indeed any student who has ever filled in a UCAS personal statement to apply to university, will also recognise that for EXACTLY what it is.

Pure and utter bullcrap.

Don't get me wrong; the candidate was very smart to write that. And indeed, it's simply because I'm so good at crapping that I got into university in the first place (that and the sexy eyelashes. --Ed) But it's still waffle. It's the waffle we come up with to pad our CVs/personal statements. It's the waffle we type into our PfP reports when we need to fill two A4 pages. It's waffle that hardworking, competent, caring doctors with families to feed and lives to save should not have to think up after shovelling through decades and decades of this:

Actual Cambridge University lecture material

Entire careers. All dependent on one lottery. I cannot imagine how it must feel like filling out that form. Knowing that everything you stand for, everything you've worked your entire life for, is dependent on what you put down. If you're a doctor who has recently gone through this, I offer you my admiration. I simply cannot imagine the hell you must be going through.

Some of my friends have advised me to switch to law and run whilst I can. I'm seriously thinking of listening to them.

NHS Reaps What It Sows; Government In Shock

I know this is a little late, but I wanted to hear what other bloggers had to say on this BBC report regarding the documents leaked from the Department of Health.

Here's what my tiny uncomprehending med student brain has grasped so far. The government has poured tons of money into the National Health Service (NHS). Then all of a sudden, they realise that they're in huge debt and surprise surprise, the NHS still isn't fixed. So they go "oh shit!" and chop jobs, close hospitals and replace doctors with nurses. Newly qualified doctors are walking the streets jobless. And poor med students like me aren't having it so easy either.

What next?

As Dr Rant so eloquently puts it, any half-starved retard could've seen this coming. You chop expenditure by axing jobs, what do you get?

Why, a job shortage, of course.

But this isn't just ANY job shortage. Britain is to be short of 1,200 GPs, 14,000 nurses and 1,100 junior and staff-grade doctors by 2011. (Watch the video, if only for its comedy value.)

Does it stop there?

Only if you believe in fluffy bunnies and La-la Land. Dr Crippen shows how, once again, the ugly racist side of medical politics may rear its head. Wat Tyler, in his economic wisdom, shows how this means even more belt-tightening for doctors and nurses alike.

And how do we solve this?

Patricia Hewitt has an answer. "Let us transform the NHS", she says, with the conviction (and vocabulary) of a prophet.

She has also, after promising to resign if she didn't fix the NHS, retracted said promise, no doubt due to her sheer conviction that she is the only thing holding the NHS together.

I will send her a picture of another Transforming prophet to inspire her along her way.

Housemanship: One Big Rite Without Rights

I'm still a bit numb by HospitalPhoenix's black-bagging (to use a V For Vendetta term) but this is a topic I feel strongly about and want to rant on. So I'm going to let my Medscape blog post on the topic speak for me instead.

In my local papers a debate broke out recently about the treatment of housemen in hospitals. Some people complained that the 34-hour shifts were draconian and amounted to torture. A parent or two who never saw their houseman child during the day spoke out. Then some old doctors came out and supported the system. The term "modern-day slavery" got bandied about a lot. Then I, because I have a big mouth and felt like giving an alternative perspective, wrote in and mentioned the European Working Time Directive. The issue is now mostly resolved. But the fact remains, housemen work long hours but instead of being rewarded with good treatment (and by this I mean a smile now and then) they are tortured in what their seniors insist is a baptism-of-fire-type ritual that every doctor-in-training goes through.

Do read the post and leave your thoughts. Profanity here, nice comments on the Medscape site please. I need my editor to think I'm actually doing something for the site other than just being the goofiest photo there...

Merry Christmas and a very happy New Year, folks!

Voting For Doctors: Reality TV Hits The Medical Profession

The Search For A Medical Superstar

I've always wished that the medical profession had more drama in it. You sit and watch all those hunks and supermodels playing doctors on TV, with all their complex moral dilemmas and impossible yet dramatic cases, and you think working in a hospital will be just like Casualty or Grey's Anatomy. Sadly, the reality is that no, theme music doesn't play as soon as you stride onto the wards in your white coat.

Thank God, then, for the Department of Health. Realising that the medical profession is too boring and not exciting enough, they've decided to inject some fun into the whole doctor-patient relationship and allow patients to rate their doctors using a survey next year. According to the BBC article:

The government is to carry out a survey in January of five million patients and ask how good appointment and phone access to their doctor is. The answers will determine how much of the £8,000 their doctor gets, from up to £72m available to England surgeries.

Cool huh? You get to rate your doctor on how efficiently they perform. Heck, you could even march in and ask him to sing you a ditty, and threaten him with a bad survey report if he doesn't. Now THIS is entertainment!

Prime Minister Tony Blair told the BBC's Question Time programme that he was "astonished" to learn some GP surgeries were refusing to set appointments more than two days in advance because of a target that all patients should be seen within 48 hours.

He said then that he would ensure NHS targets did not stop people from seeing their GPs when they wanted to.

Absolute brilliance! Set targets and force doctors to meet them, then punish the doctors for trying!

HospitalPhoenix has posted his own take on the issue here. He points out that GP surgeries that don't meet their targets are probably doing so because they're oversubscribed and hence in trouble, whereas those that do keep their appointments are probably better off financially. So what do the government do?

Why, give more money to the obedient GPs who do meet their targets, and less money to the GPs who need it most, of course.

And did the government ask doctors what THEY thought about the survey? Oh yes, of course they did. But apparently not very fairly:

But Dr Hamish Meldrum, chairman of the British Medical Association's GPs committee, said the survey was discredited because the government had added "biased questions".

He said patients had been asked about arrangements for early morning, evening and weekend surgeries at times when GPs were not expected or paid to be open. "Using a survey containing leading questions, putting words in patients' mouths, and falsely raising expectations, is not the way to do it."

What's the government trying to do here? Throw money at the doctors who support them and squeeze the belts of those who don't? Or put a finger on the independence of the medical profession at a whole? Is there a greater agenda at work here?

I don't know. I don't care. The medical profession just got a whole lot more exciting! I'm going for singing lessons. Just in case.

"My grandmother can write better prescriptions than that, and she's blind!"

Good Nursie! Here, Have A Biscuit

"Who's a good nursie?" *pat pat*

Why should you read this post? Because all of us, at some point in our lives, will be looked after by a nurse. And it's important to understand that nurses are not a happy lot. In fact, some of them are pretty miserable. (And yes, if you're thinking that this whole this-post-applies-to-you-too intro is a desperate ploy to combat the dwindling comment count on my posts, you're right. So sue me. But first comment! --Editor)

I suspect that the reason nurses generally aren't very big on medical students is that as nurses, they take so much crap from doctors whom they can't fight much, so they might as well get us BEFORE we outrank them. This phenomenon isn't exactly restricted to the UK; nurses the world over pretty much have the same complaints. Only in the United States have I ever heard about nurse unions managing to make any real progress through strikes. (And if you guessed that my source of US healthcare news is the ever-reliable and extremely accurate Grey's Anatomy, then ding ding, you're right again! What are you, psychic?--Ed.)

Today, while I was mucking about with some poor guinea-pig's intestine trying to smooth-talk it into contracting for me, a friend of mine who is a graduate medical student started telling me about her clinical rotation at Addenbrooke's Hospital here in Cambridge. On her first day, upon walking into the wards:

Angry Overworked Nurse #1: Who're you?!

Medic: I'm...I'm supposed to start my clinical rota--

Angry Overworked Nurse #1: Where's your ID tag?!

Medic: Oh, uhm, it's in here...lemme fish it ou--

Angry Overworked Nurse #1: Why aren't you wearing it? You were TOLD to wear it at all times! Oi Angry Overworked Nurse #2, c'mere. Take this medic to Dr Snobbish Surgical Chief.

Angry Overworked Nurse #2: What? But--but she's a MEDIC. Why do I get her?

Medic: Um--

Angry Overworked Nurse #1: Because I said so! I've got lots of work here. I hate doctors anyway. Take her!

Angry Overworked Nurse #2: And you think I don't?! Right, you, follow me. And keep that bloody tag on!

Now I know that sounds like an exaggeration, but it's not that far off. My friend said that not only did the nurses hate her, they were also very open about WHY they hated her. They informed her in no uncertain terms about their disdain for doctors and openly bitched about them. Of course, my friend being the smart and sensitive person she is, recognised this bitterness for what it was, and eventually made friends with the nurses on her wards. But I was reminded of her when I came across this article in the Times, which got me chuckling.

King’s College hospital NHS Trust in London is offering nurses free cappuccinos and chocolate chip biscuits to encourage them to smile at patients. They introduced the reward scheme after surveys raised concerns that nurses were not being nice enough to the sick.

Any old idiot can see there's no shortage of material here to make fun of. In fact I'm quite sure several blogs have picked up on it and done exactly that (but no, I haven't found them yet, hence the absence of links --Ed).

But I'm not gonna do that today. That'd be a cheap shot. In fact, I rather agree with this method of reward. The article isn't pretentious about WHY the hospital has started doing this. It says quite plainly,

Trusts are introducing new initiatives to improve their “customer services” because, under government reforms, hospitals now need to compete for patients.

No beating around the bush there. Government numbnuts mess up the system enough to make hospitals compete for patients, but out of the whole hulking mess comes something that finally benefits the patient (that's you and me, folks. --Ed). According to the article,

Matrons at King’s College hospital hand special thank-you cards to nurses who are seen smiling at patients or relatives, chatting with patients, having a positive attitude or doing something to make someone’s day better. Selina Truman, head of nursing in general medicine at the trust, said “This scheme is very motivating because matrons and ward sisters praise the nurses directly. It has put patients back at the centre of our work.”

Believe it or not, folks, competition's actually made things better for the patients. Anyone who's ever been in a hospital will tell you that the attitude of the attending nurses makes a huge difference in the quality of your stay. And while offering nurses free coffee and biscuits may seem like a cheap way of getting them to clean up their act, it's actually workable. It's one of those 'little things that matter' that everyone seems to go on about (married people will understand. --Ed) and, as everyone knows (including the nurses themselves! --Ed) nurses really could use some coffee.

But what move like this could stand without naysayers? Lo, already they appear on the horizon:

However, an editorial in Nursing Times magazine said nurses did not need bribes to be helpful and pleasant to patients. It said: “Excessive workloads and paperwork prevent nurses from spending time with their patients and caring for them properly. This is a fundamental problem that can never be rectified with a hot drink and a biscuit, or other such imports from industry.”

That's true, Mr Anonymous-Editor-Hiding-Behind-Anonymity-To- Avoid-Being-Skewered-By-Fantastic-Wits-Like-Mine, but it's a step in the right direction. I'm assuming the editor of the Nursing Times has been a nurse him/herself at one point, and I challenge them to find a single nurse who WOULD mind a free coffee and biscuits in return for ignoring their insanely depressing workloads long enough to flash a smile and a kind word at a patient.

Still, though, all's not well that ends well in this light-hearted tale. The article gives a taste of a more serious issue brewing:

In recent years there have been growing concerns about nurses who are “too posh to wash” and prefer to spend their time on administrative and technical tasks rather than basic care.

Two years ago a resolution at the annual congress of the Royal College of Nursing proposed that nurses were now “too clever to care” and suggested that the compassionate part of their job should be delegated to healthcare assistants.

Nurses who think above their stations. *gasp* Can it be? Are nurses becoming too highly trained to perform basic nursing care? Is this phenomenon unique to first-world Britain, which is so saddled with political correctness and human rights that nurses are no longer fit to nurse? Is this a good thing, giving nurses rights and powers without having them undergo further education, or is it a recipe for disaster?

We may never know. Or we may find out someday. But when we do, I only pray that it isn't too late to salvage the National Health Service.

How Much Is That GP In The Window?

"Now with bonus Stethoscope, Malpractice Insurance and Pink Slip!"

Recently, in the comment section of this post, Dr Crippen chided me for taking a "Ghandi-esque position on the moral high ground" in the doctor-nurse issue. I admit to being a mere medical student, a pawn in the chessboard that is the medical profession, and as such may be a little wet behind the ears at the moment. But for all the ER, Grey's Anatomy and House that I grew up watching, I still dreamed of the medical profession as being a noble and nearly-perfect one, populated by happy people in white coats with reputations and consciences as clean as the sterilised walls they worked within.

Then came medical school.

And not just ANY old medical school, but this one. In a city whose health services are going bonkers due to obviously well-planned and well-thought-out (sic) NHS reforms.

So in all my bright-eyed innocence, I decided to play medical student and go tug on a few white coats to ask them what they thought of all this nonsense. The first I pounced upon was Dr Simon Lockett, an alumnus of Jesus College who agreed to come up to deliver a talk to medical students. Sitting in the lecture theatre, I was looking for a shrewd but kindly-looking genial man in a white coat to show up and tell us all about how he's looked after hundreds of families and watched patients grow old. So I was mildly surprised when a man whose face was half-obscured by a thick moustache reminiscent of Mark Twain walked up to the podium and, in exactly the kind genial voice I'd imagined him to speak with, told us all about his adventures as a General Practitioner.

As it turns out, Dr Simon Lockett is no run-of-the-mill GP. He is Secretary of the BMA's Norfolk committee for GPs, and has been involved in medical politics for some time. When the panicked coffer-fillers at Castle Spewitt, the Evil Headquarters of NHS Management, sprung upon the brilliant idea to cut costs by denying operations to heavy smokers, Dr Lockett was one of the GPs who spoke out against it. He is mentioned near the bottom of this article in the Times. Unfortunately, we all know that GPs are only useful as grunts and scapegoats, and as such have no political say. I decided to quiz Dr Lockett on a few on the issues that have bugged Dr Crippen and other medical bloggers.

(For the benefit of the reader, any quotes from Dr Lockett have been put through my patented DeMoustachifier(TM) so that they, unlike when I first heard them, are immediately coherent to the reader.)

On being able to perform minor surgeries: Like many GPs (and by this I mean the GPs who do not have scalpel-happy tendencies and deep-rooted regrets at not having gone into surgery instead) Dr Lockett is amazed that policymakers actually believe GPs do not have enough on their hands already and spend their free time sipping tea and discussing the latest episode of EastEnders in the clinic lounge. He attributes this to most policymakers' experience of actual doctors' schedules coming solely from watching extremely accurate and authoritative medical shows like Doctor Who.

On the current management of the NHS: Dr Lockett agrees with me that the NHS, the one-of-a-kind healthcare system in one of the greatest countries in the world, is being run by a group of rabid baboons in a doughnut shop with John Prescott.


On Nurse Practitioners being on A&E front lines: The moustache shakes sadly from side to side. Having gotten into trouble enough times to develop a Spider-Man-like sense of When Not To Ask Because You Really Don't Want To Know, I decide to skip to the next question.

On the real source of the NHS financial woes: Here Dr Lockett, having had his share of the politics involved, hesitates to be overly critical. He is very generous and hmmms his way through most of his reply, saying things about how the policymakers never really had time to properly test any of the reforms before they were put into action, and as such they were hurried through. He looks at me with a knowing smile, and I know that he is silently agreeing with me that the NHS reforms were dreamt up by a 5-year-old child dosed up on crack. He suggests that the financial deficits were simply because not enough money has been put into the NHS. Patsy Hewitt, eager to deflect any blame from herself that might spoil her well-polished and professionally-scrubbed white-toothed smile, has pointed the finger at mismanagement of funds. Remember that the next time you're at your local hospital and you see a consultant drive up an hour late in a brand-new Mercedes SLR. And you wonder. *X-Files ending theme plays*

And there we have it, folks. Straight from the workhorse's mouth. Dr Lockett, despite being someone who has seen the NHS fall apart from the inside (apart, of course, from the times when he was lax enough with his trimming to allow the moustache to actually impede his vision) comes off as a very cheery fellow, still happy enough to enjoy his job, dot his consultation room with Doctor Who memorabilia, and hand furry Daleks to his patients to stop them crying. I wonder what sort of a doctor I'll make when I grow up. For some reason this comes to mind:

I can't imagine why.

P.S. To all those who sat for the Cambridge BMAT exam, good luck! Hope it went well, and that your urinary sphincters were stronger in the exam hall than mine was. Email me your tales of woe at angrymedic [at] gmail [dot] com.

Revisiting The Battlefield: The Blog-Rape of Nurse Ratchet

War is hell, folks. It leaves people scarred and traumatised, and all too often the lessons are ignored. Fortunately for a select few of us, we are already so mentally unbalanced (from, say, studying in a hypercompetitive results-obsessed university) that we are immune to the psychological attrition of war. Which is how I lived to revisit the battleground that is Nurse Ratchet's blog.

Having summarised the event in the previous post, i revisited the comments section on the offending post to see how far the battle raged, and found myself in the midst of a few tail-end skirmishes. Seeing as how both sides lambasted each other with pretty thoroughly, I tried sifting through the debris to see if there were any deeper issues that had been drowned out by the whistle of nurse-thrown grenades and the explosion of doctor-lobbed shells.

The first casualty I found was, surprise surprise, the patient. Yes, a few brave patients had wandered out into the midst of the carnage and attempted to restore some perspective, but were mostly ignored:

As a mere patient (who remembers when the NHS worked and when hospitals were clean) reading this sober and professional exchange of views I note that the low percentage of intelligent, informed and helpful comment, compared to that of the functional illiteracy, condescension, snobbery, sexism, aggression, arrogance and plain stupidity shown, accurately equates with the number of compentent medical prac (or should I follow the quackers and write "pack..."?)titioners I've come across.

What I will say is that the medical profession (and the higher up the greasy pole you climb the worse it gets) has revealed itself to be nothing more than a bunch of vain preening peacocks. If you don't have a medical degree, then you're obviously thick as shit and beneath contempt.

Unfortunatly the sheer arrogance of the medical profession knows no bounds. I mean these guys bleat on upon Quacktitioners and don't actually do anything about it. Why don't they lobby parliment or do something? What is wrong with them? Answer: they are full of shit!!!

I'm just a humble 'comsumer' of NHS services. In other words, a patient due to have an operation this week. How reassuring to see the health care professionals at each others throat in this way.

Unfortunately, not all patients are as immune to craziness as I am, and this notable casualty was so stricken by the horror that she was converted. Literally:

crivvens I am never going to be seen by nurses or doctors again. You are all really horrible, both lots of you. I will stick to boiling up seaweed and invoking Spirits

However one patient got it spot on when he/she uncovered another common thread that seemed to run through the more rational comments:

How reassuring to see the health care professionals at each others throat in this way. Why not devote your energies against the bullying control freaks in what passes for our government.

And she wasn't the only one. Many others who called for ceasefire pointed the guns towards the REAL enemies:

Grow up, all of you.While you're slagging each other off the morons at the top of the NHS are dismantling it.

Lots of posts from doctors and nurses but none from the managers. Whilst we argue the toss here they are dismantling the NHS, rewriting the rules and dumbing down roles at the behest of their political masters.

As I've said before, we need to be uniting against the common enemy: Patsy Hewitt and her DH idiots.

Meanwhile, in her Evil Headquarters at Castle Spewitt, Leicester West:

"Bwahahahahaha! Die, pitiful worms!" *zap crackle crackle*

More and more people are coming to the realisation that the NHS is being managed by a bunch of half-witted morons. The frustration and resentment of not working in a properly managed field that has the potential to be so much more, and of having their intelligence insulted by a complete goon whose only functioning body part is probably her digestive tract, is spilling over into real life. To quote the comment left by Potentilla on the previous post, "doctors are MORE prone than other professionals to close ranks behind the actions of any of their number". The nursing profession is just the same. So as tribal and knee-jerk as our reactions may be sometimes, my opinion is that this is a reaction from professions under fire by a misled public and watching sadly as their once-great field goes up in smoke, thanks to a bunch of numbskulls.

The other point, of course, is that we have completely managed to make utter arses of ourselves in front of our patients. Just today I happened upon this article in Medical Student which gives the results of a poll on the most popular profession amongst the public. Under the bold headline "Everybody Loves Us!" it states:

The Government may have tried to blame the NHS funding crisis on doctor's wages but public support for the profession is unwavering after a recent survey named medics as the most trustworthy people in the eyes of the public.

Ouch.

Right. Um. I suspect that poll needs to be redone following recent events.

Who wants to be the first to e-mail them?

(thanks to Medical Student's Casualty City for the pic)

Doctors vs Nurses: Medicine's Oldest Battle Reaches The Blogosphere

One of the most ancient battles in the medical profession has been that between doctors and nurses. Each wants the other to just hunker down and do their damn jobs, but inevitably doctors develop a superiority complex and start lording their superior selves all over the hospital whilst still running whimpering to the nearest nurse whenever anything goes wrong, whilst nurses tire of the superiority (and the arse-wiping and the bedpan-cleaning) and try to tell doctors what to do. Then people get pissed off, the kid gloves come off and things can sometimes get nasty. (Especially when you're an inexperienced medic in the maternity ward's delivery room doing your best not to rip a newborn baby's head off, and the only help available is from huge bitchy nurses long on experience but short on temper. Not that I'd know anything about that, of course.)

Well today, the floodgates did indeed open, and the Doctor vs Nurse debate broke out in the blogosphere. It all started with an angry nurse who posted a rather inflammatory comment about a patient being unnecessarily sent to A&E. She diagnosed the patient as having Quinsy, but showed little sympathy for him hollering for the paramedics after a little inflammation:

"Excuse me sir - could I have a look at your throat? What's that I see? Inflammation? Things with pus in clinging to other red swollen things?Ever had tonsillitis? Oh you have ? And it was just like this except this is worse?"

Quinsy is indeed an emergency, but to be unable to have even done the most basic of examinations before getting all excited and calling the blue light boys....well.

(this Nurse Ratchet is not to be confused with the nice Nurse Ratched in my links, who thankfully keeps her diagnoses to herself.)

Not only that, but in a previous post she makes very clear her opinion of doctors:

For too long now Nurse Ratchet has been reading blogs by erstwhile members of the Medical profession; and while the views and observations on the whole are to be commended, there runs a theme throughout of "Nurseism", or "Nurseogynism" - or even "Nurse-o-phobia". These self-satisfied, pompous, narcissistic fellows (I assume they are fellows?) take great pleasure in patronising nurses who have the temerity, nay the bare faced cheek to aspire to something greater than lovingly wiping an arse, mopping a piss soaked floor…

Now, anyone who knows me (and watches enough Russell Peters) will know that I have a theory that once in a while, just for the fun of it, God looks down upon the Earth from His throne in High Heaven, and in all His infinite wisdom picks a random person on the street, and BOOM. All hell breaks loose, with hilarious results. Now usually that person is me, but today as luck (or rather, God) would have it, this little nurse gets lucky. And along comes none other than Dr John Crippen of NHS Blog Doctor, who reads the post, and decides to add a doctorly riposte:

Oh dear me, nursey, you have, to coin a phrase, just crapped all over yourself by demonstrating the classic nursey intellectual inability to have a "DIFFERENTIAL" diagnosis. You do not have the mental card-index of diseases that all experienced doctors flip through their mind as they are assessing a patient. You can think of two diagnoses. A doctor can think of twenty.

Now usually Dr Crippen is quite civil in his lambasting of the NHS, but in this one he seems to have gone over the top a little. Unfortunately for poor Nurse Ratchet (but very fortunately for God's amusement) his is the first post, and sets the tone for about 50 other commenters who promptly materialise and proceed to take turns gang-raping the nurse and making very clear their opinions of her intellect:

Was he ill? Yep.
Was it serious? Yep.
Did he need to be in hospital? Yep.
Quickly as possible? Yep.
Could I have harmed him by delaying? Yep.
Let me guess, Nursey. You haven't been on the course yet.

Render under Caesar that which is Caesar and leave to the physician that which he knows namely the art of differential diagnosis which passeth the understanding of the ignorant.

Nurse Ratchet - we don't interfere in your job, why don't you lot stop interfering in ours and stop all the nay-saying and bitching from the side lines. If you want to diagnose, manage and treat patients - go to medical school. In the meantime, stick to the bedpans.

Then Dr Crippen decides this shows a dangerous lack of medical knowledge and respect on the part of nurses, and decides to make Nurse Ratchet the focus of a whole post on his blog.

(This is also about the time when God decides to go into Ultra-Gag-Mode.)

And so the shit truly hitteth the fan. DOCTORS.NET picks up the article and has their say, while visitors to Dr Crippen's well-known blog take potshots at Nurse Ratchet on both her blog and Dr Crippen's. Even Singapore's Angry Doctor picks up a pitchfork and joins the fray. At this time, of course, I (having a perpetual death wish) try calling for diplomacy. Strangely enough, I do not get fragged, and instead Dr Crippen backtracks and agrees with me that the debate has descended into vulgarity:

I tend to agree with you, Angry Medic. It is getting a bit vulgar and out of hand over on Nurse Ratchet's site.

Her article has been picked up by DOCTORS.NET and battalions of angry doctors have mobilised and are on the attack.

I suspect Nurse Ratchet is writing with a little bit of tongue in cheek. As was I in the first comment I made under her article.

He then very cleverly diverts the argument to the real problem, that of what he calls the "dumbing down of the NHS", including (as I mentioned in a previous post) the endless reorganisations, the target-setting, and general nonsense that the NHS has taken from prophet of doom Patricia Hewitt. And thus the real villains of the story are revealed.

The midwives.

*dum dum DUMMM*

Okay maybe not. But Dr Crippen, in his reply to me, pointed out that the line between doctor and nurse is a fine one, particularly nowadays that Patricia Dimwitt is trying to replace doctors in A&E with nurse-practitioners and community matrons.

It is fascinating to look at the job requirements to be a "community matron"
• take a comprehensive patient history
• carry out physical examinations
• use their expert knowledge and clinical judgement to identify the potential diagnosis
• refer patients for investigations where appropriate
• make a final diagnosis
• decide on and carry out treatment, including the prescribing medicines, or refer patients to an appropriate specialist

As far as I can see, that is EXACTLY what I achieved after 5 years at medical school and three or four years as a junior hospital doctor.

Spot on. The NHS is messed up, but that's not what I'm getting at here. Nurses take a lot of crap, sometimes more than doctors do, and I've worked with enough nurses to know that they can make or break a doctor, especially in his junior years. They also have a far greater impact than doctors do on the quality of a patients' stay in hospital, and the work they do cannot be undervalued. However, the hospital is sometimes a jungle, and as I saw on a National Geographic documentary so long ago, the "key to survival is respect". If we all just respect each other, let each other do their jobs, and stay the hell out of each others' way, the hospital will be a much better place.

Thank God I'm still in med school.