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.

The NHS Blog Doctor Saga: Zombie Doctors and the Revenge of the Nurses

Zombie doctors, megalomaniac nurses - who says medicine isn't fun?

Apologies for picking up on this so late, I was off on holiday in Amsterdam. (No I did not smoke any weed, okay, and the incident with the Dutch police about the magic mushrooms, the break-in and the 70-year-old lady - well who the heck asked her to use a red light in her dressing-room window anyway?! --Editor)

I got back to blogging to find the NHS Blog Doctor saga in full swing. To summarise, Dr Crippen of NHS Blog Doctor went MIA and hasn't blogged for months (not that I'd know anything about that. Hey, why my nose getting longer? --Ed) and people started getting worried. Then some dude with the very imaginative and totally original nickname of 'Dr P' posts a comment on NHS Blog Doctor announcing Crippen's death (as detailed in my previous post), leading to the Royal Mail being overwhelmed by people posting flowers and condolences (and to me having a minor heart attack. Who is this Dr P fellow anyway? Sounds like a rapper wannabe. Someone please show him this video and let him rip his penis off wanking. --Ed)

Anyhoo, Dr C's friends the Devil, Mr Eugenides and Wat Tyler have come out to say that the doctor is indeed alive and well. Having not heard from Crippen himself though, this means the good doctor is both alive AND dead. Not having the requisite number of brain cells to comprehend this (and needing a good excuse to mess around with Photoshop) I have decided this means he is UNdead. The world's first zombie doctor blogger! (Dammit. There goes another item on my Life Ambitions list. --Ed)

Then Dr P, deciding he/she isn't done gettin' jiggy with it, posts a comment on Paul Linford's blog detailing his/her evil plot to fake Crippen's death. Wow, a rapper-wannabe AND a supervillain! Where's the Scooby Doo gang when you need them? In this comment, he/she reveals the awful truth-- he/she is a NURSE. *dum dum DUMMMM*

"I have crossed swords with the guy many times through his blog due to his supreme arrogance towards the many of us out there who do not hold, or want to hold, the title of 'doctor', yet do a generally good job of holding the NHS together."

To me, this doesn't seem odd, because ol' Dr C isn't exactly known for being the biggest supporter of nurses. And this revelation can only mean more bad publicity for nurses and more venom being thrown at them by Dr C's supporters. 'Dr P' has done for good honest nurses what Osama bin Laden has done for millions of innocent peace-loving Muslims the world over - given them one heck of a bad image.

I can understand Dr P's venom at Crippen's years of nurse-bashing though. But don't you think wishing him dead is a little extreme?

I'm Dreaming Of A White Change Of Shift

(Why the weird post title, you ask? Ah, 'tis but another concoction of my brilliantly witty mind. You see, this post is both about the nursing blog carnival Change Of Shift as well as about the fact that it snowed yesterday. Hahaha geddit geddit seewhatIdidthere? --Editor)

Change of Shift is up over at my favourite nursing blog, Nurse Ratched's Place, which is also the only medblog I know of to have appeared in Blogger's Blogs Of Note. Mother Jones was kind enough to include one of my posts (yes, medic posts CAN appear in nursing blog carnivals. No, you do not have to be handsome enough to have every nurse in your hospital want to make out with you, but it helps. Cough. --Ed)

This edition of Change of Shift has a Valentine's Day theme, and Mama Jones wrote some very nice words about me:

The Angry Medic wrote this post about a nurse with a hard, tough exterior, and a heart of gold. He says that she likes him. Well of course she likes you, Angry Medic. You’re a good guy. That’s why those nurses you write about on your blog want to drag you into the nearest closet just like you see on Grey’s Anatomy. You better watch out. One of those nurses that you are so fond of may have special plans for you on Valentine’s Day.

No, that is NOT me blushing. I, um, just have some red stuff on my face. Ketchup from lunch or something. I do not blush! I am a very manly very hot medic. Cough.

Yesterday I undertook an interesting experiment in human psychology. Cambridge is a funny place. Everyone's under so much stress to perform; medical students with glasses thicker than A-Level Statistics textbooks, lecturers who sacrifice time, hairlines and contact with sunlight to stick in their labs waiting for a breakthrough, and porters who double up as riot police every night as the college bar empties. So sometimes all it takes to drive people over the edge is a small relatively mundane occurrence.

Like a little bit of snow.

King's College Great Gate

Now I know places where it snows so much that it's nothing to laugh about *ducks to avoid Eskimo whaling spear* but it NEVER snows in Cambridge, so when it does, things go a little cuckoo. The widescreen madness started at about 8.30am at the Great Gate of Trinity College, where amidst desperate medics on bicycles skidding in the streets and crashing into restaurants, a bunch of mathematicians suddenly lost their inhibitions (hey, normal people lose it when they get drunk, mathmos lose it when it snows. Who knows what goes on in their heads? --Ed) and started a snowball fight. Out came one of the porters to see what all the ruckus was, and BAM went a snowball to his face.

He then went back into the Porters' Lodge, summoned the other porters, and following standard University procedure in dealing with snowball-throwing mathmos, started a snowball fight with them.

Trinity mathmos finally lose it. Spot the tourist desperately trying to get away.

I myself skipped lectures and spent the day doing the tourist thing, outsnapping even the hordes of Japanese tourists thronging King's Parade. Taking a cue from the Bohemian Road Nurse, I enclose some of the more interesting shots I took along my travels:

Tourists snapping away on King's College Chapel, right before a porter came and kicked them off the lawn.

A Jesus College student risking expulsion, beheading, hanging and any number of other archaic punishments in the University Constitution to build a snowman on Chapel Court lawns before the porters catch him.

Jesuan students risk the wrath of Trinity College porters to build a snowman on Trinity College lawns (because everyone knows Trinity snow is more "legendary" than Jesus snow.)

"This is the best damn snow in the South of England. I only step on the best snow, y'hear? And this is the best snow. It's Trump Snow. We should charge people to step on it."

Knock On Nurses, Bring On Curses

Nurses are funny people. And I mean that in both senses of the word. Sometimes you have funny ha-ha nurses who make you laugh. And sometimes you have nurses who act funny for no apparent reason, like the one in this story. I personally have had experiences with many nurses (most of whom are hot and obviously wanted to drag me into the nearest store cupboard and do a Grey's Anatomy on me. It can be tough, being a hot young doctor in a hospital with a nursing college right behind it... --Editor). The most memorable one was with a nurse in an Intensive Care Unit who was butch and tough and looked like Dr Bailey would if she were a nurse:


But when the time came when her patients needed her, she demonstrated real care and diligence. She would even skip lunch and stay on at the station when poncy doctors dropped their clipboards and headed for the cafeteria. And she was nice to me. She'd tell me stuff the consultants wouldn't repeat for me and give me pointers before my fat was fried by said consultants.

I also knew she had a tough life. It showed. But she fought it and kept going. I met her during an attachment back in the days before medical school. She gave me my first glimpse into the hell that is medicine.

Recently a family member of mine had to have surgery. I was sitting in the waiting room trying to be the strong voice of reassurance to my family. I was, after all, a highly educated medic, dammit. But all I managed was a bad impression of a castrato singer trying not to sound like a castrato singer.

Luckily I was rescued by a nurse. Read the whole story on Medscape's med student blog The Differential. Again, do leave a friendly comment if you like the post. I need to convince my Medscape bosses that I'm more than just a goofy smile on the blog...

Snapshots of Hell: The Cambridge Round-up, New Year's Edition: Rampaging Drunkards, Cambridge Admissions and the Medical Blog Awards 2006

UPDATED: Read below for the chilling conclusion to The Drunkard's Tale! *dum dum DUMMM*

"Come, my precioussses, come to me...
but make sure you bloody well bring at least
3A's at A-Level, you pipsqueaks."

It has come to my attention that there are readers out there who have realised that I am prone to very...interesting travel experiences, and actually look forward to hearing my tales of terror (you sadistic sickos. --Editor). It has also come to my attention that there are readers out there who think I should stop whining about my travel mishaps and just take it up the tail pipe rather than posting off-topic travel rants to fill up space. So as a compromise, at the end of this post I've listed a few things I've learnt from my insanely long flight back to Britain.

Now, on with the medicine!

'Tis The Season To Self-Congratulate
It's time once again for the 2006 Medical Blog Awards! These awards are designed to honour the very best in the medical blogosphere, and to highlight the diverse world of medical blogs. Voting is now open, and I'm glad to see a few of my favourite medblogs are in the running. NHS Blog Doctor seems to have done very well, with nominations in 3 categories, a very good turnout for little over a year in blogging, as pointed out by Shiny Happy Person. SHP herself joins the good doctor in the nominations for Best Medical Weblog, along with such notables as Dr Sid Schwab, Doctor Anonymous and Dr Charles. I'd like also to point out here with some measure of pride *chest swells* that a medical student blog has also made it to this category, namely From Medskool. You're a credit to the race, brother! *thumps chest*

My only gripe with this year's Awards is that there's no Best Nursing Blog category. Some of the best medblogs out there are written by nurses, and they should be recognised in the same breath as doctors. The latest one to hit my (sadly lacking) sidebar is Travel Nurse, whose adventures in lands far, far away make trapped-in-ivory-tower me want to be a nurse. (*realises my lecturers read this blog* Sometimes! Only sometimes! --Ed)

Cambridge Admissions Results: 'Tis the Season for Heart Attacks
Cambridge admissions results are in the process of being sent out as I type this; in fact tomorrow, January 5th, is the two-year anniversary of the day I got my acceptance letter. I'd just like to take this opportunity to wish all of you who applied to Cambridge a hearty "good luck!" and if you get in, yay. If you don't, shout for joy! No, seriously. You don't know what you're getting into. It's for the best. Either way, if you feel like ranting and need someone to listen, you know where to drop me a line. (It's at angrymedic [at]gmail [dot]com, in case you don't. --Ed)

Bonus Travel Tale! Things You Learn On The Flight Into Britain

1. No matter how beautiful the bird's-eye view of nighttime London is, no matter how breathtaking the city's lights are, with the Thames snaking through the middle of it all and fireworks sprouting in the air below you, just because it all starts growing bigger, the runway appears beneath you and the plane extends its landing gear--

--doesn't mean it's not going to suddenly fire its jets and take back off into abovementioned nighttime sky, with the captain announcing that they had to abort landing to avoid crashing into the plane ahead of yours.

2. Just because you're safely out of the hellhole that is Heathrow Airport and sitting on a nice, warm coach with a group of nice old ladies all ready to get back home to Cambridge and a nice soft bed--

--doesn't mean that you're not going to be locked on abovementioned bus for half an hour because your driver has inexplicably run away and it takes that long for another National Express coach driver to discover you.

3. Just because you're home in abovementioned nice soft bed at 3am, the fireworks are dying down, and you're settling into bed after a long tiring journey--

--doesn't mean you're not going to be rudely awakened by a relentless drunkard banging on your front door trying to break in, on a night when the rest of the house isn't back in University yet and the police are busy chasing down bands of drunk students.

4. Just because you've hidden behind your door for 30 terrifying minutes whilst dialing the duty porter, and he finally comes to take care of the drunkard besieging your house--

--doesn't mean the porter isn't going to open the door, INVITE THE DRUNKARD IN, and give him a room for the night. NEXT TO YOURS.

UPDATE: Okay, I've kept you in suspense about the drunkard long enough. After about ten minutes of listening to him destroying furniture in the room next door, I called the porter to ask him what the heck he thought he was doing. He then nonchalantly told me the drunkard was actually a Jesus student who'd been temporarily given the room next to mine but was just too piss drunk to remember who he was. Or how to put keys into a keyhole.

Still want to come to Cambridge?

Happy New Year, folks. And don't forget to vote!

P.S. HospitalPhoenix Update: To all those who left comments about HospitalPhoenix, you will be relieved to know he is alive and well, as can be seen in the comments here. I for one am very relieved I can finally call off the police search.

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.