Yippee!

It was back to the medical school today for another session of wait-and-hope-like-hell-that-your-name-is-on-the-list.

It was and the mini-medic has made it to clinical phase. I can't wait to January to finally begin at the hospital full time and feel a bit more like a mini-doctor.

On top pf that - I made it home through the weather too!

Merry Christmas everyone!

Watching and Waiting

The wait is nearly over - tomorrow is results day and if all goes well I can come back in January to clinical phase and be a student doctor walking around the hospitals.

However, as well as hoping for good results, I (and every other medical student hoping to make it home after results for a family christmas) am at the mercy of the weather gods. Much of Britain's transport network has been brought to a stand-still by the wintry weather and more is due on the way.

I'm quite lucky in that I only need a 1-2 hour interval in which to get home and have a choice of routes by which to get there. If things get very desperate I could start walking from results tomorrow and still make it to my house before Santa.

Hopefully it won't come to that though, lets hope the weather gods and the exam board are both in a charitable mood this holiday season!

Photo (c) Island Transport Solutions (a.k.a. Dad)

Three days 'til freedom

The general view of things in my medic household (There are six of us under one roof!) is of tiredness, almost-readiness and just wanting the next 3 days and 2 written exams to be over as soon as possible.

OSCEs are done and although they were tricky and there are lots of things I realised after coming out that I had missed. Hopefully I and all of us will have done enough. We won't know until December 22nd whether our Christmasses and New Years will be completely relaxing or whether the revision will continue before last-chance resits in January.

So - time to buckle back down to it - see you on the other side!

Ten days 'til freedom!

I wish I had more exciting medical antics to report on. Unfortunately with the exams marching up I have been spending much of my time reading, making notes, rereading and trying to inwardly digest the mountain of material from the last 18 months.

One amusing antic happened earlier this week when my partner and I were doing OSCE practice, pretending to take blood from each other. The doorbel rang and I almost answered the door to my landlord with a turniquet still on my arm- he might have thought we were shooting up drugs!!

The practical exams themselves are this week followed by 2 written papers next week.

Then....Christmas and a break at last!

The List

Finally with 3 weeks to go before the exams we have been given our timetable for OSCEs (practical exams) and an exhaustive list of potential topics.

OSCEs work in an amusing format where a number of rooms (in this case 12) are set up each with a different task in them. You have a fixed set of time in each room then when the bell rings you pick up your stethoscope and clipboard and run to the next room.

I like this format - it gets your heart going (particularly if you have to run along a long corridor between rooms!) but you don't have time to dwell on any mistakes and it's actually pretty fun.

My list of topics for this set of OSCEs is -

Abdominal examination

Arterial pulses

Blood pressure

BMI Measurement

Cardiovascular system examination

Communication skills

Cranial nerves

ECGs

Ethics and values in medicine

Genetics

GI examination

Infection control

In hospital resuscitation

Lumps and bumps

MedLine

Musculoskeletal

Neurology

Reflexes

Respiratory system

Thyroid

Venepuncture

Start the countdown!

Apologies again for the blogging silence. Final exams for the pre-clinical phase of my course start in less than a month. This week our hospital tutor led us onto the ward where he had managed to procure 5 very gracious and patient patients!

"Here you go - 1 patient each - Do ALL the examinations"

That means these patients obliged whilst for our own education and practice we carried out-

• A general examination of their hands, face and neck
• A cardiovascular exam
• A respiratory system exam
• An abdominal exam
• A thyroid exam
• An exam of all their joints 
• A neurological exam (both of the limbs and all the cranial nerves)
• Thankfully for them and us not a rectal exam though!

Any other willing volunteers? Free healthcheck!

If we were done too fast our consultant proceeded to grill us on what we might have missed. Thankfully I noticed one of my patient's most obvious symptoms - he had a missing finger on his right hand from his previous occupation as a butcher!

Little things

Many people live under the impression that doctors are clever. In most cases this is true. Many doctors can churn out a wave of facts about every condition you wish you didn't know about. Sometimes however- taking time to go back to basics can make all the difference to the patients we treat.

Yesterday I visited the hospital for a clinical skills practice session where an old and wise doctor teaches us some of the tricks of the trade and advice on some of our basic skills like history taking and examining. I spent a good half an hour sitting with a very pleasant lady who had been in hospital over the weekend and was being treated for - as her notes put it - a 'severe septic episode'.

This woman shared her story with me and then allowed me to examine her, knowing this exercise was for my own learning and wouldn't result in any better treatment for her. Finally at the end she admitted that although she had been told she was very lucky to have been brought into hospital and treated when she was, she didn't really know what had happened to her.

Now I'm one for keeping things simple - explain something to me in short english words and I'm a happy student. This woman knew she had had a chest infection, that it had got worse causing her to have shivers and feel rotten, and that now she was in a hospital and they were pumping drugs into her arm.

All it took was for me in my best student's english to tell this woman that the infection had gone into her blood and that was why they were putting antibiotics into her blood to treat it. The dots were joined up and she was a happy woman!

No-one had taken 2 minutes to explain this to her in the 4 days she had been in hospital!

You can be as clever as you like, but that means nothing to your patients unless you can talk to them like a human being!

anyway - rant over :-)

Still Alive!

Apologies again for the long absense of the mini-medic. Second year is proving to be a busy time when it seems that if I'm not in class or making notes - I should be!


There's still plenty I want to share so whenever I get a spare moment the mini-medics opinions (and yes there are plenty of them!) will be spoken out again!

Back to Reality

After a summer that went by far too fast - it's back to the world of medicine this weekend.

The Dissertation we were kindly given to keep us busy over the break is done! (that means printed and bound twice, burnt to a CD AND submitted online for plagiarism checks- I think they'll have enough versions to be going on with!)

My bags (and boxes, and suitcases) are packed ready to move into my house with friends tomorrow- 6 medics in one house- could be busy!

Classes begin on Monday and hospital sessions the next week- actually, despite how short the summer was, I'm quite excited!

Oh, and on Monday evening I'll also becoming a 'Medic Mum' of a bright eyed first year student (or maybe even 2) Best of luck to all the new medic freshers.

I'll do my very best to update regularly on life as a second year medic (although my house may be without internet for the first 2 weeks so we'll see how things go....)

Trust me, I'm an FY1!

This time next week I will be in the South of France on holiday.

3 years from then I'll be starting my new job as one of this country's annual crop of eager (and and yes, slightly nervous) junior doctors!

Yes - it's that time of year again, all on one day the new set of straight-from-med-school shiny new doctors start their lives as, not 'tomorrow's doctors' any more, but today's doctors.

Each year the press likes to scare us with statistics about how every year the proportion of deaths rises in hospitals. This isn't just due to the junior doctors (or FY1s as they are now called) - everyone is jumping up a level on the career ladder and adjusting. The FY1s will have been shadowing their predescessors for a few weeks now since they graduated there will be plenty of more old-hands to guide them on the way.

So - if you can stay healthy next week - do. But if you do find yourself in hospital- just be nice to those shiny new medics!

Twin becomes most premature baby to survive

Amelia Hope Burden was born before the 24-week legal limit for abortion when her mother was just 23 weeks and two days pregnant. (This article from the Telegraph)

She was born weighing only 1lb 2oz ten days before her brother Arthur arrived at 1lb 4oz.

He was born in July after Amanda Staplehurst had been pregnant for 24 weeks.

She went to hospital complaining of stomach cramps only to be told that she was in labour.

Amelia Hope showed little sign of life but doctors were able to revive her.

Under law they are not obliged to do so unless they feel it is in the child’s best interest.

Miss Staplehurst, 30, from Bournemouth, told the Daily Mail: “Doctors said she had just a 10 per cent of chance of survival and we never thought she’d pull through.

“Then having delivered Amelia Hope, it was totally bizarre that for ten days I remained pregnant with Arthur. The doctors have told us they’ve never come across a case like it.”

The babies are being kept in incubators but are putting on weight and said to be developing well.

The twins’ survival will give weight to the campaign to have the abortion limit lowered.

Some campaigners would like to see it reduced to 20 weeks.

David Cameron, the Prime Minister, voted for a cut earlier this year and has said that an upper limit of 20 or 22 weeks would be “sensible”.

The previous British record for surviving premature twins was 24 weeks, the paper reported.

Ouch!

The Telegraph newspaper's online site posted a variety of x-ray images of people after various accidents and mis-steps. Simple answers to the question 'What's wrong with this picture'?

This hapless soul stepped on a fork

This person came off worst in a fight with a knife-wielding attacker.

Finally, This historical x-ray of a Boer War soldier shows a bullet which has lodged between the metatarsals of his left foot, his toes are also deformed, possibly from the army boots and long marches.

IOC teams with WHO to get people moving.

The International Olympic Committee and World Health Organization are joining forces to prevent childhood obesity and foster healthy lifestyles.

The two agencies signed a five-year agreement Wednesday at Olympic headquarters in Lausanne, Switzerland.

Under the agreement, the WHO and IOC will work at both the international and country level to promote activities to help people reduce their risk of cardiovascular disease, cancer and Type 2 diabetes.

The focus is on getting everybody moving to reduce the risk of noncommunicable diseases across all age groups, said IOC president Jacques Rogge.

Physical inactivity is ranked as the fourth leading risk factor for all deaths globally, contributing to 1.9 million deaths each year, the WHO said.

Nearly 90 per cent of fatalities before the age of 60 occur in developing countries and can be largely prevented by reducing the level of exposure to tobacco use, unhealthy diet and physical inactivity, according to the UN health agency.

Previously, the two groups worked together to implement a tobacco-free policy at Olympic Games venues and health promotion campaigns in Olympic host cities.

Read more: http://www.cbc.ca/health/story/2010/07/21/ioc-who-health-promotion.html#ixzz0uLsSsUYj

Keeping Promises.

Everyone's worrying about money these days- 'who's in charge of it?'..... 'where it's going' .... 'Will there be enough of it'.

Unicef uk has a campaign to make sure that in all the kerfuffle of the credit crunch and financial problems- we don't forget those who need help most. In September, deputy Prime Minister, Nick Clegg will attend a special UN meeting to discuss the Millennium Development Goals.


In 2000 the United Nations set themselves 8 goals to meet by 2015, targeting world poverty and inequality. Things we all take for granted.

• Eradicate extreme poverty and hunger
• Achieve universal primary education
• Promote gender equality and empower women
• Reduce child mortality
• Improve maternal health
• Combat HIV and AIDS, malaria and other diseases
• Ensure environmental sustainability
• Develop a Global Partnership for Development

2015 is getting closer and several of these goals are not on target to be met. Millions of children worldwide still do not have access to clean safe water.

Unicef has an online petition to remind the UK government of the promises they made to the poorer parts of the world.

One proposal is a 'Robin Hood Tax' which would take a very small percentage (around 0.05%) from banks and financial institutions - producing billions of pounds to help children at home or abroad.

Visit the online petition here.

All in the numbers

CBC and Statistics Canada have summed up the Nation's health by a collection of figures. Life expectancy and the number of canadians with access to a family doctor have increased, but then so have obesity cases. I'm sure the figures shape up pretty similarly for us too, back in Blighty. Can we fight the numbers?

All Change!

Just as we thought when we started learning about the structure of the NHS - it's all different as soon as we get a new government in charge.

The Conservative-LibDem government has decided to do away with Primary Care Trusts (PCTs), strategic health authorities and most NHS targets.

GPs are now to be the 'managers' and decide where the money goes in their area.

Read the full article from the BBC here.

Here are the opinions of two GPs (also from the BBC)

FOR

Dr Darin Seiger is a general practitioner from Northampton. He helped set up a GP association, Nene Commissioning, in 2007. With 650,000 patients and 350 GPs, Nene is the biggest example of commissioning by family doctors in Britain.

"If GPs are the drivers of their patient care then that's a good thing.

It's better that practices get extra support to achieve their outcomes than falling short. There will be a variety of providers out there which they can choose from.

If doctors are determining the support they need then that's an improvement.

This is all about redesigning care for the benefit of patients.

Conflicts of interest would have to be declared, of course, but with proper accountability and supervision, problems can be overcome.

Safeguards could be put in place too.

As long as GPs have the right kind of support this can work, particularly if they are split into two groups.

If the 'strategic commissioning' GPs with an interest in redesigning healthcare and the 'providing' GPs more focused on providing excellent healthcare can work together I have no doubt this will work.

The success of these proposals rests on clinicians talking to clinicians and redesigning care for the benefit of patients."

AGAINST

Dr Kambiz Boomla is a GP who practises in the East End of London.

"Firstly it's a very large budget to deal with and we know that there are probably spending cuts coming.

GPs are busy people. We don't have time to do this in between seeing patients, so we're going to have to buy in commissioning support from private companies.

My fear is that the government has a hidden agenda - to allow private companies to buy out GP practices.

But we are responsible to our patients in a way that private companies are not.

Unlike us, they are responsible to their shareholders, wherever they might be in the world.

There's also the danger of conflict of interest.

We could end up with a situation where a private company is placing contracts with sister companies which own hospitals, putting commissioner and provider in business together.

And there will be disputes over costs, which will take time and public money to sort out in the courts.

All markets in healthcare result in inequity.

People who live in better off areas would be able to purchase better healthcare than those in poorer areas.

In my view, there is no place for them at all in healthcare."

_______________________

In my (inexperienced, yet opinionated) view, whilst GPs are the first contact for many patients and those in charge of referring onto hospitals, a lot of senior (sounds better than 'older'!) doctors are still not computer literate and certainly didn't sign up to be managers when they went to Medical school.

Even within a single town, GPs from one area will feel most of the money needs to go into care of the elderly and diabetes, where as another will think it needs to go into maternity or infectious disease control- depending on the demographic of people who come to their surgery.

GPs are busy enough dealing with their own patients, let alone endless management meetings.

An organisation as big and important as the NHS surely does need some competent managers and a central strategy in order to be efficient.

It does seem to me that we are taking a step backwards.

.......Oh well, it may all change at the next election anyway!.........

How many doctors does it take?.....

So on the upside I am now entititled to walk a hospital and say 'Hello there- my name is _____ and I'm a second year medical student'.

The downside of that- it's back to the books for dissertation time.

This year I am carrying out a project on juvenile arthritis where I research the background of the condition as well as interviewing a number of patients and their families. Having already visited a couple of paediatric clinics I visited my local hospital here and asked if the rheumatologist wouldn't mind me tagging alone to observe theirs.

Apparently I wasn't the only one

When you take your slightly poorly child to an outpatient clinic and enter the consulting room- how many medical professionals do you expect to see?


The patients on Tuesday may have considered themselves lucky or unlucky to open the door and meet

• The Consultant whose clinic it was,
  
• A rheumatology registrar
• an F1 (junior doctor)
• yours truly
• and an extra consultant just visiting to fill the time!

I've heard of getting a second opinion, but there has to be a limit, surely!

Hooray!

Never (I think) have a group of nervous students been so pleased at seeing such a plain, uncelebratory message pinned on a university noticeboard.
The medical school, it seems is not one for flashy ceremony. We spent the weekend happy in the knowledge that we had done at-least-just-enough.

On Monday we were gifted with something of a breakdown of our marks. I was pleased to see I had passed 19 of the 20 written questions this year, passed all my OSCE stations (yes even the male catheter one!) and got an average of 74 %

Anywhere else that would be 'a first!!!' ........... at medical school...........

'Satisfactory'

Oh well, that'll do for me :-)

Celebration time

Sorry for the lack of blogging, I was busy escaping from my house at uni and moving back into the family home for the summer (not sure yet whether the folks are pleased aboout this or not!). STILL 3 days until results come out and I can introduce myself as a second year medical studentI

In the meantime, on Thursday we have a family outing planned to celebrate our 'adopted' homeland at the Canada Day celebrations in London's Trafalgar Square. Nothing like celebrating before results, is there eh!
The timetable for the day is:-

10:30	Canada Day opens:
	O'Canada - Canadian Tenors
	Ceremonial Drop of the Puck by the Canadian High Commissioner
	Hockey: Matches 1-4
	Canadian Pavilions Open
11:00	Cine-Club Film: La Grande Seduction
	Cooking Demonstration by Chef John Jackson
12:00	Canada on Stage - Eccodek
	Cooking Demonstration by Chef John Jackson
12:25	Kwakwaka'wakw First Nations will perform "Tlasala" (Cheif's Dance)
12:35	Kiesza
13:00	David Celia
	Cine Club Film: La Grande Seduction
	Cooking Demonstration by Chef John Jackson
13:20	Radio Radio
13:45	Hockey: Matches 5-8
14:00	Autograph Signing by Paralympic Medalist: Chantal Petitclerc
15:00	Cine Club Film: La Grande Seduction
15:30	Meet the Mounties
	Triviala
16:00	Kwakwaka'wakw First Nations will perform "Tlasala" (Cheif's Dance)
16:30	Hockey: Bronze Final
17:00	Hockey: Gold and Silver Final
17:30	Trafalgar Cup Presentations
17:35	Richie Hawtin: DJ Set
	Concert Begins:
18:15	La Patere Rose
18:40	Dan Mangan
19:05	Canadian Tenors
19:40	Hawksley Workman
20:00	Canadian Pavilions Close
20:20	Sarah Harmer
21:10	Jully Black
21:45	Bars and Food Stations Close
22:10	Closing Remarks and O'Canada
22:15	Event Ends

Visit the website here and try to make it if you can. It should be a great day!

A year ago today!

Lancaster - Natural Sciences - class of 2009

Thanks again to all the great people at Lancaster who helped me get where I am now.

Did the Earth Shake?

Yesterday afternoon a 5.0-magnitude Earthquake shook Canadians in Ontario and Quebec.



Best wishes to all my Canadian friends and family. Particularly those in Ottawa and Toronto.

Read CBC's take on it here.

Wow!

Had a long day?

It's nothing compared to the day John Isner and Nicolas Mahut have been having at Wimbledon. They shattered all records for the longest game in grand-slam history. Being forced to give up due to vanishing light after 10 hours of play and tying 59 games all in the 5th set.

But, they'll be back tomorrow to finish what they started.
Read about the match here.

All-in-all a fairly exciting day in sports land.

Edit- on day 3 of the game and after 11 hours of play, Isner won 70:68 in the final set.

Did we make it?

Yup.

But now we face Germany.

Will we make it?

BBC Sport takes a look at the permutations ahead of England's vital match and the equally-important game between the USA and Algeria in Pretoria.

ENGLAND BEAT SLOVENIA, USA DRAW OR LOSE AGAINST ALGERIA

Yup- England win the group.

ENGLAND BEAT SLOVENIA, USA BEAT ALGERIA

Yup- we still go through. Goal difference determines the group winner.

ENGLAND DRAW, USA DRAW

iffy....... goal difference again.

ENGLAND DRAW, USA WIN OR LOSE

Home time.

ENGLAND LOSE

Home time- IF we let them back in the country!

June 23 is .........

Not really sure why this day but it is so......

765 day to go until London 2012

The Organising committee are running an 'open weekend' 23-25 July. It includes hundreds of events across the UK, from sport to art, dance to exhibitions. Find out more here.
The london 2012 venues are also taking shape.

1325 days to go until Sochi 2014


and only 52 days until the first youth olympic games kick off in Singapore.

Also it's now only a 3 horse race for the 2018 Winter Olympics. The final candidate cities are

• Annecy, France
• Munich, Germany
• Pyeongchang, South Korea

I kind of hope korea win it, simply because they've been so close so many times now. Points for effort!

Little and Large!

When my mum said she was getting a doppler ultrasound of her legs and asked me if I wanted to come and observe. I imagined a hospital appointment with radiographers and big meaty equipment.



We were both a tad surprised perhaps to find that the doppler in question was more like this.



This gadget confirmed what we already knew- my mother does indeed have blood going to her feet - I could have told them that :-P

Unfortunately it didn't give us much of an answer for why all the fluid wasn't leaving her right foot again........the mystery continues.

Key NHS targets 'to be scrapped'

This came in the news today. Many doctors say some of the NHS targets are a pain in the a** but will the new changes be better or worse for patients?

Key NHS targets are to be scrapped and management costs slashed by nearly half as part of a major shake-up unveiled by the coalition Government.

Health Secretary Andrew Lansley said GPs will no longer need to see patients within 48 hours, while the four-hour maximum A&E waiting time is being relaxed.

Central scrutiny of the 18-week referral to treatment target will also be ended.

Patients' campaigners expressed concern that the reforms could lead to a "free-for-all" where health providers were not held to account.

But Mr Lansley insisted people would still have the right to demand high levels of service.

"I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes," he said.

"Doctors will be free to focus on the outcomes that matter - providing quality patient care. Patients will still be entitled to rights under the NHS Constitution, and the quality of their experiences and outcomes are what will drive improvements in the future."

Mr Lansley said the changes would help drive down the management bill for Primary Care Trusts and Strategic Health Authorities from its current level of £1.85 billion to £1 billion by 2013-14.

Although NHS spending was set to rise in real terms over the coming years, it was crucial to make "immediate" savings so they could be reinvested in care, he said.

Costs should be cut by £220 million this year, followed by a £350 million fall in 2011/12. By 2013/14 the total reduction will be £850 million.

Article from the press association

Also read from the BBC, here.

A day early, but.....

To my Dad and all the other great Dads out there.....

Happy Father's Day


PS- the cartoon is no reflection on you - it just made me smile!

All done now :-)

Blink and you miss it - year one of med school is done and dusted.

This was how OSCEs worked out for me

Day 1
1. Anatomy - male reproductive system (questions included- how would you insert a male catheter?- errrrr.....gently? )
2. ECGs (getting better at these - they were double-dutch for a while)
3. Medical research/statistics presentation
4. Anatomy - Knee joint
5. Breast examination (Male examiner: 'Talk to me as if I'm the patient'!)
6. Cardio Examination
7. Infection control (oh yes- it's the hand washing station!)

Day 2 was more of a breeze

1. Anatomy - shoulder joint (I knew something was up when the anatomy professor opened the door before I got to it and said 'Hello- you'll be having me in a minute', closed the door again and left me to quiver in my boots until the bell rang to enter)
2. General exam (yipee!)
3. History taking (yipee!)

Still have to wait a few weeks for results but fingers crossed

Getting used to freedom again- went for a sunny relaxing walk in a country park yesterday - aah :-)

Photo of the day #2 England 1-USA-1

Bad luck boys- play better next time!

You have to love (or at least have a good giggle at) the American perspective though.

Photo of the day

(Credit to Daylife.com, not me)

Name and Shame

In an article from the BBC today the 'Best and Worst NHS hospitals were named.

The Consumer watchdog Which? carried out a review of parking policies in the different NHS trusts around the UK and found wide variation in the prices charged and the amount of clamping that takes place. According to Which?, 70% of people have experienced problems with an NHS hospital car park and for nearly half, parking made what can be a very stressful time even worse.

In September last year, former health secretary Andy Burnham announced that hospital car parking charges for in-patients, their families and friends would be scrapped within three years in England. The coalition Government has no current plans to carry this out.



Speaking as a medical student, of the hospitals I visit a days parking can vary from £3 to £10, I'm sure someone is making a tidy profit somewhere. Hopefully the money is going into the trust and improving patient care. You can read the full news story here.

In other news this week.

Unhealthy living 'almost universal' in Scotland (BBC) (CBC)

Thousands of hospital patients dying 'because too few senior staff work weekends' (Telegraph)

A University of Calgary student has taken the University to court saying it violaiolated his constitutional right to freedom of speech when it disciplined him over Facebook comments. (CBC)

The WHO is pleading to increase blood donation in poorer countries (CBC)

Is the sex symbol image damaging nursing? (BBC)

Are GPs up for the challenge posted by the new government? (BBC)

Hockey!

Congrats to the Chicago Blackhawks - 2010 stanley cup champions.



The Blackhawks beat the Philadelphia Flyers in overtime of game 6.
Shame not to see a Canadian team win the cup............

but then again...............

Hockey makes me happy :-)