Would you rather be trained or educated?

Week five blues are supposed to have been and gone, but they appear to be set in for the long run right now. Quite a lot of it is due to the sheer amount of learning we’re expected to do, from first principles. I want to be a doctor dammit, not a scientist! But sometimes, you realise why we do it the traditional way here, instead of vocational training or PBHell.

Another post from Ckemtp explains why it’s better to be educated than trained, using the hypothetical situation of learning to clean an ambulance at two different companies:

At YOUR ambulance, you learn about the biological functions of bacteria and viruses. You learn their strengths, their weaknesses, how they reproduce on inanimate environmental surfaces, how they create biofilms to increase their reproductive capabilities and life span, and how pervasive they are in randomized samples from real-life ambulances. You learn how grime collects in the ambulances, how it adheres to the surfaces that you will be cleaning, and what the various types of substances are that you will most commonly find in real-world applications. The whole first day is spent on nothing but learning about dirt, grime, and germs and how they contaminate ambulance interiors. They even threw in the types of materials that the ambulance interior is made from and what the specific dirt-holding and germ-breeding properties of each material are. You see samples and scenarios pertaining to germ and dirt proliferation on ambulance interiors. Not only that, there’s homework, reading material, and a report due the next day….

Your roommate, on the other hand, went to work and found out that he too had to learn about ambulance cleaning. He learned that they also expect clean ambulances, however his choices and training are much simpler. He is told to clean the ambulance using two bottles: One marked “Cleaner” and the other marked “Germ Killer”. He is given ten rags and is told to clean the ambulance for inspection by the owner of the company using the tools given in the time allowed. He does so and is told “Good, now do it again tomorrow”. The next day, he again cleans the ambulances using the tools and training provided, and is again told “You did a good job”…

1. Which ambulance service do you think will have cleaner ambulances in the long run?
2. Which employee do you think will do an overall better job in cleaning the ambulances?
3. Which employer, “YOUR Ambulance” or “HIS Ambulance” do you think has the better philosophy?
4. Which ambulance cleaning class will result in the better, more motivated, happier employee? (Life Under The Lights)

The point here is that although you could be trained to do the procedures, what to do in certain situations, isn’t it better to put in the extra work and be educated? Would education, an in depth knowledge of why you do certain things rather than just how to do them, make you a better ambulance cleaner doctor at the end of it? Even if it is harder to begin with?

Almost fit to practice

Today was my last(ish) occupational health meeting – I got told by the nurse during Freshers’ Week that I was being referred on to discuss the slight stress related dermatitis I get on my hands, but it turned out to be a full health history and review of allergies, dermatology, and the possibly big sticking point of mental health.

The conclusion was pretty much, “well, you seem to understand your health and have plenty of control measures in place, not sure why you got asked to come here”, so all is well there. The last hurdle is to get two MMR jabs, as apparently I’m lacking measles and rubella immunity, but it shouldn’t stop me going out on placement come December. The doctor seemed to think, as I did, that having worked in healthcare for a fair while I should be the best judge of it’s affects on my health, though she did recommend anaesthesia as perfect for a mentalist like me (and suggest that perhaps I shouldn’t head into surgery, with the repetitive scrubbing up).

So just two shots to go. And to convince EEAS that I’m fine too…

I take it back: Anatomy, I love you

Need a way to remember dermatomes and myotomes? Hit play!

I’ve never been so turned on by anatomy in my life. And no, watching Bob Whitaker do something similar in the dissection room doesn’t have the same affect. Not even slightly.

Hack ‘em, slash ‘em

I started dissection last week. I feel very lucky to have this facility available – very few universities in the UK still get cadavers (four, I think?) – as it makes learning anatomy so much more real, and hence (hopefully) more likely to stray learnt. It’s also kind of exciting yet humbling at the same time, slicing open a real human body and poking and pulling at the bits inside. I’m very much a “break it and see what happens” type, constantly pulling things apart to see how they work, and given my reason for doing medicine is my sheer inquisitiveness of how a human functions, dissection is right up my street.

However, it has had some negative effects on me. These are:

1. Making me feel old. Not only am I surrounded by people who claim to be eighteen, but look like they’re only just into their teens, I also got told off by one for being disrespectful! Apparently telling jokes around a body isn’t on; I informed him that the jaded cynicism would come soon.
2. Now whenever I look at people I see their anatomy (as well as the usual “Ooo, you have nice veins”). I was looking at Porn For Girls By Girls.com (completely SFW) and found myself commenting on the “ARMS” model’s, which I found fantastic in a great anatomy demonstration way.
3. Eating meat will never be the same again. I was eating a divine steak today (at St John’s Chop House, never heard of it before), but couldn’t help carefully taking out the nerves and fascia to look at. Carving a joint is even worse…

Why I love medical textbooks

I went to a CPD session the other day run by Ant Kitchener on the acute abdomen – essentially assessing and maybe diagnosing someone with belly ache, the hardest thing to do, in my opinion, in pre-hospital care. So like any good little ETA/student HCP (I love being able to call myself that now!), I went to read up on what we were taught. And I found this in the Oxford Handbook of Clinical Medicine:

Enid Blyton’s Famous Five characters can generally solve any crime or

diagnostic problem using 1950s methodologies steeped in endless school holidays,

copious midnight feasts (always confection laden), and lashings of

homemade ginger beer.

The one insoluble problem was (and is) abdominal distension. The methods

used by the Famous Five actually contribute to each of its causes: fat, fluid,

faeces, flatus, and fetus. If you think it far-fetched to implicate ginger-beer in

the genesis of fetuses, note that because it was home-made, like the fun, there

was no limit to its intoxicating powers in those long-gone vintage summers.

Enid Blyton did her best to minimize the risks of unwanted pregnancies by

gender reassignment (George) and by making one of her characters a dog

(Timmy)—but accidents must have happened. The point is to remember to ask

‘when was your last period’ whenever confronted by a distended abdomen.

Enid Blyton’s Famous Five characters can generally solve any crime or diagnostic problem using 1950s methodologies steeped in endless school holidays, copious midnight feasts (always confection laden), and lashings of homemade ginger beer.

The one insoluble problem was (and is) abdominal distension. The methods used by the Famous Five actually contribute to each of its causes: fat, fluid, faeces, flatus, and fetus. If you think it far-fetched to implicate ginger-beer in the genesis of fetuses, note that because it was home-made, like the fun, there was no limit to its intoxicating powers in those long-gone vintage summers.

Enid Blyton did her best to minimize the risks of unwanted pregnancies by gender reassignment (George) and by making one of her characters a dog (Timmy)—but accidents must have happened. The point is to remember to ask ‘when was your last period’ whenever confronted by a distended abdomen. (OHCM)

To the point, and exceptionally memorable. Plus made me snort tea up my nose at about three am. Perfect.

On edge

It may be the two coffee mug chocolate cakes I’ve just wolfed, but I am completely on edge. I’ve tried to lay down and sleep, but I can’t. The body is shattered but the mind just won’t stop.

I’m in that horrible not one thing, not the other state that I last experienced five years ago. No longer at school, but not yet at university. Except now it’s the slightly more grown up version, between university and work. Both and neither at the same time, and all the associated worries from both sides as well as the worries about making the move – do I have enough money, will my room be ok, will everyone like me, will all my crap fit in my car… The racing thoughts go on.

I’m not sure why I’m writing this – just something to do, getting it down on screen might help empty my brain of thoughts, or maybe just tire me out. You never know, it might work out.

On the plus side, I’ve wrangled me a tutoring gig to get a bit of extra pocket money while at uni. That, and my phone contract seems to be overcharging me by about fifteen pounds a month, so I’ll see if I can’t get any of that back…

Practice makes perfect?

As part of my upcoming ‘induction week’, I spend a day meeting “my” General Practioner. And I’m really looking forward to it.

Who am I, and what have I done with Nick? Yes, so I may not come across as the biggest fan of the GP on this blog. But it’s not just me, no-one involved in prehospital work is a massive supporter of primary care. Tom Reynolds is probably the most eloquent on the subject, but we all have our horror stories. One of the first things I was taught on the job was the GP actually stands for “Get paramedic”, with the phrase, “Let’s see what the quack has written,” uttered when I asked for backup on a SAH that had been diagnosed as “?flu”.

But, shock horror, there are good GPs out there. Once in a while, we get an appropriate GP Urgent or GP Red. The doctor has been out, properly assessed the patient, worked out they do needto be in hospital within a given timeframe, given us a thorough written handover, let the hospital know, and explained what’s happening to the patient. But this happens rarely. The reason why? In the majority of cases this same GP goes out, properly assesses the patient, works out they don’t need to be in hospital (or if they do, don’t need an emergency vehicle to take them in), and treats appropriately themselves. So we don’t see them. What we do see is the lazy, bad GP, for whom every single patient has “HR 70 reg BP 120/70 RR 12″ with “chest clear, basal creps”. Every single one (I’m not joking). We see the GPs who miss the blindingly obvious MIs and strokes, and we see the GPs who call ambulances for “eye pain” and other shit that means the patient doesn’t need to be stuck in a ward full of infections, let alone a blue-light vehicle to take them there.

So because of this, pre-hospital has a deep mistrust about general practice. And the same is reciprocated, where the good GPs see the ambulance staff completely ignoring them and disregarding what they do. And it leads to all manner of incident like this Doctor Crippen rants about. Patients diebecause of ambulance staff not trusting GPs. But the crews have to gothrough the rigmarole, because they need to properly assess every patient themselves, as in the majority of cases the doctor hasn’t. The two professions, who should be working together for the benefit of patients, are in fact at each others’ throats, and it doesn’t help anyone.

Where am I going with this? Well, it’s the reason I’m really looking forward to getting involved with a GP surgery. I have a very biased view of general practice so far – a whole lot of shite from running urgents, and the bipolar opposites of some amazing GP for my personal medical issues through to those who just don’t seem to care and the continual argument of how some primary care physicians can fuck up pain management just so much. So I want to see things from the other side, the view from the overworked GP without enough time to properly do their job, having to be not only jack of all trades but also master of all trades. I want to see how the whole thing works, from start to finish, and where my pre-hospital role and (hopefully) future in-hospital job come in to the holistic, life-long care of the patients.

Don’t worry, I’m not going soft. I’m not interested in general practice as a career - even if I did have the compassion or sensitivity to deal with people, the reason I ran away from geology was the nine-to-five, stuck behind a desk life. But hopefully, working in general practice will help me see why things work the way they do. And I’ll appreciate the good GPs, forgive the GPs who occasionally slip up (and realise that I will one day be making those fuck ups), and maybe get an inkling into where those bad, lazy doctors come from, and how to avoid becoming one.

You’re a medical student now boy

I got my timetable for the next four years through the other day. It looked rammed. So to try and make it look less scary, I decided to put it onto a year planner. It didn’t work.

The next two years...

The blue bits are lectures, green and pink clinical. And yellow the dreaded exams. Anything not coloured in is “vacation”, otherwise known as “time to desperately revise while earning enough money for next term”. As you can see, there is very little of this. I’m used to Cambridge terms, with the same amount of time off as you spend in lectures! Where am I supposed to fit in all this lounging around watching daytime TV that’s expected of me as a student?

The search for job satisfaction?

Temping really doesn’t agree with me. Every time I’ve temped, no matter how positive an outlook and approach I take, within a month or so I’ve sunk into depression. I absolutely hate it.

It’s nothing wrong with the people, or even the work. It’s just the “daily grind”, waking up every morning knowing that I’ll be doing the nine-to-five at the same desk, with the same work, the same lunch break, the same scenery and same people to talk to. And more importantly, the same lack of Independence and responsibility.

The only time I’ve been truely happy in a job? Ambulance work. There’s no mindless routine, nothing to drag you down doing the same thing over and over again. Instead, you get something different every single day. New people to meet, places to see. Constantly learning. And you’re (to an extent) your own boss. You’re clinically independent in the back of a van, it’s you who has to make the decisions and take responsibility for the patient. And it’s that I love.

Ok, so it has it’s negatives. The repetitive COPD* patients, the constant waiting in A&E (I’ve dreamt of being sat in the ambulance holding area more than once), the target rather than patient driven running of the organisation. But the positives more than make up for the negatives, as far as I’m concerned, and my mental health seems to agree.

I was speaking to l0ttie the other day about this, and the decision we both made to go into medicine. Importantly, is this the right choice for me, or should I be going into pre-hospital care?

I won’t lie – the drive to go into medicine came from first aid and then ambulance work, for the exact reasons outlined above. I crave the varied life, and more, I crave the responsibility. My choice came about while working at BP – although the job was significantly more interesting than temping, it was still the same 9-5 at the same desk doing the same stuff. In the mean time I went off to countless major events at weekends/days off, working in ambulances and field hospitals, and loved every minute of it. I dreaded going back to work, losing the feeling of joy I got from being over-worked and under pressure, juggling the needs of several different patients and the comings and goings of the rest of the team, the excitement from shift work and never knowing what would come next, and at the end of it, the knowledge that I really did make a difference for people.

So I went for medicine. But will it be the same?

At the end of it, I suppose it comes down to what I enjoy about ambulance work. Is it the driving around with blue lights, is it the sitting for half a shift watching Jeremy Kyle, is it the coming into contact with people at their personal worst moment of their life? In short, is it the bits of the job that are to do with ambulance work? Or is it the varied working life, the clinical independance that I lust after? The parts of the job due to being on the front line of medical care?

Thinking about it, it’s definitely the latter. The ambulance bits of the job are good, I’ll admit it. Especially the people aspects of it (though skipping traffic is always good fun), but it’s the responsibility and decision making aspect that draws me in. It’s what I despised about being a healthcare – although I got to interact with patients, I hated being an autonoma, robotically doing the same things over and over again, never getting to use my brain and intelligence and do something good for the patient. What I always wanted was to use my skills and abilities to do the best for the patient, and I believe medicine is the best way for me to use what I’ve got, namely a modicum of intelligence and the balls to make decisions and take responsibility for someone who needs my help. What I enjoy is dealing with the patient by engaging my brain, and with medicine, there’d be far more I could do for the patient in exactly that way.

Four years to job satisfaction?

* Chronic Old Person’s Disease. What else did you think it could mean?

Fingers crossed

Finally got around to sending off the last two hurdles to my medical aspirations today – my CRB check, and my occupational health form. [Yes, so they're way overdue, but with all the jazz happening in my personal life I let the college know and they're happy for me to get them in late].

Now I don’t think the CRB check is going to be too much of a stumbling block. I’ve had around ten of them done in the past few years for an array of paid and voluntary roles, and all have come back clear. And as I haven’t been caught kiddy-fiddling or indecently exposing myself in the mean time, so should be cool on that front. Unless of course they manage one of their well publicised monumental cock-ups…

Getting occupational health clearance is a touch more worrisome.  Not hugely fussed about my allergies – the only people who’ve ever been bothered by that were St John Cambridgeshire, who were considering restricting me to low risk duties and the like, but since then I haven’t heard a peep from occupation health departments regarding them. Guess people are becoming more used to the idea of allergies in society? No, the thing that’s concerning me is how they’ll respond to the “Mental Health” section of the form.

I’m not going to lie on there, so I was as honest and open as I’ve always been about my bipolar disorder. And so far, I haven’t been refused any offers of employment due to the illness, but I have had concerns – BP requested a letter from my doctor clearing me, and both St John and the NHS have had phone consultations with me. But none of these roles have been as “serious” as medical school (or as medical school would like you to believe). The stress, the workload, the shift work; all are supposedly bad for bipolar people. Ignoring the fact that those are also bad for “normal” people, I can’t help but feel that occupational health might get a bit edgy about them placing someone with what they may see as an already defective brain in a position where they might be able to damage people.

Now I have answers to all those problems. I’ve coped with stress and high workloads before (as much as I like to play the casual dosser, I did actually have to work occasionally for my degree). And shift work is a proven non-problem, as I not only have experience of this through working in health care for the last year, doing night work with SJA, and my general work pattern at uni of all-nighters, I’ve also taken steps to minimise circadian rhythm issues, should they effect me, with sunrise alarm clocks and daylight bulbs as well as self enforced sleep schedules when things may start to be going slightly awry. On top of this is the fact that my medication has stablised what was only mild symptoms to begin with, I mean what with all the shit going on recently I haven’t once tried to kill myself or dance on the roof tops!

But will they see it that way too? I can only wait and see. Fingers crossed it will be fine, and this is me just doing my usual thang of veiwing the world in terms of worst case scenarios (works well, mind, means I’m constantly impressed with how well everything turns out). I’ve spoken to my GP, and he thinks I’d be fine. My pdoc (before I left their care, because apparently I’m fine on meds, see?) and I chatted about my plans for a medical career, and she too thought I’d be fine even with the bipolar. But for now I’m going to vent my fears and fustrations on the internet, yet more baring of my neuroses for your viewing pleasure…