Fatigue, fess-ups and... fun.

I'm in the middle of an unexpected 12 day work-a-athon pre-Great North Swim, and although I can't complain, the last seven days have definitely been ones where I think - gosh! My job is full on! In the last 7 days:

Number of significant breaking-bad-news encounters - 2

Number of prescribing errors - 1 

Number of times crying - 1 (see above. Everything was fine. Realisation one is fallible is just quite distressing)

Number of antibiotics prescribed - lots

Number of steroids prescribed - as above plus lots more

Number of other specialties who have been grumpy with me - 2 (once justifiably, the other probably not)

Number of ePortfolios that are definitely ready for end of year sign off - 0

Number of hours of sleep - definitely not enough. And progressively less as the week went on. Not on purpose, you understand.  Self-perpetuating cycle of not-being-able-to-switch-off-ness.

Number of hours in the library on my academic day - 10

Number of evenings requiring bolstering by friends - every. single. one.

What a strange existence it is to be a junior doctor... On realising this, I did what any lucky daughter would do and called my MUM.  

Now, my mother is very wise. Nonetheless, I think it takes a particularly wise mother to know what to say when one's daughter comes across as slightly unhinged. Because I do sometimes feel quite messed up about this job and my life and how much I love it and yet how bonkers it all is.  I haven't really worked out how me and my life and my friends and my job all sort of stick together.  The last of these sort of has to be the most important right now. 

And of course, my my mum is right. The first year of a new job is always a bit crazy. Probably the first two or three years, even.  All one can do is muddle through, eat food, sleep and keep yourself sane. 

And have fun along the way, bien sur!

I'm female and I'm a doctor - so what?

The above is exactly what I thought when I started medical school.  I was made aware of the Medical Women's Federation (MWF) and a lot of the issues relating to female doctors seemed quite distant to me; maternity leave... child care... Naively, I thought this was all that mattered when it came to the fact that I happen to be a girl, and frankly, was so far from my thoughts that I thought no more about the fact that I had ovaries and wore make up from time to time.

Then I read a BMJ article saying that there was a 28.6% pay gap between male and female doctors - what?! There is more to this than pure numbers, but the disparities don't stop there.  There are specialties with a particular lack of oestrogen, perhaps surgery being the most well known, but I was also alarmed to read that amongst medical academics (which I would love to count myself among one day) nearly a quarter struggle to return to work, whereas in comparison most men go to a new or promoted position after a career break.

What on earth is going on - did I miss something or are we still stuck in the last century?

I thought about my own (limited) experience as a doctor, and the advice handed down to me about where my career should go.  And it all became clear.

Discrimination feels like it should be really obvious, and that it can't possibly happen because it is so taboo these days.  And yes, sometimes it is subtle.  But often it is so obvious, I feel embarrassed that I haven't said something.  I've had comments about how I look from male senior doctors who have subsequently turned it into a team joke, and banter from another colleague when patients think I'm a member of secretarial staff (no offence intended to the secretarial staff - I just think said patients might find it a bit weird if they then witness me putting up drips, doing ward rounds with patient examinations and prescribing medicines...).  Most career advice I have been given has come with the heavy caveat about the fact I'm unlikely to pursue XYZ career because I'm a girl and off I'll run to have babies.  At the time, these little digs seem so unimportant - it is easy to laugh it off - and you don't want to seem weak and whiny by kicking up a fuss about something that's 'just a joke'.  Because sometimes it is.  And I'm sure any of the chaps I have worked with would be absolutely mortified to think they had caused offence because I'm a girl, or frankly just think it's silly banter.

But do these little chips and inferences eat away, gradually, at women? I don't know if I want to laugh these sorts of jokes off forever.  Heaven forbid I actually do have children one day and then I dread getting a whole other round of 'oh, typical, off you go, leaving us with another gap in the rota...'  And I think if you are told something enough times, you end up feeling like you either have to join the club and become almost masculine about the whole thing, or walk away completely.  That's how women stay away from the board room of many a hospital - it's just not worth the argument.

I'd like to think we can meet somewhere in the middle.  First of all, I refuse to fit the leadership stereotype of stampeding to the front, telling everyone I'm the boss and that anyone who dares to disagree with me is a fool.  I'm going to do it my way, and be an inclusive leader wherever I work.  Maybe that is a 'girlie' way of doing things, but hey - I'm a girl!

And I certainly don't want there to be an end to the fun and jokes on the ward.  But I don't desperately want my legacy to be 'that tall blonde doctor' (which was the latest 'joke' I got to enjoy at my own expense).  No, it's not a compliment. Just maybe check now and again that your jokes aren't stepping over the line, and I'll make it my job to tell you that the line has been crossed.

Maybe I'll feel differently if I'm ever lucky enough to have babies, but for now, that would be enough.

Recent training...

Oxford morning running...

More Oxford morning running...

Bradford-on-Avon --> Winsley running

Oxford Town-Gown 10k running...

With only two weeks to go til our team triathlon starts, we would be ever grateful for your support!

Today a bunch of us ran the Oxford town/gown 10k; a little warmer than we would have liked, and inevitably I brought up the rear, but nonetheless with two weeks between me and a half marathon I was pleased to make it round in less than an hour (just!)

I will post more blog-appropriate things soon, but in the mean time, if you've got some pennies going spare, consider giving them to www.justgiving.com/organisedfun.

Thanks!

K xxx

Get up, Stand up! Why Junior Doctors must lead from the front

Trainee doctors are an often forgotten entity, although we occasionally get some air time as per the Dispatches programme shown last week.  There has also been a recent wave of discussions about daily Consultant reviews and same-standard care 7 days a week, and GMC guidance for doctors about raising concerns.  

Fact is, when you arrive in hospital, you see a nurse, and then you see me.  You may see only me for a while, depending on how unwell you are.  Then you will see a series of other, but more senior, doctors in training.  You will see a consultant within 24 hours, but until then, it's doctors in training of a range of seniority levels who will manage and guide your care unless you happen to be extremely unwell.  Junior doctors look after patients on the ward, with senior input daily and as required.  If someone becomes unwell, junior doctors will often be first at the scene unless it's a cardiac arrest.  Getting your scans, blood tests, referrals etc done will generally be the responsibility of the junior doctor. 

So I'd say junior doctors like myself are fairly 'front line'.  One consultant I worked for described us as their 'eyes and ears' while they juggled their other commitments like clinics and teaching.  Junior doctors are leaders from the moment they do their first ward round (jogging behind the consultant juggling three different folders trying to write, listen and pull the curtain round all at the same time). 

I went to a national leadership conference in Bolton recently - I was one of only three foundation doctors there, and I knew the other two, which perhaps suggests that there exists only a small world of leadership-minded junior doctors.  

Hurrah!  Excellent conference, but where were the juniors?!

And it was very interesting! Because when we sat down and did a group project about solving clinical problems, or clinical governance, or patient safety, or resource management, or human capital, or the work environment, or CCGs..... etc etc..... who provided stories, anecdotes, evidence for what the issues are, and what might be done to solve them?  Ah - enter the junior doctor!  

I'm not trying to suggest there is no role for Consultants or other clinical staff, but if it helps to paint the picture, one of the Consultants there commented towards the end of one discussion that we needed to get juniors involved in these leadership issues because we still believe that change can come, and we're the ones on the ground with the ability to make these changes happen.  

But what changes?  I would describe these as twofold - attitude/cultural, and practical.

1) Attitude/culture - 

We are a new generation of doctor.  We do shift work.  We're expected to be able to do more - there's incredible medicine and surgery out there.  If someone spikes a temperature, or has a heart attack, or has complete renal shut down, there's actually something we can do about it.  We're expected to show our teamwork/publication/presentation-ing skills around a 60 hours working week. But yet we still live in some bizarre shadow of yesteryear that it was 'tougher back then', you should practically fear your consultant and seniors, and any weakness/emotion/personal life issues are almost an question of professionalism.  

Let's show a little love, people!  Yes, it was tough then, but it's tough now, just for different reasons.  Let's support each other and look after each other and, leadership evidence says, we'll be a happier, more efficient, more effective and safer clinical machine.  

2) Practical - 

There are so many on-the-ground practical challenges that remain - the way a 'Take' list is constructed.  The organisation of the blood cupboard.  The sorts of jobs you get bleeped about that might be better placed in a jobs book.  The appearance of the clerking proforma.  We use them every day - if it doesn't work, or it's impractical, let's change it!  

So junior doctor compadres - let us lead from the front, not shirk our duty and hold our heads high - for we are the medical leaders of right here, right now, and not just tomorrow.  We must engage for the sake of improved clinical care and efficiency, and be the leaders we know we are already.  

In the interests of GMC new guidance relating to social media (although I think it's pretty obvious from the side bar): my name is Karin Purshouse.  I am a Foundation year 1 Doctor. 

Look after the pennies and the alcohol will take care of itself

I'm pre-nights.  I've spent 3 out of my 5 days off at some sort of work related teaching/course etc.  I'm a little bit cranky secondary to this.

BUT

I just wanted to have a wee chat about this whole minimum price for alcohol issue that is rather a hot topic in the UK.Read more here...

Genuine confusion from me about why this is so controversial.

I feel before I start, I should lay out my own drinking habits.  I tend not to drink much alcohol, or anything, during the week.  If I went out for a meal, I'd probably share a bottle of wine with someone.  If I go to the pub, I'd have a pint and a half maybe.  I'm no Saint, particularly back in my student days, and occasionally now if I have a really awful day, but I'm generally not that bothered by alcohol.  If prohibition was back tomorrow, it'd be no biggie.

So the main statements against minimum pricing for alcohol seem to circle on an attack on personal liberties and the feeling that this won't make any difference anyway.

On the former - I find this... surprising.  Apparently moderate drinkers will be punished - really?  Under the proposals, the cheapest a bottle of wine would be is still less than a fiver.  I think most discerning drinkers would say that's still unbelievably cheap for 12 units of alcohol.  As one of said moderate drinkers, I do not feel this infringes my personal freedom.

What I see is very much the end that Sarah Woollaston is on about - the bit where people come into hospital and have had their entire lives ruined by alcohol.  In my current work environment, this can be as pancreatitis, bleeding ulcers in the stomach, liver failure... but it can also be an 'aside' part of their health problems, where they have family or employment problems as a result of alcohol.  Withdrawal effects can also be severe and life threatening.  Many have argued that increasing the cost of alcohol won't make a difference and that people will still drink.  I'd argue two things for this.  First, we cannot predict that it will stop people drinking; but surely if there's a chance it will reduce it, that's a start and worth trying.  Second, at the very least, there will be more money to provide the drugs and services people need as a result of excessive drinking.  It also frustrates me that excessive drinking is seen as a 'bad choice' made by trouble makers.  Addiction is an illness that can affect anyone from any background, and as a society we have a responsibility to supporting these people as we would those with any other illness.

I always get a bit depressed when people bemoan a change that might benefit the minority in society.  If this change was going to financially penalise people in a more active way - i.e. more money out of someone's pay cheque or increasing council tax - I would understand.  As it is, I stand to 'lose' as much as anyone in society, and yes, perhaps I'd think twice about that pint at the end of the week.  But for me, that is a price well worth paying. 

Where did all the drugs go?

My annual leave could not have come a moment too soon.  There is only so much energy and motivation in the tank of one junior doctor, and although winter seems to have made yet ANOTHER appearance, training is still going well - the advantage of living somewhere really pretty is that  even when the legs and lungs start hurting on a run, chances are there's something nice to look at while you're expiring! Yet to jump in a swimming pool, but in my defence, the run happens first!

Of course I'm suppose to be doing a bit more of THIS - i.e. reading and writing, which I am currently enjoying in the rather delightful surroundings of an Oxford cafe or three.  I am nerding out to my heart's content over many a tasty cup of coffee.  I'm on nights this weekend so the freedom is shortlived, and yet another celebration is down the pan (sorry, sister, I'll hopefully make your birthday next year!). 

In reality I am doing a lot of THIS - pondering, pen in hand, and trying to get a bit of R and R, something that does not come naturally to me at all. 

As a total aside, I realise my blog has deviated somewhat from its original purpose of my chit-chat about random things going on in medicine from the perspective of one lowly junior doctor type person, and a discussion I had this weekend made me think about this a bit more carefully.  My brother-in-law was asking me about the lack of negative drug reporting and how do drugs come to be available to us anyway?  On the latter - this is essentially what I am reading about in the current module of my studies, but in a nutshell, it's a long, arduous process lined with failure at every step.  Less than 10% of all drugs that start the clinical trial process make it out the other side, and that's the ones that even reach said process.  That amounts to a seriously expensive drop out rate, and a cost which is mopped up by any successful drugs that do pop out.  Think about how much our world has changed since the human genome project - so many possible targets for drugs to reach!  The question is, which ones and how?  Pharma hasn't got that one quite sussed yet, and it's something that everyone's trying to solve - the FDA talk about a 'Critical Path' that should take drugs safely through this process - whether this works remains to be seen.

As for the former, I think I've posted this before but Ben Goldacre's talk on the lack of negative result publishing is well worth another mention.  It's a real problem that pharma-land and the publishers have yet to address.  I'll let Dr G do the talking....

Right.  FDA report reading, here I come.... 

Training starts today!

Realising that doing a half marathon and one-mile swim all in the next four months around my rather antisocial work hours will be a little painful!

.....But this is what it's all about!

I may be on nights this week but training started today for my mega-outdoors-athon in May (Edinburgh half marathon) and June (Great North Swim).  A 7.35km run along the river on day one in the Oxford sunshine :)

I realised looking through my blog that I may have been somewhat cryptic but here's what it's all about.  There was an avalanche in Glencoe on the 19th January and close university friends of mine were amongst those involved.  They were friends not just by virtue of our time at medical school, but also an immense amount of time spent in the hills, bothys, the Irish sea, up to our knees in snow, curled up in a make-shift shelter of moss logs and many more wild places.  Their loss is still not something I can really believe is real, but they were full of so much joie de vivre and laughter that this seems a good way to start living life with them alongside us.

Begging emails of donations to follow!