The musings of a fourth year English medical student

Friday, 23 December 2016

PARIS

Pont Saint-Michel


Wow. I have just got back from a wonderful trip to Paris, thanks to my lovely sister! I turned 21 on the 21st of December, and she kindly took me on a wonderful mini break to one of my favourite cities.

Saint Germain
Scarf - Topshop
Coat - New Look
Bag - Fiorelli
Jeans - Primark
Boots - Clarks

We stayed in the Hotel Da Vinci, famously named because a man stole the Mona Lisa and hid it in this very hotel! The hotel is located in Saint-Germain, on the left side of the river. This is where we spent most of our time.


Our hotel was just around the corner from the famous Cafe de Flore. They do the most fantastic hot chocolate, and a lovely 'Saint-Germain' cocktail.

Rue Bonaparte

We walked along Rue Bonaparte, eventually arriving at le Jardin du Luxembourg.

Jardin du Luxembourg


Along the top end of Rue Bonaparte was a gorgeous Ladurée, famous for its macarons. 

Pont Saint-Michel

We also went to a classical music concert at Sainte Chapelle, which was very romantic! Sainte Chapelle is right by the Seine and Notre Dame.

Notre Dame

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Thursday, 22 December 2016

REFLECTING




I wasn't intentionally taking a break from blogging, it just happened.

I've had a fantastic time at uni. I've now finished my first term of my third year of medical school, so I am almost half way through my degree! I've had placements at General Practice, Psychiatry and Obstetrics & Gynaecology.

During this term I have been reflecting a lot. I have been thinking about what I really want from this degree. Of course, my dream is to be a doctor. However, like many vocations, it is fiercely competitive from day one. As an inherently lazy person who has no interest in competition, I sometimes struggle with motivation to work. It isn't that I'm not interested, far from it, but I usually need a bit of prodding to get started on revision. My passion is not fuelled with a need to be the best, but to do something that I love. And frankly, some medical specialities are more competitive than others. The problem is that I don't know what speciality I want to do. For example, I thought I had ruled out surgery and O&G, but then I was fascinated during a morning in a gynae-oncology theatre; now I'm reconsidering it. 

As well as becoming a doctor, my dream has also been to live in London. However, to practice medicine or study it there is very competitive. Although I've always been an ambitious person, I have lost a lot of that gusto since coming to medical school. I am now a very average student compared to my cohort, and I really doubt that I'm clever enough to get a training post in London. As much as I want it more than anything, part of me wonders what the point is in trying. I just don't think I'm good enough.

I'm torn between the ballsy Kate who goes for what she wants, and the crippling fear in the back of my head that says I'm foolish to even think I could do it. Realistically, to get into a London deanery for my FY1 jobs would involve me doing an intercalated degree, publication of some research I've done, and top marks in my written exams. That is a hell of a mountain to climb, and I don't know if I can do it. I don't know if I'll end up driving myself mad in the process. 

I think I should try, though. I think I would regret not trying rather than never knowing if I could do it.
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Sunday, 13 November 2016

OVERWHELMED



As the title suggests, the past few weeks have been pretty intense! I have finished my psychiatry placement and have had a week of cardiovascular lectures. Having said that, I couldn't tell you anything about said topic. I've been running around helping with events, doing my research project and marking essays. I haven't actually sat down and done any revision at all this week, because every time I try to I either fall asleep or get a headache. I feel bad for complaining about my workload given that many people juggle more balls than I do. Medicine never relents and only gets busier and busier, and you are expected to evolve. I love this challenge, but some days I can't stand it. Some days I want to lie in bed and not feel a sense of dread of all the deadlines looming in the air; all the knowledge I know I require but do not have yet to pass my exams. 

On top of that, the US presidential elections happened, and I am trying to decide which hospital to station myself at next year. For us at Liverpool, we do our finals in fourth year, not fifth year. You spend the vast majority of time at your 'base' hospital, pretty much doing 9-5 or 8-4. Therefore, the hospital you choose will be responsible for teaching your core finals knowledge, and getting your practical skills up to scratch in order to pass the LOCAS (Liverpool Objective Clinical Assessment System) exams. Some of the best teaching hospitals are the furthest away from where I live, and so it is a massive decision to weigh up your quality of education and where you're prepared to live or commute to. Many of us feel like we are choosing universities all over again.

I've also got a job, but am now worried how I'm going to manage with that as well! I am looking for a new car that is a bit cheaper but not succeeding. 

I am very excited for Christmas, as it's my favourite time of year. But again, there's a nagging feeling that exams are that bit closer and a whole term has nearly gone by. I'm trying to keep calm and carry on, but some days I just want to give up. Other days I am utterly in love with medicine and feel so strongly that this is what I am meant to do. I don't think I've ever worked this hard before, but I think it will be worth it. 
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Tuesday, 1 November 2016

HOW I REVISE



It has taken me the first two years of medical school to finally figure out how I revise! When you study a course that has no strict syllabus, it can be so daunting to revise. I always feel like there is no end point, but now I feel like I have a system that works okay. I am currently writing up notes for psychiatry, so thought I would share with you how I do it.

What do you need to know?
The university usually gives a list of 'learning outcomes' or 'key topics' that should be covered. As well as this, any diseases or information given in any of the university handouts and pre-reading could come up in the exam. Finally, this information has to be combined with all of the content taught in previous years. So, I read through it all, and make a bullet point list of the key information. 

Summarise
Sometimes, it is more important to know a little about a lot of things, rather than great detail in only a few diseases. I try to pick out what is important about that topic, and make it as condensed as possible, and easy to read. As well as this, sometimes in medical school the most important bit to know is the difference between diseases. Often that can be the basis for an exam question. In this case, make up tables of diseases with similar presentations and state  how they are different. 




Make your own questions
I use the free app ANKI to make decks of online flashcards. You can rate the difficulty of the questions so that you can focus more on the challenging ones. Ideally, you should always revise in the format you are going to be assessed in. 



Find past papers or mock questions
If you can't find any past papers, look in your preferred textbooks and do all the questions that they have in there. You can also find other quizzes online related to your subject. For example, I always forget the circle of Willis and end up doing this quiz each year. 



Ask friends what they're doing
Always ask other people in your year or above what they use(d) for the topic you're revising. If they are in a year above you, ask about what common questions come up. 

Work little and often
Going over 5 questions a day is way better than doing 50 in one day. Doing little bits on a regular basis helps keep you progressing and will make revising during exam time a lot less daunting. 

Save helpful information on Dropbox
If you find something really useful but don't want to waste printing it off, get a Dropbox account  and store it on there. This is so helpful for writing up lectures and saving powerpoint presentations.



<a href="https://www.bloglovin.com/blog/18319669/?claim=jbhz9ayts5m">Follow my blog with Bloglovin</a> 


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Sunday, 30 October 2016

THE FUTURE OF THE MEDIC JOURNAL?


Hello lovely people,

I thought I would update you all on what's been going on and the direction I want to take The Medic Journal.

I am nearing the end of my psychiatry placement and I am very glad of that! I have learnt about a speciality I have not been exposed to before, but psychiatry really isn't for me. I am very interested in mental health, as you know, but the life of a psychiatrist is not for me. There are many ways to practice psychiatry, and most consultants sub specialise. I was working with a lovely neuropsychiatrist in an outpatient facility, and now I am visiting nursing homes and disability centres. I've found the pharmacodynamics of the medications fascinating. 

When it comes to my own mental health, I have never been better. I truly do not feel like I have depression anymore. I am in the process of coming of my anti-depressant, Sertraline. I am so grateful to walk around and not feel a massive weight on my back; to look out and only see things in a grey scale. That is how depression felt for me, that there was no hope and I was a terrible person. I don't feel anything like that now, and I am so happy with my life. I feel very settled in Liverpool, I am loving being on placement rather than in a stuffy lecture theatre. Rob and I celebrated two years together on Friday and we had the most wonderful time. 


I have spent a lot more time on my hobbies this year. I have put a lot of effort in to styling my room and I am extremely happy with it. I don't know why, but having a tidy room makes me feel so cheery and calm. I am obsessed with gallery walls and am currently building up my own collection of art for my bedroom. I wanted to be an interior designer before I decided medicine was for me. Once I have my camera I will write a blogpost about my room.



I also really want to get more into fashion. I've always been the girl who would much rather read Vogue than a fictional book. I would spend ages pouring over the images, but never had the balls to execute the looks. I'm going to try to be more brave with my outfits and share them with you.

Overall, I want The Medic Journal to cover lifestyle as well as medicine. I'm also going to do some revision posts, as I've finally figured out what works for me!  You can look forward to my usual ranting alongside fashion, beauty, home and food. 

Kate x
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Thursday, 20 October 2016

PSYCHIATRY

My psychiatry placement has left me feeling emotionally drained. I wasn't sure whether to share this on the blog, as it isn't exactly cheery, but this was the first time I got proper emotional about a patient.

The first history I ever took off a patient (back in second year) was from someone who had attempted to commit suicide. So, going into my psychiatric placement a year later, I wasn't stumbling into it with total naïvety. Having said that, I found myself holding back tears throughout most of this placement. I was meeting patients who had suffered years of abuse of all forms, which had contributed to their conditions. One patient had a son who hung himself at age ten. Another patient self-harmed in ways that I found incredibly disturbing, which I won't share. Others who had such low self esteem that they decided not to press charges on their abusive ex-partners.

What was so upsetting about these patients' lives was knowing that the things they really needed we couldn't give. Almost every patient's problem was affected by money/housing/family/friendships/work. And of course, those things cannot be prescribed. In addition, many people developed psychiatric problems after caring for a loved one with a psychiatric problem. One patient had a fragmented relationship with her violent alcoholic son, which lead to her attempting suicide.

Now I feel sort of numb. I feel angry that our government can't support these people better. I feel depressed knowing we couldn't really help them. Doctors are seen as healers, but some things like this are beyond our realm entirely. 

I think it's hard to get the right balance between empathising with your patient and not letting it affect you personally. I've asked doctors how they handle this but received vague answers. I'm sure I will be better at balancing those tasks  with time, but I'm not really sure how. 
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Sunday, 9 October 2016

CLINICAL DOCTOR OR ACADEMIC DOCTOR?



The thing that has surprised me about medicine is that there are so many ways to practice it. Of course, I was aware that there are loads of career specialities I could pursue with a medical degree, but often I am wondering what kind of doctor I want to be. I've always been the person looking 10 steps ahead, rather than appreciating what is in front of me. And so despite only being in my 3rd year, I'm trying to figure out my career now. Realistically, I have at least 4 years until I have to choose the speciality I want to pursue, assuming I don't take time off or do an intercalated degree. But I still have no idea.

I went to an intercalation talk on Friday, and what one of the speakers said really hit home. The anaesthetist finished his speech by saying "Do you want to be the person following the guidelines or writing the guidelines". The way he said it suggested that the former would be too boring, and not ambitious enough. 

When I decided I wanted to be a doctor, it was because I loved biology and talking to people, but hated doing laboratory experiments. I wanted to understand people's lives, as well as how drugs work on the body. I love chatting to patients and letting them tell their story. And so when I got to medical school, I was astonished that people wanted to sit in labs and pipette things, use PCR, interpret data and calculate P values. I thought that was the point of other science degrees, and medicine was about the application, not the process. There are now plenty of medical students who are eager to get published, do intercalated degrees with their own research projects. That really isn't for me. 

However, I'm stuck  in this slightly awkward position of trying to enhance my career without doing things I know I hate. Involvement with research and extra degrees really help your medical CV and may help you to clinch your favourite training programme. They are not essential, but many of the high fliers have them. 

For some people, the glamour attached to a particular speciality is worth something. For example, being a surgeon seems a lot cooler than being a GP. But why do we think that? We need the surgeon and the GP. In first year, I wanted to get published, do an intercalated degree and hopefully be a surgeon. Now I've realised anatomy is bloody boring without knowing the physiology and clinical application of said knowledge, and sitting in my room on my laptop or in a lab doing electrophoresis are equally boring. The fun stuff is in the consulting room, on the wards, wherever the patients are. 

If writing the guidelines means looking at confidence intervals in the library, I'd much rather follow the guidelines and actually be in front of the patient.
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Friday, 30 September 2016

WHAT'S THE FUTURE OF MEDICINE?



I'm so sick of this Junior Doctor Contract drama. We took Hunt to court to question if he was able to impose the contract - we lost. The contract is going ahead. And then I saw this on Twitter:

Follow @doctor_oxford

Dr Clarke is choosing to not declare the trust who sent this email. But as you can see, said anonymous trust is bullying junior doctors into following the new contract.

There is evidence suggesting that junior doctors and medical students are now considering GP as their speciality. Why? It has the shortest training route (5 years including FY1 & FY2), therefore shortest time as a junior doctor. Less time on a rubbish salary and hopefully preventing burn out from the gruelling junior doctor hours. 

Morale is really low. I love being on placement, I have so much respect for the NHS staff and the extremely grateful patients. I know medicine is the only vocation for me. But how can the NHS survive when the staff have no reason to stay? It feels like the government really don't value the hardest working people in their arsenal.  
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Monday, 19 September 2016

MENTAL HEALTH: A GREY AREA





I'm currently on GP placement and am really enjoying it. Like all specialities it isn't perfect, but it is definitely on my list of potential specialities I would pursue.

One thing in particular surprised me about general practice: everyday I am seeing patients being reviewed for anti-depressants. I didn't appreciate how common it was. My heart goes out to the lovely new Mums who are finding it so hard, or the sweet old man who lives on his own and feels isolated. It's sad that as doctors we can't prescribe money, support or companionship. A lot of a patient's problem is social, and that is an area we have no control over. 

Today I had a tutorial on mental health in primary care. In all honesty, I don't know how you can distinguish depression and anxiety from the bad days and scary moments we all feel. What quantity of time is necessary for low mood to persist before it is called depression? If someone has lost a family member, is it just the natural grieving process or something more? We then carried on to discuss the guidelines on prescribing. It is recommended to carry on taking anti-depressants for 6-9 months after a patient has noticed an improvement, in order to prevent relapse. But what is relapse? 

Having suffered with depression, I tried to apply the guidance to my own case. NICE suggests that patients like myself who have a history of mental health problems should consider trying an anti-depressant. It also says that people with long-term depression (2 years +) may even be on SSRIs indefinitely. However, I also get incredibly nervous around consultants and sometimes feel like crying when I am around them. Is that anxiety or is that normal?

Recently I cannot decide if I still have depression or not. I have found some days of placement very challenging and I have been holding back tears at times when I have listened to patients' stories. But is that just part of being on a medical placement? Is that typical of having a bad day? 

Another symptom of depression is disturbed sleep and waking up in the early hours of the morning. I have recently been finding myself doing exactly this, and since my teens I have never slept that well. But then again, you could argue I have recently moved house so am in an unfamiliar environment, and the stress from my course could very well keep me up at night worrying. 

Mental health is definitely a grey area. We don't know what really causes it, how exactly the medications work, and we don't have a cure. However, as long as we keep the discussion open and allow people to know it's okay not to be okay. And however horrendous you feel, you will feel happy again. 
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Sunday, 11 September 2016

IS IT RIGHT FOR JUNIOR DOCTORS TO STRIKE?


Photo belongs to The Independent

I don't think I've come across such a controversial political topic as this. On the blog I have refrained from giving my opinions on the ongoing conflict between junior doctors and Jeremy Hunt. There are many reasons for this; one of which being that I am not a junior doctor. I have never experienced the relentless shift pattern that to them is only the bare minimum of what they do in hospital. However, this issue shows no signs of resolving any time soon, so I wanted to give my two cents. 

What does 'junior doctor' mean?
A junior doctor is someone who has finished medical school and is in the process of their post-graduate training to become a consultant or GP. This process can take between 5 years (for general practice) and 12 years plus (for consultant jobs). The starting salary is just under £230001, and goes up in increments with each year of progression through the training program. However, their training length is often longer than this. Junior doctors may have to take time out to have children or family bereavements. Some specialties encourage further research and PhDs that they need to attain in order to be competitive enough to get their end-goal consultant job. With this in mind, many people will be junior doctors for at least a decade of their life. The BBC has stated: “In total, there are 55,000 junior doctors in England - representing a third of the medical workforce”.1

What is the fuss about?
The new junior contract has increased basic pay by 13.5% on average - sounds great, doesn’t it? What Jeremy Hunt doesn’t state in his speeches is that all the add-ons to the total salary such as weekend, overtime etc. will be scrapped or severely reduced. The junior doctor salary is only half made up of the basic pay, the other half comes from these add-ons. This means overall the junior doctor salary will be less. Junior doctors would usually get paid more money for working weekends and unsociable hours (like any other normal profession would). Now, Jeremy Hunt wants to class Saturday as the same as Monday-Friday. FullFact has said: “According to the BMA, the old contracts allowed junior doctors to take a break every four hours for 30 minutes. The new contract allows one 30-minute break after five hours and then another after nine hours.”2

How hard do junior doctors actually work?
Ridiculously hard. What many people do not realize is that junior doctors have to juggle their 48-72 hour weekly workload with studying for exams. It goes without saying these exams are bloody hard and essential for them to pass. Not to mention they are a minimum of £500 each per attempt, and many do not pass the first time. Given that junior doctors are less experienced than their consultant peers, their job is extremely stressful. The little time they do have off is dedicated for exam revision. When a junior doctor is on a shift it can be difficult to stay healthy. I have overheard junior doctors say that their water consumption and urine output has been less than an AKI patient on restricted fluids. Sometimes what they preach they don’t have time to practice. Junior doctor Rose Polge committed suicide in February 20163 and mentioned Jeremy Hunt in her suicide letter. She went missing the day after he announced he was going to impose the new contract.

Why does everyone hate Jeremy Hunt?
Besides the fact he wants to impose the contract in spite of fierce opposition from the BMA, he has misinformed the public into taking his side. He will publish misleading quotes such as this “Hospitals can be frightening and confusing places for people with dementia, so our new plan will guarantee them safer 7 day hospital care”.4 He always bangs on about a 7 day service, but what he doesn’t say is that he isn’t going to provide any more resources, staffing or money into the NHS. Without sounding stupid, how can you promise to give better care if your plan is to spread doctors more thinly on the ground, pay them less, and not put anything into the NHS? Not to mention taking away nursing bursaries, putting people off entering an already understaffed profession? Jeremy Hunt is trying to persuade the public that he is going to make our healthcare system better, without making any investment into it whatsoever. In addition, he refuses to speak directly with junior doctors. Many of them have shown that they are more than happy to speak with him calmly about this situation, but he will not engage.

Is it right for junior doctors to strike?
This is something that has divided many people. Doctors do take the Hippocratic oath, promising to try their best to look after patients. However, it is fundamentally wrong to assume that any profession is not allowed to retract their work. If they cannot do so, it is slavery. There is not a single junior doctor that wants their patients to suffer. Doctors want to make a difference and help people in vulnerable times. They would not sacrifice their social life and dedicate so many years to training if they didn’t. There are many other professions that pay better for less years of training, such as: engineering, accountancy, banking, consultancy, pharmaceuticals, law and actuary science. These junior doctors would not go on strike just for the sake of it. Before the new junior doctor contract, they struggled enough to complete training, pass exams and give safe care to patients – they were already feeling overstretched and exhausted.

I hope you’ve found this helpful. Please question the headlines made by The Daily Mail etc. about junior doctors being selfish money-grabbers. It is not true. The new contract is not sustainable. There would not be talks of five-day strikes unless it was deemed necessary to grab Jeremy Hunt’s attention.



References:
1. BBC http://www.bbc.co.uk/news/health-34775980 
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Sunday, 4 September 2016

GP placement



"Hello, my name is Kate and I am a third year medical student." I'll be saying this a lot next week as I start my first ever GP placement!

I spent some of second year in a busy university hospital, but I haven't got any experience of community medicine. I am very open to the idea of being a GP, but I'm also trying to keep all options. It does scare me a little that I still don't know what speciality I want to pursue. Of course, this is the same for many medical students, and junior doctors! I am hoping that by the end of third year I've narrowed it down to a handful of possibilities... 

I feel so lucky to be where I am. As much as we may complain about medical school, I know that it is much less stressful than being a junior doctor. We still have the privilege of time off for self study, and much longer holidays than a junior doctor's annual leave! I can't believe all the opportunities I have been given and I am so grateful to be where I am.

I have a very different attitude to learning now. Before, the emphasis was on learning tedious bits of physiology, such as the blood clotting cascade. Now, I have a newfound enthusiasm to learn the bread and butter of clinical medicine. Things like antibiotics, mastering your clinical examinations, taking blood pressure etc. .

It's going to be a hard year, just as any year at medical school is. It's taken me this long to figure out how I learn best. I now know the city really well (I think), and look forward to exploring more of it! Once again, part of the challenge is finding a balance between work and life, but I'm not too worried about it. Part of having that balance is learning to stop worrying and just taking one task at a time, and enjoying the journey.
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Sunday, 21 August 2016

SEEING GHOSTS

The Newsroom, Edinburgh


I don't like writing negative blogposts, but I have to admit that going off antidepressants has been harder than I imagined. 

As I mentioned in my last blogpost, I spoke to my own GP about this, as well my dad who is also one. I asked both of them how I should do it and they both gave fairly vague, but still seemingly straightforward advice: do it gradually, and slowly halve your dose. These comments leave much to interpretation, and I have rushed this process. I have had some horrible thoughts and feelings that I thought were long forgotten - it felt like seeing a ghost, a phantom that used to exist. 

I was scared. Have I not really 'got over' depression yet? I am I 'too dependent' on this medication? Am I making the right decision? Like most confused ill people, I took to the internet. I reread what I had already seen on Mind's website (a mental health charity), and then stumbled across some advice from the Royal College of Psychiatrists. Here it suggested that: "if treatment has lasted less than 8 weeks, stopping over 1-2 weeks should be OK. After 6-8 months treatment, taper off over 6-8 weeks". Given that I had been taking Sertraline for 10 months, I completely rushed this process. I'm going to see a GP tomorrow for some further guidance and a new prescription. 

When it comes to your health, never be scared to seek help and ask questions. I completely underestimated how horrible it can feel to withdraw from an antidepressant, and  I hope this helps any of you who may go through this process now or in the future. 
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