The musings of a fourth year English medical student

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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