True mumblings, from a junior doctor...

Thesis Writing Time...

Sometimes it hurts.Normal distribution and scales

Statistics is a cruel master...

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NHS Staff Survey 2012

Strangely accurate for my trust...

Managers the problem as always

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24 Hour Seven Day Working NHS

So doctors should work 24/7 for their public, should they?

This public who think nothing of the head of the LTA getting £640,000 for making the sport smaller.

We have an over-entitled, over-fed, under-educated populace. People are not interested in taking care of themselves or others. Care has become expected rather than treasured.

Nowhere else in the world is the care as efficient or well managed. Sadly the politicians and ruling generation are all terrified of the "C" word (no not Jeremy Hunt), cancer.

Cancer can be awful, but often it's significance is over-played compared to cardiovascular disease, dementia, etc. Treatment is horrible, expensive and often of limited value. And yet we still cling to the idea of quantity rather than quality - who wants 5 extra months if you feel awful and want to die but won't… especially if it costs £1000-£10000s per day.

But the baby-boomer generation want to live to 90 in luxury, whilst our generation starve and scrape to pay for them. NIMBYs at home, and NIMLs at work and play (Not In My Lifetime).

Just think of the legacy they leave:

  • Environmental decay Poverty Global recession Youth un-employment

Just a thought...

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How to destroy angels... or hospitals

Some people are good at making things work.

Some people are good at making people work.

Very few are good at both.

Don't treat medicine like a business.

It isn't and never will be.
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Nurishment

Just a plug for Nurishment - I like it post sport and it's helped my aunt and my mum recover from surgery.

Much tastier than ensure and fortisips etc. In my and their opinion...
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Sometimes the truth will out...

Managers are usually not nasty people. However in the NHS they appear to be fuckwits.

Nicely put by a nursing colleague

Consultant in charge
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This is my 'you have just made a crap referral'

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More Rota Gaps, but that's ok cos if we ignore it no one will die...

Source 1 and Source 2

BMJ Careers Journal vs Department of Health Publicity Machine. I wonder who to believe????

Personally I would say that the 'overwhelming majority' is not enough. All this means is that the rotas are 'compliant'. Not full. Not actually workable. Not actually of benefit to patients or to doctors. It just means that another unwanted target has been foisted on the NHS by the Government and the EU. Especially as those services that have been given extra time are those who can't recruit - but every Trust already has large rota gaps and unfilled posts... How bad will it get before they relent?

No one works in the NHS for the money. If we did it for the money we'd be in the US. But then seeing as the government is obsessed with aping the world's most wasteful and unbalanced national healthcare system, I want more money (I actually don't, but in general US doctors get paid more)!

Of course what I'll actually do is do what all doctors already do - do what is right for the patient first, then what is right for their training second and finally (if forced) do what the government thinks is a good idea third.
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I Disagree - Bad Science Column on Drugs

I like Ben Goldacre. I think his writing is very well constructed and researched. But sometimes I don't agree. His drugs column is one I don't agree with.

Unfortunately he is basing his argument on an unreleased (either through a). conspiracy and censorship, or b). not being complete) 1995 WHO document about Cocaine and it use/misuse, which apparently the US government required be lost. It's existence is now denied by the WHO but is 'available' on Transform Drug Policy Foundation, who's existence is to bring about a 'just, effective and humane system to regulate and control drugs at local, national and international levels'. this is an admirable aim, but the implication is that the current status quo is not one. Therefore obviously they use evidence to back up their thought processes - again admirable. It is merely unfortunate that they are the only repository of this leaked document. That does NOT mean it's credibility is necessarily in question, but it is a happy coincidence.

Anyway, the sad thing is that this document is I believe out of step with the current situation - it is after all 14 years old at least. Does this correspond with current knowledge on the long-term damage of differing patterns of drug consumption in a more sedentary and unfit populace? Do the statements regarding positive effects on indigenous Andean populations correlate with improved life expectancy and quality of life compared to matched indigenous controls? The reason why the majority of negative consequences are due 'legal' drugs such as nicotine and alcohol is because these are legal and therefore freely available.

The actual negative effects of cocaine seem to be quite important - it is associated with increased rates of STIs - such as HIV, Hep B and Hep C. This is significant - especially in a world dramatically different to that of 1995. It is also associated with increased rates of mental illness.

In the past 14 years purity of cocaine and cocaine use has vastly increased along with the cost dramatically reducing - such that it is now cheaper than cigarettes and alcohol. The key thing is not the legality. People will take it whether it is illegal or not, if they want to. But should that be a reason to legalise it? If you legalise it you unleash a whole new wave of problems on the vulnerable and under-privileged. Sometimes the law is there not to punish but to protect. Too many people have heart attacks under 30 due to cocaine. We do not have enough long-term evidence (10+ years of scientific research) to state that there are no long term consequences to industrially produced, chemically powerful drugs

But that's just my impression having seen many people have problems.
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Rant about the EWTD and stuff...

Oh god... I will finish this someday

Basically the European Working Time Directive (EWTD or wank for short) only works if:

1. you work to the hours set, ignoring patients and the situation
2. you have enough people to cover the rota
3. you don't need to train the people on the rota
4. people don't mind seeing hundreds of different doctors during a two day stay!

Now the NHS are all in favour of the EWTD as of course it gives them an excuse to pay people less... What people fail to realise is that newly qualified nurses and newly qualified doctors are on similar salaries - in fact a nurse's basic salary is more! Plus for london weighting they can get up to £4000 as opposed to £2000. The difference is then that doctors are on-call - nights, weekends and evenings. This mean's that despite working a 48 hour week (band 1) lots of that/all of that could be out of hours. Obviously nunrses do work out of hours too, but generally, not in addition to their weekly normal hours. I am not calling for nurses to be paid less, I think when allowed to nurse and not be forced to do the pointless bureacracy that most managers want them to now, nursing a hard but rewarding job. As is being a medic. Unfortunately being a medic means fighting off the media and Nu-Labour crap of being overpaid.

The way a rota should work is:

1. Training jobs should include training.
2. Jobs should involve continuity
3. Consultants should have input into training.
4. Guidelines and protocols are for guidance.
5. There should be support available.
6. Floor time should be maximised.
7. Service time should be minimised.

But that wouldn't work as it would cost too much and be far too beneficial to the patients and the managers might be out of job. Or whatever it is they decide to call it next.

See Dr Rant for clarification on any points...
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ISCP the devils worksite

Oh my god I hate the ISCP site...

Designed by a kid with crayons, it sucks the very life from me.

WHY OH WHY could they not integrate the sodding ISCP surgeons log into it instead of attempting to botch their own?

especially as they should have bought elogbook, or even OOOTTA

Rubbish.
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New Job - Back to the mothership...

I have finally been told where my new job is...

It's in Vascular Surgery (General) which is my dream job. And at Hammersmith Hospital, which is also pretty close to my ideal of being a top dog at Charing Cross...

Little by little...
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Moving in medicine again...

I move on Wednesday into the weird world
of ITU... God I'm not looking forward to minimal changes and nothing happening! Looks like it'll bee 3 months of a complete change of direction for me. We'll see...

But on the plus side I will get to write more of this!
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