JuniorDr Issue 19

d l u o w e r Whe ? e b r e you ra t h

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MANAGING THE FUTURE OF OUR NHS THE MAGAZINE FOR JUNIOR DOCTORS

Presenting History JuniorDr is a free lifestyle magazine aimed at trainee doctors from their first day at medical school, through their sleepless foundation years and tough specialist training until they become a consultant. It’s proudly produced entirely by junior doctors – right down to every last spelling mistake. Find us quarterly in hospitals throughout the UK and updated daily at JuniorDr.com.

Team Leader Matt Peterson, team@juniordr.com Editorial Team Joe Collum, Yvette Martyn, Ivor Vanhegan, Anna Mead-Robson, Michelle Connolly, Muhunthan Thillai JuniorDr PO Box 36434, London, EC1M 6WA Tel - +44 (0) 20 7 193 6750 Fax - +44 (0) 87 0 130 6985 team@juniordr.com Health warning JuniorDr is not a publication of the NHS, David Cameron, his wife, the medical unions or any other official (or unofficial) body. The views expressed are not necessarily the views of JuniorDr or its editors, and if they are they are likely to be wrong.

It is the policy of JuniorDr not to engage in discrimination or harassment against any person on the basis of race, colour, religion, intelligence, sex, lack thereof, national origin, ancestry, incestry, age, marital status, disability, sexual orientation, or unfavourable discharges.

JuniorDr does not necessarily endorse or recommend the products and services mentioned in this magazine, especially if they bring you out in a rash. © JuniorDr 2010. All rights reserved.

Get involved We’re always looking for keen junior doctors to join the team. Benefits include getting your name in print (handy if you ever forget how to spell it) and free sweets (extra special fizzy ones). Check out JuniorDr.com.

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s the NHS fights for survival and needs to achieve a £20 billion cost saving just to maintain current services, the ability of doctors to care for patients and also resources is more important than ever. That comfortable divide between managers and doctors is over.

For junior doctors it is inevitable that we won’t be able to escape this pressure to think about the cost of services. Moreover, we shouldn’t want to. Just as our patients should receive the best care we also have a responsibility to ensure the best use of their money.

This isn’t something to fear - much of our daily workload is already managing resources - we just need to do this better. Each time we order a barrage of CRPs do we really consider that each time we cost the NHS £6 a test?

Or when we don’t bother to repeat a patients bloods in the afternoon, meaning that they can’t go home that day, do we consider that the bed will cost the NHS £150 overnight? Probably not. After all, we’ve been trained to think about the clinical outcomes not the cost.

But counting the cost doesn’t mean we have to decrease the quality of care we deliver. In fact, the savings should in reality help support innovation and better care elsewhere.

Moreover, it should help the NHS to survive.

Whether or not you agree with the government’s plans for the NHS this isn’t something we can leave to the politicians. No matter if the coalition government holds onto power or is replaced, we will still face the same problems. If we want an NHS in the future we need to take the lead.

That comfortable divide between managers and doctors is over Having doctors trained in leadership and management skills is crucial say thinktanks such as The King’s Fund. Unlike health organisations in the US and Europe, only a small fraction of NHS organisations are under management of trained clinicians.

In this issue of JuniorDr we look at management for doctors and why we need to rethink how we train the future leaders of the NHS. We discuss the pros and cons of doing an MBA and look at how doctors have used their management skills to improve NHS services.

Interested in management for doctors?

Read our guide then join go to DrTribe. com and join our management group to stay updated.

What’s inside 04 09 12 20

LATEST NEWS Management for doctors The business of surgery Repatriation medicine

24 26 30

Secret Diary of a Cardiology SpR Mr S Claus gets a check-up Medical Courses and Conferences

TRIAGE

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Tell us your news.

Email team@juniordr.com or call 020 7193 6750.

NHs

Hospitals need more senior doctors at weekends

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ospitals should increase the availability of senior doctors in acute admissions units at weekends, according to a report from the Royal College of Physicians.

Only 3% of hospitals surveyed provided 9-12 hours of weekend cover from consultant physicians specialising in acute medicine and none provided over 12 hours. Nearly three-quarters of hospitals in the survey had no cover from consultant physicians specialising in acute medicine over the weekend.

“Despite major improvements in the care of acutely ill patients which were led by the RCP following our major report in 2007, patients are still not getting the care they deserve at night and at weekends,” said RCP President Sir Richard Thompson.

“Too many junior doctors are covering too many very ill patients, and this has to change.

Our evidence shows that a predominantly

consultant-delivered medical service is the best way to improve patient care.”

The RCP looked at 126 hospitals from 109 different Trusts which completed the survey - 114 from England, 6 from Northern Ireland and 6 from Wales. The survey did not cover Scotland.

It also found that nearly half (48%) of consultant physicians responsible for assessing and treating patients on their arrival at the acute medicine ward (the “acute take”) still do routine clinics or other parts of their job as well as at the same time seeing the urgent patients. The RCP recommends that these duties should be cancelled on those days to allow physicians to concentrate wholly on the very ill patients.

Dean Royles, director of NHS Employers, said he agreed in principle with the findings: “We support the Royal College of Physicians’ call for appropriate consultant

Three-quarters of hospitals had no cover from an acute consultant over the weekend.

presence in hospitals in the evening and during weekends and believe that a change to the way consultants work would be of significant benefit to both patient care and the supervision and training of junior doctors.”

“Most NHS organisations have told us that they support this approach and many are changing the way their staff work to increase the consultant presence in hospitals during the evenings and at weekend.” www.rcplondon.ac.uk

“Too many junior doctors are covering too many very ill patients, and this has to change.”

Sir Richard Thompson RCP President

Finance

Two-year freeze on pay increments proposed

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HS Employers has proposed a twoyear freeze on pay increments for all NHS staff to meet a ‘gap’ in NHS funding.

The freeze, which could effect all NHS organisations in England, would offer in return a guarantee of ‘no compulsory redundancies for as many staff as possible’.

The plans have been presented to the trade unions including the BMA. Hamish Meldrum, Chairman of BMA Council said he is ‘extremely concerned’ by the proposals: “Doctors, like other health care staff, have already had a two-year pay freeze a real-terms pay cut. We understand the

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NEWS PULSE

financial difficulties facing the country and want to play our part in minimising the impact on patients,” said Hamish Meldrum, Chairman of BMA Council.

“Hammering the pay of health care staff still further should not be the first - and indeed, at the moment, the only - response to finding a way out of this mess.”

NHS Employers say the agreement would allow them to commit to maintaining training opportunities for junior doctors and dentists. If accepted the proposals would not impact on the Government’s proposed minimum uplift of £250 for staff earning £21,000 or less - though it is unclear how this would

be applied to junior doctor banding.

The key parties are also discussing the option to defer any increases in staff pension contributions for the same period (2011-2013). www.nhsemployers.org www.bma.org.uk

“Doctors, like other health care staff, have already had a two-year pay freeze - a real-terms pay cut.”

Hamish Meldrum Chairman of BMA Council

NEW MICROBIOLOGY TEXTBOOK

Finance

GMC cuts fees for newly qualified docs

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ewly qualified doctors will save £255 in their first two years of registration following cuts by the GMC to fees for those starting their career.

Provisionally-registered doctors will pay £100 a year (down from £145) and the cost of the first year of full registration has been halved to £210.

The changes take effect from 1 April 2011.

Fourteen thousand doctors will be helped by this change next year, saving a combined total of around £1.8m.

“These are difficult times for doctors, especially for those who have recently qualified and have large student debts. It is incumbent upon us to ensure we provide value for money and, as far as we can, control our costs,” said Niall Dickson, the Chief Executive of the GMC. Any doctor whose total annual income is less than £26,000 will also qualify for a 50% discount in their annual retention fees from 1 April 2011, after the GMC increased the income discount

threshold from £22,190; an increase of 17%.

Doctors applying for entry to the Specialist Register or GP Register will also face lower fees. The cost of a Certificate of Completion of Training (CCT) or a Certificate of Eligibility for Specialist Registration or GP Registration (CESR or CEGPR) will be reduced by £305 immediately. It will now cost £500 for a CCT and £1,600 for a CESR or CEGPR. The main Annual Retention Fee is being frozen at £420 for 2011/12. www.gmc-uk.org

“These are difficult times for doctors, especially for those who have recently qualified and have large student debts.”

Niall Dickson GMC, Chief Executive

CONTENTS PART I Foundations PART II Disease Mechanisms PART III Characteristics of

NHS

BMA: Future NHS plans at risk from cuts to protected time

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ecuring future quality and efficiency savings in the NHS will be a struggle if cuts to the protected time senior doctors can devote to the improvement of services continue, the BMA has warned.

It comes with the launch of the publication ‘Quality Time’ which highlights the importance of consultants’ Supporting Professional Activities (SPAs) - protected time for work such as the development of new services, research, safety audits and training.

Although the model NHS contract for consultants states that their working week should typically include ten hours of SPA time the BMA claims there have been widespread cuts.

Over a fifth (21%) of consultants surveyed by the BMA earlier this year said the number of SPAs in their job plan had been reduced. More than one in seven (15.1%) said their employer had reduced the standard number of SPAs for all consultants, and almost a quarter (23.8%) said their employer had reduced SPAs for newly appointed consultants.

“We believe it represents a false economy,” says Dr Mark Porter, Chairman of the BMA’s Consultants Committee.

“When consultants have time to reflect on

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services and improve them, they frequently save the taxpayer significant sums of money. The NHS has been tasked with saving £20 billion by 2014, but this already Herculean task will become even harder if staff are denied time to stand back and consider ways of working more efficiently.”

All the doctors in Quality Time say their achievements would have been either impossible or less likely without protected time. It features 21 consultants from across the UK who have used their SPA time to take forward initiatives that have improved the quality of patient care, frequently saving the NHS money. www.bma.org.uk

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The Art of Microbiology: A Clinical Approach Instructor’s Manual Instructor’s Lecture Outlines MicroMovies Instructor’s Media Guide Question Bank Diploma® Computerized Question Bank Classwire™

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January 2010 733 pages: 630 full color illustrations Paperback: 978-0-8153-6514-3: £45.00

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Americans are top fakers

Medical students

Government must ensure jobs for new junior docs after graduation: BMA

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inisters should ensure that graduates from UK medical schools have jobs to go to after graduation, say BMA leaders. It follows confirmation that applications for next year’s foundation programme have exceeded current vacancies.

The UK Foundation Programme Office (UKFPO) has announced that there were 184 more applicants from final year medical students than places available on the foundation programme, starting in August 2011.

The UKFPO have now produced a contingency plan aimed at tackling the over subscription, which will seek to allocate posts as applicants withdraw or fail their exams. The UKFPO have assured the BMA that given past withdrawal rates they do expect all applicants to find a post by August 2011.

Karin Purshouse, Chair of the BMA’s Medical Students Committee said: “It is unacceptable for any UK medical

Scientists in the US are significantly more likely to publish fake research than scientists from elsewhere in the world, according to a study published online in the Journal of Medical Ethics. The fakes were also more likely to appear in leading publications with a high ‘impact factor.’ More than half (53%) of the faked research papers had been written by a first author who was a ‘repeat offender.’ The authors searched PubMed for all scientific research papers that had been withdrawn between 2000 and 2010. jme.bmj.com

£300m of pills to swallow graduate to be in a position where they might not be able to start a job as a junior doctor after medical school.”

“The taxpayer invests £266,000 in training each student during the course of their five to six year medical degree. This public investment will be lost if medical graduates are not able to begin treating patients, especially as they are legally required to undertake this important first post before being able to practice fully as a doctor.” www.bma.org.uk

£300 million of prescription medications are wasted each year in England, according to research by the The School of Pharmacy, University of London. They estimate that £90 million worth of unused prescription medicines are stored in individuals’ homes at any one time, and up to £50 million worth of NHS supplied medicines are disposed of by care homes each year. The NHS in England spends around £100 billion on drugs each year. www.pharmacy.ac.uk

Fruit and veg save lives Medical students

Play ‘spot the mistake’ to improve good practice

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he GMC have launched a ‘spot the mistake’ cartoon strip to help medical students improve their understanding of professionalism and good practice before they start work.

Medical students can also test their knowledge through several quiz questions and case study dilemmas - taking on the role of either a medical student or the medical school. All of the activities reinforce good practice in line with the GMC guidance.

“This is a great way for medical students to understand the professional standards expected from all doctors,” said Professor Trudie Roberts, GMC Council member and Chair of the Basic Medical Education Fitness to Practise working group.

“Parts of GMC guidance have been

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NEWS PULSE

transformed into real-life scenarios and though the site is not designed to replace the guidance, it is there to increase students’ understanding, stimulate further interest and in turn, better equip the doctors of tomorrow.”

In one scenario, medical students will have to decide how best to respond to the receptionist of a busy GP surgery, who has asked if they can perform a cervical smear on a patient.

In another situation, they will have to choose whether or not to declare a previous caution for shoplifting when applying for registration.

You can visit the GMC’s new Medical students: Professional Values in Action site at: www.gmc-uk.org/static/media/medical_students/ index.html

If everyone in the UK ate their “five a day,” and cut their dietary salt and unhealthy fat intake to recommended levels, 33,000 deaths could be prevented or delayed every year, reveals research published online in the Journal of Epidemiology and Community Health. The researchers base their findings on national data for the years 2005 to 2007 for all four UK countries. Eating five portions of fruit and vegetables a day accounts for almost half of these saved lives, the study shows. www.jech.bmj.com

Psychosis ups suicide rate by 12 times People with psychotic disorders, such as schizophrenia or bipolar disorder, are 12 times more likely to commit suicide than average, according to research released by King’s Health Partners. The research found that the rate of suicide was highest in the first year following diagnosis - but remained four times greater than the general population ten years after diagnosis. www.kingshealthpartners.org

Technology

Docs on Facebook risk compromising patient relationship

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unior doctors on Facebook risk compromising the doctor-patient relationship by not deploying sufficient privacy settings, according to research published in the Journal of Medical Ethics.

Of the 405 junior doctors questioned virtually all (97%99%) displayed sufficient personal information for them to be identified, including their real name and their birth dates.

Nine out of ten (91%) displayed a personal photo and just over half displayed their current post (55%).

“Doctors must be aware that comments and pictures posted online may be misinterpreted outside their original context and may not accurately reflect their opinions and reallife behaviour,” say the authors.

“This information could also become accessible to people that it was not intended for. Moreover public availability of information on a doctor’s private life may threaten the mutual confidence between doctor and patient if the patient accesses information not intended for them.”

6% had received a friend

6% had received a friend request from a patient and four responders admitting accepting a request

request from a patient and four responders admitting accepting a request. Such requests are likely to become more common, suggest the authors.

While most respondents (85%) said they would automatically refuse a friend request from a patient, one in seven (15%) said they would decide on a case by case basis. The reasons given for accepting a patient as a friend included feeling an affinity with them and

fear of embarrassing or losing that patient if they declined.

The need to keep a professional distance or the suspicion that the patient was interested in a romantic relationship, were the primary reasons given for rejecting the request. Although a high proportion of doctors considered that such interaction might be unethical, this reason came bottom of the list. www.jme.bmj.com

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NEWS PULSE

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very society is a high society according to the Wellcome Collection’s new exhibit. From morning coffee in European cities to kava in Pacific villages, betel nut in Asia to coca leaf in the Andes, the rituals of drug use are everyday and universal, and stretch back through centuries. Their major winter exhibition High Society explores the role of mind-altering drugs in history and culture, challenging the perception that drugs are a disease of modern life.

This image, drawn by Jonathan Hares, details NASA www.wellcomecollection.org

experiments observing how common house spiders spin their webs under the influence of psychotropic drugs. Spiders who injested marijuana spun a reasonable web but lost concentration during the construction. Those under the influence of benzedrine, an amphetamine, spun their webs with great speed but with little planning leaving large holes. Caffeine appeared to make the spiders capable of spinning only a few threads at random.

at the Wellcome Collection

NASA experiments on spiders

Used with permission. Credit Jonathan Hares/Wellcome Collection.

‘High Society’ runs at the Wellcome Collection from 11 November 2010 – 27 February 2011

Management for doctors An MBA for doctors?

Taking an MBA degree as a doctor and venturing into a world traditionally considered the territory of entrepreneurs and business graduates might seem like an unusual step.

However, in recent years there has been a surge of clinicians unrolling their sleeves and replacing their ties to enter business school.

JuniorDr’s Joe Collum asks why the sudden interest in MBAs and if it’s simply a fad or if it will be a permanent shift in expectations of doctors in the future.

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ntil recently clinicians who wanted to pursue a further degree - be it to improve their employability or to explore their scientific interests have traditionally followed the well trodden paths of science or clinical research.

However, a new contender has entered the MD and PhD arena - the MBA. So what type of doctor opts for a healthcare MBA? There is often the misconception that only ‘failed clinicians’ would seek refuge in a degree program so divorced from the core medical subjects. In reality, some of the most ambitious medics can be found enrolled on these courses with the aim of not only returning to clinical practice but hoping to shape the future of healthcare.

Management and leadership have also been gaining increasing emphasis within the medical curriculum in recent years and have now become part of the expected appraisal portfolio. With the growing number of clinicians aspiring to high level organisational posts within the NHS it has fostered a climate in which formal leadership qualifications and MBAs no longer seem like an unusual accomplishment on a doctor’s CV. The MBA Course Some of the subjects and curriculum items of an MBA will be familiar and relatively comfortable territory for many doctors, such as health policy, comparative health care and clinical leadership.

However many topics, such as health economics and management science, have

Course

Duration

Format

Cost per year

Executive MBA Health Service Management Greenwich School of Management, London

24 mths

PT

£5,500

24-36 mths

PT

£4,210

12 mths

FT

£34,000

MBA Health Executive Keele University Imperial MBA Imperial College Business School

the potential to stretch clinicians beyond their comfort zones.

One of the biggest impediments to doctors completing an MBA is the cost. It is a key factor in deciding whether to take the qualification - and where to do it. More than any other degree the school where you do an MBA is crucial to how it is perceived and its credibility. This helps to explain why the same three letters can cost £3K at one college and close to £50K at another.

Aside from the cost there has never been a better time for aspiring leaders to enhance their potential with an MBA. Andrew Lansley’s health white paper sets out a future NHS where doctors are not only shaping the service but are instrumental in how it runs on a daily basis.

There is also an expectation that more doctors will take management posts in

NHS organisations - similar to the structure in the US and many European countries. David Nicholson, NHS Chief Executive, stated that ‘… within three years on every shortlist for a chief executive job in the country there will be at least one appointable clinician.’

It is clear that there is now a strong desire for doctors to ‘break in’ to the boardroom - having an MBA might just mean you needn’t kick the door down to get there.

Joe Collum is a SpR in gastroenterology and senior medical advisor to the Junior Doctor’s Advisory Team in NHS Northwest. He is currently completing an MBA at Keele University.

MANAGEMENT

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Management for doctors

To MBA or not to MBA? Unsure whether an MBA is right for you?

Emma Stanton, junior doctor and co-author of the book ‘MBA for Medics’, outlines some of the arguments for and against applying to business school.

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Masters in Business Administration (MBA) is the most popular postgraduate degree in the world.

In the United Kingdom, over 10,000 MBA students graduate annually. Yet only a handful of these are also medically qualified. And rightly so - you might think - as surely doctors are trained to treat patients, not balance sheets. Furthermore, MBAs take a considerable amount of time and money that trainees just don’t have access to, even before the current financial ischaemia set in.

But what about the evidence suggesting that when clinicians lead health services, patients do better? A recent Kings Fund publication looked at the career paths of 22 medically qualified Chief Executives in the NHS (5 per cent of total chief executive community). It concluded

that the days of ‘keen amateurs’ for medical leadership are over and that there is a need for a more structured and systematic approach to developing medical leadership in the NHS. So, to what extent does doing an MBA offer a career path for aspiring medical leaders? My opinion is that an MBA is not essential and often not practical for the majority of medics. By design, an MBA is a broad management degree, covering all the functions and practices of a business.

This includes the core traditional subjects of accounting, finance, human resources and marketing.

More recently, MBAs have evolved to include ‘softer’ areas such as leadership, entrepreneurialism, sustainability, globalisation and ethics. Undoubtedly, an MBA serves to open up routes to alternative career paths beyond clinical medicine. Medics with MBAs often consider a career move into pharma or consultancy. But an MBA is not essential for this transition either. Critics of MBAs believe management is a craft that cannot easily be taught, rather has to be learned

from experience, or analysis of experience.

So, why do an MBA? Well, it certainly is one avenue to help prepare for a career in medical leadership - which is why I did it - but is only one of many. There are growing numbers of alternative Masters courses and training programmes specifically designed to meet the challenges of health care leadership. While MBAs may carry a ‘stamp on the CV’ value, what is perhaps more relevant for aspiring clinical leaders is the hands-on experience of managing and improving health care. The shift to primary care commissioning only increases opportunities for clinicians to become involved in service improvement and management to make a difference for patient care.

Doing an MBA, or similar, is really only the beginning. It’s what you go on to do with it to improve patient care that counts.

Emma Stanton is a psychiatry Specialist Registrar at South London and Maudsley NHS Foundation Trust. She gained an executive MBA from Imperial College and is currently a Commonwealth Fund Harkness Fellow in Boston.

Emma Stanton and Clare Lemer have recently published ‘MBA for Medics’ (Radcliffe Publishing Ltd). This book summarises key topics from an MBA, as well as outlining potential career paths.

What is an MBA? MASTERS (MSc)

MEDICAL LEADERSHIP 2011/2012 ENTRY

Part-time leadership programme designed specifically to meet the needs of doctors Delivered by the Royal College of Physicians in collaboration with Birkbeck College and the London School of Hygiene and Tropical Medicine (both part of London University), this unique programme has been designed to equip doctors with the skills and expertise they need in order to attain senior management positions such as Clinical Directors, Medical Directors and Chief Executives.

The programme is open to doctors of any specialty with one to two years higher speciality training (i.e. StR 3-4 or equivalent).

Applications for the 2011/12 entry will be opening soon. To receive further information about this programme, or express an interest in applying please contact Siobhan Sparkes-McNamara via email: siobhan.sparkes-mcnamara@rcplondon.ac.uk or telephone: 020 3075 1420. Please note that places are limited and early application is advised.

www.rcplondon.ac.uk/medicalleadership

The Master of Business Administration (MBA) originated in the US during the late 19th century with the demand for a more scientific approach to management. Accreditation bodies exist specifically for MBA programs to ensure consistency and quality of graduate business education.

An MBA usually covers the disciplines of accounting, finance, marketing, human resources, operations management and leadership. Some MBA programmes are now offering specialist modules in health aimed at those working in this sector.

According the Financial Times Global MBA Rankings for 2010, London Business School leads the world (1st) followed by Said Business School, Oxford (16th) and Judge Business School, Cambridge (21st).

Management for doctors

Inside the North West Medical Leadership Programme The North West Medical Leadership Programme is the first programme to take junior doctors into management and leadership training alongside their clinical training. Darren Cousins, a junior doctor, who joined the programme last year tells of his experience.

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am currently working as a Sexual Health and HIV Specialist Registrar for four days a week and have completed the first two years of the pilot programme developed at the North Western Deanery.

The first two years of the four year programme focus on academic learning.

During this time we join the NHS general management trainees taking the MSc in Health and Public Leadership at Manchester Business School and the University of Birmingham, as well as focused courses at the Kings Fund.

We also have management placements for either one or two days per week with trainees choosing either to stay close to their place of work or experience new environments, such as spending time in primary care.

As a pilot programme we have had to juggle the demands of the course along with our clinical training and to compensate we have been allowed to negotiate extensions to our CCT dates for up to two years.

My management placements have been in service improvement with the GUM clinic where I work clinically and also in the primary care trust reconfiguring alcohol treatment services. The difference between how the foundation trust and primary care trust manage their workloads in times of financial crisis were immense and something that many trainees just wouldn’t see.

Where now?

People often ask us where we see ourselves in five, ten or twenty years time.

Most of us would envisage some management and leadership as part or all of our roles in the future. This isn’t a programme to take us out of clinical medicine. One facet of our programme that is fascinating is that leadership does not always equal NHS management as we have trainees who represent other doctors on influential national boards and committees.

It appears that the political pendulum is returning towards doctors who practise medicine but also lead and develop services. We are the people who are closest to our patients and have a significant advantage in

that we can ask patients what they think of their service in a clinic and act on it straight away - which is something that non-medical managers simply cannot do. The skills needed to manage services however should not be under-estimated and you need to do some academic learning before diving in with service redesign.

Ten years after graduation 63 per cent of MBA graduates were employed as senior managers or higher Data from Association of MBAs 2009

If you are considering whether to take the plunge and apply for the North West programme or something similar don’t forget that you will be able to use this ability in any future job that you do.

Once in post, you can regain some of the enthusiasm that you may have lost during those early clinical years. Remember when you were eighteen and applying for medical school at interview thinking that you just wanted to make the world a better place - with this programme you can try to make that a reality.

The average salary for a male UK MBA graduate working in the pharmaceuticals and healthcare sector was £97,889 average salary, plus £51,657 bonuses Data from Association of MBAs 2009

Resources

REPORT: Medical Chief Executives in the NHS: Facilitators and Barriers to their career progress; Ham, C. Clark, J. Spurgeon, P. Dickinson, H. Armit, K. (2010); NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges BOOK: MBA for Medics (Masterpass Series); Emma Stanton and Claire Lemer;

Radcliffe Publishing Ltd £24.99; ISBN 978-1846194382.

LINK: Financial Times Global MBA Rankings 2010 rankings.ft.com/businessschoolrankings/ global-mba-rankings ARTICLE: MBAs are an irrelevance for doctors; Rahul S; BMJ Careers, 20 Oct 2007

MANAGEMENT

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Management for doctors

The Business of Surgery Having the letters MBA after your name may look impressive on your application for a consultant post but how does it actually help improve clinical practice?

David O’Regan - surgeon and clinical director - explains how improving his pre-admissions clinic inspired him to pursue a MBA.

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initiated my MBA after I made a change in my outpatient clinic in 2003. I was fed up the night before surgery finding that patients who had gone through the pre-admission clinic had erroneous blood results or x-rays which meant they needed further investigation.

Until that time I had been frustrated by frequent last minute cancellations because the patients were not fit. I felt there was a better way of doing things and organised my clinics into what I call a “Fit to Admit Clinic”. In essence, everything the nurses did before continued, but at the end of the process I saw the patient, checked x-rays and blood results, checked the clerking and personally obtained consent from the patient. I also set an expected discharge date and provided the patient with a script for what was about to happen during the admission.

There was initial resistance to my plans because it was felt that I was taking over but the many benefits of the changes soon became evident: the patient’s experience was improved, and time and money

were saved (in essence 1,703 bed days over the past seven years and approximately £1.2 million or £170,000 per year since the changes were made).

Deciding on an MBA I decided to do an MBA because the people around me when I started the “Fit for Admission clinic” began to publish the success in various magazines and journals. I wanted to translate this into something for myself and I approached the business school with the idea of the change in my clinic as a basis for an MBA thesis.

I was a little reticent about joining a course having never done any “business studies” in the past. I felt that I might be a “fish out of water” sitting amongst high flyers from banking, IT, and construction. In fact, it was incredibly refreshing to step out of the clinical environment and swap and share stories with people from other industries, and realise that they shared many of the problems that I had been experiencing in the business of healthcare. There were many commonalities.

Leadership, Management & Personal Development e-Learning Some of our e-Learning Courses include: Management Excellence for Junior Doctors Presentation & Teaching Skills Understanding People Time Management & Personal Effectiveness Core Skills in Setting Effective Direction

Why eMedicus Online Learning?

eMedicus Online Learning

eMedicus is the e-Learning platform from Medicology

12

MANAGEMENT

Access courses when and wherever you like Run the training alongside a live project Highly interactive, with video & audio narration Gain certified CPD through online evaluation Find out more at:

www.eMedicus.co.uk

Management for doctors It was incredibly refreshing to step out of the clinical environment and swap and share stories with people from other industries

Teaching occurred over four days after which we had to write an assignment based around our own work environment. This provided a great opportunity to go and knock on the doors of everybody in the organisation from top to bottom and side to side. It gave me a greater insight into how the hospital worked and also introduced me to a lot of people in management who, despite not having the privilege of hands on clinical work, were also doing their best to deliver good healthcare.

I learnt to further manage my time, and despite being a full time consultant completed my MBA degree within the two years as well as handing in my thesis. I received a distinction and was one of three people in the class to complete within the two years.

New opportunities The MBA has opened new doors for me and I have delivered presentations at national fora, been involved in classes at the British Association of Medical Managers and received invitations to give talks to other hospitals by their Medical Directors.

I have now been made the Clinical Director for Cardiac Services

in my own Trust and have ambitions of extending my managerial career in the future with the ambition of becoming a Chief Executive Officer eventually. This is difficult as a practicing surgeon because one has to do a minimum number of cases per week to enable the safe delivery of surgery.

I think it is probably one of the major difficulties for surgeons going into management, but reflect that Delius Cosgrove, one of the gurus of cardiac surgery, now runs the Cleveland Clinic in America and is consulted by Barack Obama on how to deliver healthcare.

There have not been any draw backs from my decision to undertake an MBA. I have had a few comments of “you have gone over to the dark side” and have also been asked “which side of the fence are you on, doctors or managers?”. I now strongly believe there is no “side of the fence”; it is important for all clinicians to get involved with the business of healthcare.

We do not need any more money in the NHS, but we certainly need to be able to run it more effectively and efficiently. “Because that is the way we have always done it around here” is not an acceptable excuse for failing to make improvements.

David J. O’Regan MBA, MD FRCS C-Th Clinical Director, Cardiac Services, Leeds Teaching Hospitals

“Because that is the way we have always done it around here” is not an acceptable excuse for making changes

MANAGEMENT

13

Management for doctors

Leadership in the context of the emerging marketplace As the impacts of the White Paper start to take effect, Trusts across England will begin to feel the impact of increased competition. Ready Trusts will have effective business development processes in place and service-level strategies designed to ensure stability and growth over the coming years.

H

owever, many Trusts will find themselves fire fighting left field surprises that could have been predicted and mitigated with the right approach to service-level leadership. With changes to the very nature of clinical service delivery, it is vital that services are driven by a new breed of clinical leader, properly resourced and with the knowledge, skills and insight to keep their service on the straight and narrow.

Leadership has always been context dependent i.e. its style, application and focus are related to the issues of the day or major challenges that need resolving. As the context changes, leadership (and leadership development) must adapt accordingly. The environment of old was primarily focused on the organisation of clinical work for maximum clinical effectiveness. Although this remains equally pertinent today, it must be augmented by an increased focus on the business of clinical services. Today’s environment is one that can be characterised as having: • Significant uncertainty & reduced stability • Increased risk clinically, financially and strategically • Potential for job losses in a once secure employment environment

Today’s leader needs to appreciate the impact of these conditions on service-level staff, whether medical, nursing or otherwise and ensure that their application of leadership principles deal effectively with the above conditions. The impact of potential redundancies and direct personal risk is often paralysis and 14

MANAGEMENT

inertia, ironically just what services need to avoid to mitigate the likelihood of those risks becoming reality. Leaders must tend to both the strategic direction of services to ensure safe passage, as well as the emotional well-being of the workforce to ensure that strategies are implemented swiftly and effectively, with full support of the workforce. This places a heightened importance on the leadership skills of influencing and emotional intelligence.

With heightened risk, potential for personal loss and a fundamental change to the values of health, one of the greatest challenges facing leaders today, is realising consensus across a diverse workforce with very differing views as to what is happening and what it means. Consensus is vital for the successful implementation of strategy and Trusts are notoriously unsuccessful at achieving it at a service level, resorting instead to instruction, direction and even coercion to achieve their strategic aims. However, forcing things through by overcoming resistance is inconsistent with the speed of adaption necessary in a rapidly evolving environment. Successful leaders will be highly aware of the evolving landscape, able to disseminate an accurate understanding of risk and opportunity and be able to lead a group to reach consensus and act upon it in a timely manner.

This strategic adaptation process at a service level is most successful where service leaders enjoy a freedom to operate i.e. to be able to decide on service direction and implement it. Service leaders must earn this right of passage by inspiring trust and confidence in Trust management. If you were to ask yourself “what gives me confidence in the people I lead?”, you would undoubtedly return much of the following: • They know what they are doing • They achieve what they say they are going to achieve • They don’t do dangerous things • They know when to ask for help • They proactively get stuck into the tasks at hand • They solve challenges without always running for help

If you now asked yourself the question “how many service leaders, focusing specifically on the business side of health, tick all of those criteria?”, you will discover that this new breed of leader is very rare. Without question, clinicians feel they are better placed to devise service strategy than their management counterparts but in reality there is a huge dearth of the necessary knowledge, experience and insight to effectively run services as a business. Of course, this absence of expertise also exists on the management side too, placing services at extreme risk of adverse market-based changes undermining their security. The service leader that demonstrates an in-depth knowledge of the evolving landscape, a propensity to act strategically and the leadership skills to successfully lead service evolution will become a valuable commodity in the modern environment and a ‘hot recruit’ for business-orientated Trusts (not that you’d want to join one that wasn’t, of course).

So what of leadership development today? Leadership is firmly on the agenda of most Deaneries and there is an increasing number of clinical leadership programmes available through Universities. However, when you look at the provision of leadership development, its focus on the business of health, its development of strategic influencing and broad scanning abilities and indeed its ties to the emerging agenda, you will realise that leadership development with the evolving landscape in mind is still very hard to find. In all too many programmes, leadership remains a generic set of skills detached from what leaders need to be doing or fixing in services today. Unless this pattern changes radically, or leaders themselves realise there is so much more to leadership development, services will remain at risk of obsolescence and financial distress brought about by an increasingly unforgiving and competitive environment.

Mr Andrew Vincent, Managing Director & Lead Consultant, Medicology Ltd; and Dr Sara Watkin, Consultant Neonatologist, UCLH, London & Medical Director, Medicology Ltd.

Management for doctors

Profile: BUPA Medical Director Andrew Vallance-Owen For a company whose mission statement is to help people “live longer, healthier, happier lives” Andrew Vallance-Owen certainly lives that message. He’s a man on his 13th BUPA Great North Run and medical director of the UK’s largest private healthcare company with over 10 million customers around the world.

A

s the medical face of BUPA his primary job is to be responsible for the safety and quality of care but he also represents the group when a medical background is needed. This can be on diverse matters such as discussing how BUPA could assist with a UK swine flu epidemic to a government meeting at No. 10 to influence health policy.

Andrew is also a key player in the group’s expansion into emerging markets. In the last few weeks he has been to China, Australia and the Middle East. “There is a lot of international travel which although it sounds exciting can be very tiring,” says Andrew. “The timetable is hectic but I find it fascinating to be working in so many different markets.”

It’s the variety of his job that leaves Andrew with no regrets twenty-three years after leaving his clinical career. “I used to love surgery but I’ve thrown off those shackles,” he says. “The best bit about being medical director is never knowing what is going to happen next.”

the post and quickly moved up the ranks becoming Scottish Secretary before taking up the post of head of BMA policy in London.

After picking up management skills as well as an MBA whilst at the BMA he was approached by BUPA in 1994 who were looking for a new medical director for its BUPA Hospitals division. Describing himself as an ‘NHS person through and through’ Andrew was reluctant: “I’d been a garlic cross person in terms of my attitude to the whole private sector just like many junior doctors,” he said.

“But I was greeted by a young, enthusiastic BUPA team with a clear vision. I found that inspiring.”

Just one year into the post he was offered the position of medical director of the entire BUPA group. He accepted, and has been the medical face of BUPA ever since.

Medical student to medical director Andrew’s passion for leadership first developed soon after he joined Birmingham medical school back in 1970. He started by running the generic ‘wine and cheese evenings’ as president of the medical society but soon found himself voted in as student president opposing a 30 percent rise in hall fees in a fight that reached the national press.

The following year he was running for president of the NUS in a battle against now well known political candidates like Charles Clarke. He lost - but his thirst for politics continued.

Andrew joined the BMA’s junior doctor committee and became deeply involved in medical politics. Just prior to becoming a SpR the opportunity arose of a staff post in the BMA. He left clinical practice, took

tough for the first two years

16

MANAGEMENT

“I loved surgery. Being out of the operating theatre was but since then I have never looked back.”

Advising future leaders Making the transition from a clinical role to management wasn’t an easy one says Andrew: “I loved surgery. Being out of the operating theatre was tough for the first two years but since then I have never looked back.”

At that time there were no options of part-time training or secondments to gain management experience. Andrew had to make the jump from full-time surgeon to full-time BMA staffer in one go - a huge career shift even for someone who had been as involved in medical politics as he was.

Today he encourages anyone keen on following his footsteps to take advantage of the opportunities that are available to junior doctors, such as the CMO Clinical Advisor Scheme.

Andrew has recently been interviewing candidates to join Bupa as part of this year’s programme and says he was surprised at the level of leadership and entrepreneurism among junior doctors. Successful applicants will have the option of shadowing Andrew in his post at BUPA. The future for BUPA Andrew sees an exciting future for BUPA, particularly overseas. He highlights the opportunities of the group’s entry into China but recognises that this will be accompanied by some real challenges.

“I am a passionate believer in evidence based medicine and clinical governance but just transferring UK clinical governance policy into China is not realistic. It would not be understood and you couldn’t deliver it, but we are making a start,” he says.

He feels that this demonstrates one of the struggles for any doctor who makes the transition into a leadership role - achieving the balance between business and health service delivery.

Andrew says he is fortunate that his colleagues at BUPA recognise the importance of the clinical input from his team: “Putting the customer first is absolutely fundamental to BUPA and that means providing the best quality care.”

He finds the opportunities that China presents exciting and he doesn’t seem too daunted by the challenges - for someone who will be training at 6am tomorrow for his next BUPA Great Run it’s something he takes in his stride.

With that attitude taking the “live longer, healthier, happier lives” message to the world shouldn’t be a problem for Andrew Vallance-Owen.

Management for doctors

Medikidz: Medical information for kids Medikidz is the brainchild of two junior doctors - Dr. Kim ChilmanBlair and Dr. Kate Hersov. Their comic books explain childhood medical conditions in a way that aims to be imaginative, engaging and easy to understand.

JuniorDr asked Kate Hersov how they developed their idea and what is the future for Medikidz.

Where did the idea for Medikidz come from?

What has been the reaction from patients?

Medikidz was founded by myself and colleague Dr Kim Chilman-Blair following a frustrating time in paediatric medicine.

During our time as doctors, we were unable to provide young patients with resources to help educate them about their new diagnoses or medicines. There exists worldwide, an enormous lack of useful material for young people around medicine and health - most of what exists targets parents only! This realisation was the catalyst which led us to create Medikidz.

The reaction from patients, and their families, has been phenomenal. We had a recent review article in the BMJ where the 14-year old boy states “I found the comics fantastic.

The characters had big, hilarious personalities and the illustrations wouldn’t have looked out of place on Pixar’s drawing boards. More to the point, I learnt a lot from reading them.

The language wasn’t in the slightest bit condescending, and the larger than life medical superheroes taught me a lot ... making the illness seem 10 times less daunting and, ultimately, manageable”. There certainly is no better motivating factor for Medikidz than hearing feedback like that!

What does the Medikidz Foundation do?

How did your experience as a junior doctor help?

Working as a doctor you can see firsthand the fear that comes with a new diagnosis. I realised so much of this is a fear of the unknown and therefore developed a strong belief in the power of knowledge. I put great importance on providing tools to my patients, paediatric or adult, to gain that power.

Medikidz Foundation was set up by Medikidz Ltd in order to help children in developing countries gain vital medical knowledge. Medikidz established the Foundation in order to redress the paucity of even the most basic medical information for children in developing countries across Africa, Asia, and other less fortunate parts of the world.

Our graphic novels, such as Medikidz Explain... HIV, Tuberculosis and Malaria are of course particularly relevant in these regions, where diseases often spread quickly due to a lack of understanding of how they can be prevented and treated. Together with The Global Fund, Medikidz Foundation will distribute 100,000 ‘Medikidz Explain HIV’ books into Swaziland early next year.

Are there plans to expand beyond comic books?

As well as our 20 current titles on paediatric conditions (such as Epilepsy, Scoliosis, Leukaemia and Cystic Fibrosis) we have also produced titles relating to adult conditions, so that a parent/loved one, when faced with a diagnosis, has somewhere to turn to

Kate and Kim at Medikidz launch 2009

help them explain it to their children. We have published ‘What’s Up With Mum? Medikidz Explain Breast Cancer’ already and next in this series will be, ‘What’s Up With Grandpa? Medikidz Explain Alzheimer’s Disease’ and then we’d like to do Parkinson’s, Multiple Sclerosis and Schizophrenia.

We keep on getting approached all the time to write on new conditions - in fact we now have a list of 300 to do! Medikidz also have produced pamphlets and brochures explaining paediatrically-licensed medicines (increased understanding can lead to improved adherence) and hospitals investigations, such as ‘Medikidz Explain MRI Scans’ or ‘Medikidz Explain Endoscopy’.

Next year we will relaunch Medikidz. com - an online ‘Medipaedia’ with entries about conditions, investigations and medicines (like a WebMD for kids), with an integrated fully-moderated social network for children globally to connect around illness and disease (like a Facebook for sick kids!).

Since launch we have now distributed over 1,000,000 comic books globally. I think this volume in such a short space of time is due to the fact the medical community, and indeed young people themselves, have not seen a resource like Medikidz before!

Medikidz is currently recruiting and it’s your chance to join the team. View the advert on p28. www.medikidz.com

MANAGEMENT

17

Repatriation Repatriation medicine involves the transfer of patients by air, land or sea from overseas hospitals back home. JuniorDr’s Ivor Vanhegan asked Dr Tim Hammond, Chief Medical Officer of CEGA Group, about his experience of repatriation medicine and advice for junior doctors interested in it as a career.

What does a repatriation involve?

Most ‘repats’ are done on commercial airlines, although air ambulances are also employed where intensive care facilities are needed. Most doctors working in this field have training in emergency medicine (A+E), are at least ALS trained, and generally have been working for a minimum of three years post-qualification. The air ambulance work is carried out only by experienced anaesthetists with the assistance of appropriately trained nurses with experience in intensive care.

Much repatriation work is done by nursing staff, for patients who need dressing changes, intravenous drug administration, or help with mobility, fractured limbs or confusion. Doctors are needed when there is a perceived on-going or potentially unstable situation. Some of the patients I’ve brought home recently include MI’s (who may or may not have been revascularised by PCI or CABG), CVAs, GI bleeds and pneumothoraces where the patient has a chest drain in-situ.

What are the rewards and challenges of your job?

It is immensely satisfying bringing home a patient who may have been stuck in a treating hospital abroad for some time. They are always incredibly pleased to see you as you are their means of getting home and might be the first person they’ve been able to talk to in English in a long while. The opportunity to travel is always exciting, and the opportunity to spend time with a patient and make a real difference never loses its thrill.

The job does however require a good deal of confidence and patience. Deciphering hospital notes in a foreign language, organising logistical arrangements abroad and making sure the patient is appropriately fit to fly all have their stresses. That’s before you consider the adaptations needed to assess and treat a patient on board an aircraft, coupled with the paperwork and documents needed for a smooth hand-over in the UK. 18

Careers

After my house jobs I did a GP training scheme in East London, followed by some further hospital medicine. I then spent 18 months working in a mission hospital in Zambia before coming back to the UK to take up a partnership in General Practice. After 15 years I felt I had got the hang of that and it was time for a change.

CEGA is both a medical assistance and an air ambulance company.

On the medical assistance side we work on behalf of many of the major UK travel insurers, overseeing the care of their insured customers while they are abroad, and arranging safe and appropriate repatriation for them. We also work for many other organisations and agencies, many based in remote or hostile locations overseas, arranging medical care, evacuation and repatriation home.

“We get 50 or 60 new cases each

“Deciphering hospital notes

day - which can be any medical

in a foreign language, organ-

problem, anywhere in the

ising logistical arrangements

world.”

abroad and making sure the

How did you become involved in repatriation medicine?

patient is appropriately fit to

Part of my GP partnership agreement allowed a six month sabbatical every five years.

As a warning to others you should think very carefully before taking a sabbatical - six months away from your usual job is always an eye opener and the proportion of doctors who end up changing careers after sabbaticals is high.

It was the same for me. I spent the time working for an international assistance company in Moscow and Kazakhstan and thoroughly enjoyed the experience. On returning home I started looking at opportunities in this field and six months later came across an advert in the BMJ for a full time doctor at CEGA. I didn’t hesitate.

As Chief Medical Officer what does your role involve?

fly all have their stresses.”

On the air ambulance side we have a fleet of air ambulances based at Bournemouth airport which we can use to bring home any travellers who, for whatever reason, are unable to fly on a commercial flight. In addition we do air ambulance transfers for other assistance companies, the Channel Islands, the NHS, regional paediatric and neonatal transfer services and private individuals.

I am based at CEGA’s head office, and oversee all medical aspects of the business. We have a fantastic team of nurses in the office, who I work with, and I am also involved in recruiting and training the doctors and nurses who do the commercial repatriations and air ambulance flights for us.

As well as working in the office, I also go out on repatriations myself, so that I am fully

Medicine aware of the issues involved. It also gives me a chance to see some of the overseas facilities we are dealing with, and to meet some of the doctors working in them.

How do you use the your medical knowledge in your day to day job?

We get 50 or 60 new cases each day which can be any medical problem, anywhere in the world. We have to make assessments of each to ensure people are getting appropriate medical care. If they are somewhere remote, without the necessary facilities, we have a network of agents worldwide through whom we can arrange to transfer them to an appropriate hospital. We are constantly liaising with treating doctors overseas, monitoring care, and making decisions about when people are fit to return home. If necessary we will then send out a doctor or nurse to escort them back, or if needed send an air ambulance.

We are dealing with medical, surgical, orthopaedic, obstetric, paediatric, critical care, neonatal and every other type of case. My medical knowledge is therefore challenged on a daily (or hourly!) basis, and I use every scrap that I’ve ever learned, and am constantly learning new things.

We have separate ‘banks’ of doctors, one doing air ambulance work and the other doing repatriations on commercial flights. To do air ambulance work you need to have at least 2 years of specialist anaesthetic/ICU training and be currently working in a critical care environment in hospital. You need to be competent and confident that you can look after a critically ill patient on a long (up to 8 hour) transfer. Most of our doctors are ST5 or above. When they join us most have done a lot of road transfers but not done transfers by air. We provide the necessary training for this and most find the transition easy.

To do repatriations on commercial flights where the patients are obviously less critically ill you need to have done at least a year of training in an acute specialty after completing FY2. Most of our doctors are GPs, medical, surgical or emergency medicine registrars doing a research post or studying for higher degrees. It is all ‘bank’ work and we don’t have doctors on full time contracts - although some do it fairly full time for six months or so between jobs. You also must have a current ALS certificate to join our bank.

What advice do you have for doctors who are interested in getting started?

Most assistance companies have banks of doctors who do repatriation work for them.

These would normally be either on scheduled flights or non-critical patients on air ambulances. Critical care trainees would need to contact a specialist air ambulance company directly or look out for adverts in journals such as the BMJ. If it is something you enjoy there are also opportunities to move into the medical assistance side, working as a medical officer. In terms of further training for this role some knowledge of aviation medicine is useful and there are specific courses in aeromedical transport (in particular the CCAT course www.ccat-training.org.uk) which will give you a good background knowledge of the issues involved.

Anyone interested in working for CEGA can register their interest or request further information via our website www.cegagroup.com.

“It is immensely satisfying bringing home a patient who may be bored and homesick having been stuck in a treating hospital for several weeks.”

What are the requirements to work in repatriation medicine?

For medical assistance work, anyone with a good grounding in primary care or emergency medicine should be fine. There is no one branch of medicine that encompasses all you need so whatever background you have there will be learning to do.

About CEGA Group CEGA Group provides medical assistance, air ambulance and claims handling services to many leading UK and International travel insurers, companies and other organisations.

They recently won both the ‘Assistance/ Claims Handler of the Year’ and also ‘Air Ambulance Provider of the Year’ titles at the International Travel Insurance Journal Awards held in Athens in November 2009.

Careers

19

Amateur Transplants Amateur Transplants are a London based parody musical duo of junior doctors Dr. Adam Kay and Dr. Suman Biswas. Performing since they were medical students they have appeared at the Edinburgh Fringe festival every year since 2005.

Their most successful track London Underground, which criticised the London Underground strike at the time, has had over 4 million downloads. The majority of their songs however are on medical subjects with titles such as Unfit to Practice, Careless Surgeon and In Theatre.

Adam Kay tells JuniorDr’s Ivor Vanhegan why laughter really is the best medicine.

How did Amateur Transplants come about?

It’s essentially a hobby that has spiraled massively out of control.

It started as the two of us singing songs at the Soirée (Christmas Revue) at medical school and over the last decade we seem to have hoodwinked the general public into thinking it’s something they should enjoy. We’ll never forget our roots though. [Sorry, can you send my Apple Martini back? That ice isn’t crushed enough.]

Tell me about your early gigs?

I think all comedians are pretty embarrassed of their early gigs much like seeing your naked baby photos or remembering your first venflon. It took us a while to learn how to write a decent joke and how to interact with an audience. If I told you one of our first tunes we did on stage was a parody of “Rhinestone Cowboy” called “WellHung Cowboy” I think you’ll more than get the picture.

with the right thing. It was in the early days of YouTube and the concept of a viral video was very new - plus it contains a lot of swearing which as we now appreciate is both big and clever. We’re both delighted that London Underground workers are striking - as it’s keeping the song in the comedy top 10.

What are you involved with currently?

We’ve got quite a few things on the boil at the moment - our Christmas album is on the shelves and we’re just coming to the end of our run of festive shows. There’s a tour on the cards for mid-next year, another Edinburgh festival around the corner, we’re writing for a few new projects plus we’re working on a new DVD. Also, I haven’t started doing my Christmas shopping yet - oh god, stop panicking me.

Any anecdotes from gigs?

Someone died once (but that was a coincidence). Do you want a funnier story? Umm, some of the fans have been a little unusual (the one with the Adam Kay tattoo springs to mind). We seem to attract a weird crowd for some reason. We sometimes get booked for slightly inappropriate gigs - weddings, kids’ birthdays, Bar Mitzvahs: those are always pretty memorable.

Are you both still working as doctors?

I’m retired, and Suman is still putting people to sleep.

Did any of this cause any difficulties whilst at medical school?

Yes. I always seemed to be one final warning away from complete expulsion, both over shows and magazines we put out. I’m still not entirely sure what’s wrong with sending in fake applications to be the medical school dean, publishing false criminal accusations about senior members of staff or calling a show “The Talented Dr Shipman”.

How did the London Underground Song become such a big success?

This was the archetypal “lucky break” and it really propelled us on to some bigger things. It was very much being in the right place 20

MEDICAL MUSIC

Advice for others wanting to pursue comedy?

I’m not sure I should be advising medics to take up musical comedy - it’s a small enough niche as it is. In general, it’s probably best not to give up your number until you’ve made slight inroads into the comedy scene. Start with open-mike nights, think about the Edinburgh Festival, make friends with the right people - and gigs should open themselves up for you. Unless you’re shit obviously.

What is the future of Amateur Transplants?

Hopefully we’ll be the new judges on X-factor. Failing that, it will be a busy year ahead of gigs and recording. Failing that, Britain’s Got Talent.

Find more details on the Amateur Transplant website www.amateurtransplants.net including their new Christmas album which can also be downloaded from iTunes. You can also follow Adam and Suman on Twitter @amateuradam @amateursuman.

Doctors Playlist Tunes that trouble patients on their way to sleep in the anaesthetic room 1 Wake Me Up Before You Go-Go (Wham) 2 Every breath you take (Sting) 3 I’m Blue, Da Ba Dee (Effel 65) 4 Can’t fight this feeling (REO Speedwagon) 5 Take My Breath Away (Moroder) 6 Sweet Dreams Are Made of This (Eurythmics) 7 Do you really want to hurt me (Culture Club) 8 Back to Life (Soul II Soul) 9 Staying Alive (Bee Gees) 10 Don’t Leave Me This Way (Thelma Houston) 11 It Hurts So Bad (Kim Carnes) 12 Rescue Me (Fontella Bass)

Which tunes get the heart docs pumping and the psychiatrists head-banging? We find out.

Queued up tracks for that long wait in A+E to see a doctor

Sounds that get cardiac surgeons blood pumping

1 Help! I need somebody (Bananarama) 2 Calling Doctors Jones (Aqua) 3 I’m still standing after all this time (Elton John) 4 It hurts so bad (Kim Carnes) 5 Don’t leave me this way (Thelma Houston) 6 Survivor (Destiny’s Child) 7 I just died in your arms tonight (Cutting Crew) 8 I just gotta get out of this place (Bee Gees) 9 Do you really want to hurt me (Culture Club) 10 Another One Bites the Dust (Queen) 11 The drugs don’t work (The Verve) 12 I Quit (Hepburn)

1 You make my heart go boom (Jackie Wilson) 2 Listen to my heart (Culture Club) 3 My heart will go on (Celion Dion) 4 Boom, Boom, Boom (Vengaboys) 5 Don’t go breaking my heart (Elton John) 6 Bleeding heart (Jimi Hendrix) 7 Flat Beat (Flat Eric) 8 Stayin’ Alive (Bee Gees) 9 I’ll never break your heart (Backstreet Boys) 10 Unbreak my heart (Toni Braxton) 11 Don’t Leave Me This Way (Thelma Houston) 12 Mmmm Bop (Hanson)

Songs that psychiatrists can’t get out of their heads 1 Who do you think you are? (Spice Girls) 2 Can’t get you out of my head (Kylie) 3 Oops upside your head (Gap Band) 4 Suspicious Minds (Fine Young Cannibals) 5 I believe I can Fly (R Kelly) 6 The Drugs Don’t Work (The Verve) 7 I’m a Believer (The Monkees) 8 Big White Room (Melanie Garfide) 9 Everyone wants to rule the world (Tears for Fears) 10 Two Faced (Louise) 11 (You drive me) Crazy (Britney Spears) 12 Why does it always rain on me (Travis)

Leadership, Management & Personal Development Training Courses you should know about!

Insights Intensive - Understanding the Implications of the White Paper Consultant Interview Skills (Includes access to online resources) 3-day Clinical Management & Leadership Management Excellence for Junior & Middle Grade Doctors Communication Skills for Junior & Middle Grade Doctors Foundation Course in Leadership & Management for FY Doctors Presentation Excellence for Clinical Professionals

38.6%

250+

3000+

Across quarter 1 in 2010 a massive 38.6% of our bookings were either from past attendees or by personal recommendation

Medicology runs more than 250 open programmes per annum

We train over 3,000+ individuals per annum and it is consistently growing

View the courses you should know about at:

www.medicology.co.uk/juniordr MEDICAL MUSIC

21

Medicolegal Advice - in association with Medical Protection Society

The stress factor

Working as a junior doctor gives a new meaning to the word stress. Sara Williams explores how to keep it at bay

L

ast May Janet Street Porter wrote an article headlined “Depression? It’s just the new trendy illness!” She went on to write: “Get a grip girls!” – describing depression and stress as the “latest must-have” accessories for middle-class women. Her article was met with much criticism; Alistair Campbell described her opinion as “misguided” and “offensive” and Mail columnist Allison Pearson said that at least depression is manageable, unlike Janet Street Porter.

Such unsympathetic advice on handling stress demonstrates that there are still some negative mainstream attitudes of stress and depression. Stress is a real and modern illness.

According to the Health and Safety Executive (HSE), 11.4 million working days were lost in 2008/09 to stress, depression and anxiety.

Everyone suffers from some pressure in their lives: it can be a good thing, motivating us to get our work done and raising performance; however, when demands and pressures become excessive, they can lead to stress. The HSE defines stress as: “The adverse reaction people have to excessive pressures or other types of demand placed on them at work.”

How common is stress among junior doctors? Hospitals are challenging places, full About MPS for articles.qxd:MPS Checkup of info demanding individuals, who openly question the staff that work in them. In the face of this, junior doctors must maintain calm, well-presented and attentive demeanor, while multi-tasking in a frenetic environment.

The BMA’s Doctors for Doctors support service takes more than 2,000 calls a year for doctors. This service was set up by Dr Mike Peters. He says doctors most commonly contact the advice line about: • Career issues • Bullying/racial harassment • Issues with staff/partners • Complaints procedures • Feelings of exploitation • Co-existant health problem/stress • Psychological support • Inappropriate relationships with staff and patients • Work/life balance • Burn out Dr Peters says: “Most calls are about career issues. This is because when doctors have a health problem, suffer from stress or burnout, or are going through a complaint or litigation, this is often a time for them to reflect on their career specialty and whether they should change or indeed leave medicine – so they contact us.”

How to deal with stress

If you are feeling stressed or finding it difficult to cope, it is important to get help early.

12/2/10 10:05 Page 1 Not being aware of the depth of your feelings could lead to escalating problems, such as depression or drug and alcohol dependency.

Dr Peters encourages junior doctors to call Doctors for Doctors when they feel

About MPS MPS is the leading provider of comprehensive professional indemnity and expert advice to doctors, dentists and health professionals around the world.

We actively protect and promote the interests of members and believe that education is an integral part of every health professional’s development. As well as providing legal advice and representation for members, we also offer workshops, conferences and a range of publications designed to aid good practice.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.

22

MPS Members who would like more advice on the issues raised in this article can contact the medicolegal advice line on 0845 605 4000.

www.mps.org.uk The Medical Protection Society Limited.

A company limited by guarantee.

Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS.

stressed out: “We are not here for treatment or diagnosis; we are an entry level for a doctor who is having difficulty coping. We offer a reflective space to discuss problems with a colleague or a professional counsellor 24/7.”

Tips on managing stress: • Put boundaries up – learn to say no • Take time out – particularly when you start to feel stress • Keep a stress diary – to identify what things are creating stress • Acknowledge limitations • Get a good GP – see them when you are not well and listen to their advice • Hold regular meetings – we’re all human: working at the “coal face” leaves little time for this, so organise time for reflection with colleagues • Be open – say you’re stressed Coping with stress in the long term

Dr Fiona Donnelly is the chairman of the Doctors Support Network, a peer support group for doctors. Dr Donnelly says the online forum she runs receives 2,500 posts each month. The 24-hour community discuss problems and how to deal with them.

Many posts come from A&E medics, psychiatrists and GPs: Dr Donnelly says this is because they are exposed to more mental illness, so it is less stigmatised.

“I got involved in this group because I experienced stress and depression in my own life. It was brought on by a series of events that occurred in a short period of time. I got married, bought my first house, started my first psychiatry post doing the job of a higher level trainee as my consultant was off sick, and then I was assaulted by a patient.

“I left my illness for a very long time. I had no idea how ill I was. I felt very guilty, as there was a perception that people made things like this up to get out of work. I could do the job fine, but when I got home I wouldn’t leave the sofa or speak to my husband.”

Dr Donnelly says that it is vital that staff are aware of the signs of stress in their fellow employees. Her illness would have been diagnosed sooner if she’d had better support around her.

“How effective stress management is depends on the local culture of where someone is working: some areas take a hard line on

Guide to writing an effective CV The CV is now back in fashion (after a brief excommunication) and, although it may not be considered for shortlisting, it certainly forms an important part of your portfolio, which is discussed at the interview.

M

any have been caught short in trying to rewrite theirs at the last minute. Writing a good CV takes more time that you can ever anticipate and often requires a complete rethink on the way in which you should communicate your experience so that it can appeal to a total stranger. Here are some of the common mistakes made by candidates and how to avoid them:

Adopt a user-friendly format

illness, and offer support and encourage staff to take time off. However, I know of other areas where the attitude is old fashioned – if you can’t take the stress you shouldn’t be doing the job.

Dr Donnelly was an inpatient for six months and afterwards went back to work.

Despite a few relapses, she has moved on and taken hold of her life again, working as an SPR in psychiatry and bringing up two children. She attributes her success to sharing her feelings and supporting others through Doctors Support Network.

Working as a junior doctor can be one of the most stressful periods of your career, but if stress is effectively managed and the avenues to support services are well signposted and explored, stress can be managed, to the benefit of both staff and patients Useful Links

• BMA, Doctors for Doctors www.bma.org.uk/doctors_health/index.jsp

• BMA Counselling Service and Doctors Advisory Service – 08459 200169 • NHS Practitioner Health Programme www.php.nhs.uk

• Healthy Working UK

The aim of the CV is to inform a reader in 30 seconds to 2 minutes. Use a tabular format, with dates in the left margin so that they do not clog up the document. Do not overuse bold lettering. Avoid using colours.

Get to the point

Your CV is not an autobiography. Avoid writing long novels and use bullet point instead. Make sure that each bullet point actually says something useful and reflects the true nature of your experience (for example: “learnt to take blood” is not terribly exciting, but “Competent in all common procedures, including x,y and z” is far more explicit. Use active verbs and adjectives such as “organised”, “developed”, “competent in”, “experienced in”, “played a key role in”, “Instrumental in”, “proficient in”, “actively involved in”.

Signpost your experience

When describing your experience, describe it in a separate section under different headings rather than job by job. People want to know what you can do now, rather than what you did on your first day as a PRHO/FY years ago. If you have more than 4 or 5 bullets points under one section, try breaking them down into subheadings. e.g. your clinical experience may be categorised under chapters such as ward experience, oncall experience, outpatient experience and procedures.

Don’t stick to the basics

Some sections can be used to transmit several messages. For example, in the audit section, you may want to do more than just list the audits. Explain what your role was and how your audits made a difference. In the teaching section, list your experience under headings representing the different types of teaching that you have undertaken, listing examples of topics that you taught and the methods that you used.

Plan carefully

Plan your CV carefully. When brainstorming its content, do not reflect on your experience job by job, but think about why you are a good candidate from a clinical and non-clinical perspective. By allowing yourself to think along broad lines, you will find it easier to give your experience a meaningful purpose.

Your 1st choice for interview skills & personal development coaching

www.healthyworkinguk.co.uk

• British Doctors and Dentists Group www.medicouncilalcol.demon.co.uk/bddg.htm

• Sick Doctors Trust www.sick-doctors-trust.co.uk

• Doctors Support Network www.dsn.org.uk

Sara is a senior writer and editor at MPS. She writes for Casebook edits New Doctor magazine. Her contact details are sara.williams@ mps.org.uk.

ISC Medical is the UK’s leading provider of interview skills and personal development coaching for doctors. Do you want to learn more about how to approach the various teaching styles and become a better teacher?

Join one of our medical teaching & presentation skills courses Learn practical and innovative ways to teach effectively and present with confidence in this 2-day course in London. Maximum 12 people. Lots of personal attention & individual feedback. 12 CPD points.

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Secret Diary of a Cardiology SpR Monday If you’ve been following this column then you’ll know that I am finishing my final attachment before taking up my first consultant post. I have only a month remaining and my initial plan to get the most experience out of the remaining time has now turned to boredom and frustration.

The regular Monday ward round goes without hitch. Nevertheless my boss still insists on talking through each patient in turn just as he did in my first week. I consider telling him to stop interfering then realise that I will most likely be doing the same in a few months. Instead, I thank him for always showing an interest.

It’s midway through the crazy Christmas drinks season. I dismiss the juniors invitation for drinks but then later re-invite myself in a way that makes me look desperate and lonely. We drink till midnight in some rowdy city bar then I get a cab home.

I crawl into bed and down two paracetamol knowing it won’t do much good.

Tuesday I wake before my alarm goes off feeling surprising nausea free.

I arrive at CCU with a skinny latte and blueberry muffin in hand and realise that my hangover is only just setting in.

My larynx however has borne the worst of last night’s noisy bar and my voice sounds about two octaves lower. I think this makes me sound more authoritative and I test it on the medical students but they’re still as obstinate as usual.

I’ve complained a lot about the current bunch of students.

They seem disinterested and overconfident. Most of all, they lack the fear of consultants I had when I was at medical school. I suspect their biggest fear isn’t from authority but more likely what their mates post on Facebook. I feel old and head home early. I take more paracetamol and go to bed.

Wednesday Angio list this morning. I find two Christmas cards on my desk from the clinic staff. I announce to the office that I don’t send Christmas cards and I notice one of the technicians rolling her eyes. I ignore her and go to see the first patient.

He is a young male with a history of cardiomyopathy and we discuss Christmas plans and going home to spend time with family. He talks about his parents who live in Scotland and how he’s spending more time with them since he became more unwell.

I tell him about my own parents and how I’ll be much more comfortable in the company of a bottle of Merlot on Christmas day. He laughs thinking I’m joking.

After clinic I review three patients on the ward. I always find hospitals a depressing place at Christmas. I’m unsure whether this is actually the case or just my perceptions. Fortunately I’ve no more on-calls until January and I’ve no intention of swapping into a holiday shift.

I leave early to do some Christmas shopping but give up fighting through the crowds of people laden with bags and head home.

I order a takeaway from my local Japanese, open a bottle of Pinot Gris and watch TV until late.

24

SECRET DIARY

* Names have been changed to try to keep our cardiology SpR in a job - though she’s doing a pretty good job of trying to lose it without our help!

Thursday More Christmas cards. This time I moan about the waste of paper. The receptionist asks why I hate Christmas so much. I try to explain that I don’t, but realise she’s probably right and leave to do some medical student teaching.

Only one student turns up. I ask where the others are to be told they’ve gone home early for Christmas. I tell her that I’m not surprised and that they’ll be marked down at the end of their placement. She looks embarrassed for the others but I don’t care. I’m tired of their behaviour.

We go through some ECGs from CCU but the young female student takes out her iPhone and asks if we can do some on it instead. She shows me an app that allows you to take a photo of an ECG trace and the iPhone will identify the abnormality. I make a mental note to trade in my Blackberry.

After teaching the student wishes me a happy Christmas and asks me not to be too hard on her colleagues. I wish her a happy Christmas back and intentionally don’t mention anything about the other students.

Friday One of the admissions overnight was the cardiomyopathy patient from Wednesday’s angio clinic. He’s stable but won’t be going home this side of Christmas. His family have travelled down from Scotland and are sitting by his side.

I think about whether I’d have anyone sitting by my bedside and realise I would. Family are family - no matter how much they argue or don’t talk - and I suspect both my parents would come straight to the hospital just like his.

Sitting writing up the discharge summaries from the week I feel more comfortable about the impending holidays. I place a Christmas card in each pigeon hole in the angio clinic and a box of M&S on the reception desk before going home.

Later that evening my mother calls asking if I’m planning to visit this year. I tell her I will.

Focus on Finance - in association with Wesleyan Medical Sickness

Filling the Pensions Gap A

ccording to Government figures, a man retiring from the NHS pension scheme today at 60 can expect to spend 41% of his adult life in retirement and a woman 43%. That’s a long time to spend without a regular pay cheque so it makes sense to start thinking about saving for retirement now so that you can enjoy this period of your life more fully.

Your own retirement might be more than 30 years away so you should consider the effects of inflation when planning for it.

Inflation is the general increase in the prices of goods and services over time. According to the Retail Prices Index, over the last 35 years, general prices have risen by around 716%. If the same were to happen over the next 35 years then you could expect your average loaf of bread to set you back £8.31 when you come to retire!

Luckily, as employees of the NHS you have access to the NHS Pension Scheme which currently provides an inflation linked pension in retirement, based on your final salary. As a Hospital Doctor, and depending on when you joined the scheme, you earn either 1/60th or 1/80th of your ‘final salary’ as a pension for each and every year you work (subject to a maximum). Your pension will also increase in retirement by rises in the Consumer Prices Index which offers some protection against inflation.

You may have heard about potential reforms to Public Services Pensions (such as the NHS Pension Scheme) and it’s important to have an idea of how these might impact upon you and your retirement planning. A Commission headed by Lord Hutton has been tasked with reviewing the structure of

Public Services Pensions with a view to making them more sustainable and cost effective.

An interim report issued in October claims that the most effective way to reduce the cost of schemes like the NHS, at least in the short-term, is to ask members to pay more. At the moment, if you are a member of the NHS Pension Scheme, you pay between 5% and 8.5% of your salary as your contribution to the scheme. The NHS pays 14% of your salary on your behalf.

There is therefore a strong possibility that the amount you have to pay to be a member of the scheme will increase in future.

In the longer term, the Commission is considering a number of options including changing the nature of the NHS Scheme from one where the eventual benefits are based on your ‘final salary’ to one where the benefits are linked instead to your average earnings throughout your career. Increasing the minimum age at which you can take benefits from pension schemes like the NHS is also being considered.

The NHS Pension Scheme is still extremely valuable. Let’s say you work for 40 years and retire on an NHS pension of £55,000 per year plus a lump sum of £165,000. For a 65 year old man, an inflation proofed pension of £55,000 per year (which continues to be paid at the rate of half to a spouse following death), along with a £160,000 lump sum might currently cost you in excess of £1.79 million. The equivalent for a woman of the same age might cost in excess of £1.83 million. Assuming you were aged 30 now and could get a return of 5% a year on your investments, you would need to invest around £18,975 every year

until you retire in order to build up the fund required to match these benefits at age 65.

We will have to wait until Spring 2011 for the full report on Public Services Pension reforms which the Government will then consider in detail before making any changes but it’s clear that changes in public services pension schemes like the NHS is a real possibility.

The Government has also proposed radical changes to the basic State pension which could mean a flat rate pension and, for anyone born after 5 April 1978, the State pension won’t be available until age 68.

Bearing all of this in mind, you might find yourself having to save money outside of the NHS Pension Scheme in order to meet your retirement goals. Pensions are an extremely complex area and the legislation which limits how much you can pay into them is changing all of the time. Remember, it’s never too early to start planning for your retirement or to seek professional advice to help you get the retirement you want.

The above information does not constitute financial advice. If you would like more information or need general financial advice you can call Wesleyan Medical Sickness on 0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk

Specialist financial services for doctors • Savings and Investments

• Mortgages

• Retirement Planning

• Motor, home and travel insurance

• Life and Income Protection

Motor, home and travel insurance is arranged by Wesleyan for Professionals.

0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk Wesleyan Medical Sickness and Wesleyan for Professionals are trading names of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham B4 6AR. Telephone calls may be recorded for monitoring and training purposes.

FINANCE

25

Assessed

by Gil Myers

Compiled by Farhana Mann

Medical Report

MR S CLAUS Obesity Santa isn’t just big-boned. He isn’t ‘jolly’. He is obese, with a BMI of well over 35. Obesity, especially central or waist-predominant obesity, is an important risk factor for ‘Syndrome X’ the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These include diabetes mellitus, high blood pressure, high blood cholesterol and combined hyperlipidemia. The answer is clear: Diet or Die Santa.

Across

3 The symptoms of seasonal affective disorder are typically worse at this time of year (6) 5 This term is used to describe the characteristic facial appearance of someone with Williams syndrome, a rare neurodevelopmental disorder (5) 6 ‘Congo’ stain of this colour can be used to demonstrate amyloid (3) 7 Cryoglobulinaemia involves the reversible precipitation of immunoglobulins in these conditions (4) 8 This syndrome (with man) is a neurodevelopmental disorder featuring developmental delay, unusually happy demeanour, hand-flapping movements, and is a classic example of genomic imprinting (5) 10 Haemophilia B is also known as this disease; Denise’s bond girl (9) 15 Orf is a dermatological condition that can be picked up from direct contact with these animals; also give rise to many an unwanted jumper (5) 16 A typical immunoglobulin has two chains of this sort; lots of these make the trees sparkle (5) 18 Kissed under with mistle, big one is often site gout strikes (3) 19 Inverted bottles of this may be a feature in CharcotMarie-Tooth disease (9) 20 This chest finding on an asthmatic suggests a very severe attack; first word of a popular Christmas Carol (6)

Down

1 It is not known if the ‘X Factor’ will steal the Christmas no. 1 spot in 2010, but it is known that this Factor V variant causes a relatively common hereditary hypercoagulability disorder (6) 2 Name of the American psychiatrist who published a landmark multicentre trial in 1988, highlighting the effectiveness of clozapine in schizophrenia; think shape of traditional Christmas candy (4) 4 Scottish physiologist whose palsy features one-sided facial weakness; can jingle (4) 7 Having your ulnar nerves trapped could lead to your hands resembling these (5) 9 Sister Mary Joseph nodule refers to the sign of a palpable node protruding into this, as a result of metastatic spread of an abdominal/pelvic cancer (9) 10 In pseudogout, these are typically rhomboid and positively birefringent in the joint aspirate (8) 11 Pityriasis _____: the scaly lesions of this inflammatory condition typically occur in a Christmas tree distribution on the back (5) 12 Popular choice of tinsel; hypertensive retinopathy may feature this wiring (6) 13 Melanoma is predominantly a malignancy affecting people with this skin type; ideal Christmas in Northern hemisphere (5) 14 A sweeper of this historically has an increased risk of scrotal cancer; look out St Nicholas... (7) 17 Abbreviation for a neuroimaging modality that measures magnetic activity of the brain; spicy with a nut on the front (3)

You can find the crossword solution by searching for ‘crossword answers’ at www.juniordr.com

26

HOSPITAL MESS

Cyclothymia Santa locks himself away from the world for the majority of the year, not speaking to anyone (except for his ‘elves’) and then appears incredibly happy, overjoyed with everything and unable to stop laughing. He doesn’t sleep, excessively spends his money buying presents for all and then jumps in his vehicle and speeds off - all the while dressed in bright colours. A word of warning, high mood such as this is followed by irritation, recklessness and sexual disinhibition - so watch out Rudolf!

Albinism His head, beard and eyebrows are white as snow. The most likely diagnosis would be Albinism, a genetic abnormality where no pigment is found in human hair, eyes or skin, making the eyes blue, the hair white, and the skin pale. It would also explain why he is only seen at night - he lacks melanin, a protective pigment in his skin, burning easily from exposure to the sun and suffering from photosensitivity.

Red Face All those years of children leaving out ‘a little glass of whiskey to keep Santa warm’ may have left him with a problem.

Long-term alcohol use causes cirrhosis of the liver. As this stops working and begins to shut down the results are multi-systemic signs. The tiny blood vessels in his face burst leaving a permanent red face, nose and cheeks. This would go well with his jaundice, clubbing and gynaecomastia. It would also explain why he always wears gloves and baggy clothes - and why the glass you left was always empty in the morning.

Haemorhoids Santa’s sleigh doesn’t look very warm and cosy. Assuming he starts off from snow-covered Lapland and travels all across the world he must spend an awful lot of time sitting on a cold, hard seat. He doesn’t appear to have much time for toilet breaks either. Too much pressure on the rectal veins due to poor muscle tone or poor posture, coupled with obesity, sedentary lifestyle and postponing bowel movements has been proven to cause haemorrhoids. It must also be very difficult for Santa to get help - he can’t exactly pop down to his local chemist for a tube of Anusol.

Writing in the Notes places Lack of training

er

unfair for taxpay

going to be a Dear Editor, me that there’s se ri rp su t n’ es king” lack of It do ical posts (“Shoc rg su ST of ck st another sign huge la ; p4) as it’s ju 18 s Is s; st po management of surgical of Health’s mis t en tm ar ep D lt to balance the of the t be that difficu n’ ca it ly re Su . with the numtraining r medical school fo ng cyi pl ap rs numbe that overseas do e? I understand bl l la al ai av s I’m st . rs po matte ber of UK complicate e th b jo to e g th in r m fo tors co st doctor n to find the be t some return for open selectio ou xpayer sh ld ge ta K U e th ly re r training us?

- but su e shelled out fo ’v ey th K 50 £2 on the

W

hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:

Parking for one hour

Dear Editor, In response to Aaron Templet on’s letter (Sick EWTD criticism of ; Iss 18; p27) I think he’ll find there is good ev that idence that the majority of do oppose the EW ctors TD - simply ta ke a look at su results on the rvey RCSEng websi te. The EWTD skilling doctors, is deruining the mor ale of hospital ‘fi and putting pa rms’ tient’s at risk fr om poor contin care. I think A uity of aron’s point that no-one is repres ing doctors who entsupport the EW TD is because th aren’t any. Hop ere efully we can re turn to the team approach to surg based ery and proper training soon.

Victoria Ca mbes ST3 Surger y, North West Deanery

Compassion not

£3

Royal Free Hospital, London

Skip the bus at:

Free

Anonymous y ST4 Surger

EWTD is sick

Arrange a loan before you attend outpatients at:

Get Well Soon card

Enough to make you sick again at:

£2.95

article (ReliDear Editor, read your news to ed st re te in s end of life I was influence doctor ly ng ro st fs lie concerns about gious be ) but I do have p5 ; 18 s Is s; the vast majordecision nd it. I believe hi be ns io at ot take the wishes the conn religious belief a ith w s or ct wever that they ity of do sly. I suspect ho ou ri se s nt tie pa rather than a of their first as a priority n io ss pa m co t wishes. I agree may pu n of end of life io at ar cl de e iv eds to be done descript d more work ne an l ea id t no beliefs as nonthis is with religious e os th ng di an - but br is wrong. patient centred

oski Kristina Baran FY2 London

‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.

Royal Free Hospital, London

Cheaper than a dose of penicillin:

£1.30 Bowl of porridge

Crosshouse Hospital, Ayrshire

Oat-ragous prices at:

£1.45

Glasgow Royal Infirmary

Tell Goldilocks and the three bears about:

53p

coercion

Multiple sites

Crosshouse Hospital, Ayrshire

Next issue we’re checking the cost of tub of ice-cream (smallest), chicken caesar salad and an orange.

Email prices to hospitalconfidential@juniordr.com

Queens Medical Centre, Nottingham TV area and ‘nights cupboard’ with blankets, pillows, sleeping masks and earplug; A Wii area with separate TV and 4 gaming consoles; massage area with two brand new massage chairs, which feature automatic 30-minute relaxation programmes; snooker and pool table; endless supplies of drinks, food, ready-meals and twice weekly delivery of seasonal fresh fruit from a local farmer; brand new 52” LCD TV with ALL channels on SKY-HD; daily magazines and newspapers; meeting, computer and ironing areas; and kitchen. £15 per month

JuniorDr Score: ★★★★★

HOSPITAL MESS

27

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Recruitment

Specialty Training in Scotland 2011 Get ready...

At midday on 20 December 2010, applications to Round 1 Specialty training recruitment in Scotland close. Make sure you allow enough time to complete and submit your application before the deadline.

Set...

• •

Visit the website regularly for news and updates on person specifications, interview schedules and vacancies Round 2 Specialty training recruitment in Scotland will open to applications in early February 2011

Go! Visit: www.scotmt.scot.nhs.uk or Contact us at: enquiries@scotmt.org.uk



                 

28

CLASSIFIED

JUNIOR DOCTORS NEW ZEALAND/AUSTRALIA 2011

• A location where you clinical work will be counted • Time off to experience adventure on your doorstep • Time out to decide on the next phase of your career Speciality posts, rotations, urban and rural locations to suit your requirements.

We offer full recruitment service to ensure a smooth transition to your new life/workplace, plan your move abroad by applying now.

Check it out on www.genevahealth.com Register your interest today www.genevadoctors.com Freephone 0800 051 6743 Email: ruthm@genevahealth.com

?

Is there a life outside the NHS?

?

Considering a year or more abroad?

About to obtain your CCT but unsure of your career options?

?

Don’t miss this opportunity to meet with us

Get the facts!

?

Global Destinations • Australia • Singapore • Middle East

• New Zealand • Malaysia • and more

Professional Advice Manchester 19-20 March 2011 London 26-27 March 2011

UK +44 1282 818262 AU +61 7 3854 2777 SG +65 6532 1838

• Career advice and solutions • Permanent, Contract and Locum options • Professional migration advice • Registration and Work Visas fully managed • Relocations Management

Your passport to a global career www.latitudes-group.com

Fill your gap year

DOWN UNDER

If you have completed your foundation years and are looking to advance your career and experience some of the best training and practice in the world then Queensland Health has you in its sights. We offer appropriately skilled junior doctors competitive remuneration packages and an adventure like no other. Talk to us today.

Adventure.

>n. an unusual or exciting experience

Senior Ho Dr Stephen Ellio use Officer Women’s Hospita tt, Royal Brisbane & l, Queensland He alth “Although I originally hale from Wimbledon, I undertook my medical training ical ca train ttr aining ain ing n a att Glasgow University. I worked in the but decided he NHS he NHS fo NH fforr a fe ffew w yyears ear ars b ut dec decide de ide ded d tto o fi fillll my my gap year with some sunshine and work experience Down Under. I took a job with Queensland Health and relocated to Australia in 2009. I’ve now been accepted on to the Queensland Health world-renowned emergency medicine training program that offers me exposure to an unparalleled scope of practice and an extraordinary case mix in a major tertiary hospital.” Senior House Officer, Dr Stephen Elliott enjoys the training programs with Queensland Health.

Do more ... see more ... be more. Queensland Health

www.health.qld.gov.au/medical Phone +61 1800 000 093

M270810

CLASSIFIED

29

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

THE MEDICAL COURSE AND CONFERENCE DIRECTORY



 

 

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A

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

 

s doctors we hate scouring the web to find where and when we can attend the next exam revision course, training event or conference.

We think they should all be in one place - which is why we launched EventsDr.com as part of the JuniorDr network.

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 

We’re aiming to build the most comprehensive database of medical events. Below you’ll find just a selection of the full listings at EventsDr.com.

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 



 

Medicine

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 

MRCP 1

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 

Mon 4th Jan

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(5 days)



Fri 7th Jan

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  

(3 days)

Mon 4th Apr (5 days)

   

London

£490

London

£790

Manchester

£495

London

£400

London

£400

London

£650

London

£1450

London

£1450

Manchester

£580

London

£1450

London

£650

London

£1450

London

Hammersmith Medicine

 



£495

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Mon 11th Apr (5 days)

Hammersmith Medicine

MRCP 2 Mon 7th Mar (4 days)

Hammersmith Medicine The Network is a web based group of junior doctors and medical students interested in leadership, patient safety and quality improvement in the NHS

Mon 4th Jul (4 days)

Hammersmith Medicine

MRCP Paces Sat 15th Jan (2 days)

Mon 17tth Jan (4 days)

Mon 22nd Jan (4 days)

Mon 24th Jan (4 days)

Hammersmith Medicine

Mon 24th Jan (4 days)

Sat 29th Jan (2 days)

1 Wimpole Street London, W1G 0AE

30

EVENTSDR.COM

Mon 31st Jan (4 days)

Got an event to add?

Do it free at EventsDr.com Sat 5th Feb (2 days)

Mon 7th Feb (4 days)

Forthcoming

courses MRCPCH 1

6-10 December London 13-17 Dec’ Manchester 7-9 January London

£600

£580

Manchester

London

Hammersmith Medicine

MRCP 2 PACES 17-20 January London 22-23 January Manchester 24-27 January London 29-30 January Manchester 31 Jan-3 Feb London

MRCPCH 1

Surgery

10-15 January 26-28 January

MRCs b Thu 20th Jan (1 day) Applied Surgical Sciences and Critical Care

Surgical Anatomy and OSCE/Viva

Sat 29th Jan (2 days)

Sat 7th May (2 days)

MRCPCH Clinical

£125

Cardiff

16-17 October 15-16 January 22-23 January

£325

Cardiff

29-30 January 7-8 May

£799

London

10-12 November 9-11 March

£799

London

£890

London

£490

London

Number 1 for Medical Interviews & Applications

£259

London

£259

London

Courses in small groups for a more personal approach

£311.38

London

£264.38

Birmingham

Fri 21st Jan (2 days)

London London Kingston Hillingdon Kingston

MRCS B OSCE London London

SpR Management

London London

web: www.pastest.co.uk telephone: 01565

752000

Psychiatry MRCPch 1 Mon 10th Jan (6 days)

Wed 26th Jan (3 days)

Others Leadership & Interview Skills Sat 8th Jan (1 day) GPVTS/GPST interview skills

Sat 15th Jan (1 day) CT/ST interview skills

Wed 19th Jan (1 day) Management Excellence for Junior & Middle Grade Doctors

Wed 23rd Mar (1 day) Communication Skills for Junior & Middle Grade Doctors

We offer a range of medical interview courses and services to optimise your chances of success at medical interviews

0845 266 9487 7 days a week

8:30am - 11pm

www.iscmedical.co.uk EVENTSDR.COM

31

MEDICAL PROTECTION SOCIETY PROFESSIONAL SUPPORT AND EXPERT ADVICE

Take MPS on your travels Valuable protection if working overseas MPS is the world’s leading provider of comprehensive professional indemnity and expert advice to doctors, dentists and health professionals.

Medicine is an increasingly mobile profession, with doctors travelling the world to work.

MPS is the world’s largest mutual medical defence organisation operating internationally. We have members in more than 40 countries, so if you decide to work overseas, membership can be arranged easily. It is one less thing to worry about.

The main jurisdictions where MPS operates besides the UK are Ireland, South Africa, New Zealand, Hong Kong, Singapore, Malaysia, West Indies, and Kenya. However, we do have smaller numbers of members in other countries, so it is

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often possible to continue your membership, even in unlikely places, for example if you are doing voluntary work overseas.

MPS has also made arrangements with Australian insurance company, MIPS, to cover members practising in state indemnified hospitals for up to one year (extended to a maximum of 24 months on request).

MPS prides itself on being a flexible organisation with membership designed to suit you.

If you are thinking of working outside of the UK, please contact membership services.

Call Membership services on 0845 718 7187 Email member.help@mps.org.uk Visit www.mps.org.uk

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.

The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London, W1G 0PS.