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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 Yvette Martyn, Ivor Vanhegan, Anna MeadRobson, 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 2011. 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.
MEDICINE - THERE’S AN APP FOR THAT! I n December the total number of mobile phone app downloads passed 22 billion - the equivalent of four for each person on the planet. If you’ve got a smartphone it won’t be a surprise to you how addictive they have become. Whether you’re ordering groceries, finding directions or revising for MRCP1 in the hospital mess - there’s now an app for everything. Mobile apps have revolutionised how we use our mobile phones and are now starting to revolutionise how we practice healthcare. With four out of five medical students now owning a smartphone - three times more than the average person - medicine is a profession app developers are keen to exploit. Current apps can enable you to view your patient’s live ECG trace from anywhere with a mobile signal or complete instant blood analysis by plugging a small cartridge into your iPhone. In this issue we review the best mobile apps to help you decide what you should be carrying in your pocket (p9). But where’s my JuniorDr app you might be asking? Look out for our new (and free) mobile app in the iTunes and Android app stores this Spring. As well as all the news and features you’d expect we’re using geolocation technology to offer some fancy new tools. We also have an iPad version in development which means you’ll soon be able to read JuniorDr wherever you are. Also in this issue Mikey Byrant, our blogger from Sierra Leone, tells us about a Christmas where doctors desire more basic things than mobile phone apps (p18). Rather than playing Angry Birds on his iPhone Mikey’s holidays are spent dealing with
more unexpected arrivals into Freetown’s children’s hospital. On page 16 we look at flexible training and the opportunities for trainees who would like to work less than full time. As the demand for less than full time training grows Emma Tyson and Ellie Galloway offer advice on how to set up and apply for a ‘slot share’. Remember, JuniorDr is a magazine produced entirely by you. We need you to get involved and make it your community. We’re planning a special section on junior doctor research in June so if there’s anything you think we should be including do let us know at team@juniordr.com.
What’s inside 04 08 09 16
LATEST NEWS Photo feature Best Medical Apps Working part-time: a guide
18 22 26
christmas in sierra leone Dr. FairyTale: james bond Courses and Conferences
TRIAGE
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Tell us your news. Email team@juniordr.com or call 020 7193 6750.
NHS REFORMS
More consultants taking early retirement as NHS dissatisfaction grows
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he number of consultants taking voluntary early retirement in 2011 increased by nearly three quarters compared with 2010, according to a report published in BMJ Careers. This high rate reflects the growing dissatisfaction among consultants with the changes underway in the NHS says the BMA. The data, from the NHS Business Services Authority Pensions Division, shows that the proportion of consultants taking voluntary early retirement before the age of 60 increased by 72.4% in the past year, from 98 doctors in 2010 to 169 in 2011. Over the past five years the proportion of consultants taking early retirement has almost doubled from 7.3% in 2006 to 14.0% in 2011. Ian Wilson, deputy chairman of the BMA’s Consultants Committee, said increasingly long hours and intensity of work, partly due to the drop in junior doctors’ availability following new working time restrictions; changes to NHS pensions; and reform of the NHS are collectively making many consultants opt for retirement at the earliest possible opportunity. “Anecdotally doctors are telling us all the time that if they could retire they would retire, whereas in the past doctors tended to want to carry on for as long as they were able to,” he says. “People are feeling disempowered by
NHS structures and NHS functioning, and there’s an attraction for people to retire from the rat race.” Many consultants are frustrated with the way the health service is changing, partly as a result of the ongoing reforms set out in the Health and Social Care bill, and other changes that are taking place, said Dr Wilson. Furthermore the changes planned for public sector pensions - such as increased contribution rates and the end of final salary pensions - are driving consultants to take retirement now rather than stay while the government’s proposals play out, he said. The NHS Business Services Authority
says this increase is driven in part by the rise in the size of the consultant workforce, which has grown by 4.5% year on year over the past 10 years, and the changing age profile of consultants.
holding registration with a licence to practise, and from £145 to £140 for doctors holding registration without a licence to practise. Both will be effective from 1 April 2012. Provisionally-registered doctors will pay £95 a year, down from £100 in 2011 and £145 in 2010. It is estimated that the 245,000 doctors on the register will save an estimated combined total of over £6.5 million.
The reduction in fees has been made possible by improvements in efficiency, says GMC chief executive Niall Dickson, which has led to savings of over £8 million in 2011. “We have a responsibility to provide value for money and, as far as we can, to control our costs. Last year we were able to freeze the annual fee paid by all doctors and cut the fee paid by newly qualified doctors.”
www.bmjcareers.com
“People are feeling disempowered by NHS structures and NHS functioning, and there’s an attraction for people to retire from the rat race.” Ian Wilson Deputy chairman, BMA Consultants Committee
GMC
GMC cuts fees for all doctors
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he General Medical Council is cutting fees for all doctors - the first time the annual fee paid has been cut since it was introduced in 1970. The Annual Retention Fee will be reduced from £420 to £390 for doctors
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NEWS PULSE
www.gmc-uk.org
NEW IN 2012
GLOBAL HEALTH
Doctor migration to developed nations costs sub-Saharan Africa billions of dollars
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ub-Saharan African countries that train and invest in their doctors end up losing billions of pounds as the clinicians leave to work in developed nations, according to a study published in the BMJ. According to the study, South Africa and Zimbabwe have the greatest economic losses in doctors due to emigration, while Australia, Canada, the UK and the US benefit the most from the recruitment of physicians educated in other countries. The study by the University of Ottawa estimated the monetary cost of educating a doctor through primary, secondary and medical school in nine sub-Saharan countries with significant HIV-prevalence. These included Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. The results show that governments spend between £13,600 (Uganda) to £38,000 (South Africa) to train doctors. The countries included in the study paid around £1.3 billion to train their doctors only to see them migrate to richer countries. The authors add that the benefit to the UK was around £1.7 billion and for the United States around £579 million.
978-0-415-68003-5
The migration of health workers from poor countries contributes to weak health systems in low-income countries and is considered a primary threat to achieving the health-related Millennium Development Goals, says the study. In 2010, the World Health Assembly adopted the first “Code of Practice on the International Recruitment of Health Personnel” that recognises problems associated with doctor migration and calls on wealthy countries to provide financial assistance to source countries affected by health worker losses.
978-0-415-68416-3
www.bmj.com
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WORKING CONDITIONS
GP consultations increasingly more intense and complex
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ine out of ten GPs (88%) have reported that the intensity of their consultations has increased over the last five years, according to a BMA survey of 18,757 GPs. 84% also feel the tasks they are required to do are more complex. The results come from a major BMA survey of general practice in the UK on issues ranging from workload and morale to the potential changes from the Health and Social Care bill. 46,700 GPs were polled with a response rate of 40 percent. “Much of the work we do now, such as looking after people with diabetes, used to be done in hospital and even though it’s work we want to do because of the clear benefit to patients, it has made it harder to fit a consultation into a ten minute time slot and it can make it more difficult to deal with surges in demand,” said Dr Laurence Buckman, Chairman of the BMA GPs Committee. Seven in ten (68%) GPs in England are
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concerned about conflicts of interest inherent in the reforms, both for the impact they could have on the patient-doctor relationship (68%) and because of their role as both the commissioners and providers of care (69%).
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Public health honours
Training
BMA: UKFPO must ‘get a grip’ on jobs for newly qualified doctors
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edical student leaders have called on ministers to ‘get a grip’ on the problems allocating jobs to newly qualified UK educated doctors after it emerged that there are more applicants than places available for the Foundation Programme for a second year running. The UK Foundation Programme Office (UKFPO) announced that there were 81 more applications from final year medical students than there were places on next year’s Foundation Programme, which begins in August 2012. “While it is a relief that the oversubscription is lower than in 2011, when 185 students were left in limbo about their first job, it is unacceptable that for a second successive year we are facing this situation,” said Marion Matheson, Co-Chair of the BMA’s Medical Student Committee. “It is worrying that the UKFPO and ministers now appear to regard this as a routine problem that students will have to endure each year.” The BMA has urged the government to
“It is worrying that the UKFPO and ministers now appear to regard this as a routine problem that students will have to endure each year.” Marion Matheson Co-Chair, BMA Medical Student Committee
ensure all UK medical graduates receive a place on the Foundation Programme as soon as possible and that no UK graduate is left without a job next year. It is expected that vacancies will arise as each year a number of students withdraw their applications because of personal reasons or they fail their exams. “Having a system that leaves some UK graduates unemployed after medical school would be a colossal waste of the £266,000 of taxpayers money spent training each medical student. It is essential that ministers get a grip on the factors behind this situation to ensure we don’t have a repeat of this situation every year.” www.bma.org.uk
Conscientious objection should be right, say med students
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NEWS PULSE
jrsm.rsmjournals.com
RIP from CPR less on TV The public may have an over-optimistic impression of survival and neurological outcome after cardiac arrest because newspapers tend to report success stories, according to a study published in the Journal of the Royal Society of Medicine. Researchers looked at cardiac arrests that occurred outside hospital which were reported in newspapers in the first six months of 2010. Of these 17.7% survived to hospital discharge, almost all with good neurological outcome. This compares with an estimated survival rate of less than 10% for out-of-hospital cardiac arrests in Europe. jrsm.rsmjournals.com
ETHICS
octors should be allowed to object to any procedure that conflicts with their personal, moral or religious beliefs according to a survey of medical students published in the Journal of Medical Ethics. Nearly half of respondents (45%) believed in the right of doctors to conscientiously object and refuse to treat a patient who wanted an abortion, contraceptive services, or who was drunk or high on drugs, or who wanted an intimate examination and was of the opposite sex. In response to the question: ‘Do you think that doctors should be entitled to object to any procedure for which they have a moral, cultural or religious disagreement?’ 45% said yes; 14% were unsure; 40% said no. Three out of four Muslim students (76%) responded in the affirmative, as did over half
The number one medical specialty to appear on the New Year’s Honours list in the last decade is public health medicine, according to research published in the Journal of the Royal Society of Medicine. GPs head the league table in terms of numbers but when this figure is converted to a percentage of all registered GPs, a relatively small proportion receives honours. Public health medicine, despite ranking fourth overall in absolute numbers, comes out top in percentage terms.
of Jewish, Protestant and ‘Other’ students. The proportions of those with other faiths who said ‘yes’, ranged from 34% (Hindu) to 46% (Catholics). Over 700 medical students at medical schools in Cardiff, London, and Leeds completed anonymous questionnaires to canvass their views. Just under a third (30%) said they had no faith. Students on the traditional five year course (21%) were more likely to raise objections than those on the four year course (3%). “Once qualified as doctors, if all these respondents acted on their conscience and refused to perform certain procedures, it may become impossible for conscientious objectors to be accommodated in medicine,” says the study author Dr Sophie Strickland, King George Hospital, Barking Havering and Redbridge University Hospitals. www.jme.bmj.com
Dirty med students Only 21 percent of medical students could identify five true and two false indications of when and when not to wash their hands in the clinical setting, according to a study by the Association for Professionals in Infection Control and Epidemiology. Additionally, the students expected that their own hand hygiene compliance would be “good” while that of nurses would be lower, despite other published data that show a significantly higher rate of compliance among nursing students. www.apic.org
Doctors for hire There has been a 90% increase in recently qualified doctors going freelance or focusing on locum work, according to a study by the contractor PAYE administration company FPS. However, mid-career doctors and nurses (those aged 29 to 49) are now less likely to take on contracted work, suggesting they are holding on to permanent positions in the health sector. www.nationalfreelancersday.org.uk
Finance
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edical students from low income backgrounds are graduating over £13,000 more in debt than their better off peers, according to a new report from the BMA. The results from the survey also indicate that the number of students from the lowest income brackets in medical school has declined in the past 12 months. The survey of more than 2,800 medical students found that the average medical student debt on graduation has risen from £23,909 to £24,092. However, those from lower income brackets are graduating with a projected debt of £37,588, up from £26,324 in the past 12 months. The number of medical students from low income backgrounds studying in medical schools has dropped from 14% to 11% in the past year. “It is hardly surprising that there has been a noticeable and worrying drop in the number of students coming from less well off backgrounds. With the government intent on allowing universities to charge up to £9,000 a year in tuition fees from 2012 the picture for all medical students looks bleak,” said Elly Pilavachi, Co-Chair of the BMA’s Medical Student Committee
Medical Masterclass MRCP(UK) exam revision and preparation materials from the Royal College of Physicians Medical Masterclass packages are available for both individual and institutional sales and comprise: •
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WORKING CONDITIONS
Most training rotas now EWTD compliant
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ost of the 300 doctors in training rotas exempted from the 48 hour limit on working time imposed by the European Working Time Directive (EWTD) are now compliant, according to a report by BMJ Careers. Rotas at 77 hospital trusts in England were “derogated” from the EWTD when it was introduced in August 2009, allowing them to operate at a maximum of 52 hours a week instead of 48 hours until 31 July 2011. All of 57 trusts that responded to a freedom of information request confirmed that their training rotas are now compliant with the 48 hour limit stipulated in the directive. Some trusts had made their derogated rotas compliant with the 48 hour limit as of 2009, whereas others, such as Peterborough and Stamford Hospitals Trust, had only ensured compliance by October this year. Alder Hey Children’s NHS Foundation Trust reported difficulty recruiting for some posts, but said it expects the rotas to be compliant shortly.
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Higher debt forcing out students from low income backgrounds
EXHIBITION
Designing Out Medical Error Infection Control The Carestation (now sold as the ‘CareCentre’ by UK manufacturers and partners Bristol Maid) is a unit placed at the end of the hospital bed, containing all the necessary equipment for common healthcare processes. It is intended to streamline staff workflow and improve access to equipment. It contains aprons and gloves, a medication locker, a flat surface for writing, a folder holder, alcohol hand gel, a clinical waste bin and cleaning wipes.
Hand Hygiene Building on the successful National Patient Safety Agency ‘Clean Your Hands’ campaign, the research focused on reminders within the bedspace. A simple symbol, taking cues from construction safety signage, replaces the often ignored and confusing plethora of signage currently surrounding the alcohol hand gel dispensers. The clear sign is accompanied by a simple communications campaign to educate staff about the symbol.
Vital Signs The new trolley design features an improved cable management system, making it much easier to clean between patients. The touch screen computer automatically records the patient’s vital signs and displays them on a chart. This removes the errors in transcription and interpretation found in the research. This design is in ongoing development with US manufacturers Humanscale.
Make it Better: Designing Out Medical Error Tuesday 31 January - Saturday 04 February Qvist Gallery, Hunterian Museum. Free entry
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ake It Better is an exhibition of designs for the clinical environment aimed at reducing medical
error. Mistakes made in healthcare can have huge human and financial costs. The design of much medical equipment and environments is outdated, confusing and can lead to errors. Patient safety is a complex issue that needs approaching from different viewpoints. A multidisciplinary team was brought together for three years to research medical error and involve front line clinical staff in developing new designs. The results are a suite of research findings and innovative designs aimed at better supporting front line staff and reducing medical error at the bedside. Research undertaken by the Helen Hamlyn Centre for Design, Royal College of Art and Imperial College, London. Funded by the Engineering and Physical Sciences Research Council.
www.domeproject.org.uk
Hunterian Museum Royal College of Surgeons 35-43 Lincoln’s Inn Fields London WC2A 3PE Tube: Holborn www.hunterianmuseum.org
Best Medical Apps
Whether it’s calculating gentamicin doses, checking the latest guidelines or practicing MCQs the smartphone has become an essential piece of medical kit for working on the move. As the number of medical apps breaks through the 10,000 barrier we test out the best apps for work, revision and play.
Airstrip iPhone, iPad, Android, Blackberry, Windows Mobile FREE
This is one of those apps that has the potential to change the world - or at least make on-calls a lot less painful. AirStrip allows you to securely view live streaming patient monitoring data from wherever you are. You can check in on your patients and review their vitals, cardiac waveforms, labs, medications, intakes and outputs, and allergies - all within seconds of when they were recorded. Unfortunately it does require your hospital to have purchased and installed AirStrip but this now spreading across the US and making a presence in the UK. In the meantime there is a demo built into the mobile app to let you see the potential of this new technology.
Medscape iPhone, iPad, Android, Blackberry, Windows Mobile FREE
BMJ iPad £2.99 per issue
Medscape is produced by US healthcare company WebMD but don’t let the American background put you off. This mobile app recorded has over a 1 million users and was the most downloaded free medical app from iTunes in 2010. As well as the standard news and alerts you can choose the specialities relevant to you for personalised content updated daily. You can view the prescribing information for 8,000+ brand and generic drugs - and impressively pill images for when you can’t work out what’s what. There are over 600 educational videos and over 4000 learning articles to keep you busy between ward rounds, including a CME library. What’s also clever about this app is that both the clinical reference and drug database can be accessed anywhere without an internet connection or Wifi. Overall it’s an indispensable app with so many functions you will forgive all the Americanisms.
Reading medical journals has never been a pleasant experience - there are the never-ending pages of text, tiny data tables and hours spent scanning through to find what you need. Then the iPad arrived. No medical journal has managed to do the transition to the iPad as well as the BMJ. It’s graphical, well-organised and the research is a joy to read. As well as the full content from the weekly version you’ll also find the blogs, podcasts and videos from BMJ.com If you’re a BMA member you can get your iPad verion of the journal for free - otherwise it’s an expensive £2.99 per issue.
Medical APPS
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Best Medical Apps 10
Medical APPS
iResus iPhone FREE
Although we wouldn’t suggest you pull out your iPhone at the next resus you attend we do think this is an excellent app for reviewing the guidelines. Produced by the UK Resuscitation Council it provides the latest guidance on your phone. It’s automatically updated when guidelines are reviewed and you can also choose to receive alerts and news. Overall it’s a simple app well executed.
Prognosis iPhone, Android FREE
We love this app. It’s a game that lets you investigate, deduce and diagnose complex clinical cases on your smartphone. Each case takes a few minutes and helpfully includes some learning points for each scenario you complete. Although the cases are aimed at board exams in the US you’ll find most of them suitable for UK specialties - though we did find many of them a little simplistic. It’s a great way to make use of those spare 10 minutes in the hospital mess or on the bus after a night on call. A new case is added every weekend so it’s the app which you’ll keep on using.
Micromedex iPhone, iPad, Android FREE
A great free mobile app which brings Micromedex to your smartphone - a comprehensive source of drug information similar to the software and web versions. There are over 4500+ search terms covering all generic and trade prescriptions. As well as the standard information you’d expect there is comprehensive contraindications, dosage and pharmacokinetic information.
Best Medical Apps
Best Medical Apps d2u iPhone, Android, Blackberry FREE
It’s technically more of an online service than an iPhone application but d2u allows you to dictate speech and get an accurate typed version by a human within an hour. It’s perfect for lazy doctors who don’t have access to a NHS secretary. Although we don’t recommend using it for patient information the service is reputed to be secure with 128 bit encryption. For short dictations of less than 5 minutes you should receive your text back within an hour - more than 5 minutes and your completed files will be returned within 24hrs. The cost of dictation is £1.55 per minute of dictation.
Visible body iPad £20.99
Visible Body is a 3D human anatomy app which allows you to explore the human body in a completely different way. The graphics in this anatomy app are stunning and the experience is unlike anything you could find in a traditional textbook. There are over 2,500 structures which can be rotated, tilted and zoomed. Each has detailed shading allowing you to easily see different structures within the male and female models. The app also has a useful search function which makes revising for exams much easier.
Diagnosaurus Ddx iPhone, Android, Windows, Palm, Blackberry iPhone 68p, Android 64p, Windows FREE, Palm FREE, Blackberry FREE
Diagnosaurus allows you to search over 1,000 differential diagnoses by organ system, symptom, disease, or browse all entries to help you reach an accurate diagnosis. Alongside each differential you’ll see the others to allow you to compare. That’s it - nothing else - but it’s simple and effective.
Medical APPS
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Best Medical Apps 12
Medical APPS
Best Medical Apps ECG Guide iPhone, iPad, Android, Blackberry iPhone/iPad 69p, Android £3.02, Blackberry $9.99
One of the most frustrating things about being a doctor is having to learn and interpret ECG traces. We’re still waiting for an app that eliminates the need completely but in the meantime ECG Guide will help you to improve your interpretation. We found it a really useful learning aid as it introduces the approach to ECG interpretation and covers analysis of rate, rhythm, axis and waveforms. There are over 200 examples of common and uncommon ECGs and it has a comprehensive section on arrthymias. Once you’ve mastered reading ECGs there are 100+ multiple-choice questions to test your understanding and a ‘rapid reference section’ to help when you encounter difficult ECGs in clinical practice.
NHS Direct iPhone, Android FREE
Not strictly for doctors but we were very impressed by this app from NHS Direct. It allows patients to check their symptoms when feeling unwell and then offers advice on how to look after themselves whilst recovering. If they need input from an expert they complete some questions and one of the NHS Direct team calls them back. It’s not quite telehealth but a good step forward from the traditional NHS Direct service. The app also offers a personalised guide to improving your health though we didn’t find this quite as useful.
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Medicolegal Advice - in association
Digital docs Sara Williams explores the pitfalls of using social networking sites
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he saying goes “what happens on tour stays on tour”, but when posting online bear in mind that what happens on Twitter stays on Google forever. Doctors should exercise caution when making entries on social networking sites the internet is not a private space and nothing is truly anonymous, even if you use a pseudonym. Recently, a hospital doctor’s tweeting sparked a national debate about what was appropriate for a medical professional to say on a social networking site. The trouble lies in that you never really know who is reading what you write; you could have a friend-ofa-friend reading your Facebook status, who might happen to be a patient or a disapproving member of the public.
In hot water MPS is aware of cases where junior doctors have discussed patients on social networking sites, assuming that they would not be identified - but they were exposed
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and those involved were disciplined. Similar findings were released by the American Medical Association, who undertook research that uncovered online breaches of patient confidentiality on social networking sites by junior doctors. The research found explicit postings that revealed private patient information; most were in blogs, including Facebook, some containing enough clinical information that a patient could be identified.1
you should be careful about both their content and your privacy settings - remember what happened to the doctors and nurses who took part in the Lying Down Game while at work and posted about it online? However, tight privacy settings can create a false sense of security. Comments about your day-to-day work and the patients you have seen, even if anonymous, still pose a risk, as the information may be identifiable and so may breach confidentiality.
Posting material online
Protecting yourself
Social networking sites blur the boundary between an individual’s public and professional life. Be wary of posting inappropriate material on social media sites, such as photos that may bring your professionalism or that of colleagues into question, even if they are taken in your free time. If you do choose to post photographs, then
Ways to protect yourself when using social media:
with the Medical Protection Society
• Remember to log out when you are moving from one terminal to another. • Check what levels of privacy you have set up. • Enable secure browsing using https. This can be found under the account settings tabs of most social networking sites. • Choose a password with a mixture of upper and lower case letters and other characters, and change it as regularly as is practical.2 The appetite for social networking can only get bigger, so doctors should take advantage of its many benefits, as long as they are balanced against the risks.
Frequently asked questions Blogs
Q
I work as a junior doctor in urology in a large teaching hospital; I’ve been
Things to remember:
thinking of setting up a blog. What advice would you give?
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Our advice would be to tread cautiously and to consider all the following pitfalls: breach of patient confidentiality; defamation; breach of contract (your trust or board may not be happy with what you have to say). It would be sensible to obtain the permission of trust/board management and your educational supervisor before taking the matter forward. Ensure you adhere to relevant GMC guidance, see Good Medical Practice. Friend requests
Q
A former patient whom I saw when I was a medical student has approached me on Facebook - they want to add me as a friend. What should I do?
A
Don’t accept. Social network sites are called so for a reason. It is extremely important that you retain professional boundaries between yourself, your patients and former patients. The GMC says that doctors who comment in the public domain about their work or the provision of healthcare must respect patient confidentiality. Should you post about a patient and they identify themselves, you could face a charge of breaching patient confidentiality and, before you know it, a GMC investigation into your fitness to practise.
networking site; what should I do?
A
It is often too easy to give a kneejerk reaction. Although a negative comment may be upsetting, and seen as damaging to your professionalism, or even possibly defamatory, it is important to keep a cool head and look at the issues objectively. Initially, talk to senior trusted colleague or your medical defence organisation to discuss the situation and the best way forward. Think about what the patient has said and whether this is an indicator of an underlying concern that needs to be investigated further. You may wish to consider treating this as a complaints, and invite the individual to discuss their concerns. By following this advice, the matter can be investigated, an explanation provided, lessons learned and if appropriate an apology provided.
Useful links • BMA, Using Social Media (2011) • Williams S, Tweeting into Trouble, New Doctor (3) 1 (2010) - www.medicalprotection.org/uk/new-doctor/january-2010/ tweeting-into-trouble • GMC, Good Medical Practice (2006) Pars 60-62
• Do not accept current or former patients as friends/followers. • Doctors and medical students who post online have an ethical obligation to declare any conflicts of interest. 1 American Medical Association info for articles.qxd:MPS Checkup 12/2/10 10:05 Page- www.ama-assn.orgii 1 • The ethical and legal duty to protectAbout MPS Responding to negative comments 2 Sophos, Facebook Security Best Practices - www. confidentiality applies equally on the sophos.com/en-us/security-news-trends/best-practices/ internet as to other media. facebook.aspxiii A patient has written negative • It is inappropriate to post informal, 3 BMA, Using Social Media (2011) comments about me on a social personal or derogatory comments about patients or colleagues on public internet forums. • Ensure that you do not inadvertently breach your contract of employment, by being aware of your local commissioning body or health board’s policy MPS is the leading provider of comprehensive professional on blogging, etc. MPS Members who indemnity and expert advice to doctors, dentists and health would like more advice • Defamation law can apply to any professionals around the world. on the issues raised in comments posted on the web made this article can contact in either a personal or professional We actively protect and promote the interests of members the medicolegal advice capacity. and believe that education is an integral part of every health line on 0845 605 4000. • Have tight privacy settings, but be professional’s development. As well as providing legal advice aware that not all information can be and representation for members, we also offer workshops, www.mps.org.uk conferences and a range of publications designed to aid good protected on the web. practice. • Be conscious of your online image The Medical Protection Society Limited. A company limited by guarantee. when posting images on the web and MPS is not an insurance company. All the benefits of Registered in England No. 36142 consider how it may impact on your at 33 Cavendish Square, membership of MPS are discretionary as set out in the 3 London W1G 0PS. professional standing. Memorandum and Articles of Association.
Q
About MPS
15
WORKING PARTTIME: A GUIDE Foundation doctors Emma Tyson and Ellie Galloway talk through the process of applying for less than full time training (LTFT) after switching from full time to part time working and share their experience of a successful slot share.
A
s of April 2011 there were 3777 trainees working less than full time (LTFT) in the UK - 6.6% of the total number of doctors. Although 95% of these were women there were also a significant proportion of male doctors would also like to work LTFT in the future. Helped by the changing demographics of the medical profession and demands for greater flexibility along with better work-life balance, the opportunities for LTFT have increased over the last decade. Who can work part-time? All trainees are eligible to apply to train less than full time and any ‘well founded reason’ which would prevent someone training on a full-time basis would be considered. Doctors who wish to train LTFT mainly fall into two categories which have been defined by the deaneries as Category 1 • Trainees with a disability or in ill health (may also include those on in vitro fertility programmes) • Trainees (both men and women) with a responsibility of caring for children • Trainees with a responsibility for caring for an ill/disabled partner, relative or other dependant
Category 2 • Unique opportunities for their own personal/ professional development eg. training for national/international sporting events • Extraordinary responsibility eg. a national committee • Religious commitment - involving training for a particular religious role • Non-medical professional development (eg. management/law/fine arts courses)
Trainees may train less than full time from the outset or transfer from full-time to LTFT (and back again if required). Until July 2010 LTFT trainees could 16
Careers
train in supernumery posts which were funded from the deanery however the need to cut costs has meant the end of this opportunity. Most LTFT trainees now work part time as part of a ‘slot share’ arrangement with the remainder managing to carry out reduced sessions in a full time post. Slot Sharing Slot sharing is when two trainees share one full-time post and manage the out-ofhours between them. Slot share partners are not expected to cover unexpected absence, such as sickness or maternity leave of their slot share counterpart. The deanery can sometimes provide the additional funding for slot shares where the total hours worked between the two trainees is greater than a 100% full time equivalent. This can act as an incentive to the employing trust as they can end up with more clinical time, however the availability of this funding can vary between deaneries In general slot share trainees need to work at least 50% WTE and this may involve sharing with a different person on each rotation. Reduced sessions in a full time post This is a more uncommon arrangement where a trainee occupies an established fulltime post but works reduced hours. This is usually only agreed after repeated attempts at setting up a slot share have not been successful. Experience of a slot share When I qualified as a doctor my son was six years old and I had initially thought that I would try and complete my foundation years before considering part time work for my specialty training. My ill patients tended not to be European Working Time Directive compliant which made predictable finishes difficult. Although I was lucky enough to have excellent child care I found the first year a struggle, with balancing the demands of
work and home life becoming increasingly stressful. After a year of feeling guilty when leaving work and also feeling guilty for not being at home enough, I decided that my best option was to work less than full time hours. Initially I was slightly embarrassed to admit that I was going to be part-time - worried that I would be perceived to be ‘skiving’ and somehow not a ’proper doctor’. My concerns were unfounded however, as the words ‘I work part time’ seem to be met with positivity and almost universal envy! How it works The initial process of applying for LTFT is fairly standard nationally and, although not complicated, it is a fairly paperwork heavy process. At a local level, once you’ve got deanery approval, there is a little more variability as some trusts may be able to be accommodating than others. My FY2 post was at the Royal Surrey in Guildford and the coordinator there could not have been more helpful. There are two main issues that need to be resolved - firstly finding a suitable job share ‘other half ’ and secondly finding a job that lends itself to less than full time workers. My job share partner Emma and I are currently working in A and E along with nine other SHOs. The shifts are each ten hours long and follow a fixed nine week rota with some weeks comprising 70 hours and others just 30 hours. We are treated as one person so simply divide the line between us. Emma works half of the shifts and I do the other half plus three extra shifts over the nine week period thereby increasing my hours up to the 60 % of full time that I am contracted for. A and E is the perfect place to work less than full time as continuity is not an issue. For our next job in medical education there will be a greater need for the two of us to share a single job. We have already discussed the work to be
done and how we intend to divide the tasks. For example, we have planned an overlap in our shifts so that we can spend some time together during the working week and will also create a shared email account so that we are contactable as one person. Positive points We were very fortunate that we were allowed to choose our own shifts as long as we covered our allocated line of the rota. We particularly liked the fact that this allows us to be an integrated part of the team and also experience the full range of shifts - neither of us would feel that we had truly worked in casualty if we hadn’t had our fair share of intoxicated Saturday night patients and rugby injured Sunday ones. The reduced hours that
Emma Tyson and Ellie Galloway
Emma and I work means that we have much more flexibility for swapping shifts for child care reasons. Whilst this is obviously beneficial for the two of us it has had the unforeseen advantage that we are invariably able to perform shift swaps with others. It is extremely difficult for the full time SHOs to swap duties due to the almost impossible task of finding a replacement shift that does not clash with the duties they are already rostered for. We are both really pleased that we are able to help in this way. Another concern that we both had was that we would be adversely affected by our reduced exposure to cases. Although we clearly do see less patients than our full time colleagues, we do have the time (and energy!) to read around the interesting cases that we have seen. Emma and I also meet weekly to discuss the patients we have treated so that we each get the benefit of learning by experience - albeit indirectly. If one of us is unable to attend formal teaching we take notes for our ‘other half ’. … and the negatives Being out of sync with other trainees does have disadvantages. The main one being the need to find a job to cover the ‘gap’ between the end of FY2 and starting core training. Although neither Emma nor myself are at this stage yet I can see that it may be problematic. We have also found that although we are less than full time there is still the need to fit in formal training/audits etc and this has meant that we sometimes need to come in to work on our days off. Finally, working reduced hours means receiving a dramatically reduced salary. Words of advice If I could sum up how to make a successful slot share work well it would be that there needs to be good communication, fairness and flexibility in division of work. We are fortunate that this has not been an issue between the two of us but as slot sharing is something of a lottery it could certainly be a problem for some. On balance, job sharing is a perfect solution that enables progression as a doctor without compromising family commitments. We would thoroughly recommend it. If you want to find out more about flexible working and ask advice from others visit the careers section at JuniorDr.com.
References 1 Analysis of the bi-annual survey of less than full time training 1st November 2010 - 30th April 2011. West Midlands Deanery www.westmidlandsdeanery.nhs.uk/LinkClick.aspx?fileticket=wD 2 Women and medicine, the future. June 2009 Royal College of Physicians http://www.rcpsg.ac.uk/FellowsandMembers/ RCPSG_projects/Documents/Flexible%20Working/RCPLondon_Summary_Report.pdf 3 British Medical Association Cohort study 1995, eighth report http://www.bma.org.uk/healthcare_policy/cohort_studies/cohort8.jsp 4 Kent, Surrey, Sussex Deanery LTFT Policy http://kssdeanery.org/sites/kssdeanery/files/KSS%20Less%20Than%20Full%20 Time%20Training%20Policy.pdf
Careers
17
Christmas in Sierra Leone
As you sat down to your Christmas dinner our JuniorDr blogger, FY2 Dr Mikey Bryant, was in Sierra Leone with healthcare charity Mercy Ships. He has been volunteering in a children’s clinic for a year in a country where 1 in 5 children don’t live to see their 5th birthday. In his Christmas update we hear how his usual quiet Welsh Christmas has been replaced by an altogether more chaotic affair.
Day 23 - Christmas Day I wake up this morning to the sound of energetic singing from somewhere in my mind. I lie half-awake for a little while, my mind still in Wales with choirs singing Silent Night into endless dark evenings, Mum organising stockings and roasting turkey - I can almost smell it. I am woken into rude reality by the distinctive ‘green-swamp’ smell of cassava leaves coming through the mosquito net, shattering any dreams of roast meat. The singing is real though as a distinctly Krio-sounding ‘Away in a manger’ rings out. In some ways, Christmas here doesn’t feel that different; there are still plastic Santas everywhere with numerous streets decorated with lanterns and tacky lights. The biggest difference here is the lack of money being thrown around and most of the children who come in today are just glad to be surviving and eating from day to day. The thought of a child in Freetown throwing a tantrum about not getting the right colour dress or right make of shoe is unheard of. I say Merry Christmas to everyone who comes in and try to find out a bit about what is going on with the multitude of ailments. There is no ‘granny-dumping’ here and very few signs of the winter sniffles I had grown so used to in Wales - instead we have a clinic where everyone who makes it in is incredibly unwell and often at death’s door. The children are heartbreaking again today. I had thought I was a calm and unemotional lad but today I find myself taking impromptu toilet breaks to sort myself out. It is just after one of these when Sarah comes rushing in, saying “Dr Mikey! We get dis one year old pikin, he hav only 4 kilos!” “He can’t be one year old!” I respond, stunned at what that meant. She doesn’t answer but just hands me a tiny bundle emitting a pitiful cry. As I unwrap the layers, the tiny bundle gets depressingly smaller until there is just a collection of skin covering matchstick thin ribs. “Wetin don happen wi dis pikin?” I ask almost frightened to hear the response. It turns out this little girl has been unwell with diarrhoea and blood for over three months but dad was insistent on taking the child to local medicine men. I can see the tell-tale signs of traditional healing, including a piece of string over the fontanelle ‘to make breathing fine’. Now
18
JUNIORDR BLOG
“I had thought I was a calm and unemotional lad but today I find myself taking impromptu toilet breaks to sort myself out.” it may well be too late. She is painfully dehydrated; skin turgor having long gone, and our first priority is to get fluid in. Thankfully, Sarah is a dab hand at putting in drips these days, and pretty soon we are doing all we can and can only hope it is enough.
Day 24 It is Friday afternoon. I have decided that our nurses are a lot brighter than I had thought and that it would be great to be able to teach them a little more, so have arranged a few slides to go through some basic stuff. Everyone is ominously quiet as I ask questions about blood cells and what they all do. I’d forgotten this is a generation of people who haven’t had the benefit of a secondary school education where everything was spelled out in simple terms. Still, there is huge enthusiasm and I find myself wishing I had more time to go into more detail. I move onto worms and here everyone is in their element; I barely have to teach as I hear stories about how ascaris goes ‘walka walka’ around children’s lungs and stomachs, and how hookworms ‘don go insie de skin’ and cause ‘runnibelli’. I am astounded at this sudden burst of knowledge. Afterwards, Kaddie runs up and shows me pictures they have all drawn of various species of worm from an ancient textbook. It turns out essential knowledge has been quite well-covered in the knowledge sieve of the civil war. Later that afternoon we have the chance to visit the government children’s hospital. Theoretically this serves as a tertiary centre for the whole of Freetown. We have referred a number of patients there
“In England, children in paediatric wards have hundreds of cuddly teddies to play with. Out here, the only cuddly friends are the rats.”
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Night sweats? ourselves and I am curious to see what happens to them. Sharon from VSO greets us as we come in looking worried. She seems to have developed a permanently concerned frown since arriving. She shows us the ‘intensive care unit’ where she explains that the main difference here from the rest of the hospital is that there are twice as many nurses. I gaze around at the toddlers with ballooning bellies, the beds with five babies all sharing the same oxygen concentrator and the staff running around from one resus to another and realise how lucky I am to be working in a small NGO-led hospital where we have a reliable supply of medicine and equipment. The constant sound of wailing comes drifting in from the corridor. Sharon tells me that after every death the mums cry for just a few minutes but give it all they can. I can understand why Sharon looks as though she is carrying the whole world. Her last words before we leave sum up the visit perfectly, “In England, children in paediatric wards have hundreds of cuddly teddies to play with. Out here, the only cuddly friends are the rats”. Merry Christmas, I reflect, bitterly. In the end everyone has left and a strange hush falls. Mandy smiles at me and thanks me for ‘making her day easier’. I can’t imagine what this must have been like with just one doctor here.
It’s four a.m. You’ve been bleeped. You know what to do. But it would be good to get a second opinion – just for peace of mind. That’s exactly what Best Practice provides. A trusted second opinion on the assessment, treatment and management of patients. On call. All day. All night. Just when you need it.
For the best in clinical decision support tools, visit bestpractice.bmj.com
You can follow Mikey’s journey online at JuniorDr.com by clicking on blogs.
DIAGNOSE • TREAT • MANAGE • LEARN
WIN an iPad
Your chance to WIN a new 32GB Apple iPad 3G*. Wesleyan Medical Sickness specialise in providing tailored financial advice to medical professionals. Our iPad competition is exclusive for medics. To enter visit www.wesleyan.co.uk/ipadcompetition *Terms and Conditions apply. See entry form for details. Model shown for illustration purposes only and may differ from actual prize. Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Ltd 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. HD-AD-15 (02/11)
Focus on Finance - in association with Wesleyan Medical Sickness
Buying your first home F
inancial planning for a new home should begin even before you start looking through the property pages. In this article Wesleyan Medical Sickness gives you guidance on how to plan for your first mortgage. Before you buy The property market has suffered a slump during the economic downturn. According to the most recent Land Registry House Price Index, the average house price in England and Wales is still falling, with a 2.6% drop in the 12 months to September 2011 to £162,109. While this may seem like good news for first time buyers, the downturn has also meant lenders are expecting buyers to put down a much larger lump sum than they would have done a few years ago. Over the past two decades, the average deposit has risen from an average of £6,700 to more than £65,000*. First time buyers moving into a starter home generally won’t be faced with a deposit that big, but the fact remains that you will still be expected to find a sizeable deposit of about 15-20% of the property’s value, so it’s important to work out how much you are able to save towards it and other associated costs. Effective budgeting will be vital: By making a note of your income and expenditure, you will be able to highlight areas where you may be able to cut back and save. When you put money away, try to find a savings products with a good rate that will help your savings grow quickly. A Cash ISA is a tax efficient option. Finding the right mortgage How much you need to borrow will depend on the value of the property, the
deposit you’ve accumulated, your income and other expenditures. Getting the right mortgage is crucial as it will impact on long term financial planning. There are a variety of options available, with two of the most common being variable rate and fixed rate mortgages. A variable rate mortgage is linked to the rise and fall of the Bank of England base rate, while a fixed rate mortgage provides a set level for a designated period of time. For many first time buyers, a fixed rate mortgage will help them budget better. Payments can be fixed for a set period of time such as two, three or five years to provide certainty. Others, with the ability to absorb increases and cope with varied payments, may decide they would be better off with a variable rate that usually fluctuates with the base rate but is generally cheaper than the fixed rate option. The base rate has been at 0.5% for the past two-and-a-half years and will inevitably rise, although when that will be is impossible to say. Also gaining in popularity in recent years has been guarantor mortgages where, if you don’t earn enough to buy a property, a parent can step in and act as guarantor for the shortfall. Although with most guarantor mortgages your parent’s name does not have to appear on the mortgage agreement or the property deeds, they will still be liable for the loan if you do not keep up repayments. Once you have decided on the kind of mortgage you will be having, you need to consider how you will re-pay it. The two main ways are repayment or interest only. A repayment mortgage means that over the length of the loan you will eventually pay off the full amount, plus interest. An interest only mortgage means you are only paying
off the interest accrued every month. The payments will be lower, but at the end of the loan period you will still owe the amount you originally borrowed. With so many mortgage providers and deals out there, it is advisable to talk to a financial adviser who can search the whole of market to find the best deal to suit you. Other expenses to consider The deposit and mortgage repayments will not be the only expense. You will need to pay for a solicitor to approve the paperwork, carry out land searches and arrange the contracts to exchange. In addition a survey is required to check the physical condition of the property. Stamp duty, a government tax paid when you buy a property over a certain amount, may also be applicable. The amount of tax is a percentage of the property value, although first time buyers don’t have to pay it on a home under £250,000. Conclusion Buying a home is most probably the largest financial commitment and investment you will make. By talking to a financial adviser with expert knowledge of the medical profession you can ensure you get the deal that is best suited to you. * First Direct research, September 2011
For more information or for specialist financial advice contact Wesleyan Medical Sickness on 0800 107 5352 or visit the website at www.wesleyan.co.uk/doctors
Specialist financial services for doctors • Savings and Investments
• Mortgages
• Retirement Planning
• Motor, home and travel insurance
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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
21
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Assessed by Gil Myers
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7 Dilutional hyponatraemia is that resulting from an excess of this (5) reaction to the principally in (6) 8 Disease caused by the presence of ticks or (9) 9 The term used to describe environment is middle-aged 2Forms the individuals who readily develop antibodies (IgE) in response to common diminished elderly (4) erived framework of the though awareness environmental antigens (5) 12 Very symptom of mental disorder where leaves 5Drug thatrare causes mouth and place is unimpaired; ca plant; the individual he or she can intoofa the wolf (11) 13 Individual in which a theturn pupil for teethbelieves to be heard in ed as eye to dilatefrom (9) the leaves can attach; the 15 Alkaloid mutation has beware occured (6) derived of the coca clubs (6) plant; can ic (7) movie's shark be used as anaesthetic (7) 17 6Wart Inflammation of the occuring onwindpipe (10) 16The attaching its teeth ion of of thewithin foot bone, especiallymembrane 19 Blister or large vesicle (4) 20 sole Air cavity in the face or forming initially however (plural) pipe (10) (7) skull (5) over the dorsal (3) arge 10This disorder is embryo, but soon 3variety of white ) characterized by expanding to blood cellthat can be a manifestation 1 The ‘vu’ of temporal lobe epilepsy, repetitive and enclose itwhere things within distinguished by suddenly feel unfamiliar (6) 2 Forms the framework of the mouth andwithin place persistent completely ecially the presence in its aggressive or attaching itsitsteeth cavity (6) for teeth to attach; beware the movie’s shark however e or cytoplasm of antisocial (plural) (3) 3 Variety of white blood cell distinguished by 18Surgical the presenceremoval, in its granules that stain behaviour, via a colposcope, purple-black with cytoplasm of granules that stain purple-black with Romanowsky stains (8) typically of this-shaped Romanowsky 4 Primary polycythaemia is knownrecognized as polycythaemia principally in in ____; occurs tissue segment stains (8) at can be middle-aged or elderly (4) 5 Drugchildhood; that causesDaniel the pupil of the eye to dilate (9) from the cervix; 4Primary Barenboim tation 6 Wart occuring on sole of the foot (7) 10 This disorder is characterized by best with ice famously likes to polycythaemia is ral lobe repetitive and persistent aggressive or antisocial behaviour, typically recognized in cream (4) do this (7) known as where childhood; Daniel Barenboim famously likes to do this (7) 11 Heel bone (9) polycythaemia ddenly 11Heel bone (9) 14 State in which ____; occursreaction to the environment is diminished though awareness is miliar 14State unimpaired; can be heard in clubs (6) in 16which The membrane forming initially over the dorsal embryo, but soon expanding to enclose it completely within its cavity (6) 18 Surgical removal, via a colposcope, of this-shaped tissue segment from the cervix; best with ice cream (4) You can find the crossword solution by searching for ‘crossword answers’ at www.juniordr.com Compiled by Farhana Mann
22
HOSPITAL MESS
JAMES BOND 007
or reasons of National Security, ‘Mr Smith’ would not give me his real name. However, he informed me that he was “On Her Majesty’s Secret Service”. He was of slim build, blue-grey eyes, a “cruel” mouth and short, black hair. There was a faint scar of the Cyrillic letter “?” on his hand - which he informed me came from Russia “with love”. On the surface, he appears to be a healthy, attractive man. However, ‘Mr Smith’ has a number of dangerous vices that may seriously affect his life, namely smoking, drinking and sexual intercourse. He is a life-long smoker, at one point reaching 70 cigarettes a day. In the past he has attempted to cut back himself, as this was affecting his job and that cigarettes were clearly a “Licence to Kill”. In the past, he was sent to a health farm because of his boss’s concerns about his habit. ‘Mr Smith’ smokes a blend of Balkan and Turkish tobacco with a higher than average tar content called “Morland Specials”. I attempted to advise ‘Mr Smith’ about his habit but he only replied, “Doctor, No. You only live twice”. ‘Mr Smith’ drinks alcohol to excess. His intake, since I have known him has been of 317 drinks of which 101 are whisky, 35 sakes, 30 glasses of champagne and a mere 19 vodka martinis (which he claims are his favourite). ‘Mr Smith’ feels that drinking was an important part of his job (working at Casinos, Royal engagements, etc) and that alcohol gave him inner peace - eloquently described as a “Quantum of Solace”. It was not only the amount of alcohol that is a concern, but also his food consumption. I have advised cutting back on both but he refused saying only that he would “diet another day”. As well as smoking and drinking, ‘Mr Smith’ claims to have had “pussy, galore”. He clearly indulges in meaningless affairs, mostly one night stands, with virtually every woman he encounters. He doesn’t seem concerned about STDs - sleeping with one woman despite her “Octopussy”. This may explain why he reports some genital itching and “Thunderballs”. A major concern I had for ‘Mr Smith’ was of heavy metal poisoning. At various points he referred to his Goldfinger, his Goldeneye and to “The man with the Golden Gun” - which I presume to be a euphemism. Gold poisoning, like all very metals, causes headaches, irritability, insomnia and depression. In fact, ‘Mr Smith’ did feel that “The World Is Not Enough” which would suggest a low mood was present. This type of poisoning can affect vision so I would suggest a referral to an ophthalmologist “for his eyes only”. In conclusion, I have informed ‘Mr Smith’ that if he continues to behave in this manner he will be “living daylight” hours in a medical ward and, while “diamonds are forever”, his health is not and that I would be prepared for him to “live and let die” without an intervention.
Writing in the Notes
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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:
Bowl of porridge
£1.80
Royal Free Hospital, London
Tell the three bears about -
40p A4 B/W photocopy
y London Deaner
Countess of Chester Hospital, Chester
Better to copy it out by hand at -
20p
St Bartholomew’s Hospital, London
Remember the trees at -
No numbers does
10p
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Dear Editor, If you ignore a problem it does n’t go away. Th should be a mes at sage for the Dep artment of Hea on the EWTD lth debacle (Conce rn over working as NHS in Eng hours land stops mon itoring; Iss 22, Being unable to p7). state how many rotas are compl with the Europe iant an Working Tim e Directive does mean things are n’t fine - potentially they could be m worse than we uch all expect. Con sidering the nu of DH impose mber d directives to measure outcom shouldn’t the co es, mpliance with EU rules be on the key measure e of s they have to re cord? Name wit
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doctors
Africa; ycling the Six: (C s! be Fa e ev doctors Kudos to St hear of junior to g in ir sp in ’s ing their Iss 22, p3) It icine and follow ed m e id ts ou e the last thinking of lif out your trip in ab t ou d un fo d it cerdreams. I only ed your blog an w llo fo e nc si spired by issue but have ip. I’m truly in tr sy ea an en mention tainly hasn’t be going - not to ep ke to n io at you conyour determin rs of Dairy Milk ba am gr 0 45 xt stage the impressive luck with the ne d oo G g! in tt si sume in one h of the journey. Daljit Sing
, Manchester Surgical trainee
‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.
Jotter pad
Royal Preston Hospital, Preston
Find some scrap paper instead at -
£1.49
Royal Free Hospital, London
Go note taking crazy at -
59p
Weston General Hospital, Weston-Super-Mare
Next issue we’re checking the cost of a bowl of 4 AA batteries, a pocket sized pack of tissues and a hot chocolate. Email prices to hospitalconfidential@juniordr.com
Colchester General Hospital Colchester Doctor’s Mess has a flatscreen TV with Sky, microwave, dishwasher, and coffee maker. Off the main mess is a room with three computers. The usual tea, coffee, toast and cereals are provided along with daily newspapers. One plus is having a cleaner. Mess fees are £10 a month with occasional subsidised mess nights out.
JuniorDr Score:
★★★✩✩
HOSPITAL MESS
23
Weekend Ward Escape to the
Isle of Man
The Canary Islands have the sun, the island of Ibiza has the clubs and Malta has the history so why would you choose the Isle of Man? Well, if tail-less cats, horse-drawn trams and a big water wheel sound like a welcome change from sunburn, sore ears and showy sights it might just be the island getaway for you. Getting there It may be close but being stuck in the middle of the Irish Sea makes getting there a little tricky. Flights from carriers such as BA and Flybe leave from most UK airports including London, Edinburgh, Manchester and Newcastle. If you’re worried about your carbon footprint you can take ferries from Liverpool, Belfast or Heysham - prices are from £39. Journey times can be a long 3 hours but it does leave you within walking distance of Douglas, the island’s capital.
Where to stay? Douglas is probably the best base for a weekend trip especially if you decide against hiring a car. Trams and buses connect from here to all the main towns and tourist destinations. For a cheap but comfortable stay try the Arrandale which offers rooms from £60 per night. Apartments are also available if you prefer more independence (www. arrandale.com). Alternatively, you could try the Regency Hotel in the centre of Douglas, which although mainly catering for business customers offers good weekend rates (www. regency.im).
Eating
Manx kippers are probably the island’s best know delicacy. Kippers - herrings that have been filleted and cured by smoking - used to form one of the islands biggest industries until fish stocks dwindled and now supplies are brought in from the North Sea. Try them for breakfast with bread and butter or take a tour of Moores factory (www.manxkippers.com) which has been ‘kippering’ since 1882. For dinner try Ciapellis - rated as one of the UK’s top restaurants - serving great Italian and seafood (Noble’s Park, Douglas). Alternatively try fish and chips at the Harbour Lights restaurant in Peel at the other end of the island (www.HarbourLightsIoM.co.uk).
TT races - This, the island’s biggest tourist draw, brings over 60,000 visitors for probably the world’s most famous road motorcycle road race. It’s one of the most exciting spectator events which also makes finding accommodation from the end of May into early June tricky Snaefell - An electric tram takes you 2,000ft to the top of the island’s largest mountain. On a clear day you get a magnificent view of the entire island and can look out over England, Scotland, Wales and Ireland.
Key attractions Laxey Wheel - For such a small island it can be quite a surprise to find the world’s largest waterwheel with a diameter of 72ft. It was built in 1854 to drain water from the surrounding mining industry.
House of Mannanan - Located in the fishing town of Peel on the islands west coast is an interactive heritage centre which shows how the Manx Celts and Viking settlers shaped the island’s history. Perfect for when it rains. Find the full Isle of Man guide at JuniorDr.com.
Key facts • Population - 85,000 • Language - english • Currency - £1 = £1
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