JuniorDr Issue 27 by JuniorDr

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Tweet, tweet #healthcare 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 Mead-Robson, Michelle Connolly, Muhunthan Thillai, Alison Ridley 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 2012. 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.

witter isn’t just the hottest way to stay up-to-date with Justin Bieber’s latest hairstyle. According to Wired magazine it has overtaken Facebook as the most influential social network for healthcare professionals. As the number of worldwide users reaches half a billion, medical leaders have taken to tweeting their thoughts to the world. Whether it’s a call to oppose the NHS reforms or canvassing opinion on the future of the ePortfolio, Twitter is where you’ll find the latest action. Guided by your mentions we’ve curated a list of the top 40 people you should be following on Twitter (page 9). From the junior doctor Twitterati to the movers and shakers in the healthcare arena we’ve tried to capture the most influential. Know someone we’ve missed? You can add to our Twitter list online at JuniorDr.com. Also, don’t forget to add us (@juniordr) to ensure you stay upto-date with the latest news and gossip for junior doctors. In our study paper this issue (p14) we ask if medical students should be able to travel overseas on elective with aid agencies and non-governmental organisations. JuniorDr’s Sonia Tsukagoshi looks at the perception of the security threat, experiential learning, ethical considerations and contribution that students can realistically offer. We list the responses from 28 aid agencies with regards to their provisions for students. Also in this issue we offer some advice on coping with illness as a junior doctor. Doctors should be experts in illness but as a group we are notoriously bad at looking after our own health, says JuniorDr’s Rosie Puplett. Find out what you should do to manage longterm illness (p18). Finally don’t forget that our content doesn’t end here. Check out our new website where you can find hundreds of articles and resources - all optimised for reading on your tablet or smartphone. It’s also your opportunity to contribute, share your experiences and be part of the JuniorDr community.

What’s inside 04 09 14 18

LATEST NEWS TOP 40 on Twitter Electives with aid agencies

24 26

Diary from Sierra Leone Courses and Conferences

Illness as a junior doctor

TRIAGE

Tell us your news. Email team@juniordr.com or call 020 7193 6750.

Social Media

1 in 10 admissions staff check social media during shortlisting

edical students and junior doctors are being warned that their past Twitter and Facebook posts are increasingly being checked as part of shortlisting for medical school and jobs. A study, the largest of its kind published online in Postgraduate Medical Journal, found that one in 10 (9%) staff involved in selection admitted to using social networking sites to evaluate applicants. One in five (19%) said they used some type of internet search to pick up information on applicants. A small proportion (3-4%) said they used the information they found to reject a candidate. Admissions staff disagree that gathering information this way is a violation of privacy. Two out of three respondents said they were somewhat or very familiar with researching individuals on social networking sites. The responses were from 600 staff involved in admissions procedures for medical schools and residency programs across the the US. Most respondents were either program directors or residency coordinators. Only around one in seven (15%) said they plan to use the web/ social networking sites to search out information on candidates in

future, but 29% were neutral on the issue, prompting the authors to suggest that the use of this method could therefore increase. 58% disagreed or strongly disagreed that it was a violation of privacy to search for an applicant’s name on social networking sites. Furthermore, over half (53%) agreed that online professionalism should be a factor in the selection process and that “unprofessional behaviour” evidenced from wall posts/comments, photos, and group memberships should compromise an applicant. 53% agreed that online professionalism should be a factor in the selection process. “Social networking sites will inevitably affect future selection of doctors and residents,” say the authors. “Formal guidelines for professional behaviour on social networking sites might help applicants avoid unforeseen bias in the selection process.” www.pmj.bmj.com/lookup/doi/10.1136/postgradmedj-2012-131283

Medical students

University of Exeter launches medical school

new medical school has been launched at the University of Exeter with the first intake of 130 students expected in September 2013. Applications have recently closed, and demand for the course is high with 15 applicants for every place. The University of Exeter currently holds The Sunday Times University of the Year 2012-2013. The medical school research functions will focus on personalised medicine in four areas of NHS activity: Health Services research, Diabetes, Cardiovascular Risk and Ageing,

NEWS PULSE

Environment and Human Health, and Neuroscience and Mental Health. It will also form a base for 100 researchers. “We are making rapid progress in establishing the University of Exeter Medical School, and look forward to welcoming the 2013 intake,” said Professor Steve Thornton, Dean of the University of Exeter Medical School. “We have ambitious plans for the Medical School and will be making investments of many millions over the next five years, ensuring that we offer the best in teaching, facilities and research.”

University of Exeter Medical School building

www.exeter.ac.uk

NEW IN 2012

PoliticS

Doctors launch National Health Action political party

octors have launched a new political party which aims to put the NHS at the heart of the next general election. The party, National Health Action, opposes the Health and Social Care Act which it believes is ‘wrecking’ the NHS in England by allowing it to be broken up and sold off. They intend to put up around 50 candidates in general election constituencies and will also field candidates in local council elections. In their manifesto the party aims to fight for the original NHS principle of provision of good quality health and social care fairly to all members of the community, free at the time of need. “For generations we’ve trusted the NHS to be a safety net for everyone in times of need,” said party co-leader and cancer specialist Dr Clive Peedell. “Putting the values of business and the markets

ahead of those of patients and communities will ruin the NHS. This destruction is being fasttracked by Tory and coalition policies. We hope our new party will halt this process.” Among their aims is to abolish the purchaser/provider split and de-commercialise the health system.

978-0-415-68003-5

www.nationalhealthaction.org.uk

978-0-415-68416-3

Pay and conditions

National NHS pay agreements should be dropped, says think tank

he NHS should scrap the current national pay agreements for doctors and replace them with local and performance-related agreements, says leading think tank Reform. The report, Doctors and Nurses, said that maintaining the current agreement was a ‘glaring contradiction’ in plans to improve the NHS. It suggests the government should follow examples such as the South West Pay Consortium which is fighting to develop local pay agreements. “The current negotiations on NHS pay are a test for the new secretary of state. There is a glaring contradiction between his goal of a higher quality NHS and his Department’s support for national pay arrangements,” said Nick Seddon, deputy director of Reform. The report also says a surplus of doctors ‘creates an opportunity to drive down pay’ and end the ‘job for life’ expectation of newly qualified doctors. It also called for a relaxation of immigration rules for doctors to give providers ‘freedom’ to decide how to recruit and reward employees.

Responding to the comments BMA council chair Mark Porter said ‘demotivating staff by attacking their terms and conditions would be hugely damaging to the NHS.’ “Nationally agreed contracts are fundamental to a national health service. Regionally negotiated pay would undermine the national ethos of the NHS, waste resources, and lead to recruitment problems for some areas.”

978-1-85996-264-0

www.reform.co.uk

978-0-415-69314-1 Recently published

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Who you gonna call?

Training

Visa reforms threaten junior doctor training

he BMA has called for urgent help for overseas junior doctors who graduated from UK medical schools and are now facing problems completing specialty training due to changes in visa requirements. This year the tier-1 (post-study work) visa route that allowed graduates to compete fairly with their fellow UK graduates for ST (specialty training) programmes was removed. An exemption was offered from the RLMT (resident labour market test), which says doctors born overseas can only apply for posts if there are no suitable UK or EEA (European Economic Area) candidates. The replacement rules mean that these graduates can only be exempt from the RLMT if they are continuing in the same specialty with the same employer or sponsor. The BMA claims that UK-trained overseas graduates who did not go straight into core training or ST from the foundation programme based their career decisions on incomplete information.

“This represents a huge loss of skill and a waste of taxpayers’ money to partially train a doctor and then move the goalposts so they cannot complete training,” said BMA junior doctors committee chair Dr Ben Molyneux. “We have lobbied the Department of Health and the UKBA to exempt doctors in this situation until [individuals] currently in core training have passed into higher specialty training, but this has fallen on unwilling ears.” www.bma.org.uk

“This represents a huge loss of skill and a waste of taxpayers’ money to partially train a doctor and then move the goalposts so they cannot complete training.” Dr Ben Molyneux Chair BMA junior doctors committee

The GMC has launched a new confidential helpline which doctors can call to raise concerns about patient safety. Callers to 0161 923 6399 can speak to specially trained advisors who will be able to take forward concerns about individual doctors or organisations. The GMC makes it clear that doctors have a duty to put patients’ interests first and act to protect them at all times - this overrides personal and professional loyalties. www.gmc-uk.org

War on the frontline Physical attacks and assaults on NHS staff have increased to 59,744 - an increase of 3.3% from the previous year. The total, compiled by NHS Protect, is equivalent to one attack for every 47 NHS staff. 75% of assaults were classified as “involving medical factors” which meant that the attacker was at the time receiving treatment which was regarded to have contributed to their aggression.

Medical students

www.bma.org.uk

2 per cent reduction in medical student places for 2013

edical student places are to be cut by 2 per cent in 2013 to reduce the risk of unemployment among newly qualified doctors, following The Review of Medical and Dental School Intakes in England. The work, commissioned by the Department of Health, recommends reducing the current target of 6,195 by 124 students from 2013. It has also called on a review of

the numbers in 2014 and reassessed every three years. The hope is that it will reduce the number of Foundation Year doctors regularly being forced to find work overseas. The report also advises keeping the cap on overseas students at 7.5%. BMA medical students committee joint deputy chair Melody Rahman said she was pleased the number of medical student places and junior doctor jobs was being looked at more closely: “The BMA has been concerned for a number of year that there is a real prospect of medical unemployment in the future because there are not enough jobs for the number of freshly qualified doctors leaving medical school.” The report, produced by the Health and Education National Strategic Exchange, accepts that the decisions will not be felt for many years due to the length of medical training. It predicts the impact will not be felt on the number of fully trained doctors in medical specialties until around 2025. www.dh.gov.uk

No thaw on pay Doctors’ pay should be frozen for a third year say NHS Employers. Their recommendation to the Doctors’ and Dentists’ Review Body is that the unnecessary cost of increasing doctors’ pay would divert money away from the delivery of patient services. The BMA is arguing for a minimum 1% uplift across all doctors. www.nhsemployers.org

GMC fees fall The GMC fee for newly qualified doctors and those in training has been cut for the second year running. The registration fee for newly qualified doctors will reduce from £195 to £185. Provisional registration will reduce from £95 to £90. For all other doctors holding a registration with a licence to practise the Annual Retention Fee has been frozen at £390. www.gmc-uk.org

NEWS PULSE

WORKING CONDITIONS

AoMRC: Consultants must review patients at weekends and bank holidays

atients in hospital should be reviewed by a consultant at least once every 24 hours, including weekends and bank holidays, unless there is a good reason for them to not to have a daily review, say the Academy of Medical Royal Colleges. The report, ‘Seven Day Consultant Present Care’, brings together 20 colleges and faculties in a commitment to deliver high quality care to patients seven days a week. It highlights that it is unacceptable not to provide consultant-led care at weekends if evidence suggests that this is best for patients. Patients admitted to a UK hospital at a weekend are more likely to die during their hospital stay than those admitted during weekdays. “It cannot be right that over weekends and “It cannot be right that over weekends bank holidays, patients and bank holidays, patients may may receive a lower receive a lower standard of care than standard of care than they would during the week.” they would during the week,” said ProfesProfessor Norman Williams President of the Royal sor Norman Williams, College of Surgeons Steering Group Chair and President of the Royal College of Surgeons of England. “Ensuring that key staff are available to provide this support will come at a cost. However this is crucial for the full benefit of seven day consultant-led care to be realised.” Three patient-centred standards to guide the delivery of consistent care irrespective of the day of the week are highlighted in the publication: • Hospital inpatients should be reviewed by an on-site consultant at least once every 24 hours, seven days a week, unless it has been determined that this is not necessary for the patient • Consultant-supervised interventions and investigations along with reports should be provided daily if the results will change the outcome or status of the patient’s overall care before the next ‘normal’ working day. This should include interventions which will enable immediate discharge or a shortened length of stay • Support services both in hospitals and in the primary care community setting should be available daily to ensure that the next steps in the patient’s treatment, as determined by the daily consultant review, can be taken. Currently, the availability of consultants and equivalent senior doctors varies widely across locations and across different areas of medicine in the evenings and at weekends. The report calls for the NHS to ensure that appropriate resources and adequate numbers of consultants are provided to enable consultant-led care to be achieved, seven days a week.

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NEWS PULSE

Doctors, Dissection and Resurrection Men Museum of London

urgery is a dangerous practice, requiring detailed knowledge of human anatomy. The best tool for learning has always been a real body. But finding enough ‘subjects’ for dissection has never been easy. In the early 19th century, a huge demand for fresh bodies fuelled the gruesome practice of body snatching. Doctors, Dissection and Resurrection Men at the Museum of London explores the murky world of the resurrection men and the ambitious surgeon-anatomist they supplied with fresh corpses. Exhibition open 10am-6pm daily, last admission 4.30pm £9, £7 concs Museum of London, 150 London Wall, London EC2Y 5HN Nearest tube: St Paul’s/Barbican

NHS workers gain half price admission on Mondays (usually £9) Present a valid NHS staff ID at the Museum of London admission desk.

www.museumoflondon.org.uk

The London Hospital Operating Room Used with permission. © The Royal London Hospital Archives.

Media Docs

Twitter TOP40

Alastair McLellan @HSJEditor Editor of Health Service Journal-the UK’s leading health policy, leadership and management title. Followers: 8,604 • Tweets: 8,731 • Average tweets per day: 7 • Influencer power: 123

‘END OF AN ERA, BREAKING OF A NEW DAWN’. Today’s winner of ‘most pompous press release title’ (in this case the opening of new health centre)”

Famous words:

Stuart Flanagan @Dr_Stuart Resident Doctor on BBC Radio 1’s Surgery. Also on C5’s Live With..., 5Live & Radio 4. Indie Kid/Soul Rebel/Telefantasy Geek Followers: 2,018 • Tweets: 5,227 • Average tweets per day: 6 • Influencer power: 30

“I wish the media wouldn’t describe dying of cancer as ‘losing a battle’. No-one ever died from cancer due to not fighting hard enough”

Famous words:

Keir Shiels @keirshiels SHO in paediatrics, sometime winetaster and overly middle class. Doctor off BBC’s ‘Junior Doctors: Your Life in Their Hands’ Followers: 6,120 • Tweets: 32,850 • Average tweets per day: 51 • Influencer power: 52

“Worth noting it would only take 2 doctors to section Andrew Lansley. Any volunteers? #nhs #nhsreform #NHSBill”

Famous words:

Richard Horton @richardhorton1 Editor of the Lancet. Welcome to a permanent attack on the present. Followers: 5,038 • Tweets: 4,551 • Average tweets per day: 4 • Influencer power: 344

“I am reliably informed that DH tries to avoid including Jeremy Hunt in its work. He knows little, engages less, and is way out of his depth.”

Famous words:

Max Pemberton @MaxPemberton Doctor and Daily Telegraph columnist. Followers: 5,616 • Tweets: 9,710 • Average tweets per day: 7 • Influencer power: 132

“Argh! just seen someone sitting opposite me on train is reading my book. Quite embarrassed. Watching for signs of enjoyment. He’s frowning.”

Famous words:

Fiona Godlee @fgodlee I’m editor of the BMJ and mother to two young children and am hoping my friends understand. Followers: 3,483 • Tweets: 692 • Average tweets per day: 0.5 • Influencer power: 72

“The man taking my order for lunch asked my name, and then asked “So where’s Shrek?” At home looking after the kids I said.”

Famous words:

Whether it’s tweeting about lunch in the hospital canteen or sharing ways to improve healthcare, Twitter is quickly becoming the hottest social media platform for doctors. Discovering who to follow among the half a billion Twitter users isn’t easy. We asked you to recommend the hottest 140 word tweeters. Here’s the JuniorDr Twitter Top 40.

Dr Christian Jessen @DoctorChristian British Doctor and Sexual Health Campaigner. Presenter of Channel 4’s Supersize Vs Superskinny & the BAFTA Award Winning Embarrassing Bodies. Followers: 166,017 • Tweets: 15,184 • Average tweets per day: 11 • Influencer power: 1687

“How’s this for an embarrassing statistic for a Sunday morning: 1 in 3 men in the UK are too fat to see their own penis!”

Famous words:

Twitter top 50

Twitter TOP50 Junior Doctors Andy Neill @AndyNeill Emergency Med Trainee in Ireland. Site at emergencymedicineireland.com interests in #Anatomy #FOAMed (Free Open Acces Meducation) #EM Followers: 3,770 • Tweets: 2,943 • Average tweets per day: 5 • Influencer power: 55

“There was a time I was pretty sweet at physiology. Replaced all that with anatomy - only so much space in a small brain.”

Famous words:

Natalie Silvey @silv24 Doctor, domestic goddess-in-Training, Science Geek, passionate about Global Health, tweets in a personal capacity. Also tweets @TwitJournalClub and runs #twitjc Followers: 3,440 • Tweets: 46,600 • Average tweets per day: 44 • Influencer power: 19

“Today I saw an example of why the NHS is amazing, I see examples every single day. And I am so proud to be working as a doctor in the NHS.”

Famous words:

David S @Danielf90 Doctor in Manchester. Oxford graduate. 24. Gay. Loves Theatre. Jew...ish. Interested in public health, patient safety, health service design & life in general. Followers: 1,853 • Tweets: 46,797 • Average tweets per day: 34 • Influencer power: 8

“Today involved lots of baked goods & lots of tears. I’ll miss ward 6 so much! Had a blast. Never thought I’d enjoy being an F1 this much.”

Famous words:

Dave Jones @welsh_gas_doc Propofologist in Wales - Propoffologio yng Nghymru. Followers: 9,073 • Tweets: 35,372 • Average tweets per day: 31 • Influencer power: 131

“The day that I’m made to work for Serco or Virgin is the day that I hang up my stethoscope and do something else.”

Famous words:

Matt @themattmak Emergency Medicine doctor. Tweets on healthcare, politics, education, leadership, travel and media. Followers: 4,431 • Tweets: 4,077 • Average tweets per day: 6 • Influencer power: 161

“Never, and I mean never, say the ‘Q’ word. It doesn’t actually affect how busy a shift is, but you will get evils all day #tipsfornewdocs”

Famous words:

Damian Roland @Damian_Roland Do something better together #nhschangeday NIHR Doctoral Research Fellow: evaluating educational interventions http://bit.ly/NRVek3 #FOAMed Followers: 2,503 • Tweets: 3,358 • Average tweets per day: 3 • Influencer power: 29

“If anyone sees a cardboard tube with Damian on it could they possibly let the Leicester crew know I have forgotten our poster.”

Famous words:

Emma Stanton @doctorpreneur Followers: 3,320 • Tweets: 3,896 • Average tweets per day: 3 • Influencer power: 52

Famous words: “Of all the cigarettes smoked in the US, half are smoked by people with mental health problems”

Twitter top 50

Technology Berci Meskó, MD, PhD @Berci

Medical doctor with PhD in Genomics, aspiring futurist, Founder of http://Webicina. com, Speaker, Blogger, university lecturer, Health 2.0 Consultant, WP admin. Followers: 22,183 • Tweets: 24,750 • Average tweets per day: 12 • Influencer power: 133

“Paralyzed Woman Outfitted with MindControlled Arm Feeds Herself for First Time in Decade (VIDEO) http://t.co/KlGJdgXK”

Famous words:

Carl Reynolds @drcjar

London based physician, Health informatician, coFounder of Open Health Care UK. Interested in developing Healthcare Digital Services among other things. Followers: 560 • Tweets: 1,209 • Average tweets per day: 1.5 • Influencer power: 47

Famous words: “We expect every GP practice to have a publicly available letter box, why not an email address? might help patients etc to get in touch.”

Dr Ed Wallitt @PodmedicsEd

I’m a doctor that speaks code. Founder of podmedics.com. Director of Podmedics Ltd, a UK-based company that builds physician-led Software Solutions for Health. Followers: 1,036 • Tweets: 2,264 • Average tweets per day: 1.6 • Influencer power: 28

Famous words: “Please can all people who frequent Paddington GUM clinic stop watching Embarrassing Bodies on C4 - it tends to up our attendance rate.”

Want to easily subscribe to these top Tweeters? Go to our list at www.juniordr.com/index.php/features/twitter

Doctors Dr Grumble @drgrumble

Trauma Anaesthetist @traumagasdoc

NHS consultant.

Doctor specialising in anaesthesia: Trauma, Education, GI, general all Rounder, Scandi, cyclist, runner, Musician. Occasional trash tweets Saturday Nights.

Followers: 2,924 • Tweets: 12,523 • Average tweets per day: 12 • Influencer power: 185

Famous words: “Guidelines

don’t turn bad doctors into good ones. The bad doctor has an infinite capacity to misapply guidelines on a grand scale.” AnneMarie Cunningham

Followers: 2,553 • Tweets: 4,197 • Average tweets per day: 7 • Influencer power: 206

Famous words: “The three great lies of a doctor: - I’ll be there in five minutes - I’m nearly finished - This won’t hurt.”

@amcunningham

Chris Roseveare @CRoseveare

GP, Clinical Lecturer and EdD Student... interested in everything:) Determined not to be one of the Sheep.

Consultant Physician; Editor, Acute Medicine journal; President, Society for Acute Medicine; enjoys writing and teaching; tweets are my own views.

Followers: 8,596 • Tweets: 81,523 • Average tweets per day: 49 • Influencer power: 47

Famous words: “Quote from medical student re PBL “Three hours of guessing what to learn?” #meded”

Followers: 283 • Tweets: 1,134 • Average tweets per day: 2 • Influencer power: 50

Famous words: “It’s time for senior doctors to stop finding reasons why #7dayworking can’t happen and start to look at how/when/what we can deliver.”

Jonathon Tomlinson @mellojonny Passionate about general practice, very interested in patients. Accident prone. For a publicly funded, collaborative NHS. Followers: 3,897 • Tweets: 19,830 • Average tweets per day: 16 • Influencer power: 108

Famous words: “Patient’s T-shirt this am. ‘My imaginary chronic illness is more real than your imaginary medical expertise’ :) http://t.co/XMt70xee”

Annabel Bentley @doctorblogs doctor in london,likes beaches, patient-orientated Evidence, informed decision making &health2.0 Blogs Onmedica.com, BMJ [personal tweets]. Followers: 13,093 • Tweets: 4,506 • Average tweets per day: 3 • Influencer power: 58

Famous words: “Surgeon

at #Quality2012 says to me: “I don’t follow any guidelines. No-one tells *me* what to do” <wow> is this the norm or outlier viewpoint?”

Twitter top 50

Twitter TOP50 ACADEMIA

POLITICAL

Ben Goldacre @bengoldacre

Ben Molyneux @drbenmolyneux

Nerd cheerleader, Bad Science person, stats Geek, research fellow in Epidemiology, procrastinator.

Chairman of the BMA Junior Doctors Committee, working to get great training for all.

Followers: 242,549 • Tweets: 33,175 • Average tweets per day: 16 • Influencer power: 935

Followers: 1,542 • Tweets: 1,209 • Average tweets per day: 1.5 • Influencer power: 69

Famous words: “I am stroking my huge pile of leaked industry emails. Been a bit busy recently. The ones involving Royal Colleges are the worst. Deary me.”

Famous words: “Just had Ed Milliband and Andy Burnham do a ‘surprise’ visit to our ward. There was also lots of ‘surprise’ cleaning and tidying just before.”

Trisha Greenhalgh @trishgreenhalgh

Clive Peedell @cpeedell

Doctor, academic, agitator, ageing athlete

Co-leader National Health Action party. Cochair NHS Consultants Association, BMA Council, Consultant Oncologist.

Followers: 4,520 • Tweets: 6,061 • Average tweets per day: 18 • Influencer power: 477

Famous words: “Oops.

On Skype to @DouglasNobleMD Me: “Is that your toddler’s scribble drawing on wall?” Him: “No, it’s my map of the US healthcare system””

Patients Mental Health @Sectioned_ In 2011 I was detained in the UK’s busiest acute psychiatric hospital, a brutal & sometimes hilarious intro to NHS mental health care. You’ve gotta laugh! Followers: 2,513 • Tweets: 10,690 • Average tweets per day: 31 • Influencer power: 205

Famous words: “Downside of having a psychiatric diagnosis: you can’t dye your hair red or be grumpy & opinionated without it being considered a symptom.”

Ninjabetic @ninjabetic1 Youth ambassador at Diabetes UK. A Ninja with type1 diabetes supporting & understanding people who live with D. Join the chat & make a change! Followers: 1,350 • Tweets: 12,452 • Average tweets per day: 44 • Influencer power: 21

Followers: 5,296 • Tweets: 9,394 • Average tweets per day: 20 • Influencer power: 1130

Famous words: “Can all Twitter NHS staff please state: “Shirley Williams is no friend of the NHS and no friend of mine” #libdems #nhs #LDConf ”

Jeremy Hunt @jeremy_hunt Conservative MP for South West Surrey and Secretary of State for Health Followers: 32,166 • Tweets: 569 • Average tweets per day: 0.5 • Influencer power: 1354

Famous words: “Welcome to my first Dept Health tweet. Busy morning looking at improving mortality rates for big killer diseases.”

Andy Burnham @andyburnhammp Member of Parliament for Leigh and Shadow Health Secretary. Followers: 35,027 • Tweets: 365 • Average tweets per day: 3 • Influencer power: 1436

Famous words: “19 #NHS trusts in SW prepare to sack nurses & break national pay. Meanwhile, in other news, the bill for agency nurses is soaring. Madness.”

Famous words: “I’ve

decided my diabetes New Years resolution for 2013 is to get my hba1c done every 3 months (as I should anyway).” Kate Granger @GrangerKate Wife, daughter, sister, friend, doctor, patient and author. Always trying to look on the bright side of life.

Followers: 2,571 • Tweets: 822 • Average tweets per day: 3 • Influencer power: 240

Famous words: “Please

give blood. Last year I needed 15 units of packed cells & 8 units of platelets to get me through chemo.”

Twitter top 50

What is influencer power? Measuring someone’s influence on Twitter is difficult and not an exact science. We’ve determined our influencer power primarily by the number of tweets per hundred from a user which are retweeted. This is commonly seen as the industry standard measure.

Education/training Clare Gerada @clarercgp

Dean Royles @NHSE_Dean

Chair of the Royal College of General Practitioners.

Chief Executive, the NHS Employers organisation. Committed to keeping you up to date with the latest HR thinking & advice. Own views.

Followers: 12,229 • Tweets: 25,393 • Average tweets per day: 28 • Influencer power: 71

Famous words: “Public

wake up. Your #NHS is disappearing. Care will never again be according to need but ability to pay. http://t.co/pClYeh7m”

Followers: 2,316 • Tweets: 5,101 • Average tweets per day: 8 • Influencer power: 185

Famous words: “Nearly 60 thousand assaults on NHS staff.

Yes, you read that right - 60 thousand. http://t.co/u6oS7D1W”

Thinkers Nigel Edwards @nedwards_1

Liam Donaldson @DonaldsonLiam

Health policy, delivery & improvement in the UK & Europe. Looking for radical new ways to look at healthcare

Former Chief Medical Officer England. Thinks, speaks, writes and leads in Public Health, Healthcare quality and safety, Global Health.

Followers: 4,047 • Tweets: 1,474 • Average tweets per day: 2 • Influencer power: 137

Followers: 3,267 • Tweets: 779 • Average tweets per day: 1.8 • Influencer power: 223

Famous words: “Lessons in #NHSreform 1: Once in a generation opportunities to change the NHS: 2000, 2006, 2008, 2010 - its clearly generations of cats.”

Famous words: “Spoke at Rotary event for Paralympians some disabled by polio. Number of people in small London room same as remaining polio cases globally.”

Chris Ham @profchrisham

Muir Gray @muirgray

Chief executive of The King’s Fund

Physician, Preventive. Care Specialist, Director of the National Knowledge Service.

Followers: 4,953 • Tweets: 1,591 • Average tweets per day: 3 • Influencer power: 169

Famous words: “Here’s to a peaceful and healthy 2012. Let’s ensure the NHS remains there for us all and provides the ‘serenity’ Bevan intended in ‘48.”

Followers: 3,922 • Tweets: 4,047 • Average tweets per day: 3 • Influencer power: 88

Famous words: “Most healthcare is Brownian Motion, the random movement of patients, professionals, blood samples and documents.”

Helen Bevan @helenbevan

Prof Steve Field @ProfSteveField

Leader of improvement, innovation & radical change in NHS @nhsinstituteuk. Focus on strengths more than deficiencies. All views my own.

Deputy Medical Director NHS CB - Health Inequalities & Chair National Inclusion Health Board. GP in Birmingham. Life long Baggies fan - Boing Boing!

Followers: 3,644 • Tweets: 2,056 • Average tweets per day: 3 • Influencer power: 326

Followers: 3,720 • Tweets: 3,141 • Average tweets per day: 9 • Influencer power: 150

Famous words: “Healthcare leaders can learn much from Tupperware re using social media to connect with employees http://t.co/k6n5cSEh thanks @bethcabrera”

Famous words: “Oh dear we seem to have failed in our PH messages in Brum via @Telegraph Chip shop serves deep fried #Christmas dinner http://t.co/coZCWm7V”

Resources

JuniorDr Top Tweeters List - www.juniordr.com/index.php/features/twitter An Introductory Guide Learn How to Tweet & Why You Should Consider Doing So - BC Patient Safety & Quality Council - http://bit.ly/RKxWjo Guidance - Doctors use of social media - GMC - http://bit.ly/I0ITnV The pitfalls of using social media sites - MPS - http://bit.ly/TdkCSV

Twitter top 50

Should medical students be able to travel overseas on elective with aid agencies

and non-governmental organisations? Abstract A growing number of medical students have a genuine interest in pursuing careers in global health. The medical elective is an excellent opportunity for experiential learning. Provided students are in safe, supervised environments, in a sector that seeks to professionalise training, seeing the realities of healthcare delivery overseas during electives may form an excellent foundation for ongoing training in humanitarian work. We conducted a questionnaire study to assess whether students and doctors believe that travelling on elective with non-governmental organisations is useful. From 296 responses we describe the perception of the security threat, experiential learning, ethical considerations and, above all, the contribution that students can realistically offer. We also list responses from 28 aid agencies with regards to their provisions for students. Our assertion is that medical students have skills useful to some organisations and that, in turn, there is much that students can learn on such placements.

Background Perhaps the last place one would want to see a medical student is in the vicinity of a natural disaster or war zone. Providing safe and supportive learning environments for students has been a medical education priority across the world for generations and as Global Health establishes its place within the medical school curriculum we look for practical ways to teach and engage students with global medical priorities. The medical student elective has long been a highly prized period set aside from formal undergraduate study(1) and there is no doubt that as Global Health grows as a medical specialty, students are keen, now more than ever, to conduct electives in low resource settings, experiencing different cultures and providing a medical service under supervision(2, 3). In 1974, only 10-60% of students claimed to travel abroad(1), whereas, it is considered the norm to do so now. Exposure during medical school to low-resource setting work increases the likelihood of 14

JUNIORDR RESEARCH

continued postgraduate interest in international medicine or work with poor and ethnic minority communities at home(2, 3). It also allows students to decide, at an early stage, whether a career in the humanitarian sector is truly for them. Aid agencies frequently operate in environments that pose significant security threats. This and an estimate of the actual clinical contribution a student can make have been traditional barriers to student participation in overseas humanitarian work.

We contacted charities and aid agencies to ask their policy on allowing medical students to travel with them and what arrangements they have for engaging with medical students in general We propose that there is both clinical and non-clinical work that students can do that make students an effective human resource for aid agencies, and that students are well placed to form cross-cultural relations and inject enthusiasm into long-term projects that seek to address the pervasive challenges in the social determinants of malnutrition, maternal and infant mortality, basic inadequacies in shelter, housing, sanitation, education, employment and the empowerment of individuals and communities(2, 3, 4). In turn, NGOs are well placed to nurture practice according to humanitarian principles and provide an excellent environment to learn the practicalities of implementing effective global health initiatives, monitor their success and work through daily impediments that clinicians all over the world are likely to eventually face in their personal practice. By building better connections with agencies, can we provide a safe and effective learning environment for medical students in low resource settings? We conducted this study in response to enquiries from students seeking opportunities to work with aid agencies and sent

questionnaires to students in the UK and overseas to see just how much interest there is in an elective with an aid agency. We then consulted aid agencies to determine how they engage with students and might accommodate a medical student elective.

Methods An online questionnaire (see online supplementary information) was circulated from February to March, 2012. The questionnaire was circulated locally by the authors in the institutions where we worked with the approval of the institutions (Kings College Hospital, Oxford medical school, Oxford surgical deanery in the UK and the Medical School of International Health in Israel). We then contacted charities and aid agencies to ask their policy on allowing medical students to travel with them and what arrangements they have for engaging with medical students in general. This was done principally by email and telephone and we have their permission to identify and quote them. Results A total of 296 questionnaire responses from students and doctors of various specialties (out of a possible of 618 in the UK and Israel) were received. We estimate that most of the responses were from the UK but this is difficult to verify as we did not ask respondents their institution on the questionnaire. 47% (n=140) of respondents had already completed their elective, 48% (n=141) planned to travel overseas on medical school elective. Only 5% (n=15) had not been or had no plans to go on elective. 23% (n=67) had done previous humanitarian work in a medical or non-medical capacity. 9% (n=27) had no interest in humanitarian work. Below, in figures 1 to 3, are the details of responses to key questions we asked:

Aid Agency

Comment The objective of Operation Smile’s programme for medical students on medical projects is to present future medical professionals with an experience of what it takes to provide complete patient care in a medical project environment, from first registration of the patient through post-surgical follow up treatment. The medical student role is observational only, and is not to include surgical, anaesthetic, paediatric or pharmacological clinical contact. The German Red Cross has an extensive volunteer network that includes medical students as well as qualified doctors. There are opportunities to work locally but overseas work requires training and skills that students are unlikely to have until they have gained further experience. Medical students are welcome and have attended Pan African Heart Foundation (PANAHF) missions previously. They participate as second assistants in theatre, in screening for rheumatic heart valve disease and as nursing assistants in the Coronary Care Intensive Care Unit. We encourage them to do this on their elective so they can generate a report following the mission.

Figure 1

Students are accepted on Cure International projects and go fairly regularly but remain students and are under the care of the doctors there, but they probably do a lot more practical procedures than they would do here in the UK. Anonymous*

Figure 2

We are running two clinics where we have occasionally hosted medical students when we are able to find the funds to cover the cost of their ticket. They have assisted in seeing patients, research and improving clinical systems. Mercy Ships accepts medical students in a non-clinical capacity. Medical students can volunteer on the ship in roles such as working in the food service, hospitality and administration department. The charity requires volunteers to work rather than to learn and be coached, and looks for volunteers to have a least two years postgraduate experience before volunteering for most medical positions in the hospital. Many dental and medical students have used their electives or holidays to help on the Mercy Ships and there are opportunities to use their time off to observe in the operating theatres, and help on the wards or join an outreach team (e.g. dental, eye, agricultural, those visiting prisons and orphanages). 80% of our medical volunteers are students in various stages of their training and various areas of nursing and healthcare. The more training/experience they have, the more of an involved role they will have. Operation Hernia accepts medical students to join their volunteer teams as part of their elective period. Official permission must be received from the dean (or equivalent) of their medical school. Students act as a full team member, as general helpers for patient screening, preoperative assessment, theatre scrub, recovery team, postoperative nursing and assistance with research (or they may carry out their own project with permission). Invariably, students will wish to stay longer than the surgery mission (1-2 weeks) and this can usually be arranged with the host institution.

Figure 3

Together Works Society (affiliated with Monty’s Beach Lodge) have a number of programmes that are very good for students to learn from, both in a medical and nonmedical way. We are very rural but we do need help in many areas. We have hosted many different groups over the past few years. We have a small clinic we built near our beach lodge. There is a hospital 15 minutes drive away and also larger hospitals in the cities within an hour. Medical students are accepted as volunteers at Asha Community Health and Development Society. They will be primarily involved in our English Literacy Programme but, being based in the slums, will have ample opportunity to shadow doctors and closely observe the healthcare activities undertaken there. The Vine Trust is involved in a number of charitable projects. The only medical project involves the Amazon Hope Medical and Dental Programme - composed of 8 UK volunteer medics (doctors, dentists and nurses) who join up with Peruvian medics to deliver primary care onboard two ships to remote Amazonian communities. Depending on available space on trips, we are able to accommodate a final year student for a two week trip (provided they can be supervised by members of our medical/dental team). PRIME Partnerships in International Medical Education uses well-trained, experienced tutors to provide high quality training for doctors and medical teachers. Students are welcome in a supportive role and will gain from the teaching experience. Voluntary Services Overseas (VSO) are currently looking for surgeons at Specialist Training year 2 and above. The rationale for this is that this is the minimum requirement requested by our overseas partners whom we recruit volunteers on behalf of. In many instances you would be training other surgeons and working in low resource and challenging settings and it is for these reasons that an appropriate minimum level of experience is required. Overseas medical staff for Medecins Sans Frontieres (MSF) are expected to train, coach and supervise paramedical and medical staff in the countries in which they work. As they are unqualified, medical students would not be in a position to do this. There could also be the ethical issue of unqualified medical staff practising medicine on patients. In line with Save the Children’s aim of encouraging self-sufficiency and building skills locally, we employ national staff wherever possible. The relatively few expatriate staff we do employ are all qualified and experienced professionals, with specific areas of expertise not available in the country. Tropical Health and Education Trust (THET) currently does not offer medical students placements abroad. We work to improve health services in developing countries through harnessing the expertise and experience of UK health professionals. By placing professional volunteers from the UK in long-term institutional health partnerships, their counterparts can receive training designed to upgrade their skills. We are currently looking into identifying ways in which we can engage students in parts of projects in an sustainable and appropriate way.

JUNIORDR RESEARCH

Should medical students be able to travel overseas on elective with aid agencies

and non-governmental organisations? Aid Agency

Comment Mercy Corps do not take on medical students for our work. Wherever possible, we hire local professionals, including medical staff. We only hire professionals who are fully qualified and experienced in their roles in all areas of our work, whether health or otherwise. Medecins du Monde do not send medical students to the field. We usually employ graduates with a minimum of 2 years of experience. The reasons for this are: we often operate in difficult circumstances where experience is needed and we are not able to supervise the students. As we work with local staff on our projects the number of expatriate staff is usually quite limited, too. Often our teams train local staff so our projects are sustainable. Based on our mandate, Christian Blind Mission (CBM) recruits ophthalmologists and Orthopaedic and rehabilitation surgeons, as well as programme managers with extensive overseas experience, language skills and inter-cultural competence (among other medical/technical requirements). The British Red Cross does not take medical students on mission. It is however, a leading provider of delegates to the International Red Cross and Red Crescent Movement. Our aim is to send people whose skills cannot be found locally. ORBIS’ mission is to preserve and restore sight by strengthening the capacity of our local partners throughout the developing world. Our efforts to teach and train are carried out by a dedicated expert volunteer cadre of Consultant ophthalmologists, ophthalmic nurses and other paramedical specialists. Medical students occasionally apply to work with ORBIS during their elective period, in either an administrative or observational role at their own expense. Age UK’s international work is done in partnership with our sister organization Help Age International and they work in partnership with local organizations and projects in developing countries. Because of this, all volunteers and staff are recruited directly in the countries where we work and we do not accept medical students or volunteers from the UK to help with the projects. Tearfund does not own or manage any projects overseas (except in complex disaster situations) as we work through local groups of evangelical Christians. We are not, therefore, responsible for the staffing of these projects. Generally, the main way we work is through mobilising local churches to look at the resources that they have and then to look at what their needs are and how they, as a church and community, can meet them with what they already have. ActionAid uses volunteers in the UK to assist in our administration and we really do value their input and support but we do not have the international systems in place to manage volunteers in emergency situations overseas. We prefer to use local knowledge and expertise whenever possible to avoid overburdening the local/national leaderships with an influx of volunteers. We will continue to review this policy.

VISION 2020 Links Programme (affiliated with London School of Hygiene and Tropical Medicine) help to set up eye links with institutions in Africa and institutions here in the UK. Medical students do have some opportunity to become involved in the link, although, not always in a medical capacity.

Oxfam GB is not a medical charity and does not recruit doctors or nurses but it does campaign for accessible healthcare and helps set up basic and affordable healthcare in vulnerable communities. Oxfam works with local development agencies, and for local medical students on short term placements who are prepared to do non-medical work, there may be opportunities to support local workers on projects. Physicians for Human Rights works locally in Israel only. We have refugee clinics in Israel and a mobile clinic that travels to villages in the Palestinian Authority that medical students are welcome to attend. We have access to the medical school in a programme called “Man and Medicine” which teaches humanities to medical students and here we present our attitude regarding topics like the “prison physician “ or “the medical rights of foreign workers” and many other topics. We do not operate overseas and therefore, would not have medical students with us abroad. We believe that during their learning years at medical school there are social and health problems that medical students can learn about in their own country and that learning Arabic and speaking to POW’s, as well as participating in the clinics beside doctors and nurses, is a good way to start learning Global Health. The difficulty is that we find it hard enough to find and integrate ‘less qualified’ staff in these programmes, particularly as Merlin are trying to maximise the use of local staff and we are constrained in many places by who is allowed to practise and where professional liability rests. This is particularly true in emergency situations. If you take Haiti, there were, in principle, local staff available but in some cases no mechanism for verifying qualification. *Aid agency wished to remain anonymous due to being inundated with student requests Figure 4. Roles for medical students: responses from humanitarian organisations

JUNIORDR RESEARCH

Aid agency responses We asked aid agencies whether they were prepared to take medical students with them on selected missions and what engagement they had with medical students. Their responses are tabulated below in Figure 4. We have not named agencies that did not grant us permission but have received permission to publish all the responses we received.

This research confirms that there is a genuine interest amongst medical students in Global Health; and that students are keen to work in low resource settings with aid agencies, NGO’s or charities, as well as in hospital placements that are the norm now Discussion Perhaps as a consequence of globalisation, studying and eventually seeking a career in Global Health is increasingly popular amongst medical students(3, 4). While medical schools adapt to develop new courses, the practical aspects of the social determinants of health, the solutions and the real difficulties in implementing these are much harder to teach. Students understand the principles of Global Health policy in broad terms but the detail, the interaction of local and global factors and the real effects of poverty, overcrowding and a lack of infrastructure are much harder to grasp. We believe that there is a place for students to have the opportunity to benefit from the experience of humanitarian agencies and institutions who know these challenges well. This research confirms that there is a genuine interest amongst medical students in Global Health; and that students are keen to work in low resource settings with aid agencies, NGO’s or charities, as well as in hospital placements that are the norm now. Students have supportive skills they can offer experienced

Policy Accepts medical students in clinical capacity

Accepts medical students in non-clinical capacity

Recruits qualified health professionals only

Recruits locally only

Aid Agencies German Red Cross Pan Africa Heart Foundation (PANAHF) Cure International Starfish Operation Hernia Together Works Society Vine Trust Anonymous*

health professionals; basic clinical skills they can use directly with patients; and non-clinical expertise that can be employed to the benefit of local populations and organizations. Moreover, students are well-motivated, dedicated and a potential asset in terms of fundraising and publicity, which might be of benefit to aid agencies.

Asha Community Health and Development Society Mercy Ships ORBIS Operation Smile PRIME Partnerships in International Medicine Education Physicians for human rights (PHR) VISION 2020 Links Programme Voluntary Services Overseas (VSO) Medecins Sans Frontieres (MSF) Save the Children Mercy Corps Medecins du Monde Tropical Health and Education Trust (THET) Christian Blind Mission (CBM) Tearfund ActionAid Age UK/Help Age International British Red Cross Oxfam Great Britain Merlin

Figure 5. Summary table of responses from humanitarian organisations

Despite the wellintentioned enthusiasm of visiting doctors or students, personal experience or learning on mission is secondary to the service provided Some NGOs recognise the resourcefulness and eagerness to learn that many students exhibit which can be harnessed in a supportive role. Mercy Ships allow students to help with the day-to-day running of the ship and encourage them to be involved in clinical work in their free time. Students on Pan Africa Heart Foundation missions can work as nursing assistants and have opportunities to assist in theatre. Operation Smile involve students in public health teaching with other supervised clinical exposure during their stay. While there are opportunities to engage with these institutions in classrooms and lecture theatres, as with all areas of medicine, practical experience is important to consolidate theoretical knowledge.(5) The contribution of this experience to an understanding of the pressures incumbent in ensuring healthy populations may be invaluable in learning Global Health. The potential pitfalls for students on humanitarian missions are significant, however, and as our data shows, agencies in war zones or acute disaster response discourage inexperienced healthcare workers on the basis of prohibitive security risks and the level of skill required to make a useful contribution. Many NGOs request relevant professional experience amongst other interpersonal skills(6) due to the

need to send small self-sufficient teams to areas of need for extended periods of time. The primary objective of any humanitarian mission is the provision of appropriate care to the local population(7). Despite the wellintentioned enthusiasm of visiting doctors or students, personal experience or learning on mission is secondary to the service provided(8). Many aid agencies recruit locally to encourage sustainable health systems and only recruit from high-income countries if particular skills are required to train locals. In these situations student involvement would be impractical. Much literature has focused on exactly what students should be able to do on elective and ethical practice in overseas travel and work. Although providers should not do more than what they are competent to do, it has been shown that both students and junior doctors can be indispensable if working within their abilities(4). Our view is that with proper supervision, students may participate in the treatment of patients and the organisation of their care, and learn from healthcare professionals who have time to teach them whilst becoming an integral member of the team. This should be no different from practice at home. Provided that students are well-prepared and aid agencies have programmes that accommodate students and have qualified staff with time to teach, we would endorse student electives with aid agencies where students can learn safely and work effectively, contributing to the benefit of all.

Acknowledgements We would like to thank Timothy de Valence, Verena Knobloch and Emily Owen for their help with the questionnaires and the humanitarian organisations who responded to our enquiries about medical student involvement in their work. Authors Miss Sonia Tsukagoshi,

MBBS, BSc, DTM&H, MRCS Core Surgical Trainee year 2, Oxford deanery, UK

Mr Eric P Heymann,

MBBS, MD, CCCM Emergency and Pre-hospital 2nd year Resident, Neuchatel Cantonal Hospital, Switzerland

Miss Seema Biswas,

MSc, FRCS, FHEA General Surgeon, Red Cross Health Delegate, British Red Cross

For references and conflicts of interest statement please see article online.

JUNIORDR RESEARCH

Coping with illness as a junior doctor Doctors should be experts in illness but as a group we are notoriously bad at looking after our own health, says JuniorDr’s Rosie Puplett. We often feel pressured into working even when we are unwell, either by other staff members or (more often) by ourselves.

his is becoming a bigger issue as the EWTD stretches medical teams to breaking point, and rates of sick leave are increasing amongst junior doctors - as recent research by the Royal College of Physicians has shown. There are many reasons why doctors become ill, from a physical illness to work-related stress. If you feel that you are unwell it is important that you act promptly. This helps your employer and colleagues, but most importantly it helps you to take control of the situation and get back on your feet as quickly as possible.

“It is important to try and seek help early and to try and behave like any other patient; and seek advice from your GP or occupational health department.”

Putting your health first The first - and often most difficult - step is to identify when you are unwell enough to warrant action. Key things that should make you think carefully about your health are increasing levels of tiredness, deteriorating ability to cope with work or life outside work, and concern from others about your wellbeing. The first port of call should usually be your GP. As they are a doctor themselves they can often empathise with your position. Your occupational health department will be able to help too, as they are experts in the complex interactions between health and work and can be a good source of practical advice. The sooner you involve GPs or occupational health, the easier it will be to get on top of things. You could also speak to your clinical or educational supervisor at this stage if you feel able to.

If you need time off … • Don’t be too hard on yourself! An unwell doctor is the same as an unwell person and you may well need some time away from 18

MEDICAL STUDENTS Support

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work get back on your feet. • Speak to someone from your deanery - they can help you come up with an action plan with regards to your training. If approached early they can often be flexible. They can also help tailor your return to work to best suit you and can help you to consider your long term career goals. • Try not to feel responsible for leaving your colleagues to cope without you. Filling gaps in the rota is the duty of your trust, not you. Hopefully once you are better you will be able to return to work refreshed, and will be far more use to your team than when you were ill! • Telling your colleagues that you are signed off work can be difficult, but they can be a great source of support. As long as your supervisors know what is going on you don’t need to tell anyone else yourself if you don’t want to.

Practical and financial support You may well need extra support, financially and practically, while you are off sick. There are a few things you can do to help yourself: • Ensure you are paid correctly - you are entitled to paid sick leave and statutory sick pay once that runs out (currently £79.15 a week). Talk to your pay roll department. • Speak to your bank manager early on - you may be able to take a repayment holiday from your loan or extend your overdraft until you are back on your feet. Also speak to the council or your energy provider if you are envisaging having difficulty paying bills. • Draw up a budget. Look for areas where you can cut costs and reduce unnecessary outgoings. Don’t neglect yourself however - it is important that you stay warm, well fed and in touch with the outside world! Tools such as budget worksheets can be a great help. • Look into benefits - if you are receiving SSP you may well be eligible for housing and council tax benefit. The process can be

S4D_Ad_Print.pdf 1 30/08/2012 16:40:37

Support4Doctors is an online portal of information for UK doctors. It offers specialist advice and support for doctors and their families on career, health and financial issues. The site also offers a database of organisations that can provide further help. Support4Doctors is a project of the Royal Medical Benevolent Fund. The RMBF is the leading UK charity for doctors, medical students and their families. We provide financial support, money advice and information when it is most needed due to illness, age, bereavement or disability.

Useful resources The British Medical Association

www.bma.org.uk

Doctors For Doctors (BMA Counseling and Doctor Advisor

Service) www.bma.org.uk/doctorsfordoctors

Royal Medical Benevolent Fund

www.rmbf.org and www.support4doctors.org

Royal Medical Foundation

Doctors Support Network

CMY

www.royalmedicalfoundation.org

www.dsn.org.uk

The Sick Doctors Trust

www.sick-doctors-trust.co.uk International Stress Management Organisation UK

www.isma.org.uk

The Citizens Advice Bureau (CAB)

Each year the RMBF helps hundreds of doctors, medical students and their dependants. The RMBF's help ranges from financial assistance in the form of grants and interest-free loans to a telephone befriending scheme for those who may be isolated and in need of support. For beneficiaries in particular financial need the RMBF can arrange money/debt management advice and in cases where it is appropriate the RMBF may also be able to help with return to work support.

www.citizensadvice.org.uk and www.adviceguide.org.uk DirectGov (information on claiming statutory sick pay and

benefits) www.direct.gov.uk

lengthy and you need a lot of documentary evidence so start early. Benefits are there to help people who are unable to work don’t feel ashamed about claiming them. • There are several organisations which can help doctors in financial difficulty - the BMA offers support to its members, and the Royal Medical Benevolent Fund, the Royal Medical Foundation and BMA Charities can all provide a range of financial assistance and advice • Talk to your friends and family - even if they can’t help you financially they can be a great source of support Overall the best thing you can do if you think you are unwell is to be honest with yourself about your situation, and speak to someone early on. Remember, doctors are not immune from becoming ill, and your health is important!

The RMBF is committed to leading the way in providing support and advice to members of the medical profession and their dependants. To find out more about our work, or how you can get involved visit the RMBF website.

www.rmbf.org Registered office: 24 King’s Road, Wimbledon, London SW19 8QN. Tel: 0208 540 9194. A charity registered with the Charity Commission No 207275. A company limited by guarantee. Registered in England No 139113

MEDICAL STUDENTS support

Medicolegal Advice - in association

Write your way

to the top Filling in applications for training posts requires careful consideration. You will face fierce competition from other trainees, so make a difference, stand out and sell yourself, says Charlotte Hudson.

edical jobs are becoming increasingly competitive so it is vital you nail your application to get the job you want. One way to do this is to get your own research or writing published to make your application form stand out from the rest. By showing your potential employer that you have had your work published showcases your commitment and drive, as well as your ability to write clearly and persuasively. Clear and concise writing is a key skill to develop for a successful medical career. Writing comprehensive and coherent patient notes is the cornerstone of good medical practice and will aid your defence should a negligence claim arise against you; so getting

your writing published now will put you in good stead for the future. Writing not only allows you to release your thoughts from your mind, it allows you to get some distance from a clinical situation, problem or career decision, and enables you to think analytically and observe the bigger picture.

It is important to remember to maintain good medical practice when writing for newspapers or blogs. Even if your words are anonymised, you should be careful.

with the Medical Protection Society How can you get your foot in the door of the publishing world? 1. Pick a suitable topic to write about

ER, Grey’s Anatomy, Scrubs and House are popular medical dramas that fascinate the public, so as a member of the medical profession you are well placed to write about your unique experiences. Just remember to approach the topics with sensitivity and make sure you don’t breach patient confidentiality, or get into trouble with your hospital/GP surgery. 2. Write a letter to a medical journal/newspaper

Writing a letter to a medical journal, or writing to a newspaper about a hot medical topic, can be a good way of getting your name in print without the need for heavyweight research to back up your opinions. Most national newspapers have much bigger circulation and readership figures than medical journals, so it’s worthwhile keeping up with public health issues and taking any chance to comment. For example, a well-worded letter to a national paper about how an increase in hospital patients is affecting junior doctors in training might catch an editor’s eye. 3. Blog!

You don’t have to wait eagerly to hear if your article/letter has made the cut; get your words published immediately by posting them onto your personal blog online. You could write about anything medical related and share your thoughts with the public – a regular blog is useful if you plan to try your hand at writing a column, feature or advice page once qualified. However, this comes with a word of warning. MPS has seen doctors face complaints over unwise commentary. You should always write as if you can be identified, never drop your standards of professionalism, and don’t say anything that you wouldn’t be happy to put your name to. 4. Remain professional

when writing for newspapers or blogs. Even if your words are anonymised, you should be careful. • Patient confidentiality always applies. For example, many publications, including Student BMJ require that everyone who submits articles or photos containing medical details has written consent from the patient, whether or not the patient is named in the article. • Check all your facts. The rules of publishing mean that you could fall foul of laws around defamation (harming someone’s reputation) – not to mention damaging your own career prospects – if you publish incorrect or potentially damaging information about people, whether in hard copy or online. • Don’t write about anything that might affect your future career as a doctor, eg, excessive drinking, drugs or the wilder side of your social life. Remember that as a doctor, your personal and professional life can no longer be completely separated. • Always reference any quotes or information gained from other publications or authors. Plagiarism, or passing off others’ work as your own, is a serious academic offence, and could cost you a training post or job. When filling in an application you should never embellish your experience or abilities, eg, don’t say that you have written numerous articles for a newspaper or blog, if you can’t prove it. If you have a topic that you would like discussed contact charlotte.hudson@mps.org.uk.

The GMC in Good Medical Practice, states, “You must always be honest about your experience, qualifications and position, particularly when applying for posts”. If questions are raised about your probity, ie, your honesty and trustworthiness, and whether you act with integrity, you could damage your reputation, and indeed, the reputation of the medical profession.

It is important to remember to maintain good medical practice

MPS is the world’s leading medical defence organisation, putting members first by providing professional support and expert advice throughout their careers. MPS supports members through the world’s largest network of medicolegal experts. We have a unique team of more than 100 specialist lawyers and medicolegal advisers (doctors with legal training). We are also committed to sharing our experience with members to help them avoid problems and provide the very best care for their patients. The educational portfolio available includes publications, conferences, lectures, presentations, workshops, E-learning and clinical risk assessments.

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.

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

Keeping your finances healthy for 2013 and beyond

a loss of earnings (such as if you start receiving your pension), you reach the maximum age for your policy or you die.

fter the excesses of Christmas, millions of people resolve to live a more healthy lifestyle in the New Year. As well as your physical wellbeing, this is also a good time to look at the health of your finances.

Consider your mortgage

Reduce debts

The key to any New Year’s resolution is starting well and there is little point in having savings if you are in debt – the interest you earn on your savings may be less than you pay on your debts. Start the New Year by making a list of everything you owe including unpaid bills and other loans. Then set about paying off the most expensive first, which will usually be store and credit cards. If you are having problems clearing your credit card balance, consider transferring to a new card with a 0% introductory rate. It is no longer so attractive to keep switching your balance around as many providers now charge transfer fees when you move, but you will normally get up to 12 months at 0%.

shares without having to pay tax on any gains you make. You only have until 5 April to use up your 2012/13 ISA allowance, which is £11,280 for a stocks and shares ISA or a maximum of £5,640 in a cash ISA, with the rest in shares. The 2013/14 total ISA allowance will be £11,520. If you are saving for a short term goal and would like easy access to your cash, then a cash ISA may be the best option.

Review your bank account

Protect your income

At this stage of your career, you may still be using the bank account you set up as a student, so you could be missing out on additional services that are available from your bank. Also, with interest rates so low, you should check what rate you’re receiving on your current and savings accounts. If it’s low or almost non-existent, consider talking to your bank to see if there is a better account they can offer or check the best buy tables in the weekend press to see if there are better deals available.

If you are off ill for a lengthy period it may impact on your income, so ensure you have plans in place to protect your finances. If you are employed by the NHS and fall ill, you will be entitled to NHS sick pay, but if you are still unable to work when that runs out, then you may have to draw upon your own savings or, if eligible, rely on state benefits. However, an income protection policy will provide you with a regular tax-free income based on your full earnings, typically up to 50% of your pre-incapacity level. Most policies pay out until you are well enough to return to work, are no longer suffering from

Set up an Individual Savings Account

ISAs allow you save cash or invest in

If you have a mortgage, because of the current low interest rates, you may be paying less for it now than in previous years. However, you may still be paying too much and there may be deals around that could save you money. You might find an offset mortgage is more appropriate for you, especially if you have money sitting in a low interest savings account. Remember to find out whether you will incur any penalties for switching mortgages. Shop around for general insurance

The time of year you buy insurance will generally depend on your renewal dates. However you can still do some research now and make a note of where the best deals are for cheaper motor and household insurance. If your time is limited, you might want to find an insurer that offers a more flexible personalised service. Check your utility bills

Many people stay with the same energy company year-on-year not realising they could be saving money by changing supplier. Why not spend a bit of time checking whether you are getting the best deals. Conclusion

It is never too early – either in your career or during the year – to start thinking about your finances. Talk to a financial adviser with expertise of the medical profession to ensure you are on the right track.

The above information does not constitute financial advice. If you would like more information or need specialist financial advice, call Wesleyan Medical Sickness on 0800 358 6060 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

• 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

Making the best of it in

Sierra Leone FY2 Dr Mikey Bryant is in Sierra Leone with healthcare charity Mercy Ships. He has been volunteering in a children’s clinic for a year in a country where one in five children don’t live to see their 5th birthday. In this regular column he gives us an update on his experience.

riday has arrived, which is always a bit of a relief for me. The waiting room is still rammed full but thankfully most of the babies are here for vaccines rather than because they need a doctor. This gives me a bit of time to chat with some mothers of the children who have been unwell. There are some interesting children who have come through today, including a child with bronchiolitis who was very wheezy earlier this week. Thankfully, when I examine her this morning many of the characteristic wheezes have subsided and the baby isn’t breathing too quickly. There are a couple of oddities though, the baby’s anterior fontanelle has a piece of string sticking up from it like a drunken aerial, and there is a belt made from the hair of a very unfortunate cow attached to the child’s waist. I ask what it is all for and immediately realise I have opened a huge can of worms. “It will make the breathing work well!” exclaims the mother excitedly. These situations are difficult as I want to keep the mother on my side so that she will take the medicines I’m going to give her. At the same time it just doesn’t seem right to leave her in this position of not understanding what is really going on with her child. In the end, I take the risk and try to explain why a piece of string on the fontanelle isn’t going to help. “I can only hope that over the next week she comes back and I can beat the “holy man” at his own game!”

Thankfully, she is quite receptive to what I’m saying and I manage to do it without treading on any cultural toes. It takes all the Krio I’ve picked up in the last few months. In the end I am thankful I explained everything to her and developed a rapport as the next thing she asks is about giving hot water to her baby! She tells me a “holy man” told her it was a good idea and would get the breathing demon out of the child. For many people in Sierra Leone, there is very little difference between healthcare and Spiritual issues, often leading to very damaging outcomes. I rush to tell her why I don’t think water is going to help and she agrees to give breast milk only. To me it feels like a kind of victory. I can only hope that over the next week she comes back and I can beat the “holy man” at his own game! Read Mikey’s blog online at www.juniordr.com 24

HOSPITAL MESS

Assessed by Gil Myers

Medical Report

Obesity

MR S CLAUS

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. 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 More complaints

= more feedback

the increasDear Editor, st your article on re te in ith w ad I re ctors (Complaints against do m co of r be m gh; Iss 26; ing nu s reach record hi or ct do t ns ai ag did you sugplaints article however, e th in re he ow nts could be p4). N mber of complai nu g in ris e th at and feelgest th more opportunity ng vi ha s nt tie pa due to ck. I think the le to offer feedba ab rt fo m co e or wering peoing m large part in empo a ed ay pl s ha et g comments intern omed to providin st cu ac e m co be ple to ample. ComipAdvisor for ex Tr of e ris e th - take a profession if od thing but as go a r ve ne e ar s fficult to act plaint wrong it’s often di t’s ha w ow kn n’t we do uraged? ey should be enco th be ay M . em on th Caroline Willis

GP Trainee

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:

Pringles

£1.29 Plain doughnut

y Rousseau CT2 London

ation

Appraising revalid

evalidation to n commences (R When revalidatio ; Iss 26; p7) and r GMC Confirm be em ce ec D in t ar st pporting eviden e six pieces of su id ov l pr ua to nn A ve l. ha sa e ai w appr at this links with th t k an or rt w po of im nt s ou it’ am es require a huge appraisals as traine will overlap so ns io ct se e y of thes menand paper. Man to duplicate docu ve ha n’t do e w please ensure me directors and training program tation. Hopefully this. ork together on the GMC can w withheld Name

y, ST3 Psychiatr

London

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

£1.99

Addenbrooke’s Hospital, Cambridge

Don’t pop or you won’t stop at,

Follow the GP le

Dear Editor, As a medical tr ainee I was inte rested to hear about the prop osal to extend GP training fro three to four year m s (Extension of G P training gains support of MEE ; Iss 26; p6). I was initially surprised that GP tr aining was actual ly so short - considering other sp ecialities such as cardiology can take eight years. Extending traini ng makes sense but shouldn’t w e should move to ‘lifetime’ training? With revalid ation coming in to force surely w now have checks e in place to ensu re competencies. A ‘lifetime’ lear ning plan means we would think more pro-activel y about constant ly improving our skills. We also kn ow a significant number of errors come from olde r doctors who ha ven’t kept up-todate with new m edical knowledg e. Isma

More cash till jingles than Pringles at,

Alder Hey Childrens Hospital, Liverpool

They think you’re doughnuts at,

£1.10

St Thomas’s Hospital, London

Tell Homer Simpson about,

60p Bottle of Sprite (500ml)

Newham University Hospital, Newham

Stick to the water fountain at,

£1.29

Addenbrooke’s Hospital, Cambridge

Fizz-tastic prices at,

75p

Cirencester Hospital, Gloucestershire

Next issue we’re checking the cost of a toothbrush, a jacket potato with cheese and a regular 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:

★★★II

HOSPITAL MESS

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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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