OXFORD SPECIALTY TRAINING all you need to prepare for specialization
Oxford Specialty Training is a brand new series and the first to take account of the new training structure and syllabuses, as introduced by the Modernising Medical Careers initiative.
• • • COMING IN SPRING 2009 • • • TRAINING IN SURGERY
TRAINING IN OPHTHALMOLOGY
A complete curriculum guide to specialty training in surgery, covering the material taught during the first two years of training, as well as the topics examined as part of Royal College membership. Written by both trainees who are currently completing their specialty training, and senior practitioners, the information is accurate, comprehensive and at the appropriate level.
This full colour book is the first to take account of the new ophthalmic training structure and syllabus, as defined by the Royal College of Ophthalmologists (RCOphth). As a theoretical and practical aid for trainee ophthalmologists and FY doctors, it is a guide through the initial years of the new postgraduate Ophthalmic Specialist Training. It will also appeal to candidates preparing for the Fellowship of the Royal College of Ophthalmology (FRCOphth) exam.
978-0-19-920475-5 | January 2009 | £39.95 | paperback
978-0-19-923759-3 | February 2009 | £49.95 | paperback
TRAINING IN OBSTETRICS AND GYNAECOLOGY
TRAINING IN ANAESTHESIA
Accurate and evidence-based, this textbook for junior obstetricians and gynaecologists contains all |the material relevant to everyday practice and the new RCOG curriculum. It has been written and edited by inspiring teams that combine juniors, new and established consultants working across a range of settings, and many of the UK's top experts in obstetrics and gynaecology.
Training in Anaesthesia is a curriculum-based guide to the first phase of specialty training in anaesthetics, comprehensively covering the techinques, assessments, and basic medical and physiological knowledge that trainees learn as part of their basic training, and which are examined by the Primary FRCA qualification. The book is authored by both trainees and specialists, and has been comprehensively edited and peer-reviewed.
978-0-19-921847-9 | March 2009 | £39.95 | paperback
978-0-19-922726-6 | July 2009 | £49.95 | paperback
• • • f o rt h c o m i n g • • • TRAINING IN PAEDIATRICS | 978-0-19-922773-0 | September 2009 | £39.95 | paperback TRAINING IN PSYCHIATRY | 978-0-19-922758-7 | November 2009 | £49.95 | paperback TRAINING IN MEDICINE | 978-0-19-923045-7 | February 2010 | £49.95 | paperback
available in all good bookshops and directly from OUP
ARE YOU READY FOR A HEALTH RECESSION? THE MAGAZINE FOR TRAINEE DOCTORS
Presenting History JuniorDr is a free distribution lifestyle magazine produced by doctors for the UK’s Medical Students, Foundation Year Trainees, Specialist Trainees, GP Trainees and Specialist Registrars. You can find us quarterly in hospitals and medical schools throughout England, Scotland, Wales and Northern Ireland, and updated daily at JuniorDr.com. Editor Ashley McKimm, editor@juniordr.com Editorial Team Michelle Connolly, Anita Sharma, Muhunthan Thillai, Grace Bandoy Newsdesk news@juniordr.com Advertising & Production Rob Peterson, ads@juniordr.com JuniorDr PO Box 36434, London, EC1M 6WA Tel - +44 (0) 20 7 684 2343 Fax - +44 (0) 87 0 130 6985 team@juniordr.com Health warning JuniorDr is not a publication of the NHS, Gordon Brown, 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. Copyright JuniorDr 2008. 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.
A
s the UK free-falls into the worst recession of our lifetime it’s not just the public’s pockets feeling the pinch, it’s our health too - and it will suffer long after the mortgage and credit markets start flowing again say the experts. In this issue we look at how the credit crunch is likely to affect our nation’s health and ask if the UK really is on the verge of a ‘health recession’. Our analysis looks at how the KFC Bargain Bucket is becoming the food of choice for cash-strapped families as the cost of fruit and vegetables soar by 15 percent. We also learn that a third of us have already quit our gym memberships while the rest are skipping exercise to spend more time at work. So what are the effects, if any, that we’re likely to see in our clinics? Mental health is already showing the early effects of the credit crunch. Presentations with depression and anxiety are up by a third in some hospitals while others are increasing consulting rooms to deal with the impending surge. Previous recessions in the UK show strong evidence that health inequalities worsen. This one comes at a bad time for the government with the recent launch of key public health strategies to tackle obesity and alcohol. One programme, Change 4 Life, which was launched this year to a fanfare of publicity aims to get families to ‘eat well, exercise more and live longer’ - a campaign that is looking increasingly more difficult as the recession takes grip. As doctors we’ve been relatively immune to the stresses of the global downtrun. Our jobs at least seem secure until the NHS budget gets reviewed in 2011. More noticeable may be effects on our patients and longer term health especially if the current dip turns into a full scale health recession.
“The KFC bargain bucket is becoming the choice for cash-strapped families.”
Ashley McKimm JuniorDr Editor-in-Chief
What’s inside 04 09 14 15 20 22
LATEST NEWS
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Hospital Confidential
Are we in a health recession? Top Anaesthesiology Websites Bringing ambulances to Mumbai SECRET DIARY OF A CARDIOLOGY SPR Wizard of Oz gets a check-up
TRIAGE
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Tell us your news. Email team@juniordr.com or call 020 7684 2343.
working hours
Irish junior doctors vote for strike action
J
unior doctors in the Irish Republic have voted overwhelmingly in favour of strike action if ongoing talks this month over cutbacks in overtime and allowances fail. 99 percent of the returned ballots voted in favour of industrial action, up to and including all-out strike action, according the Irish Medical Organisation - the equivalent of the BMA. Ireland currently has just under 5,000 junior doctors (NCHDs) and the IMO estimates that junior doctor salaries would be cut by as much as 40 percent under the proposals. “Management’s attempt to unilaterally impose rosters irrespective of the consequences for patient care and safety or the training needs of the NCHDs is clearly driven by Health Service Executive (HSE) directions aimed at cutting costs”, said Dr
Dr John Morris
John Morris, Vice President and NCHD Committee Member. “We cannot and will not accept discussion or consideration of breaches to NCHD core contractual entitlements under the heading of cost containment. The overwhelming vote in favour of industrial action demonstrates the level of anger amongst our NCHD members,” he said. The measures are aimed to save €90m per year. The HSE blamed the cutbacks on the need to meet the European Working Time Directive: “The Health Service Executive (HSE) is disappointed that the IMO should feel it necessary to consider embarking upon industrial action. The HSE is only seeking to reduce doctors’ working time to comply with the EU directive. Any action
by doctors which would cause anxiety and upset to patients would be regretted.” Talks are continuing in Dublin to resolve the dispute. www.imo.ie www.hse.ie
Proposed changes
Vice President IMO
• Mandatory 1 hour unpaid meal break
“The overwhelming vote in favour of industrial action demonstrates the level of anger amongst our NCHD members.”
NHS
Doctors still the most trusted profession 4
NEWS PULSE
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Data from the IMO
• Suspension of Training Grant and PGMDB Allowance • Discontinuation of Higher Degree and Diploma Allowance • Attendance at in-house training no longer paid • Discontinuation of Living Out Allowance • Introduction of mandatory unpaid Pre call/Post call • Maximisation of on call off site where feasible • Cross cover across different specialities to be maximised
octors have topped the poll of professionals that the public trust the most for the 25th year running, according to the latest survey commissioned by the Royal College of Physicians. Ipsos MORI polled over 2,000 people as to whether they
trusted different professions to tell the truth. More than 92 percent of the public trusted doctors, closely followed by teachers at 87 percent. Only one in four trusted government ministers, however it was journalists and politician who ranked lowest with just one
in five of the public trusting either of them to tell the truth. Doctors have consistently topped the list of most trusted professions in virtually every year since 1983 when the poll began. www.rcplondon.ac.uk
UK GPs best paid in Europe British GPs are the best paid in Europe according to a study by the Netherlands Institute of Health Services Research and Maastricht University. The survey of earnings in 2005 found UK GPs on top at £108,680 per annum with German GPs the second highest paid at £72,170. The French earned £45,200 on average with Belgium GPs earning the lowest at £21,270. www.biomedcentral.com
Stretch before surgery A warm-up of 15 to 20 minutes with simple surgical exercises prior to an operation leads to a substantial increase in proficiency of surgical skills, according to a paper published in the Journal of the American College of Surgeons. The study of 46 surgeons across varying specialties and experience levels also found the warm-up raised alertness and improved performance of fatigued surgeons. www.facs.org
Quitting the smokers bark Smokers are more likely to quit smoking for the sake of their pets’ health than they are for their own, according to research published in the journal Tobacco Control. The survey of 3300 people found that one in three of the smokers (28.4%) said that being aware that smoking was bad for their pets’ health would spur them to give up.
training
750 UK training placements for overseas doctors M ore overseas junior doctors will be able to take a two-year training placement in the NHS, the Department of Health has announced. The current Medical Training Initiative (MTI) that has offered 250 time-limited placements for doctors from developing countries last year will now be expanded to provide up to 750 opportunities. It will offer international medical graduates from English speaking countries in the developing world - where medical training is not widely available - the opportunity to secure vital training and work experience in the UK. “I am very pleased to be able to expand MTI which will give greater numbers of doctors from developing countries the chance to secure vital training and work experience in this country,” Health Minister Ann Keen said. “We will benefit greatly from their time with us and when they return home, they will be able to apply the skills and knowledge developed during their time here.” The MTI placements can only be made available where a suitable UK doctor cannot be found. The Department of Health has been
tobaccocontrol.bmj.com
New Director of Medical Education
H
www.dh.gov.uk
www.bapio.co.uk
Dr Ramesh Mehta BAPIO President
www.dh.gov.uk
“BAPIO is delighted that the Department of Health is expanding this initiative which allows international doctors to train and benefit from medical expertise in the UK.”
medical students
More needed to encourage poor into medicine
Dr Patricia Hamilton has been appointed as the new Director of Medical Education for England. Dr Hamilton is currently President of the Royal College of Paediatrics and Child Health and will be in charge of the Modernising Medical Careers Programme. The post has a remit covering the full range of medical training from undergraduate through to CCT.
working with the GMC, BMA, British Association of Physicians of Indian Origin (BAPIO) and NHS Employers. BAPIO president, Dr Ramesh Mehta said: “BAPIO is delighted that the Department of Health is expanding this initiative which allows international doctors to train and benefit from medical expertise in the UK. We are also pleased that this will ensure the preservation of our strong historical links with the UK.”
ealth ministers must halt spiraling graduate debt and remove the educational barriers that prevent low income pupils attending medical school, the BMA has warned. The statement came in response to the publication of the Public Accounts Committee’s (PAC) report into widening participation in higher education. “While every student has financial worries, medical students face particular pressures as their degrees are longer and more expensive than other undergraduate courses,” said Louise McMenemy, BMA Medical Student Committee lead on widening participation at medical school. At present medical graduates leave university
with £21,000 worth of debt on average, a figure that could rise as high as £37,000 in the next few years now that variable top up fees have been introduced. The BMA did note that improvements have been made for both women and ethnic minorities looking to enter medicine. In 2007 almost one third of students offered a place at medical school were from ethnic minority backgrounds, while just under three in five were women. www.bma.org.uk
NEWS PULSE
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Silence is safer
training
Patients at risk as hours slashed - say surgeons P
atients across the country will be placed at risk and their quality of care will suffer as hospitals prepare for the full implementation of the EWTD, the Royal College of Surgeons has warned. A survey by the RCSEng Association of Surgeons in Training found that 90 per cent of trainees are already exceeding their rostered hours on a weekly basis. It believes that 80 per cent would support an opt-out of the EWTD to protect training. “On the one hand, the immediate effects on patient care in the NHS are potentially disastrous. There are simply not the surgeons in the UK to fill the gaps when every doctor’s hours are cut to a 48 hour per week maximum,” said John Black, President of the Royal College of Surgeons. “On the other, trainees are telling the college they cannot gain enough experience to progress on the shortened hours. The choice for the nation is clear – do we want patients of the future to be treated by a group of highly skilled and experienced surgeons; or be passed
John Black
President of the Royal College of Surgeons
“There are simply not the surgeons in the UK to fill the gaps when every doctor’s hours are cut to a 48 hour per week maximum.” around a wider group of lower skilled surgeons with less experience.” According to the latest data from NHS employers in England in April 2008, 46 percent of junior doctors were working on rotas where they are likely to be working between 48 and 56 hours per week. Trusts are open to fines of up to £5000 per breach from August when EWTD hours are exceeded. www.rcseng.ac.uk www.dh.gov.uk
Five ‘NHS academies’ announced T
First Academic Health Science Centres: * Cambridge University Health Partners * Imperial College * King’s Health Partners * Manchester AHSC * UCL Partners
www.urotoday.com
Single sex ward Hospitals that treat patients in mixed sex accommodation will not be paid for their care from 2010, Health Secretary Alan Johnson has announced. A £100 million Privacy and Dignity Fund has been offered to help Trusts make swift adjustments to hospital accommodation. Guidance to trusts is that men and women should not have to share sleeping accommodation or toilet facilities. www.dh.gov.uk
Vaginal vision
nhs
he first five partnerships between universities and NHS institutions to form ‘NHS Academies’ have been announced by Health Secretary Alan Johnson. The newly announced Academic Health Science Centres (AHSCs) based in London, Cambridge and Manchester are structured to help ensure that research breakthroughs lead to much faster direct clinical benefits for patients. Universities and NHS organisations will work together to deliver world-class research, education and patient care. The hope is that this will allow UK institutions to compete with globally established centres such as John Hopkins in Baltimore, USA. In 2005, the top sixteen ranked hospitals in the USA were all AHSCs.
Playing music in the operating theatre may distract junior surgeons and reduce the effectiveness of new task performance and learning, according to a study published in UroToday. The randomised control trial found participants listening to activating music had a significantly worse total task time and instrument distance travelled.
A healthy donor kidney was successfully extracted through a small incision in the back of the donor’s vagina in the first procedure of its kind this February. The surgery at Johns Hopkins University School of Medicine took three and a half hours - the same as a traditional laparoscopic procedure - in what was a scar-free, minimally invasive and pain-free procedure. www.hopkinsmedicine.org
Checklist for safer surgery Imperial College – Designated an Academic Health Science Centre
Lord Tugendhat, Chairman of Imperial College Healthcare NHS Trust, said it meant better healthcare for the UK: “We are delighted to be recognised as an AHSC. This approach is recognised internationally as delivering better healthcare outcomes and it is excellent news for local people and the UK as a whole that it has been adopted here.” www.ournhs.nhs.uk/ahsc/
Using a surgical patient safety checklist could result in a third fewer deaths and complications during non-urgent cardiac surgery, according to a study published in the New England Journal of Medicine. The survey looked at eight hospitals in eight cities around the world. Of the 234 million surgical operations take place globally each year 3 to 16 percent have major complications. www.nejm.org
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NEWS PULSE
What the doctor ordered? Prescribing is a major hazard for junior doctors, writes Sara Williams. Read about Dr S’s experience and avoid making the same mistake
Dr S is on duty in the children’s area in A&E. He has just seen Jack, a two-year-old child with a high temperature. He sits down to write his notes and takes the opportunity to ask one of the nurses to give Jack 180mg of paracetamol (appropriate to weight).
From over-prescribing, transferring incorrectly to new charts and prescribing for the wrong patient, to forged prescriptions and overdoses, incorrect dosages, interactions and allergies, prescribing is fraught with risk. Junior doctors can safeguard themselves by developing a good knowledge of the pharmacology and the legislation surrounding drugs, and the trust protocols and controlled drug routines. If unsure, always get a second opinion.
She asks for it to be prescribed, but Dr S insists that he needs the A&E card to write his notes, and the child is in the cubicle opposite the nursing station (he points to it) “you cannot miss him”, he says. The nurse agrees reluctantly and goes to get the medicine and Dr S concentrates on writing on the card.
Make sure that you always document allergies and double-check names, doses, frequency and, in some cases, eg, anticonvulsants, brand names. You should not feel pressured to do anything beyond your competence; always take advice from a senior colleague if you are uncertain. If you are unsure about a prescription, or mishear on a ward round, always seek clarification, never guess. If a patient is admitted and there is any doubt regarding their current medication then consult the GP.
The nurse walks into the cubicle and gives the child the paracetamol. Dr S finishes his writing and approaches the cubicle to find out that there is now a different child sitting there – Alex. He anxiously turns to the nurse to find out if she has given the medication to the boy who is now in the cubicle, and she says “yes”. Dr S informs Alex’s family of what has happened and explains that the paracetamol was not prescribed for their child. He apologises profusely and immediately calculates whether the paracetamol could cause an overdose. Luckily Alex was a bigger child, and had not taken any paracetamol recently, so no harm was done. Dr S makes sure Jack gets his paracetamol, and fills in an incident form; he apologises to the nurse involved and they discuss what happened, and agree that it was an easily preventable mistake. Later that day Dr S discusses the incident with his consultant.
Handovers are another tricky area for junior doctors. Teams must work together in the allotted time to ensure that clinically unstable patients are identified, plans for further care are put in place and tasks not yet completed are clearly understood by seniors, as well as juniors. Patient information should be written clearly for the handover team.
Survival tips Prescriptions should clearly identify the patient, the drug, the dose, frequency and start/finish dates, be written or typed and be signed by the prescriber. Be aware of and clearly document a patient’s drug allergies. Good handovers require good leadership and communication.
© iStockphoto.com
Refer to the BNF. It is accessible online if your copy goes missing. Verbal prescriptions are only acceptable in emergency situations and should be written up at the first available opportunity. Particular care should be taken that the correct drug and dose is used.
Useful links MPS factsheet, Safe prescribing – www.medicalprotection.org/uk/factsheets/prescribing GMC – Good Practice in Prescribing Medicines (2006) – www.gmc-uk.org/guidance/current/library/prescriptions_faqs.asp
Prescribing safely The scenario above illustrates why prescribing can be a minefield and the level of vigilance and attention that is required to do it safely. It is one of the most dangerous areas for all clinicians, so the hazard warning lights in your brain should be flashing persistently when prescribing anything.
BMA – Evidence-based Prescribing (2007) – www.bma.org.uk/ap.nsf/Content/evidencebasedprescribing?Open Document&Highlight=2,prescribing British National Formulary – www.bnf.org. British National Formulary for Children – www.bnfc.org
MPS professional support and expert advice 24 hour medicolegal emergency advice line Medicolegal publications – Casebook and New Doctor Risk Management materials including medicolegal booklets
Online resources including factsheets and case scenarios Educational support through discounts with leading publishers Largest international protection organisation
For more information call 0845 718 7187 Or visit 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. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.
MPS0803
JUNIORDR GLADIATOR
AMAZON
28-
year-old junior doctor Zoe Williams has joined hit TV show Gladiators as ‘Amazon’. Zoe previously worked at the Royal Victoria Infirmary in Newcastle. She can be seen Sundays at 6pm on Sky1 and Sky1 HD. sky1.sky.com/show/gladiators
Image used courtesy of BSkyB
The Health
Crunch Prepare for the ‘health recession’. Believe the media hype and we’ll be a nation of anxious insomniacs surviving on 2p Asda sausages by the end of 2009. City workers with ‘square mile syndrome’ will be jumping from their Vitra designed offices onto the streets below, and our clinics will be overrun with depressed and obese patients with soaring blood pressure and new onset diabetes. As the UK freefalls into the worst recession of our lifetime should we be worried about the impact on public health or are these fears just ‘health crunch hype’? Ashley McKimm looks at how the financial turmoil is likely to affect our nation’s health and asks if the UK really is on the verge of a ‘health recession’.
T
hree out of four Brits are already convinced that their health will get worse in 2009 because of the financial downturn - and their habits are already realising this. As fresh fruit and vegetables get replaced by the KFC Bargain Bucket government targets on obesity, alcohol and narrowing health inequalities look likely to go unmet as people make their health a lower priority. What makes the ‘health crunch’ different from most other health issues is that it’s the young that are feeling most vulnerable. Almost twice as many 18-24 year olds believe their health will be effected compared to the over 55s. Women also fear the downturn more with only a tenth reporting no financial anxieties compared to a quarter of men.1
Eating healthy is too expensive In 2008 the government launched its ‘Healthy Weight, Healthy Lives’ initiative.2 The aim was to encourage families to ‘eat well, move more and live longer’ - a strategy that now looks increasingly likely to falter in coming years. Already over half of UK shoppers report they are now buying from supermarket budget ranges to help save money, with 15 percent cutting back on relatively expensive fresh fruit and vegetables. It’s not surprising when you consider the cost of meat and fish has soared by 25 percent in the last year while fruit and vegetables have risen 15 percent.3 Eating healthy is one of the first compromises families make, says Bridget Benelam,
Nutritional Scientist at the British Nutrition Foundation: “There is a danger in the current economic climate that people will forget about 5-a-
THE HEALTH CRUNCH
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The health crunch day and reach for cheap convenience foods that are often high in fat and salt and low in fibre, vitamins and minerals,” she says. “However, with a little planning and preparation, meals can be both cheap and healthy, using plenty of low-cost fruit and vegetables, including frozen and tinned varieties, and cheap ingredients like pasta, rice, potatoes and pulses.” But that might not be so easy. The National Consumer Council, which checks supermarket prices in England found that over half of instore promotions were related to foods high in fat and sugar - despite Food Standards Agency advice that these
Key Statistics • 15 percent cutting back on relatively expensive fresh fruit and vegetables. • A third of UK gym goers have cancelled their memberships. • Seven percent are drinking more alcohol. • Six percent of people have starting smoking again. • Two-thirds blaming money and work worries for their insomnia. • PFI building projects stand at the lowest level for the last decade.
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THE HEALTH CRUNCH
‘occasional’ foods should make up just seven percent of diets. The lowest socio-economic groups are likely to suffer most in the oncoming recession driving health inequalities even further apart. Demand for free school meals is already up in two out of five council areas as low-income and unemployed parents struggle with food prices.4
Too stressed to exercise It’s not just our diet that has been credit crunched - our exercise habits are feeling the pinch too says, Professor Graham Macgregor, Chairman of the Blood Pressure Association. A third of UK gym goers have cancelled their memberships in the past six months to reduce outgoings - with nearly half (42 percent) saying they would like to keep going but couldn’t afford it. Of the remainder, one-fifth have reduced the time they spend on exercise due to working longer hours. “It’s clear that Britons are under pressure and this could have serious health consequences,” says Professor Macgregor. “The dual effect on lifestyles of the credit crunch and lack of concern over long term health is putting the nation at risk of a blood pressure ticking time bomb.” Stressed workers are hitting the bottle too. Seven percent are drinking more alcohol than before the ‘credit crunch’, with nine percent believing this will be the case in the next six months. Six percent of people have started smoking again.3
The Great Depression The Samaritans launched a well publicised campaign to help depressed and suicidal City workers but it’s not just the finance sector that is hard hit. Those in the lowest socio-economic profiles already have a higher incidence of mental illness - a statistic that is likely to be compounded by the latest downturn. Mental health is expected to be most impacted by the economic downturn and service provision is already being affected. Evidence from previous recessions shows that there is a noticeable early spike in incidence of depression and anxiety disorders and that’s already becoming evident to service providers across the country. Glasgow’s Priory Hospital has opened new consulting rooms to deal with the surge, which they attribute to financial concerns and increased work pressures. In London, Capio Nightingale, an independent
mental health hospital, has reported that people seeking advice for mental health disorders has surged by a third. It’s something that has the government and Health Secretary Alan Johnson worried: “In the current economic downturn, the potential exists for more people to become anxious or depressed and experience lower levels of mental well-being,” he said. Johnson has announced an investment of £13 million to create a faster roll-out of therapy services across the UK in 2009 which will be linked to employment support workers. Studies in America of previous economic downturns have found that with each percentage rise in unemployment there was an accompanied seven percent rise in non-psychotic mental health disorders.5
Sleepless Britain Fears over our jobs and livelihoods also appear to be keeping us awake. In a recent survey by NetDoctor nearly half of the 1,000 men and women questioned said they were sleeping worse now than a year ago. Stress was cited as a major factor, with two-thirds blaming money and work worries for their insomnia.
Professor MacGregor Chairman, Blood Pressure Association
“The dual effects on lifestyles of the credit crunch and lack of concern over long term health is putting the nation at risk of a blood pressure ticking time bomb.”
Estate Agents top the sleep deprivation poll getting five hours and 50 minutes sleep a night - more than two hours less than the daily recommended sleep quota.6 When we are awake 15 percent of us claim we’re working longer hours and half of us are less likely to take time off during an economic slowdown. Those living in London are worst - with one-third too busy to have time to see a doctor. Research published in Diabetic Medicine shows that psychological distress such
as anxiety and insomnia doubles the risk of developing type 2 diabetes in men.7
NHS Crisis As the UK public debt looks set to soar over £1 trillion - worse than most other developed nations - experts are waiting for a strangle hold on public spending in future years. NHS funding is enjoying an agreed
spending increase until 2011 but the future after this date is uncertain. NHS programmes may have to be cut says John Appleby - chief economist of think-tank the King’s Fund - in a paper published in the British Medical Journal. “NHS spending is guaranteed up to April 2011, what happens after then looks decidedly less rosy. The health service will almost certainly have to plan for lower growth in
FAST FOOD ALCOHOL Smoking Obesity
funding from 2011 onwards,” he said. Appleby expects funding to remain essentially static from 2011 to 2014 as the government struggles to control public debt. NHS building projects have also been hit. PFI funded building projects dropped by half last year and stand at the lowest level for a decade, according to Public Private Finance magazine. Even Virgin Healthcare which planned to enter the healthcare market bowed out under the current economic conditions.8 Outside the NHS, pharmaceutical companies are expected to slash research budgets as investors take a more risk-averse approach. GlaxoSmithKline has already announced 850 job cuts in research and development this year alone.
Any upside to the downturn? Despite the gloomy outlook not all health indicators are expected to worsen long term. Public health experts suggest that as consumers tighten their spending, high cost habits such as smoking are likely to appear more attractive to quit. Jobs in the health sector continue to remain robust and were the only ones to show growth amid the recession according to the Recruitment and Employment Confederation. With the UK now looking unlikely to come out of recession until 2011 the evidence suggests that health will be hit. How strongly depends on how effective current public health strategies can buffer the downturn and prevent a health downturn turning into a ‘health crunch’.
HEALTH SPENDING PFI EXERCISE FRUIT & VEGETABLES
References 1. BUPA — http://www.bupa.co.uk/about/html/pr/131108_worried_women.html 2. ‘Health Weight, Healty Lives’ — http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_6585 3. Britain Under Pressure — http://www.friendsprovident.com/common/layouts/subSectionLayout.jhtml?pageId=fpcouk/SitePageHTML:Press+Release+Display+Page+Rebrande d+Media&repositoryItemId=fpcouk/pressreleases:fppr08092008creditcrunchhealth&pag eNum=1 4. Local Government Association — http://www.lga.gov.uk/lga/core/page. do?pageId=1318106
5. Healthy living in hard times; Christopher J. Ruhm; Journal of Health Economics; doi:10.1016/j.jhealeco.2004.09.007 6. Travelodge — http://www.travelodge.co.uk/press_releases/press_release. php?id=322&search=credit%20crunch 7. Hypothalamic arousal, insulin resistance and Type 2 diabetes mellitus; Björntorp, P.; Holm, G.; Rosmond, R.; Diabetic Medicine, Volume 16, Number 5, May 1999, pp. 373383(11) 10.1046/j.1464-5491.1999.00067.x 8. Public Private Finance Magazine — http://www.pppbulletin.com/?ppf=true
THE HEALTH CRUNCH
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Leadership & Management Development
Why all the fuss?
Open any publication offering news and insight into health service matters and you’ll find a reference to the importance of good quality leadership & management at a clinical level. Furthermore, turn up to your consultant interview without a requisite demonstration of both learning and practice in this area and you’ll find yourself on the sharp end of some uncomfortable questions (if you were lucky enough even to get short listed without this heavily referenced in your CV). We examine what leadership and management really are and how to go about ensuring you stack up when the time is right. Leadership & Management – Understanding the difference Do managers need to lead or do leaders need to manage? Are they the same, different or simply is one part of the other and if so which? There is reasonable agreement that leadership is about setting direction and management is about implementing it. However, if we leave it at that, it does raise a question about the enormous emphasis currently on developing leadership in doctors when broadly the Department of Health & Government sets direction. Furthermore, doctors are finding themselves with ever less authority over their own lot, with job planning dictating how they are deployed, targets & finance dictating what they focus on and with many feeling their everyday status has returned to that of worker bee, not clinical leader. ‘Why’ is an issue we’ll return to later but some of the answer lies in ‘what’ – the deeper meaning of leadership & management. Leadership Besides setting direction, leadership is about aligning, enabling and motivating people towards that direction, or vision, as it is often termed. That’s an ‘on the ground’ job and whilst service delivery expectations increase, so does the need for more of this type of leadership. It can also be argued that leaders do the right thing based on the true purpose they serve (welfare of the patient, in the case of doctors) whereas managers follow the instructions of more senior managers. This is readily evidenced by the approach of ‘management’ to the 4 hour target in A&E, where compliance with the 4 hour timeslot often seems to take precedent over the right, sensible or appropriate thing to do. Furthermore, local leaders do set direction by taking a national plan and creating a local vision based upon marrying the principles or requirements of the master plan with local variances & priorities. So, at a service level, leadership is vital to provide:
• Direction aligned with national priorities but locally interpreted • A moral compass to ensure that we do what is right • A driving force that aligns people with direction, whilst keeping their motivation high Management Despite the process-orientation of management, it is difficult to see how you can manage effectively without a strong consideration of people. Management is effectively concerned with taking a strategic direction and turning it into an operational plan, utilising the resources at your disposal (including human resources). The role of management traditionally includes: • Determining objectives • Forecasting & information gathering • Planning & organising • Directing & coordinating • Controlling • Communicating We think this traditional view needs augmenting with the essence of leadership too, as doctors aspire to a role that effectively encompasses both and where both are necessary to operate effectively at a consultant level. The leadership imperative in modern healthcare Returning to that ‘why’ question, there is a far greater imperative to develop leadership skill in our clinical workforce today and it has very little to do with medicine itself. With our population forecast to grow from approximately 60 million to around 71 million over a 25 year period, with life expectancy increasing by 5 years over the same horizon and with the balance of population moving more towards the retirement group, we are going to find ourselves with ever increasing healthcare demand and an ever decreasing ability to pay for it. The magnitude of this set of compounded challenges dictates a complete rethink in our model of healthcare delivery and with that comes a
significant need for the right kind of leader to see us through very turbulent waters. Lord Darzi has outlined a new model, controversial in places, with an increasing emphasis on market forces and new provider types. Under this radical plan the traditional NHS, hierarchical and centrally led, transitions to being locally led through the commissioning process, with ‘any willing provider’ delivering healthcare as long as it matches service specifications and quality controls. That requires a fundamental change to the organisation of the doctor role, to our commonly held models of the medical employment contract and to the activity that senior doctors will be engaging in as the new model takes shape. Forearmed is forewarned, so why is the level of awareness in this area so low? It could just be by design! Effective leadership & management development The attributes of an effective leadership & management development programme become much clearer when you consider the context in which that leadership & management will be dispensed i.e. the changing healthcare landscape. Without delving into the minutiae, a robust programme will include: • Understanding the evolving healthcare environment and how it will change • Both business and clinical leadership skills, including both strategic and operational leadership • Management principles aligned to the new environment, not based on the old healthcare paradigm This suggests some care and attention in your choice of provider, to avoid developing a set of skills matched to a health service model that is rapidly dissolving. Equally, it is vital that doctors in training and consultants alike develop a much deeper understanding of the evolving landscape and what it means to them. Medicology’s Insights Day (www. nhsinsights.co.uk) is designed to provide just such insight and is a good place to start. Mr Andrew J Vincent, Managing Director, Medicology Ltd Dr Sara L Watkin, Medical Director, Medicology Ltd
MEDICAL STUDENTS TRAINING
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Elderly to improve balance the Wii way
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nsteady over 70 year-olds are being recruited by the University of Aberdeen to discover whether the Nintendo Wii Fit can help reduce falls and fractures. The study, funded by the British Geriatrics Society, aims to test the Wii’s balance board as to whether it has the potential to reduce falls in the elderly by improving balance. “When I was working in the University of Aberdeen osteoporosis unit, my main aim was to prevent fractures. A total of 90% of hip fractures are due to falls,” explained Dr Alison Stewart, Honorary Research Fellow at the University of Aberdeen, who came up with the idea. “As many older people have a problem with their balance, I wanted to investigate balance and initially I proposed using a piece of equipment that cost several thousand pounds,” she said. “When no grants were forthcoming to pay for this equipment, I heard that the Wii Fit balance board might do exactly the same thing.”
Anaesthesiology Websites
AnesthesiaNow www.anesthesianow.com
A professional UK based web portal for anesthesia with the latest news and journal papers, along with good CME resources. Requires free registration.
Association of Anaesthetists www.aagbi.org
Contains a selection of free topical podcasts along with conferences and seminars for members. The site also provides access to the association’s journal - Anaesthesia.
FreshGasFlow.com www.freshgasflow.com
Focuses on the practical aspects of equipment and the physics of anaesthesia. Great for understanding vapourisers, gas flow and endotracheal tubes - and there are a few puzzles and jokes too.
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News, discussion boards and a strong focus on exams as well as being a Royal College of Anaesthetists endorsed training site make AnaesthesiaUK a must in any trainee’s bookmarks.
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14
MEDICAL STUDENTS TECHNOLOGY
Bringing ambulances to Mumbai When an elderly man in Manchester spots the first signs of a heart attack it takes just a simple ‘999’ call to have an ambulance by his side within 12 minutes. It’s a service we take for granted but things aren’t so simple in Mumbai, India.
F
or its 20 million inhabitants they had no global number to call and no coordinated ambulance service. In fact, 90 percent of an ambulance’s revenue came from carrying dead bodies so there has been no incentive to treat the ill. That was until a group of young graduates aimed to change everything. Dial 1298, a non-profit company, was started with the aim of providing an ambulance service to anyone, anytime through the single four digit number 1298. For the five graduates - Shaffi Mather, Sweta Mangal, Naresh Jain, Manish Sacheti and Ravi Krishna - who devised the service they had personal experience of needing medical care in India where only 6 percent of the population have access to emergency ambulance services.
90 percent of an ambulance’s revenue came from carrying dead bodies Shaffi Mather had a personal experience in which his mother choked in her sleep during the night. Unsure of how to relieve her or what number to call for help, Shaffi felt helpless. Although Shaffi’s mother survived, this experience left a lasting impression on him. A week later, Ravi Krishna’s close friend died in a road traffic accident because timely medical attention was not available. These events made them realise
Doctor and emergency medical equipment
the acute need for an organized and networked Ambulance service in India for saving lives. Uniquely, patients using the Dial 1298 service who want to go to a private hospital pay for the service (around £20) while those going to public hospitals pay either half this or the fee is waived if they can afford neither. It’s a business plan that covers the costs of the service and is winning esteem from social entrepreneurs around the globe. At present the service has 50 ambulances and has been credited with saving over 50,000 lives in Mumbai since the service first started 36 months ago. The team have worked closely with the London Ambulance Service who are one of the supporters of the programme and upon which the service is modelled - right down to the forms
the paramedics complete. Although the budget has been tight it doesn’t mean the ambulances are lacking in the latest technology. After each Dial 1298 call the nearest free ambulance is immediately dispatched and directed via GPS. Dial 1298 ambulances were the first on the scene of the during the Mumbai bombings of November 2008. Over the coming months the 1298 service is being expanded with a service undergoing development in Kerala and the team are bidding to provide ambulances as part of a public-private partnership in New Delhi. 1298 is also being used as a model for the development of emergency ambulance services across the developing world. www.1298.in
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Doctors working in the United Kingdom can take advantage of the introduction of more streamlined processes to gain registration to work in Victoria, Australia. With this simpler registration process and the development of new initiatives, the Victorian Government hopes that more doctors from the UK will consider moving Down Under.
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he introduction of the Competent Authority Pathway makes it easier for non-specialist doctors to work in Australia. It enables eligible doctors working in the UK to apply for advanced standing toward the Australian Medical Council (AMC) certificate. Doctors who are granted advanced standing will be exempt from the AMC examinations, both Part A (MCQ) and Part B (Clinical). Instead, General Registration may be granted, following successful workplace based assessments while working under supervision. For doctors who would like to move to Victoria long-term, the fast track to General Registration assists in gaining permanent residency. For UK specialists who want to work in Victoria, there is the Specialist Pathway and the Area of Need (AON) Specialist Pathway. More information about the different registration pathways can be found at www.amc.org.au To assist doctors working the UK, a website has been developed where doctors can express their interest to work in Victoria and request to receive an information pack. It also helps
18
WORKING OVERSEAS
connect doctors to vacant positions. Visit www. health.vic.gov.au/workforce/register. Furthermore, the Victorian Government is holding a series of information seminars across the UK in early April. To find out more and book your place to attend visit www.health.vic. gov.au/workforce/seminars Work in one of the world’s most liveable cities Victoria offers UK doctors excellent professional and lifestyle opportunities. Melbourne, Victoria’s capital, is one of the world’s most liveable and cosmopolitan cities. It is the sporting and cultural capital of Australia. Outside Melbourne, the cities and towns are home to stunning coastline, mountains and scenic national parks. The Victorian public health system is among the best in the world. Victorian hospitals treat some of the most complex cases in the country and are at the forefront of medical research. There are opportunities to work in a diverse range of interesting and rewarding settings; from smaller health care centres serving farming communities to large tertiary hospitals in Melbourne and regional centres.
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Secret Diary of a Cardiology SpR Monday If you’ve been following this column you’ll realise that I was about to make arguably the most important career decision of my life. As I come to the end of my SpR jobs with an MD, a few papers and some serious butt-kissing along the way, I think I could have a decent shot at most jobs that come my way. After a busy week on call, Douglas, my boss and mentor dropped a bombshell. The hospital had achieved the highest ratings as part of its Foundation review process. This enabled the management to tender for a new consultant post, which they were awarded. Douglas told me that if I wanted it, it was mine. I would be the only female cardiologist among five men, not to mention that I was a good couple of decades younger than anyone else in the team. I had a long think, then did what any rational person in my situation would do at a time like this. I went skiing.
Tuesday I had booked a few days with my two best friends. Both girls, both married. After getting in late last night and crashing straight to bed, today was our first day on the slopes. We’d hired rooms in a fantastic five star chalet. We were sharing with a few other people, mostly couples, but had a lounge with a real fireplace as well as our own personal chef. After an angio-bursting breakfast of bacon, sausage and eggs, I pick up my rented skis and follow the others out. I used to go skiing every year as a child with my parents but as my relationship with them soured over the years (mainly due to the fact that unlike my other siblings I had chosen my career over having a family) my skiing had suffered too. I spend most of the morning falling over. By late afternoon though, I find my form and managed the medium slopes with little difficulty. I have a light dinner and go to bed, exhausted.
Wednesday An early start this morning back on the slopes. Skiing can be a lonely but beautiful experience. We were meeting up during the day and spending the evenings together but the three of us were of hugely different abilities and had decided to ski apart. As I career down the pristine white slopes it gives me the chance to seriously evaluate things. I hadn’t actually made a conscious decision to focus on my career. But this was the dilemma that had been following me on the slopes. To accept the offer or not. I had initially thought I’d made up my mind but now I wasn’t so sure and I had come here to make a final decision. We stay up late eating roast beef (very English), apple strudel and drinking lots and lots of perfectly chilled Pinot Grigio as well as the odd glass of Merlot.
Thursday The day goes by pretty slowly, partly due to my hangover from last night. I ski slowly, stopping for copious strong and sickly sweet espressos at the bottom of the mountains. A light lunch and we retire from the slopes for an afternoon of pampering in the local spa. A back, neck and foot massage really hit the spot. A mud bath and long cool Jacuzzi afterwards leave me feeling completely refreshed.
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SECRET DIARY
* Names have been changed to try to keep our cardiology SpR in a job - though she’s doing a pretty good job of trying to lose it without our help!
We decided against another heavy drinking session, partly as we’re all going back tomorrow to attend a hen party in London this weekend where no doubt we’ll be exercising our livers again. Both my friends are married and one has a ten month old boy at home. This is the first time she’s been away from him since he was born and in between the stories of poo on the carpet and vomit in her hair she seems to miss him terribly. The other one wants kids and will no doubt join the ranks of motherhood very soon. I listened to the stories and realize that the longing for my own family has never really gone away, it’s just been suppressed. Taking up Douglas’ offer of a job in London would make meeting someone and starting a family that much harder.
Friday I spend the morning skiing and then have a long hot shower before the flight home. We make good time and are back in central London by four in the afternoon. I part from my friends, knowing that we’ll meet tomorrow afternoon for a fantastic weekend of drinking, dancing and the odd naked waiter. On the way back to my flat I glance at my watch. I get off the tube and hop into a black cab. If I rush, I may just make it. Settling down and having a family is important for me, more so than anything else including my career. But the offer of a job at a London teaching hospital with all the academic glory, prestige and private practice that comes with it is tempting. Very tempting. If only there was a way to combine them both? Not to mention that four of the five existing consultants are idiots and one of them (who shall remain nameless) is a complete bastard. I jump out of the cab and swiftly make it up three flights of steps to the cardiology offices. Douglas is still there, packing up for the day. He looks at me in surprise and asks how the skiing went. I smile. We talk for a few minutes and then I shake his hand. As I leave he calls my name and I turn back. “Welcome to the team,” he says.
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ou’re probably now at a stage in your life when, possibly for the first time, you’ve got a regular income and a bit of extra cash in your pocket. The temptation to spend must be strong and there’s nothing wrong with treating yourself especially as you work so hard. But you should also start to think about squirreling some of that cash away. It sounds boring but remember that having savings gives you choices – choice of whether and where to buy a house, where to go on holiday, where to educate your children and, further down the line, choice of when to retire. However if you have any outstanding debts, such as a student loan, pay these off before you start saving. It’s likely that the interest you’re paying on the loan is going to be greater than what you’re going to earn on any savings. You might think that you’ve got plenty of time before you need to start saving but do you know that you have only 432 pay days in your career, assuming you start your medical career at age 25 and retire at 60. By the time you hit 35, when you may be taking up a Principles post, you will have only 300 pay days to go. There are many reasons to save. It’s sensible and re-assuring to have at the very least an emergency fund in place to cover you if you can’t work for any reason or need a cash injection. The size of the fund is up to you but we think three months pay after tax is a good starting point. Another good reason to start saving is to get on the property ladder. You may find it
more difficult in the current climate to get a mortgage and having a good deposit could help. Alternatively you might want to save for a holiday of a lifetime, school fees for children or even, if you’re really planning ahead, for early retirement. It makes sense to stash some cash away on a regular basis. The first question is how much? Obviously that’s your choice but make sure you are comfortable with the amount you choose. You’ll still want to have some fun in life and generally treat yourself. So the question to ask is “How much can I put away and forget about?” Then consider whether you’re saving for a short term objective such as a new car or a longer term project such as amassing funds for further education costs. Equally important is where to house your savings and this will depend on your attitude to risk, as well as any specific savings goals that you have.
Every type of saving carries some degree of risk. Generally the higher the risk, the higher the potential return and vice versa. The level of risk tends to be low for cash deposits increasing with other assets such as government and corporate bonds through to stocks and shares that can carry a high level of risk. However the real return on cash deposits reduces over time. This is because if you put all of your cash into a bank deposit account for a long period of time, the return is affected by inflation. Your risk profile may alter as your situation and saving objective changes. You may feel that you are happy with a greater level of risk for longer term savings such as retirement planning but want a lower risk for a shorter term goal. You should make the most of any tax efficient saving opportunities. If you have money in the bank, consider moving it to an ISA - an individual savings account. You can invest into an ISA on a regular basis or make a lump sum investment. When you withdraw your accumulated capital you won’t pay any income tax on it. You can currently invest up to £3,600 in a cash ISA or £7,200 into a stocks and shares ISA each year. The latter are better suited to longer-tem investments (a minimum of five years) as they are designed to run for a longer time. There are other types of saving vehicles available all with different tax implications and varying levels of risk and return. You should talk with a financial adviser to ensure that you choose the right saving plan to meet your objectives for both short and long-term saving.
The above information does not constitute financial advice. Wesleyan Medical Sickness provides specialist financial advice for doctors. Telephone 0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk
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Assessed by Gil Myers
Medical Report
Wizard of Oz
C
onsider this a group session. What with busy surgeries sometimes it’s easier to see a family together. It may not be best practice but you can’t just give patients magic beans and send them home anymore. Instead of journals, lately I have been getting medical information from the newspapers - a valuable source of the latest advancements in diagnosis and treatment options.
Dorothy A difficult set of symptoms to diagnose from: vertigo, euphoria, paranoia and visual hallucinations (“munchkins singing and dancing”). All these could clearly be put down to a number of causes including drugs, violent video games and Facebook. However, in this case I think the answer lies in Dorothy’s need to stay awake to avoid the “Wicked Witch” has meant her drinking too many energy drinks and overdosing on ginseng. As an active ingredient of these beverages, ginseng can cause all these and easily account for her erratic behaviour. Treatment should be given in the form of a “clip round the ear” and a period of National Service.
Across:
2 Large endocrine gland in base of neck (7) 5 Ringing or buzzing of the ears; frequently unknown cause (8) 6 Name associated with this sign: JVP rising with inspiration as in constrictive pericarditis (8) 8 Curved, slightly twisted strip of bone forming part of the skeleton of the thorax; good with barbeque sauce when porcine (3) 9 Inborn defect of metabolism causing deposition of oxalate in kidneys and elsewhere, eventually renal failure (8) 11 Classification system for colorectal adenocarcinoma; members of the nobility (5) 13 Type of diabetes due to impaired water resorption by kidneys because of reduced ADH secretion (9) 16 Whitish crescent shaped area at the base of the nail (6) 17 Organ of sight (3) 18 In acute appendicitis, this sign reveals pain is more in the RIF than the LIF when the LIF is pressed (6) 19 Drug of choice for treatment resistant schizophrenia; linked with weight gain, diabetes and requires regular blood monitoring (9) 20 Severe generalised muscle wasting implying malnutrition (8). Down:
1 Founded the school of Analytical Psychology; had a famous difference of opinion with a certain Sigmund Freud (4) 3 Difficult or painful micturition (7) 4 Condition in which the teeth are extremely small (11) 7 Broad flat muscle in calf; behind gastrocnemius (6) 9 Small bone (7) 10 Abnormal involuntary movement (10) 12 Term for ‘spoon shaped nails’ (11) 14 Name associated with set of diagnostic criteria for multiple sclerosis as well as a popular fast food chain (8) 15 Of the liver (7).
You can find the answers at www.juniordr.com/world/crossword Compiled by Farhana Haque-Mann
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HOSPITAL MESS
Lion His main complaint is of a generalised anxiety state with occasional “panic attacks” brought on without a known precipitant. Although it’s hard to rule out thyroid problems because of a large mane obscuring the neck, it would seem an unlikely cause. As it is impossible to determine the source of these worries, I would move straight onto a trial of propranolol to remove “the fear” completely. That would be just what the newspapers would suggest.
Scarecrow Although seemingly happy, it appears that the patient suffers from nihilistic delusions with the result that he has the firmly held belief he does not have a brain. Despite any arguments to the contrary this belief is unshakable and unrelenting. While further investigations - EEG, CT (head) would be useful, it may be more efficient to consider placebo surgery, with a fake brain shown to him before then “implanted”. I would recommend using bran, pins and needles to construct such a pseudo-cerebellum.
Tinman On observation of his gait and body posture, I would assume that there are classic signs of Ankylosing Spondylitis. The “stiff neck turn” and odd movements are almost pathognomic. Ankylosing Spondylitis is a chronic, often painful, inflammatory arthritis. It affects joints in the spine and the sacroilium in the pelvis, causing eventual fusion of the spine. His grey skin could be an atypical side-effect of his previous pharmacological treatments, so I would therefore suggest frankincense as alternative remedy.
Writing in the Notes
y needs mashing
Couch potato stud
t readers, nior doctors are Dear overweigh us to read that ju ro ou m hu it d I fin tatoes’ (‘Junior sion of couch po es of pr a to in g p4) considering ‘turnin warning’ Iss 11 to ta po h uc co t two weeks. I’d doctor work for at leas at n w do t sa t e in five’ docI haven’ on why ‘only on as re e th at th t e exercise three sugges utes of moderat in m 30 urs es ag an tors m sy doing 70 ho at we’re too bu th of is st k re ee e w th a spital times g around the ho in nt ri sp e iv ns of inte the time!
W
hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:
Celebrations Chocolates (460g)
s a Dr Fairytale
check-up
Dear Editor, Rather than di agnosing ‘celeb ta Claus and H rities’ like Sanomer Simpson I think Dr Fair needs to becom ytale e a little more proactive in asse your cardiology ssing SpR (‘Secret D iary of a Cardi SpR’ Iss 11 p20) ology . She presents as depressed, teeter on the edge of ing alcohol addictio n and in the m a nervous breakd idst of own. Assuming she’s real as you shouldn’t we be say a little worried about her? It is concerning that also reading her colu mn is inspiring to specialise in me cardiology once I qualify - thou expect this is fo gh I r all the wrong reasons.
Cardiology SpR Fan Cardiff Scho ol of Medici ne
ton
Antarctic East Ac
eyr, ative and fasciDear Ross Hofm ur truly inform yo r fo u yo k Than ntarctic Doctor’ arctica (‘The A nt A on le tic ar urous I’d connating tle more advent lit a as w I If ). fter reading the Iss 11 p9 ur footsteps. A yo in g in w llo teresting comsider fo er that it’s an in ev w ho te no d di normally at piece I operate perfectly n ca u yo at th h while Lonparison nditions on eart is o C in the worst co res of snow th -90 a few centimet r te t af ou up ll ro ed iz don se t should ndon Transpor Lo s ap rh Pe . month time! husky dogs next Satinsky Dr Annabel on , West Lond GP Partner
‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.
£5.99
Whipps Cross Hospital, London
It’s time to celebrate at:
£4.95
ham Gabriel Beec FY1, Colchester
Cardiologist need
They ruin the party at:
Bic ball pen
Norwich University Hospital, Norwich
Too expensive to write a complaint at:
40p
Royal London Hospital, London
Doodle-tastic:
20p ‘Get Well Soon’ card (cheapest)
Royal Free Hospital, London
Enough to make you sick again:
£1.25
Bristol General Hospital, London
Better than a dose of penicillin:
90p
Royal Bournemouth Hospital, Bournemouth
Next issue we’re checking the cost of a ham sandwich on white bread (no salad), Evian water 50cl and a sachet of tomato ketchup. Email prices to hospitalconfidential@juniordr.com.
Trafford General Hospital, Manchester The Mess has a newly decorated lounge, which includes a television and snooker table. Adjacent to the mess, a quiet area for study is available with PC, printer and Medline Search facility and CD-ROM texts (a laptop and CD-ROM can also be borrowed). The doctors also have their own dining area where Barbara the waitress serves breakfast and lunch. In the restaurant foyer vending machines sell snacks, drinks and chilled foods. The latter may be reheated in the adjacent microwave ovens.
JuniorDr Score: ★★✩✩✩
HOSPITAL MESS
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