JuniorDr
JuniorDr.com Free for Junior Doctors Issue 5
Thanks Patricia!
Presenting History JuniorDr is a free distribution magazine produced quarterly for the UK’s junior doctors. You can find us in hospitals throughout England, Scotland, Wales and Northern Ireland, and online at JuniorDr.com.
Editor Ashley McKimm SHO Addiction Psychiatry
Don’t force us to choose between our patients and our jobs
editor@juniordr.com Editorial Team Mareeni Raymond London
Michelle Connolly London
Hi Wu-Ling Nottingham
Muhunthan Thillai Chelmsford
Thanks to Andro Monzon, Manju Sharma, Sanj Gupta
Ashley McKimm Editor SHO Addiction Psychiatry, London
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Editorial Over and over the Department of Health claims that patient care is not being compromised by MTAS. For the 22,000 of us who were dragged away from our jobs to attend interviews we would argue that the reality is somewhat different. With as little as 24 hours notice MTAS is tempting doctors, whose livelihoods depend on attending, to take shortcuts to be there - if they don’t they’ll be out of the NHS anyway. I know. I was given just 22 hours notice by email for my interview with a fully booked clinic the following day. No alternative times for the interview were allowed - you either attend or are considered ‘no longer interested in the post’. Choose to see my patients and I may find myself unemployed in two months time. So don’t tell us that we’re not being blackmailed into choosing between patients and our jobs. It’s clear that we are. Luckily the whole process has deteriorated to the point of farce where it has become completely incomprehensible to the public. They can still attend hospitals with only the faintest inkling that everything’s falling apart. They’re
Triage
JuniorDr
unaware that the solemn, apathetic faces of junior doctors that greet them on the wards aren’t just tired after a long shift - they’re tired of the NHS. I doubt any of us would wish to be scheduled for an op this August if we had the choice.
“So don’t tell us that
we’re not being blackmailed into choosing between patients and our jobs. It’s clear that we are. ” As doctors we didn’t take our jobs to play politics or to have to constantly fight against the system. Today we have no choice. We resent the NHS, the Department of Health and the whole MTAS process. Sadly it’s too late for potentially thousands of doctors packing up their stethoscopes who care passionately about patients. It’s time to get someone in charge of the NHS who actually cares about patients and won’t compromise on it. Good luck NHS.
> What’s on the inside Escape MTAS Fed up with the NHS? Here’s our guide to alternative careers Page 10
Escape MTAS Working overseas Page 14
Latest News Page 4
Wanna bet? Gambling with addiction Page 15
Secret diary of a Cardiology SpR Page 21
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JuniorDr The Pulse
News Pulse Tell us your news. Email the team at newsdesk@juniordr.com or call us on 020 7684 2343.
MTAS Special Report
Department of Health admit “we’ve no idea” of MTAS cost LONDON Millions of pounds of public money has been spent on the MTAS selection process but the Department of Health admitted to JuniorDr they’ve “no idea” of the final total. Deaneries have claimed the enormous scale of MTAS has made accommodating interviews on their own sites impossible, forcing them to relocate to alternative venues. Football stadiums, a racecourse and luxury hotels have been among the sites. “The most cost-effective way to run a large number of interview panels, in many cases, was to hire conference facilities to accommodate the interview panels,” said the Department of Health. “Many different venues were used for the MTAS recruitment process including NHS Trusts, medical royal colleges and deanery headquarters.” Unusual locations Many doctors attending interviews were surprised by the location of selection panels:
“My interviews were conducted in three private boxes overlooking the football pitch. With the state of MTAS by that stage I was more interested in the view than the questions.” One candidate who attended an interview at Bolton Stadium North Eastern Deanery
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“My interviews were conducted in three private boxes overlooking the football pitch,” reported one candidate who attended the North-Eastern deanery interviews at the Reebok Stadium, home of the Bolton Wanderers. “With the state of MTAS by that stage I was more interested in the view than the questions. Surely they could find a more cost-effective venue.” London Deanery used bedrooms at the Gatwick Holiday Inn with clinical scenarios conducted around the furniture. “I wasn’t expecting to be spending the afternoon in a bedroom with two other consultant interviewers,” said one surprised candidate. £6.3 million over 5 years Costs for the application process itself have also risen from the projected £5.8 million at it’s conception: “Expanding to United Kingdom wide coverage and incorporating academic/specialty and general practitioner recruitment into a single, tworound recruitment exercise has slightly increased set-up costs,” Health Minister Ms Rosie Winterton told parliament. “The projected cost of the service is now expected to be £6.3 million over five years.” It comes at a time when the NHS is struggling with a £500 million deficit from the last financial year. No data is available on the loss of clinical time from cancelled clinics and procedures. Over 20,000 interviews were conducted around the UK causing significant disruption to trainees and consultant interviewers.
> Locations of interviews
Newmarket Racecourse Eastern Deanery Cost - £120 (small box) to £1200 (conference) “We have had to recruit more than 1,200 posts, in a relatively short period of time. The Rowley Mile at Newmarket was one of the few venues that could accommodate this scale of operation, whilst being accessible to junior doctors and consultants who were conducting the interviews. It therefore represents good value for money,” says the Eastern Deanery.
Hilton Hotel, Cardiff Wales Deanery Cost - £300-400 per day (small meeting room), bedrooms from £90 “Feeling tense? There’s always time to indulge in one of the wide range of treatments and massages, available at the Hilton Cardiff hotel” says the brochure - sadly MTAS candidates were sweating it out upstairs, not in the spa.
Bolton Wanderers Stadium North-Eastern Deanery Cost - £95-400 (executive boxes/day) Describes itself as “one of the country’s newest and most unusual hotel and conference venues”. The Trotters are flying high in the premiership this season candidates must be hoping for similar luck.
Holiday Inn London/KSS Deanery Cost - £90-150 It may not be the Hilton and interviews may have been held in the bedrooms - but at least there was somewhere to lie down when things got too much.
The Great Idea February 2003 Modernising Medical Careers, a policy document outlining the principles for reform of postgraduate medical education is published. It confirms plans for a foundation programme and specialist training. Further frameworks are put in place over the following two years. In 2005 the first cohort of F1 doctors start placements. The application process for specialty training is agreed in August 2006.
Open for business Monday 22nd January MTAS opens the online application process. Concern is already raised over the format of questions and the inability to submit a CV.
Computer meltdown Friday 2nd February Problems with the MTAS computer system lead to many applicants being unable to access the site. Deadline for applications is extended twice and finally closes at 9am on Monday.
First interviews offered Friday 2nd February Thousands of doctors who expected to be short-listed panic when not granted first round interviews. Royal Colleges express concern over the selection criteria. BMA suffers criticism for lack of action. Remedy UK is formed by junior doctors to fight MTAS and plans large public demonstration. Government vows to press on with selection process.
Thousands hit the streets Saturday 17th March 10,000 junior doctors, supporters and Mums4Medics hit Westminster and Glasgow to call for the scrapping of MTAS. Government says it recognises concerns but reaffirms commitment to the current selection process.
Everyone offered an interview Wednesday 4th April MTAS review group backtracks and guarantees all doctors an interview for their first-choice post.
Personal info found online Tuesday 26th April Channel 4 reveals personal details of foundation MTAS applicants, including race and sexual orientation, are freely available online. MTAS website suspended.
MTAS scrapped Tuesday 15th May Patricia Hewitt announces scrapping of MTAS. Interviews that have taken place and those already scheduled for Round 1 will stand. Round 2 will be conducted at a local deanery level.
Remedy loses high court battle Wednesday 23rd May The legal fight against the Department of Health calling for the interviews carried out so far only to count towards temporary appointments, not substantive posts, fails. DH accepts legal cost award leaving Remedy with a £45K bill.
Round 1 jobs offer Early June Final job offers are to be made to applicants with remaining posts to be offered in Round 2.
MTAS Special Report
Volunteer abroad - DH tells docs LONDON Junior doctors left unemployed by MTAS should volunteer abroad, suggests NHS Employers in a leaked paper on how to deal with thousands of potentially jobless medics. The agency, part of the NHS, approached Voluntary Service Overseas (VSO) - an organisation which co-ordinates voluntary work - in April when they realised up to 10,000 junior doctors were facing unemployment this August. In their proposal they highlighted the fact that volunteering has always ‘been popular among NHS staff’ - a statement that outraged South Cambridgeshire MP, Andrew Lansley: “The Government is ‘volunteering’ junior doctors to join the Voluntary Service Overseas, so that they go abroad,” he told parliament.
The Pulse
JuniorDr > MTAS timeline to failure
“It struck me that VSO is about volunteering—not the distressed reallocation of doctors from the United Kingdom to overseas, which is outrageous.” VSO currently only accept doctors with a minimum of three years post-registration experience so the impact would be minimal. Fears of widespread unemployment has lead many deaneries to ask trusts to create temporary posts to decrease the unemployment burden. “If our most talented doctors are forced out of training, they will head overseas or leave medicine entirely,” said Jo Hilbourne, the BMA’s junior doctor representative. “Their patients will lose out on the right to be treated by the best doctors. And taxpayers will get no return on the millions of pounds spent on medical training.”
MTAS Special Report
Royal College of Surgeons quits MTAS review LONDON The Royal College of Surgeons has announced its withdrawal from the Review Group on MTAS. In an open letter to Professor Neil Douglas, Chair of the MTAS Review Group, the college warns that the DH has not made adequate transitional arrangements for a large number of senior house officers who are in danger of being lost to the NHS. Mr Bernard Ribeiro, President of the RCS, expressed his frustration at continued attempts to persuade the DH of the unique requirements for surgical trainees: “Almost two years after first raising my concerns, there is still no recognition whatsoever by the DH of the scale of this problem or its profound implications, far less
the prospect of an acceptable solution in terms of a temporary expansion of national training numbers.” He called for 240 extra training posts over the next three years and expressed concern that trainees are being selected too early in their career before they have had a chance to prove their dexterity in the operating theatre. “Surgery has unique requirements in terms of recruitment - the criteria for selection include diagnostic skills, clinical judgment and manual dexterity. It is neither practical, nor indeed safe, to select junior doctors with a view to a career in surgery without the opportunity for assessing whether they have the full mix of professional skills required,” he said.
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JuniorDr Working Conditions
World
The Pulse
Obs and gynae worst for bullying LONDON Junior doctors in Obstetrics and Gynaecology are nearly three times more likely to be bullied at work than GP trainees, according to the latest National Survey of Trainees. One in every six junior doctors in obstetrics and gynaecology is subjected to ‘persistent behaviour that has undermined their professional confidence and/or self-esteem’. The findings support studies that have found a higher prevalence of harassing or discriminatory behaviours in surgery and obstetrics and gynaecology. Overall 10.5 percent of the 23,000 doctors questioned reported bullying, however the rate may be as high as 16.5 percent if those who did not wish to answer are taken as a yes response. SpR trainees were more likely to report a consultant as the sources of their bullying while SHO trainees were more likely to
> Bullying league table Percentage reporting bullying (highest to lowest) Obs and Gynae SpR (16%) Obs and Gynae SHO Emergency Medicine SHO Surgery SHO (14%) Anaesthetics SHO (12%) Emergency Medicine SpR Medicine SHO Surgery SpR Paediatrics SHO Paediatrics SpR Medicine SpR Anaesthetics SpR Psychiatry SHO Radiology SpR (8%) Psychiatry SpR GP (6%) National Training Survey 2006
report other trainees or nursing staff. The study also found trainees from outside the UK are less likely to feel bullied by consultants while it was more commonly reported in older trainees.
Spanish docs more likely to drink and drive MADRID Male Spanish doctors are twice as likely to drink and drive as other non-health graduates, according to researchers at the Department of Preventative Medicine at Universidad de Navarra, Spain. The study of nearly 17,000 graduates found that 30 percent of respondents reported “sometimes” drinking and driving. Female nurses and doctors and male nurses were all 1.2 times as likely to drink and drive as non-health workers. Male doctors were even less responsible, being twice as likely to drink and drive as non-health workers. “The role of health professionals in educating the population regarding the health consequences of drinking and driving had long been advocated,” says Maria Segui-Gomez, study author. “Yet their ability to do so may be impaired due to their own lifestyles.”
Training
EU reform threatens UK medical training
Nurses less naughty Two-thirds of nursing students believe it’s wrong to lie to patients, twice as many as in 1983. The survey, carried out at the School of Nursing in Greater Manchester found that 66 per cent felt it was unprofessional to lie to a patient compared with 33 percent in 1983. It also found that those agreeing with the statement ‘a good nurse should be prepared to change shifts at short notice to help out’ had halved to 25 percent. www.salford.ac.uk
Symptoms by the stars Virgos have an increased risk of vomiting during pregnancy, Pisces have an increased risk of heart failure and Libras have an increased risk of fracturing their pelvises, according to a study by researchers at the Institute for Clinical Evaluative Sciences in Toronto. The 'tongue-in-cheek' study which looked at data from 10 million people found that each of the 12 astrological signs had at least two medical disorders associated with them. www.ices.on.ca
Sneeze at working hours Hayfever sufferers miss an average of an hour a week during peak season, according to a study published in the Primary Care Respiratory Journal. Employees cited lack of sleep and a negative impact on their quality of life as the two main reasons for missing work. Watery eyes and sneezing also had a moderately negative effect on their productivity at work. www.gpiag.org/journ/
Nail Gun Injuries Spike LONDON Plans to make degrees more compatible across Europe threaten the quality of medical education in the UK, reports the BMA in a statement made this month. The so-called ‘Bologna Process’, a Europe-wide initiative due to be implemented in 2011, aims to increase the ability of students to study and work abroad. If approved it would mean that all degrees would follow the same pattern of a three year Bachelors degree followed by a two year Masters. A medical student could thereby complete a first degree in England and continue their education in France. It’s a move that would disrupt medical training says Emily
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Rigby, Chair of the BMA Medical Students’ Committee: “Any attempt at an arbitrary divide of a UK medical degree wouldn’t work - a student wanting to move could end up missing out on a really important part of his or her education.” Recent changes have moved undergraduate medical education in the UK towards an integrated model of clinical and basic science - which UK academics believe is ahead of the separate approach on continental Europe. “Trying to standardise medical education across Europe would be terrible for the UK - it would take us back ten years,” says Rigby. UK education ministers will meet later this month in London to discuss the declaration.
Injuries from nail guns in the USA have almost doubled since 2001 according to the National Institute for Occupational Health and Safety. Just under 15,000 ‘weekend carpenters’ with nail gun injuries are admitted to emergency rooms. Around 96 percent are male with an average age of 35.
“Trying to standardise medical education across Europe would be terrible for the UK - it would take us back ten years” Emily Rigby Chair BMA Medical Students Committee
www.cdc.gov/niosh/
Cut pocket money Youths who receive more than £10 a week in pocket money and who buy alcohol for themselves are more likely to become 'problem drinkers', according to a survey of over 10,000 teenagers by Liverpool John Moores University. www.ljmu.ac.uk
JuniorDr The NHS
The NHS Going, going, gone?
Cutting hours won’t stop exhaustion or mistakes
LONDON The majority of NHS care will be private in ten years’ time, believes half of junior doctors questioned by the BMA. Nine in ten of the thousand polled feel the role of the private sector in the NHS will continue to grow but only 15 percent believe this will benefit patients. Many felt privatisation would affect their future career progression Around half did not see themselves working in the NHS in a decade with only a third feeling it would be through choice. Less than one in five thought doctors would automatically get a job in the NHS on completion of their training. “Despite the fact that the UK remains short of fully trained medical staff, the future for many junior doctors is looking pretty grim,” says Jo Hilbourne, chairman of the BMA Junior Doctors Committee.
LONDON European Working Time Directive measures aimed at cutting working hours won’t reduce junior doctor exhaustion or mistakes, according to a new study published in the Occupational and Environmental Medicine journal. They found that rota changes and night shifts were more influential than total number of hours worked in determining sleepiness among junior doctors and fatigue related clinical errors. Of the 1,400 medics questioned a third classified themselves as “excessively sleepy” - twice the rate of the general population. European Working Time Directives are due to reduce the maximum hours worked by UK doctors from 58 hours to 48 by 2009. One in four said they had fallen asleep at the wheel of their
car whilst driving home with a further two-thirds saying they had been close to falling asleep. Night shifts were found to have increased the risk of sleepiness whilst driving by a half, and shift changes increased the risk of error by a third. Two-thirds said they had made a mistake associated with fatigue, with nearly half stating that this has been in the last six months. “Long work hours are not the
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only aspect of work patterns that needs to be managed to reduce sleepiness and fatigue-related clinical errors among junior doctors,” said Dr Phillip Gander, study co-ordinator. “The findings support the view that a more comprehensive risk management approach is needed to reduce doctors’ sleepiness and improve patient safety.”
The Pulse
The NHS
JuniorDr The Pulse
Journal Review Be dirty, be happy LONDON Treatment of mice with friendly bacteria, normally found in the soil, altered their behaviour in a similar way to antidepressant drugs, according to a report published in the latest issue of Neuroscience. The study arose after human cancer patients being treated with the bacteria Mycobacterium vaccae unexpectedly reported increases in their quality of life. On examination of the mice they found that treatment with M. vaccae activated a group of neurons producing serotonin - a major neurotransmitter regulating mood.
> Mycobacterium vaccae
“These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health,” says Dr Chris Lowry, lead author on the paper from Bristol University. “They also leave us wondering if we shouldn’t all be spending more time playing in the dirt.” www.bristol.ac.uk
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Compressions without mouth-to-mouth best for out-of-hospital arrests CHICAGO Chances of surviving a cardiac arrest outside a hospital are almost twice as high if bystanders perform chestcompression only resuscitation instead of traditional CPR, according to research published in The Lancet. The study analysed the outcomes of over 4,000 resuscitation attempts in Japan performed by laypeople at the scene after they witnessed a collapse. It is the first trial to compare survival rates of cardiac arrest patients with and without mouth-to-mouth ventilations as treated by bystanders. 19.4 percent of patients survived with a favourable neurological outcome if bystanders administered chestcompressions only, compared to 11.2 percent who received chest compressions and mouth-tomouth breathing. Dr Ewy, director of the Sarver Heart Centre at the University of Arizona, has long advocated chest-compression-only resuscitation for out-of-hospital cardiac arrest, “We have found that the survival rate is higher even when the blood has less oxygen content, but is moved through the body by continuous chest compressions, than when the blood contains a lot of oxygen but is not circulated well because chest compressions are interrupted for mouth-to-mouth ventilations.” He believes eliminating the need for mouth-to-mouth should also dramatically increase the
incidence of bystander resuscitation attempts. Studies have shown that the majority of people would not perform CPR on a stranger, partly out of fear of contracting diseases. The researchers continue to recommend guideline CPR including pulmonary ventilation for respiratory arrest events such as near-drowning, drug overdose or choking. “For cardiac arrest, the term ‘rescue breathing’ is actually a paradox. We now know that not only is it not helpful, but it’s very harmful,” says Ewy. “It is also very interesting to find how a sizeable group of laypeople, by spontaneously performing a technique that has neither been taught nor formally endorsed, achieved better outcomes than with a technique that has been advocated and taught at a cost of millions of dollars and millions of man-hours.” www.lancet.com
“For cardiac arrest, the term 'rescue breathing' is actually a paradox. We now know that not only is it not helpful, but it's very harmful.” Dr Ewy Director, Sarver Heart Centre University of Arizona
JuniorDr
Aggression, not celebration fuels alcohol use CARDIFF It’s aggression, not the outcome of a match, that fuels drinking among rugby spectators, according to a study published in Criminal Behaviour and Mental Health. The survey of 200 male rugby supporters at Cardiff’s Millennium Stadium found that spectators in the winning and drawing groups rated themselves as more aggressive than those whose team just lost. More aggressive spectators have been shown to drink more alcohol after the match. “It appears that aggression, not celebration, determined how much spectators planned to drink after the match,” says lead author Simon Moore, of the Violence Research Group, Cardiff University. “These results are also consistent with events around the world which have seen the fans of
Children who sleep more weigh less, according to research by Northwestern University. They found that sleeping an additional hour reduced young children’s chance of being overweight by a third. The study looked at over 2,000 children and excluded confounders including social class, education and race. www.srcd.org
Walk-in ... slowly
winning teams run riot after the match.” The authors say the results could have important implications for crowd control. Threats of future punishment will have little influence based on this model and rapid deployment of police and on the spot fines could be more effective, suggests the team.
Happy and hypotensive WARWICK Blood pressure is directly linked to a nation’s overall happiness, report researchers at the University of Warwick. The researchers drew on a study of 15,000 people from across Europe which looked at happiness indicators and found that results correlated directly with blood pressure. Sweden, Denmark and the UK rank at the top of this blood pressure based happiness league while Germany, Portugal and Finland come bottom. The research is the first to demonstrate that there is a connection between nations’ happiness and blood-pressure levels. The researchers believe that it could offer a way for policy makers to move away from simply focusing on GDP.
Stay in bed and stay slim
“Maybe economists and doctors are going to have to work together in the design of future economic policies,” said University of Warwick Economist Professor Andrew Oswald. www.warwick.ac.uk
> Blood pressure happiness Sweden Denmark UK Netherlands Ireland Luxembourg Spain Greece Italy Belgium Austria Finland Germany Portugal
NHS walk-in centres do not shorten waiting times for GPs in primary care, according to a study published in the BMJ. They suggested the centres created more demand by seeing patients who would not otherwise have attended for healthcare, or duplicated services where patients are referred back to their GP. One of the initial aims of walk-in centres was to speed up access to community GPs. www.bmj.com
Smoking makes you sick Smokers clock up almost eight additional days of sick leave each year than their non-smoking colleagues, according to a study in Sweden. The study of 14,000 workers showed 11 additional days of absence for smokers but this was reduced to eight after allowing for confounders such as socio-economic status and poorer underlying health.
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Computer says “no” A computer predicts the wishes of incapacitated patients better than family or loved ones, according to a study by the US National Institutes of Health. After being provided with demographic data and personal characteristics the computer calculated the correct patient choice in over twothirds of cases - more accurately than relatives. www.plosjournals.org
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Migraine memory master Women with a lifetime history of migraine show less of a cognitive decline with time than women without the condition, according to a study by the American Academy of Neurology. Medications such as ibuprofen, which is suspected to have a protective effect on memory, may be partially responsible for the result say the researchers. www.aacn.org
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JuniorDr Features
Escape MTAS
- your alternativ No job security? Expected to uproot your life at short notice? Slaving long hours and weekends without any thanks? ... sounds like you’re working for the NHS. The latest survey shows that nearly half of us don’t see ourselves employed by the NHS in a decade anyway, so maybe now is the time to get out. If you do decide to make the break the good news is that as a qualified doctor you are very employable in fields allied to and also totally separate to medicine. Choosing a new career, however, can involve soul searching, important decisions and lots of applications - though thankfully none via MTAS. JuniorDr’s Steve Ginn offers some advice Why leave medicine? It’s a mistake to think that in other fields you’ll automatically earn more money, work less hours and have less stress than in the NHS. High pressure City jobs can make a Friday night A&E shift seem like child’s play. Consider why you want to change your career. You may vow to dump your GMC registration many times but is the
> Celebrity former doctors Working in the arts > Harry Hill - comedian, wears shirts with big collars > Tony Gardner - actor > Jonathan Miller - author and theatre director > Michael Crichton - writer, film director, TV producer In parliament > Liam Fox (shadow Defence Secretary), Howard Stoat, Richard Taylor and Andrew Murrisford In management > Over half a dozen trust chief execs
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dissatisfaction a permanent disillusionment or simply a temporary blip? House jobs are well-known to be an almost universally miserable experience and you may find that you enjoy being a doctor when you’re no longer bottom of the pile. If it’s the people you work with that are the problem, then think yourself lucky that you’ve the opportunity to move posts every six months, rather than being stuck in an office with them permanently. If you’re still not convinced remember that the European Working Time Directive
and MTAS are, in theory, meant to improve life and careers for us doctors. It is still possible that things may improve after the fallout from MTAS settles. Escaping your stethoscope If it’s medicine that you want to see the back of then a career in a totally new field is an obvious choice. As an employee (and patient) the NHS can be very frustrating experience and can often be very slow to adapt and hierarchical. People stay junior for much longer with less responsibility than they might expect to have in the private sector. In terms of the disadvantages of leaving medicine it actually pays very well compared to other careers. This only becomes clear when trying to find a job outside the profession with an equal salary. You may also no longer get the same status and respect that you enjoyed whilst a doctor. Despite all our complaints, hours are relatively fixed in medicine and legally protected. In contrast you may find yourself at the whim of private sector bosses working through annual leave and weekends. With the exception of the recent MTAS debacle, job security is relatively good as a doctor and it’s
surprisingly hard to be fired. Outside medicine you run the risk of being only as good as your last annual appraisal. Finally, it is worth considering the sort of personality you have and how well you gel within new environments. Within medicine idiosyncrasies are tolerated, even celebrated, whereas in the private sector they may make you rapidly unemployable. What's out there? A good place to start searching for a new career is your old university careers office where you’ll often be able to use their facilities free for a number of years following graduation. You may also be able to book an appointment to see a graduate careers advisor, pick up leaflets and check out careers fair details. Graduate careers fairs are a great way to see what’s available and to speak to potential employers faceto-face. Also, talk to your friends in jobs where you have an interest. There’s nothing better than a personal recommendation if you do decide to apply. What do you have to offer? Surviving five years at medical school counts for a lot, as does that all important ‘Dr’ in front of your name. Many of your skills will be transferable to most professions. The day of an average doctor actually includes a large number of
Pharmaceutical Industry
ve career guide
different abilities - here’s just a few you can mention if anyone asks: Working in teams - Quote the infamous ‘multi-disciplinary team’ and also ward rounds and weekends teams on call. Time management - A skill used to finish the team round, ward jobs and checking the bloods all in time for ‘Countdown’ in the mess. Problem solving - Recall that time you sorted out who would look after Mrs. Smith’s dog when you decided she needed to stay in hospital? Decision making - Is this tricky enough to call the consultant? Communication skills - Talking to angry relatives is something even the most talented politician would struggle with. Data analysis - Don’t forget all those ECGs that nurses constantly stick under your nose. Working under pressure - When are we not! Using Your Medical Knowledge Despite wanting to hang up your stethoscope understandably a lot of medical graduates are keen to pursue an allied career to medicine. Unfortunately entry can often rely on a substantial amount of medical practice or further qualifications. Possibilities include: Alternative and complementary medicine - You’ll need another qualification for this, but your medical knowledge is useful especially if you have experience
of anatomy or physiology. Civil service management and medical politics - There are openings in government for people interested in health policy, management or administration. A significant amount of medical experience is necessary to get senior posts however. Medical journalism, publishing and informatics - A competitive field to get into but attractive if you fancy seeing yourself in print. Pay is poor except for a prominent few. Medical law, medical defence organisations and ethics - The demand for medically trained lawyers is likely to increase over the coming years. To enter this field a professional qualification and period of vocational training is required. Medical research charities Your work here could include developing and administering research programmes, fundraising or working to raise public awareness. Pharmaceutical firms - There are three core areas in which pharmaceutical physicians specialise: clinical research (trials on new treatments prior to market launch), ongoing medical support for marketed products and pharmacovigilance (drug safety for prelaunch and marketed products). It’s worth remembering that once you’ve done all your research and thought about your options, you can always decide to stick with what you’ve got. Just
I had always thought about working as a doctor in the pharmaceutical industry. When I reached the end of my SHO rotation, I thought this would be a good time to start investigating this little known branch of medicine. Name: My job is varied and has a Sean Knox number of aspects. I support Employer: ongoing work with existing GlaxoSmith Kline drugs making sure that Job Role: promotional material is Medical Ad visor medically and scientifically in Diabetes accurate and complies with industry guidelines; I train and produce teaching materials for sales representatives and visit doctors who are authorities in diabetes in order to gain insight into what is happening in clinical practice. I travel quite a bit, both locally and internationally, attending meetings and conferences. I feel that as a medical doctor working in industry I can have a lot of influence on future treatments and so create a much broader benefit for patients than I was able to working within the NHS. I do sometimes miss the clinical aspects and patient contact that was part of my previous role, and in order to keep my hand in I do the odd locum. “Working in industry I have just become a member of the I can have a lot of Faculty of Pharmaceutical Physicians. This will allow me to do the diploma in influence on future pharmaceutical medicine (Dip Pharm treatments and so Med) which will be the first step in create a much higher medical training to become a consultant in pharmaceutical medicine. broader benefit for I don’t miss the frustrations of patients than I was working in the NHS, especially the lack able to working of resources and the bureaucracy. I find it stimulating working in an within the NHS” environment where most people who work with me have no medical background, yet we are all working toward benefiting patients’ lives. This leads to a broad range of opinions and allows us to examine any issue from all angles. It still feels foreign to me (and I hope it continues to do so) to be in an environment which is very sales driven. But that’s why the industry employs doctors to bring about the necessary balance. The remuneration in working for the private sector is much better and my starting salary was approximately 30 percent higher than my previous NHS salary. I also get excellent benefits, including a car allowance, a bonus and private medical cover. If you are interested in working for the pharmaceutical industry you will need to have worked as a doctor for three years post foundation training. The best place to start is by talking to doctors who are currently working in the industry and by visiting company websites. The British Association of Pharmaceutical Physicians (BrAPP) website also is also a great resource for anyone wanting further information. There are agencies that specialise in placing doctors working in clinical medicine into industry of which the web addresses are: www.onlymedics.co.uk www.axess.co.uk www.thersagroup.com
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the knowledge that there are wide options available for you may help. Change of mind You may find that those you talk to are surprised that you are thinking of giving up medicine which is still looked upon as a vocation rather than a job and thus something you don’t really ‘leave’. Some former doctors report that even years after leaving the profession they are still called up about their friends’ sick children. If you are serious about a career change it’s often a difficult mindset to change.
Useful Links www.bmjcareers.com - For medical jobs UK and abroad. It has a useful careers advice section and case studies of careers available to doctors These all offer jobs right across the spectrum and give an idea of what’s out there www.reed.co.uk www.monster.co.uk www.guardian.co.uk/jobs
Expert advice o n seeking an alte rnative career Dr Simon Eccles Author, ‘So You Want to be a Br ai
n Surgeon?’ > Be clear in yo ur own mind ab out your reason wanting to leav for e medicine. > Have a clear idea of what it is you’re getting in of research and to (do lots talk to others w ho have taken th intend to take). e step you > Have a plan fo r how you’re go ing to get out (a leaving date, pe targeted rhaps after getti ng a qualificatio on a whim) and n, and not how you might get back. > If you really w ant to do this th en don’t get put senior doctors w off by ho will predict the end of the w leave! orld if you
Medical Media As a doctor I had practiced in obstetrics and gynaecology, anaesthetics and finally psychiatry in which I also worked as a researcher. Unfortunately as a South African national I found that I was not able to gain employment on the rotations of my choice and so decided to think of other possible directions. I now work as an Editoral Registrar for the British Medical Name: Kirsten Pa Journal. This is a one year trick training post which allows Employer: experience of working in BMJ medical publishing. The BMJ Job Role: receives between 8,000 and Editorial 9,000 submissions a year, Registrar which all need to be read by editors (less than 40 per cent are sent out for review) and this is a major part of the job, but there are also opportunities to commission articles and write as well. So far I have found the job to be very enjoyable. I find my days to be more intellectually stimulating than they used to be when I was an SHO. Although it is not essential to have journalistic experience for my job clearly anything you have done will help you stand out from other candidates. I used to run a community magazine with my husband and also “I find my days to be run and maintain a website. Given the more intellectually number of papers I read, research stimulating than they experience is also a big plus. My position does have some used to be when I was disadvantages. The biggest is that I an SHO.” would be de-skilled if I ever wished to return to clinical medicine. It also has no patient contact and I sometimes find myself missing this. The position does undertake to have equivalent pay to the same level in the NHS, but in the long term remuneration versus the NHS is probably less. At the end of the year there is no guaranteed job but many previous editorial registrars are now employed here or in one of the other BMJ Journals group of companies. Other previous post-holders now work as freelance paper readers.
The City When I left medicine to join McKinsey I had been working as a medical registrar in Hepatology and Transplant and was also doing a PhD. I had been qualified for eight years but felt ready to move on as I had been finding the specialised nature of my job too narrow and felt that a change of career would offer new opportunities and challenges. Management consultants advise businesses about improving their performance. This could be concerning areas as diverse as company finance, strategy, operations or organisation. After six years with McKinsey I am now a partner and travel widely, working with several different sectors including Biotech, R&D and NGOs. In my new career my medical training has been very helpful, especially when I have been working on healthcare projects, but I have also found the ‘softer’ communication skills that it taught me useful. It was a difficult decision to give up my career in medicine. Other people’s reactions were mixed and I did have some initial doubts. However I would now say that I am 100 percent pleased with the choice I have made - I only miss medicine very occasionally. My working conditions and hours are much improved and although my average days are longer than they were, they are less regimented and I am no longer subjected to on-calls Name: or have to swap shifts in order to go on holiday. My salary is also much higher than Mubasher Sh “My salary is now it would have been had I continued to work for the NHS. eikh Employer: If you are interested in a career in management consultancy the best place to much higher than McKinsey & Company it would have been start is by doing some internet research. Companies like McKinsey are very Job Role: interested in recruiting people with varied backgrounds and having had a previous Partner had I continued to career is likely to be more of a help than a hindrance. www.mckinsey.com work for the NHS.”
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RSMtrainees Benefits of Joining the RSM Welcome to the Royal Society of Medicine As a charity set up to provide a broad range of education activities for medical professionals, The Royal Society of Medicine is dedicated to helping young doctors develop and progress their careers, we strive to make it the perfect environment in which to enhance your skills and improve your future prospects. The major changes brought about by MMC also present new challenges for those responsible for providing appropriate educational opportunities for Trainees, like the work done here at the Royal Society of Medicine. The difficulties, disruption and anxiety currently being experienced by doctors entering specialist training have brought into sharp relief the Royal Society of Medicine’s programmes for Trainee education. In addition to the substantial number of meetings and prize evenings already attended by trainees, new activities are now being considered by a recently formed Young Fellows Focus Group. John Scadding, Academic Dean, The Royal Society of Medicine Visit www.rsm.ac.uk/yf for more comments from the Dean
Prizes RSM Academic and Research
Meetings for Trainees
Surgery Section
Coloproctology Section
Submission Deadline: 3 September 2007 Prize: £250
Submission Deadline: 1 October 2007 Prize: Travelling Fellowship to American Society of Coloproctology and Rectal Surgeons Annual meeting
11 June Autopsy Day (Histopathology)
Geriatrics & Gerontology Section Submission Deadline: 28 September 2007 Prize: Engraved Decanter and one year's membership to the RSM
Urology Section Submission Deadline: 12 October 2007 Prize: RSM travelling fellowship to the RSM Urology Section spring overseas scientific meeting
RSM Young Fellows/Trainee Membership -
(spaces available)
16 June Win the publication game (spaces available)
20 June 10th National Registrars' and New Practitioners' study day (spaces available)
25 June Teaching Skills for Doctors (spaces available)
7 July Interview Skills Training Day (spaces available)
7 July MTAS Conference (spaces available)
Visit www.rsm.ac.uk or call 020 7290 2991
• Unique networking opportunities with other medical professionals at all levels • Over 350 medical education meetings every year in over 55 specialties • Career development meetings especially for Young Fellows • Over 65 Society Prizes annually • Interaction with MMC and update meetings • Use of the renowned RSM postgraduate medical library and e-facilities
The RSM has a graduated membership for Young Fellows, depending on the date of your qualification, starting at just £65 pa. We also offer a 50% discount on your subscription rate if you are temporarily out of work, enabling you to continue using the RSM training, networking and library to further your career at a lower rate. Visit www.rsmmembership.org for more information.
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Escape MTAS - work overseas South Africa
in rural South Africa. Having clinical, travel and life experience Take some time abroad and gain nce. Many rural hospitals erie exp of the pros and cons of the re awa am I e, s ther ked wor and trained geographically breathtaking part at all levels, despite often being in ad. abro g goin re have a shortage of medical staff Years befo ple finish at least their Foundation experience of Africa. I recommend that peo ca are: significant gains in clinical Afri th Sou in k wor to ding deci tors doc burnout!); UK are for bew ons (but reas n ts mai The community; no EWTD limi and f staf dly frien ; ents pati e and competence; appreciativ ch e opportunities. ; and impressive touristy/lifestyl lth Initiative (www.rhi.org.za), whi ries sala reasonable South Africa, called the Rural Hea in d ined base obta tion are s nisa visa orga k it Wor prof s. I volunteer for a not-fororientation and relocation processe st with the application, placement, interests, and goals with employs a team of recruiters to assi doctors' skills, level of experience, g chin mat s ude incl the nt eme Plac . London inistration of the work permit at at the South African Embassy in than a small cost to cover adm r othe , free ided prov is ice the pool of vacancies. This serv y are free online at Embassy. es in greater detail. The issu e thes er cov ch whi Greg Lydall I have written 2 articles, t/332/7548/174. prin gi/re m/c j.co s.bm focu reer http://ca
Australia & New Zealand I worked in Melbourne, Australia for a year and a half after my house jobs. I found the post by applying directly to a district general hospital in Melbourne with my CV. During my time there I had the oppo rtunity to do posts in Neurology, A&E and ICU. High staffing levels in A&E meant that we were able to investigate, diagnose and manage patients before referring them on for specialis t treatment - in this way, I gained a wide range of clinical experience. On my salary I was able to live in a shared flat, with a pool and gym in the apartment block, and also had the opportunity to travel all over Australia (my ICU placement was a 1 week on, 1 week off rota, so I went on holiday every other week!) I would highly recommend Australi a as a brilliant place to work and play. Amanda Sinai Resources www.doctorconnect.gov.uk www.genevahealth.com.au
Canada I enjoyed my medical school elective in Canada so much that I went back during my SHO years. Canada does have a shortage of doctors at the moment, especially in rural areas, so it’s definitely a place to consider. For most long-term posts in Canada you’ll need to sit exams but you can get a temporary licence to practise. I was lucky as I had an offer from a residency program which involved some clinical and research work and managed to avoid this. Requirements do vary by province so do some research. You’ll notice a difference in the way doctors practice too - there’s more time to talk to patients and carry out complete investigations. Don’t rule out rural posts - they’re often better for experience and not as stressful as an city placement. One thing that continued to shock me about Canada is the size - it takes almost the same length of time to fly from one coast to the other as it does from the east coast to the UK! If you like the outdoors you’ll love it. There’ll be plenty of opportunities for skiing and hiking. I left a few months for travelling after so consider that too. I’m still planning to move back there, hopefully after I finish my GP training, so it can’t have been that bad! David Marek Resources www.healthmatchbc.org
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Wanna bet? - gambling with addiction A quarter of a million new gamblers are expected following the Government's controversial decision to permit a Las Vegas style resort casino in Manchester, along with 16 other new casinos throughout the rest of the country. It has led to fears that the UK's relatively low prevalence of problem gambling will more than double in line with the United States. JuniorDr’s Michelle Connolly takes a look at pathological gambling, a psychiatric diagnosis, and speaks to Europe's only professor of gambling studies, Mark Griffiths.
Gambling - ‘the act of risking the loss of something of value on an uncertain outcome in the hope of winning something of greater value’ - isn’t new. Records show the ancient Chinese were placing bets back in 3000BC and even the Egyptians enjoyed a flutter in the shadows of the pyramids. In fact, whole countries have been decided on the roll of the dice. When the kings of Sweden and Norway couldn’t agree on the ownership of land in 1000AD a roll of the dice turned entire towns over to the Vikings. Today the acceptance of gambling varies around the world. Some Islamic nations prohibit gambling and the vast majority impose some form of regulation. In the UK, regulation first started when Henry VII banned his soldiers from gambling when he found they were spending more
time placing bets than training. This year the government is taking the unprecedented step of relaxing legislation. When is gambling considered pathological? Pathological gambling (PG) was first listed as a psychiatric diagnosis in 1980. It is an addiction to the altered psychological state experienced whilst gambling - similar to the high gained from narcotic substances. Just as a drug addict needs more of a psychoactive substance to get high, the problem gambler must place higher and higher wagers in an attempt to win back lost money - a term known as ‘chasing losses’.
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then as lottery fever gripped Ireland in 1987, he increased the amounts he was gambling. “It was turf accounts [horse betting] initially. I’d place up to £5 twenty years ago. Then the Irish lottery began and I would increase my bets to £500,” he says. But it was the advent of online gambling which made Patrick’s gambling addiction worse. “I'd bet up to £5000 online at a time, and larger sums on the horses; I’d bet on anything that moved.” The Rush Many gamblers are addicted to something specific which influences the type and form of gambling. For Patrick it was the excitement of the event and chance of a big win. “I had such an adrenaline rush when the events I had bet upon were coming to their conclusion,” he says. “I nearly passed out one day when a horse was involved in
Consequences
“ I used to nip home to place bets until I found out that I could bet on my mobile and even then I was constantly checking results. Colleagues thought I was cheating on my wife.” Patrick Diagnosed Pathological Gambler
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Afflicting just under one per cent of the UK population, pathological gambling is a chronic, progressive disorder more commonly found in patients being treated for alcohol or drug dependency. The personal and social consequences are obvious (and enormous) - suicide, divorce, bankruptcy and criminal behaviour. Understanding the thought process of problem gamblers is often difficult to grasp, even for doctors. Those affected will commonly gamble their money used for basic needs, such as food, as in their minds this has become the only way to provide more food. It’s common for pathological gamblers to have a long history when they present, up to 20 years in many cases. Men typically start gambling 10 years before women, and seek help three years later. Patrick, a recovering gambler, spoke candidly to JuniorDr about his addiction: “I lived in Curragh, Ireland, an area famed for its horse racing. Gambling is second nature to most people there,” he explained. He started betting on horses,
up, I had already made the decision to stop though, as I was getting suicidal thoughts and hated my life.” Despite his own experience Patrick is not opposed to the Government’s plans to build a Las Vegas style super casino in Manchester: “Everyone has the right to be entertained by whatever form they wish. It would be foolish to ban any activity to protect the few who don’t know when to stop.” Patrick feels the best way to get a problem gambler into recovery is to try all possible treatments, and to find one that works for them. “After the person has accepted they have a problem, all avenues should be explored: GA, counselling and treatment centres. I don’t think there is one best method,” he says. “I suffered a physical, mental and spiritual decline and am now on the road to recovery one day at a time.”
Betting is the most popular form of gambling, with £47.7 billion staked in 2005; in the same year, £4.9 billion was wagered on the National Lottery Source: Gamcare
a photo finish for £5000 which I lost.” Many gamblers gradually develop a deepset belief that they will win: “I began to make plans for a house by the coast and giving up work. When I went to GA I heard many similar stories of people convinced they’d inhabit their fantasy world once they’d won big.” “My work suffered as I was always thinking about my gambling. I used to nip home to place bets until I found out that I could bet on my mobile and even then I was constantly checking results. Colleagues thought I was cheating on my wife,” he adds. “I had got to the stage where I neglected everything. I was at my computer as soon as I came in the door, my wife didn’t mention anything in the beginning, but I started making excuses for not going out; in the end I didn’t even care if she left me. She asked if I was gambling again and I owned
“Incidentally,” he points out, “I meet a lot of gamblers in Alcoholics Anonymous; I believe it is very common to replace one addiction with another.” Liberalised laws The new Gambling Act will be fully implemented by September 1, 2007. It updates existing regulation to enforce protective measures for newer forms of gambling, notably online gambling. Three new types of casino will be licensed: the regional, or 'super casino', which will be located in Manchester, and the large and small casino; there are to be eight of each. The maximum jackpot permitted in gaming machines in the latter two will be £4,000. The Act’s aims are to keep gambling crime free, to ensure that gambling is fair and open, and that vulnerable adults are protected. The seventeen new
On average each pathological gambler will ‘severely’ affect the lives of 15 others to support their gambling Gamblers Anonymous
casinos are to be monitored through a social impact study. Outline of plans for Manchester The city’s Beswick area will be home to a casino with up to 1,250 unlimited jackpot machines. The complex will include restaurants, swimming pool and an urban sports venue alongside the usual expected increase in the number of bars and nightclubs. The city’s bid organisers promised the ‘resort’ casino would create some 2,700 jobs. The race to win the license to operate Manchester’s supercasino is already underway, with betting firm Ladbrokes currently leading the pack. Betting nation Gambling looks set to play a more dominant role in Britain's future landscape. Advertising can commence in 2007, and Ryanair's maverick chief executive, Michael O’Leary, has announced that passengers will be able to gamble midflight as a means to offset airfares. The British Medical
Association has warned that the relaxed regulations will herald a rise in addictions which must be countered by better addiction services, which currently even fail to screen for gambling. Dissatisfied with the Act’s aim of raising £3 million annually for the Responsibility in Gambling Trust, the main treatment funding body, the BMA called for a £10 million annual contribution. Culture Secretary Tessa Jowell tried to re-assure parliament that Britain wasn’t gambling with its mental health: “Las Vegas is not coming to Great Britain. British casinos will be under the strictest controls in the world. Tricks of the trade will not be allowed. There will be no free alcohol to induce more gambling, and no pumped oxygen to keep players awake.” She also has indicated that if the loosened gambling law results in an increase in Britain’s relatively low problem gambling incidence, she will shut them down. JuniorDr spoke to Professor Mark Griffiths, a gambler himself, based at the International Gaming
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> Medical care in the UK Junior Dr invited members of the GamCare forum to talk about experiences of approaching their GP. Susie “I sat there in tears saying ‘I don't know how much longer I can carry on’ and my GP said, ‘See how you feel tomorrow and let me know if we can help’ , as he got up, signalling the end of the appointment. I spoke to a different doctor a few days later who signed me off sick and referred me for counselling. I’m lucky in that my company pays for private therapy for ‘addictions’ (even at The Priory if necessary) but you do need a GP referral first. If I hadn’t gone back to the second doctor I wouldn't have got that referral.” John “I told my GP that I was suicidal and all I got was a lecture on how gambling was ‘very very bad’, no offer of counselling; he didn't give me any phone numbers where I could receive help and refused me sleeping tablets and anti-depressants. Later that day I was very close to attempting suicide. I won't be going back there for support; I’ll stick to GA and GamCare for help.”
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JuniorDr Features Mark Griffiths International Gaming Research Unit Nottingham Trent University
Research Unit, Nottingham Trent University. “I do gamble, but only because I am buying a form of entertainment,” he says. “My sole aim is not to win money. If one enters a casino with the sole aim of winning money, then one is much more likely to become addicted than if the evening at the casino is treated as simply a ‘night out’, an alternative to the pub.” When the National Lottery was launched in 1994, it sparked a similar outcry. Medical journals received many letters from doctors worried that we’d turn into an offshore Las Vegas. “That was all very knee-jerk. You cannot become addicted to something that takes place only twice a week,” asserts Professor Griffiths. “You can never ever become addicted to the National Lottery, but you can become addicted to buying tickets.” Six years after the Lottery’s introduction the British Gambling Prevalence Survey, in which Professor Griffiths was involved, found that less than one percent of the adult population were problem
gamblers but that amongst adolescents, the figure was as high as five percent. “A study found that some 15 year olds got a buzz from buying lottery tickets, which was heightened as they were doing it illegally and it was this feeling to which they were addicted,” he explains. Griffiths wants a loophole in the Act to be closed that allows children to gamble on slot machines in arcades and leisure centres. He feel this is imperative given that slot machines are the most damaging form of gambling: “Slot machines are the crack cocaine of gambling because of the high event frequency - you can gamble twelve times in a minute, and the machine manufacturers build in ‘near misses’ that give the impression that you're close to winning.” Medicalisation Pathological gambling is a specific psychiatric diagnosis. It falls into a similar category as schizophrenia and depression. Many argue, however, that the
medicalisation of gambling is a step too far. “I’m not trying to medicalise gambling,” he says. “But this behaviour is pathological. I receive lots of calls from the media about gardening, internet and sex addicts - that’s the medicalisation of society for you! But with those ‘addictions’, they’re not addicted in the pathological sense, as they don’t exhibit the classical signs of dependency.” “Gambling is particularly debilitating, as there is a big financial loss involved; if one is addicted to the internet, the only loss is time. Furthermore, problem gamblers often engage in criminal activity to recoup losses. The same cannot be said of being addicted to the internet or sex. And very few video games addicts fulfil all the criteria of addiction, i.e. they do not suffer withdrawal, nor do they become tolerant.” Addictive personalities Many gamblers excuse their actions stating that they simply have an ‘addictive personality’,
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JuniorDr the same footing as other forms of addiction. People understand that you can be addicted to a substance,” he says. “But they find it hard to see how someone can be addicted to the high that the action of gambling causes." “I am not anti-gambling,” he emphasises. “I even gamble myself, but I believe that the protective mechanisms need to be enhanced and the intoxicated must be stopped from gambling. People are owed an informed choice: they should be told the chances of winning.”
NHS Treatment
“The current £3m-a-year allocation equates to only £10 for each of our 300,000 problem gamblers per year. This is entirely inadequate,” says Griffiths. As Britain relaxes its legislation doctors must inform themselves about pathological gambling and its consequences. Many are unsure about the consequences of the change in the law - but everyone hopes it’s a gamble that will pay off.
Questions remain on how well the NHS is prepared for the new gambling legislation. Professor Griffiths recalls how, on registering with a new GP, he was asked whether he smokes, drinks or takes illicit substances, but not whether he gambles. “Doctors certainly do not receive enough training in tackling addictions. The NHS urgently needs to put gambling on
References Professor Griffiths authored the BMA report Gambling addiction and its treatment within the NHS, which can be downloaded h e r e : www.bma.org.uk/ap.nsf/Content/gambling addiction Beaudoin, C & Cox B (1999) Characteristics of problem gambling: A preliminary study using DSM-IV based questionnaire. Canadian Journal of Psychiatry, June 1999. Lesieur HR, Rosenthal RJ: Pathological gambling: a review of the literature (prepared for the American Psychiatric Association Task Force on DMS-IV Committee on Disorders of Impulse Control Not Elsewhere Classified). Journal of Gambling Studies 1991;7:5-39.
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but it’s not something Griffiths believes in: “I don’t believe in the concept of an addictive personality," he says. “People who are addicted to gambling exhibit traits that are not unique to addiction. There is no evidence that there's one personality trait that points to an addictive personality. Addicts often use the addictive personality as an excuse for their behaviour." "Problem gambling shows all the traits of addiction to alcohol or psychoactive substances. In addition, studies have shown that SSRIs such as fluoxetine are effective PG therapies.”
> Resource guide Help for clients Gamblers Anonymous gamblersanonymous.org.uk Offering support since 1964. Gam Anon www.gamanon.org.uk 08700 50 88 80 For those affected by another person's gambling. GamCare www.gamcare.org.uk 0845 6000 133 Provides online chat rooms as an outlet for problem gamblers to talk to others, and residential programs.
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order online @ www.pastest.co.uk uncommon; immediate failure arises from excision of a structure other than the vas or presence of a duplex system. Late recanalisation occurs in around 1:2000 patients. Other risks include haematoma, infection and persisting orchalgia in 15% of patients. 4. A D The cardinal features of acute arterial occlusion are remembered as the 6 P's: pallor, paraesthesia, paralysis, pain, pulseless and 'perishing with cold'. Unlike chronic atherosclerotic stenoses there is insufficient time for collateral vessel development, resulting in loss of tissue viability. Upto 6 hours of leg ischaemia will produce a painful, pale limb that may have sensory deficit. After 6 hours the limb will develop mottling. At around 12 hours the leg will develop non-reversible tissue injury and compartment syndrome. Signs of irreversible tissue loss include: calf tenderness, weakness, fixed mottling and sensory loss. Depending on the clinical circumstance, management is either by surgical embolectomy with a Fogarty catheter or
focal thrombolysis via an intra-arterial catheter. Unlike coronary artery occlusion, systemic thrombolysis is not used. Initial management always includes heparin anticoagulation. 5. A C E Chest drain insertion into the 'safe triangle', the apex of which lies in the axilla, as defined above minimises risk of injury to the internal mammary artery and breast tissue, as well as being relatively more cosmetic. The incision and path of dissection should be made along the superior aspect of the rib to avoid injury to the intercostal vessels. Blunt insertion using a SpencerWells clamp or similar - rather than a trochar - to separate muscle fibres has become the standard method. Suction is useful for large air leaks. However, a low volume pump is inappropriate for rapid flow air leaks as it effects a situation similar to clamping and may in fact exacerbate a pneumothorax. Drain removal is carried out while the patient performs Valsalva's manoeuvre with a brisk, firm movement while an assistant ties the previously inserted closure sutures.
Workshop
Answers and Teaching Notes any type of surgery, but is particularly associated with prolonged immobility, 1. B D E pelvic/major abdominal surgery, surgery in Primary head injury is incurred at time of lithotomy or Lloyd-Davies positions, or any trauma, whereas secondary injury arises procedure for malignancy. It may occur later due to hypoxia, cerebral oedema and hours to days post-operation. Arterial blood infection. Initial management aims to gas typically shoes hypoxia with low CO2 minimise secondary injury prior to (increased respiratory rate). Chest X-ray is definitive treatment by optimising airway, commonly normal and helpful for excluding breathing and circulatory support and other respiratory pathologies. A positive Djudicious use of the osmotic diuretic dimer, although useful in non-surgical mannitol to temporarily reduce intracerebral patients, is non-specific following surgical pressure. trauma. A normal D-dimer is helpful Head injuries may be classified as mild (although not 100% specific) in excluding (GCS >12), moderate (GCS 8-12) or severe thrombosis. (GCS<8). In conscious patients, the absence of a skull fracture or confusion makes 3. B D E likelihood of intracerebral haematoma Vasectomy involves excision of a section around 1/6000. However the combination of of vas deferens with the aim of producing a skull fracture plus confusion or permanent sterility either under local or deterioration of conscious level is associated general anaesthetic. The results of with a 25% likelihood of intracerebral vasectomy reversal are unpredictable an haematoma. Cushing's response ( BP, pulse, often unsatisfactory. Spermatozoa present in respiration) is an ominous sign of rising the vas may take some time to be eliminated, intracerebral pressure. and therefore patients are counselled to continue using alternative contraception 2. A C E until two semen analyses (usually at 8 and Pulmonary embolism may occur following 12 weeks) are clear. Vasectomy failure is
A: Other modes of contraception can be abandoned one week following surgery. B: Long-term orchalgia occurs in 15% of patients. C: Reversal is usually effective. D: 1:2000 patients become fertile again due to recanalisation of the vas. E: Semen analysis is performed at around 8 and 12 weeks following surgery.
Q3 When discussing vasectomy with a patient: A: Associated with sudden onset of dyspnoea with or without chest pain. B: Arterial blood gas typically shoes hypoxia with high CO2. C: Chest X-ray is typically normal. D: Positive D-dimer is a helpful indicator of DVT and PE. E: CT pulmonary angiography is the gold standard investigation in most centres.
Q2 Pulmonary embolism in the post-operative patient: A: Severe head injury is defined as GCS<12. B: The presence of skull fracture and confusion in a conscious patient is associated with a 25% likelihood of intracerebral haematoma. C: Primary brain injury arises due to hypoxia, cerebral oedema and infection following trauma and secondary brain injury occurs as a complication of surgical management. D: Cushing's response is an ominous sign. E: 200mL of 20% mannitol is helpful for temporarily reducing intracerebral pressure.
Q1 When assessing head injuries:
ISBN 1904627846 Price: £22.99 Surgeon's Survival Guide to the Foundation Years Jonathan Ghosh, Michael Murphy
A: The 'safe triangle' for insertion is bordered by the anterior border of latissimus dorsi, the lateral border of pectoralis major and a line superior to the nipple level. B: Incision and dissection should be made along the lower aspect of a rib. C: Blunt dissection into the pleural cavity had become universal. D: A low-volume/low-pressure pump (e.g. Roberts pump) is appropriate for large air leaks. E: Drain removal is performed while the patient performs forced expiration.
Q5 Regarding chest drain insertion: A: The most likely differential diagnosis is acute limb ischaemia due to embolisation. B: Systemic thrombolysis is indicted. C: Heparin infusion should be deferred in case surgery is required. D: Signs of irreversible ischaemia include calf tenderness and fixed mottling. E: Lower limb symptoms lasting in excess of four hours would suggest irreversible ischaemia. touch. The patient has a history of atrial fibrillation and ECG shows this to be uncontrolled. have been asked to assess a patient with an Q4 You acutely pulseless, pale and painful leg that is cold to
Think you know the procedure for chest drain insertion? Or how to assess a head injury? This issue, in association with Pastest’s ‘Surgeon’s Survival Guide to the Foundation Years’, we bring you a selection of self-test questions to check your surgical knowledge.
R
in association with
Test yourself SPONSORED FEATURE
Wednesday
If you’ve been following this column, and I hope you have, you may be interested to know that James and I are now officially going out and have been for three months (actually quite a bit longer for me). He’s a senior researcher in my lab and we’ve managed to keep it hush for now, although I think the prof knows. That’s only because he knows everything. Everyone else is either in the dark or pretending very well. I spent most of the day grappling with those damn myocytes again. I’ve finally mastered the art of pipetting but still can’t do it and talk at the same time. My cells keep dying but at least my patients seem to do ok. If I leave these three years with no publications but a batch of surviving cells then I will consider it a success. I leave the lab late and watch a little television with dinner. I have a couple of glasses of South African Merlot and spend the first half of the night asleep on the sofa before I realise where I am and drag myself back to bed.
Today is my one clinical day. Angio suite all morning where things go smoothly. I'm doing them on my own now and that includes balloons and stents. A consultant has to be nearby but as I’ve worked here for two years now they just let me get on with things. I’ve only had one near miss so far. You have to be very careful when you’re moving wires around insides someone’s coronary arteries. I spend a few hours on the ward and do consults in the afternoon and one of them needs an echo. It feels good to actually work on real people for a change and is something I'm missing more and more as my time in research goes on. I drop by the lab to pick up some papers and someone
several hours of number crunching before leaving. James comes over to mine and we watch a movie, drink red wine and go to bed late. Friday A disaster at work. All my statistical analysis from the entire week is gone. Apparently I should have backed it up as every now and again one of the servers goes down and is wiped. As the data were all in a numbers programme backing it up wasn’t as easy as it sounds. I punch the keyboard with my fists and almost break it shocking everyone in the lab. I decide to leave for a coffee and drink this calmly whilst considering my options. I could stay in all weekend whilst the data is still fresh in my mind. But I was supposed t o
Features
The Secret Diary of a Cardiology SpR
Monday
Tuesday Meetings all morning. I smile at James during one of them but he pretends to ignore me. The grant proposals for the entire department are being finalised and everyone is getting worried about their jobs. I’m lucky as the funding from my doctorate comes from outside but I pretend to be nervous like everyone else. I spend the afternoon catching up on my data analysis. I have all these numbers from my experiments and the hard part is actually trying to make sense of them and working out if they are relevant or not. We have a statistician on our team but talking to him is like getting an explanation from a computer. I leave at five and meet James in town for a drink. We have dinner at a small Italian place where he seems to know the waiters very well. I wonder who else he’s taken there? We go onto a bar for drinks but leave early as he recognises someone from the lab. We end up back at his and don’t do much sleeping.
tells me that James is out for dinner. Which is strange as I’m sure he told me he had a lot of work to do tonight. I try calling his phone but decide against leaving a message when I get voicemail. I go home and go to bed early. Thursday I get in by eight and spend the morning in the lab. James’ sister came over last night and it turns out he was having dinner with her. I would have loved to meet her but he tells me that he’s not ready for this yet. I have to miss lunch as I’m running some experiments which can’t wait. My cells finally seem to be making it through. I get a false reading at one point and want to throw it out but have to include it so I can’t be accused of falsifying the results. I stay late to analyse some more data. I end up putting in
spend it with James. I can always stay late during the week. I decide to go with the latter option. The prof calls me into his office in the afternoon and we end up talking about a number of things. He tells me that he knows about James. He also tells me that he doesn’t have a problem with inter-office relationships but he also tells me to be careful. I ask him what he means but he declines to elaborate. It gets close to six and James calls to tell me that he’s meeting friends tomorrow and asks if he can put our weekend away on hold. I reluctantly agree and decide to spend all weekend at my desk. Number crunching.
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!
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JuniorDr
SPONSORED FEATURE
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Cardiac Arrhythmias
Human Sectional Anatomy Third Edition Harold Ellis Bari M Logan Adrian Dixon
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First published in 1991, Human Sectional Anatomy set new standards with the superb photographic quality of its cadaver sections and accompanying radiological images. Now in its third edition, this unsurpassed quality remains and is further enhanced by additional material including several completely new pages of saggital and coronal sections and new, improved radiological images obtained using the most up-todate equipment. The photographic material is accompanied by invaluable notes with details of key anatomical and radiological features. Summer 2007 · RRP £85.00 978 0 340 91222 5 · 272pp · 610 illus
Find it difficult to tell atrial fibrillation from sinoatrial block? This issue, in association with Cardiac Arrhythmias : Practical Notes on Interpretation and Treatment from Hodder Arnold, we offer you the opportunity to test yourself on ECG traces. You can find the answers on the right. Arrhythmia 1
Arrhythmia 2
Arrhythmia 3
Arrhythmia 1 - Atrial fibrillation with rapid ventricular response. The f waves are of low amplitude but the diagnosis is clear from the totally irregular ventricular rhythm; Arrhythmia 2 - Two episodes of second-degree sinoatrial block; Arrhythmia 3 - Atrial synchronized and then atrioventricular sequential pacing, i.e. DDD pacemaker; beats.
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Making Sense of Medical Ethics Alan G. Johnson Paul R.V. Johnson Written from a practical rather than a philosophical perspective, Making Sense of Medical Ethics offers a nononsense introduction to the principles of medical ethics, as applied to the everyday care of patients, the development of novel therapies and the undertaking of pioneering basic medical research. The authors call upon their extensive experience of clinical practice, research and teaching to illustrate how ethical principles can be applied in different 'reallife' situations. November 2006 · RRP £17.99 978 0 340 92559 1 · 236pp · 30 illus Pocket Prescriber 2007-8 Timothy R J Nicholson Building on the success and popularity of the first edition, Pocket Prescriber 2007-8 has been fully updated to incorporate new drugs, reflect recent changes in dosages and prescribing practice, and omit drugs no longer on the market. By focusing on the 500 key drugs that are most commonly prescribed, in a convenient A to Z listing, the book avoids overwhelming the reader with information and remains userfriendly, providing the most essential clinical pharmacology information that busy clinicians need at their fingertips, in a handy pocket-sized format. October 2006 · RRP £10.99 978 0 340 93907 9 · 240pp · 10 illus
JuniorDr Features
Weekend ward escape to
Oslo
There are two facts everyone should know about the Vikings. First, they never wore helmets with two horns and second, they’ve progressed pretty far from their club-welding, rape-and-pillage period. Today Norwegians are hoping that you’ll flock to their fjords and rave about their reindeer in the hope of making their country one of the hottest destinations this year. Just don’t come back with a horned helmet – you’ll just look a fool to those in the know. Getting there BA (www.ba.com) fly direct to Oslo but check out Norwegian, Norway’s low cost operator, where you can pick up return flights for under £80 (www.norweigan.no). Ryanair also serve Norway but use Torp airport, a three hour bus journey away, so isn’t a great option for a weekend trip. Getting to the town centre is simple. Flybussen (www.flybussen.no) operate a coach service in 45 minutes or you can get there in half the time with an express train costing around £10. Where to stay? Norway is ridiculously expensive and you’ll struggle to find affordable accommodation anywhere. One of the cheapest, PHotels (www.p-hotels.no), offer very basic double rooms for under £70. Breakfast is a baguette and carton of juice in a bag hung on your door, however the location is excellent just off Oslo’s main street, Karl Johansgate. A little more expensive and ten minutes tram ride from the town centre is the Gabelshus Hotel (www.gabelshus.no). Situated in a residential area it offers renovated rooms, a huge buffet breakfast and free use of spa facilities in the basement for around £100 a night. Eating For a traditional Norwegian meal take the metro 40 minutes up the mountain to the log and stone restaurant Holmenkollen (www.holmenkollen.no) but get there while it’s still daylight to enjoy the view. Reindeer, a tender meat, with a taste between beef and liver, is a top choice. Alternatively if you crave a
more swish Scandinavian dining experience try Sult – which means ‘hunger’ (www.sult.no). This trendy venue attracts the fashion consciousness Oslo-ites and offers controversial but tasty foodstuffs like whale steaks. Unfortunately eating cheap is impossible in Oslo where a Big Mac meal costs over £7 and you’ll struggle to pick up a bottle of water for less than £2. Do as the locals do and jump on a free bus to Ikea where you can munch without needing a to arrange a mortgage. Key attractions Fjords – Oslo sits on a rather flat piece of land so you have to travel pretty far to get a glimpse of the spectacular fjords. A package called Norway in a Nutshell (www.norwayinanutshell.com) offers full-day train, bus and boat passes to get you there. If you’ve got time take the train one-way from Oslo to Bergen, ranked as the most picturesque in Europe, and catch a flight back to the UK from there. Vigelandsparken – 200 human sculptures, some mildly pornographic, fill this park on the outskirts of Oslo. Containing the world’s largest granite sculpture it’s a relaxing retreat from the city and a great way get some amusing holiday photos too. Edward Munch Museum – Famous for his Scream painting, which was even more famously stolen a few years ago. Worth a quick look. Find the full Oslo guide at JuniorDr.com. Key facts
The pics Clockwise from top left Norwegian Kroner; Bergen; Norwegian Fjords; Oslo Town Centre; Vigelandsparken
> Population - 500,000 > Language - Norwegian > Currency - 1£ = 11.63NOK
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JuniorDr
General Practitioner to the Stars
Medical Report - Mr Peter Pan Antisocial personality disorder and norms, impulsive Pan’s disregard for social rules An ASPD is recognisable by Mr Pan claims, when talking rights and feelings of others. Mr behaviour and indifference to the statement is worrying This ”. forget ‘em after I kill ‘em “I ns, actio ent viol ious prev t abou viour he should really be his immature and narcissistic beha enough by itself but coupled with remain at large in the y team. Should he be allowed to investigated by a forensic psychiatr er. of all his “Lost boys” in dang community he may well put the lives Dwarfism having control over his not grow up”, Mr Pan is accused of Described as “The boy who would s of cartilage or bone rder rfism are caused by genetic diso stature but most forms of human dwa which exists against e udic prej al soci clear example of the development. The accusation is a loyment options and is social and marital opportunities, emp extreme shortness. It may reduce to spend time with keen This may explain why Mr Pan is associated with low self-esteem. all-powerful. and re matu ed he is respected and consider children in a fantasy world where "Accidentally" Poisoned y language of “Bells”. n person who is able to speak the Fair Mr. Pan reports he is the only know te “doors to place crea and e” tenc “Imagine things into exis He claims to have the ability to leaves and the juices that is described as: “clad in skeleton people in Nowhereland”. Mr. Pan tances, when applied to that certain naturally occurring subs flow from trees”. It is well known ding intense visual inclu ces erful entheogenic experien pow e caus led, inha or , skin the ns of reality). It is not hallucinations (perceived extensio hallucinations, euphoria and true de: Salva divinorum, verland” but some likely plants inclu known if any of these grow in “Ne cybin mushrooms, psilo ans; plant used by Mazatec sham also known as Magic Mint, a Mexican e South American nativ a a, grin pere ms”; or Anadenanthera commonly called “magic mushroo tree which contains DMT.
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Assessed by Gil Myers
Goth ntly associated with re has been shown to be significa Not a diagnosis in itself, Goth cultu end, Mr Pan does appear viour and violent actions. To this increased self-harm, criminal beha will be an awfully big quoted as claiming that “To die to be fascinated by death. He is children halfway, so dead with “go . Darling, that he would adventure” and has told others, Mrs ical taste or piercing but tendencies don’t stretch to his mus they wouldn’t be scared”. His Goth medieval world of dark orian style clothes and a pseudo Mr Pan follows the fashion of Vict images. ing to Paraphilia An unresolved Oedipal Complex lead Wendy, Tiger Lily, and re. He has conflicting feelings for Mr Pan desires for a mother figu es - which could all etyp arch each represent different female Tinker Bell, who could be said to adult Wendy, now the to d duce intro is ation. When Mr Pan possibly hint at a Freudian interpret dy’s daughter, Wen , down and cries. Mr Pan claims Jane which he married with a daughter, he breaks her” mot new his Neverland and to let her “be Wendy with asked him to take her with him to ther toge off fly “we : in his description was child ng, joyfully accepted. What followed appi a kidn Another interpretation would be sorrowfully looking off after us”. endangerment and grooming.
It’s tough being a doctor these days. Patients turn-up having researched their ailments on Google. Sometimes a little reassurance that they don’t know everything makes us feel better. We did some spot check-ups at a busy London mainline station asking the public to tell us about a common condition. Now, just what was it? Describe the symptoms? “You become really sick then you die. It’s almost always fatal.” Spencer, British Transport Police Who gets it? “Africans. They get it in Africa. I think it’s from monkeys. The Americans got it too once ... but it was from a monkey too.” Carol, Estate agent Is it always fatal? “I hope so. You wouldn’t want people walking around with it!” Semple, Biochemist Is it contagious? “No. It just grows and grows like a cancer. Most people need surgery to remove it but I'm pretty sure you can’t catch it unless you maybe have a transplant or something.” Ismir, Student Is it preventable? “Oh yes! Stay away from jungles and maybe stick to the Costa del Sol for your summer hols. Don’t think there’s a vaccine mind, but I'm not sure about that one.” Paul, Umemployed How can it be treated? “It can’t. It’s one of those incurable diseases. Those poor souls who get it don’t have a chance.”
Yeap. It was an easy one this time. Ebola is the disease we questioned these commuters about ... and following our varicose vein questions last time we were pleasantly surprised by their knowledge.
(B.H.S, M.&.S, R.S.V.P.)
We offered all our interviewees a factsheet and are pleased to confirm that Ismir isn’t a medical student.
Features
Dr Fairytale
Ask the public
JuniorDr Employment
Enrich your career. Enhance your quality of life. Practice medicine in rural British Columbia, Canada. Variety and challenge, the chance to make a difference in people’s lives, a lifestyle most people only dream about. With its natural beauty, recreational opportunities, clean air and affordable housing, rural British Columbia offers doctors a quality of life that is envied around the world as well as competitive compensation and benefit packages. MEET HEALTH MATCH BC’S RECRUITMENT CONSULTANTS AT: UK Radiological Congress June 11 – 13, G-Mex, Manchester, Stand 531 Annual Meeting of the Royal College of Psychiatrists June 19 – 22, Edinburgh International Conference Centre, Stand 23 OR JOIN US FOR AN INFORMATION SESSION AT: Radisson Edwardian Hotel Peter Street, Manchester, June 14, 7:00 pm Channings Hotel 12 –16 South Learmonth Gardens, Edinburgh, June 18, 7:00 pm
www.healthmatchbc.org Please note: Specialists with postgraduate training from the UK or Ireland must hold the CCT/CCST or equivalent from the UK Higher Specialist Training Authority. Family/ general practitioners must have a minimum of 2 years of approved and accredited post-graduate training.
Health Match BC is a province-wide physician, registered nurse and pharmacist recruitment service funded by the Government of British Columbia, Canada.
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25
JuniorDr The Mess
Top
4
Ethical advisor How to analyse an ethically difficult case As doctors, you will inevitably come across ethical problems. But once you've identified an ethics issue, how do you resolve it? The next two columns present two popular methods of case analysis. The first, and most widely known way to analyse a medical ethics case is the Four Principles approach. This approach anchors medical morality on four key principles: respect for autonomy [in brief, the obligation to respect people's ability to make choices for themselves and set their own goals], beneficence [the obligation to do good], non-maleficence [the obligation not to cause harm], and justice [the obligation to act fairly in treating people and allocating resources]. Although these principles sound appealing, they are too abstract to be helpful in a particular case. So, more specific rules can be derived from each of these principles. For example, under ‘respect for autonomy’, you will find ‘tell the truth to patients’ [because patients need accurate information to make choices], 'don’t breach confidentiality' [because patients give you information on the understanding that you’ll keep it secret], ‘obtain informed consent’ [because you should ask people’s permission before you do things to their bodies], and so on. Under ‘beneficence’, you might find ‘act in what you think is in the best interests of the patient’, ‘acquire relevant skills and maintain them’ [including by going to courses and reading medical journals], ‘communicate clearly with patients’, ‘ask for assistance if in doubt’, and so on. When examining a case, you should go through each of those four principles. They are, in a way, a checklist. Does X respect Mr Smith’s autonomy? Is X in his best interests? Will X cause harm and, if so, will this harm be outweighed by the benefits? [note that, when
26
the patient is competent, his views will partly determine whether a proposed treatment is in his best interests or will cause more harm and good. People hold different views about what’s desirable and undesirable for themselves]. Is X respectful of Mr Smith’s human and legal rights and is it an appropriate use of resources? Make sure you don’t just consider the patient, but also how the principles might affect others, including the medical team and patient's relatives. Sometimes, the principles will conflict. You will want to respect the patient's autonomy by not breaching confidentiality but your obligations of beneficence and non-maleficence towards your colleagues, other patients and society point to disclosing Mr Smith’s case of Ebola contracted on his recent trip to the jungles of the Congo. In fact, you also have a obligation to breach confidentiality (Public Health Act 1988) as Ebola is a notifiable disease. The obligation to respect autonomy, then, is not absolute but prima facie. In other words, it is binding unless it conflicts with a weightier, prima facie obligation. This is true for each of the four principles. None of them takes automatic priority. Their moral weight will depend on the circumstances. In the case of Mr Smith, we would all agree that the combined principles of justice, beneficence and non-maleficence [by appealing to the potentially catastrophic consequences of respecting confidentiality and the requirements of the law] outweigh the duty to respect confidentiality. Who said there are no right answers in ethics? Daniel K. Sokol Lecturer in Ethics, University of Keele,
alternative employment ideas
Scared you’ll be one of the 10,000 unemployed doctors this August? Worried that you’re not qualified for any other profession? ... don’t fear. Here’s four alternative employment ideas to save you from begging on the streets
1. Fatten-up your wallet Offer liposuction from a converted chippy van at service stations, and rock concerts. With half the population predicted to be overweight by 2010 it's a sure winner. You could even sell burgers from the back to keep the punters returning for more.
2. Available for hire Searching for low cost childcare? Unemployed paediatric registrar with 8 years NHS training looking for work. Great with kids. Will work for accommodation, food and small living allowance. Can complete post-natal check, administer vaccinations and trained in paediatric resuscitation. Available to start August.
3. Sexy surgical SHO 6ft sumptuous blond escort ready to service your darkest medical fantasies. Full doctors uniform and stethoscope. Appendectomies and hip replacements available as optional extras. Call now.
4. Set up a bookshop 10,000 ex-doctors means there’s going to be roughly a quarter of a million unwanted textbooks this August. Collect all those discarded copies of Kumar and Clarke before they’re used to set fire to the Department of Health and set-up a second hand medical bookstore. Consider exporting overseas where doctors still have jobs.
JuniorDr
When 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 -
Toothbrush A trip to the dentist would be cheaper at Belfast City Hospital £2.29
WOW!
Teeth-tastic -
While we doctors are puzzling over squiggles on ECG traces, prescribing IV nystatin and ordering MR scans for patients with metal implants there are a bunch of people in the background quietly observing what’s going on. Porters, students, secretaries and canteen staff see the other side of hospital medicine. We’ve asked them to tell all. sudden movements I would have had to jump in but luckily he slowly put it down and we managed to restrain him. The nurse was deeply traumatised. The strangest incident I’ve ever dealt with was when a group of medical students got into a fight. They were members of opposing sides in a rugby match and on the way back the winners started to taunt the losers. There was a chase and it ended up in a fight in our lobby. I couldn’t believe having to separate the crème of our country from trying to beat each other up. One thing I love about the job is the food. Whenever I get to the canteen I get the choicest plate of food and always get given an extra helping from the ladies behind the counter - it must be the uniform that does it. Quietest times are when I'm on at three am. There is often nothing to do as casualty has calmed down. We carry out patrols of the floors checking that things are ok and they usually are. We all meet for a coffee in the control room. We have a handover system at the end of the shift. We all meet in the control room and hand over our radios. Usually there's nothing to hand on but sometimes there is. Last year we had a gun scare and eight of us went down to casualty. The armed police were called but it ended up being a kid with a toy. Thankfully I’ve never had to deal with a gun. Yet.
Homerton Hospital, London 99p
Chocolate chip muffin You’ll choke on the price alone at Bristol Royal Infirmary £1.25
WOW!
Buy one for your favourite patient at Royal United Hospital, Bath 70p
LOW!
Portion of chips Skip it and have a salad at Belfast City Hospital £1.10
WOW!
Just remember cholesterol at QE2 Hospital, Welwyn Garden City 70p
LOW!
Next issue we’re checking a Magnum Classic ice-cream, Dairy Milk (49g) and Jacket Potato with cheese. Email team@juniordr.com.
Which mess is the best?
JAMES SECURITY GUARD (LONDON) I've been a security guard for nearly twenty years and in the same hospital for the last eleven. The hardest things about my job are the shift patterns. Doctors complain about their hours but it is nothing compared to mine. Three days on, three days of nights and then three days off. I've worked like that for years. Most of my day is pretty boring. I help the porters out a lot when there isn’t much to do and I know them all by first name. Most of the incidents during the day are minor. I get called when patient’s relatives get nasty and cause problems. Or if a patient tries to harm themselves. Smaller hospitals make do with porters but there are always at least four guards on duty here at any one time. Things start to heat up in the evenings - especially at the weekends. We have a busy casualty department. The doctors and nurses are excellent but on a Saturday night we get full with drunken yobs and drug abusers. Many just sleep it off but we regularly get patients who are violent. I once had to mediate when a patient held a nurse at knife-point in a cubicle. The police were called but for the first ten minutes I had to talk the man down calmly. He held the knife up to her throat but was very still. If he had made any
LOW!
> Princess Alexandra, Harlow
Reported by Sanj Gupta
Walking the corridors
The Mess
Hospital
What it’s got Sky HD on 42in High Def plasma, wireless 16Mb broadband, leather sofas, lava lamps, newly refurbished and moved in March 07, 3 computers in separate computer room: 2 for allaccess broadband. Kitchen with dishwasher, microwave, basic food bread, tea, coffee, biccys etc usually topped up. Separate chill out/quiet room (with a few old sofas!). £10/month. JuniorDr Score - 5/5
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