The Medic Crunch

Inflation is something I’ve frankly never understood. Perhaps odd for a child of the Thatcher years but economics has never particularly interested me. It is only recently that I’ve come to recognise the consequences of the current economic climate and for the first time start to feel the real squeeze. Being a medical student living in one of the most expensive cities in the world has started to take its toll. Coupled to that, the very real recession we seem to be plunging into means that things are not likely to look up anytime soon.


Yes my friends, welcome to ‘The Medic Crunch’.

House prices dropping at a record rate makes home owners reluctant to sell, preventing first time buyers getting on the ladder. The consequence of which – more and more people rent, hence pushing up rent prices. Inflation rocketing on essential items such as food and increased utility bills for gas and electric, it all adds up.

And what does the government do for us?

1. Increases the basic loan by 2.5% (well below current rates of inflation)
2. Charge us £3000 a year in top-up fees (or £3145 as it’s linked to inflation)
3. Remove free hospital accommodation for foundation year doctors who have just accumulated 5+ years of student debt, with no compensation.
4. Offer a pathetic salary to newly qualified doctors.
5. Limit the amount of hours worked by impoverished junior doctors in line with the EWTD.
6. Fuck up the economy so none of us can afford to eat.
   

Good one.

To make matters worse, we can’t win. We’re deemed “lazy students who get up mid afternoon in time for Jeremy Kyle”, who will then “go on to become lazy GPs earning £100,000+ a year”. Jeremy Kyle?? I can barely afford the TV licence!

A year’s tuition - £3000+
A year’s accommodation - £6000+
A degree in medicine – Penniless
For everything thing else, there’s MasterCard.

Finding a job has proven near impossible, with medics finishing late in the year after all the other students have had time to go on holiday and get the work. I’ve managed to secure myself a weeks temping so far, which hopefully will lead on to something more substantial. Fingers crossed.

Grand Rounds 4.43

EXTRA, EXTRA, READ ALL ABOUT IT! That’s right folks, this week I shall be dishing as much dirt on the latest rumours, gossip and scandal that the blogosphere can handle, and all from a rather slanderous angle!

DEATH ON DIALYSIS: IT TAKES THE PISS – ABOUTANURSE grapples with the concept of self-doubt surrounding sudden and unexpected death on the wards, in this touching, heartfelt recollection.

THE REAL DEAL – THE DAILY RHINO crosses a personal threshold as he finally feels like a doctor.

“During my last weekend on-call, our unit had five deaths within about sixteen hours. None were unexpected, but all were quietly heartbreaking. Two stood out and taught me skills I know I'll find useful throughout my career”

DECIEVED, IGNORED AND LIED TO – THE LITTLE MEDIC tells of his story and battle with the medical school, in an epic and well thought out post.

BREATHTAKING – A MEDICAL STUDENT aces a barrage of questions on the wards from a neurosurgeon in the aptly named “My Airway”.

CANCER: A FUNNY OLD BUSINESS – Neuroanthropology.net
“Marjorie, I see you got a new hair-do.” She gave a laughing in-your-face reply, “Yeah, well that’s what happens when you get CANCER! Ha!”

ALZHEIMERS AND THE SILVER LINING - VITUM MEDICINUS recounts an unusual response to this debilitating disease.

SUNNY SIDE UP – RURAL DOCTORING discusses a complication in a second birth – “I don't want to have the baby with my butthole up in the air" and I don’t blame her!

A CLOSE SHAVE as Jeffery Leow reviews OCCAMS RAZOR, an episode of House MD whereby our resident hero saves the day in the nick of time.

FRYING THE BACON – NHS BLOG DOC dishes the dirt on an unscrupulous doctor, a truly fantastic tirade in an exciting triple bill – PART ONE and PART TWO and PART THREE

A SCAR OF THE FACE OF THE NHS – THE SHRINK examines whether physical illness within the mental service is an area of neglect.

PILL PUSHING – DR R looks deep into the bosom of big pharma. EVERYTHING HEALTH further scrutinises the cosy relationship between pharmaceuticals and academia.

À LA MODE! THE DRAGONFLY INITIATIVE discusses the stylish, sterile, scrubs attire for this surgical season!

COULDN’T MEDICARE LESS? THE BLOG THAT ATE MANHATTAN discusses the domino effect of doctors dropping Medicare. HEALTH INSURANCE BLOG may urge you to reconsider as they breakdown the various costs and coverage.

A RIGHT PAIN IN THE NECK – THE BACK PAIN BLOG examines the use of cervical collars for minor neck injuries.

I SMELL A RAT – THE COCKROACH CATCHER discusses an unexpected case of thallium poisoning, presenting as a psychiatric disorder.

DIABETICS UNITE! DIABETES MINE rallies to try and round up fellow sufferers to lobby for an insulin testing kit.

HOLD THE PHONES! DR VAL receives an impromptu call from her retired paediatrician.

INSURANCE: DENIED – SIX UNTIL ME battles with the fat cats over the management of their diabetes.

THEY MUST BE NUTS – TINY SHRINK visits an article written on the misdiagnoses of schizophrenia, and relates this to their own experiences in medicine.

OLDER AND WISER – EMERGIBLOG looks at the dangerous antics of adolescents admitted in the ER.

THE TRUTH ABOUT SPERM – DOC GURLEY asks just when is it right to tell donor children where they came from?

INTERVIEW WITH THE PRESIDENT - MEDGADGET interviews Dr J James Rohack of the AMA

And that’s a wrap! The next Grand Rounds will be held over at Grunt Doc on the 23rd July 2008.

Hosting Grand Rounds, Vol 4, No 43 - Tuesday 15th July

Big news, huge news! Next week's Grand Rounds will be held here on Tuesday 15th July!

So please send in all submissions to unprotectedtext@hotmail.co.uk by 9pm (GMT) Sunday 13th July.

A dose of first year medicine

It’s over one year on since I first started this blog, back in the days of wonderment, excitement and feverish anticipation. A whole year of lectures, practicals, workshops, placements, tutorials, patients and exams – and a year that has come with sweet highs and bitter lows. Medicine it would seem is the abyss, and one year on I am still right at the top, staring down.

The Good

“I've never seen so many men wasted so badly”

Anatomy

The best subject in the first year, by a long shot. Anatomy turned out to be far more in depth, and artistic than I’d previously thought. A subject so literally self-indulgent, an apprenticeship in medicine, as it isn’t readily understood through textbooks and lectures.

People

There are a lot of different people, from very different backgrounds that you forge friendships with. People who are incredibly talented, hard working and selfless. Friends that share everything you go through, those who you know you will be training with, and reflecting back upon with, many years from now. They are what make the low points of medical school bearable.

Clinical medicine

In between the physiology, anatomy and various other basic sciences comes the odd radiograph, ECG tracing or case study photograph slipped in to show exactly why it is important to understand the volumes of drivel we crawl through.

Dissection

Keen to cut from day one, it was a must have option for me. Only available as a selected study module, thus not everyone gets to do it (nor wishes to do it). I wouldn’t say it’s essential in order to learn gross anatomy properly, and although we were confined to the limbs this year, it still proved to be both disgusting and beautiful.

GP Placement

The only place you really get to appreciate the humanitarian face of medicine. But despite getting to meet real patients, it is still a farce, as the patients are hand picked, generally not feeling too unwell and offer a rather cosy view into their personal lives.

The Bad

“One bastard goes in, another one comes out”

FunMed

The ‘Fundamentals of Medicine’ module that made up the entire first term was by far the most boring and uninspiring material ever devised by man. It is, or should be the textbook definition of ‘a crock of shit’. As said before on many occasions, it proved to be neither fun, nor particularly medical. The PBLs too, were far from medical by nature, the function of this specially extended module? I’m guessing to fill out the timetable.

PBL

I was willing to give it a try, but it failed as a bitter disappointment. As the content gradually became more interesting, the motivation to do it thoroughly was lost. The endless shuffling of tutors and their various contrasting styles of teaching PBL became fairly soul-destroying, and the seven-step, waste-of-space guidance went out the window on day one.

Exams

In all we sat around fifteen exams throughout the first year. It is a given, and readily accepted that we signed ourselves up to this torment, but the continuous onslaught of looming examinations and stints of revision throughout the year, grinds. The one, insignificant upshot to medical school exams is that they tend to be on the whole multiple choice. The advantage to this, of course being that we don’t have to write very much.

The Ugly





“You're smart enough to know that talking won't save you”

The most disturbing disease I’ve come across in the first year:

Harlequins Ichthyosis

Why the picture? To make the point that it’s all very well sitting in the warm ambience of the lecture theatre, and PBL rooms reading about these disturbing, yet still very foreign diseases. However, the ugly truth being I know very little of what goes on in the hospitals, in the lives of patients and in the real world of medicine.


And finally the most boring lecture of the year award goes to…

Locomotor’s ‘Walking and Posture’!

Who could predict they actually managed to talk for a solid hour on the mechanism of a step?!

Vacant

Three weeks into summer and I am as yet to find myself a job. The agency hasn’t got anything at the moment, the university advertised some paid work, and they are as yet to get back to me. In addition to just moving into a new flat, with all the usual initial expenses it would seem my dad has cut me off without reason or prior warning, just days before rent day. Wanker.

Oddly, and out of the blue I received a reply to an e-mail I sent way back in February for a research placement, something in cardiac physiology. Turns out they had trouble getting some experimental parts in, and there’s a lot of preparatory work involved. I have no idea if there’s any funding available, but am fairly doubtful. In addition I’m under the impression that the commute would take far too long from my flat, as the hospital is on the other side of the city.

The e-mail ended with:

“If you are still interested in such a project then please let me know. You would be working under difficult circumstances and need to show considerable initiative.”

Initiative? Probably not for me then.

Year one, done

Results day, for the seventh consecutive year, same anticipation, same ambiguity. The always uncomfortable social etiquette that accompanies results day – Should you ask? Should you tell? Blanket congratulations, well done to all even if you failed.

There’s a saying that goes, “What do you call the guy who graduates bottom of his class in medical school?”

“Doctor”, of course.

It is essentially, pass-fail, no longer 2:2, 2:1 or first class as with normal degrees. Often it seems the only incentive is to gain the minimal grades (in our year four C’s) to make it to the next year.

With the ever-increasing number of people in my year reading this blog, I’ve decided to post my results one last time, for in years to come I’d prefer to avoid unnecessary angst or judgement by proxy (all of which is completely my own doing).

Three A’s and a B, ergo, I am a second year!

OSCEs Episode I - A Phantom Menace

After the final end of year exam I have reached one single conclusion; that OSCEs are perhaps the most intense two hours of the first year. Normally I manage to compose myself and suppress any inevitable anxieties that arise with exams, but being thrown into an OSCE situation for the first time really is a testament of character.

For one, you don’t know what to expect, unless you are like half of the year (myself included), who sat it on the second day, after the first cohort had told us what to expect – which is another moot point. It’s remarkable just how helpful and selfless that those who you are technically in direct competition with, will be to help you out for the exam.

Sifting through homogenous histology pictures, trying to complete answer forms in the five minute allocated slots all the while your time literally ebbs away on forty inch plasma screens spread throughout the room. It’s the timer that got me most, and as I’m sure everyone else.

Then there are the five observed stations, where all the clinical skills and various interview techniques are silently scrutinised by examiners and patients alike. The timer ticking down the seconds in the background, the stations themselves have a cringe worthy artificial ambience.

That’s the scene set, here’s how mine went:

Station 1 – Consent:

An old lady with rheumatoid arthritis waiting to see the doctor. We as medical students are asked to gain consent to interview them and report back later.

Of course, she wasn’t willing to give consent to start. She was tired, felt unwell and wanted to see the doctor. In practice I wouldn’t badger a poor old lady for five minutes to agree to divulge all manner of personal details regarding her condition, but what else do you do in an OSCE? So after multiple rejections, and on the verge of backing off she gave me the okay and the station was over. I’m not entirely sure if that was the right thing to do, as being a pushy, coercive medical student probably counted against me.

Station 2 – Lower limb reflexes:

A quick station and I was told so at the start. Nearly forgot to wash hands, as ridiculous as that sounds but all too easy with the nature of the exam. This time a friendly 4th year medical student. A quick tap on the knees and ankle was all it needed, it was too easy – for which I thought was down to the girl trying to help me out. In retrospect I think she was pretending to have hyperreflexia, of course in reality if this were the case her legs would be spastic, wasted and I doubt she would be able to stand up for the exam anyway.

It’s hard to know what they’re looking for. At the end of the test she said I’d done excellently, to which the senior examiner responded with a terse “he did alright”. Maybe trying to knock me down a few pegs, there seems to be a lot of mind games involved in these OSCEs. Best not to over-think it and move on to the next station.

Station 3 – Guiding the blind:

Perhaps my best station, or at least seemed to go most smoothly. The blind man was pretending to be asleep at the start and was startled when I touched his arm. We had to guide him past a curtain, sit him down and give him some information. For some unbeknown reason I offered him the printed information leaflet to take away, not even thinking that it is a fairly useless thing to give a blind man. I changed my mind and gave him a cassette tape and led him back. It was in all, a fairly easy station.

Station 4 – Abdominal examination:

The ten minute station and probably my favourite exam. Went fairly smoothly, naming the 9 regions to palpate and what each contained. I actually quite enjoyed it. The examiner asked where the upper edge of the liver was, I guessed around the 5th intercostal space, still no idea if that’s correct. Felt a bit sorry for the patient as my hands were stone cold, for which I did apologise for. As it was a ten minute station I didn’t notice the buzzer go halfway through signalling the five minute mark and was convinced at the end I’d rushed through and finished within four minutes.

Station 5 – CPR:

My knees weren’t built for kneeling, as demonstrated by the loud snaps made when I knelt down next to resus Annie. There was an intense burning sensation for the five minutes as I thrust and flailed up and down in front of the ice queen examiner of that station. It wasn’t all that clear what was expected, when to stop or even if the thing was clean. After four minutes, and probably breaking each and every one of Annie’s ribs I was allowed to stop.

So on the whole, not overly enjoyable. I probably made far too many mistakes rushing due to time limits. It’s a strange exam to sit, part in total silence part flailing around and babbling incoherently. Yet, it concludes the first year, 1/5 a doctor (supposedly…) but for a more personal milestone I am officially half way through my time in university – four down, four to go.

Well, pending the exam results…

OSCE

In about 1hrs time I'll be sitting my first OSCE.

Not sure what to expect, who knows it may be even vaguely enjoyable?

Apologies for not posting recently, been far too busy with end of year revision and moving out, with that comes a lack of internet at the new flat.

Still, it'll be nice to finish the first year. Expect updates fairly soon, thanks for tuning in.

Gone phishin'

This post is totally reactionary, but hell is it ever justified.

I would just like to say to whatever cunt bucket that decided to go phishing in my pond, that you, you little fucktard are a wankstain on the sheets of society.

Spending my money on a Rapidshare account so you can download your pathetic pornography at a higher bandwidth.

That’s nearly a whole months food shopping you’ve stolen from me.

The phone call to the bank cost me another £5 just to cancel my fucking debit card.

I have no access to any cash for at least the next 5 working days.

It’s almost a week till my exams and I am far too pissed off to do any productive revision.

That is the true extent to your crime, you worthless little bitchprick.

Because I'm a lazy shit

A 75 year old man was admitted to hospital with SOB, severe fatigue, muscle weakness and swollen ankles. At night he says he requires four pillows and often wakes due to shortness of breath. His history revealed that for several years he has experienced episodes of chest pain and shortness of breath on exertion. On examination he was noted to have slight cyanosis, distension of neck veins, tachypnoea (20/min), tachycardia (110BPM), ankle oedema and rales at the lung bases bilaterally. His BP was 115/80. The chest x-ray examination showed an enlarged heart and diffuse density at both lung bases. An ECG showed normal sinus rhythm. Treatment included bed rest and administration of digitoxin and a diuretic.

******************

Once again, if anyone can help explain this scenario it would be of great help. I think I understand it on the most part, being that it's heart failure. We've done right-heart failure before, so am I right in assuming this is left-sided?