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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Thursday, 13 December 2012

Doctors cry (especially junior ones)

Ok, so I am really bored of crying at work.

Since I started working back in August, I have probably had a cry-per-month ratio higher than I have ever had in my life.  The thing is, I don't cry.  Normally.  So by way of learning to 'Man Up', here's my cry diary from the last few months.

Cry number 1 - Day 1 of work.  Ward that normally has quite a few doctors on it - find myself completely on my own for a chunk of the afternoon.  Feel overwhelmed by number of jobs to do and no idea how to do them, along with being asked questions I don't know the answers to.  New SHO arrives and makes the fatal mistake of asking me if I'm ok.  Cue tears.

Cry number 2 (and 3, 4, 5) - First set of nights.  At the end of a busy, horrible first ever medical night shift, I realise in front of the entire team that I made a small mistake - an error based on lack of knowledge of a particular routine.  A non-dangerous mistake that breaks me at the end of a long 13 hours.  Two nights later, and I'm similarly being dragged all over the hospital.  At 3am, I have a choice between the patient who is desaturating down to 50%, a blood pressure of 65 or chest pain.  That means the patient with the minor-sounding problem is unfortunately not a priority.  Said patient lets it known she is not very happy about this when I finally reach her at 7am.  For me, it's the final straw.  Didn't feel I'd been very supported in this  decision making process by the nursing staff, and once I've calmed down a bit, I have a chat about supporting each other during the night shift.  I think the patient realised I was upset and once I'd sat down going through her problems for half an hour, seemed to be more content with the situation and that I hadn't apologised for my tardiness without meaning it.  A few people subsequently asking 'if I'm OK' triggers Cry 4 and 5.

Cry number 6 - having had no deaths on my clinical team, we have three deaths in one week.  One patient who I'd seen over a weekend on call, and happened to see during an on call later the subsequent week, dies literally in front of me.  Then we had a couple of admissions that week of patients with dementia who had stopped eating and drinking.  Taking a history was impossible.  Persuading them to have bloods taken was tricky.  The underlying feeling of 'I can't actually make this situation any better' and 'What am I actually doing? What can I bring to this situation?' proves a little more than I can bear.  In fairness, I don't actually cry, but the only place I can find to hide to take a few deep breaths is the patients' bathroom.

Cry number 7 - there's a long pause before cry number 7.  Another weekend on call.  It's been a very busy Saturday and once the day registrar has left at 5pm, I'm on my own to sort everyone out til 9.30pm handover.  The bleep is out of control with non-urgent jobs.  Then at quarter to 9, someone is spiking a temperature.  I decide this is the most urgent job, and the others on my list will need to be handed over. I speedily do an assessment (my bleep obviously continuing to go off), take some bloods, take some cultures, get a new drip up.... and as I'm getting these things sorted in the office, I'm still being called - 'Doctor, can you just....'.  I don't know how I can say it differently - that unless the problem is more urgent than the one I'm dealing with right now, it will have to wait 5 minutes.  I head to handover, and I'm not angry, just tired and frustrated with myself for not being able to do 3 things at once.  The SHO reminds me that I can't expect to be able to do everything.  My night counterpart brings some water and tissues, and I get it together.  What a wimp.

Cry number 8 (8???? This is ridiculous) - new job, working late.  My senior and I assess a patient.  Once her blood tests are back, my senior decides she needs an urgent scan.  The person who would do the scan disagrees.  He does not communicate these feelings in a very sensitive way.  Some poor documentation on my part confuses the situation (which I apologise for) and overall I feel quite stupid and like my professionalism is being questioned a little unfairly.  It's the last of these which sets me off.  This has all happened over the phone, and I'm with my senior seeing another patient on another ward by this point, so a whole set of healthcare staff and patients alike are completely mystified by this sobbing doctor.  When I see said person later (scan finally done and entirely justified), I apologise for my part in any confusion.  I receive no apology.

You see?  I totally need to man up.

The thing that frustrates me more is, I am coming to believe now that actually, I am an alright doctor.  This is quite a big deal for self-depricating little me.  I had my end/start of rotation appraisals recently, and yesterday saw my feedback from the doctors, nurses, ward clerks, pharmacists from my previous rotation.  Their feedback was really nice! Of course, I am now sort of back to square one in a new job and the amount still to learn is overwhelming.  I am still just a junior doctor.  But I'm ok with that, because I know that, despite all of the above events, I learn from my mistakes and that I'm not terrible.

So really there is nothing to cry about.  I just need to learn to back myself, and cope better when things get a bit stressful.  And perhaps carry some Kleenex around in my on-call bag.  

Monday, 10 December 2012

Hello job, goodbye life

I finished my first rotation this week and it was with a degree of sadness and trepidation that I left the hospital and job I was only vaguely starting to feel on top of, in exchange for a new job in a much bigger hospital.

I now work in surgery, and my hours are, as one might say, 'plus plus antisocial'.  There is literally no regular evening hobby I can do any day of the week, because all my shifts either start, finish or occupy the evening time.  

Means of coping with this?

Go home and find your mama and give her a big hug.  Go for a stroll and contemplate life.  Generally escape the bubble that is 'work'.  

Buy yourself a truly excellent Christmas jumper.  And stop getting too bah humbug everytime they play 'Driving Home for Christmas' on the radio.  Because I will not be driving home for Christmas.  Even if I did, only the cat will be there because my family are (rightly) taking the opportunity to visit our extended family.  

Go to the pub and have a snuggly mulled wine with good friends.

I am determined not to be a whiner!  It's been quite an intense time, but my new musical and literary flavours of the month are helping plenty - I've just bought Lucy Rose (old favourite for complex reasons) and Alex Clare (@alexanderclare for all you twitter fans)'s albums, and can highly recommend both.  Book wise, a charity shop trawl proved fruitful.... 10pm finishes for me for the next 7 days, so I'm spending my early mornings with my nose in a (non-medical) book to keep my sanity and a smile on my face.  

Saturday, 24 November 2012

The final leg of Two Weeks in the Life...

Day 10: Wednesday.

Really flagging now.  My two direct seniors are on call today again so I have them with me briefly then I'm on my own to prepare for the consultant ward round in the afternoon, and I have my medical student again to entertain.  I have compulsory teaching at lunchtime which is rather inconvenient but the ward round in the afternoon goes off reasonably without a hitch. I've been invited to a friend's for dinner and I don't get there til after 8 before meeting some other friends for a drink.  Struggling to suppress an insatiable urge to get 'out of my head' by now, and probably head home a bit later than I should have done.

Day 11: Thursday.  Final on call of the 2 week mega-work-a-thon, and I'm post take, so start at 8am.  It's reasonably painless but post-take days are always a bit more chaotic than I would like, with a combination of managing all your new patients and sorting out all of your existing ones.  One of our existing patients is quite unwell and it's quite handy that I'm on call in the evening as I can reassess him later on knowing all about him already.  I feel completely snowed under in the afternoon as my SHO is sorting out the few remaining new patients (most of whom are on other wards by now and therefore no longer our responsibility) and my Reg has other work to do.  A lot of our patients are to be discharged in the next couple of days and if I don't get on top of my discharge summaries today, I'm going to be in a right fix tomorrow.  I'm not really able to offer my medical student much by way of time as I have so much paperwork to do.  There's also an important end-of-life discussion that needs to be had with one of our patients' relatives; it's always upsetting to have to accept that your efforts are proving futile and ultimately someone may just be nearing the end of their life, but we have a very frank discussion and all agree a plan of action with my Reg.

Post 5-pm, I have a few jobs handed over, but nothing too overwhelming.  A lot of warfarin dosing and a few IV fluids to prescribe, and a couple of patients to review.

The person who's on nights is late - he's never late.  I carry on with a couple of small jobs I might have otherwise handed over when the night SHO appears at around 10pm - it turns out the night version of me has had a car accident in all the bad weather.  Fortunately he's alright, but obviously can't work, so the SHO tells me to hand over to him instead.  I drive home at the pace of snails as the weather really is awful and I'm feeling a bit shaken by the news of my friend, and when I get home I call him to make sure he's ok.  So by the time I have my sad dinner of microwave rice, it's gone midnight.

Day 12: Friday!  The last day!  I'm doing a quality improvement project with one of the other doctors so I arrive for 8am again to collect data from around the hospital before my day starts proper at 9am.  I get some unprecedented praise from the pharmacist for getting all of my 7 discharge scripts to her before lunchtime - you've got to take these small positive moments!  My SHO and I try to see everyone before this afternoon and pre-empt the jobs that might need doing, and by lunchtime I'm feeling quite on top of things.  A quick lunch, and I'm ready for the boss in the afternoon.  My SHO and Reg are both on call, again, today, so I'm on my own to direct the boss round everyone.  Even though we've discharged a lot of people, the remaining patients are all quite complicated and unwell, including my unwell patient from yesterday.  The boss seems reasonably content with how we've managed him.  Some relatives want a detailed update about one of our patients - I spoke to them at the weekend so know them already.  By this point it's after 5 and we still haven't seen half of the patients - it's important obviously to give a full update, but it's a challenge balancing this with the time owed to each of the other patients, and the general brain fatigue that has set in from being at work everyday for 12 days in a row.  The boss handles the situation like a pro, and everyone leaves happy.  It's after 6 by the time we've seen everyone, and it's left to me now to mop up the remaining jobs and prepare the weekend jobs list and put out the blood cards for the phlebotomists to take.

I finish, triumphant, around 7pm.  I'm going away to Devon this weekend with some of my junior doctor chums, and I am greeted by them with a flat cap and a beer.  Relief!  My twelve days are done, and addressing Life Beyond Work can now commence.



Wednesday, 21 November 2012

Weekend-a-geddon +2

Day 6: Saturday morning.  Slept terribly, got to bed late and awake at 6am. At work I am delighted to find I have a senior person to review patients who we've been asked to review over the weekend.  This is excellent news as it leaves me free to do the more menial jobs of chasing blood tests and receiving the rather endless stream of bleeps.  We're doing well (with just one crash call to run to) and by the time he goes home at 5pm, I've even eaten some food, had some fluids and feel vaguely on top of things.

Post 5pm, I'm on my own to mop up the remnant jobs and address any arising issues.  The problem is, there's only one of me, and I only have two hands.  The hospital has been so busy that a lot of the patients I've been asked to check bloods for over the weekend have been moved (many to the other side of the hospital), but their blood test cards haven't, so it's down to me to find out where they've gone and do the blood tests myself.  In addition to that, there's patients who are unwell, drips that need replacing and families who want updates.  My bleep is going off every five minutes and I've no sooner started a job than my bleep goes off again.  I have to risk-stratify my list of jobs and decide which ones I will have to hand over.  I get to 9.30pm and I am beaten.  A few tears are shed, not because someone has upset me, but just because I am tired and frustrated with myself.  My seniors always remind me that I need to just CHILL and accept that I can't do everything; although I know that, it's just frustrating that that's the case and ultimately, it's irrelevant to the patient or nurse at the end of that bleep you've just received that you've been on the go for 12 hours.  Just as we sit to hand over, an arrest call goes out and we all peg it to the relevant ward to start CPR. We're unsuccessful and it's a slightly sombre end to the day.

After all of that, I go back to my own ward to check a couple of things and leave hospital after 10.  Home after 11.  Quick pizza dinner, bed.  Same again tomorrow.

Day 7: Sunday morning.  Cream crackered and eat the remnants of last night's pizza for breakfast before heading into work.  Classy.

The ward registrar and I get tactical - I hate being disorganised and today I've consolidated the ten sheets of hand over patients into one 'ultimate list of lists'.  It's pretty frantic for the first five hours as we go round reviewing the patients we've been asked to review, chasing bloods, the odd cannula and trying valiantly to encourage people to put non-urgent jobs in a ward-based book rather than bleeping me all the time.  Another crash call takes us jogging into A and E - this patient survives.  When the ward registrar leaves at 5, I've got a fairly manageable to-do list.  I'm majorly flagging but there are still bloods to take and chase, and just at the end of the day, I'm asked to review someone who's breathing has changed.  It's quite a satisfying bit of teamwork as we get his bloods, ECG, chest x-ray and diagnosis within the space of about an hour.  The night junior doctor greets me with a cup of tea.  My hero.
An accidental snap, but accurately reflects the fatigue!

Day 8: Monday.  Everyone else is looking bright eyed and bushy tailed - the week is no shorter if you've done the weekend on call so I'd better keep up the pace!  Over the weekend my ward has essentially discharged half of its patients so it's all new faces - but luckily I know a lot of them because I've been involved in their management over the weekend.

My registrar and senior house officer are both on call today in the admissions unit so we're a team until midday and after that I'm on my own.  There are only a couple of patients left to see, a few discharges to sort out and the care for everybody else to coordinate.  Finish about 6pm and the boss turns up - luckily I have something useful to say about the day!  Time to head home, walk in the door about 7.30pm.  First time I've been in the door before 11.30pm since Thursday.  And then to the pub.

Day 9: Tuesday.  An unusual week this week as I'm at a meeting today for the whole day.  Although it's still a full day of work, it's refreshing to think about something else (although it is still basically medicine chat).  Issues discussed include women in medicine, something I feel increasingly passionate about.  It is different being a female doctor, because ultimately, I predominantly serve an age group of population for whom female doctors was a rarity.  Persuading them that I'm a doctor can be a challenge.

Get home no earlier than if I'd been at my normal day job and go to a friend's house for dinner.  Inevitably, medical chat predominates, although we reflect a lot on how we got to being here and how it's going to impact on the rest of our lives.  It's funny to think that we chose a career when we were just teenagers, and it's one which almost defines my whole identity now.  We talk about our respective 'Medical Finals breakdown moments' - the two weeks when I was doing my final exams at medical school were absolutely painful for my family to have to hear about over the phone.  It's weird how now that I'm doing it as a job, I don't feel they need to hear about the bad days.  They've done their time, and they don't need the worry of a wailing daughter down the phone!

Saturday, 17 November 2012

Two weeks in the life of...

I'm embarking on that most feared 12 consecutive day work-a-thon.  Thought I'd keep a little diary, more for my own benefit in future years, but also because sometimes people are interested in what I actually do everyday.  Read at your peril.

Day 1
Post take.  That means all the patients who have come in to hospital over the weekend are now my team's responsibility, and I arrive an hour early (8am) to start the post-take ward round.  Not as painful as it could have been, and we've seen and sorted all of our patients by 5pm.  Find out a patient of mine died on the ward over the weekend, so this also needs to be addressed during the day.  Lunch is spent at Journal Club, where we discuss a paper on risk stratification for pulmonary embolism.  On call in the evening - it's busy, and I'm on ward cover.  Issues include a spiking high temperature, low blood pressure, agitation and a few patients I've been handed over to review/chase tests for.  Finish at 10pm.

Day 2
9am start today.  I have a medical student, so amongst doing a ward round of our patients (including a few who have been put on wards the other side of the hospital), we're trying to do some teaching as we go along.  I supervise them seeing some patients on our ward.  A bit upset as another patient has passed away - it's difficult to see a family you have got to know deal with this difficult part of life.  A couple of our patients are quite unwell and need urgent investigations, so there's quite a bit of running around making sure they are getting sorted out.  Today lunchtime is spent at our 'Tricky Cases Meeting', where we discuss cases of interest and do literature searches on these topics.  Finish around 6pm, and have planned to go to the cinema with some friends. Soooo tired but determined to do something relaxing away from work.

Day 3
9am start again.  Busy, and trying to make sure my medical student is having an educational time as well as getting our work done. Compulsory teaching at lunchtime today on respiratory medicine.  We have a full ward round today with the whole team which starts quite late so we finish at about half five.  We're scheduled to do the case based discussion tomorrow, so my colleague and I sit in the office preparing our presentation.  Get home after 7, cook dinner for housemate who cooked me dinner last week.  I have assessed work due for a course this week, plus haven't addressed my mountain of emails, so spend the evening replying to emails, reading some literature and submitting the course work.

Day 4
Again trying to balance seeing everyone on my ward in a timely fashion and making sure my medical student is learning something.  We spend lunchtime presenting our case based discussion which goes quite well I think.  We see a couple of our more complex patients with the boss late in the evening and I get home about half 7.  I'd invited a couple of friends round to have dinner with my housemate and I, so it's in the door, cooker on, get chopping!

Day 5
We spend much of the morning sorting out an unwell patient who has come under our care, and then get cracking with seeing everyone else.  I'm on call today - just as there was a thought of grabbing lunch, a crash call goes out and I'm off to A and E with the rest of the on call team.  A brief sandwich-stop later, I'm back on the ward, but the boss is delayed and we start late in the afternoon with a final round before the weekend.  It's an interesting juggle between finishing all the jobs from my own ward, receiving on-call bleeps from all the medical wards and getting evening/weekend handovers from my colleagues.  It's quite depressing seeing everyone else slip away while you know it's just you and a bleeping machine for the next 72 hours.  Relieved when my night counterpart arrives, and I only have a couple of things to handover.  It's now a bit quieter, so we have a quick chat.  Dealing with your personal life - it gets a back seat at best sometimes so it's nice to catch up with a colleague who's also your friend rather than just having your game face on all the time.  Home after 11.  Reheat the remnants of last night's dinner.  Bed.  Up tomorrow at half 7 to do another 13 hours.


Sunday, 11 November 2012

'You get me?'

The furore surrounding the Liverpool Care Pathway (or, as the Daily Mail are currently calling it, 'pathway to death'' or something like that) has caused much discussion in my hospital, as you might imagine.  My feelings on this issue are best shared another time.  But one thing it has made me reflect on is whether I really explain what I mean - i.e. 'You get me?'

Here's the problem - doctors are human, are not perfect and have feelings.  Shocking I know.  And no matter how many times you have been trained to deliver bad news, it ultimately goes against your instincts to tell someone, explicitly, something awful.

'I think you might have cancer'

'I think your dad/mum/wife/husband might be dying'

Those two words in particular - 'cancer' and 'dying' - are surprisingly hard to get out.

There's two reasons for this - first is, it's just really hard telling something these things.  And I know that's what we're trained to do, but you know that once those words have passed your lips, little else you say will be heard.  Even if the cancer is in its early stages, or very treatable, it's heard (understandably) as cancer, and that's that, despite what you say after that.

And secondly, despite popular belief, it's not actually all that easy to know, particularly with the latter, if it's true.  Dying is not a finite art.  Until I started training for this, I'd never seen someone die before.  What I do know is this - everyone will die.  And I wouldn't wish dying in discomfort or pain on anyone.  So if someone might be dying, yes, of course, do everything you can to actively manage the situation with whatever treatment is needed; but also consider that if this is going to be this person's last hours on earth, it should be with dignity and peace.  These two things are not mutually exclusive.

But either way, this whole issue of the LCP has made me think first and foremost of all the patients who have died since I started working, and how closely we have worked with the patient and their families to make sure everyone is informed and comfortable to the end.  It is so difficult to say these final, definitive words about what we think is going to happen next.  But it is not enough to 'think' we have explained what is going on - hiding behind medical words or terms which are not explicit enough is insufficient.  It is far harder hearing this sort of difficult news than delivering it - I will never ever forget that it is my job to be sensitive, explain clearly and make sure we are all singing from the same hymn sheet.  

Thursday, 1 November 2012

Common Sense Science. My very favourite kind!


Because I decided life wasn’t busy enough (!) and I have this irritating obsession with learning things, I’ve just started a course in translational medicine.  What, I hear you cry?  This has been the general reaction from my colleagues and chums.  So I thought I’d take a break from my first assignment to give you my take on what I’m increasingly seeing as ‘Common Sense Science’. 

I think to describe translational medicine; it’s probably easier to think of what one might expect medical research to achieve.  I’d probably kick off with understanding how disease functions on a molecular level, how it starts and progresses, what cells and proteins are involved.  I’d then move on to working out what parts of this mechanism we could target – what are the most important drivers of the disease process?  Next – how can we manipulate these?  Do we have to go back to the original genes that programme the components of the mechanism?  Can we block, change or remove certain cogs in the machine using drugs, chemicals or radiation?  And finally, how do we take all of that into something that you or I could walk into a hospital and benefit from, to either reduce our risk of, or treat, a certain disease? 

Sounds pretty common sense, huh?  Essentially, I think Translational Medicine is taking our understanding of how disease works and using that to make effective treatments for patients.  Sznol has described this better elsewhere as a four- or five-point process, but that’s my take on Common Sense Science.

But it can also work the other way around.  For example, a commonly cited case of pharmacology-gone-(slightly)-wrong is that of Imatinib, a drug designed to target an important disease-progressing protein in a form of leukaemia (Chronic Myeloid Leukaemia).  Cited as a wonder-drug and potential cure, they then realised that actually some patients didn’t benefit from it at all, or alternatively, stopped responding to it after an initially positive response.  Rather than abandon ship, research groups have sought to understand why certain patients are resistant, or develop, resistance to imatinib.  As a result of reversing the bench-to-bedside process, hopefully patients will benefit from imatinib, or drugs like it, in years to come. 

My initial delve into the translational world has raised some interesting quandaries for me.  First, the idea of human beings as a test model.  In the surgical world, it is now well recognised that with new techniques such as laparoscopic (key-hole) surgery increasingly used, and challenges to training opportunities ever-more prevalent, we must create an environment where patients are not practice models.  Innovations in virtual reality and simulators, as well as robotic surgery, are gathering a-pace.  But can the same really happen in the medical (i.e. not surgical) world?  Human beings are so complicated that no other animal, petri dish or fancy chemical model could ever hope to recreate us in our entirety.  But are we ready to accept that we must be willing to be the trial run for drugs?

Second, the idea of physician scientists.  Many authors talk of scientific progress progressing faster than clinical science – i.e. scientists are getting there faster than people like me (remembering though that I am a very junior physician.  In fact I don’t know if I even feel comfortable calling myself that!).   I am an academic trainee, which means that over the next two years, I have some protected research time.  But I have certainly been in situations where people have questioned whether it is wise, or even safe, for me to do this.  Shouldn’t I be training to be a safe physician first and foremost?  Is it appropriate for me to be taking time out of this early stage in my career to do research?  I find this astonishing, and even more so now that I’ve read a bit more about translational medicine.  How are we ever to bridge the gap between scientific innovation and clinical outcomes if there aren’t the people there to bridge the gap?  Stepping into a lab as a physician is a bit like stepping into a parallel universe, and frankly, I’d rather get on board now so I can learn from the start how to combine my life as a physician and a researcher rather than later.  You don’t need to tell me twice about patient safety – it’s what keeps me up at night, me and every other junior doctor. 

Me, Everything Everything and a cup of tea are getting on nicely in our quest to get this assignment done.  And yes, I have received a suitable amount of heckling from my friends that this is how I choose to spend a small chunk of my week of annual leave. 

Monday, 29 October 2012

Addendum to 'Night Shifts'

11. The bit when you've finished your night shifts and have an entirely function-less day where you know not whether to sleep or stay awake and wind up doing neither particularly well.

Moral of the story - the day you finish your nights will always be a write off.  Stash up a backlog of Downton and Homeland and deal with it.  

Tuesday, 23 October 2012

Lifelong learning!

I just wanted to do a quick shout out for this amazing website which I'm currently doing a course on.  Coursera does a whole range of courses for free at various universities around the world - amazing!  I've just started a short course in Community Change in Public Health at John Hopkins University, which I'm doing in my PJs and slippers in the comfort of my own home (on post nights zero days).

No vested interests, just wanted to spread the word.  I love a bit of learning, I do.
The beautiful North.  Oh, how I miss you!
Also - I'm rediscovering long lost music that reminds me of times past (you know that thing where certain times in your life have a sort of soundtrack attached to them?) - I forgot how great Snow Patrol are!  Music and medicine seem to go hand in hand with me - I feel a bit lost when I have one without the other.  

Friday, 19 October 2012

Night shifts

Night shifts are....

1) Waking up patients who really don't want to be woken up because that blood test result you were asked to chase took until 11pm to come back and turned out to be really quite abnormal.

2) Questioning your judgement.  All. The. Time.

3) Asking your seniors unbelievably stupid questions about unimportant things (but you'll remember and learn for next time).

4) Trying to not get too creeped out by the long, dark hospital corridors you are walking along by yourself.

5) Jumping a mile when your bleep goes off just as you've found somewhere to sit quietly for five minutes.

6) IV fluids.

7) Sometimes making tough choices about where to be at any given time.

8) Sometimes feeling this is what you actually trained for 6 years for rather than doing lots of daytime paperwork.

9) Sometimes feeling that 6 years was so not enough.

10) Switching your entire body clock around - a 2:1 ratio of work to sleep will just have to do.

but most of all:
Trying your hardest to keep your wits about you for a very long time, and having something to look forward to when it's all over!

Monday, 15 October 2012

I'm a patient - get me out of here!

My junior doctor chums and I have a cringe every now and then when we think of some of the 'catchphrases' we've developed.  Whether it's asking the patient 'if you've had a bit of a funny do' (read: fit, faint, fall or similar), joking with them 'you look far too well to be in hospital' or apologising for the cold pair of hands examining their chest/abdomen/arms etc by wittily remarking 'well, you know what they say - cold hands, warm heart!', I suppose it's inevitable to develop a stock response to common situations.

But, the one I am always happy to cringe at, is 'well, don't take this the wrong way Mrs XYZ.... but I hope I don't see you again any time soon' - which usually means, we've finally crossed our T's, dotted our I's and found a way for you to get out of here.

Don't misunderstand me - I'm not trying to get rid of my patients; in fact, often quite the opposite - but it is a small triumph for all involved when a patient is finally able to leave hospital.

It is one of the most frustrating part of my job that once a patient is medically fit, there is no certainty that they will be discharged soon.  The BBC is well on the case with this, and it's not a new issue. Although I work in one of the areas with the highest rates of this, it's something I have witnessed since being a medical student in all areas of the country I've trained in.


So what's going wrong?

From my perspective, there's one main issue.  Our old friend, Communication.

There are a lot of players when it comes to getting someone home, and unfortunately, they're rarely present on the pitch at the same time to talk about what's going on.  Patient's wishes are paramount, but input from the medical team, physios, occupational therapists and any other appropriate healthcare workers is needed to identify their needs in the community.  Families may feel they have extra information which may be useful, but this must be balanced with maintaining the patient's autonomy.  Then the social worker is loaded with all of this information and a whole other collection of issues (place of discharge, funding streams etc) come into play.  The difficulty is, a delay in information or progress from one of these groups can hold the whole thing up.  That can even start from a medical perspective, with many multidisciplinary teams being unwilling to start discharge planning until a patient is medically well.

Then there's the disjoint between health and social care.  People often ask me what sort of things I see most often as a junior doctor - an easy answer - it's usually some end effect of someone struggling to cope at home: 'off legs', falls, confusion.  I'm not denying there are often (mostly?) medical components to this as well, but there's a tendency to categorise - is this a medical or a social issue?  I think you'll find it's both.  But apparently we have to box them first and deal with them separately.  Except - it's not really dealt with when you spot the patient's name on the admissions board 24 hours after you signed the end of their discharge letter.  A large part of this is also the lack of support and backing we give the social worker.  We have a large team of healthcare workers of various disciplines that support a patient to discharge in hospital - but arguably the social worker has the toughest job of essentially getting a patient's whole life in order in as short a time as possible.  Basically, all hail the social worker.  We love you, and need more of you!  And finally, the most frustrating off all.  Vacant place in nursing home.  The paperwork's all done.  The patient's delighted.  Their family's delighted.  You're delighted.  And then the transport gets cancelled. And then they lose their place in the home.  And we're back to square one.

So what can be done?

I've worked in some hospitals where there's essentially a multidisciplinary handover every single morning - perhaps that would improve communications.  Efficient ward rounds would leave us with more availability later in the day to catch up with other healthcare workers on the wards, and of course families.  Speaking of the latter, having a more formal means of ensuring patients and their families have regular windows of time to access doctors, nurses, or indeed anyone who they feel would improve their understanding of what's going on.

If politicians, NHS managers, doctors, ANYONE, is serious about giving our ageing society a better deal, I'd suggest the medical/social interface would be an excellent place to start.  

Sunday, 5 August 2012

First Days as a Junior Doctor

As you may have gathered, my full time job is not, sadly, as a Open Access advocate, but my passion to campaign for Open Access is driven by what my actual (new) job is, as a junior doctor.  Three days in, and we're still smiling (just!)!

I think the main lesson I've learned is this: when in doubt, phone switchboard.  Because I think almost universally, all new doctors and I have agreed that what makes the first few days tough is organisation, or lack thereof.

Day one started off well.  I'd done some shadowing the week before, but really it was the final day of shadowing that gave me the truest flavour of what was to come.  My predecessor did his best to tell me how to make various things happen and generously said I should contact him if I had any queries, however big or small.  So when day one kicked off, I was buoyed by a feeling of 'this is going to be painful, but I'm as ready as I'll ever be'.  A few hours later, an inevitable few tears were shed - my list of things to do seemed too huge to contemplate, and many of them I was unsure how to make happen (referrals, ordering investigations, that sort of thing).  Nothing life threatening obviously, but enough to make you feel wholly inadequate!  At medical school, I had deliberately committed a lot of time in the early run up to finals getting slick at these sort of jobs, but ultimately systems differ everywhere.  You wouldn't believe how many different ways there are to write a discharge summary.

Last ones out of the hospital!
By the end of the week though, I think I was a bit more on top of things.  This is where my 'call switchboard' mantra was born.  Well, not just switchboard.  Asking for help is fortunately not something I'm embarrassed to do, and those around me have been amazing at answering questions big and small, complex and simple, and coming to help when I need it.  The challenge really is organisation, because inevitably someone will get sick, or relatives will appear who want to to have a discussion, or something else will disrupt your to-do list, and you have to be ready to deal with it without forgetting the rest of your tasks.

Most of all I am grateful to the team I'm working in - the porters, the domestic staff, the physios and OTs, the nurses, the other doctors - all of whom have had a brief smile and conversation to share as we work together and make me feel like I do belong there, even if I'm still learning.

There will be more long, long days ahead, and many more moments of uncertainty, but nothing beats that doctor-patient interaction for me.  Whenever I've been stressed or scared, it's only taken a brief moment with a worried patient for me to know that I'm exactly where I want to be.  Cheesy, but true.

Monday, 23 July 2012

Open Access is for Students

It's been a rainy summer in the UK so far, but the sun shone brightly over the Right to Research Coalition's General Assembly on Open Access.  Where better to assemble a group of students from all over the world than Budapest, the city where the Budapest Open Access Initiative was founded a decade ago.  It was a real treat to meet students from many disciplines, organisations (ranging from individual universities to international representative groups) and backgrounds (everything from grassroots like me to full time Open Access advocates).

Discussions with new friends and colleagues
I won't go into details here as I've written the meat and potatoes of what went on elsewhere, so for this, I'll focus on my personal impressions of the meeting.

First of all, it was great just to meet all these passionate people from different corners of the world.  NAGPS, ESTIEM, EFPSA, SPARC - please google these organisational acronyms to your heart's content, but they represent a diversity we rarely get to encounter in the medical world.  But for me, it was most useful to hear from individual universities, of which there were a couple there, to hear what they had done on the ground to promote OA, and the barriers they had overcome.  Main learning outcome: Go and make friends with your librarians!

It was also unique to have a discussion based conference, rather than presentation after presentation.  Far more engaging.

It takes tea to tango
And an interesting thing for me was exploring the subtle differences in culture and structures between our countries.  It sounds obvious but universities and higher education are not organised the same the world over, and nor are the methods in which we communicate on a micro level with each other, and on a macro level with bigger organisations.  Creativity, understanding and adaptation will be the name of the game to overcome these obstacles.

My enthusiasm for a swift blog entry is that I'm unlikely to have time after this weekend.  I am starting my first, proper job since the one I got aged 15 (and that was a weekend job.  In many ways, so is my new one, it's just that I have to work weekdays too).  I suspect my worst fears are being realised, and I'm growing up.  In all seriousness - an exciting but daunting week ahead for me personally, but where Open Access is concerned, lots of VERY COOL things happening the world over, and hopefully more things in the UK soon.


In the meantime, here's the PLoS blog from pre-conference - I hope it is clear that I think OA is for everyone, but post-conference-analysis tells me that students have a hell of a lot to bring to the table.  

Friday, 29 June 2012

I love the NHS


Oh yes I do, and if you're British, I hope you do too!

Yesterday, the Supreme Court in America voted to uphold the Affordable Care Act.  It may not be a national health service as we know it, but in passing it, the USA goes one step closer to making sure everyone will be able to access medical care.  
Now, if any Americans read this blog, it remains a mystery to most people I have spoken to in the UK as to why one would oppose this law.  44 million Americans don't have health insurance.  38 million additional people have inadequate health insurance.  That equates to around one third of American citizens potentially being unable to access healthcare.  The USA is probably the richest country in the world, but the life expectancy is 50th in the world.  And yet 31% of Americans believe they will be harmed by the Affordable Care Act?

National Health Care does not equate to communism.  It doesn't mean you can't still pay for a private provider if you have the money. It means you're saying that it matters to you that everybody can go to the doctor if they need to.  Of particular concern to me is the effect on people with chronic diseases - and with the ageing population, it is vital that healthcare systems are in place to support people through lengthier, more complex disease trajectories.

I read on CBS that the fundamental opposition is that people want a better economy more than they want a better health care system.  This is the ultimate mystery to me - better healthcare, healthier workforce, healthier economy (as evidenced by a 2006 study by McKee and colleagues).  But surely this is a question of social responsibility, believing that your neighbour deserves the same care as you'd hope to get, regardless of the size of his pay cheque.

At BMA conference
I'm not trying to put together a thorough and detailed argument, but at the end of the day, the NHS is an amazing organisation and one that we must defend.  It's not perfect, of course (that's for another time).  But the point is, as a doctor, I know I'll be able to care for anyone who needs care, and as a person, I know that my friends, family and indeed anyone can be assured of treatment regardless of their healthcare ailment.  We have our own battle in the UK with the Health and Social Care Act - and that's to prevent us going to the very system that Obama's trying to change.  

Tuesday, 26 June 2012

Open Access - advantageous for all

Sea.... sun.... sand.... well, it's out there, but I'm spending rather more time indoors at the BMA's Annual Representative Meeting in Bournemouth.  One full day down has seen debates regarding key issues affecting medical students and junior doctors, the health reforms, health inequalities... to name but a few.

I'm delighted to report that the BMA voted to support Open Access, and to support the work of the Right to Research Coalition!  Great that the medical profession, from medical students up to senior doctors and GPs support Open Access.


I read this paper today which evaluates how successful openly published papers are - very, apparently.  It offers a brief meta-analysis of papers that explore Open Access citation advantage.  It suggests that the majority of papers published with free availability are more heavily cited - a 300-450% advantage for medical papers.  It makes complete sense - the more people who can read your work, the more likely it is to be cited - but it's heartening to see it in figures and numbers.  Having intercalated and spent a few months in a lab with full-time scientists, it is clear that having your work published and cited is absolutely fundamental to the ongoing success of research groups and therefore scientific progress.  Further evidence that we must promote Open Access to help spread the word and drive research forward.

As Professor Averil Mansfield, Chairman of the Board of Science at the BMA, reminded us today, doctors have a powerful role to play in promoting issues we believe are important, raising their profile to both the government and the public.  She spoke about what has been done to tackle smoking, obesity, road safety, illicit drug use - it just shows that we must use our voice across a broad range of issues, and Open Access must be no different.  

Wednesday, 23 May 2012

If you do one thing today...

.... sign this petition - It's a petition to Barack Obama demanding free access to publicly funded research.  It CAN be done!  It doesn't matter if you're not in the States, your petition signature still counts.  It literally only takes a minute.  If you're still not sure why Open Access matters, read some of my posts below or check out www.righttoresearch.org.

If I can fill it in from the UK in between the 'Childhood Developmental Dance Routine' (new and improved version) and making up yet another ridiculous rhyme for this, that or the other (just discovered a great one for Valproate side effects) then I have every faith that you can too!
Some 'light reading'

Wednesday, 16 May 2012

Getting Global with Open Access

Exciting news!  Look here to read all about the Right to Research Coalition's General Assembly in Budapest this July, where the global student community will come together to share ideas and advocacy tools regarding Open Access.  What an awesome opportunity to meet students from all over the world passionate about research being accessible and available to all.

If you're interested in making it happen here in the UK, and all over the world, drop me an email and register for the GA now!

Two weeks (ish) til finals now so soon I will be back in a world that does not revolve around revise-eat-revise-clinical skills-revise-nap-tea-revise-eat-MOSLER practice-revise-.....etc. etc shortly.  You get the drill.  Daumen druecken bitte!

Aaaand.....
Look what the European Commission has recommended?  Absolutely amazing!

Wednesday, 2 May 2012

A bit of good news

One of my best friends got married recently, and I'm using his wedding cake as a reminder of happier things!

  You can read some joint BMA/Medsin writing on the PLoS blogsite about the recent respective conferences here. I'll quickly scribble about some Open Access developments to retain some non-revision writing.

Open Access is really, well, opening up, here in the UK.  Wikipedia founder Jimmy Wales is supporting the Government's plans to make research freely accessible on the internet.  David Willetts made the announcement today, noting that the government spend £5bn on research and could save millions by making research available to all.   Dame Janet Finch has been invited to report on how we can make Open Access a reality.  To have the Minister of State for Universities and Science making such a statement is a huge step forward for Open Access in the UK.  The report is due in the summer.

Not much more to say from me for now.  Apologies if I cry on you at some point in the next few weeks for something as innocuous as making me a cup of tea (this seems to be the current affliction of a lot of female final years at the moment!). Normal service will shortly be resumed. And I'd really appreciate the tea :)

Friday, 20 April 2012

Not a failure, just human

Feeling stressed? Run down? A little bit blue?
Well, that's the deal, isn't it? Part and parcel of life, and if you want to be a doctor, you'll find a way to cope.

This is what I think most of us feel like at regular phases of our time at medical school.  Now, I'm not trying to suggest we're special or unique in this - clearly other jobs are also stressful and leave you struggling to cope.  It just seems ironic to me that given what we're training to do, we're not so hot on a bit of introspection and admitting that we're not coping.  Great at dishing out the advice, not so much listening to it ourselves.

Last year I went to a Medsin conference entitled 'The Good, the Bad and the Mad', and found myself feeling quite choked by a talk given about mental health and medical professionals.  Because I felt that they were talking about me.  

I'll share a little of a particular year of my training in hopes that you won't make the same mistakes I did.  In a nutshell, I was doing too much.  Every day was a jogging match between university and my other commitments.  Meals were had on public transport, if at all.  I lost about a stone in weight.  Everyone told me I looked terrible, but I was so panicked I would fail at keeping up that I couldn't get out of the cycle.  Tears were shed at the slightest aggravation, and fun activities were approached with a degree of guilt.  Were it not for the insanely supportive people I had in my life, well; to be honest, I don't know what I'd have done.  It was probably the most frightening phase of my life.  And what's awful is, because ultimately I 'survived' (I don't mean to sound dramatic, but it's honestly what it felt like) and the year in broad terms was a successful one, it is easy to think it was all worth it.

Fear of failure is both a powerful motivator and a dangerous weapon.  It's ultimately at the heart of why many say medics are particularly terrible at confessing any weakness or difficulty.  This is where the problem lies - we have to get away from feeling like we've failed - if anything, we've triumphed in the art of reflection!  I'm more alarmed by the idea that doctors hide away from these issues, as if they don't happen.  Well, last time I checked, we're humans, not robots.

A few months on, and I'm fine, but it's certainly changed my perspective on things.  I sent my gran's Christmas card a whole week early for once.  Cooking is now a priority and a joy - (I swear revision doubles your food requirements or something).  I've learned to say 'No' (although I can't deny that there's still a little guilt involved).  But probably most importantly I've realised that no man is an island.  I will forever be grateful to the people that got me through that year.  We are each other's support network; let's embrace it, and be thankful for it.

Monday, 16 April 2012

An exercise in listening

I sometimes think that the BT advert that tells us 'it's good to talk' could have been dreamt up by someone who had been spying on me, and was trying to make me feel better about the fact that I talk.  A lot.

And this weekend, I was reminded again why I need to stop talking.  Apart from the fact that there is no real filter between what I'm thinking about and what I subsequently say (and therefore absolutely no quality control!), I listened to so many excellent things this weekend that I hereby promise to make my life more of an exercise in listening.  

This weekend I was at the BMA's Medical Students Conference in Nottingham - medical students from all over the UK spending two days debating motions on issues as diverse as binge drinking to the current oversubscription situation for foundation jobs, student finance to research databases, academic training to supporting charitable work.  The stand-out speeches for me were always the first time speakers.  I went to my first conference three years ago and I was T-E-R-R-I-F-I-E-D - nothing gives you palpitations like the first time you face the crowd.  It was exciting to hear about what novel issues people had identified, what ideas people had for tackling them and then hearing them be debated with such eloquence.  Great news - the motion in support of Open Access to research passed!

Medicine is always seen as a competitive kind of area to work in, but at the conference, it warmed my heart to see that friendship and camaraderie are not dead.  Perhaps people criticise us young 'uns for being full of wishful thinking, big ideas and a distinct absence of cynicism, but I am delighted to embrace this label. I love that we can come to the table with such different ideas, haggle it out and still leave as friends. 

Shall we dance?
But such haggling only comes with a predominant dose of listening, and I am hereby making it my halfway-through-April resolution to frankly pipe down.  Quantic and Alice Russell are making this endeavour significantly easier at the present time.  Hurrah for music! And for friends - meeting people like those at the conference this weekend is probably my favourite thing ever. 

Tuesday, 10 April 2012

Well Done Wellcome!

Having just returned from a family Easter trip, I've had plenty of time over the last few days to think about Open Access to research.  Then the Wellcome Trust absolutely leads the way and decides that all its research will be accessible to everyone.  During my year in London last year, I used to walk past that building almost everyday - how exciting that a body as eminent as the Wellcome Trust has taken such a massive leap step.

I know I've rabbited on about Open Access before, but the book I've nearly finished reading has given me renewed reason to reiterate its importance.  If anyone else has ever read 'A Short History of Nearly Everything' by Bill Bryson, perhaps you'll agree that an overriding theme that comes across is that science and discovery is as much about communication as it is about the actual thing that has been identified.  Discoveries have laid dormant for years, decades even, because the researcher wasn't a very nice person, or didn't explain it very well, or simply picked the wrong medium through which to tell the world.  The first of these - well, a good friend of mine once said that he made it his mission to always be nice to everyone, because you never know under what circumstances you may meet again (the medical world in particular is a frighteningly small place - plus, it's nice to be important but it's far more important to be nice!).  The second - let's hope all those communication skills we learn at medical school extend to the written word.  And as for the last - at least now we have things like conferences and Pubmed to spread the message, regardless of where the information is originally shared.  I suppose what I'm saying is - these things are all still issues now, perhaps (hopefully?) to a lesser degree than they were before.  What is truly laughable is the idea that having overcome all of those challenges (as well as the discovery itself), the greater population can't actually read anything about what you've done.  Imagine if Einstein's Theory of Relativity had been approached in this way?

We need universities to start opening the doors and saying YES to making the research they publish accessible to all.  Will they start being left behind if groups like the Wellcome Trust make their studies accessible?  Ultimately research is just one idea following another - ideas tend to flow more smoothly if you can have full access to the preceding ones.  
'Knuckling down'
It's just my luck that just as I have to really knuckle down to some finals revision that I want to jump up and down about Open Access instead.  Really excited about pushing forward with the great work being done by the Right to Research Coalition over the summer to get the message out to the UK's medical schools.  Watch this space!

Friday, 30 March 2012

Global Health and the Medical Student

This is only intended as a brief post, to link in with my recent post reflecting on the recent attendance of Medsin-UK at the International Federation of Medical Student Associations (IFMSA) General Assembly (GA) in Accra, Ghana.  If you're interested, you can read it here, or go to the Medsin-UK blogs.

Dr Ankomah and the apprentice, 2008
It seems apt that the brilliant team of UK medical students have just returned from the place that really confirmed my interest in medicine in the first place.  As a bright-eyed, bushy-tailed 17-year-old, I fundraised to go to Ghana for a month and worked in a hospital near Accra. I was also lucky to work in more rural areas, delivering a couple of outreach health workshops.  The experience taught me both the basics of medicine at a time when I was struggling to see beyond A-Levels, never mind university, and gave me an insight into the realities of health care in another country.  I loved it so much, I returned to West Africa after my second year at Medical School as a backpacker around Ghana, Togo and Benin.  Of course, no trip would have been complete without popping in to see Dr Ankomah, and I hope to return at some point when I'm qualified.  I have been something of a backpacking enthusiast but the more places I see in the world, the more I realise I have yet to experience.  The diversity of world is truly exciting.  But unfortunately the diversity extends to the quality of healthcare, perpetuated by the different healthcare challenges facing each corner of the world.

I'm no expert in Global Health, but my time at Newcastle University has facilitated many situations where I have learned more about it.  Early on, as a fresher, I trained with the Newcastle branch of Sexpression to deliver sexual health education to young people in Newcastle, and it was interesting to contrast these experiences with those of our outreach projects in Ghana.  It was through further work with Medsin-UK as part of the committee for the Global Health Conference here in Newcastle, and through attending the IFMSA meeting in Copenhagen last Autumn, that I really learned a lot more about the role medical students have to play in the global health message.  I think what I find most exciting is that global health often starts at home; we can challenge the health inequalities we have right here on our doorstep.  It is particularly exciting to hear about the Global Health Education Project, which promotes Global Health Education as an integral part of medical education.  Sometimes it can seem daunting and unachievable as a medical student to get involved in these various projects, but local activities are a great place to start.  

Sunday, 25 March 2012

Open Access to Research

As a medical student, research is something we 'should' know something about, and 'should' use to develop an evidence based approach to our clinical practice.  We do our best to critically appraise the literature, understand what all the statistics actually mean and, fingers crossed, we'll be able to tell you at the end of it whether the research was any good or not.  

I certainly didn't give a great deal of thought to how we are physically able to access research articles.  It wasn't until I did some lab time of my own that I realised also that a lot of research means starting from scratch, because raw data from research studies stays within that research group.  

It was around this time that I became aware of the Right to Research Coalition (http://righttoresearch.org/) which is based across the pond, but we're working to get a base here in the UK for this important issue.  So what is Open Access and why is it important for research and clinical practice, and, indeed, global health and the international community?

When I want to read a research article, it's quite straightforward - I just log in to Pubmed either on campus or I log in from home.  Every now and again I'll hit a brick wall and be unable to access a relevant article. Has that ever happened to you?  Imagine that happened every time you tried to read any article you ever wanted to read.  Then think what research developments have happened in the last few months alone.  Aspirin to prevent cancer, laparascopic surgery for colorectal cancer, the pros and cons of new targeted therapies... Our ability to stay up to date clinically relies on our being able to read journal articles with ease; and yet some journals cost thousands of pounds for a subscription.  Great, if you are part of an organisation that does this for you, but not so great if you're not.  

Now, if you're thinking 'yes, but research is expensive and this is a way of paying for it' - well, research has kind of already been paid for, often by the government or charities.  We have a right to see this research.  A system that was never designed for profit has been made into one.  There are many more open access journals now, demonstrating that it is a sustainable business model.  

The problem isn't just clinical up-to-date-ness, it's also a question of making science accessible to all.  This blog explains the problem through the eyes of a scientist in India:http://poynder.blogspot.co.uk/2006/05/why-india-needs-open-access.html.  Simply, we are shutting off many countries of the world either from seeing what research is happening elsewhere, and therefore from being able to add to the knowledge base.  If we are serious about global health (and we should be), this needs to be addressed.  

Finally, it's also a question of making research more streamlined.  Just think - when you read a research article about something, you are told the aims and objective, the data is categorised and analysed and then you are told the conclusions of the study.  But what about the raw data?  That stays with the author.  Obviously this is also a question of research ethics and patient confidentiality, but what if that raw data could be accessible to other research groups rather than having to start from the beginning? 

I'd urge you to check out some of the links above if you're interested:
www.righttoresearch.org
http://poynder.blogspot.co.uk/2006/05/why-india-needs-open-access.html

What do you think about Open Access?  Have you heard of it before, do you think it's a good thing?

Karin

Saturday, 24 March 2012

First Post Pressure!

So it is with slight trepidation that I enter the world of the Professional Blog.  Hello!  I hope from time to time you will pop and hopefully read something that you like, or that you share some of the things I am interested in.

To get cracking, I thought I'd start with a wee post about the BMA Council Election in which I'm currently standing as a candidate.  If you know me, I'd really appreciate your vote!  If you don't know me, and are wondering who on earth to pick on the epic-ly long ballot form, I'd like to tell you a bit more about myself and perhaps you'll consider voting for me too.

I'm a Scottish/German/English medical student - born in Glasgow, grew up in Wiltshire.  I can thank my German mother for the spelling of my first name and continuing to be better at English than I am, and my English dad for his willingness to help me with my maths queries.  The local secondary school that I attended happened to be a Performing Arts school and none of my family are medics, so medicine certainly wasn't a foregone conclusion for me!  However, I am so glad I chose this profession - I know I probably still have the rose tinted glasses of a medical student on, but I have loved my training at Newcastle University (with a detour to intercalate at Imperial in Surgery and Anaesthesia), and the extracurricular activities that have come my way have led me to become interested in medical politics.

I came very much from the grassroots level to the BMA.  At medical school, I trained with Sexpression to run sexual health workshops for young people in the North East, a role which later led me co-coordinate a National Sexpression Conference in Newcastle and train other students to lead workshops.  This led me to work with Medsin, and I was the logistics coordinator for the Global Health Conference in Newcastle.  But it was really as President of the Newcastle Medical and Dental Students Council (NMDSC) that I became really interested in medical student representation and medical politics - apart from organising various social events, it also gave me a sense of what representation can achieve on the ground.  For example, we organised peer parenting, along with a Cheese and Wine mixer to help 'parents' meet their 'children (freshers)' in a more relaxed environment, and wrote a Freshers guide for prospective Medical Students.  I remain passionate about staying in touch with what's happening at a grassroots level, and aware of what people want and need.  I should also say that the NMDSC committee was a brilliant committee to work in, with real teamwork and camaraderie, and I felt excited about working in such a motivated group and really getting things done.

I became involved with the BMA as the medical school rep (MSC rep) in my fourth year, and have never looked back.  I was struck by what the MSC could achieve and the high level on which it lobbied for medical students.

I was Chair of the Medical Students Committee (MSC) 2010-11, a role that was challenging but exciting.  Just as I took over, the Foundation Programme Oversubscription was announced, as was the Browne Review, and the start of the year was a blur of lobbying, meetings and media work to try and get our message to the politicians and organisations making the decisions.  Regarding student finance, we lobbied hard to get Medical Students to be seen as a group who required special consideration - only 1 in 7 medical students come from a lower income background, a figure that has since increased further.  Although the £9000 fees were pushed through, we did manage to secure a guarantee for NHS bursary funding for subsequent year, without which students may have been paying up front for their education right at the end of their medical degrees.  As for the Oversubscription, we cited how medical unemployment constituted a waste of taxpayers money, and eventually all graduates were offered a Foundation job.  I also attended the International Federation of Medical Student Associations (IFMSA) meeting in Copenhagen with Medsin UK, sitting on the Standing Committee for Medical Education.  There, I was fortunate to be able to discuss ideas about student representation, student feedback and political lobbying with medical students from all over the world.  There were of course many other issues that the MSC worked towards last year, which involved working with the GMC, the Medical Schools Council, UKFPO, Foundation School Directors and importantly, committees within the BMA.

As MSC Chair, I represented Medical Students as a non-voting member of BMA Council.  There aren't many voices from our end of the medical profession on Council, and I think we need to be vocal to ensure our voice is heard.  Having seen what is involved, I think I have the experience to contribute and be that voice.

This year, having returned to Newcastle, I still sit on the MSC Executive Committee and sit on the Junior Doctors Committee, and feel that this experience would help bring continuity to the role on Council.  I'm also working on developing the Right to Research agenda in the UK after meeting the RtR Director at IFMSA - I blog on behalf of Medsin-UK at.... http://blogs.plos.org/speakingofmedicine/.

I think I'll stop there... and round things off by saying how much I have enjoyed the experiences I have had so far, and how lucky I have been to meet the great people I have met in the MSC and the BMA as a whole.  If you ever despair of the apathy of today's young people, come along to a BMA MSC meeting and your heart will be warmed!  It has been invigorating and inspiring to work with so many brilliant people.  If I was voted onto Council, I would work my socks off!

Danke sehr, und alles gute,
Karin