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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.

Sunday, 27 October 2013

The Truth, the Whole Truth and Nothing but the Truth

I spent the first half of this weekend with a legendary friend in Bristol, who puts me to shame every time I see him with his literary and life broad-scope. He waved Intelligent Life, The Economist's side journal, at me as a 'must read', with particular reference to an article on a Brazilian tribe's approach to medicine.

On towards home, and to Papa Purshouse, who is an engineer and extremely squeamish; our worlds rarely collide (apart from a memorable episode during my intercalation when I was doing a module on biomechanics).  So it was with great surprise that his favourite light read, The Economist, was waved in my face soon after rocking up at my parents' doorstep.

And lo, The Economist defined my weekend unexpectedly with the question - How Truthful is Science?

My background interest in Open Access has driven my curiosity into how we read information, and how that information comes to be something you are able to read in the comfort of your home/lab/office. Whilst I learned how to critically appraise and analyse literature at medical school, it's people like Ben Goldacre who have made me question the information in front of me in a more global way.  The cover feature in the Economist this week notes that the vast majority of findings in scientific research studies have been found to be unreproducible, and reiterates what Ben Goldacre has been saying for a number of years about positive result publication bias.  The article notes that reviewers rarely reanalyse the data, and that there is no culture or appetite for data replication by other research groups to validate data.  Peer review on submitting a paper is seen as the gold standard of quality assurance.  And yet, it doesn't seem to be working.  John Bohannon recently tested this theory by submitting a fake article on an invented study - it was accepted by 157 out of 304 journals.

It is funny to reflect on this as a junior medical doctor with research aspirations.  The Economist article is right - one is looking for results. Often, a negative result is seen as a hurdle to overcome rather than a result in itself. I cannot think of many memorable studies I have read with a negative result (apart from the whole bevacizumab 'disease free survival versus overall survival' debacle).  But at my stage, the obsession with publications from those around me is almost suffocating.  Of course, we want to do it properly and accurately. I fear the peer review process as much as the next person. But once it's out in script, it is Job Done.  The idea of going back over someone else's work instead of moving on to the next thing is unthinkable.  In the Economist article, they talk about a lab that offers to validate your results independently - but who pays for this? Individual scientists? And where is the value-added in the system for this?

My key reflection on this is the lack of value on peer review. Peer review is done for free and is an expected part of the job for any established scientist. And yet, on the biography page of most scientists, all that is listed is their list of publications. There is no note about the number of articles they have peer reviewed. In the financial squeeze, scientists have to focus on what will keep them employed - and at the moment, that's research output rather than a really cracking review.

So back to the Intelligent Life article, where a journalist follows a Brazilian tribe and observes their health care rituals. He reflects on how he brings his own prejudices to the situation; how can these methods possibly work? And yet they do. I guess overall, we assume the system we know is best.  But, much like the argument in favour of open access, perhaps we need to think beyond the devil we know to find a more accurate way of answering science's big questions.

Friday, 25 October 2013

A blog-a-plug

I've just discovered this beautiful photo blog created by someone who lost his wife to breast cancer.  The photos are just really beautiful.

The author only writes a few short passages about their life together in his blog alongside each of his photographs, but this little nugget reminded me of something my friend and I talked about when sat in the canteen in a Scottish hospital some months ago.

'Before going to sleep Jen and I used to ask each other what the best and worst part of the day was, choosing to tell the best part last so we could fall asleep happy. The night we came home from the hospital after being told that Jennifer’s liver was failing and she didn’t have long to live, I asked Jen to tell me what she loved most about the day, which we had spent with family and a few close friends. Jennifer thought for a moment then looked through my eyes and into my soul. She said, “I loved it all.” 

Today I loved a lot of things; the week has had its moments but I shall tuck those away and think of the lovely parts instead.

Sunday, 20 October 2013

Being Thankful

This is NOT a post about female doctors or other such controversies.  This is a post about good and simple things.

Today has been an absolute triumph on many levels.
a) I squeezed in a lovely wee run first thing around my ye olde worlde corner of the world
b) They played Be Thou My Vision in Church. I did not cry! Progress.
c) Exercise numero deux - badminton for the first time since I was about 12.
d) It's raining outside, I'm snug inside, fat jumper on, fire roaring away.
e) I'm going to visit Granny Germany soon.
f) I'm on top of my Masters (which means I'm behind on everything else, but hey, small victories!)

YES! Toasty warm on a rainy Sunday. 

It's Harvest Season so in church today the speaker asked us what we had to be thankful for? So many things, obviously, but it fitted in nicely with my recent 'life refresher'. I have let a few personal and professional things get on top of me in the last few weeks, and just felt sad about a whole bunch of stuff. I guess I'm just used to being able to control my feelings; damn that game face again! And I guess doing the job that I do, when you lose that mental positivity, it's easy to pull yourself down a hole.

Thankfully, I passed that exam, and decided this would be the spring board to a positive K Dog. Because my job is really pretty damn good fun, I get to meet cool people every single day and although I'm not perfect, I'm not a terrible doctor!  This week I had one such patient who reminded me of why it's so awesome. We instantly hit it off, and once I'd done the necessary 'spanish inquisition' of the history and examination, we had some more informal chat while I was taking his blood and getting other things sorted. He had had such an amazing life and I left my shift with a real spring in my step with the tales he had told. In what other job do you get to share so much about yourself, and have so much shared with you? I went to meet some friends later that evening and described how I'd had 'one of those patients who just makes everything worthwhile' and it was amazing to see how they all beamed at the memory of having had such patients themselves.

Obviously that's not what it's always like, but it's those more joyful moments of human spirit that I really value when I get to see them at work. I delivered my first tutorial session this week at one of the Oxford University colleges to a group of new medical students, and although they are at the start of a very long journey, I so desperately don't want them to lose sight of what it's all about. I might be stressed sometimes, miss important family/friend occasions from time to time and be committing myself to another thousand exams in the next few years, but it's a life that I strangely love.

So onwards and upwards. There is indeed much and many people to be thankful for. Hey, I became an Auntie! Coolest. Thing. Ever.