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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.

Wednesday, 27 August 2014

Singing songs and other human things

On popping home recently, I bumped into a very old friend - someone I hadn't seen for years. I always find myself embarrassed by myself in these situations - there's something about saying 'Um... so I'm a doctor' that has the potential to feel like you've dropped a bomb.  Out of the resulting crater can spill out a whole bunch of emotions, as it did in this instance.  My friend had close family who were going through the complex map that is NHS-and-social-care and they were deeply frustrated.  Doctors crooking their heads and telling them what they thought was best, despite being a quarter of the age of the patient.  An a-amotional stream of medical types who had fifteen minutes maximum per day devoted to each of their patients (ward of 20 patients, 8 hour day - you do the maths).

There is always a question in clinical medicine (and I have previously written about the pros and cons of the so-called game face in medicine) - how much of 'you' do you reveal?  Particularly when you're a junior doctor, and, dare I say it, particularly when you're a female junior doctor?  When does 'being yourself' just become unprofessional?

I find myself increasingly leaning more on the human side of things than others might.  My friends roared with laughter when they heard that I sang an entire song from my childhood to a patient (and their family) because I thought it might make her smile at an otherwise rather difficult time.  I regularly tell tales and memories of my grandparents, and my (still living and going on mightily aged 93) grandmother is frankly famous from the number of patients I have told about her as an example of age just being a number and focusing more on what people can do rather than the date on their birth certificate.  If patients or relatives sigh at me and say 'you doctors just don't know what it's like' with complex discharge planning regarding their elderly relative who lives 300 miles away from them, I am willing to share their frustration with my own family's experience of exactly the same thing.  I talk German to my patients who are German.  I only introduce myself as 'Dr Purshouse' when the situation requires it (e.g. official-dom) - the rest of the time I'm 'Karin, one of the doctors'.

You're probably reading thinking I'm marking myself out for sainthood, but these are not beliefs and practices held by everyone.  Some people (and my colleagues) want doctors to maintain a more professional manner.  One of my colleague always introduces himself as 'Dr So-and-so' so there is no confusion later on about who he is, and to a degree also set the tone - he is a professional, giving his professional view.  Frankly it can be just confusing to patients, and a more formal approach can make it easier to understand who everyone is.  Some doctors prefer to keep their private lives to themselves, absolutely all of it, and part of that is also self-preservation and not getting too emotionally involved with their patients.

Trying to be a 'serious doctor'.
My take on this?  I am a doctor, and I ask for the same professional respect as I afford every human being (patients, colleagues, anyone), but if I wanted to be an emotionless robot, I would have picked a different job.  Obviously I judge every situation on its merits, and being super-casual is not what showing your human character is about.  Sometimes I think I should be a bit more formal at highlighting my role though: one of the questions on a confusion questionnaire screen is 'what is my job' - and if I had a nickel for every time someone said 'secretary'....

Hmm.  Perhaps I should try it for a while.  Keep the singing, but instead do a trial of 'Hello, I'm Dr Purshouse but please call me Karin' as a compromise?

Oh, it's tricky being a doctor and being human!

Tuesday, 19 August 2014

Open Access, Closed Door

Earlier this week, I got some exciting news - an article I wrote is going to be published! It's a small online journal with a teeny impact factor, but for baby doctors like me, it is great to just get some experience of the whole process.  It's an article on novel therapies for small cell lung cancer that I wrote for my Masters, if you're interested...

But here's the big hurdle: how to make it Open Access?

Now anyone who reads journals will be familiar with the difficulty of reaching journal articles stuck behind massive pay walls.  It's very frustrating - you find the article on Pubmed (other search engines are available) that promises to tell you everything you want to know about a topic, or explain the method for a certain experiment you want to do, or could outline a study you thought was novel but has actually already been done.  They problem?  You either have to hope your institution has access (that is, if you have an institutional affiliation) and if not, it's tough cheese unless you want to fork out some big bucks to read the article.  Which might turn out to be useless, but of course you don't know that until you've read it.

And this is all despite the fact that research is largely publicly funded and undertaken by scientists who get paid relatively diddly squat to do ground breaking research.  Journals are supplied with articles from said scientists, and then the refining and peer review process happens by other scientists in the same field who do not get paid to do so.  Most journals these days are predominantly read online.  So the main overheads for journals are for editing, formatting etc... Um... so why do journal subscriptions cost so much...?

Especially in the UK, there has been a real drive towards Open Access, and encouraging journals to make their publications freely available.  One method to cover the overhead costs is to charge a publication fee - and herein lies my challenge.  For a little journal like the one I'm publishing in, it still costs a few hundred dollars to meet that fee.

Who pays for that?  Me.  I pay for that.  Because institutions can often only support those who are funded through specific funding bodies who usually ring fence some of their monies for that purpose (e.g. Wellcome, RCUK).  This reflects well on these organisations, but you're a bit stuck if they're not your funders.

Doesn't this just become a thing where people who can afford to pay get stuff published (in this scientific world that is already ruled by a 'he who survives must publish' mantra?), thus devaluing the whole process into one driven by money?  And what about those in the developing world - how do their research groups publish in even the smaller journals with these kinds of fees?  And what hope is there of reaching some of the bigger, more expensive journals, who have much higher publication fees? And what about journals that are a mix of open access and pay-for articles - if you have to pay a subscription fee for the whole lot anyway, don't you just end up paying twice - once to publish and another to read?

I'm totally team Open Access, but it feels a bit like some journals are winning a game where old boundaries remain and new ones have been created.  Hmm.  I don't like those sorts of professional games.

As a complete aside and nothing to do with the above, my new-found employment freedom has given me a bit of brain breathing space which I didn't even realise I needed.  The kind of breathing space that actually winds you quite majorly when all those squashed parts of the soul get some air time.  Without wishing to get too heavy with you, dear blog reader, I will instead say that I can most heartily recommend such pauses, and share with you the view from the lake I went swimming in yesterday.  Pretty sweet, huh?

Sunday, 10 August 2014

Black Wednesday

It's official - I am one of the unemployed masses.  Well, sort of - available and willing to locum at a hospital near you!  And that's what I've been doing this week, weathering the perceived storm that is 'Black Wednesday'.

Black Wednesday instils fear in Joe Public and junior doctors alike - the first day of work for thousands of newly qualified doctors, and simultaneously changeover day for most doctors in training (i.e. everyone from a senior house officer to senior registrars).  It's hard to imagine any other job where on a Tuesday you could be working a 13 hour shift in Exeter, and expected to rock up to your new job in Inverness the next day.  The finger is often pointed at the newly qualified ones as to why the death rate is allegedly higher on Black Wednesday; I think you could make a strong case for the mass move of all junior doctors as a bigger factor.

Although you get an induction, every hospital has different computer systems, different parameters for certain blood tests, different ways of requesting tests, different ways of managing some acute medical problems, different departments available on site...  And hospitals are big places!  Running to a crash call in a hospital you don't know is rather tricky when you don't know where you're going and you don't know who anyone is (sometimes it's useful to know that the guy running next to you is the anaesthetist).  The whole week is an upheaval - the above scenario of moving across the UK is not uncommon, and is seemingly rarely considered in rota planning.  I know a number of my colleagues who only got their rotas the week before starting their new job in a new place.  This means sometimes working a 19-day stretch if you're unlucky enough to finish one job having worked the weekend, and start the next scheduled to work the next.  And that's before you throw night shifts into the equation.  In one case my friend has been rota'd onto nights the weekend she is supposed to be getting married!  Given that changeover day is exactly the same every year and the rota itself can only likely change very slightly, this all seems a little ridiculous.  The flexibility in the system is created by junior doctors themselves - swapping last-minute on calls and cross-covering to allow someone an afternoon to at least move house.

I offered to do extra night shifts on Wednesday and Thursday nights, thinking I must be the craziest person in the NHS.  Given how many night shifts I have already done in the last four months and how completely frenzied they often are, the thought of doing them on a week where no-one knows what's going on seemed foolhardy at best.  But actually it was great - certainly at my hospital they threw a lot of doctors at the situation of handover week, and gave a bit of purpose and use to doctors already working in the hospital such as myself who are doing 'F3' (i.e. finished their first two years of clinical practice and now taking a year out).  We offered the continuity of those logistical uncertainties that come from simply working in a new environment, as well as being an extra person to call upon for the newly qualified doctors.  Well, at least I hope I did...  For me it was a useful combination of learning to advise junior docs and continuing to gain more clinical experience as a junior doctor myself.  In my job, every day is a school day.  Pretty great, huh?

People get very worried about the medical knowledge of new junior doctors.  But this week's experience tells me that while new junior doctors may lack experience, crucially they know how to ask for it.  Perhaps people should focus a little more on easing the transition between jobs of the thousands of doctors in training at the rungs higher up the ladder.  After all, they're the ones that all these newly qualified doctors will turn to on their first days when things get tough.

In the mean time, I'm off to get my life back before Fulbrighting begins.  Can you believe it?  A year ago it was just a pipe-dream, and now I'm about to move to Connecticut for 9 months.  But more on that later.