Recent training...

Oxford morning running...

More Oxford morning running...

Bradford-on-Avon --> Winsley running

Oxford Town-Gown 10k running...

With only two weeks to go til our team triathlon starts, we would be ever grateful for your support!

Today a bunch of us ran the Oxford town/gown 10k; a little warmer than we would have liked, and inevitably I brought up the rear, but nonetheless with two weeks between me and a half marathon I was pleased to make it round in less than an hour (just!)

I will post more blog-appropriate things soon, but in the mean time, if you've got some pennies going spare, consider giving them to www.justgiving.com/organisedfun.

Thanks!

K xxx

Get up, Stand up! Why Junior Doctors must lead from the front

Trainee doctors are an often forgotten entity, although we occasionally get some air time as per the Dispatches programme shown last week.  There has also been a recent wave of discussions about daily Consultant reviews and same-standard care 7 days a week, and GMC guidance for doctors about raising concerns.  

Fact is, when you arrive in hospital, you see a nurse, and then you see me.  You may see only me for a while, depending on how unwell you are.  Then you will see a series of other, but more senior, doctors in training.  You will see a consultant within 24 hours, but until then, it's doctors in training of a range of seniority levels who will manage and guide your care unless you happen to be extremely unwell.  Junior doctors look after patients on the ward, with senior input daily and as required.  If someone becomes unwell, junior doctors will often be first at the scene unless it's a cardiac arrest.  Getting your scans, blood tests, referrals etc done will generally be the responsibility of the junior doctor. 

So I'd say junior doctors like myself are fairly 'front line'.  One consultant I worked for described us as their 'eyes and ears' while they juggled their other commitments like clinics and teaching.  Junior doctors are leaders from the moment they do their first ward round (jogging behind the consultant juggling three different folders trying to write, listen and pull the curtain round all at the same time). 

I went to a national leadership conference in Bolton recently - I was one of only three foundation doctors there, and I knew the other two, which perhaps suggests that there exists only a small world of leadership-minded junior doctors.  

Hurrah!  Excellent conference, but where were the juniors?!

And it was very interesting! Because when we sat down and did a group project about solving clinical problems, or clinical governance, or patient safety, or resource management, or human capital, or the work environment, or CCGs..... etc etc..... who provided stories, anecdotes, evidence for what the issues are, and what might be done to solve them?  Ah - enter the junior doctor!  

I'm not trying to suggest there is no role for Consultants or other clinical staff, but if it helps to paint the picture, one of the Consultants there commented towards the end of one discussion that we needed to get juniors involved in these leadership issues because we still believe that change can come, and we're the ones on the ground with the ability to make these changes happen.  

But what changes?  I would describe these as twofold - attitude/cultural, and practical.

1) Attitude/culture - 

We are a new generation of doctor.  We do shift work.  We're expected to be able to do more - there's incredible medicine and surgery out there.  If someone spikes a temperature, or has a heart attack, or has complete renal shut down, there's actually something we can do about it.  We're expected to show our teamwork/publication/presentation-ing skills around a 60 hours working week. But yet we still live in some bizarre shadow of yesteryear that it was 'tougher back then', you should practically fear your consultant and seniors, and any weakness/emotion/personal life issues are almost an question of professionalism.  

Let's show a little love, people!  Yes, it was tough then, but it's tough now, just for different reasons.  Let's support each other and look after each other and, leadership evidence says, we'll be a happier, more efficient, more effective and safer clinical machine.  

2) Practical - 

There are so many on-the-ground practical challenges that remain - the way a 'Take' list is constructed.  The organisation of the blood cupboard.  The sorts of jobs you get bleeped about that might be better placed in a jobs book.  The appearance of the clerking proforma.  We use them every day - if it doesn't work, or it's impractical, let's change it!  

So junior doctor compadres - let us lead from the front, not shirk our duty and hold our heads high - for we are the medical leaders of right here, right now, and not just tomorrow.  We must engage for the sake of improved clinical care and efficiency, and be the leaders we know we are already.  

In the interests of GMC new guidance relating to social media (although I think it's pretty obvious from the side bar): my name is Karin Purshouse.  I am a Foundation year 1 Doctor. 

Look after the pennies and the alcohol will take care of itself

I'm pre-nights.  I've spent 3 out of my 5 days off at some sort of work related teaching/course etc.  I'm a little bit cranky secondary to this.

BUT

I just wanted to have a wee chat about this whole minimum price for alcohol issue that is rather a hot topic in the UK.Read more here...

Genuine confusion from me about why this is so controversial.

I feel before I start, I should lay out my own drinking habits.  I tend not to drink much alcohol, or anything, during the week.  If I went out for a meal, I'd probably share a bottle of wine with someone.  If I go to the pub, I'd have a pint and a half maybe.  I'm no Saint, particularly back in my student days, and occasionally now if I have a really awful day, but I'm generally not that bothered by alcohol.  If prohibition was back tomorrow, it'd be no biggie.

So the main statements against minimum pricing for alcohol seem to circle on an attack on personal liberties and the feeling that this won't make any difference anyway.

On the former - I find this... surprising.  Apparently moderate drinkers will be punished - really?  Under the proposals, the cheapest a bottle of wine would be is still less than a fiver.  I think most discerning drinkers would say that's still unbelievably cheap for 12 units of alcohol.  As one of said moderate drinkers, I do not feel this infringes my personal freedom.

What I see is very much the end that Sarah Woollaston is on about - the bit where people come into hospital and have had their entire lives ruined by alcohol.  In my current work environment, this can be as pancreatitis, bleeding ulcers in the stomach, liver failure... but it can also be an 'aside' part of their health problems, where they have family or employment problems as a result of alcohol.  Withdrawal effects can also be severe and life threatening.  Many have argued that increasing the cost of alcohol won't make a difference and that people will still drink.  I'd argue two things for this.  First, we cannot predict that it will stop people drinking; but surely if there's a chance it will reduce it, that's a start and worth trying.  Second, at the very least, there will be more money to provide the drugs and services people need as a result of excessive drinking.  It also frustrates me that excessive drinking is seen as a 'bad choice' made by trouble makers.  Addiction is an illness that can affect anyone from any background, and as a society we have a responsibility to supporting these people as we would those with any other illness.

I always get a bit depressed when people bemoan a change that might benefit the minority in society.  If this change was going to financially penalise people in a more active way - i.e. more money out of someone's pay cheque or increasing council tax - I would understand.  As it is, I stand to 'lose' as much as anyone in society, and yes, perhaps I'd think twice about that pint at the end of the week.  But for me, that is a price well worth paying. 

Where did all the drugs go?

My annual leave could not have come a moment too soon.  There is only so much energy and motivation in the tank of one junior doctor, and although winter seems to have made yet ANOTHER appearance, training is still going well - the advantage of living somewhere really pretty is that  even when the legs and lungs start hurting on a run, chances are there's something nice to look at while you're expiring! Yet to jump in a swimming pool, but in my defence, the run happens first!

Of course I'm suppose to be doing a bit more of THIS - i.e. reading and writing, which I am currently enjoying in the rather delightful surroundings of an Oxford cafe or three.  I am nerding out to my heart's content over many a tasty cup of coffee.  I'm on nights this weekend so the freedom is shortlived, and yet another celebration is down the pan (sorry, sister, I'll hopefully make your birthday next year!). 

In reality I am doing a lot of THIS - pondering, pen in hand, and trying to get a bit of R and R, something that does not come naturally to me at all. 

As a total aside, I realise my blog has deviated somewhat from its original purpose of my chit-chat about random things going on in medicine from the perspective of one lowly junior doctor type person, and a discussion I had this weekend made me think about this a bit more carefully.  My brother-in-law was asking me about the lack of negative drug reporting and how do drugs come to be available to us anyway?  On the latter - this is essentially what I am reading about in the current module of my studies, but in a nutshell, it's a long, arduous process lined with failure at every step.  Less than 10% of all drugs that start the clinical trial process make it out the other side, and that's the ones that even reach said process.  That amounts to a seriously expensive drop out rate, and a cost which is mopped up by any successful drugs that do pop out.  Think about how much our world has changed since the human genome project - so many possible targets for drugs to reach!  The question is, which ones and how?  Pharma hasn't got that one quite sussed yet, and it's something that everyone's trying to solve - the FDA talk about a 'Critical Path' that should take drugs safely through this process - whether this works remains to be seen.

As for the former, I think I've posted this before but Ben Goldacre's talk on the lack of negative result publishing is well worth another mention.  It's a real problem that pharma-land and the publishers have yet to address.  I'll let Dr G do the talking....

Right.  FDA report reading, here I come.... 

Training starts today!

Realising that doing a half marathon and one-mile swim all in the next four months around my rather antisocial work hours will be a little painful!

.....But this is what it's all about!

I may be on nights this week but training started today for my mega-outdoors-athon in May (Edinburgh half marathon) and June (Great North Swim).  A 7.35km run along the river on day one in the Oxford sunshine :)

I realised looking through my blog that I may have been somewhat cryptic but here's what it's all about.  There was an avalanche in Glencoe on the 19th January and close university friends of mine were amongst those involved.  They were friends not just by virtue of our time at medical school, but also an immense amount of time spent in the hills, bothys, the Irish sea, up to our knees in snow, curled up in a make-shift shelter of moss logs and many more wild places.  Their loss is still not something I can really believe is real, but they were full of so much joie de vivre and laughter that this seems a good way to start living life with them alongside us.

Begging emails of donations to follow!  

About Grief

Grief is something most people experience at some point in their lives.  For most of us, our first encounter with it is the loss of a pet or a grandparent.  For me, it was my grandad when I was 11.  I still remember being the one who picked up the phone that day to hear my dad at the other end of the line telling me the news.

Those who know me will know these last couple of weeks have been more challenging than I could ever imagine thanks to the recent deaths of, and serious injuries to, some of my closest friends ('Tier one', one might say).  The only comfort was that at least I had annual leave that week to be with my friends, to laugh and cry together, and to be able to do things like go on a hospital visit and attend funerals.  

But then, all falls silent.  

The rota waits for no-one, and I was back at work this week.  One email I received this week congratulated me on 'feeling ready to return to work'.  Hmmm.  Was I ready?  Well, my lovely friends wouldn't thank me for sitting on my bum sobbing away, and the good thing about being a doctor is that going to work at least seems to be a useful thing to do.  Work keeps you busy, but it is merely a shield.  The weekend comes.  You go to church.  The first hymn is Be Thou My Vision.  Cue - total meltdown.  

For my wonderful friends, Una Finnegan and Rachel Majumdar, and my other beautiful friend still in hospital. xxx

The events two weeks ago will stay with me forever, but so will my experience of grief itself.  It's like riding a wave, where the ups are tremendous and peppered with joyful memories from the past along with renewed zest for life, but the downs are low, low, and painful.  And embarrassing (who wants their colleagues and peers to see their faces blotched and tear stained?).  When you're riding the wave with other people on the same wave, that's fine.  Crying and laughing in quick succession becomes strangely natural.  The challenge is when those around you are not on the wave, because the event is not something that has affected them.  What does one say? What does one say during either the ups or the downs?  'Keep your chin up' (How very British).  'Work today was the worst thing ever' (hmmm.  Perhaps choose your audience when making such comments).  'I'd feel better by being there for you' (this is ok but not if you're making me feel worse in the process).  Maybe I'm being harsh....

But what has been AMAZING is the love and support from so, so, so many people.  Random messages and emails from people who knew them, who didn't know them, who had a suspicion that I knew them, and every message so kind.  I know it sounds silly but it was genuinely so helpful to know that people were supporting us.  Friends' families opened their doors and gave us somewhere to stay,  food, hugs, a cheesy film to watch and transport PRN.  It has been a tremendously warming experience amidst the sadness of it all.  I can only hope my friends' parents and families have felt this warmth also.  

So I may not know much about grief, but I'll tell you, it's unpredictable and unbearable.  But what joy to know how much you can love someone, and love those around you.  So I'm going to keep loving people, and should the time ever come that someone needs me like I need my friends right now, they are going to feel so loved they won't know what to do.

The Long Winter....

Did Christmas happen?  How on earth is it 2013?!

Christmas was a work-filled affair for me, so it genuinely doesn't feel like Christmas happened at all.  I was working 7pm-8am night shifts the whole of Christmas week, and I'm nearly at the end of a week of 7am-7pm shifts all of this New Years week.

My family were all abroad (parents with my 91 year old grandmother in Germany, sister with her in laws in South Africa).  On Christmas day, I spoke to my sister for about 90 seconds when I was at work preparing for handover.  I ate a slightly weird breakfast of chicken wrapped in bacon with a weird carrot mash and potatoes on my tod before sleeping my way through Christmas day.  When I woke in the evening to go to work, I had mushroom risotto.  That was my Christmas day.

But you know what?  We had a mince pie or two, donned our Christmas jumpers and ... carried on as usual.   Perhaps there are romantic visions that we serenade our patients with a carol or two, or give them all Christmas cake.  But the reality is, it is just like any other night shift without a moment's peace. There really is nothing, truly nothing, to smile about when you have to certify a death early on Christmas morning.  But this is what happens on a night shift, any night shift.  For every patient we saw during that week of nights, you felt awful that this was they were spending the season; after all, all I had to do was turn up to work!

And plus I have a substitute family of my fellow on-call buddies when my biological ones are in absentia.  You come to lean so heavily on your colleagues for a brief conversation, consolation, a giggle, advice....

I am absolutely exhausted now, but I am relieved that I did my best over Christmas and New Year to keep a smile on mine and as many other faces as possible.  The post-Christmas phase has been nothing short of manic, but hey, a smile's contagious right?

I have made two New Year's resolutions - both of which I am already actioning!
1) Have at least one regular hobby (in absence of being free any evening of the week each week - this is temporarily being filled by 'Reading' and 'Eating with friends'.  I'm just finishing Operation Mincemeat - incredible. Even post-nights, it kept me glued the whole 4-5 hours on the train to Newcastle between Christmas and NY.  I am also making the reading of a Sunday newspaper a weekly feature. )
2) Make more non-medic friends.  Evidenced by the fact I am going on holiday with a majority of non-medics at the end of Jan.  And I'm having lunch with a non-medic on Saturday.  You think this is extreme and constitutes unnecessary categorisation on the basis of employment?  Listen, I love my friends.  BUT.  You have no IDEA how dull my chat has become.  I need to broaden my horizons.