‘Specialist IV nurses mean Junior Doctors get to do more IVs’

I did a locum shift at the hospital I used to work at last night; since I’ve left they’ve acquired a team of specialist ‘IV Nurses’. If a patient is on an IV medication or a drip then they need a cannula that goes in a vein – this needs to be changed every so often, or if it looks infected.

In the ‘old days’ it was the Doctors’ job to put the cannula in and to give drugs through it (iv). Then protocols changed and nurses got to give drugs, then some of them learnt to do put cannulas in, but it was generally the Doctors’ job. You don’t ask a nurse to put one in, you do it yourself, but if it comes out some nurses will put it back in and some will call you.

To reduce infection they’ve got a specialist team of nurses who are going to put all the cannulas in, check they’re not infected and clearly document the whole process.

The thing is, getting IV access in a sick patient is a vital skill in medicine, and if you’ve got a collapsed patient a Doctor needs to be able to get IV access. Now. At first I was horrified – if the IV nurses were doing all the IVs then how would the junior Doctors learn to do them?

And if IV nurses can’t get them in then who are they going to call? A Junior Doctor of course: who hasn’t got enough practice in doing IVs.

 But since the IV nursing team was introduced the Junior Doctors are doing more cannulas.

Seriously. At first I wasn’t sure how this worked: but it was happening.

I have a theory. The key is that finding a vein takes two things, persistence and practice. If you are going to try the ‘easy looking’ one, miss, then call someone else, you never get the practice in cannulating difficult ones. If you feel bad about hurting people and know there’s someone more experienced around the corner, you tend to try the easy looking one then give up. I know – I was useless as a medical student at cannulas.

 The ward nurses must have been doing the majority of IV cannulas in the past, they knew the junior doctors and worked with them, they knew how busy they were and tried to get it in themselves. The IV nurses are a different team, don’t know the doctors personally and have lots of cannulas to do. So they seem to be doing the easy ones and passing the difficult ones onto the Junior Doctors: who are still getting practice in cannulating difficult patients.

So this hugely expensive excercise doesn’t seem to be costing the Junior Doctors their training as predicted, whether or not it reduces Hospital acquired infection remains to be seen. 

Transsexual v. Transgender

Confused about which term to use? Or just think that the PC Brigade keep inventing more pointless terms to confuse us all. Actually it’s quite simple once you get your head round it.

Sex is Biological, Gender is Social: confused? lets use an example

Lets imagine you’re a woman walking down the street, with a child in toe, a lot of the things you are doing at the moment you are doing because you are a woman.

Sex

The fact you’re biologically female means that it’s you that gave birth to the baby, to enable that you have wider hips than a man does, you also have breasts to feed the baby with – and attract the said man to provide semen to provide said baby. This is all happening because your sex is female.

Gender

You’re not at work at the moment, because the society you live in lets you have maternity leave. Society has also made you feel ugly because the baby has kept you up all night and you’re too tired to put make-up on and do your hair, society also dictates which clothes are for men to wear and which clothes are for women to wear. In our society it’sok for you to wear your jeans and shirt which are identical to clothes your partner might wear without anyone saying that you’re dressed as a man.

On the other hand if you were going to your wedding it wouldn’t consider it acceptable for you to wear a three piece suit, you’d be expected to wear a dress.

If you go back to work then people will make comments along the lines of ‘Oh dear, you must miss your baby’
Anyway all this is true because of your gender.

Now lets imagine you want to become male:

You might want to change your sex:

That would mean removing breasts, taking hormones to make you grow a beard, making your body look male.

Or you might want to change your gender:

That would mean dressing in clothes than a man was likely to wear, changing your hair and makeup, if you decided to stay at home with the baby or work part time then people (who didn’t know about your past) would make comments along the lines of ‘don’t you miss your job?’ and ‘how good of you to change your baby’s nappy’ .

Transsexuals are people who want to change their bodies, and transgendered people want to change the role they play in society.

In real life – no one will change your body unless you have started to change your gender, and society won’t really let you change your gender unless you make some attempt to change your body.

So why is it important? Only in one small way: if you wish to be Transgender, rather than Transsexual you will need some surgery to change the outward signs of your gender, (breasts etc) but you don’t actually need anything in your pants changed.

Incidently you don’t need a penis to use the men’s changing room at the swimming pool, you just need a large towel.

So it’s a good idea to work out which sort you are before you think of genital surgery.

I’m still confused should I refer to you lot as ‘Transsexual’ or ‘Transgender?’

It doesn’t really matter, the terms can pretty much be used interchangeably, if they get offended by you using the wrong one they really need a life anyway. Or you can say ‘trans’ which seems to cover all areas.

So which are you?

Dunno really. I like the fact my body is male and the fact people treat me as male. I also like chocolate and nice-looking women. Next question please.

Things I regret: a warning to medical students

There aren’t many things I regret in life, but here’s a few.

1. Not buying a house with my friends during my year out whilst having surgery and stuff in 2001 – the one we were thinking of buying is now worth £40 000 more
2. Loosing my Pharmacology Textbook, and my Neurology one as well. I’m going to end up spending good money on books I already own but have lost.
3. Not paying much attention in pre-clincal years. I just found it boring because there were no patients: but now I’m trying to learn the things that were in the lectures I skipped.

Free revision for the MRCP part 1

I’ve been feeling a bit skint at the moment, with the GRC fee (£140) and the MRCP Part 1 fee £330 both coming out at the same month. So I haven’t been able to renew my membership of onexamination.com, which has given me the chance to find plenty of free ways of revising for the MRCP. Of course as The Deanery don’t want us to take the Part 1 then there’s no money for study leave.

1. Did you know that the Oxford Textbook of Medicine is available for free if you’re registered on Doctors.net.uk. As is the Oxford Textbook of Nephrology.

2. BMJ learning – free if you’re a member of the the BMA and has good quality learning resources. Basically you read through some written stuff, then answer MCQs on it right afterwards, so it sinks it a bit more than reading a textbook.

3 I’ve found a brilliant little programme which is frankly almost as good as onexamination, and free. It’s called Medexam and it’s written by Dr Declan O’Kane, and available for free on his website.

This may sound like I’m selling it really I’m not: but I do like it. It’s not quite finished yet. It’s not a website but a programme you download on your computer, you have to unzip the files and compile it. Although it’s not as instinctively interactive it takes all of 30 seconds to work your way around. But once you do it’s great.

The programme doesn’t aim to emulate any particular exam, so the questions may not all be MRCP standard. You can choose either ‘Finals’, ‘Post Grad’ or ‘Specialist’ standard and it aims to cover all subjects so it may contain questions that aren’t relevant to the MRCP. However he’s a Consultant Physician himself, so I think they may be biased in our direction. It’s a beta release at the moment, and you have to keep reinstalling it to get the updated one. I’d prefer it on a website to be honest, but I imagine that would cost a lot more.

The other disadvantage is that it’s a windows programme and I use Linux at home so I can’t use it at home.

I can’t believe he’s done all this in his spare time – it’s a great little tool and definitely worth some attention. If you want to support him you can buy books through his link to amazon which seems a nice idea.

Anyway here’s a link – go to the website down load it and have a go. http://www.dok.org.uk/

There is one advantage of books over the onexamination.come – if you buy a book you don’t have keep renewing it.

Gender roles – aren’t they weird?

I offered to cook Christmas dinner for my Nan this year – much to her shock and amazement. She just didn’t believe I knew how to cook. My father and Grandfather would never cook anything beyond a snack for himself. This got me thinking about gender roles.

One of the advantages of being 25 and childless is that ‘gender roles’ don’t impact much on my social circle. Most people I know live alone or with friends and the men and women don’t do anything different just because they are men or women. It’s not although the women I know are nurses and all the men are doctors, or that women in my social circle tend to do the housework. I’m sure this will change once children are on the scene, but at the moment things seem fairly equitable.

Things are very different for the different generations. My grandmother for instance, who has been very good at the whole gender change thing treats me very differently now.

As soon as she found out about my sex change she rang up and asked if she could her sewing kit back as I wouldn’t be needing it any more. She’d given me the kit a few years ago and it was quite useful I don’t actually enjoy sewing but I can sew buttons back on when they fall off. However my Grandma expected that now I was male then when buttons feel off I’d give the clothes to my mum to mend. The next time I visited she asked me to help move heavy things in the garden – when in the past she would have asked me to help with the cooking.

A week or so after I changed role, when I still looked like a butch lesbian, one of my female friends asked me to walk her home because she didn’t feel safe on her own. I then walked back to my own house, in the dark, on my own. I was so pleased to be treated as male that I didn’t want to point out that a ‘bad transsexual’ would probably be more vulnerable than a woman alone. I’m not any stronger than I was before but women ask me to carry bags for them, open jars, and walk them home.

In general I haven’t really changed the way I act – gender roles are different in the LGBT community. Men don’t walk women home, men cook, women cook, women do DIY, so do men. If stuff needs doing in a same sex household someone has to do it

I find the fact that some people treat me differently an amusing side affect of changing gender rather than a big deal. However some people seem to think that the reason you change gender is to take on a new gender role: they say things like.

‘Why have the operation, you already wear mens clothes and work as a mechanic?’

But however much I tried to act male, wear the clothes, and do DIY, something still felt wrong. I was still a women in men’s clothes and that felt wrong.

Now I feel right – but obviously I’m not an XY man, I still have XX chromosomes and no penis etc. So what’s different? Well I’ve managed to remove enough external signs of women-ness to make my deluded innerself believe that I’m in the right sort of body. No breasts that get in the way of everything and keep knocking things over, no awkward weird bleeding with no injury- I may understand the physiology but it still seems wrong when it happens to me. The hormones mean no random mood swings at different times of the month for no apparent reason and they mean people treat me as male so don’t keep reminding me I’m female.

Now I’ve got an inner feeling of calm and confidence, I’m more cheerful, more sociable, less depressed and generally happier.

But I’m a scientist I want more evidence of benefit than all that woolly new age stuff. I want a something quantifiable that I can do a Standard Deviation and a Confidence interval on.

A decsion: I’m going to take the exam.

Application form posted, cheque posted, folder organised, revision timetable made. I’m going to take the MRCP Part 1 on the 23rd of Janurary, which is the earliest date I’d be eligable to take it. Actually it’s two days before I’m offically eligable, it’s meant to be 18 months after graduation and my degree graduation was on the 25th, but they’ve told me that they don’t mind.

Parting with Three Hundred Pounds.

I’ve just received an email from our local College Tutor and person involved in the higher medical training: he thinks that whilst passing Part 1 is not supposed to give me an advantage, having it isn’t going to be a detriment (apart from financially). It seems that the bizarre career advice was probably misinformation.  

 The question is – should I go ahead and submit an application? The form is completed and put in an stamped envelope along with a large cheque for three hundred pounds: I have 10 days to decide whether to send it.

I think I’m going to because although it’s a lot of work it’s work that I need to do whenever I take the exam. I tend to be a ‘last minute reviser’ so I have a feeling that my serious revision as opposed to the ‘reading about interesting stuff’  is going to start whenever I officially submit myself for the exam.  Parting with that amount of money does tend to focus the mind somewhat.

The disadvantage is that it might all be pointless. If I don’t get onto a medical training programme and decide to change speciality. I’ve spent a good while googling today and have unearthed aninteresting PDF document from the Joint Committe on Higher Medical Training http://www.jchmt.org.uk/update_08.pdf. Of course I use interesting in the loosest sense of the word. I expect that those of you who want to know if transsexuals have penises have already stopped reading.

 It turns out that I am missing one of the ‘desirable’ characteristics: Honors or Merit in Medical school. I think I have both the other ‘desirable’ ones, – ‘commitment to medicine’ and ‘excellent communication skills’

 So what does this mean? That I have a chance, or that I should spend my three hundred pounds on booze/books/a car/a time machine to go and redo all of my medschool exams. Well to be honest – no one knows – no one knows how many people will apply to Core Medical Training – it’s the first year the programme’s run like this. No one knows how many of them will have all the desirable characteristics. No one knows how the change in visa regulations for overseas Doctors will affect the numbers of applicants.

And if I don’t get on?

Then I’m likely to apply for two years of FTSA jobs, a one year contract that provides training, but isn’t linked to a Consultant post, in medicine, finish my MRCP, and although I won’t be able to get a Consultant post, and apply for entry into sub-speciality training in GU medicine in two years time, bearing in mind that preference would be given to people who have done the ‘Common Medical Training’ Programme as opposed to two FTSA grade jobs. If that fails then I’ll get some Obs and Gyne training and take a non-consultant post in GU, or do a PhD, or sod off to South Africa and do my training there – where I’d learn far more about HIV than the UK. Either way the MRCP would give me useful knowledge I’ve nothing to loose apart from three hundred pounds in exam fee. 

Right. That’s settled it then.

Can I nick an envelope off anyone? I’ve got an large cheque and a form to post.

David Batty’s crusade to save boobs and willies and more on Dr Russell Reid

I’ve been watching the media coverage of Russell Reid’s GMC hearing with gradually increasing interest. The Guardian seems to be providing the most extensive coverage. The Guardian, as a left wing liberal paper, is often accused of being trans-phobic by the trans community. I can’t see the logic of this, and I admit I’m a Guardian reader myself. It was very supportive of the right for equal rights in law – but it has also covered the arguments against; I remember one article about how lesbians sometimes feel that all masculine women are under pressure to become ‘transgendered’, it was a reasonably balanced article, but it was felt by some to be attacking trans people.

David Batty, a reporter working for the Guardian first wrote this long feature for Guardian Weekend ‘exposing’ the sex change industry where he broke the story that not all transsexuals are happy with their treatment. I think this is a fair and balanced piece, he doesn’t say all transsexuals regret it, but that more should be done to pick out those that don’t http://www.guardian.co.uk/gender/story/0,,1272112,00.html

Understandably, now it’s come to the Tribunal, David Batty has written many articles covering the hearing – this is clearly an area that interests him, and I think he genuinely thinks of himself as a crusader against poor treatment for transsexuals. He’s written a couple of pieces recording the hearing – not especially salacious given the content, one about a patient who Russel Reid advised to work as an escort and one about the fact he treated a paedophile, if you look between the lines it seems that he should have questioned the story more closely rather than not treated a paedophile.

The results of regretted gender reassignment are horrific and we should do everything we can to stop patients having gender reassignment who will then regret it. I have no penis and would love one – I can only imagine how devastating it would be to have a fully functional one removed. I should also add that I like breasts (except when attached to me) and I think that it’s an awful shame when they’re removed.

The loss of functional organs is dreadful. But why has there been no outrage about people misdiagnosed the ‘other way’, people who were told that they were not trans when they were?Anecdotally I know of suicide attempts, depression, and I have heard of several MtFs who were forced into prostitution to pay for surgery privately after being denied it by other routes. What about the people who were told that they could not have hormones because they ‘did not look feminine’ when they were wearing trouser suits, they way most women do? What about transsexual people who buy hormones illegally leading to an increased risk of side effects because of a lack of monitoring?

We need better healthcare for Gender Dysphoria: and transsexual people would benefit as much as non-transsexual ones who are more likely to be misdiagnosised with poor quality provision.

When is passing an exam a career disadvantage? Welcome to the disturbing world of Modernising Medicial Careers

Every so often something comes along that makes me feel as dispirited and angry as Dr Crippen

So, you’ve decide that you want to do medicine, realise that the next step is going to be to pass the MRCP Part 1 exam, and get on a medical training rotation in Medicine. So you start revising so you have a good chance of ‘not failing’ at the first sitting. All so far so good.

The MRCP Part 1 is a difficult exam assessing your medical knowledge, passing it generally required quite a lot of work, learning about medicine. If you were considering who to accept for a Medical Training Rotation wouldn’t you think that a candidate that had invested a lot of their personal time and money in passing the exam would be likely to work hard?

Well no, apparently not, I’ve just received some of the most bizarre career advice on earth.

‘Don’t take your MRCP Part 1, it might stop you getting onto a medical training rotation.’

What? So passing an exam that will increase your ability to do a job will prevent you getting it? Yes, that’s right, part of the requirements for basic medical training is not having MRCP Part 1. Is anyone else as confused as I am by this?

I see the logic in not needing MRCP Part 1 to get on basic Medical Training, the whole point of Modernising Medical Careers (aka MMC) is to change the emphasis of medical training from your ability to pass obscure exams to your ability to do the job, or to be more precise your ability do well in an ‘assessment centre’, I’m not sure what an assessment centre is, but it seems more reliable than the ability to network.

Actually if I’m going to be honest not being able to take the MRCP Part 1 when I want to is the least of a Junior Doctor’s worries. All the old certainties are being swept away, it’s a time of change and it feels scary. In the old days things weren’t perfect, but at least you knew where you stood. We worked long hours for low pay whilst we were young, passed difficult exams, and got on with it, you knew where you stood. Unemployment was virtually unheard of, Membership of the Royal College of Physicians was a badge of honor. Consultants had power and ran the Health Service.

Now nurses are doing diagnosis and treatment, doctors feel like we are facing unemployment. If we do get on the new training rotations there aren’t Consultant jobs to go into, and we won’t be as experienced or competent as Consultants in the ‘good old days’. If we don’t then we feel abandoned by the wayside, left to rot in non training jobs.

A post formerly known as ‘Wibble’

I’m in the process of changing my birth certificate, which means legally becoming male. It means I can get married and adopt children. I have no desire to do either, but apparently it seems a useful thing to do.

When I transitioned way back in 2001 you couldn’t change your birth certificate – so once I’d taken hormones enough to pass, had all the surgery I wanted for the time being, and changed my driving license I considered myself ‘finished’ and put the whole messy  transition business behind me.

I could have changed my birth certificate last year – but I was a bit distracted with buying a house. However the whole ‘Russell Reid/GMC’ thing has brought it to my attention again. I want to get the final bit of paperwork done – once this is done I no one can say I’m not a bloke. Well actually they can, but I can get married and adopt children, which I don’t want to do. I just worry that if I was diagnosed by a psychiatrist has been struck off then someone can in the future say ‘you’re not male- you were diagnosed by someone whose practice was so dodgey that they were struck off’. If I’ve got a male birth certificate then I can keep it quiet.

Getting to the point..

Anyway, to do this I need to get a large amount of paperwork and send it to the Gender Recognition Panel one of these bits of paper is a Statutory declaration where I make a formal announcement that I intend to live as male until I die and that I’m not married to a man, then it has to be signed by a Solicitor or a Magistrate.

know of someone who was charged £50 by a solicitor, so I duly rang up my local magistrates court. After a bit of a confused kerfuffle they apologised for the fact that they were going to charge me £8, and booked me in for Wednesday.

Today I rang up and confirmed that they’d received my cheque for £8, which they hadn’t as it had got lost in the post, offered to pop into the building with cash, which they couldn’t accept, and finally settled on faxing them my credit card details which they couldn’t take over the phone. In passing I asked exactly what a statutory declaration involved:

Oh you just stand up in front of the Bench, the Magistrate reads out the declaration, and it’s signed.’

‘Er, ok, how many people are there?’

Only about six, and maybe a few people from the Utility companies’

‘Er’

‘Most of the statutory declarations relate to electricity, so they’ll be there waiting for the next one’

‘Okay… so anyone can be there?’

‘Well yes, it’s a court’

Once I’d finished wondering why you’d want to do a statuary declaration to the Gas Board, I realised I’m going to have to stand up in a court and say I’m trans. In the town where I work. In front of people I could be treating. I had a vision of it getting into the local paper, though heaven knows why a reporter from a local paper would be in such a routine court session. Ok I was scared, I’m not the sort of person that normally gets scared in unfamiliar situations, so this was rather new for me.

And besides how was I supposed to get time off work?

Can you just hold my bleep whilst I go to the Magistrates court?

Or perhaps:

Can you hold my bleep whilst I go and legally have a sex change?

Within five minutes I’d convinced myself that this was going to be a career-ending move. Eventually I decided that perhaps spending an extra £40 and going to a solicitor was going to be a good idea. Fortunately there was a solicitor’s office two doors down from my office. The office consisted of one very untidy room and no receptionist.

‘How much for a statutory declaration?’

‘Eight pounds – do you want me to sign it now?’

He seemed totally unfazed by the whole thing, and offered to act for me if I ever wanted to sell my house. I popped back to my office, drew up a statutory declaration based on the template, and within 10 minutes it was done. I’ve spent this evening sorting out the paperwork, and tomorrow I’ll post it. Assuming of course that they take my medical references as it was written by Russell Reid.