Christmas cards in the age of web 2.0

My wife and I wrote our Christmas cards last night, we haven’t posted them yet, but writing is a start. This is a marathon excercise, most of my friends are in their 20s so are moving around fairly regularly. So first one has to send facebook messages, e mails and texts to establish what peoples addresses are.

Then there’s the question of ‘do they celebrate Christmas’. Many of my friends have only recently moved to the UK, often from India or Pakistan. Do they want to be included or not? I’m an atheist anyway – so I always send very secular cards, but it’s still a Christian festival. Actually it’s a pagan festival – but we should move on.

Then one has to establish what ones current title is. In a social circle where nearly everyone is a doctor you cannot assume that their husband or wife will be Mr or Mrs. The chances are they will also be Dr.

Those of us who were hoping to be surgeons may have passed their MRCS exam which changes their title back to ‘Mr or Miss/Mrs/Ms’. Established which title female surgeons wish to be known is another challenge. But how does one establish whether one has passed an exam or not?

We seem to have negotiated it all ok though. Hopefully they’ll be in the post sometime next week.

Our Water Cooler

I was chatting to my boss about my plans to do a PhD, what topic I should think of doing, and how to find a supervisor. Then our colleague joined us and we talked about the new Radiologist that had just been appointed, and who was likely to apply for the vacant job, or perhaps poisoned chalice, of Medical Director.

Except we don’t have a water cooler. We were talking over a tin of Quality Street chocolates, whilst Doris wandered up and down behind us asking what day it was again and again. Every so often we stopped and told her it was Thursday. In the background Rose kept saying ‘Help me’ we went to her and asked what help she wanted, but she couldn’t remember. So we went back to who fancied being Medical Director, and five minutes later Rose was asking us to help her, and Doris wanted to know what day it was again.

Donated by  grateful relatives. Quality Street and Roses are a constant feature on most wards. You should really worry about wards where there is no Quality Street. Forget Audits and Nursing Quality Indicators, the amount of chocolates is the real indicator of the Nursing Care. The very good wards get Thornton’s Chocolates.

A few weeks ago I met my wife at her office. It was very strange. There was no faint smell of urine. There were no demented people wandering up and down. And there were no Quality Street. It was all so false.

I couldn’t work anywhere without Doris and Rose and the faint smell of urine. Though sometimes it takes quite a lot of willpower to resist the Quality Street.

It’s April, and that means a New Job.

Must blog more. I mean I look at my stats and it seems that every day about 50 people do visit here? And what do they see? So far nothing.

I left the last job and went to the BGS conference which was great fun and really interesting as well as being useful and slightly drunken experience. I paid for it all myself as well. I’ve got loads of ideas for research and things and a good idea of the future of Elderly Medicine from it. This meant that I started my new job in a new hospital, on a day without induction.

I have to admit I don’t like change. I like hospitals to stay the same, and I like not to move if I can help it. This explains why I’ve only worked at two hospitals in the nearly 4 years since starting work. After a while they feel like home, and you get to know people. Though what is scary is how many of your skills are not generic at all, but instead specific to that hospital.

For instance this hospital has computerised blood tests, and of course I spent the first few days trying to work the computer, once I’d gone on the training course I was okay. I was hopelessly disorentated at first.

Nevertheless the patients were fine because renal medicine is populated by some of the most obsessive people known to  man. Today my consultant called me and told me that I should stop someones medication because his potassium high. The thing is in most jobs it’s the juniors who check the blood results.

In a way I like it. Once you get over the fact that you’re not allowed to make decisions and it’s basically being a house officer again.

*yawn*

Busy day on admissions ward. One of the weird things happening at the moment is that we’re really struggling to find locums. It wasn’t that long ago that locum shifts were hard to come by, that there would be a few of us desperate for the few shifts that were going. 

Now there’s more shifts available and a lot fewer people doing them, today one of my colleagues was ill and I was trying to find a locum. Switchboard are supposed to find a locum, but they aren’t very good at it, I don’t know why they struggle! BUt they don’t try hard enough, they only ring people once, when really you have to harass them until they feel really bad. It was a lovely sunny day and no one wanted to work. I didn’t want to work. 

The problem isn’t that there are less willing locums, though there are less of them. It used to be that overseas doctors would come over and locum until they got a permanent job. Now there is a need for work permits for doctors on the HSMP, so there are fewer doctors willing to locum. 

Also there are more shifts. Now there are two sorts of jobs. Training and non-training. Non training jobs are appointed by the hospital and they are jobs that aren’t accredited for training – so are sort of dead end jobs. Then there are training posts which are appointed by the Deanery. But the deanery can only appoint training jobs once a year. 

So when people get pregnant, or go on leave, or get sick, the hospital tries to appoint a non-training post – but can’t find anyone to do it. Which means we are running on less doctors.  Introducing the lack of flexiblity means that there are less doctors willing to full time locum for a bit whilst something comes up. Which means we muddle through without them and try and get through by covering their on calls with internal locums.  

The long and the short of it is that if you are asked all the time to do locum shifts, you turn some of them down. When there were few shifts there were the same amount of willing volunteers for internal locums, so we would compete to be the first to be asked. If there was a shift that your colleague got that you weren’t asked you’d be a bit annoyed.  People were jealous of the amount of locumming I did! 

Now we are asked all the time, and days off become days when you could be earning money. Your heart sinks when you are asked because you have to say yes, because no one else will. There are times when we muddle through with what we’ve got  and don’t fill shifts. I managed to persuade someone to come in from home to help out today. So life was sane again.

It’s nice to be needed, and it’s nice to know that there aren’t any unemployed doctors at the moment. There are doctors in dead end jobs, but that’s different, there’s no one who’s actually unemployed.

In this week’s BMJ – is depression overdiagnosed? – And Acupuncture doesn’t work for OA of knees.

I’ve decided to write a blog entry every week on my thoughts on the week’s medical journals – partly to try and keep myself up to date. As the New England Journal Of Medicine hasn’t yet got my change of address request this week it’s the BMJ.

Depression

There are two opinion pieces: one that depression is over diagnosed and we are medicating sadness, and one that treatment for depression is lifesaving. I’ve got no strong feelings on this – partly because I don’t personally treat depression. I do treat the consequences of depression – as in patients who overdose, and I have worked in psychiatry in the past. I can do a psychiatric assessment on someone who has self harmed if I have to.

Here’s a link (by the way you can only see the first 150 words).

When I was an F1 in Psychiatry I saw people with depression in outpatients clinics, I treated them with anti-depressants – they wanted talking therapy or a sick note. I didn’t have time to do psychoanalysis or CBT, I hadn’t been trained to do CBT but if I had done then I didn’t have the time, I did give them sick notes, though sometimes I wondered if being unemployed was really what was getting them down. Then I saw them again in three months time, some of them had recovered, some of them hadn’t. Sometimes I tried other sorts of drugs. The whole thing was unbelievably depressing.

A lot of people who are treated for depression are basically sad because their life is rubbish, but as a Doctor you want to help, so you prescribe anti-depressants. A few times I told people that they were sad because their life was rubbish – but it was probably easier to get their life better than to treat depression.

Interestingly when Imipramine, the first antidepressant, was first developed Geigy were wondering if there were enough people with depression to warrant marketing it. Now it seems the world and his wife have depression.

A few months later a friend lost her natural bounce and I persuaded her to take an SSRI.  She got her bounce back, it wasn’t quite back to normal, it was definitely a sightly artificial bounce, but it was a bounce all the same.

I don’t think she’d have bothered going to her GP to tell him that she felt a bit miserable if she hadn’t known that there were treatments available. She did benefit though.

So yes, maybe we are treating more sad people with tablets when previously we’d have just thought that they were a bit run down. But they are feeling better as a result. Well some of them are.

Thank god I’m not working in Psychiatry any more. The patients didn’t get much better but by the end of your average outpatient clinic I wanted to slit my wrist.

OA and Acupuncture. Here’s a link

Sometimes I wonder if there’s any point doing trials of alternative medicine, because it seems that most people have made up their mind before reading the trial. Either you think that alternative medicine works and if the trial shows that it doesn’t it was badly conducted, or you believe that acupuncture is balls and the trial was badly conducted if it showed that it worked.

Anyway, whatever the outcome of this trial you have to give them credit for developing a placebo acupuncture needle – that makes you feel that the skin is penetrated even though it isn’t. Now that’s cool.

I personally had thought that sticking a needle in a spasmed muscle did probably relief the spasm, and had some belief that Western Style Acupuncture worked. This was a trial of traditional Chinese Acupuncture, which is different it was rather large and didn’t seem to have any effect on subjective pain though.

Will it change my practice?

No, because most of my contact with arthritis is clearing up the renal failure, and GI bleeds caused by Non-Steroidal Anti-inflammatory. I usually change their analgesia to Co-Codamol, which has one of 3 effects

1. None at all, and they want their NSAID back

2. Constipation – and they want their NSAID back

3. Confusion – and they want to kill the small goblin under the hospital bed.

I’d quite like to be able to advise them to try acupuncture. It wouldn’t cause them to have stomach ulcers or renal failure, so would be A Good Thing. Unfortunately it doesn’t work, this trial was convincing enough that I would probably not recommend acupuncture now. Not that I ever did before – because they all wanted their NSAIDs back, not acupuncture.

Vegatarianism and Animal Testing.

As a Doctor and very lapsed Hindu my Mum often asks me:

How can you be Vegetarian yet Pro Animal Testing?

• When I made a very nice Chilli for tea I substituted the Meat for kidney beans. This provided all the protein I needed from the meal. It didn’t taste quite the same, but it certainly was close enough to be a chilli all the same. If I wanted it to be closer in texture to meat I would use Aduki Beans, or perhaps a 5-Bean-Mix.
• If I wanted to test a new drug for safely I couldn’t inject it into a Kidney Bean. I couldn’t even use a frozen product from Linda McCartney. I would need to use some animals.
• If we didn’t use animals in research then Medicine would never move on.