Top time for Hot Water in 2012?

“Personal profiles on Facebook and other social-networking sites are a trove of inappropriate and embarrassing photographs and discomfiting breaches of confidentiality. You might expect that from your friends and even some colleagues — but what about your doctor?” Time Magazine

This is current news in 2012, but if you look at the date of publication of this time article, it’s September 2009. Although this was published over two years ago, we think medical students are going to be coming under increasing scrutiny as the year unfolds.

It’s happened before, in the UK…

Remember people playing the lying down game? Roll back to Swindon, UK. A number of junior doctors were suspended for what many medical students and doctors considered hijinks: posing for photographs whilst lying down in unusual places. See our example of the latest MRI-PET scanner here:

It’s happening now…

A research paper from 2010 looked at a small group of medical students in Liverpool, UK. Over half had witnessed unprofessional behaviour by their colleagues on social media.

Dr Amy Cunningham, a lecturer from Cardiff University recently highlighted on Twitter and her blog about doctors using slang on social media, e.g. referring to ‘mad-wives’ instead of midwives. For her efforts, both she and the doctors in question were both applauded and criticised by healthcare professionals and different elements of the national press.

Help is at hand…

If things seem a bit blurry and you dont know who to turn to for advice, fear not – as we have compiled a handy list of references:

• From Your Institution – Check if you have guidelines at your University, and follow them!
• From Professional organisations
• From the MPS: The pitfalls of social networking
• From the BMA: Using social media: practical and ethical guidance for doctors and medical students
• From the AMA: Social Media and the Medical Profession: A guide to online professionalism for medical practitioners and medical students.
• Help From Within – We think ‘use your moral compass’ is a great adage. See the moral compass example of one experienced GP below.

Advice from an experienced user of social media

One of our medical professionals says this:

“I use this principle. If I wouldn’t be happy with any of: my mother, friends, work colleagues, peers, nurses, receptionists, patients, friends of patients, children of patients, professional licencing bodies, line manager seeing it, don’t post it. Do not post anything relating to your workplace, patients, or patient care online. If you have a grievance, use formal channels.”

What about anonymity online, protected tweets, protected postings?

“Just be careful. Is it worth risking your professional status over such minutia? The security of these areas is becoming increasing difficult to police. Don’t go there.”

Happy – and safe – tweeting in 2012!

Photo by upsuportsmouthPoorer medical students’ debts have also soared. Those from low-income backgrounds graduate over £13,000 more in debt than better off students – graduating with a projected debt of £37,588 (up from £26,324 in the past 12 months).

The survey from the BMA also reports that the number of medical students from the lowest income brackets is in decline over the past 12 months.

Co-chairwoman of the BMA Medical Student Committee Elly Pilavachi said:

“Medical students are now facing extremely high levels of graduation debt. Many are clearly heavily dependent on financial support from their families and friends to get through the intensive, five to six-year medical course. However, the picture for those from low-income backgrounds is particularly alarming with their debt levels a staggering £13,000 higher than those from higher income brackets.”

Clearly there is a lot to think about if you are planning on becoming a medical student, or already are one. What do you think about the current financial plight of med students?

F1 is luck of the draw – F2 is up to you!

By now, three weeks into the job it seems that most of our F1’s, whilst they may not have found their feet completely per se, have managed to work out the various tricks in order to survive, and most importantly serve the particular whims of their consultant.

Photo by barelyanythingAlthough in my experience, and my brief presentation to the new surgical F1’s yesterday, when I say working out the tricks to survive… what I mean is how best to divide their time between making sure that Mr Philips, their one and only patient, has had enough paracetamol to cover his headache whilst he waits for his op, and more importantly how to switch on the TV in the mess.

The surgical F1 jobs in the hospital can be really mixed bags, and it entirely depends on your consultant. One surgeon will micro manage his patients down to individual drug doses, whilst another will be content to NEVER STEP ON THE WARD, only interacting with patients when they are under anaesthetic. The point of this being that as a surgical F1 you need to address how best to use your time.

The Firm system is still in place for surgical teams and that gives the week to week ward work a different pace to medicine. In surgery you can be snowed under with patients and jobs one week, but until your surgeon is “On Take” next, every patient who is discharged is off your list and won’t be replaced. Thus its quite feasible you may end shortly before the next “On Take” of having only one remaining patient to look after – USE THIS TIME!

Surgeons love an audience, if it is your thing use the time you have when the wards are quieter to get into theatre, ask can you assist, of if an exceptionally complex op, just ask to observe, its unlikely they’ll say no. Talk to your consultant as a human being (they might not be, but give it a try) there will always be opportunities, whether it’s getting in on a paper, or helping with a simple audit, but you’ll have to go hunting for them.

Your surgery rotation is a great time to plump up your ePortfolio

Now I’ve banged on about this hellish piece of electronic dictat before but it does have its uses. You might find yourself loath with an unearthly contempt your present job, be that colorectal surgery, respiratory or dermatology. If so your ePortfolio is your golden ticket out.

If you get enough bells and whistles hanging off this electronic annoyance you will be able to have your picks of the jobs for F2, and I cannot emphasise this enough. As a medical student, when you selected your jobs, you chose things you thought might be interesting, or that you might possibly want to have a career in.

Now you know the reality of those jobs good or bad. A well filled ePortfolio is your ticket out of your personal Hell onto the ward you wish you were working on – Remember a bad job on F1 is the luck of the draw, getting the best job for you and your career is entirely down to that electronic hoop jump, so learn how to make it work for you, and grasp whatever extra time you have.

Finally take heart, its payday next week – but more on that later!

Well we’re now 14 days into our new F1′s and so far no one has sunk, there have been a few have fallen overboard from the boat, but they have all been successfully pulled back into the boat by either seniors or other F1′s.

Photo by chrisinplymouthI say boat, but I think tiny little dinghy is more appropriate. For myself even two weeks after being spat out of our sociology focused GP Factory Ship, sorry I mean Medical School, I still felt thoroughly unprepared, and every day it seemed as if there was more work piling up, and that I was going home later and later.

With regard to the progressively worsening home time, I remember the feeling of absolute astonishment and amazement after, having been there alone on the wards for about an hour after everyone else had left, one of the SHOs came up to me and said “What are you still doing here! Right, let’s see what jobs you’ve got left and we’ll sort them together”.

Now why could I have practically hugged this SHO for all he was worth because of those simple words of kindness? Well up until that point, I had been having an astonishingly bad day.

I’d been lambasted by El Diablo for not being the Registrar, yelled at for not knowing where the Registrar was, and finally, talked to in his quietest, angriest voice, with little bits of spittle escaping the corners of his mouth, because it was apparently my fault that the nurses had not weighed any of the new patients, who  were admitted last night after I’d gone home. (I think he was also trying to insinuate that the deterioration in the NHS in general was also my fault, but he was having a slightly harder time making that conclusively my responsibility).

I think it’s important that I point out that I didn’t hug the SHO, largely because he was a massive Rugby player who I recognised from the year above me at the medical school – frankly I don’t think it would have gone down too well. But i was more than pleased, that after two weeks of fighting to keep my head above water, and surviving El Diablo’s daily torment, someone had actually noticed I was about to sink, and pulled me back, into the metaphorical dinghy.

Life didn’t improve magically over night, but I did know that there was help. The SHO showed me how to organise things slightly better, and he also told me to try and stand up to El Diablo – but that wouldn’t happen for another week…

So… tips from week 2

• It will take time, but learn to prioritise.  You’ve been taught a lot about prioritising, but importantly what things can, at the end of the day, be left until tomorrow morning. Such as writing up bloods for tomorrow’s ward round, they don’t need to be done before you go, come in early and have them prepared for the round. Even if you have to come in 30mins earlier, it’s important to go home and get some rest.
• Make sure your getting enough sleep. I recall one of the “Big Dogs” in our year, I was talking to his house mate on our first Friday out after starting work, and asked where he was, to be told he had been passed out on the couch since 7:30pm.
• Make time for your friends, it’s very easy to get isolated in a cycle of work, home, eat and sleep. Even if it’s just organising to eat lunch together in hospital, it will maintain your support network, as horribly sociological as that sounds.
• Recognise that being on call in the evening is not the same as normal ward work. On calls you do not “treat” patients, you fight fires. As terrible as it is to say it your patients have to “survive” evening and weekends, before Norma service resumes in the morning.
• Finally I’ve said it many times, but it is especially true for on calls – take plenty of food, making sure at least part of it is health, and whilst on call, make time for yourself to stop and eat. You need the break, and you’ll function more efficiently after your return.

Well we survived week 1, and (almost) as importantly so did all of our patients! Congratulations, and if you felt that you (almost) didn’t survive that first week – DON’T WORRY TOO HARD. IT WILL GET BETTER

Now I’m not going to tell you that soon life will be grand, consultants will come to love you, and they will invite you to their summer BBQ and introduce you to their eldest daughter – they might, but that would be unlikely (and rather irregular to boot!).

The biggest issue I had when starting as an F1, and I have seen it repeated in the new F1s this week, was a lack of confidence. Let’s all be honest, despite being absolutely no different from 2 weeks ago, you now are, at least to the outside world, a real doctor.

But what does this actually mean? – basically now, when someone, probably a nurse, asks you what drug you would give to a patient for problem x, rather than just being an academic exercise, that person will then ask you to write it on a drug chart AND THEN ACTUALLY GIVE THAT DRUG TO A LIVING, BREATHING PATIENT.

Photo by Carter ComicsI think I must have checked the dose of aspirin at least 10 times in my first week as an F1!! Oh heck I knew it was 75mg once daily, but was I sure, was I completely confident? Thus I kept on checking – what was I expecting I don’t know? It wasn’t as if it would have changed since the morning!

I found that it is was lack of confidence, combined with the realisation that this isn’t just a paper test anymore which made me very tired by the end of my first month – getting it wrong now matters!

When I started on the ward as an F1, I very quickly made friends with our ward pharmacist, largely because of the number of errors I would make on the drug charts. She would come and find me – and putting on her best “stern and disapproving face” would ask if I really meant to give the patient a certain dose, and ask what I thought might be better – she was (and still remains) absolutely fantastic and couldn’t maintain her “stern” face for long, simply because she knew that I was new, and although I wasn’t getting it right as often as a I should – I was TRYING.

REMEMBER AS LONG AS YOU’RE WORKING HARD, THE WHOLE WARD TEAM WILL SUPPORT YOU! You are not alone, despite what it might feel like.

Ok… this week’s top 5 tips

1. Trust the nursing staff. Some have been there longer than the consultants, they will help steer you and guide you when you find yourself alone on the wards – this will be particularly important when you are on nights or on call – remember the nurses control the flow of biscuits and chocolate so be nice, and say PLEASE and THANK YOU.

2. Don’t be frightened of leaving the ward. Sometimes a department (mainly radiology) will be exceptionally busy, and no one can answer the phone – everyone hates a ringing phone, so walk round to the department. You’ll get to know the people on the other end of the line, and I guarantee you that you’re scan requests will be more easily accepted.

3. Call for help often and early. Try not to get stressed when you don’t know what’s going on. You might be a doctor now, but for the first couple of weeks you’ll be barely more than a grunt. Your job is to carry out your seniors instructions. If nursing staff are telling you that a patient as a problem and you don’t know what to do, call for help. No one will expect you to know everything from day one – Ok Dr Satan the Consultant might – but he is in the minority.

4. Accept you WILL make mistakes. You are human, and you will learn through trial and error, but don’t worry, the nurses, and the “stern looking” ward pharmacist are normally exceptionally, and they’ll normally catch things, and show you where you went wrong. Don’t beat yourself up when you do.

5. Start work on your ePortfolio NOW. It’s a pain in the neck, many would describe it as a waste of time. Personally I don’t do well with reflective learning either, BUT IT IS COMPULSORY. In several months you’ll have to think back over the things you have done, and try and remember what was important, if you do it now – i) its easier, ii) you’ll forget less things, iii) life will get more stressful when you are trying to fill in the other parts of the ePortfolio, so start the reflective bit NOW.

Look our for james’s next blog post – the trials of week 2.

It’s worth researching publications before you start to write. You’re much more likely to get published if you write something targeted at a particular audience or slot, that you know the editor will be interested in.

Don’t send anything in without reading the author guidelines and understanding where it might be placed. And check for word limits – there’s no point toiling for hours over a lengthy Tolstoy-esque manuscript and sending it to the editor of a short health news section – no matter how brilliantly written, they simply won’t have time to read it!

Where to publish

Publications that accept articles from medical students include:

Junior Doctor

New Doctor

Medical Student

Student BMJ

Medical Educator

So, what are you waiting for? Your publishing career is waiting to get started! Let us know any experiences you have had with publishing via a comment on the blog.

You may not be attempting any sonnets, but writing is a key skill for a successful medical career. Getting research or writing published will make your CV stand out in whatever specialty you go into. Even writing patient notes and case reports needs good writing skills, grammar and clear English.

Although you probably won’t get the chance or be expected to have original research published while at medical school, there are lots of other ways you can get your foot in the door of the publishing world.

You’re probably thinking that you’re far too busy cramming your brain with an encyclopaedia of knowledge, attending lectures, submitting essays or travelling between hospitals for clinical practice to have time for anything more creative.

However, writing can be a really good way of getting some distance on a clinical situation, problem or career decision. It’s also a good tool for refreshing your mind and reminding you of your ability to think analytically and look at the bigger picture – some of the most important skills for being a successful doctor.

Here are our top five tips on getting started:

1. Voice your opinion

Got something to say? Writing a letter to a medical journal, or writing to a newspaper on a hot medical topic, can be a good way of getting your name in print without the need for heavyweight research to back up your opinions. Most national newspapers have much bigger circulation and readership figures than medical journals, so it’s worthwhile keeping up with public health issues and taking any chance to comment. For example, a well-worded letter to a national paper about how rising tuition fees might affect medical students could catch an editor’s eye. There’s a lot of competition to get letters published, so getting yours in print can go on your CV as a real achievement, showcasing your self-motivation, knowledge of current affairs and ability to analyse and write clearly and persuasively.

2. Keep it real

As a medical student, you are going through some unique experiences, seeing and doing things that most people never get a chance to do. You are also in a profession that is endlessly fascinating to the public (just look at the number of medical dramas on TV). You have a wealth of things to write about, from what it’s like experiencing your first dissection class, to coming face-to-face with patients, or the terror of being asked a question you can’t answer on your first ward round. Of course, you will need to approach all these topics with sensitivity and make sure you never breach patient confidentiality or get into trouble with your medical school.

3. Bag yourself a blog

Instead of idly surfing the web while avoiding the big pile of lecture notes waiting to be looked over, why not make use of the distracting nature of the internet and start a weblog? Less formal than a diary, and easier to get published than a journal article, it has the added advantage that you can make it anonymous (although you should still be aware of confidentiality, fact checking and libel laws, see below). Write about anything, from studying to the romantic difficulties posed by medical student life, and see if you can spark some online debates! A regular blog will be useful if you ever want to try your hand at writing a column, feature or advice page once qualified. However, this comes with a word of warning. The Medical Protection Society has seen doctors face complaints over unwise commentary. You should always write as if you can be identified, never drop your standards of professionalism, and don’t say anything that you wouldn’t be happy to put your name to, or say face-to-face.

4. Don’t get carried away

It’s tempting to think that as a student, you can write about anything and be immune from any comeback as you are not yet officially qualified. However the GMC and the Medical Schools Council expect and require students at medical school to behave as professionals before they qualify, as well as in the years that follow. Even one-off mistakes, in circumstances such as breaches of patient confidentiality, plagiarism, poor attitude or alcohol misuse, could harm your chances of obtaining provisional or substantive registration. Here are a few pitfalls to be aware of:

• Patient confidentiality always applies. For example, Student BMJ requires that everyone who submits articles or photos containing medical details has written consent from the patient, whether or not the patient is named in the article.
• Check all your facts. The rules of publishing mean that you could fall foul of laws around defamation (harming someone’s reputation) – not to mention damaging your own career prospects – if you publish incorrect or potentially damaging information about people, whether in hard copy or online.
• Don’t write about anything that might affect your future career as a doctor, eg, excessive drinking, drugs or the wilder side of student social life. Remember that as a doctor, your personal and professional life can no longer be completely separated. A career in medicine brings many privileges, and also responsibility – you should set out to be a role model from now on.
• Always include references for any quotes or information gained from other publications or authors. Plagiarism, or passing off others’ work as your own, is extremely frowned-upon and in serious cases, could even lead to you being subject to student fitness-to-practise proceedings.

5. Look close to home

Check out your university newspaper – it’s not just there for media and journalism students to practise on. Read it first, to see where you might be able to place articles. Contact the editor for advice – they might welcome a regular feature on medical student life.

In  our next post, we look at places where you could get published.

Article written by Frances Warneford of the MPS, where student membership is free!

1. Know your usage.

Even larger student households could use fairly few GBs (gigabytes) a month if everyone only goes online to browse.   Almost all the cheapest deals have download limits so it’s worth checking.

More likely, however, is that you and your housemates will often need to download large files of research or course resources and then watch online videos and/or download music on top of that. If that sounds familiar, an unlimited deal is essential.

2. Don’t forget the phone.

Always remember to factor in the cost of line rental when comparing broadband deals.  The only way of avoiding it at the moment is with Virgin Media.

If, like many student households, you’ve all got mobile contracts and won’t use the landline at all consider line rental from O2 or Be broadband without inclusive calls which is considerably cheaper.

Also note that if any of you have a mobile contract with O2, Orange or (soon) Vodafone you’re entitled to a £5-ish a month discount on your home broadband – so ask for it!

3. Don’t worry about contract length too much.

Students often worry about finding a deal that lasts for the length of the academic year but nine times out of ten it’s cheaper and easier to get a 12 month deal and pay the whole contract.

Short contract or no contract deals don’t come with free hardware and also attract a hefty sign up fee. Unless you’re moving every six months or more often, it’s not worth it.

4. Stay clear of mobile broadband (90% of the time).

Currently, most mobile broadband deals seem to be made for commuters. And no-one else. Download limits are small and seem to be shrinking by the day, speeds are less than speedy yet prices have barely moved and, in terms of pounds per GB, home broadband is far cheaper.

It’s tempting, granted, to get online on the go but a combination of free wi-fi and campus computers will achieve the same thing for hundreds of pounds less and only a little more effort.

5. Look for the best deals…

The best broadband deals are online, at least for the first contract. Of course, the best and, sometimes, the very cheapest student broadband is the deal you negotiate with your provider. But that’s another money saving story for another time…

A 74 year old retired GP, Dr Wallis comes to see you.His wife reports that his memory is not ‘as it was’  however the retired GP dismisses this as ‘nonsense’ and proceeds to tell you about his early research on the use of anti tuberculous medications. His wife is concerned that he may have a brain tumour. The concern about this is that she has read brain tumours can cause memory problems.

Dr Wallis is frustrated by his wife’s concerns about his memory and mentions she is always meddling in his affairs. In his history his wife tells you he has put on a stone in weight, and fractured an ankle when being run over by a car 12 months ago.

PMHx

Previous history of skin psoriasis, treated with topical preparations only.

Drug history

Vitamin D tablets ordered over the internet (patient unsure of strength, wife believes it to be 1000 international units a day)

Examination

You proceed to examine Dr Wallis to evaluate him for any neurological problems. The examination is as follows.

Observations normal. Normal Cardiovascular, Respiratory and Gastrointestinal Examination

Neurology:

Cranial Nerve Exam

Normal. Fundoscopy normal.

Mental Test Score:

Adapted from Hodkinson HM. “Evaluation of a mental test score for assessment of mental impairment in the elderly.” Age and Ageing 1972;1:233-8

Recent blood tests

What is the most likely diagnosis is this just ‘old age’, and does the patient require any other investigations? You can pick a maximum of 5 answers.

A free subscription is on offer for what we judge as the best ‘free text’ answer to this question!

1. Medical Protection: The Medical Protection Society

The MPS has a range of online resources and clinical information to help guide medical students and healthcare professionals through their medical training. One thing we like is their magazine for newly qualified junior doctors which are handy for a quick read through relevant junior doctor experiences of life at work. New Doctor magazine can be found here, and Medical Student pages (UK) here.

2. Mnemonics: Medical Mnemonics

We love Mnemonics. Take this one for joint pain.

SOFTER TISSUE:
Sepsis
Osteoarthritis
Fractures
Tendon/muscle
Epiphyseal
Referred
Tumor
Ischaemia
Seropositive arthritides
Seronegative arthritides
Urate
Extra-articular rheumatism (such as polymylagia)

They missed trauma out but hey, nobody’s perfect.

3. Anatomy Guides: Cross sectional Anatomy from anatomy atlases .

We think this picture is of a brain. It’s definitely not the glenohumeral joint.

4. Radiology Help: IMIAIOS

We like this sitter from IMAIOS, who provide detailed pictures like the one you can see here of the famous Scottie dog. We thought it looked like a lumbar spine. How wrong we were.

By the way, you won’t see many more lumbar spine radiographs because your local radiologist will probably have a heart attack if you try to request one! This is because they are notoriously useless at picking anything important up, other than fractures.

5. Stats Advice: BMJ Stats Pages

The BMJ weigh in with a great free resource which requires no subscription. The BMJ really are helping doctors make better decisions (we’re aiming to help you as a medical student make the best decision).

6. iPhone App: IResus

We love this app from the developers at Imobilemedic.com.  You might get a few funny looks from doctors over45 at the next cardiac arrest if you whip this out, and remember not to spill your coffee on your iPhone.

7. Apps for all Smartphones: Med Calc

Thought the Anion Gap was a tourist attraction north of Watford? We’ve got new for you….

If you need to work out a BMI, GCS or Disease Activity score quick? Check out Med Calc… It works on most smart phones. As one contributor said: “I use this most days at work”*

We are fairly certain this is just to show off, but we love this app.

8. General Information: GP Notebook

Most of the GPs that we deal with from medical educator would be doing well to be dealing with most of the complex stuff listed on here. Need to know the classification system for bone tumours? Look no further.

9. Quick information: Wikipedia

Wikipedia is still top of our list for those obscure things you need to know about. As students you always need to be sure to check your sources, however there comes a time when you need fast reliable information, or when you need to read round a topic.  The Journal Nature found that Wikipedia was as good as the Encyclopaedia Britannica across a range of scientific areas. That’s good enough for us, this represents web2.0 in action!

10. Free MCQs & video: Medical Educator

You didnt think we would leave ourselves out did you? If you don’t know already, signing up is completely free and gives you access to loads of our sample multi-questions, videos and podcasts.

Got any other top free resources that you know, use and love? Leave a comment and share the joy!