Saturday, 21 March 2015

CBM

The most boring post so far.

I'm on my last placement before my final exams, at a GP surgery in Shropshire. The exams after are sort of important, but I'm not very good at revising. Usually I scribble notes on scrap paper then lose the sheets. Sometimes I copy and paste from wikipedia or type notes on my laptop. More often than not I get lots of books out of the library, then flick through a few pages of each before falling asleep. You'd have thought that having sat exams every year of the last decade that I would have come up with a system that works by now.

Until now I've never ever used colours, or attempted to make notes even remotely legible. So here, to prove that I can, I will upload some GP management algorithms I made. Maybe they'll be of some use to another hapless finalist.

Atrial Fibrillation


p.s. CHA2DS2VaSc
Warfarin is more effective at preventing strokes than aspirin
New guidance suggests that any score (except Sex Category = Female in isolation) should prompt consideration of anticoagulation, possibly with Dabigatran.


Type 2 Diabetes 
Oral Hypoglycaemic Medicatio 



Asthma



Edit: I did do a bit more work and instantly failed to persevere with any revision plan. Also I realise that these three pages are obviously inadequate and inaccurate and illegible, but I'm keeping them here anyway just 'cause.

Saturday, 14 March 2015

Women.

Although it is almost a whole week past International Women’s Day (March 8th), now seems like a good time to write at length about women and gender in Medicine - I’m not going to wait through the next 51 weeks of international man time just to make this post more date-appropriate. Anyway, no one has ever been accused of sexism on the internet so this should be quite safe.

I have just finished my Obstetrics and Gynaecology placement at the Birmingham Women’s Hospital. Unexpectedly I found the subject really quite interesting. Women have always been (and mostly remain) almost a complete mystery to me so learning a bit about how they are put together has been enlightening. Before medical school I was quite sure I would never specialise in O+G: I think I subscribed to the lazy stereotype that male doctors who do O+G must be socially unusual, or worse, creepy. I’ve come to realise that this is pretty unfair. There is nothing special about gynaecological problems and I don’t think male gynaecologists should be at all maligned for taking an interest in women’s health. The gender of healthcare professionals is rarely relevant, and articles like this don't help.



Turns out the specialty is attractive to at least 10 American doctors, and they make some persuasive points, such as the observation that O+G is a varied specialty that is often a lot more optimistic than some of the others – the patients are often younger with more treatable conditions and happier outcomes like the delivery of a new hilarious tiny idiot person.

A point these Americans don’t raise is that by definition a male gynaecologist/obstetrician can never experience any of the problems or procedures his patients do. I’m not sure whether this is an advantage or a disadvantage. Does it matter? Is the cardiologist expected to know what a heart attack feels like? But I observe that some of the female students I was on placement with might visibly cringe more during teaching on childbirth for example - is greater insight afforded by virtue of being of female anatomy and physiology? Or perhaps greater clarity can be usefully achieved if your male gynaecologist can be objective? Perhaps the “surgical” nature of the career or antisocial schedule and on-calls are more suited to ancient presumed male characteristics. I’ll sit on the fence for this issue (and all issues - the extra height gives me a better view). From what I’ve seen in hospital the patients on the whole don’t themselves seem to mind much whether it is a man or woman treating them.

However, I’ve never been more aware of my gender than when inside the women’s hospital. Even the hospital’s name reminds me that my puny Y chromosome excludes me from the club. For example in the genital vandalism of childbirth men may arguably have an important role early on, but the overall experience of pregnancy and labour is almost entirely restricted to women. Part of the medical degree curriculum involves observing and assisting in the delivery of babies, and in order to see more “normal” deliveries this involves shadowing midwives as they guide expectant mothers through the process. It is interesting (I think) to note that almost all midwives are female; in 2008 there were 132 (0.37%) men out of 35,505 UK registered midwives. It appears that midwives suffer more from gender stereotyping than male gynaecologist. Or at least it might be - I have completely failed to find the equivalent statistic for O+G doctors. There are certainly loads of occupations where men outnumber women, but I can’t think of any where the imbalance is quite so extreme, and often there are positive steps being taken to address the imbalance.

For example what I do know is that currently only 9.5% of consultant surgeons are female. This could be partly explained as historically medicine has been male-dominated and it will take some time for more recent female doctors to go through the training - the year I started medical school 55% of entrants were female (and most still are). A career in surgery is unattractive to women, and to me, for lots of reasons, but I’m digressing. And after my five weeks obsessing over gender and medicine I don’t really know what my point is. Some might say that the gender-specific ability to empathise with certain conditions could be useful, or perhaps appreciated by some patients, but I really don’t think there is any actual reason, beyond slow-changing societal structure and attitudes, why a man or a woman should be better or worse at any job. Groundbreaking stuff.