day zero, nearly

Tomorrow is the first day of the rest of my life

Well, at least as much as every new day is anyway. Today I drove up the M6 to move into hospital accommodation outside of a hospital near Manchester. I have a small and uninspiring room with a shared kitchen and bathroom, all of which are decorated mostly with police warnings about the high incidence of crime in the area. It’s not quite luxurious, but it is cheap, clean, comfortable and convenient for now.

Tomorrow I turn up to my hospital for a final few days of lectures and hanging around on the ward to prepare me for Wednesday 5^th August, my first proper day as a junior doctor. I’m glad of this apparently gradual introduction to actual work. It seems quite manageable, but despite this I can’t quite shake a fairly powerful sense of dread. Part of this is the feeling I get daily when reading about Jeremy Hunt’s nefarious schemes and the government’s absolute refusal to address the concerns of many, but I’m sure I’ll rant about all of that it here at some point. 

I’m suspicious of change at the best of times so a large part of my dread is from a bit of underlying stress in starting a new job in a new city. Most immediately unsettling however is the fact that the annual new doctor changeover day “Black Wednesday” is associated with a 6% increase in patient mortality. We are fairly closely supervised by seniors to begin with so things aren't supposed to go far wrong, but even so when new doctors joke about trying not to get ill in August, we're actually deadly serious.

But despite all of this I really am looking forward to the challenge, dread and all. I chose medicine for a reason and it’s taken an inefficient length of education to get here so I am very eager to finally do some (hopefully meaningful and useful) work contribute a little to something important.

Helping people, doing good, saving lives, changing the world, etc etc etc. It’s not easy being a hero you know. (Really I’m just looking forward to my first proper pay packet.)

Cape day

Yesterday, Wednesday July 15^th, was an important day because I wore a hat and costume and shook hands with another man wearing a costume in a hall of other people wearing costumes, and I also got a piece of paper with my name on it. Turns out wearing a baggy gown over my suit was a good idea as it hid (to some extent) my extreme sweatiness in the beautiful sunshine. Despite this many people seemed to want to take my photograph a lot, and there was an awful lot of clapping, smiling, handshakes and sweaty hugs. I was pleasantly surprised how enjoyable such a strange series of events turned out to be.

Gryffindor

In the hall those of us receiving our MBChB stood up and recited the GMC’s “duties of a doctor”, a modern-day Hippocratic Oath of sorts. I was reminded that there’s a fair bit of responsibility in my chosen job. I think that it’s quite a good creed, so worth reinforcing by typing it out here:

I promise to:
- Make the care of my patient my first concern, providing a good standard of practice and care
- Keep my professional knowledge and skills up to date and recognise and work within the limits of my competence

I promise to:
- Take prompt action if I think that patient safety, dignity or comfort is compromised, and protect and promote the health of patients and the public

I promise to:
- Treat patients as individuals and respect their dignity, treat them politely and considerately and respect their right to confidentiality

I promise to:
- Work in partnership with patients, listening and responding to their concerns and preferences

- Give patients the information they want or need in a way they can understand
- Respect patients’ right to reach decisions with me about their treatment and care

- Support patients in caring for themselves, to improve and maintain their health

I promise to:

- Work with colleagues in ways that best serve patients’ interests
- Be honest and open and act with integrity
- Never discriminate unfairly against patients or colleagues
- Never abuse my patients’ trust in me or the public’s trust in the profession

I know that I am personally accountable for my professional practice
I must always be prepared to justify my decisions and actions

ex-med-student

Since passing my finals I've received four or five emails addressing me as Dr.

All of them are junk e-mails but I still get a small warm zap of egoism each time. And although I haven't yet seen any patients or participated in the hat ceremony my identity as medical student is steadily and undeniably drifting away from me.

The most significant manifestation is the expiration of my student card which runs out at the end of the month. I am deeply saddened at the prospect of paying actual money to acquire that daily shameful extra cheeseburger from the McDonalds down the road from the hospital.

This all means that my rubbish unoriginal blog title and url need updating too. "medstudentwords" was boring but descriptive but now its not even accurate. So, until I outgrow it or change it, the new title for my home on the digital will be "juniorblogtor".   I am aware that this is an extremely poor title, but my alternatives were even worse:

cyberjonny
technolojonny
drblog
procrastimedicine
bowelsoftheweb
juniordoctorwords
crashcall
blogtoroctopus
drblogtopus
droctoblog
weak-foundations
diarrhoeaideas
jonnyology
blogacetamolqds

sheesh.

Kindle RIP

I broke my Kindle. Well actually it belongs/belonged to my brother but I’ve been using it for over a year. It is/was a third generation kindle with a keyboard and wifi and it was very good. I was 61% through Jonathan Safran Foer’s “Everything is Illuminated” but now the top half of the screen became un-illuminated so I can only read the bottom half of each page. Incidentally the first 61% of EIL is pretty good. I’ve not seen the film.

It puts me in a difficult position because I hate kindles. I hate them because they threaten to extinguish the printed press. Ebooks are cheaper than books, but unless people keep buying books then there will be no bookshops, and without bookshops there is no browsing. I hate that Kindles are made by the sinisterly convenient Amazon.co.uk, and so contribute to the mega tax-avoiding corporation undercutting the traditional retailers and dehumanising shopping in general. Physical items have pleasing weight, texture, colour; ebooks are merely ghosts of books. The distinctive smell of books, of old dusty relics or new shiny stories, is far far better than the smell of plastic and silicon, of ones and zeroes. I hate kindles because they look rubbish on bookshelves, and because you can’t judge them by their covers. How will people know all of the impressive-sounding books I’ve bought but not read if they’re not pretentiously displayed in my house?

Kindle's are not welcome in Hay-On-Wye

At the same time, I love kindles. I love that I can carry around 100 virtual books more easily than 100 real ones, and so have on one’s person a book for all moods and occasions, the ability to abandon a title and replace it at a moment’s whim. I love that I can obtain almost any book almost instantly, or can download UK newspapers to read in non-UK countries.  I love that I can read the very hungry caterpillar on the train without the judgement of others. I love that there are zillions of free ebooks including legally downloaded copies of books from 70 years after the author’s death. I love that I can read all of the books that my brother downloaded to the kindle before I seized control.

Since I will be graduating and leaving Birmingham in a couple of weeks I attended my final book club meeting recently. It was sad to say farewell to a great group of people who’ve shared a good number of varied books. I hope to continue the discussions with virtual meetings using goodreads (also owned by blasted amazon), so I’ve another reason to continue with the kindle.

So in order to read the rest of the books I’ve started, and to not lose the books already downloaded onto the device, and in the interests of fairness and good manners I’ve ordered a replacement kindle for my brother, and I will continue to borrow it from him indefinitely. 

I don't know what to think about Scotland

This time last year I had finished my exams and was quickly realising that I didn’t really know the first thing about Africa (or medicine), and I was feeling excited about starting my elective in Tanzania.

This time this year I have finished my exams and am quickly realising that I don’t really know the first thing about medicine (or Africa), and I am feeling intensely glum about the future.

My life of late has been dull in the extreme: I’ve done a bit of revision and sat a few exams and I have been slowly abusing my body with junk food and terrible sleep hygiene for a long time.  So I’ve looked forward to finishing the final set of my extended student career. I anticipated spending the time afterwards reading things for interest not exams, maybe bloviating some more on the internet, reacquainting myself with ignored friends and family, and re-engaging in general. I was looking forward to beginning life and work in Manchester as an FY1 doctor for the long suffering NHS.

Alas, any joy gained from finishing my medical finals on Thursday was violently annihilated by the election results a few hours later. The exit poll was worse than all the previous polls, and the result worse even than that. We have voted for another 5 years of conservative government, except now it will be unmitigated by Liberal Democrat presence.  I am concerned that this country is becoming unkind and insular and selfish and unpleasant, that the people in it are seemingly unconcerned about the healthcare system, about the poor, about immigrants, about welfare, about human rights, about food banks, inequality, about relations with Europe, about big corporations holding governments to ransom.

But smallest of victories: Nigel Farage, and Paul Nuttall and 619 other UKIP failed to win seats, despite some 3.88million UKIP votes. Nearly 4 million adult human beings decided voting UKIP was a good idea.

I stole this picture from the bbc website

It’s cruel that the Tory’s unexpected success has benefited so much from the surge of their ideological opponents in the SNP. It seems that fear of an SNP-Lab coalition dissuaded enough labour voters, whereas hatred for the ruling Tories England caused an SNP whitewash in Scotland.

It’s tempting to blame our electoral system; under proportional representation the parliament would look significantly different:

Party	Actual result	P.R.	Difference
Conservatives	331	242	-89
Labour	232	199	-33
Lib Dem	8	51	43
SNP	56	31	-25
Ukip	1	82	81
Green	1	24	23

In my simplification to consider coalition governments:

“LEFT” = LAB(232) + LD(8) + SNP(56) + GREEN(1) = 297 (vs 305 PR)
“RIGHT” = TORY (331) + UKIP(1) = 332 (vs 324 PR)

(Apologies for ignoring all of the smaller and welsh/NI parties)

But I suppose the reality is much more complicated than this – a lot people I know would have voted differently under proportional representation. Plus I see no chance of voting reform as it would never benefit the ruling parties, and of course 2011’s AV referendum was a shambles.

There’s lots and lots and lots to say about the state of British politics this week, and lots has been said and re-said and said again, and I’m aware that I’m neither qualified nor able to clearly articulate the issues.

So I’ll just quote a line from Richard Herring’s blog:

“This is democracy though. It’s all about what most people vote for. And people are fucking idiots, so you can’t be surprised when they do something stupid”

Or perhaps a better and more optimistic one from Aneurin Bevan 1948:

"The NHS will last as long as there are folk left with the faith to fight for it"