My two cents on the contracts

Today, after months of negotiations and strikes, Jeremy Hunt, the health secretary in the UK, announced that he will impose a new contract on Junior Doctors in England on 1st August this year. The changes in the contract effectively remove safeguards currently imposed on hospitals to prevent junior doctors from working too many hours so that they don’t become exhausted and thus compromise the safety of their patients. The changes also reduce the overall pay, despite a rise in basic pay of junior doctors by re-classifying normal working hours to include Saturdays and longer weekdays where they would normally be paid extra for working these unsociable hours.
The government has been in discussion with the BMA, the medical union, to negotiate these changes but legally they do not need to agree for the contract to be put in place, Hunt can force it through regardless.
There have been strikes and a strong sense of unity between members of the profession with overwhelming support for the strikes both from within the medical profession and the public.
Now. The government have tried to suggest that the anger with this contract is all to do with the pay, however many medics have publicly and eloquently expressed that in fact it is all to do with patient safety.
What really gets to me is that anyone with half a brain can see that in applying to medical school we commit ourselves to long days of studying, short holidays, working weekends and constant fear of failure. We work our socks off, and in the UK will leave with up to £80k of student debt. On a normal NHS salary progression, I will not pay off my student debt and the roughly 5% compound interest in the 30 years before it gets written off. We are simply not in it for the money.
As it is, FY1s (doctors in their first year after graduating) are at times required to work a full working week, be on-call over the weekend and work the next full week – 12 straight days of work is exhausting whatever you do and your decision-making will suffer and when the decisions you make affect people’s health and lives, it’s pretty scary.
I am happy to take on the debt. The lost weekends. The 5 years of intense study. The constant fear of failure. The late nights. The frankly alarming coffee habit. The constant bloody exhaustion and I’ll miss family and social events. All of it, because I’m working towards my dream job.
But what I ask for in return, is to work in conditions in which it is not certain that my exhaustion will result in the death of a patient, which is exactly what these contract changes will do.
I stand with the BMA. Don’t make me a killer Jeremy.



To which side does Sir dress?

At the end of our previous encounter, we found our sleep-deprived heroes dissembling a human body with rudimentary tools…
We are studying the pelvis. It’s a tricky old area to get to, we are told. Takes a bit of manoeuvring and hard work. And a box saw.
I’m pretty sure the saws we used in woodwork when I was 11 were more advanced than this but hey ho, off we go.
Someone is allocated the task of first removing the cadaver’s torso and then standing the legs upside-down, using the newly-created cross-sectional surface of the top of the hips as a base. Easy enough. A few crunching minutes later and the feet are up in the air, as if doing a handstand. Or, rather, hip stand?
‘Right. Next step, we want one leg, not two, so cut it in half down the middle.’
‘The middle?’
‘Yes the middle.’
Yes there.’
‘Where his…thing is?’
‘Yes exactly, I said the middle didn’t I?’
‘Oh, ok. But, well, to which side shall Sir dress?’
In the end Sir dressed equally on either side, cue winces all round.
Happily the most distressing part of this thrilling tale is still to come as our heroes are required to clean certain contents of the specimen in order to appreciate structural findings.
So I scooped the poo out of the rectum with my finger.

Thoughts from the Dissecting Room

In my many hours spend in the dissecting room, what has most surprised me is the frequency with which the gender of the cadaver is misidentified.
‘How hard can it be?’, I hear you ask. My thoughts exactly.
In our introductory session in the dissecting room, as fresh-faced and wide-eyed first years, we are asked to appreciate the great contribution that the cadavers have made, their outstanding generosity and foresight in life to consider donating their body to aid our education. It is a fantastic contribution, we agree, and so selfless of them and their families to agree to making such a valuable bequest.
We feel honoured, as we remove the coverings, to meet our cadaver, who will be the source of such great learning over the year to come. The bodies are grey and almost inhuman following the preservation process, and we proceed with trepidation, trying to take in the sight before us. The face, for now, remains covered as most will never have seen death in such a way, and it takes some time to become accustomed to it.
‘Wow’, I hear from a fellow student across the table. ‘This woman made such an incredible decision to do this for us.’
I exchange a look with a friend, and we both turn back to face the cadaver lying in front of us. The naked cadaver. Unclothed. As bare as the day they were born. We look back at each other. For before us on the table, in all his glory, lies a man. Most definitely a man. With all the manly appendages and without all the less manly features. No doubt. Unmistakable. Male.
When I applied for medical school I was told it would be tough to get in, they expect top grades, personability, professionalism, common sense, they want the model students of this world who can play twelve instruments, speak seven languages, hike their way through all of the Duke of Edinburgh awards and play international level sports whilst bashing out a publishable personal statement and, oh go on then, why not knock out a few best-selling novels as well, maybe a Nobel prize or two whilst you’re at it. But never, in the highly specific set of requirements do they mention being able to identify the gender of a naked body.
I do not wish to be presumptuous and nor do I claim to have insight into the minds of the interview panels for medical schools, and please, I implore you to correct me if I am wrong, but
I would have thought
When lying uncovered in front of you
Is a cadaver with no gender ambiguity
This happened on three further occasions that year.
With the same cadaver.
Fast-forward twelve months and find us in the same location, eye bags as dark as our newly-acquired outlook on life, sawing through a man’s groin with a set of tools acquired, surely, from the local discount hardware store; respect indeed. But that’s another story.

Freedom of Expression

Even with my limited and rudimentary knowledge of medicine, I have some pretty strong opinions on certain ethical and sociopolitical themes. The role and future of the NHS, for example, as well as abortion, assisted suicide, equality, even the treatment of obesity, drug and alcohol dependence and smoking-related diseases, not to mention my political preferences.

I’d like to think I have reasoned and balanced arguments to support my views but I don’t know what limits professionalism set on my expression of those views, which is why I don’t feel comfortable even to commit them anonymously to this blog. Does anonymity permit freer speech? As a practising clinician, do one’s own views become irrelevant? If a clinician’s views, say religiously, contravened a patient’s wishes for abortion, should they be able to ask a colleague to perform the procedure in their stead? And how far would this extend. To prescribing contraception? What if nobody else was available? Should they deny a patient’s wishes based on the clinician’s own beliefs.

I’m sure there are guidelines, policies and procedures surrounding this and related issues but from a purely ethical perspective, it fascinates me.

I’m wary on my personal social media sites of avoiding controversy, swearing and alluding to political or ethical values for fear of seeming ‘unprofessional’. I feel I must become a neutral entity, a monkey dancing at the whim of the patient audience.

So. Why do you want to study medicine?

Ah, yes. That most dreaded of inevitable interview questions.

All of the med school interviews I had included it and I gave different answers each time, with varying degrees of success. There is an argument that this question is only asked to relax you and get you speaking because the panel expect you’ve thought about it and, to some extent, prepared an answer. I know the guy sitting next to me before an interview, sweating nervously and frantically trying to memorise his typed answers had. But I hadn’t.

I’m not bothered if it’s a question that the interviewers are genuinely listening to or whether they use it as time to zone out and start their paperwork whilst you stumble over your words, but I think it’s awful. Who, as a naive, inexperienced teenager, can give a coherent answer without endless clichés, sounding sickening or spouting the compulsory ‘I just want to help people’?

In truth, I was alerted to the possibility of pursuing a career in medicine by TV medical dramas (E.R. and House chief among them). However, I’d have to be a fair few drinks on the way to being trolleyed to rock up to an interview and confess to watching the number of episodes of those programmes that I have. (It’s all of them, if you’re wondering). I don’t think I’d want my doctor to have that kind of capacity for audiovisual consumption. I want to know mine were reciting rare genetic diseases from their cot before they stick that gloved hand wherever it’s going.

But isn’t honesty one of the core values we expect from a medic? Should I have said, ‘I want to be a doctor because Hugh Laurie’s really cracking in his role and Dr Greene sets the tone’? Whilst honesty is important, there is a point at which you should just stop sharing quite so much about, for example, how much you enjoy picking your nose and to be blunt, should shut up.

At interview I was asked on more than one occasion whether I had medics in my family. I replied truthfully that I don’t, because I didn’t want to lie but I didn’t feel entirely comfortable answering the question. I didn’t want that to affect my chances any more than it would if I did; level playing field and all that. So honesty: yes, good, wonderful. To an extent.

And to the original question. Why do I want to study medicine?

Not a bloody clue.


Welcome to my blog!

This September, I’ll be off to uni to study medicine and I thought it might be fun and useful to keep a little record of what’s going on. When I was deciding on what I wanted to do, I found that there wasn’t enough info about what it’s really like being a med student and I hope that this blog will give a bit of insight into life at medical school.

I’ll try and write a bit about lots of different aspects of student life, whether it’s the day-to-day goings on or my musings about medicine, ethics and society and I hope they’ll be informative and/or useful and/or (ideally) a teensy bit entertaining.

There area few months to go until I actually start, so there’ll be some preamble for you to endure or enjoy as the mood takes you.

So, let’s get this show on the road!