Whilst most would make resolutions of things to do in 2014, I am more certain of things that I may not do ...
Some musings over traditional family values, happiness, consumption and the perils of having children late in life.
Discovering a forgotten letter triggered some ambivalent recollections of different times.
I now realise, that my generation is unique. The generation before me, had very few practical procedures and doctoring largely involved furrowed brows, a limited number of blood tests and lots of bed rest. Conversely, the generation after me has delegated the responsibility for procedures to other departments. Now the liver biopsies are ultrasound guided. Chest drains are only placed by respiratory physicians. Pacing is done by cardiologists. But it wasn’t all bad. I fondly remember the after-wardround coffees when we would laugh and exchange anecdotes. I remember the story of the vagrant having a VF arrest in A&E. When the defibrillator shock was administered, all his flies jumped out of his hair, in beautiful synchrony! I recall the patient who had a VF arrest in the middle of a sentence. He fell back unconscious onto the pillow. Glancing at the cardiac monitor, I gave him a thump in the chest. To my surprise he immediately sat up again and shouted “OUCH - WHAT DID YOU DO THAT FOR!?!”. Our camaraderie translated into a deep sense of loyalty. Nobody took any sick leave. Absence would land colleagues in impossible situations. If you didn’t come to work, your colleagues would have to pick up twice their normal workload, see twice as many patients in clinics or the ward round would last 6 hours instead of 3 hours. Acute medical takes were busy, usually with 20-30 medical admissions. This was an era when patients were stockpiled on trolleys in A&E and women gave birth in corridors next to heart attacks and acute abdomens. I recall feeling particularly rough in the middle of a Medical Take, I checked my temperature to find it to be 38.7 ⁰C. I phoned my wife for a moan and ask for her opinion about taking some ampicillin. “Don’t be an idiot, take a paracetamol and GET ON WITH IT!!!”, was the reply. What did I expect from a doctor?
Well another successful UEG Week draws to its conclusion
I still don’t get it but hopefully this is only true in our Professional Lives !
Voter apathy is well recognised phenomenon. No doubt caused by our pulverisingly boring politicians.
Paradoxically politics should not be boring. It should be about passion! A passion to change things for the better, for the majority, for the country, or for humankind.
The reason why you have not heard of “medical meeting apathy” is because I just made the term up. I have seen it creeping in over the last 20 years. Many past colleagues and research compatriots are nowadays never seen at medical meetings. Perhaps they feel that they can keep up to date by reading journals and looking up the occasional guideline on the BSG website? No doubt, the institutions they work for are happy to keep their noses firmly pressed against the rockface. Furthermore, partners and young children are rarely pleased to see you go away. How is little John going to get back from Rugby camp on Sunday? Who is going to take young Phillippa back from her dance classes on Tuesday?
Taking a little “me time”, away from the coalface not only make us better doctors, but also more fulfilled human beings. Furthermore, a larger membership base makes it more difficult to ignore Gastroenterological issues in Brussels, Whitehall or wherever the corridors of power lie.
So how can we claw back some territory lost to “medical meeting apathy”? The UEG Week 2013 has several new features attempting to do just this. Naturally, you can still ask questions using your mobile telephone, but you can now also linger after presentations for a more in-depth discussion with speakers. Daily, round table discussions have also been introduced. To encourage participation, there is even a free lunch! Will more tedious topics such as viral hepatitis, be provided with a better lunch? In addition, there are more “tandem talks”, whereby two presenters thrash out the ins and outs of some topic. For the Postgraduate Course, I have been paired up with Dieter Hahnloser to debate the “Management of Dysplasia in Colitis”. We have put something special together.
Some other controversial topics have been juxtaposed such as Guy Boeckxstaens who argue that refractory GORD is all about the acid pocket, versus Ronnie Fass who believes that it’s all in the brain (does he mean in the mind?). Fernando Azpiroz talks about functional disorders being part of the lifestyle versus Robin Spiller who believes that it is post-infective. Naively, I am surprised that there is nobody arguing that its usually in the patients head. I guess that its no accident that I am an endoscopist. There is also a session looking into non-invasive monitoring of liver disease (biomarkers vs elastography). Can’t help to think that we can get all the prognostic information in reply to 3 simple questions: a) Do you have a Job? b) Do you have a Drivers License? c) Do you have a Wife? If the patient replies "No" to all 3 questions, the prognosis is grim!
For those poor people left behind, manning the coalface, there is “live streaming” from 2-3 sessions every day. Furthermore, 3 sessions will be recorded and published online by Tuesday 15 October; “Multidisciplinary management of IBD”, “Non-invasive testing and staging in GI and Liver Disease” and the Monday morning Opening Plenary Session. Finally, your friends and colleagues can monitor your social activities on the new Live UEG Social Wall.By the way, don’t miss an opportunity to see my latest, hot dance moves in the "Wasserwerk" on Sunday evening!
Waiting for her University interview, my daughter found herself next to a young man who pronounced that he already had a place at Charles University.
“Do you think that I should mention this in the interview”, he asked. “Oh absolutely”” was the unequivocal reply. Cruel, but in Medicine there is no prize for second best in the high stakes University Interview.
Nevertheless, the young man had a University place assured at Charles University in Prague. Nowadays, every University is doing their utmost to attract foreign students. The incentive is clear; money! The flow of foreign investment is welcome to Universities which are falling over themselves offering tuition in English or German. For students too, there are advantages; pulling free from overbearing parents, getting an International education from a famous institution, meeting people from other cultural backgrounds.
I don’t take issue with the idea of paying for an education. It is hard to imagine a better investment. Nor can I blame bright and bushy tailed youngsters for seeking a Medical education abroad if they have been turned down by their own establishments.
Nevertheless, I am worried. As a young Swede, I spent 5 years training in medicine in the UK. Once I had passed my exams, I was free to practise anywhere in Europe. I don't think that I would have been much good looking after patients outside of the UK or Sweden! After all, without communication skills, as doctors we can not hope to build rapport or explain a schedule of investigations or the rationale for medication to our patients.
Naturally, the challenges of moving to a new country and learning a new language may be somewhat less acute for senior doctors who not only have already been fully trained in a system they understand but also have years of practical experience in communicating with patients in their own language.
I do have a second concern. Charles University is a venerable old institution, founded in 1348, but there are other establishments with less of a track record. Medical courses in English for foreigners are now offered in more than 30 institutions in a wide range of countries incluing Austria, Italy, United Kingdom, Spain, the Czech Republic, Slovakia, Hungary, Latvia, Estonia, Lithuania, Malta, Croatia, Bulgaria, Poland and the Netherlands.
How do you know that every institution produce graduates who have received a training which equips them for caring for patients in any European country, although there may be different medical problems, requiring different tests and different management to the country they trained in?
Conversely, imagine a great medical course, providing excellent training from which a fantastic junior doctor graduates who has the misfortune of becoming embroiled in some medical mishap in a foreign country. It would then be all too easy to cast dispersions on his training, albeit of the best standard. Would it not be in the Universities own interest to have tests in place to prove the quality of their graduates if they choose to work in another European country to that in which they trained?
Of course, many students leave a University after receiving education which does not equip them well for the world they are facing. Students may graduate from Leeds University with an education in Hotel Management which may not equip them well for looking after a Hotel in Nigeria. However, the havoc a badly trained doctor can wreak is of a different order. After all it is difficult to kill someone with a “bad degree” in business management.
Currently, it is also possible for doctors to simpy move country when struck off a medical register. In 2008, a German doctor was struck off the UK medical register after a patient died following a diamorphine overdose. He may still be free to practise in Germany.
Finally, even if the medical knowledge is sound, doctors may not understand “the system” of when and how to investigate and when and how to treat. A case in point was my daughter (she is now in her fourth year) who, during a recent “elective period” in Fiji, was advised to treat a patient complaining of leg cramps with potassium tablets. Unconventional therapy in the UK - but perhaps it works on a tropical island? However, when given to an old patient in Birmingham, potassium tablets may well prove fatal.
Isn't it about time that all countries of the European Union introduce comprehensive checks on the medical knowledge and communication skills of doctors trained in outside institutions?
At a recent dinner party, I found that our hosts had converted their kitchen and dining room into a modern, combined “dining kitchen”.
1) Once the live cases have been confirmed, inform the endoscopist of all clinical details together with radiology, images/video footage and histology. Full details of the patients’ preferences, medical history and comorbidities, is even more important. If possible, try to arrange for the patient and endoscopist to meet before going live. With this preparation, the endoscopist will have all the facts at the fingertips and can better explain why the patient has been selected for a particular procedure. 2) Encourage the endoscopist to bring his own consumables and ask which diathermy machine would be preferred. 3) Arrange for staff in the endoscopy room to be able to speak the language of the endoscopist as well as the patients’ native language. In spite of the obvious pitfalls, Live Demonstrations are unique. There is no better way of illustrating a technique to a large audience. However, it is the discussion around the case which is more important than the actual “cutting". Yes, a Zenker’s diverticulum can be treated endoscopically but when is it better to do this surgically? When is a Heller’s myotomy inadequate and the patient should be referred for POEM? At a good Live Demonstration, the audience is provided with a clear explanation of why a particular procedure has been selected over alternatives strategies such as “watchful waiting”, surgery or an alternative endoscopic technique. Naturally, as the case unfolds, the management plan may change and “plan B” or even “plan C” may be invoked. Indeed, the best and most educational Live Cases are those in which the Endoscopist changes his mind. Almost everything we do as doctors are balanced, continuous assessments with few absolute rights or wrongs. Indeed, being comfortable with making decisions when there is no protocol to follow, is what we are trained for and what sets us apart from other healthcare professionals.
Social media is one of those technological developments which set generations apart.
Join our Growing Band of Endoscopy Brothers on Twitter (click the photo below)!
A couple of weeks ago, BMJ launched “Let the Patient Revolution Begin” on its front page(BMJ 2013;34).
Without a word, the “Medical Rep”, slid the device across the table
Old age is a country which few plan to visit
Professor Carol Dweck and my mea culpa
Sometime I surprise myself by remembering key moments in the path to the present English NHS.
My daughters primary school teacher recently asked me to come to school and do a short presentation on healthy living.
Last week I was referred a patient with Peutz-Jeghers syndrome. An earlier enteroscopy had found some polyps in the duodenum which they wanted me to remove.
There would have been strong arguments against the UEG developing an eLearning site in 2010.
Well the celebratory 20th anniversary the UEG Week is finally here!
It's about time that we take the lead on this contentious topic.
The English Equality Act 2010 has now made “Ageism within the NHS” illegal.