tag:blogger.com,1999:blog-152985992024-03-07T20:18:43.775+00:00The Daily RhinoRohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.comBlogger119125tag:blogger.com,1999:blog-15298599.post-62665013436178780282008-12-22T22:33:00.003+00:002008-12-22T22:54:55.859+00:00Death of a GP<span style="font-family: arial;font-size:78%;" >Dear Lord Darzi,<br /><br />I’m an SHO – sorry, CT1 – and have never had any inclination to become a GP. Hence, in my somewhat selfish way, I disagreed with, but largely ignored, your infamous polyclinic plans. Yet two funerals I attended this year brought into sharp focus why I, and thousands of doctors, feel polyclinics are a step in the wrong direction.<br /><br />My mother’s younger sister met her husband at medical school in India and mirroring countless similar couples, came to the UK in the 1980s to start a family. Both worked as hospital SHOs for a time before becoming GPs in the north of England.<br /><br />My aunt stayed at the same practice for many years, becoming a fast favourite with patients due to her caring nature and comforting smile. She raised my two cousins, the eldest of whom is now an F1. My uncle also excelled in his career and expanded his practice immensely. He pioneered many new initiatives, sat on various committees but never forgot his priority was his patients. His devotion to their care won him a profile in the Daily Mail as ‘Britain’s favourite GP’; secretly nominated by patients and staff. He found the whole thing embarrassing.<br /><br />Both would routinely go far beyond the call of duty for their patients. Yet they would be the first to tell you that they were not exceptions. Their dedication to care, the relationships they built with patients and their place in the community is shared by GPs across the UK. Genuine family doctors.<br /><br />Their diagnoses of two different cancers came years apart, but they died within three weeks of each other this summer. They were in their mid-fifties and desperately tried to keep working as long as they could. Both felt most comfortable in an NHS hospital when unwell.<br /><br />I organised both funerals in the same crematorium. Its capacity was one hundred and on both occasions it was filled more than twice over. I enjoyed chatting to patients who simply felt ‘they ought to be there’. They emphasised how they regarded my aunt and uncle as honest friends, who they confided in, trusted and who never hesitated to tell them the truth.<br /><br />A tall man with long hair, tattoos and a leather jacket, smiled when he thought about my uncle’s place in his life:<br /><br /><span style="font-style: italic; color: rgb(153, 0, 0);">“I’ve had seven children, three wives and four houses...Dr X has been the only constant in my life!”</span><br /><br />It is this one line that makes me fearful the British public’s relationship with their most important doctor will change forever.<br /><br />My cousin wants to follow in her parents’ footsteps as a general practitioner. I want her to be able to experience the lasting relationships with patients my aunt and uncle did. I want her to be a constant in their lives.<br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-18606691078304583032008-07-11T15:31:00.005+01:002008-07-22T23:36:10.121+01:00Real Doctor<span style=";font-family:arial;font-size:78%;" >Originally published in the June issue of <a href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a></span><span style=";font-family:arial;font-size:78%;" >.<br /><br /><span style="font-weight: bold;">THE </span>very first plasty I wrote after graduating was entitled '<a href="http://dailyrhino.blogspot.com/2006/11/pretend-doctor.html">Pretend Doctor</a>'. So it seems rather fitting that my last column as a foundation doctor (the first two years of training) carries the title of 'Real Doctor'. It has taken me two years before I felt ready to describe myself this way, but after last weekend I realised my two F-years have taught me more than I realised.<br /><br /></span><span style=";font-family:arial;font-size:78%;" >Some months I have to struggle to find something to write about. Other months it is immediately apparent. I didn't even have to think about the subject matter for my final column as I recently experienced one of the most memorable few days I suspect I will ever work through.</span><span style=";font-family:arial;font-size:78%;" ><br /><br /></span><span style=";font-family:arial;font-size:78%;" >I am currently working in ITU and thoroughly enjoying it. I have been looking forward to this job all year and am considering it as a career choice, but it has only recently dawned on me how ITU is as much about death as it is about saving lives.<br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://www.austinchronicle.com/binary/7456/cols_ventura-37617.jpeg" /><br /></span></div><span style=";font-family:arial;font-size:78%;" ><br />During my last weekend on-call, our unit had five deaths within about sixteen hours. None were unexpected, but all were quietly heartbreaking. Two stood out and taught me skills I know I'll find useful throughout my career. The first case was that of a 27 year-old man I shall call Stephen. Stephen had been in the unit for the best part of three weeks. He was admitted with a severe pneumococcal pneumonia on the background of pulmonary sarcoid. Over the days he had developed horrific ARDS with multiple broncho-pleural fistulae and bilateral pneumothoraces.<br /><br />He was critically unwell for the majority of his stay, dramatically hypoxaemic and hypercapnic, before entering multi-organ failure. By the weekend I was on-call, he had four large-bore chest drains in his chest and quite astonishing surgical emphysema all over his body, puffing his face up like a beachball.<br /><br />Stephen also had an amazing family. His siblings and parents took shifts to keep him company (only two visitors are allowed at a time) and made sure his favourite records were always spinning in his room. He had an enviable soul music collection, with Marvin Gaye, Stevie Wonder, Smokey Robinson and Billie Holliday constantly vying for attention with the sound of Stephen's high-frequency oscillatory ventilator.<br /><br />His family were understanding, grateful, calm, realistic, loving and clearly brought closer together by the slow deterioration of their son and brother.<br /><br />On Saturday chest drains numbers five and six were inserted to attempt to further re-inflate his lungs. He now had three drains in each hemithorax. All six were on suction and bubbling furiously away.<br /><br />About half an hour before I finished my shift, Stephen's nurse called me in a panic. One of the new drains had stopped bubbling after draining some blood. I realised the tube had a big clot in it and tried to unblock it. This proved somewhat tricky as the clot extended along the entire length of the tube. As I asked for a bladder syringe Stephen's blood pressure started dropping. His systolic fell from 90 to 60 in less than a minute.<br /><br />Marvin Gaye provided the backing music.<br /><br />With metaraminol in one hand and the bladder syringe in the other, I nervously kept his BP propped up. I thought this is </span><span style="font-style: italic;font-family:arial;font-size:78%;" >probably</span><span style=";font-family:arial;font-size:78%;" > the kind of thing my SpR should know about, but she was speaking to another patient's family. They were in tears, asking her to pull the plug on their loved one, yet she had to rush out midway.<br /><br />Before she arrived Stephen went into PEA arrest and I started chest compressions. A cycle or two into CPR, Stephen still had no output. I was sure the chest drain was the problem but unblocking it was not easy. Suddenly an idea hit me, one that was both a product of following simple guidelines and attempting to diagnose the problem.<br /><br />It was Stephen's 28th birthday. Meanwhile, Al Green was singing.<br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://www.hmdhealthcare.com/images/ivc_product.jpg" /><br /></span></div><span style=";font-family:arial;font-size:78%;" ><br />I pulled an orange cannula out of the crash trolley and plunged it deep into Stephen's left chest. A whoosh of air was followed by a recordable blood pressure and a pulse. I'd done it. A tension pneumothorax is such a film and TV cliché but for obvious reasons, it's as dramatic as hell.<br /><br />I wanted to be the one to talk to Stephen's family. I am not sure why, was it anticipating the kudos I would receive after telling them of my actions? Or was it simply because I had developed a relationship with them and wanted to be involved? They were, as always, quite remarkable. They seemed genuinely concerned with thanking Stephen's nurse and me. Whatever bravado I had felt melted away as I realised that despite my proud moment, Stephen was in the same position he was in half an hour before.<br /><br />By the time Stephen died, aged twenty eight and one day, within a day of this tumultuous episode, he had seven drains in his chest. A final blow was dealt when the transplant team, requested by his family, opened Stephen to find not a single viable organ.<br /><br />Another death at the weekend was that of an old friend, a 70 year-old I will name John. I say old friend because I had known John for eight months. I met him in A&E and got to know him and his family during my four renal months, during which he was an inpatient for the entire duration. John had a past medical history as long as your arm and what I thought was the family from hell.<br /><br />The entire renal team was wary of them. They were abusive, demanding, unfair and sometimes malicious. In fact I wrote about them once before because they drove me up the wall. John paid me a visit in ITU; his fourth admission there.<br /><br />I warned colleagues: "be careful with that family" but soon realised that it was the renal ward they had trouble with, not any individuals, as they were perfectly friendly to me in ITU and indeed sought me out as someone to talk to as I was a familiar face. John became very sick very fast and suddenly I found myself in the breaking bad news mindset. Once again I took close family into the 'relatives' room' to suggest he had only hours remaining.<br /><br />From the first time I met John he was bed-bound and withdrawn, but I learnt he was once a proud patriarch of a huge extended family. His two daughters and his wife remained by his side as the months had gone by and whilst I would once have ducked into the doctors' office to avoid a confrontation, now I saw three women losing the man of their house. I was overcome with guilt. I should never have let myself dislike these people.<br /><br />John's wife, who had become quite motherly to me over the weeks and months, surprised me. She leapt up to hug me and said "I'm so glad it was you." I can assure you I wouldn't be glad if I was my doctor but I think one recognisable face in the bustle of ITU was reassuring.<br /><br />Later I was with another patient and my SpR came over in floods of tears.<br /><br />"What's wrong?"<br />"It's John, his whole family's there and it's just so sad. They're asking for you."<br /><br />I nervously parted the curtains around his bed and found about twenty people crying, holding hands, saying prayers. It was clear that John commanded utter respect from those around him. It would have been nice to know him as his former self.<br /><br />His wife brought me right into the middle of the throng and I felt like a complete imposter. Did they know how I used to feel about them? She told me that I always treated John like more than just a patient, that she would be sad she wouldn't see me again and that I will always be in her prayers.<br /><br />I definitely did not deserve this. The feeling of guilt at receiving praise I was unworthy of, combined with the real happiness that I had made something of a connection with this family was unusual. I am sure I won't forget what John's wife said to me, perhaps even more so because of our colourful previous dynamic.<br /><br />Corny or not, I can honestly say I will remember this weekend as a seminal point in my career. The moment I realised I am a doctor that can save a life - albeit only postponing death for a day - and that can make an emotional connection with a patient's family.<br /><br />In the nicest possible sense, I hope you all experience an occasion in your career where you are forced to exceed what you thought were your limitations. When I finally got a day off several days later, I was exhausted and drained, but I had never felt more positive about my job. These are the experiences that teach you more than any DOP or CbD ever could.<br /><br />After four fantastic years editing and writing </span> <span style="font-style: italic;font-family:arial;font-size:78%;" >Medical Student Newspaper</span><span style=";font-family:arial;font-size:78%;" >, I can finally switch my bleep off. Good luck.</span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com7tag:blogger.com,1999:blog-15298599.post-12192918618810097702008-05-13T13:17:00.001+01:002008-07-16T00:05:56.560+01:00They hate you<span style="font-family: arial;font-size:78%;" >Originally published in <a href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a>.<br /><br /></span> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-weight: bold;font-size:78%;" >BECOMING</span><span style="font-size:78%;"> a doctor isn’t what it used to be. Communication skills, ethics, breaking bad news and familiarising oneself with the Job Centre would be foreign to medical graduands of the past.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Doctors have rapidly changed in their training and their demographic. Yet some things remain constant. We still have one aim - to cure the patient. And our roles as hospital leaders family doctors continue unchanged. Well…not so.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Within the health profession we are constantly under threat from government interference, nurses encroaching on our duties and hospital managers breathing down our necks. At work, we are no longer masters of our realm, but commodities.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />So surely we can rely on a cheer that has buoyed generations of doctors, the love and respect of our thankful patients. Sorry, wrong again.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />I am not referring to irate patients at the GP’s surgery nor pushy mums in A&E, but the particular section of the public that calls themselves the media.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />You are, almost certainly, an avid reader of </span><span style="font-style: italic;font-size:78%;" >Medical Student Newspaper</span><span style="font-size:78%;"> (right?!) So you might well believe that all newspapers regard doctors with the same awe and overt love that we do. But, do you know, you’d be wrong?<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />The simple fact is that the media hates you.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br /></span><span style="font-size:78%;">Make little mistake about this, for if you have not yet noticed it then bear it in mind as you survey the national headlines for the next few weeks. Soon enough you will see that doctors are viewed as over-privileged, over-paid, greedy, incompetent simpletons who sap money from the public sector.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Five years ago an article in the BMJ, which surveyed a small group of junior doctors, found that new medical school graduates were increasingly disillusioned by media attitudes to doctors, and ‘doctor-bashing’ became a familiar term.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />The phenomenon has snow-balled. The phrase ‘doctor-bashing’ was coined some twenty years ago but the seeds were planted far earlier than that. The American writer Ambrose Bierce quipped at the turn of the twentieth century, “</span><span style="font-style: italic;font-size:78%;" >Physician</span><span style="font-size:78%;">, n. One upon whom we set our hopes when ill and our dogs when well.”<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />It is clear which particular breed of doctor has the roughest time at the hands of the journalist, the general practitioner.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Venerable, cardigan-wearing, bespectacled family doctor with a pot of lollipops. Dangerous, selfish, lazy fatcat. The criticisms range from mischievous generalisation based on a bad experience, to mean insults and fallacies.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br /><st1:country-region><st1:place>Britain</st1:place></st1:country-region> appears to suffer this peculiar ailment most grievously. In the <st1:country-region><st1:place>US</st1:place></st1:country-region>, where admittedly the whole health service is markedly different to ours, success is admired and applauded. If a doctor earns well, there is no assumption he or she has done it at the expense of patients.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Whereas here, doctors are thought to uniformly earn stellar salaries which should mean they are public servants with a job description the patients are free to adjust.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Why has the media decided to demonise the medical profession? The negative portrayal of doctors is now cited as one of the more demoralising aspects of working in medicine in the <st1:country-region><st1:place>UK</st1:place></st1:country-region>.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Papers and television news love a scandal. Sensational stories about dodgy doctors are understandably popular in the press. However the rest of us soon become tarred with the same brush as Harold Shipman. <o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Key accelerants to the growing hatred of medics were the recent consultant and GP pay deals, offered by the Department of Health. The pay rises afforded to the average NHS consultant and the average NHS GP were indeed generous and whether they were deserved is, in fact, entirely immaterial. The fact is that doctors have born the brunt of media fury at the deals. Somehow we are to blame for a deal the government put forward; we are the bad guys for negotiating a good deal.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />In a nutshell, GPs agreed a few years ago to take a small pay cut in exchange for avoiding out-of-hours work. Seeing as it has been established that doctors are lazy, columnists are keen to point out that they cannot get an appointment when they want. This means after they have gone to work, picked the kids up, walked the dog and gone to pilates. So somehow, their life and their commitments outweigh those of the GP, who should make the time.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Much as it warms my cockles, even a retrograde cynic like me will acknowledge the move away from the paternalistic ‘doctor-knows-best’ attitude was healthy. And it would be churlish to suggest that doctors don’t make mistakes. We should be open in our admission of mistakes, but increasing litigation makes this difficult.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />I am particularly conscious of the public’s attitude towards doctors this month, as I was asked to be a guest on the <a href="http://dailyrhino.blogspot.com/2008/04/incendiary-views.html">PM Programme</a>, on BBC Radio 4.</span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />The PM research team had been reading an old issue of </span><span style="font-style: italic;font-size:78%;" >Medical Student Newspaper</span><span style="font-size:78%;"> and came across the <a href="http://dailyrhino.blogspot.com/2006/11/pretend-doctor.html">first piece</a> I wrote as a doctor, which concerned ash cash, the fee paid on completion of a cremation form.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />It is a very interesting topic and I wish debate ensuing the programme had been as stimulating. However it proved to be a very depressing experience. With some subtle editing I had been made to sound a little crass (mentioning ash cash is used on every day items such as food, rent and alcohol after a grieving daughter expressed her sadness at paying the fee when her mum died), but overall the experience was not too harrowing.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />The BBC website and <a href="http://nhsblogdoc.blogspot.com/2008/04/dead-bodies-and-ash-cash.html">NHS Blog Doc</a> (legendary blogger and former </span><span style="font-style: italic;font-size:78%;" >Medical Student Newspaper</span><span style="font-size:78%;"> writer) picked up the story and became hotbeds for debate. The deeper concepts of coping with death as a house officer, the unpleasantness of funerals and the legal implications of what the cremation form means were not examined. Instead the comments from members of the public morphed into one hundred and eighty two savage assaults on doctors’ salaries (I made the mistake of referring to an F1’s pay as ‘meagre’), our arrogance, our insensitivity and even allegations of gross misconduct.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />When commenters expressed outrage that they should pay for a funeral, I suggested they should also be annoyed at the undertaker, who charges far more than a doctor. No. Let one thing be clear - the anger was squarely aimed at the doctor, no one else.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Some alarming misconceptions came to light (that we demand the fee from relatives, that we’re paid overtime, that cremation forms are private work done on NHS time), but if I tried to point them out I was ignored or shouted down. A few valiant doctors also attempted to calm the furore but to little avail.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />The more sinister reasoning behind the increased dislike of doctors is that, coupled with MMC, there is a concerted effort to undermine and break up doctors in the UK, so that as we are replaced by nurse practitioners, we have no unified voice or public support to support us.<o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><br />Like that fat kid in school, now no one likes you.<o:p></o:p></span></p> <span style="font-family: arial;font-size:78%;" ><br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-27434936156112972092008-04-20T02:21:00.002+01:002008-04-20T03:22:40.357+01:00Incendiary views<span style="font-weight: bold;font-family:arial;font-size:78%;" >I WAS</span><span style="font-size:78%;"><span style="font-family:arial;"> on the wireless today. It's not the first time - I was on Anita Rani's show on the BBC Asian Network talking all about porn, but that's another story. Today I </span></span><span style="font-style: italic;font-family:arial;font-size:78%;" >made it</span><span style="font-size:78%;"><span style="font-family:arial;">, interviewed by Eddie Mair on </span><a style="font-family: arial;" href="http://www.bbc.co.uk/blogs/ipm/2008/04/ash_cash.shtml">iPM</a><span style="font-family:arial;">. Like most people, I despise hearing my voice, but it could have been worse. I was asked to comment as </span><a style="font-family: arial;" href="http://dailyrhino.blogspot.com/2006/11/pretend-doctor.html">a piece</a><span style="font-family:arial;"> I wrote for the </span><a style="font-family: arial;" href="http://www.medical-student.co.uk/">paper</a><span style="font-family:arial;"> about a year and a half ago was picked up. The topic under discussion was ash cash.</span><br /><br /><span style="font-family:arial;">No sooner than one British establishment featured the DR, another did. Now I've </span></span><span style="font-style: italic;font-family:arial;font-size:78%;" >really</span><span style="font-size:78%;"><span style="font-family:arial;"> made it. The great </span><a style="font-family: arial;" href="http://nhsblogdoc.blogspot.com/2008/04/dead-bodies-and-ash-cash.html">Dr Crippen</a><span style="font-family:arial;"> talked about ash cash too, which is why I thought I'd write this quick note.</span><br /><br /><span style="font-family:arial;">The passage quoted on Dr Crippen's and iPM's blogs is tongue-in-cheek and I take any accusation of being insensitive on the chin, for it is deserved. But the passage should be taken in context, so do please read the rest.</span><br /><br /><span style="font-family:arial;">Dr Crippen does indeed make the exact same point I did in the extended interview, hospital doctors who deal with death on a daily basis utilise coping strategies that are insensitive. When we talk about getting your ash cash from the ash point, or make jokes about celestial transfers to the big ward in the sky, it is merely a way of distancing ourselves from the fact someone has snuffed it. Crippo's right, we don't develop the same relationships with our patients that a GP might (well, polyclinics will see an end to that).</span><br /><br /></span><span style="color: rgb(153, 0, 0);font-family:arial;font-size:78%;" ><blockquote>"I wish I was young again so that it could all be fun and “ash cash”, but I am no longer young. My skin is no longer Rhino-thick for now I understand what I am doing, and how important it is that I do it properly." [<a href="http://nhsblogdoc.blogspot.com/2008/04/dead-bodies-and-ash-cash.html">Link</a>]<br /></blockquote></span><span style="font-size:78%;"><br /><span style="font-family:arial;">I enjoyed reading some time back that the venerable NHS Blog Doc describes himself as a curmudgeonly git, as this is how most of my friends would refer to me. Whilst I have maturing to do before I reach Crippenesque gravitas, it does not mean that youth eschews pathos.</span><br /><br /><span style="font-family:arial;">Sure we joke and pick up our ash cash cheques, but I think we all spend a quiet moment contemplating the elapsed life we are signing off into the flames. In its great early days, </span></span><span style="font-style: italic;font-family:arial;font-size:78%;" >Scrubs </span><span style="font-size:78%;"><span style="font-family:arial;">occasionally featured some great lines. JD looks at his first dead patient and says "he looked exactly the same, only completely different."</span><br /><br /><span style="font-family:arial;">Moments like this, and fumbling awkwardly for a pacemaker across a cold corpse, are the experiences that stay with you and shape your development in medicine. But they're put away and covered by tasteless jokes at the pub. Just the way, I feel, it should be.</span></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-61493245041471740592008-04-19T18:59:00.000+01:002008-04-19T19:01:43.456+01:00Scrooge McDoc<span style=";font-family:arial;font-size:78%;" >Originally published in the April issue of <a style="font-style: italic;" href="http://www.medical-student.co.uk/">Medical Student Newspaper</a>.<span style="font-weight: bold;"><br /><br />YET</span> another horrible, horrible month rolls around and curse you Satan, curse you, I'm still alive.<br /><br />Something's gone terribly awry as I am working a nightshift in A&E...when I don't have to. Yes I have voluntarily taken a locum shift in the hellhole that spat me out four months ago.<br /><br />In fact this is just one in a line of locum shifts I am making a tradition. One nurse takes great pleasure in teasing me, "ooh look who's back, he who said he would never step foot in here again! You love it really."<br /><br />How wrong she is. The question is then begged: why am I here? I don't seek to answer this in quite the metaphysical way Aristotle intended, but why am I seeing a perianal abscess at 1am? The only reason people do anything, money.<br /><br />Once upon a time I used to pride myself on being quite an enlightened soul. Sure sure, this sounds funny NOW but only because you know me as the shallow git I undoubtedly am. However money never used to be high on my life's agenda.<br /><br />I suppose any doctor would say the same - we're all in the wrong profession if money was our primary concern. But I really was other-worldly in my disinterest with money. I was generous and thought I would work for free as long as I had a roof over my head.<br /><br />What complete gash. Over the last few months I have become the guy Scrooge McDuck aspired to be, well except for the swimming in your own money thing. That ducker still trumps me there.<br /><br />I seem to spend my every waking minute thinking about money, whistling Pink Floyd's Money and carrying the FT. Just carrying it, I can’t read it. Now the reason I have subjected myself to additional A&E (along with some medical SHO) locums become clearer. I want money.<br /><br />I think I can pinpoint where my slide from Buddha-like nirvana to cash-hungry Scotsman happened, and like just about everything in my life, it revolves around jobs.<br /><br />It was only when I actually got a job that the immense stress on my shoulders became apparent. For months I had deluded myself that I was a chilled out cat, unaffected by job applications and an insecure future. In reality I never realised how much I was suffering.<br /><br />I'm not alone. Perhaps 50% of my friends are still without employment come August. Feeling insecure about the future is a horrible thing and it had engendered a passion for money I had never experienced before.<br /><br />With money, I felt I would be able to absorb the blows dealt to me by unemployment, I thought my Benjamins would help me roll with the punches. I spoke to senior colleagues about how much cash I would have to sleep on when I got to their level.<br /><br />Horror. It turns out I'm earning more than my registrar. Sweet Jesus, several more years of hard graft and my pay will go DOWN.<br /><br />Not only were my hopes of having a money-mattress dashed, I realised I wouldn't even have enough notes to light cigars with. 'Twas at this point I resolved to turn my efforts towards lining my pockets with the green.<br /><br />Hence why you find me here, volunteering my time in the place I hate for the sum of £30 an hour. Sounds quite tasty, right? Certainly more than an SHO could expect to make in a permanent post. What if I just worked locum shifts? I calculate I could have an annual salary of £72,000. Not actually that impressive when I consider my best mate, who was at uni half as long as me, is on the same figure plus bonus and his company are buying him an Audi R8. I still drive my Nissan Micra.<br /><br />As it happens, I know someone that decided to do exactly this, be a lifelong locum. He now owns five properties. The crucial difference is he is a GP. An agency I am registered with lists the following pay rates for hospital doctors: F1 - £21/hour, SHO £30/hour, SpR £34/hour and consultant £46/hour. The rates are the same irrespective of time or day.<br /><br />For general practitioners, who will now be fully qualified five years out of medical school have slightly different rates: Mon to Fri - £100/hour, weekend - £125/hour and bank holiday - £200/hour.<br /><br />The positives, let's concentrate on the positives. 20% discount at Nando’s. Back of the net.<br /><br /><br />Despite my enjoyment at reaping the rewards of locum shifts, they do represent a short-sighted waste of money by the NHS. A recent BMA survey shows that 30% of junior doctors are working on teams with at least one vacancy. My team has three. Hospitals spend money on expensive locums to cover shifts, but most of the time hapless SHOs and SpRs are strong-armed into ‘working a few extra hours’.<br /><br />These vacant posts, all the more risible when thousands of SHOs are unemployed, are a legacy of MTAS and this year’s unnamed successor.<br /><br />Consider two systems, both flawed. Years ago the SHO slaved away for three hundred hours a week, slept once a fortnight, knew all the patients and learnt bucketloads. Now I work a shift system, have an astonishing four handovers a day and there is practically no continuity of care for patients. Surely there is a middle ground?<br /><br />As juniors’ training hours are slashed by the European Working Time Directive, and the time it takes to become a consultant is reduced by the government, we move towards a scenario where tomorrow’s consultants have perhaps a quarter the experience of present-day consultants. Likewise, practical skills suffer.<br /><br />A renal job should mean getting to do loads of central lines. Sure…provided there is no team of specialist nurses inserting all the lines. They’re good at what they do, they’re cheaper than an SHO and don’t move on every four months, so why would a trust want a doctor doing these procedures? This way the number of expensive and troublesome doctors can be cut.<br /><br />A superb plan. Except for the fact that I severely doubt the venous access specialist nurses will be around at 2am when a patient has crashing septic shock and needs a central line. But I will.</span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-51288532476096534052008-03-21T01:33:00.000+00:002008-03-21T01:37:57.311+00:00Suspicious behaviour<span style="font-size:78%;"><span style="font-family:arial;">[via </span><a style="font-family: arial;" href="http://www.boingboing.net/2008/03/04/london-cops-declare.html">BoingBoing</a><span style="font-family:arial;">]</span><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://craphound.com/images/2311166742_7e71c2f9e5.jpg" height="495" width="500" /></span></p><span style="font-size:78%;"><br /><span style="font-family:arial;">When I first saw </span><em style="font-family: arial;">V for Vendetta</em><span style="font-family:arial;"> I was not overly impressed, but enjoyed the dark prediction of where London and the UK are heading. Perhaps we're one step closer. Many of you will have seen the asinine Met Police </span><a style="font-family: arial;" href="http://www.met.police.uk/campaigns/campaign_ct_2008.htm">campaign</a><span style="font-family:arial;"> that suggested we are too stupid to make common sense decisions about people with cameras and that somehow the Police are effective on acting upon tips. I love the fact that one poster alerts you to the dangers of people with more than one mobile phone. I might have to report every single Gujurati I know.</span><br /><br /><span style="font-family:arial;">Here are some responses.</span><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm3.static.flickr.com/2238/2310840095_f241f68ee5.jpg?v=0" height="500" width="405" /></span></p><div style="text-align: center;font-family:arial;"><span style="font-size:78%;">From <a href="http://www.flickr.com/photos/illegalphotos/">illegalphotos</a><br /></span></div><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm4.static.flickr.com/3229/2311540111_9716c06db0.jpg" height="500" width="372" /></span></p><div style="text-align: center;font-family:arial;"><span style="font-size:78%;">From <a href="http://www.flickr.com/photos/rubin110/">Rubin110</a><br /></span></div><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm3.static.flickr.com/2314/2312810016_6b1b442ac4.jpg?v=0" height="500" width="387" /></span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm4.static.flickr.com/3202/2312826998_c54b76ff09.jpg?v=0" height="500" width="373" /></span></p><div style="text-align: center;font-family:arial;"><span style="font-size:78%;">From <a href="http://www.flickr.com/photos/mr_atrocity/">Mr Atrocity</a><br /></span></div><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"> </span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://img85.imageshack.us/img85/4177/cobblerslu0.jpg" height="606" width="450" /></span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm3.static.flickr.com/2063/2312906073_85f22db266.jpg?v=0" height="500" width="500" /></span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"> </span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm4.static.flickr.com/3101/2312229117_d5f3bb86d0.jpg?v=0" /><br /></span></p><p style="text-align: center;font-family:arial;"><span style="font-size:78%;">From <a href="http://www.flickr.com/photos/24405297@N07/">Citizen.Kaned</a><br /></span></p><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"> </span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm3.static.flickr.com/2330/2312332700_5a97b7f5eb_o.jpg" height="510" width="379" /></span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"> </span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://www.ou1.com/bb/photo_fix_it.jpg" height="495" width="500" /></span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"> </span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm4.static.flickr.com/3091/2313651498_4d8739cf96.jpg?v=0" height="500" width="372" /></span></p><div style="text-align: center;font-family:arial;"><span style="font-size:78%;">From <a href="http://www.flickr.com/photos/24437939@N06/">thornae</a><br /></span></div><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"> </span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://www.glyphjockey.com/pix08/londonmeowing.jpg" height="459" width="500" /></span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"> </span></p><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm3.static.flickr.com/2010/2312900753_e65cde440e.jpg?v=0" height="500" width="372" /></span></p><div style="text-align: center;font-family:arial;"><span style="font-size:78%;">From <a href="http://www.flickr.com/photos/24437939@N06/">thornae</a></span></div>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-6246776797458384722008-03-20T22:59:00.001+00:002008-04-20T03:36:37.531+01:00The Renal Angle<span style="font-size:78%;"><span style="font-family:arial;">Originally published in the March issue of </span><a style="font-family: arial;" href="http://medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a><span style="font-family:arial;">.</span><br /><br /><span style="font-weight: bold;font-family:arial;" >I'M</span><span style="font-family:arial;"> desperately trying to avoid writing about the rhino sitting on the elephant riding a unicycle in the room, again. </span><br /><br /><span style="font-family:arial;">You’re bored of my ramblings about jobs, applications, unemployment and emigration. OK you’re bored of more than that. You’re bored of my tangential offal, lazy similes, dull subject matter and self-endulgent banter. But you’re still reading so haha up yours in your face pwned roflcopter lollerskates lmaonade lollercaust lollergeddon!!!!11!!!one </span><br /><br /><span style="font-family:arial;">Hence I will endeavour to side-step my impending joblessness by telling you about the joys of renal medicine. Stop laughing. </span><br /><br /><span style="font-family:arial;">I started this job having been a doctor for sixteen months and the step-up in responsibility was immense. I cover all renal, access surgery, dialysis and transplant patients and much of the time there is no registrar on-call with me. Just me and one of the country’s biggest renal units. Uh oh. </span><br /><br /><span style="font-family:arial;">Getting used to dealing with critically unwell patients is part of being a hospital doctor and after my A&E resus experience I am feeling more confident. However an unexpected duty has been the referrals and calls for advice I have received from several other hospitals and local GPs. </span><br /><br /><span style="font-family:arial;">At first I was apologetic and bumbling when GPs asked basic questions but as my ego grew in stature, I became more confident. Patients may still refer to me as ‘the one who doesn’t look old enough to be a doctor’ but on the other end of the phone my tenor tones could be anyone. </span><br /><br /><span style="font-family:arial;">Recently I took a call from a teaching hospital, where an A&E SHO had seen a dialysis patient and wanted to arrange a transfer as he was ‘due dialysis’. It transpired he was septic and far too unstable to transfer, so I was surprised this doctor hadn’t sent him to ITU. Secondly, when I asked if he needed to be dialysed, she had no idea how one would decide this. </span><br /><br /><span style="font-family:arial;">I walked her through the basics of fluid assessment and electrolyte control, much as I do with third year medical students. It was only when she gave me her name at the end did we both realise she had been an SHO at my previous hospital, several years above me and signing my DOPS. </span><br /><br /><span style="font-family:arial;">Roles do often reverse when rotating around medical specialties. From the A&E grunt making the referrals, I am now taking them. I fight my natural tendencies and try not to be an arse, as I know how unpleasant referring to a dickhead is. </span><br /><br /><span style="font-family:arial;">I don’t mind being called by house officers - I remember what it was like and I remember not needing to study much nephrology to pass finals. So I try to emulate the specialists I’ve enjoyed talking to and take time to explain renal physiology or the concepts of dialysis. </span><br /><br /><span style="font-family:arial;">However when a surgeon calls, I have a little fun. Like the cardiothoracic consultant who asked his SHO to call me due to a rising creatinine. I suggested perhaps the new prescription of trimethoprim and the gentamicin level of 29 (aim <10)><br /><br /><span style="font-family:arial;">“Is the renal function normal?”</span><br /><span style="font-family:arial;">“Yes.”</span><br /><span style="font-family:arial;">“So it sounds like a urology problem, not a renal one.”</span><br /><span style="font-family:arial;">“But it’s renal colic.”</span><br /><span style="font-family:arial;">“No, it’s urology colic.” </span><br /><br /><span style="font-family:arial;">A big poster at work tells me to ‘Save a Life, Give Blood’. Right on. Clearly some people think this is a cop-out. In light of the recent kidney-harvesting ring rumbled in India, I discovered a phenomenon I had never previously known about. </span><br /><br /><span style="font-family:arial;">Donating a kidney is amazing. Doing this for a loved one is understandable, but I was immensely impressed when I first met a guy who was giving a childhood friend his right kidney. Yet nothing prepared me for the ‘altruistic donor’. </span><br /><br /><span style="font-family:arial;">This is normally a man (in my experience) who wakes up one day and thinks “you know, I have too many kidneys”. He decides to undergo general anaesthesia and have half his piss-making equipment chopped out - for someone he will never meet. It’s quite astonishing - even a curmudgeonly git like me can be impressed by truly generous people, however loonie I think they are.</span></span></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-74450041069575431112008-02-01T18:33:00.000+00:002008-03-19T18:48:27.262+00:00The bastard son of MTAS<span style=";font-family:arial;font-size:78%;" >Originally published in the February issue of <a style="font-style: italic;" href="http://www.medical-student.co.uk/">Medical Student Newspaper</a>.<br /><br /><span style="font-weight: bold;">GOOD</span> morning my friend! A warm good morning to you all. I love you, faithful readers, I love you with all my heart. But sadly I wish to commit heinous murder upon you at this present juncture in time, and indeed upon anyone that gits in mah way cos I is mad.<br /><br />What, you might ask, has made such a normally cheery (I can be cheery) soul like me so irate? Did that A&E job finally make me crack? On the contrary, I finished it since I last saw you and have moved onto renal and transplant medicine. Wonderful wonderful.<br /><br />Was it a bothersome patient what yanked my crank? No, I have been tolerating humans quite well recently. Is it the fact that my girlfriend’s Mum is staying with her for a month? Yes you’re quite astute, that’s probably not helping BUT it ain’t the root cause.<br /><br />You’ve guessed it – job applications. I have brought you MMC news from the coalface over these last sixteen months, but at no point have I ever felt so low. Sure I’ll be cracking jokes in this piece, but secretly (and by writing this here, not secretly) I want to end my life. And I haven’t forgotten about murdering you either.<br /><br />So what’s the dilly-yo? In a nutshell, for those shitbricks that haven’t been paying attention for twelve months, in 2007 the government unleashed its full wrath upon those lazy doctors and made tens of thousands jobless. 28,000 doctors applied for 15,500 jobs.<br /><br />They did this by installing a woeful new application system, reducing the number of training posts despite record numbers of new graduates and not accounting for the many overseas doctors that work here but inviting a lot more in.<br /><br />Thousands of junior doctors, many of whom are my friends, left the country. No one outside the rank of SHO seems that annoyed, so please do tell non-medics why they should be. Each of these doctors cost a quarter of a million pounds of taxpayers’ money to train. We, as a nation, have just let hundreds of millions walk out of the door. Australia, New Zealand and Canada’s gain is our huge loss.<br /><br />I never thought I was the ‘leaving kind’. I love London and want to stay. That could be my downfall.<br /><br />This year, it is worse. We were reassured but I think we all knew this to be false. However, last year we were provided with some ammunition. The Tooke Report, detailed in previous issues of this newspaper, made two key assertions. First, that government involvement with the training of junior doctors must stop. This has not transpired. Secondly, that the European Working Time Directive (which I recall being my first cover story as editor in 2004) is detrimental to junior doctors’ training by preventing sufficient hours learning on the job.<br /><br />Reasons things will be worse this year include: many of the jobless SHOs from last year will be competing with this year’s glut for the same finite amount of jobs (in fact less, as much of the run-through allocation is filled). A recent ruling means that British-trained doctors are given no preference to overseas doctors when allocating jobs.<br /><br />Overall, an estimated 22,000 applicants will compete for 9,000 jobs. Friends in other professional disciplines often seem confused as to why this is a problem. “Competition is healthy” they say, echoing what the government has been trying to dupe patients with. The key point is that in the UK, doctors can only train in the NHS, there is no alternative as there would be in a bank or law firm.<br /><br />Continuing on from this analogy, consider my story, which I fear will be typical.<br /><br />Today I received an email from Oxford Deanery, telling me I have been invited for interview in six days. I have heard, from an unsubstantiated source, that about five hundred applications for Core Medical Training were received by Oxford. They have 27 jobs to give away. So I am delighted I have been granted an interview.<br /><br />But I have applied to both London and Kent, Surrey and Sussex because I, like a vast swathe of my colleagues, have been scared shitless by what happened last year. I have tried not to hedge my bets and end up jobless.<br /><br />Let’s imagine I do well in the interview (you need a fertile imagination) and am offered a post. At this point I know none of the following: which hospital(s) I will be working in, my pay, my rota nor what firms I will be doing. Yet I have 48 hours and nor more to accept. If I don’t reply, I am assumed to have rejected the offer.<br /><br />If I accept, I have to withdraw from all other Deaneries. The only problem is, London make their offers two and a half months after Oxford. So if I decide I want to wait it our for London – and then get offered nothing, I will have thrown away a job. Or if I hold out for London and get given a job I don’t want, I would rather have stayed with Oxford.<br /><br />Taking our comparison back to banking or law, which companies do you know that would make a job offer with no details about the job whatsoever? Which industries can you think of where the boss doesn’t choose his own staff? And although some jobs make you move around the country, which gives a few weeks’ notice as to location, forcing the employee to sell, buy and move houses in a month?<br /><br />Lastly, see if you know any banks or consultancies that would send this message to its employees. My ultimate boss, the government, sent all junior doctors a letter in January. It essentially said “don’t apply for anything competitive, you probably won’t get it. Don’t turn down any job applications, you will be lucky to even get one. Don’t be upset if you end up doing something you didn’t apply for, you should be thankful you’re employed.”<br /><br />It amounted to: Aim Low. No fucking way any City firm says that to its employees. We’re being grown as a generation of ‘just passable’ docs. MMC engenders a culture of striving for mediocrity.<br /><br />As I said before, I love London with all my heart. I want to make my life here. But in the last few weeks I have done some deep thinking. I had a hot bath recently – where I do my best thinking – and asked myself one question, “do I want to be a doctor?” I had toyed with the idea of leaving. Friends enquired at banks and they want to start me on £80-100,000p.a. But I realised I like being a doctor. It’s what I’m best at and I want to do it. This was a relief as I had started to have doubts.<br /><br />The second question I asked myself was, “do I want to be a doctor in the UK?” I now know that without drastic change of far more than just the subject of this article – nurse quacktitioners, paltry consultant opportunities and the media’s attitude to us – I cannot stay here. The system has broken me.<br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-15083747454335386402007-11-05T03:06:00.001+00:002008-04-20T02:10:18.216+01:00All Hallow's A&E<p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;">Originally published in the November issue of <a href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a>.</span></p><p face="arial" style="text-align: center; font-family: arial;" class="MsoNormal"> <img src="http://www.costumeshopper.com/Merchant2/graphics/00000001/59657.jpg" /><br /></p><div style="text-align: justify; font-family: arial;"> </div><p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><o:p></o:p></span></p><div style="text-align: justify; font-family: arial;"> </div><p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><span style="font-weight: bold;">IT’S HALLOWE’EN</span> in A&E. I start my shift at <st1:time minute="0" hour="22">10pm</st1:time> with a few minutes’ grace to read some emails. A study in <i>The Lancet</i> examined romances in medical dramas and found a “marked preponderance of brilliant, tall, muscular, male doctors with chiselled features, working in emergency medicine”.<br /><br />Two out of six. As I can’t really take any credit for being male, I better try to enjoy my last month ‘working in emergency medicine’, which won’t be easy.<br /><br />My first patient is what we politely refer to as a complete loon. I’ll call her Agnes and she’s visiting us from the local psychiatric hospital. Agnes has been sectioned for some time (don’t ask me what number) and hates the psychiatric ward she is on. It quickly becomes clear she is fabricating a story to get out of her ward. The psychiatrist must have seen her, realised he knows nothing about medicine and sent her to A&E.<br /><br />It is, however, a little difficult to understand her as she has two Nicorette inhalers in her mouth. Not to mention the five Nicorette patches on her abdomen, her brown sunglasses, orange hair, five overcoats and two scarves.</span></p><div style="text-align: justify; font-family: arial;"> </div><p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;">Her sense of humour seems to be intact though:<br /><br /><span style="color: rgb(153, 0, 0);"> “Doc, I’m telling you now, if you send me back there I will kill myself.”</span><o:p style="color: rgb(153, 0, 0);"></o:p><br /><span style="color: rgb(153, 0, 0);"> “Well that’s convenient,” I replied, “because when people want to kill themselves we send them to psychiatric hospital.”</span><o:p style="color: rgb(153, 0, 0);"></o:p><br /><span style="color: rgb(153, 0, 0);"> “In that case I don’t want to kill myself, I want to live!”</span><br /><br />I’m rather in the mood for seeing some ghouls and ghosties tonight, and head to Minors in the hope of stitching up a pitchfork-laceration or vampire bite. I’m collared on the way by sister saying two are waiting in Resus.<br /><br />I generally like working in Resus. You see, the overriding gripe I have about A&E is time-wasters. I have to resist slapping jackasses with nothing better to do with their time than ignore the sign saying “Accident and Emergency” and waltz in with problems they’ve had for years. But Resus patients (normally) aren’t faking it.<br /><br />We’re short-staffed and I end up seeing two patients simultaneously. This is not only dangerous, it’s confusing. Luckily (for me, not them) they had almost identical problems (chest infections and fast AF) and pretty similar names, so I just said everything twice.<br /><br />There’s no chance of me getting to Minors to see any pumpkin-heads after I’m finished with the two old boys in Resus, as “people are breaching in Majors.” Nurses always shout this at me under the impression I’m going to care.<br /><br />A guy who felt his throat was closed for a minute, but is fine now. A girl who had chest pain but thinks it was wind. Then a bad-tempered Francophone jobseeker who broke his foot and was put in a cast two days ago, has a fracture clinic appointment in the morning and saw his GP two hours before coming to A&E. I explained broken feet do normally hurt, but he wasn’t satisfied.<br /><br />In fact he turned out to be a real prick and I had to threaten to call security, in French, before he left. Not before shouting in Franglais:<o:p></o:p></span></p><div style="text-align: justify; font-family: arial;"> </div><p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><span style="color: rgb(153, 0, 0);">“Where you from? How old you? You’re too yang bro! Je veut un autre médecin. Na, na, you got a long way to go.”</span><br /><br />Whilst he was undeniably a tosser, he was probably right.<br /><br />Where are those damn vampires? A frikking zombie at least, please Satan brighten my evening with something macabre.<br /><br />The three others doctors on duty and myself wade through nursing home specials, neurotic parents, drunkards, asthmatics and more chest and abdo pains than you can shake a steth at.<br /><br /><st1:time minute="0" hour="6">6 o’clock</st1:time> in the AM rolls around and I realise no fluid has entered or exited my body all night. I decide this is a perfect opportunity to dipstick my own urine, which is so dark it absorbs all light in the bathroom and I piss on my scrubs.<br /><br />2+ protein, 1+ blood, 1+ ketones. Ketones? I wonder what my blood glucose is? 2.9! Sweet, a new record. I mean, I think I’m going to faint. I rush dinner having wasted half my break investigating myself.<br /><br />Back on the shop floor and I pick up the next card. “Limb problems” is the non-specific triage category and at last it’s a bunch of piss-artists in fancy dress. w00t!<br /><br />My patient is not only dressed as an axe-wielding blood-soaked doctor, she’s an absolute hottie (I only mean that in a purely Hippocratical way).</span></p><p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;">Good-natured drunks are always fun so I act the part. Whilst taking a history I point to her friend in vampire garb and ask, “he with you?” and then examine her neck.</span></p><div style="text-align: justify; font-family: arial;"> </div><p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;"><span style="color: rgb(153, 0, 0);">"What are you doing?" <span style="color: rgb(0, 0, 0);">asks the friend.</span></span><br /><span style="color: rgb(153, 0, 0);"> "I need to know if she’s turned."</span></span></p><div style="text-align: justify; font-family: arial;"> </div><p style="text-align: justify;font-family:arial;" class="MsoNormal"><span style="font-size:78%;">So she clearly has a thing for doctors and I will be spending the next half hour with her in a small room sewing up her elbow. I silently offer thanks to the Prince of Darkness as my mind turns back to that <span style="font-style: italic;">Lancet</span> article.<br /><br />However as she’s face-down for the stitching, I (tragically) spend most of the time talking to her friend, who wants to become a doctor. I give him half-mumbled answers as I get so engrossed in trying a fancy mattress-running suture combination on this hapless girl’s elbow.<br /><br />When I’m done she bounds off without so much as a “thank you doctor, you saved my life” and an unexpected kiss on the lips, or a “how can I ever repay you?” and a lingering kiss on the cheek or even a “call me!” and an airkiss. In fact there was a distinct lack of kissing.<br /><br />Somewhat confused as to how I could POSSIBLY have been turned down, I remembered I was lacking in brilliance, height, muscles and chiselled features. Soon I would lose my job title of emergency doctor as well. I mulled it over and decided I would rather undergo extensive leg-lengthening surgery than take another A&E job.<br /><br />I finally allowed the chatter of friend-who-wants-to-be-doctor through and in an unusual display of paternalism, I put a hand on his shoulder and said “son, don’t do it.”<br /><br />My shift would be up soon and I could grab a Rosie Lee’s Full English on my way home. Working nights eliminates your ability to do anything, so I’ll get back to working on my serum and saving the world from vampires next week. Right now, I’m just the daysleeper.<o:p></o:p></span></p>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-86792506269012313822007-10-15T17:05:00.000+01:002007-10-15T18:09:05.125+01:00Quack<span style="font-weight: bold;font-family:arial;font-size:78%;" >THE</span><span style=";font-family:arial;font-size:78%;" > geniuses behind <a href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a> have produced some essential reading for all final year medics in the UK, in conjunction with <a href="http://www.doctors.net.uk/">doctors.net.uk</a>. </span><span style="font-style: italic; font-weight: bold;font-family:arial;font-size:78%;" >Quack</span><span style=";font-family:arial;font-size:78%;" > contains all the knowledge one needs to apply for a Foundation post and more. Join the <a href="http://sgul.facebook.com/group.php?gid=5606941621&ref=mf">Facebook group</a>.<br /><br />My contributions included updated versions of <a href="http://dailyrhino.blogspot.com/2006/01/hows-it-hanging.html">stethoscope psychology</a>, <a href="http://dailyrhino.blogspot.com/2006/06/revision-it-brings-death.html">depraved revision</a>, <a href="http://dailyrhino.blogspot.com/2007/05/beginners-guide-to-mtas-fiasco.html">a breakdown of the MTAS saga</a> and the WISE words below.<br /><br />By the way, </span><span style="font-style: italic;font-family:arial;font-size:78%;" >Medical Student Newspaper</span><span style=";font-family:arial;font-size:78%;" > has won yet another award nomination. It is in the running for the Best Student Newspaper in the country at this year's <a href="http://media.guardian.co.uk/studentmediaawards">Guardian Student Media Awards</a>. Every year since the paper's inception has brought some silverware; fingers crossed.<br /><br /><br /><br /><span style="font-size:180%;"><span style="font-weight: bold; color: rgb(153, 0, 0);">How to be the coolest, most pimped-out, badass FY1 at your hospital</span></span><br /><span style="font-style: italic;">What you need to know as a first year doc and what you haven’t been told</span><br /><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm3.static.flickr.com/2271/1578738015_ba8c3e9bb4_o.jpg" alt="ALS Algorithm" height="688" width="550" /><br /></span></div><span style=";font-family:arial;font-size:78%;" ><br /><span style="font-weight: bold;">The most up-to-date Advanced Life Support (ALS) algorithm. Use this at any stage during your Foundation Years; acutely unwell patients will be a common encounter and you should feel confident in determining whether a patient is cool or whether they need your help. If unsure, feel free to ask “are you cool?” Don’t be afraid to tell your patients to BE COOL.</span><br /><br /><br /></span> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;"><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">There is no one way to be a good FY1, or house officer, as you will still find yourself referred to. However there are certain hints and tips that can be imparted by those that made it through. Intact. Unscathed. Ready to fight another day. ONWARD!<br /><br />First and foremost, your first year as a doctor should be about enjoying yourself. Never forget this. There are many similarities to life at medical school; you will probably live in halls, go out too much and make lots of new friends. The only real differences are that you can’t bunk off anymore, but you do get paid.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">The single greatest fear of a new doctor is that they will do some harm to a patient. This, whilst not impossible, is improbable. The reason being that you have spent four to six years learning how to do the opposite.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">You are so imbued with misplaced self-doubt when you start working that you end up being over cautious. This is normal. Don’t worry about making mistakes, just concentrate on enjoying yourself and the rest will flow.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">Perhaps the one gem of information I wish I had been given before I started was that you did not need to be top of the class at medical school to succeed in your first year of work.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">In fact, where you ranked has no correlation whatsoever to how you will perform and you should put it out of your mind entirely.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">If the comparison of FY1 to medical school can be extended, then the first week is Freshers’. With most junior medical staff now starting at the beginning of August every year, the hospital will be atwitter with introductions and nice-to-meet-yous when you start.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">The first few days are rarely taxing. They normally consist of induction talks, orientation sessions and a gradual easing into the job.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">You might turn out to be one of the unlucky punters that kicks off work with an on-call. Daunting it may be, but on-calls are fantastic learning opportunities. Asking for help is something you should never be afraid of doing in your first year. People will fully expect you to ask the most inane of questions, even if you feel like an idiot. Get over that embarrassment and ask – better that than goofing up something easy.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">There is also no shortage of people to ask. Obviously your immediate seniors are a logical first step, but the resource you will invariably draw upon throughout your junior years is the nursing staff. If you take one piece of advice away from this article, make it this: be nice to nurses.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">Nurses can make your life so much easier if you acknowledge their existence and value their contribution, and they can equally give you grief if you piss them off.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">Nurses, like anyone else, don’t like being talked down to by snooty doctors. If you’re not sure what fluids to write up, or what the dose of metoclopramide is, asking a nurse is a good first move.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">Having said that, nurses go through a learning process too and might be just as green as you. If you’re unsure about any advice given, there’s no harm getting a second opinion. You will find that the ability to know what is duff advice and what is good sense develops quickly and naturally.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">A further word about those nurses. Most FY1s will be ward-based and whilst it is useful to be nice to nurses on-call, it is imperative to establish good relationships with the nurses on your own ward. They can be inordinately helpful if you’re mates. Not to mention that if you can have a laugh with the nurses, social workers, ward clerks, physios, OTs, HCAs or medical support workers on your ward, your job will all the more fun.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">This provides a convenient segue onto what is likely to be the bane of your life during the Foundation Programme. Assessments. You thought tick-boxes and form-filling ended with graduation. I laugh at your foolishness.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">Working well with those around you will stand you in very good stead for a key part of your overall assessment, the min-ePAT. Out of all the nonsense you are forced to complete in your first year, this is a very useful exercise.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">On two occasions you are required to nominate twelve co-workers, of whom only a limited amount can be doctors, to anonymously say what they think about you. As you can imagine, the ability to be frank allows your colleagues to give you what can frequently turn out to be valuable advice.</span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">All that need be said about the rest of your assessments is that the sooner you get them out of the way, the better. Try not to leave yourself a week to get all the forms filled in, it is no fun.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">To reiterate, it is imperative you concentrate on having fun in your first year. It comes only once and just about every doctor you meet looks back on their house officer year with great nostalgia and fondness. No amount of hints and tips from seniors will replace your learning-by-doing, so try not to be wallflower.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">If something that interests you is happening, be it inserting a central line or an appendicectomy, try to get involved. Be in the right place at the right time, but don’t be a dick – share out opportunities with friends.<o:p></o:p><br /><br />Developing confidence comes far more easily to some than others, but ultimately the only occasion it matters is when a patient’s health is in question. If you are seeing someone in A&E or on the ward and you are unhappy about something, never worry about ‘bothering’ your seniors. Whilst it may be surprising to some, no one will criticise a new doctor for being too safe.<o:p></o:p><br /><br />Lastly, if you are one of those keen young things that wants his or her name in lights, your first step would be to leave medicine. However if you want to stay, you might want to consider getting involved with an audit, a presentation or two (most hospitals expect a Grand Round presentation from all the juniors) and if you’re extra ambitious, a publication.<o:p></o:p><br /><br />Having said all that, none of these are necessities. The only compulsory objectives for an FY1 are consolidating your medical knowledge (it’s up there somewhere, even if it doesn’t feel like it), seeing patients, getting organised, using your hands, extra-curricular high jinx and wild japes. These are integral to being a good doctor. Good luck and get ready to work like a HO.</span></p><span style=";font-family:arial;font-size:78%;" ><br /></span><p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;">Originally published in <span style="font-style: italic;"><a href="http://sgul.facebook.com/group.php?gid=5606941621">Quack: Foundation School Guide</a>.</span></span></p><p class="MsoNormal" style="font-family:arial;"><span style="font-size:78%;"><span style="font-style: italic;"><span style="font-style: italic;"><span style="font-style: italic;"></span></span></span>Diagram inspired by <a href="http://www.resus.org.uk/pages/als.pdf">ALS guidelines</a> and a flowchart from <a href="http://www.amazon.com/Antarctica-Kim-Stanley-Robinson/dp/0553574027/ref=sr_1_1/103-1816347-6520643?ie=UTF8&s=books&qid=1192467647&sr=1-1"><span style="font-style: italic;">Antarctica</span></a>, by Kim Stanley Robinson.<br /></span></p> <span style=";font-family:arial;font-size:78%;" ><br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-31190942013149034682007-10-15T16:33:00.001+01:002008-04-20T03:36:53.572+01:00Four hours to drama<span style=";font-family:arial;font-size:78%;" >My regular column in </span><span style=";font-family:arial;font-size:78%;" ><a style="font-style: italic;" href="http://www.medical-student.co.uk/">Medical Student Newspaper</a></span><span style=";font-family:arial;font-size:78%;" > has been reprised this academic year. This year it is, of course, 'F2. Woohoo.' Originally published in the October issue,<br /><br /><br /><span style="font-weight: bold;">I’M CANCEROUS</span>. Yes that’s right, I’m back for a fourth year running. This year, I come to you from the dizzy heights of the most superlative foundation doctor there is, THE MIGHTY F2.<br /><br />A new generation of fresh-faced F1s replaced me and all my ilk. Now I’m supposed to know shit, you know, and stuff.<br /><br />A&E’s a funny place to work. Over 90% of you will spend four months ‘on the medical front line’ as I am now. Unless you choose to pursue this field (ya crazy fool), your A&E rotation will be the job that brings you more excitement, boredom and frustration than any other. Mostly frustration.<br /><br />No longer is the emphasis based on diagnosis, which is what draws so many into medicine, but on exclusion. Can you send this healthy 30 year-old chap home...are you SURE he hasn’t had an MI? Let’s refer him to the medics for a twelve-hour trop and take up a hospital bed just in case. It’s mind-numbingly un-stimulating at times.<br /><br />There are many positives about working in A&E. Exposure to a wide range of problems, dealing with genuine emergencies, seeing instant results. My particular hospital has four great consultants and as St. George’s is a Centre of Excellence for countless specialties, I see some crazee sheeyrt.<br /><br />However the one overwhelming negative is that <span style="font-style: italic;">it is A&E</span>. There is no area of medicine that has been toyed with by the government as much as the emergency department.<br /><br />Because waiting times are so easy to quantify and brag about before an election, A&E is a convenient place to pull numbers from. It is also one of two first points of contact for patients. The other is, of course, general practice, which has been tinkered with almost as much, chiefly to the detriment of A&E departments.<br /><br /></span><div style="text-align: center;"><span style=";font-family:arial;font-size:78%;" ><img src="http://www.cartoonstock.com/lowres/sbo0353l.jpg" /></span><br /></div><span style=";font-family:arial;font-size:78%;" ><br />The ridiculous lack of sufficient out-of-hours GP provision, NHS dentists, the creation of stop-gaps like NHS Direct and obscene waits for GP appointments mean we are inundated with complaints that are neither accidents nor emergencies.<br /><br />Yet each person that attends A&E has to be seen, diagnosed, treated and moved out of the department in four hours.<br /><br />As all five <span style="font-style: italic;">Rohinplasty </span>readers will know (it’s going up), I am obsessed with a solid evidence base. I use that as a chat up line sometimes. Anyway, one would like to think that those responsible for these four hours used all the available data to construct a sophisticated model of a working A&E and thus extrapolated a suitable figure.<br /><br />The truth is probably more along the lines of pin-the-tail-on-the-number, with an arbitrary figure being plucked from the air.<br /><br />The reality is a shambles. Of course no standard duration can be applied to A&E patients, as there is no one type of A&E patient. Some are out within ten minutes but some need several hours.<br /><br /></span><div style="text-align: center;"><span style=";font-family:arial;font-size:78%;" ><img src="http://www.cartoonstock.com/newscartoons/cartoonists/sda/lowres/sdan76l.jpg" /></span><br /></div><span style=";font-family:arial;font-size:78%;" ><br />A far more sensible system, as I’m sure an honest government would concede, would consist of clinicians deciding how long each patient needed to be safely dealt with.<br /><br />However politicians make decisions, not doctors, so that ‘four hour waits’ can be political weapons.<br /><br />Only 2% of patients are allowed to ‘breach’.<br /><br />I figured, like many others, a cavalier attitude was the way forward and thought I would ignore breaches and put the patient first. The NHS doesn’t work that way.<br /><br />Unwell patients often need to stay in A&E until they are stable enough to be transferred. Pissheads need to sober up before they go.<br /><br />The Medical Assessment Unit, or MAU, that most of you will be familiar with by now, owes its existence to the four-hour-wait. MAUs were created to stop the clock. The vast majority of patients admitted to a hospital come under the care of the general physicians. Hence all medical patients now go to MAUs where there is no timer.<br /><br />There is no guarantee they will be adequately treated by the time they arrive there and there is no guarantee they will be seen by the doctors looking after them, hence negating the entire reason for the four hour rule.<br /><br />I must be careful with what I say about my employer, so suffice it to say that unfortunately cooking the books MAY OR MAY NOT OCCUR at SOME hospitals around the country. Will that sound sufficiently vague in court?<br /><br />Picture the scene. A patient needs a urine dipstick to make a diagnosis of a UTI. However a nurse is off sick and the nursing staff is over-stretched. No one gets the urine sample. The patient breaches. If this breach were recorded perhaps management would see that missing nurse’s value.<br /><br />However if the number of breaches is the same as on any other night, the hospital realises she’s unnecessary and sacks her. They congratulate each other on more money saved. The system is broken, nothing changes.<br /><br /></span><div style="text-align: center;"><span style=";font-family:arial;font-size:78%;" ><img src="http://www.bbc.co.uk/wiltshire/features/images/gwh_a_and_e.jpg" /></span><br /></div><span style=";font-family:arial;font-size:78%;" ><br />We have some bizarre A&E mentality now that stipulates the customer is always right. But the patient is rarely first.<br /><br />Nurses will drive you slowly mad with a phrase you will quickly grow tired of, “come on, your patient’s about to breach.” I normally cave.<br /><br /><br />Title reference to <a style="font-style: italic;" href="http://www.amazon.co.uk/Nine-Hours-Rama-Stanley-Wolpert/dp/9997410440">Nine Hours to Rama</a>.<br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-34249354555604885232007-08-15T21:18:00.000+01:002007-08-16T01:41:57.233+01:00"A new star rises" - Part Two<span style=";font-family:arial;font-size:78%;" ><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm1.static.flickr.com/89/238749679_7b7de436a5.jpg?v=0" height="439" width="500" /></span></p><span style=";font-family:arial;font-size:78%;" ><br /><span style="font-weight: bold;">SIXTY</span> years of a free <st1></st1><st1>India</st1> have passed. Where is it now?<br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;"><strong>"We have hard work ahead"</strong></span></blockquote><span style=";font-family:arial;font-size:78%;" ><br />Amartya Sen, a man who has watched <st1></st1><st1>India</st1> change over this time, divided an assessment of <st1></st1><st1>India</st1>'s progress since <st1></st1><st1>Independence</st1> into three categories. First, the practice of democracy, second the removal of social inequality and backwardness and lastly the achievement of economic progress and equity.<o></o><br /><br />He wrote this on the 50th anniversary of Indian independence and essentially concluded whilst democracy was intact in <st1></st1><st1>India</st1>, it was failing on the second count. India's economy, of which we hear so much today, was beginning to gather pace in 1997, but it is surprising that the monumental leaps and bounds the GDP and purchasing power have made occurred in only the last decade.<o></o><br /><br />Sunny Hundal, another famous thinker, <a href="http://www.pickledpolitics.com/archives/1315#comment-76330">said</a> in response to <a href="http://www.pickledpolitics.com/archives/1315">Part One</a> that "religious minorities in <st1></st1><st1>India</st1> snort in derision when <st1></st1><st1>India</st1> is declared as a democracy." Well, they may scoff all they like, but the democracy central to Gandhi and Nehru's aspirations for <st1></st1><st1>India</st1> is standing tall.<br /><br />Take the example of <st1></st1><st1>India</st1>'s <st1></st1><st1>Texas</st1>. Uttar Pradesh is the biggest, most powerful and most backward state (excepting <st1>Bihar</st1>). It has produced eight Indian prime ministers and has a population larger than <st1></st1><st1>Pakistan</st1>.<o></o><br /><br />For the best part of twenty years, UP had been ruled by coalitions, most recently dominated by the BJP and the Samajwadi Party. Despite the majority of UP residents being woefully uneducated, the voters turned out in force earlier this year and swept one party, the once insignificant Bahujan Samaj, into power with an absolute majority.<o></o><br /><br />The socialist-leaning party was created in 1984 to empower the dalits (untouchables) but campaigned on a platform of social justice which transcended caste and class. UPians, sick of politicians exploiting caste divides, replaced the old with the new.<br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;"><strong>"To build up a prosperous, democratic and progressive nation"</strong></span></blockquote><span style=";font-family:arial;font-size:78%;" ><br />Indian democracy's downfall has oft been predicted, at no point more assuredly than when Indira Gandhi declared a state of emergency in 1975. As dissenting voices rose, the government took steps to quash any opposition. Sanjay engineered a forced sterilisation programme and brutally cleared the slums surrounding <st1></st1><st1>Delhi</st1>'s Jama Masjid. Political dissenters were arrested and tortured.<o></o><br /><br />Ultimately, Gandhi's contravention against the Indian belief of freedom of the press was her downfall. By censoring newspapers she astonishingly misjudged her popularity and when elections were called in 1977, the Janata Party washed her out of power. Good came from the unfortunate episode, the electorate had spoken.<br /><br />Democracy, viewed by much of the world as Western hegemony, is alive (but not necessarily well) in <st1></st1><st1>India</st1>. Parties have won votes and come into power. They have lost and stepped aside. The press is free to criticise.<o></o><br /><br />However a liberal democracy alone does not a successful country make. Corruption continues to pervade every aspect of Indian society (the fairytale story in UP is somewhat spoiled by corruption allegations surrounding the leader of the BSP) and will continue to do so for the foreseeable future.<br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;"><strong>"The ending of poverty and ignorance and disease and inequality of opportunity"</strong></span></blockquote><span style=";font-family:arial;font-size:78%;" ><br />Some figures.<br /><br /></span> <table class="MsoTableGrid" style="border: medium none ; border-collapse: collapse;font-family:arial;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 213.05pt;" valign="top" width="284"> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;"><st1:country-region><st1:place>India</st1:place></st1:country-region><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Population growth rate 1.6%<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Median age 24.8<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Life expectancy 68.6<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">GDP growth rate 9.2%<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">GDP per capita $3800<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Literacy: 61%<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">(male 73.4%, female 47.8%)<o:p></o:p></span></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; width: 213.05pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="284"> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;"><st1:country-region><st1:place>China</st1:place></st1:country-region><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Population growth rate 0.6%<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Median age 33.2<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Life expectancy 72.9<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">GDP growth rate 10.7%<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">GDP per capita $7,700<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">Literacy: 90.9%<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style="font-size:78%;">(male 95%, female 86.5%)<o:p></o:p></span></p> </td> </tr> </tbody></table> <span style="font-size:78%;"><br /><br /></span><span style=";font-family:arial;font-size:78%;" >The statistic that leaps from that table is </span><span style="font-size:78%;"><st1 style="font-family: arial;"></st1><st1 style="font-family: arial;">China</st1></span><span style=";font-family:arial;font-size:78%;" >'s literacy rate. The two Asian powerhouses have a healthy economic rivalry, but </span><span style="font-size:78%;"><st1 style="font-family: arial;"></st1><st1 style="font-family: arial;">China</st1></span><span style=";font-family:arial;font-size:78%;" >'s overall education rate leaves </span><span style="font-size:78%;"><st1 style="font-family: arial;"></st1><st1 style="font-family: arial;">India</st1></span><span style=";font-family:arial;font-size:78%;" >'s in the dust. The number of university graduates in </span><span style="font-size:78%;"><st1 style="font-family: arial;"></st1><st1 style="font-family: arial;">India</st1></span><span style=";font-family:arial;font-size:78%;" > conversely dwarves the number in </span><span style="font-size:78%;"><st1 style="font-family: arial;"></st1><st1 style="font-family: arial;">China</st1></span><span style=";font-family:arial;font-size:78%;" >, but inequality abounds. Kerala's life expectancy and literacy surpass </span><span style="font-size:78%;"><st1 style="font-family: arial;"></st1><st1 style="font-family: arial;">China</st1></span><span style=";font-family:arial;font-size:78%;" >'s, </span><span style="font-size:78%;"><st1 style="font-family: arial;">Bihar</st1></span><span style=";font-family:arial;font-size:78%;" >'s rank lower than </span><span style="font-size:78%;"><st1 style="font-family: arial;"></st1><st1 style="font-family: arial;">Bangladesh</st1></span><span style=";font-family:arial;font-size:78%;" >.</span><span style="font-size:78%;"><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm1.static.flickr.com/95/222141960_03c444885f.jpg?v=0" height="375" width="500" /></span></p><span style=";font-family:arial;font-size:78%;" ><br />Today Manmohan Singh said his country will not be truly free until poverty is eradicated. This will not happen for many years. He pledged to put an end to malnutrition by 2012. Whilst this too seems like fanciful thinking, for the first time in most Indian's living memory, there is a genuine belief good things will happen.<o></o><br /><br /><st1></st1><st1>China</st1> is not a democracy. But it has succeeded in spreading the wealth to a greater extent than <st1></st1><st1>India</st1>. Indian commentators may seize upon the fact that <st1></st1><st1>China</st1>'s growth has created millions of disenfranchised migrant workers and peasants, but poverty (which was on a similar scale to <st1></st1><st1>India</st1> in the first half of the last century) has been combated far more effectively. Why?<o></o><br /><br /><st1></st1><st1>China</st1> is a global heavyweight in exporting manufactured goods. Whilst <st1></st1><st1>India</st1> exports IT and scientific expertise, much of <st1></st1><st1>China</st1>'s overseas business relies on 'unskilled' labour. Unskilled, but not unschooled. Chinese industry employs tens of millions - literate, schooled workers but not university graduates.<o></o><br /><br /><st1></st1><st1>India</st1>'s higher education establishments have gained deserved worldwide accolade, but studying at IIT or IIM is a dream achieved by a tiny minority in <st1></st1><st1>India</st1>. Emphasis needs to be placed upon improving <st1></st1><st1>India</st1>'s schools. If one examines the syllabus at a typical secondary school in rural <st1></st1><st1>India</st1>, it is truly shocking to see how far ahead Indian schoolchildren are than their Western peers. Or rather, it's depressing to see how <st1></st1><st1>Britain</st1>'s schools have dumbed down.<br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1246/1085377539_0c037cdbc8.jpg?v=1186911270" /></span></p><span style=";font-family:arial;font-size:78%;" ><br />Yet these schools are under-funded and in a state of disrepair. Without a basic level of education, a wider interaction with <st1></st1><st1>India</st1>'s economic success story will not be possible. The 'trickle-down' effect will take too long and much of <st1></st1><st1>India</st1>'s poor will never receive so much as a drop without a concerted effort to equalise the wealth.<o></o><br /><br />It has been demonstrated that <st1></st1><st1>China</st1> can enjoy the same - if not more - success without the joys of democracy, so should its perseverance in <st1></st1><st1>India</st1> continue to be a thing of pride? Democracy, at a basic level, acts as a safety check. Leaders have to act decisively in times of crisis, or risk falling from grace. Returning to Amartya Sen, he achieved fame many years ago by reasoning that famines were a political product, not an agricultural one.<o></o><br /><br /><st1></st1><st1>India</st1>, previously ravaged by famines, has not suffered one since <st1></st1><st1>Independence</st1>. Mao Zedong's Great Leap Forward is regarded as a massive economic blunder, but it's also one that killed over 20 million Chinese by causing the Great Chinese Famine. Amartya Sen credits democracy for this not being repeated in <st1></st1><st1>India</st1>.<br /></span><p align="center" style="font-family:arial;"><span style="font-size:78%;"><img src="http://img165.imageshack.us/img165/5523/indiachartstimegw5.jpg" /></span></p><span style=";font-family:arial;font-size:78%;" ><br />The Indian entrepreneurial spirit has captured the imagination of the financial media around the world. Lakshmi Mittal is now the fifth richest man in the world and he is one of the faces responsible for Indian business being viewed in a new light.<o></o><br /><br />The West had just grown accustomed to <st1></st1><st1>India</st1> becoming the world's back office, but now Indian businesses have developed a bona fide reputation as predatory. Mittal's acquisition of Arcelor and the biggest Indian takeover of a foreign company, Tata's buyout of Corus, have worried complacent Western CEOs.<br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm1.static.flickr.com/11/15653504_41c5f13faa.jpg?v=0" height="375" width="500" /></span></p><span style=";font-family:arial;font-size:78%;" ><br />The Reliance Group, divided by fighting brothers Mukesh and Anil, looks set to unleash supermarkets and more mobile phones on Indian consumers itching to spend.<br /><br />I am conscious that as an Indian-born NRI it is easy to don rose-tinted glasses and turn a blind eye to the widespread suffering ever-present in <st1></st1><st1>India</st1>. Concordantly, urban Indians can romanticise the lives of their rural compatriots, conjuring a pleasant country life and oblivious to the fact many of their forebears fled those very conditions for the city.<o></o><br /><br />Atanu Dey and Reuben Abraham, Mumbai economists, suggest that the <a href="http://nationalinterest.in/wp-content/uploads/2007/08/pragati-issue5-august2007-communityed.pdf">best way ahead</a> for the hundreds of thousands of villages and the handful of teeming, unplanned urban sprawls which live in coexistence now is to reach a compromise. <st1></st1><st1>India</st1> must create new urban centres to relieve the pressure still exacted upon the major cities by unchecked and overwhelming migration.<br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm1.static.flickr.com/105/273648919_70ad9adcf1.jpg?v=0" /></span></p><span style=";font-family:arial;font-size:78%;" ><br />Along with education, perhaps <st1></st1><st1>India</st1>'s two greatest challenges are cementing the equal position of women in society and providing adequate healthcare to the masses.<o></o><br /><br />I follow <st1></st1><st1>India</st1>'s medical breakthroughs and shortcomings with interest. It is a familiar story, of world-beating advances and horrific inadequacy. It may surprise some that I am realistically considering pursuing a career in an Indian hospital, but the factor holding me back is an uncertainty that I could work knowing that, unless I work in a decrepit public hospital, I will only be treating the rich, be they Indian or visiting health tourists.<o></o><br /><br />Global centres of excellence are built with the government assistance, on the agreement they will run a 'poor ward' or two. News agencies like NDTV have revealed these wards are routinely empty, treating ministers' families or filled with foreign, paying, visitors. <st1></st1><st1>India</st1> will soon have <a href="http://www.pickledpolitics.com/archives/166">more HIV sufferers</a> than any other country. Little is being done to prevent this.<br /></span><blockquote style="font-family:arial;"><span style="font-size:78%;"><strong><span style="color: rgb(153, 0, 0);">"Fullness of life to every man and woman"</span> </strong></span></blockquote><span style=";font-family:arial;font-size:78%;" ><br />Much is made of the ascendancy of women. The new President is Pratibha Patil. She advocated sterilising those with genetic disease. However, she did found a bank to empower women in the 1970s. A good role model for Indian girls. Well, she stole millions not only from her empowered female customers, but also a sugar factory and a charitable trust. Some role model.<o></o><br /><br />In <a href="http://www.guardian.co.uk/india/story/0,,2148302,00.html">yesterday's Guardian</a>, Sagarike Ghose, presenter on CNN's Indian counterpart, worries the Indian women's movement has lost its way. Perceived early successes have led to a backlash against 'feminist types'. Young women see individual freedom (to smoke, wear short skirts, get laid) as more important than a collective freedom to express themselves as half the country's population.<o></o><br /><br />Of course, whilst practices like <a href="http://www.pickledpolitics.com/archives/235">female foeticide</a>, acid attacks and honour killings continue, women may make up less than 50% of the population.<br /><br />Ghose states that as Indian feminism failed to have a clear goal, young Indian girls have adopted a beautiful and vapid role model to aspire to. She makes a great point that certainly rings true to me, that of the pseudo-traditionalist:<o></o><br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;">The heroines of "new <st1></st1><st1>India</st1>" films were presented not as individuals attempting to create their own lives in a new economy, as millions of women across <st1></st1><st1>India</st1> were doing. Instead, the films showed young brides following religious ritual down to the last detail - viewing the moon through a sieve, praying before their in-laws' photographs, and spending their girlhoods working towards getting a husband.<br /><br />When I met students at a prestigious women's college at <st1></st1><st1>Delhi</st1> <st1>University</st1> last month, the majority told me that they wanted to get married to a rich man and have week-long weddings, with all the rituals, because that was part of "Indian tradition". They didn't want to be the "feminist type".</span></blockquote><span style=";font-family:arial;font-size:78%;" ><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1053/525964517_9d1f34c529.jpg?v=0" /></span></p><span style=";font-family:arial;font-size:78%;" ><br />This notion is, no doubt, fuelled by another Indian behemoth, the TV industry. Few realise that television revenues this year will be around £3 billion, double that of Bollywood. I've watched the soaps that grip <st1></st1><st1>India</st1> - it's an experience I would not wish upon my worst enemy - and every female character is truly depressing.<o></o><br /><br />Masterminding the televisual revolution sweeping <st1></st1><st1>India</st1> are people like former rice salesman Subhash Chandra, chair of Zee TV. Television sets are becoming more affordable and more ubiquitous. Seasoned industrialist Ratan Tata wants to go even further with his plans to unveil an ultra-cheap car for the masses. The carbon footprint of millions more with a shiny new car will be a crater.<br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;"><strong>"We rejoice in that freedom, even though clouds surround us"</strong></span></blockquote><span style=";font-family:arial;font-size:78%;" ><br />A tumultuous sixty years promises much ahead. <st1></st1><st1>India</st1> is developing into a great nation, albeit one wracked with problems. As it teeters on the brink of superpowerdom, it is far from the India Gandhi had envisioned. But on this anniversary a genuine hope and optimism drift above a fascinating process of growth. <st1></st1><st1>India</st1> may be 60 years of age, but looking at the faces that will shape its next 60, it is young.<br /><br />Picture credits, from top:<br /><br />Tricolour, <a href="http://flickr.com/photos/artstander/">artsander</a><br />Paperboy, <a href="http://flickr.com/photos/gargi/">Calamur</a><br />KK Menon, <a href="http://flickr.com/photos/gaurang/">gaurang</a><br />India economics, <a href="http://www.time.com/">TIME.com</a><br />Tata truck, <a href="http://flickr.com/photos/gargi/">Calamur</a><br />Demure, <a href="http://www.flickr.com/photos/lethajose/">Letha Jose</a></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-47126179093962186502007-08-15T21:14:00.000+01:002007-08-15T21:18:39.630+01:00"A new star rises" - Part One<span style="font-size:78%;"><span style="font-family:arial;"><span style="font-weight: bold;">THE</span> other father of the nation, Jawaharlal Nehru, ushered in a momentous change in Asia with one of the </span><a style="font-family: arial;" href="http://uk.youtube.com/watch?v=JLPDisHlmb8">greatest speeches</a><span style="font-family:arial;"> ever recorded. As part of his legacy he left behind decades of economic folly, but I will always have a tremendous admiration for the man, if only for that amazing oratory which, even now, encapsulates the myriad complexities of a vast nation.</span><br /><br /><span style="font-family:arial;">In a split article, a brief look back at the last 60 years sets the scene for gazing ahead.</span><br /></span><p style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://www.boloji.com/architecture/00044a.jpg" height="294" width="229" /></span></p><span style="font-size:78%;"><br /><br /></span><blockquote style="font-family:arial;"><span style="font-size:78%;"><strong style="color: rgb(153, 0, 0);">"The soul of a nation, long supressed, finds utterance"</strong><strong> </strong></span></blockquote><span style="font-size:78%;"><br /><span style="font-family:arial;">Despite the spilled blood now mixed with the dusts of Bengal and Punjab, despite the largest movement of people in history, despite shameful conduct on the parts of Hindus, Muslims, Sikhs and the British, Partition remains a footnote to many.</span><br /><br /><span style="font-family:arial;">I do not wish to dwell on the heartache of Partition in this article. Although I have missed the entire </span><a style="font-family: arial;" href="http://www.bbc.co.uk/indiapakistan/">BBC India/Pakistan</a><span style="font-family:arial;"> season leading up to Independence, I managed to catch half of </span><a style="font-family: arial;" href="http://www.bbc.co.uk/bbcone/listings/programme.shtml?day=thursday&service_id=4223&FILENAME=20070816/20070817_0150_4223_26346_90"><em>Partition: The Day India Burned</em></a><span style="font-family:arial;"> today, which demonstrates what the BBC is still the best at. It was also the first British documentary about India I have seen which featured none of the following: Nitin Sawhney, Meera Syaal, Talvin Singh, State of Bengal or Nihal Arthanayake. Perhaps that's why I liked it so much.</span><br /><br /><span style="font-family:arial;">In the years following Partition, India plodded onward and took a socialist path toward development. It became a republic and created an admirable constitution. Primary education and rural areas were forgotten as the government concentrated on the developing urban sprawls. Legions of Indians grew up illiterate.</span><br /><br /><span style="font-family:arial;">Nehru's popularity had taken a battering when half a million people lost their lives after Partition, but as optimism replaced memories of loved ones, Indians felt hope in the free air. In 1962 these hopes were dashed when China steam-rollered Indian troops, still in disarray, and seized Arunachel Pradesh. This came years after India had provided home to the fleeing Dalai Lama.</span><br /><br /><span style="font-family:arial;">Nehru came under heavy fire for the disastrous campaign and his failure to see the attack coming. He died two years later.</span><br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;"><strong>"Brothers and sisters who have been cut off from us"</strong></span></blockquote><span style="font-size:78%;"><br /><span style="font-family:arial;">Three years on from the Sino-Indian war, India fought an adversary it had clashed with once before, and would do again. Three (or four) wars over the region of Kashmir ensured Indo-Pakistani relations remained cold for decades.</span><br /></span><p align="center" style="font-family:arial;"><span style="font-size:78%;"><img src="http://upload.wikimedia.org/wikipedia/en/thumb/6/62/Apu_Pather1.jpg/200px-Apu_Pather1.jpg" /></span></p><span style="font-size:78%;"><br /><span style="font-family:arial;">Indian films reflected the conflicting moods in the country. Bengali cinema, which awoke the world to India's film industry in the fifties, often depicted a cosmopolitan, Westernised India juxtaposed with pathetic poverty in all its gore. Meanwhile the quickly-growing Bombay movie business churned out films full of Indian heroes and heroines to lift the nation's spirits.</span><br /><br /><span style="font-family:arial;">Nevertheless, millions of Indians made their homes abroad. Britain and America, in particular, benefitted from the 'Indian brain drain', a trend that is happily being reversed now.</span><br /><br /><span style="font-family:arial;">Bangladesh was born in 1971 and as defeated Pakistani troops withdrew, they slaughtered as much of Dhaka's intelligensia as they could round up. Nehru's daughter, Indira Gandhi, ended her torrid first time in power after a brief period of </span><strike style="font-family: arial;">military</strike><span style="font-family:arial;"> police-enforced emergency rule and India's first nuclear test.</span><br /><br /><span style="font-family:arial;">When she returned to power some years later, she would be assassinated by her Sikh bodyguards on her way to meet Peter Ustinov. They shot in retalliation for her foolhardy storming of Amritsar's Golden Temple. Operation Bluestar was the name given to the attempt to defeat Sikh militants who aggressively sought an independent state.</span><br /><br /><span style="font-family:arial;">Her elder son would soon follow in her footsteps, first to lead India and then to be assassinated. His younger brother, Sanjay, was killed in a plane crash and Rajiv was a reluctant heir to his family's legacy. A Tamil Tigress bearing a bouquet of flowers killed Rajiv Gandhi for his part in sending Indian troops sent to a war-torn Sri Lanka. The parallels between the family and a political dynasty in America meant the Nehru/Gandhi clan were oft referred to as the Kennedys of India.</span><br /><br /><span style="font-family:arial;">Three years ago Rajiv Gandhi's widow, Sonia, led the resurgent Congress Party to power and controversially stepped aside to allow economist Manmohan Singh to become Prime Minister. At the time, India was a majority-Hindu democracy with a ruling party led by a Catholic, a Sikh PM and a Muslim president. Rajiv and Sonia's son, Rahul Gandhi, is a popular young politician.</span><br /></span><p align="center" style="font-family:arial;"><span style="font-size:78%;"><img src="http://www.hindu.com/2006/05/02/images/2006050203570901.jpg" height="314" width="351" /></span></p><span style="font-size:78%;"><br /><span style="font-family:arial;">Mahatma Gandhi's teachings went on to influence Nelson Mandela, Martin Luther King, Aung Sang Suu Kyi and the Dalai Lama, but he wasn't popular with all in India. Maoist Naxalites, entirely disparate from the Hindu right but united by their hatred of Gandhi, were thought to be all but eliminated in the 1970s. Manmohan Singh recently described them as the biggest internal threat to security and their popularity is once again on the increase.</span><br /><br /><span style="font-family:arial;">India's population reached half a billion in the 1970s. A food crisis and twenty years of imports was halted by an example of a developing nation's understanding of their own environment. India's Green Revolution and Operation Flood saw the government aid farmers and allow the country to become self-sufficient.</span><br /><br /><span style="font-family:arial;">The environment, however, </span><a style="font-family: arial;" href="http://en.wikipedia.org/wiki/Bhopal_Disaster">paid a terrible price</a><span style="font-family:arial;"> in 1984, when 40 tonnes of methyl isocyanate was released by the Union Carbide pesticide plant in Bhopal. An estimated 22,000 people died as a result and the Bhopal Medical Appeal alleges one person dies a day due to the disaster.</span><br /></span><p align="center" style="font-family:arial;"><span style="font-size:78%;"><img src="http://studentorgs.utexas.edu/aidaustin/bhopal/bhopal.JPG" /></span></p><span style="font-size:78%;"><br /><br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;"><strong>"After long slumber and struggle, awake, vital, free..."</strong></span></blockquote><span style="font-size:78%;"><br /><span style="font-family:arial;">As Narasimha Rao quietly paved the way for India to become the burgeoning economic superpower we hear about today by lifting stifling tariffs, a dark chapter in modern India's history unfolded in Uttar Pradesh.</span><br /></span><p align="center" style="font-family:arial;"><span style="font-size:78%;"><img src="http://www.geocities.com/indianfascism/Babri/babriMasjid.jpg" height="264" width="450" /></span></p><span style="font-size:78%;"><br /><span style="font-family:arial;">75,000 kar sevaks, far right Hindus, destroyed the sixteenth century Babri Masjid (mosque) in Ayodyha, claiming it was built upon the site of Lord Ram's birth. Nationwide riots ensued and spilt over into Bangladesh. Ten years on, in 2002, Muslim extremists ignite a train of Hindu pilgrims, killing 58. Narendra Modi, chief minister of Gujarat fuelled a fire burning amongst Hindus eager for blood.</span><br /><br /><span style="font-family:arial;">A sickening backlash saw near one thousand people, overwhelmingly Muslim, perish in the first riots to be broadcast live on TV. The BJP were condemned for doing nothing to prevent the killing.</span><br /><br /><span style="font-family:arial;">A year before the latest Kashmir clash, India and Pakistan become nuclear powers in 1998.</span><br /><br /><span style="font-family:arial;">India's history has been peppered with terrorist attacks. Only the more notable are mentioned here. 250 died as 13 bombs went off in Bombay on the 12th of March 1993, Dawood Ibrahim exacting revenge for Babri Masjid is thought responsible. Pakistani group Lashkar-e-Toiba are blamed for the death of 52 in Mumbai in 2003. Five bombings hit Mumbai in eight months.</span><br /><br /><span style="font-family:arial;">Delhi, seat of India's government, </span><a style="font-family: arial;" href="http://www.pickledpolitics.com/archives/109">is targetted in 2005</a><span style="font-family:arial;">. The Pakistani Islamic Inquilab Mahaz claim responsibility for the death of 59 two days before Diwali, citing Kashmir as their cause. in 2006, seven bombs explode in eleven rush-hour minutes on Mumbai trains. Lashkar-e-Toiba were once again identified as responsible, in collaboration with the Students Islamic Movement of India. There was no Hindu backlash.</span><br /><br /><span style="font-family:arial;">The city's resilience and determination to return to normal were truly inspirational. Western Railways restored full service by the evening and investors rallied, causing the Mumbai Stock Exchange to end the day 3% up.</span><br /><br /><span style="font-family:arial;">Last month, the Sensex surpassed the 15,000 mark.</span><br /><br /><span style="font-family:arial;">Tomorrow, Part Two:</span><br /></span><blockquote style="color: rgb(153, 0, 0);font-family:arial;"><span style="font-size:78%;"><strong>"We have hard work ahead"</strong></span></blockquote><span style="font-size:78%;"><br /><span style="font-family:arial;">Titles are taken from Nehru's speech, </span><em style="font-family: arial;">A Tryst with Destiny</em><span style="font-family:arial;"> [</span><a style="font-family: arial;" href="http://en.wikipedia.org/wiki/Tryst_with_destiny">full text</a><span style="font-family:arial;">]. I'm not ashamed to say simply reading it can move me to tears.</span></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com3tag:blogger.com,1999:blog-15298599.post-45032530220794585822007-07-18T14:14:00.000+01:002007-07-18T16:25:20.648+01:00Who needs the Kwik-E-Mart?<span style="font-size:78%;"><img style="font-family: arial;" src="http://www.ultrabrown.com/wp-content/uploads/rohin-simpsons.jpg" alt="rohin-simpsons.jpg" align="right" hspace="20" vspace="10" /><span style="font-family: arial;">Over a year and a half ago I wrote my first post for Pickled Politics, entitled ‘</span><a style="font-family: arial;" href="http://www.pickledpolitics.com/archives/52">Much Apu About Nothing</a><span style="font-family: arial;">’ and it concerned my love for Springfield’s favourite shopkeeper. I sought to explain why I feel Apu is a positive character, having heard opinions against him. This has proved easily to be my most widely-read post.</span><br /><br /><span style="font-family: arial;">Recently a publicity campaign for the upcoming Simpsons movie has developed into a contentious issue in America and </span><a style="font-family: arial;" href="http://www.ultrabrown.com/">Ultrabrown’s</a><span style="font-family: arial;"> Manish has quickly become the </span><a style="font-family: arial;" href="http://www.ultrabrown.com/posts/the-cnn-clip">go-to man</a><span style="font-family: arial;"> for all things Apu. What Manish probably doesn’t realise that it was his view of Apu that inspired my article; I wanted to highlight how the British perception of Apu is so different from the American. So I figured I should chuck my two cents in, but I’ll try not to duplicate my reasons for being an Apu fan this time.</span><br /><br /><span style="font-family: arial;">The recent ‘</span><a style="font-family: arial;" href="http://commentisfree.guardian.co.uk/manish_vij/2007/07/the_apu_tragedy.html">Apu controversy</a><span style="font-family: arial;">’, having made national American and Indian news, may have started as a debate about the ad campaign, but it has grown into a new dissection of Apu’s character.</span><br /><br /><br /><br /><span style="font-family: arial;">It is thus fundamental to separate the 7-Eleven issue from related discussion. Examining the former first, Manish has, in several posts, argued succinctly why this promotional strategy irks him. Central to my defence of Apu has always been his context. The Simpsons parodies all its inhabitants and Apu is not a racist stereotype but a rounded, human figure.</span><br /><br /><span style="font-family: arial;">This advertising campaign removes Apu from that context. Apu, like all the caricatures in Springfield, exists on two levels. Every character has a superficial exterior, which personifies a stereotype; they also have a rich personality which undermines all of those clichés.</span><br /><br /><span style="font-family: arial;">I have learnt that unfortunately the fact Apu has a memorable catchphrase has resulted in it being used as a racist taunt in America. Critics of Apu argue this shows that he is the sole troubling character, which is why he draws so much flak. However I feel that sadly racists in the US would still be abusing Indians without a convenient convenience store catchphrase. The fact some Indians in the US dislike hearing “thank you, come again” reveals more about how American society has latched onto tormenting Indians than the racism of Apu.</span><br /><br /><span style="font-family: arial;">Upon initially viewing the dozen-or-so Kwik-E-Marts, I loved the idea and I still do. The one point upon which I agree wholeheartedly with Manish is his criticism of the role the real-life shopkeepers have played in this saga. The majority of 7-Eleven employees affected by this campaign seem to be of Asian origin. Almost all seem game for a laugh, but dressing them up as Apu can surely not be in their best interests.</span><br /><br /><span style="font-family: arial;">I think the Brits reading this will feel the way I initially felt, that there’s no harm in assuming the role of Apu for the month. But once again context is paramount. My view of the American experience for an Indian, shaped predominantly from the writing of Indian Americans and </span><a style="font-family: arial;" href="http://www.imdb.com/title/tt0366551/">Harold and Kumar</a><span style="font-family: arial;"> is one where Indian shopkeepers can frequently be the subjects of abuse. If this is indeed the case, the dumb racist’s conflation of a stereotyped Indian and a real one will only be reinforced by an Apu outfit and name badge.</span><br /><br /><span style="font-family: arial;">However, if Indian shopkeepers aren’t subject to more abuse than others, then I can’t see any difference between the UK and the US, so I once again see nothing wrong with Apu. The basis for criticising him or his place in this advertising is grounded in the assertion that America is inherently racist, whether this is true, you decide.</span><br /><br /><span style="font-family: arial;">I do not buy the argument that Americans are not familiar with Indians, which is cited as making Apu more harmful than other stereotypes. Firstly, I think “Americans don’t know any Indians” doesn’t wash anymore, secondly many of the stereotyped minorities are those Americans might be unfamiliar with like the Scots or the Japanese. Lastly, and most importantly, no special familiarity is needed. The vast majority of Americans </span><em style="font-family: arial;">will </em><span style="font-family: arial;">be familiar with the Indian shopkeeper and that is the very reason he is in The Simpsons. He effectively needs those stereotypies so that he can be recognised in his place in the town's makeup, and to act as a framework to flesh him out.</span><br /><br /><span style="font-family: arial;">Another sore point for those who dislike Apu is his accent. It’s a comical accent but they say it is racist. Why? Because he is voiced by a non-Indian. This is nonsense. Are we seriously suggesting that only brown-skinned actors can voice brown cartoon characters? A blacked-up white man playing an Indian on screen would be wrong. But only a bigot would complain if a Pakistani played an Indian, because they “look right”. What of the analogous “sounding right”? The Indian voice is not dramatically different in timbre or pitch.</span><br /><br /><span style="font-family: arial;">I think saying there is a racial barrier to voices as well as skin is dangerous ground. If a white man should not do an Indian accent, then can an Indian comedian not impersonate a white celebrity or voice a black cartoon character? The accent itself is criticised as unrealistic, but if based on a genuine thick Indian accent, opposition to Apu would not stop.</span><br /><br /><span style="font-family: arial;">Annoyance at Apu’s accent is based on a false double standard, exposed by today’s multicultural society. The white West and the brown East are now intimately intertwined. When Western, </span><em style="font-family: arial;">but</em><span style="font-family: arial;"> </span><em style="font-family: arial;">brown</em><span style="font-family: arial;"> actors adopt ridiculous accents, such as Kal Penn in Van Wilder (the actor credited with trying to reclaim Apu’s phrase), there are few complainants.</span><br /><br /><span style="font-family: arial;">But there is no reason why someone born and raised outside India is more qualified to attempt an Indian accent simply due to the fact his skin is brown. Those who don’t like Hank Azaria voicing Apu don’t ask for a test of ‘Indianess’ in a replacement candidate, they would be appeased by just Asian heritage. I have British Indian friends who do a more fake Apu-like Indian accent than some white friends. Indian actors make fun of regional accents in Indian films, but it’s OK cos that’s brown-on-brown. This is all phoney. The belief that “only our kind can make fun of us” is unhealthy and reactionary.</span><br /><br /><span style="font-family: arial;">Most Indians, in whatever country, like Apu. Comments on British, American and Indian blogs have overwhelmingly favoured him, so Manish is firmly in the minority. It seems somewhat condescending to insist Apu degrades convenience store employees if they themselves have no problem with the character. It would be more condescending still if their views were dismissed as being insecure eager-to-please immigrants.</span><br /><br /><span style="font-family: arial;">Levelling the notion that if we are party to the Apu joke, we are condemning future generations of brown-skinned people in white countries to racism is unwarranted. Forced attempts to reclaim a phrase or reject a cartoon character are laying the onus on us to change our ways instead of those guilty of racism.</span><br /><br /><span style="font-family: arial;">I feel I haven’t addressed everything, so I will do my best to participate in comments. If you wish for a more detailed examination of Apu, please do read my </span><a style="font-family: arial;" href="http://www.pickledpolitics.com/archives/52">first piece</a><span style="font-family: arial;">. Manish and I have both written plenty about Apu. His massively commented-upon Comment is Free </span><a style="font-family: arial;" href="http://commentisfree.guardian.co.uk/manish_vij/2007/07/the_apu_tragedy.html">article</a><span style="font-family: arial;"> criticised the 7-Eleven campaign. He and I are agreed that the subtle nuances of Apu’s character are lost in the adverts. But we remain in disagreement about just about everything else to do with Dr Nahasapeemapetilon.</span><br /><br /><span style="font-family: arial;">Many of the CiF comments are along the lines of “I’m X and my community is mocked as well, but I don’t complain”. Not all of these statements can be explained away by Indians being less familiar to Americans, and while I do not think Indians complain more (as has been alleged), I am not sure I fully understand why Apu is so much more of a talking point than any other character. I cannot help but feel some of it is due to the fact he is a key main player, which is a testament to his importance, not his subjugation.</span></span><a name='more'></a>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-26110153480743374652007-07-12T12:24:00.000+01:002007-07-13T15:25:07.522+01:00Try before you prescribe<span style="font-size:78%;"><span style="font-family:arial;">Originally published in the June issue of </span><a style="font-family: arial;" href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a><span style="font-family:arial;">.</span><br /><br /><span style="color: rgb(153, 0, 0);font-family:arial;" >How can you ETHICALLY suggest anything for your patient without trying it for yourself? Following a long line of self-experimenting medics, I enlisted some help to make sure I was </span></span><span style="font-style: italic; color: rgb(153, 0, 0);font-family:arial;font-size:78%;" >doing right</span><span style="font-size:78%;"><span style="color: rgb(153, 0, 0);font-family:arial;" > by my patients.</span><br /><br /></span><span style="font-weight: bold;font-family:arial;font-size:78%;" >IT</span><span style="font-size:78%;"><span style="font-family:arial;"> all started last summer. My good friend Froy (star of the </span><a style="font-family: arial;" href="http://dailyrhino.blogspot.com/2006/11/pretend-doctor.html">October Rohinplasty</a><span style="font-family:arial;">) and I had been consuming alcohol whilst watching the blasted World Cup. Soon afterwards we found ourselves re-enacting Streetfighter II on Richmond Green.</span><br /><br /><span style="font-family:arial;">Normally I am Ryu and a sure-fire victor. Perhaps it was the Cobra I had been drinking, but I chose Dhalsim this time; Froy was Zangief. One spinning pile-driver later and I was in West Middlesex Hospital demanding morphine for my </span><a style="font-family: arial;" href="http://dailyrhino.blogspot.com/2006/06/ebert-and-rohin.html">dislocated and broken thumb</a><span style="font-family:arial;">.</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://www.hkfsd.gov.hk/home/images/equipment/ambulance/images/photo/Entonox.jpg" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;">They appeased me with nitrous oxide. Despite Froy inhaling far more than me, void of any injury that he was, we took it upon ourselves to learn about more of the things doctors prescribe for patients.</span><br /><br /><span style="font-family:arial;">By the way, nitrous oxide is truly a wondrous trip. I thoroughly enjoyed my analgesia, even though I had to wear a vomit bowl on my head to stop those goddamn bats getting at my hair.</span><br /><br /><br /><br /></span><span style="font-weight: bold;font-family:arial;font-size:78%;" >DIETARY SUPPLEMENTS</span><span style="font-size:78%;"><br /><br /><span style="font-family:arial;">We ask for dietitian input frequently at St. Peter’s, chiefly because two of them are hot. Apparently they also supply food things for lazy patients. Lazy? That’s my middle name!</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1151/798147193_01d5a09665.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;"><span style="font-weight: bold;">Fortijuice</span>: “A distinctive aroma and a refreshing initial tang. However marred by an iron-y aftertaste, somewhat remeniscent of blood. Goes well with hospital hotpot, but a shameful 150kcal per bottle makes this drink a disappointing 2/5.”</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1105/798147117_9721ae8114.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;">Did you look at Fortijuice and think “looks like some good shit, but I want it as a mousse?” Well damn this is your lucky day. It would be if <span style="font-weight: bold;">Forticreme </span>- the gelatinous equivalent of Fortijuice - wasn’t such a revolting pot of quivering horrors. A sad 0/5.</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1013/798147209_0a012d4e78.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;">I’m an unshamed fan of <span style="font-weight: bold;">Scandishake</span>. Available in the holy trinity of milkshake flavours but the strawberry stands out. A light, tasty whip of calories and vitamins, the fact you have to mix it yourself only adds to the outrageous fun. With a healthy 600kcal per shake, its real plus is it supplies 70% of the suggested saturated fat intake in one easy glass of goodness. An effortless 4/5.</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1238/798147219_7d24263d3a.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1391/798147109_dacb4aa506.jpg?v=0" /><br /></span></div><div style="text-align: center;font-family:arial;"><span style="font-size:78%;">1 spoonful = 1 steak<br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;"><span style="font-weight: bold;">Calogen </span>is the undisputed gangster in the wild world of dietetics. Reading the nutritional info is enough to strike fear in the hearts of most men, with 250ml packing almost 5000kJ. Upon corking the bottle, one is greeting with a welcome bouquet of strawberry triglycerides. A curious mercury-like surface tension causes it to remain on a spoon when held upside down, but the taste is laced with surprising velvet, supported by a bra of marshmallow. 5/5.</span><br /><br /><br /><br /></span><span style="font-weight: bold;font-family:arial;font-size:78%;" >FLUID REPLACEMENT</span><span style="font-size:78%;"><br /><br /><span style="font-family:arial;">If you’re anything like me, you’ve spent hours on end wondering what IV fluids actually TASTE like. We took the Rohin & Froy (double) blind taste test. Saline vs dextrose vs gelofusine.</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1300/798395055_31674e34ee.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;">I chose <span style="font-weight: bold;">gelofusine</span>. I did this quite deliberately, it was obvious from its darker hue, because I really wanted to drink a COLLOID. Little did I know, I already had - Calogen is a fat emulsion. Somehow I wish I had not gulped the gelofusine with such gusto. I’d imagine this is what man juice tastes like. Remind me to ask the nurses later. Taste: 0/5.</span><br /><br /><span style="font-family:arial;">Froy samples an old favourite, <span style="font-weight: bold;">normal saline</span>. Although not with any KCl though, that would be weird. “Saltier than a salty sea dog that’s been sailing on a sea of salt in a giant salt shaker with a hull full of salt, who’s just overdosed on salt because he ate some salted peanuts that were salty but not salty enough.” Salt value: 5/5. Taste: 0/5.</span><br /><br /><br /><br /></span><span style="font-weight: bold;font-family:arial;font-size:78%;" >PROCEDURES</span><span style="font-size:78%;"><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1402/798147237_f48628d02d.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;"><span style="font-weight: bold;">Cannulation </span>is one of the most common procedures patients undergo in hospital - it is a popular way of getting MRSA. I started with a pathetic blue but then steeled my resolve and chose the green venflon, as not only did it complement my yellow T-shirt nicely, I was attracted to its impressive flow rate of 120ml/min.</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1253/798394963_a96e2e8d24.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;">Sweet mother of God, I never realised how much this hurt. Maybe due to the fact I was cannulating myself, but something made this excruciatingly painful.</span><br /><br /><span style="font-family:arial;">However the pain was relieved by a sensation I recommend to anyone - a big flush of refridgerated normal saline. If I took heroin, I’d definitely put it in the fridge. </span></span><span style="font-weight: bold; font-style: italic;font-family:arial;font-size:78%;" >If</span><span style="font-size:78%;"><span style="font-family:arial;">. Pain rating: 3/5.</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1087/798394827_a920bcd8b9.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;"><span style="font-weight: bold;">BM testing</span>. This is so painless I can’t even be bothered to write about it. It’s lame, I don’t get why people do this. Who wants to know their blood sugar? Boring! Pain rating: 0/5.</span><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1226/798394653_b56cd4ef8f.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;">People always seem to moan about <span style="font-weight: bold;">ABGs </span>over venflons. As far as I can tell, it’s the other way round. I enjoyed seeing my arterial blood fountain out into a syringe. I quite fancy an angiogram now. Radial approach, wooo! Pain rating: 2/5.</span><br /><br /><br /><br /></span><span style="font-weight: bold;font-family:arial;font-size:78%;" >THINGS WE MIGHT HAVE TRIED. <span style="font-style: italic;">MIGHT MIGHT MIGHT</span>.</span><span style="font-size:78%;"><br /><br /></span><div style="text-align: center;font-family:arial;"><span style="font-size:78%;"><img src="http://farm2.static.flickr.com/1230/798394969_4bb75cd94b.jpg?v=0" /><br /></span></div><span style="font-size:78%;"><br /><span style="font-family:arial;"><span style="font-weight: bold;">Morphine </span>is a powerful and dangerous opioid analgesic and sedative. It can cause respiratory depression, itching, and constipation. Froy and I are off to spend the rest of the afternoon lying in the sun watching cricket.</span><br /><br /><span style="color: rgb(153, 0, 0); font-style: italic;font-family:arial;" >The legal bit: So that the editor of Medical Student Newspaper or any Daily Rhino-reader does not perform any further painful procedures on me, neither I nor Medical Student Newspaper advocate taking any of the products mentioned in this article unless prescribed by a medical professional. All products utilised were expired or unsuitable for patient use.</span></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com2tag:blogger.com,1999:blog-15298599.post-42591798265066173512007-07-11T18:14:00.000+01:002007-07-19T18:47:08.208+01:00Shilpa and Shakespeare cockroaches<span style="FONT-WEIGHT: bold;font-family:arial;font-size:78%;" >I HAVE</span><span style="font-family:arial;font-size:78%;"> received a bunch of emails from this guy, who must've got my address from <a href="http://www.pickledpolitics.com/">Pickled Politics</a>. The most recent simply had this post's title as its subject and is re-published below. I figured it needed to be shared with no alterations at all.<br /><br /><br /><br /><br /><br /><span style="COLOR: rgb(102,0,0)">From: Our revenge for Shilpa Shetty </span><our_revenge_for_shilpa_shetty@yahoo.com style="font-family:arial;"><br /><span style="COLOR: rgb(102,0,0)">To: rohin at pickledpolitics dot com</span><br /><span style="COLOR: rgb(102,0,0)">Date: 03-Jul-2007 20:41 </span><br /><span style="COLOR: rgb(102,0,0)">Subject: Shilpa & Shakespeare cockroaches</span><br /><br /><span style="COLOR: rgb(102,0,0);font-size:130%;" ><br /><span style="FONT-WEIGHT: bold">Dirty English = Shakespeare cockroaches</span><br /><br /><span style="FONT-WEIGHT: bold">Stupid English = Humpty Dumpty</span></span><br /><br /><br /><span style="COLOR: rgb(102,0,0)">Shilpa should have abused back her uncivilized english abusers by insulting them as, Shakespeare cockroaches and Humpty Dumptys, but unfortunately, she did not know it. Otherwise, if she had known these two remarks, she would surely have insulted back her tormentors with the remarks of Shakespeare cockroach and Humpty Dumpty.</span><br /><br /><br /><span style="COLOR: rgb(102,0,0)">We are now spreading this message in the Indian community all over the world. We request all our fellow Indians to use the insults of Shakespeare cockroach and Humpty Dumpty, each time they come under abuse and refuse to suffer in silence. If you do not respond abuse with abuse, then the racist remarks used by uncivilized and evil english will continue and will grow further. If you abuse back with the remark of Shakespeare cockroach, then the uncivilized english will think twice before abusing you.</span><br /><br /><br /><span style="COLOR: rgb(102,0,0)">This is the only practical way to deal with the abusive and evil Shakespeare cockroaches and Humpty Dumptys, who are the biggest fascists of the world. England is a fascist country and we now call it, Nazi England.</span><br /><br /><br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(102,0,0)">We love our Shilpa.</span><br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(102,0,0)">We hate Jade Goody, the Shakespeare cockroach.</span><br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(102,0,0)">We hate Jade Goody, the Humpty Dumpty.</span><br /><br /><span style="FONT-WEIGHT: bold; COLOR: rgb(102,0,0)">We hate Nazi England.</span><br /><br /><br /><br /><span style="COLOR: rgb(102,0,0)">Very very very angry against Shakespeare cockroaches,</span><br /><span style="COLOR: rgb(102,0,0)">Rajesh Kumar & friends,</span><br /><span style="COLOR: rgb(102,0,0)">France</span><br /><br /><span style="COLOR: rgb(102,0,0);font-size:100%;" ><br /><span style="FONT-WEIGHT: bold">1) Shakespeare cockroach</span><br /><span style="FONT-WEIGHT: bold">2) Humpty Dumpty</span></span><span style="FONT-WEIGHT: bold; COLOR: rgb(102,0,0)"> </span><br /><span style="COLOR: rgb(102,0,0)">------------------------------------</span><br /><br /><span style="COLOR: rgb(102,0,0)">Shakespeare cockroach is a humiliating slur against the dirty english and is used against all english people. Those english who have no brains and are stupids, are called HUMPTY DUMPTYS.</span><br /><br /><span style="COLOR: rgb(102,0,0)">Shakespeare cockroach is a very very humiliating slur against all dirty english.</span><br /><br /><span style="COLOR: rgb(102,0,0)">Humpty Dumpty is a very very humiliating slur against all stupid & brainless english.</span><br /><br /></OUR_REVENGE_FOR_SHILPA_SHETTY@YAHOO.COM></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com5tag:blogger.com,1999:blog-15298599.post-65516695505282111412007-07-04T23:07:00.000+01:002007-07-04T23:12:32.184+01:00SHO me the exit<span style="font-family: arial;font-family:arial;font-size:78%;" ><span style="font-style: italic;"><a href="http://www.pickledpolitics.com/archives/1233">Cross post on Pickled Politics.</a></span><span style="font-weight: bold;"><br /><br />SEVEN </span>of the suspects arrested under suspicion of involvement with the terrorist attacks over the last few days are NHS junior doctors or medical students. Britain's threat level has only today been stepped down from 'critical' to 'severe' and heightened security at airports remains in place. As a shifty-looking NHS junior doctor flying out of the UK on Friday, these events have had particular resonance.<br /></span><p style="font-family: arial;font-family:arial;" align="left"><span style="font-size:78%;">Almost three months after junior doctors were in the news protesting a disastrous job shortage, a friend at work quipped "I think some of these guys are taking their <a href="http://dailyrhino.blogspot.com/2007/05/beginners-guide-to-mtas-fiasco.html">MTAS</a> protests a bit far." Hey, perhaps these guys were just pissed off at being laid off...</span></p><span style="font-family: arial;font-family:arial;font-size:78%;" ><br /></span><p style="text-align: center; font-family: arial;font-family:arial;"><span style="font-size:78%;"><img src="http://www.telegraph.co.uk/news/graphics/2007/07/03/asha/asha3.jpg" title="Mohammed Asha" alt="Mohammed Asha" height="315" width="420" /></span><span style="font-size:78%;"><em><br /></em></span></p><p style="text-align: center; font-family: arial;font-family:arial;"><span style="font-size:78%;"><em>"Brilliant": Mohammed Asha topped his class several times.</em></span><br /></p><span style="font-family: arial;font-family:arial;font-size:78%;" >Two Iraqi doctors seem to be at the heart of the attempted terror campaign, thought responsible for both the Glasgow Airport attack and two unsuccessful bombs in London two days prior. A British cleric working in Iraq had recently been informed of an impending attack on Britain by an Al Qaeda leader, with the ominous warning that "the people who cure you will kill you."<br /><br />The suspects, of Iraqi, Saudi, Indian and Jordanian origin, have opened a debate on the role overseas doctors play in the British health system. It is a widely acknowledged fact that the NHS survives on the contribution of doctors trained abroad. Many would go so far as to say that the NHS would not exist today had doctors from the sub-continent buoyed it through its early decades. Today approximately 128,000 of the 277,000 doctors on the GMC Register are from overseas medical schools.<br /><br />The requirement of a work permit for foreign junior doctors only came into place last year, as the UK was producing more doctors itself (many of whom are now leaving for Australia, New Zealand and Canada). Medical Student Newspaper <a href="http://www.medical-student.co.uk/issues/current/files/May2006.pdf">covered</a> the fact that even overseas undergraduates in British medical schools, who pay almost £100,000 in tuition fees, were instructed to apply for work permits despite being halfway through training.<br /><br />The normal vetting process for doctors involves a professional and linguistic assessment (the <a href="http://www.gmc-uk.org/doctors/plab/index.asp">PLAB</a>) and a probation period working in the NHS before a full registration is offered. Doctors from the EU are exempt from these checks. No doctors are specifically questioned on their political views.<br /><br />Members of British Muslim medical groups, such as Dr Abdula Shehu of the Muslim Doctors Association, <a href="http://news.bbc.co.uk/1/hi/health/6264236.stm">are afraid</a> there will be a backlash against Muslim doctors. To me, this sounds improbable. Doctors can't be picked out on the street - most people know doctors via being treated by them. I doubt people will suddenly assume their family GP Dr Hussain is a terrorist.<br /><br />However not much has been said about medical students, who interact with a far more diverse group of people than doctors. We have previously <a href="http://www.pickledpolitics.com/archives/167">touched</a> <a href="http://http//www.pickledpolitics.com/archives/1072">upon</a> the religious fanaticism that lurks on British university campuses and I'm sure there will be sympathisers amongst British Muslim students, just as there is likely to be some ill will toward normal Islamic students.<br /><br />What appears to be happening is a questioning of Britain's reliance on overseas doctors. Gordon Brown has already pledged a review of NHS recruitment and 'skilled migrant workers' background checks. Intelligence agencies said they will have to "widen the net" when searching for potential bombers. A somewhat romantic illusion that doctors are above activities like terrorism has been laid to rest, but the debate over the ability to cure and kill is a fascinating one.<br /><br />The Times today <a href="http://www.timesonline.co.uk/tol/news/uk/article2026813.ece">revealed</a> details of the two Indian suspects, now known to be cousins. Both spent most of their time in the UK socialising only with other foreign doctors, often just Indians. Details of the other suspects' lives is patchy, but again most character testimonies have come from Muslim friends and acquaintances. In my hospital accomodation, a cluster of several apartment blocks, several are populated solely by immigrants. It is quite possible to have a job in the NHS and live with, work with and socialise with only those from outside the UK.<br /><br />The disparate group of eight people seem linked only by two things, being Muslim and medicine.<br /><br />The NHS is prohibited from actively recruiting from countries at risk of a 'brain-drain' (though less than a quarter of recruitment agencies the NHS uses has signed up to this), but a doctor from such a country is entitled to apply independently. A huge proportion of the NHS is accounted for by foreign workers, with thousands of doctors from 150 countries, nurses from the Phillipines, India, Ghana and Nigeria or cleaners from Nepal, Ghana and Nigeria. These countries' health systems are woefully understaffed.<br /><br />In the wake of 7/7, we clutched at straws for what might have driven those men to kill. Poverty, social deprivation, a lack of feeling British. This time, whilst I can assure you juniors doctors are not flushed with money, they are certainly not on the poverty line. These doctors had no call to feel British as they weren't, but it seems apparent they resented the country they had chosen to work in.<br /><br />Their reason for attacking the UK might have been the same as previous terrorists, but how did they become subject to such extreme views in spite of their high educational level and respected job? Much could be speculated about doctors from Iraq - they sought revenge for a fallen friend, an insult to their country - but then why were Indian Muslims angry?<br /><br />I realise I am posing more questions than I am answering. I do not feel increasing security checks on skilled migrants will solve the problem. We do not know if some of these men (and woman) were radicalised in the UK. For me, and many like me, the very nature of the NHS is under scrutiny. A thoroughly British convention, it is a puzzling behemoth of nations. Isolation for someone new to the UK is very easy in the NHS - how many other mass employers routinely provide cheap digs next to your workplace combined with 60 hour weeks?<br /><br />The NHS remains perpetually over-stretched and under pressure to cut waiting times; see more patients; improve treatments. None of this is possible without sufficent staffing, frequently drawn from the countries that need medical professionals the most. Whilst not apparently linked to recent events, the fact the NHS is driving thousands of its best and brightest abroad every year can only be worrying.<br /><br />I'll end with an anecdote. After the Tsunami, I spent a month working at relief camps around Sri Lanka's coast. I returned to Heathrow with a shaved head, a month's tan, a big rucksack and four days of stubble. The security officers saw me a mile off and took me to a special area where they searched me and my bags. They rummaged through sweaty clothes and pirate DVDs, firing a series of questions at me.<br /><br />As soon as the chap looking through my bag found my stethoscope, both officers immediately packed everything back in and apologised for bothering me. I was sure the "I'm a doctor" line would be an evergreen get-out clause for airport security. Oh well, wish me luck this weekend.<br /><br />(Kind of related, I thoroughly recommend Michael Moore's new film, <a href="http://www.imdb.com/title/tt0386032/">Sicko</a>.)</span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-63507027972576277082007-06-26T23:03:00.000+01:002007-06-26T23:50:01.120+01:00Someday you realise your Mum's not going to live forever<div style="text-align: justify; font-family: arial;font-family:arial;"><span style="font-size:78%;">Originally published in the June issue of <a href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a>.<br /><br /><br /><span style="font-weight: bold;">MY</span> first year is drawing to a close. The next generation of F1s have graduated, got pissed and are enjoying that golden summer after medschool. Soon I will no longer be the most junior doc on the team and I might even have people asking for my advice. Every time I mess something up (and I will) after the end of July, I won’t be able to simply excuse myself on the grounds I am “just the house officer”.<br /><br />Part of the exercise in group stupidity that is our MMC assessments is a tedious cataloguing of ‘reflective practice’. We are supposed to document the cock-ups, the near-misses and blips that we have learnt from. Of course I spent half an hour before my sign-off meeting making mine up.<br /><br />Ironically, writing this column has forced me to reflect on my conduct as a doctor more than any contrived questionnaire could. I spent a little while browsing what I have written for <span style="font-style: italic;">Medical Student Newspaper</span> this year and I realise I have come full circle. The first piece I wrote, in October last year, professed how I need to see things through the eyes of patients’ family members. I didn’t change. Nine months on, tragic events have finally shocked me into an attitude re-evaluation.<br /><br />One of the many criticisms one could level at me is cockiness. I have been gung-ho on more than one occasion. Whilst I have not endangered patients, I have certainly made more work for myself by charging ahead without due forethought – and more importantly I could have made a patient’s stay less unpleasant.<br /><br />I write this having just returned from Royal Free’s ITU. My very best mate’s Mum suddenly suffered a massive antero-lateral MI and out-of-hospital VF arrest. He’s a school friend and a lawyer, she’s a healthy woman in her mid-40s with no risk factors apart from family history. Without going into details, she has been making erratic but slow progress over the last two weeks and we are optimistic.<br /><br />I’ve tried to be as supportive as I could be, but I’ve also done my utmost to explain the immensely complex events to my friend. I hope I helped. However, in a roundabout way, I have helped myself.<br /><br />I’ve been privileged enough this year to get exposed to a high level of critical care. I’ve managed patients in coronary care and in surgical HDU. Next year I’ll be working in medical HDU and ITU. I love it – standing behind the chart, absorbing the figures.<br /><br /></span><div style="text-align: center;"><span style="font-size:78%;"><img src="http://www.surgeryencyclopedia.com/images/gesu_02_img0124.jpg" /><br /></span></div><span style="font-size:78%;"><br />Heart rate, pulmonary capillary wedge pressure, MAP, fluid balance, CVP, inotropic support, balloon pump settings, sats, lactate, base excess, ejection fraction and so on. I got a buzz out of being able to know what was happening with the patient without even seeing their face.<br /><br />Suddenly one of those collections of stats was someone I knew. I finally put a face to the figures. More than that, I put a face to the relatives that spend their whole day in the waiting room, desperately hanging on for a glimmer of hope. I became one of them for a time.<br /><br />When you’re looking after a full HDU, something is always happening. When you’re concentrating on only one patient, nothing seems to happen. Our days consisted of sitting silently in the waiting room, walking around the block, nipping out for cigarettes and if we were very lucky, perhaps a minute with the SpR.<br /><br />There’s a vast difference between nursing staff. Some are rude, obstructive and lie. They claim the doctors are far too busy to speak to relatives. When I’ve been on call, I’ve positively approved of this attitude. Now on the other side, I realise little is more frustrating. Other nurses are great and really keep relatives in the loop. Likewise, some doctors are jerks. Others are absolutely fantastic.<br /><br />In a less acute setting it can be even worse. My Mum has also spent some time in hospital recently. In contrast to my friend’s mother, this was a planned admission for a knee replacement. Straightforward, but the potential for complications always exists. And whilst not life-threatening, my Mum suffered badly with wound and chest infections and terrible post-op analgesia.<br /><br />She had to wait four hours for a doctor to write up pain relief. The nurses would mindlessly repeat “we’ve bleeped him” and when he eventually arrived, he dismissed everything I said, presumably because he thought I was too junior.<br /><br />This pattern of waiting for the doctor was played out daily, perhaps part of a scheme to free up hospital beds, as after a few days my Mum was desperate to leave.<br /><br />So much of the modern medical apprenticeship appears twee and pointless. Hoops to be jumped through, like the aforementioned reflective practice essays, or apparent time-wasting like communication skills classes at medical school. I was as vocal as anyone with my criticism of what medicine is becoming. I echoed consultants who bemoaned the demise of ‘the old system’ of being taught the science and picking the rest up by osmosis.<br /><br />Now I wonder if I should have attended more of those communication skills sessions. When I say “more”, I really mean “at least one”.<br /><br />Textbooks have taught me what I need to know about managing a GI bleed or a sore knee. What textbook could I turn to when I first told a family their father had died? I have broken this news about half a dozen times this year. I am not happy with how any of them went.<br /><br />Sure, you live and learn, but I look at some of my colleagues and cannot help feeling that they were just born with a better ability at this sort of thing. I think one <span style="font-style: italic;">can </span>learn to communicate better, I have just never felt it to be a priority. For it is a paradox in life that whilst we are more conscious of our shortcomings than our strengths, we spend less time rectifying our foibles than doing what we’re good at.<br /><br />Hence this year I have consciously pursued an agenda to improve my practical abilities. I’ve taken out an appendix, intubated, cardioverted, lumbar punctured, put in about ten chest and ascitic drains, four femoral lines, two arterial lines, one temporary pacing wire and aspirated more chests and knees than I care to remember. The one procedure I have been especially keen to master has been the internal jugular central line. I have managed to do six, with supervision, simply by being a pest and keeping my eyes open.<br /><br /></span><div style="text-align: center;"><span style="font-size:78%;"><img src="http://www.site-rite.com/images/illustration.jpg" /><br /></span></div><span style="font-size:78%;"><br />Conversely I have avoided interacting with patients and families for the vast majority of the time. I make excuses to myself that my jobs have all been too busy, but I seem to have made time for all of the above. My development has been uneven.<br /><br />Last week an acutely unwell woman came in to the MAU. There was talk in the air of a central line being needed. The on-call SpR had not had time overnight. Aha! My opportunity. Number seven here we come. “I’ll get everything ready” I said as I practically forced the team into accepting me as the man for the job.<br /><br />The woman began to deteriorate. I was already preparing to insert the line when her breathing became erratic. “Rohin, don’t worry, you go ahead but we need to get this line in quite quickly,” said one of the registrars present. I looked down and saw quite a young woman. I saw my friend’s Mum. I saw my Mum.<br /><br />In an acute and unpredictable setting like this, would my running a catheter by this woman’s lung and into her right atrium really be the best we can offer her? I desperately wanted to get another central line under my belt, but I stepped back. “I think you should do this one,” I said to the reg, “I’ll watch you this time.”<br /><br />Perhaps I am learning something.<br /></span></div>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com3tag:blogger.com,1999:blog-15298599.post-27707499884586684872007-05-16T00:56:00.000+01:002007-10-15T18:47:55.774+01:00The beginner's guide to the MTAS fiasco<p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Originally published in the May issue of <a style="font-style: italic;" href="http://www.medical-student.co.uk/">Medical Student Newspaper</a>.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><span style="font-weight: bold;">ARE </span>you a bit muddled with this whole MTAS business? Do you nod along politely when people talk about ‘all those poor junior doctors’? Do you secretly not have a clue about medical training? Are you Patricia Hewitt?</span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" > </p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><a href="http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/16/ndocs16.xml">MTAS is no more</a>. <a href="http://nhsblogdoc.blogspot.com/2007/05/end-of-mtas.html">People are happy</a>. You should know why.</span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><o:p> </o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><span style="font-weight: bold;">The history</span><o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><o:p></o:p><st1:time minute="20" hour="4"></st1:time>Four score and seven years ago, Aneurin Bevan invented a work experience programme for Indian doctors called the NHS. Some British doctors joined in and then we had a health provider the world envied. This glorious period, where all the developed countries in the world tried to model themselves on our free health service was truly a wonderful time. It lasted an entire Wednesday afternoon.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">After a few decades, the Indian doctors opened a whisky distillery in Sheffield and the Brits retired to Eastbourne. And so it came to pass that new doctors began applying for jobs.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">They used an ingenious system the Romans used to call a 'resumé'. For many hundreds of years this system was used to select junior doctors. But sadly it all came to an attractive end with the famous case of Professor Fry's colorectal firm which consisted exclusively of nubile Swedish female SHOs and one androgynous Thai boy.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Some f*cking genius suggested current selection criteria is outmoded and unfair and the seeds of MMC were planted. That genius had good intentions, but I'd sure like to punch him in the mouth.</span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><span style=""></span><br /></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><span style="font-weight: bold;">A new way of choosing doctors</span><o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><o:p></o:p>Deep in the desert forests of Shropshire, a small band of vegan peoples started shaping the future of medical training. Out of clay. They deemed it appropriate to do away with millennia of tradition and replace the CV with a form made from Satan's flatus.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">They say the man responsible for the form designed it with only one hand, as the other is chained to a pipe in his mother's cellar. They say he owns an extensive collection of mermaid porn and rubs soup into his face for hours on end.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">MDAP was born, but was so hypoxic at birth it had to be transferred to NICU. An inexperienced F2 had a stab at intubating MDAP but tore straight through its pharynx causing it to die horribly and in great pain.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">From its twisted and mutilated neonatal corpse rose the spectre of MTAS. MTAS was a healthier baby than MDAP and made it to school, where it had no friends. This year MTAS put thousands of SHOs in a big pot and shook them around a bit. A few thousand fell out and they went in the jobless pile.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">MTAS took a look at the other doctors in the pot and chose a few budbud, whop, spik and bongo names to chuck out, even though they were all Brits. Then MTAS got bored and emailed credit card numbers, pant sizes and sexual preferences of junior doctors to crack dealers, the Klan and C.H.U.D.S.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">A Big Medical Association a lot of us pay to represent us didn't do anything to begin with. They were playing MarioKart 64 and kept hitting the lightning before the jump.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">A group of sewer-dwelling radioactive amphibians called ReptileUK tried to murder the MTAS staff and the Department of Health with sharpened baguettes.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Some splinter members broke off and realised the key to success was a Facebook group and a flash mob in London. RemedyUK got an unwashed mass of junior doctors together with the promise of blood doughnuts. They protested. Then the Big Medical Association weighed in with immaculate - and by that I mean woefully late - timing.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Patricia Hewitt, meanwhile, dropped her purse into the toilet and lost her library card. She went to the library and asked for a new card. For some reason she explained to the librarian she needed a new card because she dropped her old one in the toilet. As she left, she silently thought to herself "why did I tell her?"<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">In the deep West Midlands, the ST interview panel walked out. Patricia Hewitt said MTAS was a rousing success. New Zealand, Canada and Australia opened special British doctor immigration lanes at international airports to cope with the exodus from the UK. Patricia Hewitt said any minister that makes an error should resign. She kept on workin’.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Senior deanery staff walked out. Patricia Hewitt said pulling out of MTAS "was simply not a credible option since it would be impossible to place the best candidates in posts and fulfil the service needs in time for August using the old system."<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Yet with a mighty slash from Occam's razor, MTAS was culled and lived no more. One day before court proceedings into the fairness of the system began.</span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><br /></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><span style="font-weight: bold;">A newer way of choosing doctors - the future</span><o:p></o:p></span></p> <p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;"><o:p></o:p><span style="font-style: italic;">Medical Student Newspaper </span>can exclusively reveal what will happen next. Sure, we're told hospitals will be using the old CV system to pick jobs, but we all know this is jive man, pure damn JIVE!<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">It does seem apparent that an elaborate new system of assessments will form the basis of selection for ST posts from next year. Obviously many of the skills required will remain the same.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">For example, the requirements for a surgical ST1 job will still revolve around the basic tenets of managing the acutely unwell surgical patient, operative experience, watermelon seed spitting and Turkmeni dancing. Interviews will be replaced by three-stage contests between rival candidates.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">The first round will consist of a barefoot jump-rope endurance challenge, with ropes made of glass and a floor made of knives. The second round is obviously ostrich wrestling, now a core part of most medical school curricula. However all trash talk must be in a broad Irish brogue.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Lastly, potential specialist trainee doctors will be selected according to their performance in the petrol gargling clinical governance contest. Only four things will be required prior to short-listing candidates.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">They will want a plaster cast of your ear, your thigh circumference, a portfolio of every venflon you've ever inserted (specifying the colour and volume of saline used for flush) and finally fourteen DOPS, twenty two mini-CEXs and eighty five thousand CbDs.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">Joking aside, thousands of British junior doctors took up jobs in new continents, far from family and friends. Of those that remained in the UK, about 33,000 have been waiting to hear if they have one of 22,000 jobs or if they will fill a void by working in a short, stop-gap, non-training post. Worse still, they will be reported to the GMC if they choose to leave if offered a better post.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">The £250,000 it cost the taxpayer to train each one of them and the streams of cash being poured in to try and rectify the situation are apparently collateral damage.<br /></span></p><p style="font-family: arial;font-family:arial;" class="MsoNormal" ><span style="font-size:78%;">One can only hope that your year avoids the genuine heartache MTAS has caused. But spare a thought for those a few years above you, life’s been unfair.<o:p></o:p></span></p> <p style="font-family: arial;" class="MsoNormal" face="arial"><span style="font-size:78%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family: arial;"><span style="font-size:78%;"><o:p></o:p>If you really want to learn more about getting into the new medical training system, you need to buy <a href="http://www.amazon.co.uk/Foundation-Programme-Doctors-Getting-Out/dp/1846191165"><span style="font-style: italic;">The Foundation Programme: Getting In, Getting On and Getting Out</span></a>. DO IT.</span></p> <p style="font-family: arial;" class="MsoNormal"></p>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-17170943701486664942007-05-06T16:44:00.000+01:002007-06-26T23:53:40.585+01:00The student becomes the master. THE MASTER I TELL YOU.<span style="font-size:78%;"><span style="font-family:arial;">Originally published in the April issue of </span><a style="font-family: arial;" href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a><span style="font-family:arial;">.</span><br /><br /><span style="font-weight: bold;font-family:arial;" >F2 JOBS</span><span style="font-family:arial;"> are out, huzzah! With nothing more than an arbitrary survey of me asking my friends, it seems as though most of my fellow F1s are happy with what they'll be hating next year.</span><br /><br /><span style="font-family:arial;">Contrary to the February issue's prediction of becoming a McGP in Slough, I managed to land A&E, renal medicine and ITU at St. George's. I could not be more pleased. However there is one problem - I will have no one to boss around. I don't think I'll have an F1 for any of these firms.</span><br /><br /><span style="font-family:arial;">My one consolation is that I might be lucky enough to have some hapless medical students to do my bidding. Although they must be the right type of medical students. The right type of medical student is one that loves bleeding people, sticking in venflons, writing TTOs and getting me food. It's the kind of student I was not. In fact, now that I find myself in the bizarre position of imparting knowledge (ha) onto students, I realise I would have hated to have someone as work-shy as me for a shadow.</span><br /><br /><span style="font-family:arial;">I have a long and distinguished history of hypocrisy and you will be pleased to know I have continued it into my working life. Despite being a lazy and ignorant medstudent, I have no qualms violently demanding nothing less than complete dedication from my assistant house officers. Other people's students, however, I send home as early as I can.</span><br /><br /><span style="font-family:arial;">"Finished lunch? Yeah why don't you head off? Your team doesn't need you this afternoon. Just tell them Rohin said you could go home."</span><br /><br /><span style="font-family:arial;">The teams in question always seem 'annoyed' with me; I know they're just showing their affection in a male-acceptable way. When my students ask for the same courtesy, I have to work very hard not to throttle them with their new tourniquet.</span><br /><br /><span style="font-family:arial;">"Have you checked the bloods, done a PR on the fat guy and got me a bacon sandwich? Nooooo? Chop chop then, get to it woman!"</span><br /><br /><span style="font-family:arial;">Nowadays I stop short of physical contact, after the nasty business that occurred when I tried to encourage Valerie with a firm slap on the arse. The less said about that, the better.</span><br /><br /><span style="font-family:arial;">The simple fact is that house officers are far more willing to help keen students as opposed to layabouts. I have discovered this too late. I cringe when I think what my house officers must've thought of me. Except for my firm at Medway. You'd be surprised how a hot SHO can motivate a young man to put in the hours.</span><br /><br /><span style="font-family:arial;">Willingness to get involved with the firm isn't the only criterion upon which we rank students. During my first firm I had twelve students at one time. Twelve. At St. Peter's we open our doors to third, fourth and fifth years from both Imperial and St. George's. Thus I find myself in a prime position to make sweeping generalisations and unfair comparisons between the two medical schools.</span><br /><br /><span style="font-family:arial;">Third years are uniformly a nuisance, whether they come from Gimperial or George's. They buzz around and get under foot like insects. Bad insects. Insects that carry some sort of disease. But not mosquitoes because they don't crunch when you kill them. Maybe cockroaches. But not that big. Like some disease-carrying medium-sized hard-shelled scuttling insect. Yeah.</span><br /><br /><span style="font-family:arial;">I do feel sorry for the ICSM little ones though - they're abandoned on the wards for up to ten weeks with almost no instruction. They wander around like lost puppies and have to rely on the good nature of the junior doctors to teach them clinical skills and create educational tasks for them to do. So if they're with me, they're screwed.</span><br /><br /><span style="font-family:arial;">Fourth years are, without doubt, the most accomplished skivers. I feel barely qualified to comment on their characteristics as students as I have seen so little of them. I prided myself on my unparalleled bunkalicious skivism, but some of these guys make me look like an amateur. </span><br /><br /><span style="font-family:arial;">It is the final years with whom F1s have most contact. I have now had seventeen shadows and they break down nicely into three sub-categories. George's five years, George's four-years (GEPs) and Imperial (sixth years). Each group has their own idiosyncrasies and foibles.</span><br /><br /><span style="font-family:arial;">The conventional five year St. George's final year is thoroughly competent, relaxed around patients and ready to get stuck in. I, of course, feel more than a little kinship with them as I was one just ten months ago. They're keen to absorb knowledge, which is just as well as most of them have plenty to learn. The best Venflonners by a country mile.</span><br /><br /><span style="font-family:arial;">Imperial final years – though it pains me to say it - seem to be more book-smart. There are few experiences more humiliating than being shown up by a smartarse student, but it happens so frequently I have grown to expect it. And there are myriad ways for me to exact a horrible catheterising revenge. In contrast to their admirable knowledge, some Imperial medics can be deficient in patient skills.</span><br /><br /><span style="font-family:arial;">Lastly, by far the most interesting category is the GEPs. While they are exceptional players of blood bottle bowls, they are either doddery to the point of comedy or utterly set in their ways. One of my recent students, a German chap in his mid-30s and post PhD, lacked any logical thought whatsoever.</span><br /><br /><span style="font-family:arial;">However, I will freely accept that me repeatedly shouting "I’m a cybernetic organism", “you’re a CHOIRBOY compared to me, a CHOIRBOY”!” and "who is your daddy and what does he do?" in an Arnie voice cannot have helped. Austria, Germany...same thing, right?</span><br /><br /><span style="font-family:arial;">The transition from student to competent doctor is a gradual one and it comes as something of a shock to find yourself suddenly obligated to teach mates you've been getting pissed with for the last five years. In between emptying alcogel dispensers on each other, stealing drug rep goodies and flicking elastic bands at nurses, teaching students is one of the highlights of being a junior doctor, for as one teaches, one learns. I feel like I should dematerialise on Dagobah after that line. Lastly, a special thanks to Davina Hensman and Matt Roe, the best students I've had!</span><br /><br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-60313905740424655522007-05-06T16:30:00.000+01:002007-06-26T23:51:54.437+01:00Patrica Blewitt<span style=";font-family:arial;font-size:78%;" ><span style="font-family:arial;">Originally published in the March issue of <a href="http://www.medical-student.co.uk/"><span style="font-style: italic;">Medical Student Newspaper</span></a>. just before the protest on the 17th of March.</span><br /><br /></span><span style=";font-family:arial;font-size:78%;" ><span style="font-weight: bold;">THEY’RE</span> calling it Black Monday. I had a stupid article all about bossing students around prewritten in my head, but felt there was no way I could ignore Black Monday and its implications. This month has been dominated by the plight of our SHOs.<br /><br />Medicine is a career where both a strict hierarchy and a fluid camaraderie co-exist. The SHOs I work with are both my seniors and my friends. Mulling over their pathetic predicament genuinely makes me despair. This month’s news section details how thousands of SHOs have been shafted by MTAS. The almighty fiasco has been played out in the national media as well as in every doctors’ mess across the country. Black Monday was the 26th of February when seemingly all my SHO friends learnt they had not been shortlisted for any ST jobs.<br /><br />Why has the system gone so spectacularly wrong? Why are so many gifted young doctors jobless? How could this country have caused thousands of its brightest to plan moving abroad? A catalogue of calamity has led to a situation where little can surprise anyone aware of what has been going on. When we hear that a Deanery has been using police cadets to shortlist the vast numbers of applications, we barely raise an eyebrow. It may or may not be true, but it’s hardly more farfetched than some confirmed details so far.<br /><br />The news that the entire West Midlands surgical interview panel resigned en masse on the first day of ST3 interviews spread like wildfire. In some ways, British doctors have never been so united around one cause. Part of the reason doctors from every walk of life are taking an interest is that they were all SHOs once upon a time. GPs and hospital doctors were SHOs at one point. They often remember their formative years with fond nostalgia and that a generation is being robbed of their chance at medical training troubles many greatly.<br /><br />When I was a student, especially in my pre-clinical years, actual doctoring was a world away and I had no concept of what issues juniors faced. Hence I wanted to try to convey the mood hanging over your future profession to you. I cannot recall any time in British medicine as dark as this. Countless doctors have written desperate accounts of how they don’t deserve to enter unemployment. I clearly recall my school careers adviser selling medicine to me as a field where I would “never be out of a job.”<br /><br />In fact I recently ran into someone from my year at school, now an SHO. I took a gap year and did a BSc, he didn’t. He has not been given any interviews; I might well avoid this fiasco altogether. Two years of dossing around might have been the difference between being a doctor and signing on. The figure being widely quoted in the press is 30,000 doctors applying for 22,000 posts. However the number of training posts may be substantially lower as many are career grade non-training posts, into which MMC is trying to guide people.<br /><br />There are specific reasons, other than impending dole queues, which have particularly angered SHOs. Government mouthpieces like Lord Hunt, the Health Minister, spouts lunacy like: “We know the system is working well in many parts of the country...Let's be clear, there has always been competition for these specialist training places and there ought to be because these are the senior jobs. It's important we get the right people.”<br /><br />Getting the right people is laughably far from the reality. The minority of friends who have gained interviews have been allocated them in an inexplicable manner. My current SHO, a highly experienced and superb old George’s boy, has been given an interview in London, the most competitive of all Deaneries, but nothing in his three less-competitive backup choices.<br /><br />Patricia Hewitt, the Health Secretary has been warned for years that the UK is forcing junior doctors abroad. Many of the Royal Colleges have been angered by the complexity of the scheme and statements by the government that the Royal Colleges were complicit with all plans. This prompted a rapid response from all the major colleges, to ensure applicants knew that the Royal Colleges had been kept in the dark as well.<br /><br />The government has cynically utilised the fact that the vast majority of doctors are scared to leave the profession. Most jobless SHOs face three options. Some could emigrate, but this is impossible for many. The majority will not find alternatives in the UK but will not quit altogether simply because they want to be doctors.<br /><br />Yet another factor unpopular with candidates has been the application form itself. Last month I gently poked fun at the F2 application form. However similarly inane questions make even less sense for ST posts. Doctors who have augmented their CVs with publications, courses and qualifications have found themselves no better off than those that haven’t. The system has earned itself a reputation as a lottery due to the conventional, tried and tested, system of a CV and references being scrapped. Only a few 150 word answers to generic questions determines your future.<br /><br />Perhaps most embarrassingly of all are the number of errors. Some SHOs have received interviews in areas they did not apply to and a confidential booklet outlining selection criteria was leaked on the Internet. It detailed “methods & best practice for upskilling selectors”.<br /><br />St. George’s and St. Thomas’ have written public letters of protest to Prof Elizabeth Paice, chairman of the Conference of Post Graduate Medical Deans, calling on them to "revoke the current fatally flawed system". Our friends are being treated like shit, show them your support.<br /><br /></span><span style=";font-family:arial;font-size:78%;" ><br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com0tag:blogger.com,1999:blog-15298599.post-11517193652992796232007-02-18T19:12:00.000+00:002007-02-18T19:48:06.424+00:00BUY. MY. BOOK.<div style="text-align: center;"><br /><br /><a href="http://www.amazon.co.uk/o/ASIN/1846191165/ref=s9_asin_image_1/203-9422726-40" title="Photo Sharing"><img src="http://farm1.static.flickr.com/184/394363164_f310362b0f_o.jpg" border="0" height="729" width="550" /></a><br /><br /></div>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com2tag:blogger.com,1999:blog-15298599.post-38416140285779974862007-02-18T18:18:00.000+00:002007-06-26T23:54:08.441+01:00I LOVE MTAS!<span style=";font-family:arial;font-size:78%;" ><span style="font-style: italic;">Originally published in the February issue of </span><a href="http://www.medical-student.co.uk/">Medical Student Newspaper</a></span><span style=";font-family:arial;font-size:78%;" ><span style="font-weight: bold;"><br /><br /><span style="font-family:arial;">MMC</span></span></span><span style=";font-family:arial;font-size:78%;" > is in its third horrible year, so here's a little something for you medical students who find themselves in the midst of being randomly-allocated an F1 job. Next year you'll do it all over again!<br /><br />Many of you have recently heard whereabouts in the country you are able to apply to for your first job. I thought I could worry you further by sharing the questions you will probably be answering in the future. In an act of unfathomable laziness, I have published my completed F2 form in its entirety.<br /><br />In this world of uncertain careers, job shortages, cheap flights to Australia and down-banding, it is almost comforting - and by that I mean horrifying - that we have to fill out answers to these mind-numbing questions year after year.<br /><br />Remember, you must always use all 75 words you're allowed. ALWAYS.<br /><br />Here are some websites you might find useful when applying for jobs in medicine:<br /><br /><a href="http://www2.goldmansachs.com/careers">www2.goldmansachs.com/careers</a><br /><a href="http://graduates.deloitte.co.uk/">graduates.deloitte.co.uk</a><br /><a href="http://www.ubs.com/graduates">www.ubs.com/graduates</a><br /><a href="http://www.ml.com/careers">www.ml.com/careers</a><br /><a href="http://www.pwc.com/uk">www.pwc.com/uk</a><br /><a href="http://www.kpmg.co.uk/careers">www.kpmg.co.uk/careers</a><br /><br /><br /></span><div style="text-align: center;"><span style=";font-family:arial;font-size:78%;" ><img src="http://farm1.static.flickr.com/136/394363166_2cb8f5c783_o.jpg" alt="foundation copy" height="50" width="520" /></span><br /></div><span style=";font-family:arial;font-size:78%;" ><br /></span><span style=";font-family:arial;font-size:78%;" ><span style="font-weight: bold;">Name:</span><br />The Daily Rhino<br /><br /><span style="font-weight: bold;">Medical School:</span><br />St. George's Hospital Medical School (that was the damn name when I entered)<br />Tooting<br /><br /><span style="font-weight: bold;">Date of Graduation:</span><br />07/06<br /><br /><span style="font-weight: bold;">Primary qualifications:</span><br />MBBS (London)<br />BSc (Bronze Swimming Certificate)<br /><br /><span style="font-weight: bold;">Evidence of high academic achievement gained after completion of secondary education (or equivalent):</span><br />None.<br /><br /><br /><span style="font-weight: bold;">Using an example from your F1 experience to date, describe how your communication skills have improved an individual patient's care.</span><br />An elderly, deaf, confused, Jamaican, homeless man was diagnosed with penile cancer. His difficulty hearing, coupled with his dementia and lack of English comprehension, made it difficult for him to understand when the consultant informed him he had a neoplastic mass in the corpus cavernosum. Hence I decided to use my honed communication skills, by shouting in his ear: “E BLAASCLAAT, YA DINGALING BE CHICHI BRER!” He understood immediately and insisted I was the best shouter he had ever met. (75 words)<br /><br /><br /><span style="font-weight: bold;">Using an example from your F1 experience to date, demonstrate how you have learned from a potentially serious mistake or error and how your practice has changed as a result.</span><br />I make mistakes on such a regular basis, I can happily say I am learning a huge amount. It is difficult to identify a solitary mistake, but in retrospect I think one stands out. During my entire career at medical school, I never attended lectures, classes or PBLs once. I chose instead to spend my time watching Sponge Bob Squarepants and listening to Pink Floyd. At the time, I was sure I was doing the right thing, but now I’m fairly confident not attending medical school was a mistake. This occurred to me when I realised I don’t know any medicine on my first day of work. Still, no one’s noticed yet. (75 words)<br /><br /><br /><span style="font-weight: bold;">Describe an example drawn from your F1 experience where teamwork was ineffective. Why do you think it went wrong and what did you learn from it for the future?</span><br />During Wednesday evening five-a-side, I made a glorious run down the left wing and Gee didn’t pass out wide, instead trying to make an impossible run past a flat back 3. He does it all the fucking time, MAN it annoys me. So the following week I kicked him in the shins as hard as I could. Haha, that’ll teach him teamwork. (64 words)<br /><br />And this was very important and so I thought yes the end. (75 words)<br /><br /><br /><span style="font-weight: bold;">In the curriculum there are 16 competencies. Choose 2 and give a different example from your F1 experience for each demonstrating your achievement of this competency and the significance to you.</span><br /><br /><span style="font-weight: bold;">Safely and effectively uses common analgesic drugs (75 words)</span><br />Oh man, the amount of times I’ve used analgesic drugs, jeez I’m so safe and effective, I could do it in my sleep. I mean safe safe, not safe SAFE). Now that cannabis is legal for all uses, I’ll be ideally placed to teach my MS, OA and teenage patients how to roll scuds, pencils, Ls, tulips, megas and super-MCs. I’ll teach them the superiority of silver Rizla and the importance of a poking biro. I have also taken Paracetamol - yeah I was fine thanks. (75 words)<br /><br /><span style="font-weight: bold;">Discusses Do Not Attempt Resuscitation (DNAR) orders/advance directives appropriately (75 words)</span><br />A sick patient was going to die but his family felt otherwise and wanted him resuscitated at all costs, despite the medical reg insisting this would be unsuccessful. I tried to help out and I think I got the message across succinctly. I drew my ceremonial bat’leth and slay the patient’s grandson. If the family would protesteth, they would all taste my blade. Too late, I could not spare any of them. As I slashed back and forth, I muttered loudly over my breath, “this hurts me more than it hurts you.” Were a truer word ever spoken? Yes. (75 words)<br /><br /><br /><span style="font-weight: bold;">Give an example of a professional achievement from your F1 year, such as an audit or presentation, not already described and its significance to you.</span><br />I have much to be proud of. I have audited some shit about murderation. I write a monthly column for some medical student paper which brings joy to millions. But perhaps the most admirable of my admirable achievements is my ability to slice a man in half with my fist, like Sonny Chiba. I can also punch out a human male’s eyeballs with a fist-punch. Basically, my fists are battering irons imbued with fury. This is significant to me because it’s cool. (75 words)<br /><br /><br /><span style="font-weight: bold;">Describe actions you have taken to prepare for your future career choice and progress made (75 words).</span><br />Since a tender age, maybe 4 but I’m not sure, I have wanted to be an evil doctor with a mighty neck beard where I stored actual crunk. I have spoken to my careers advisor and undertaken a SCI59 questionnaire, which both suggested I should follow the course of evil and dedicate my life to the blood god that slaughtered my ancestors. I realise it’s almost impossible to land a London evil rotation, so as staying in the capital is important to me, I’ll probably end up doing histopathology. EVIL histopathology. (75 words)<br /><br /><br /><span style="font-weight: bold;">The programme you applied for:</span><br />Emergency Medicine (St George's, 4 months)<br />Renal Medicine (St George's, 4 months)<br />Intensive Care Medicine (St George's, 4 months)<br /><br /><span style="font-weight: bold;">The programme you have obtained:</span><br />Public Health (Stoke Mandeville PCT, 4 months)<br />Homeopathy and Reiki (Weston Super-Mare High St, 4 months)<br />In-house McGP (Slough McDonald’s, 4 months)<br /><br /><br /><br />Another happy junior doctor.<br /><br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com1tag:blogger.com,1999:blog-15298599.post-1167084807299884342006-12-25T22:04:00.000+00:002006-12-25T22:13:27.316+00:00Hinglish 2<div style="text-align: center;"><a href="http://farm1.static.flickr.com/166/333154153_0e56f63755_o.jpg" title="Fasial Bleeching"><img src="http://farm1.static.flickr.com/144/333154157_5399400c4f_o.jpg" border=0; alt="Fasial bleeching Sm" height="338" width="530" /></a></div>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com2tag:blogger.com,1999:blog-15298599.post-1164134429360492992006-11-21T17:35:00.001+00:002008-03-19T18:50:12.653+00:00F1. It's fun: Drugged up and in demand<span style=";font-family:arial;font-size:78%;" ><span style="font-style: italic;">Originally published in the November issue of </span><a href="http://www.medical-student.co.uk/">Medical Student Newspaper</a>.<br /><br /><span style="font-weight: bold;">WHEN</span> I was a student, I thought I was a bit of a bum. This was predominantly because I was, in fact, a bum. On those rare occasions when Jupiter was in the House of Saturn and the Moon was waxing, I decided to show up to whatever firm I happened to be doing. A combination of my overt ineptitude and uncontrollable humming of the Rocky theme music made me feel like I was little more than a nuisance, constantly getting underfoot of the people actually working.<br /><br />With the exception of some fantastic doctors I encountered, a large amount of hospital staff made students feel particularly unwelcome on their clinical attachments. Now I've got that magical 'Dr' in front of my name, I'm treated very differently. For the first time in my life, I'm in demand.<br /><br />I am endlessly courted by drug reps. No matter how many times I tell them I'm not that type of boy, they continue to thrust their increasingly bizarre freebies into my alco-wiped hands. For example, I recently experienced a glorious period in my life: I didn't pay for a single lunch all week. For whilst my position in the hospital has changed since I graduated, my cheapskate tendencies have remained entirely unabated.<br /><br /></span><div style="text-align: center;"><span style=";font-family:arial;font-size:78%;" ><img src="http://www.schizoaffective.org/drugreppens.jpg" /></span><br /></div><span style=";font-family:arial;font-size:78%;" ><br />I revel in my free lunches, but all <span style="font-style: italic;">Medical Student Newspaper</span> readers will know that there is <a href="http://www.nofreelunch.org/">nofreelunch.org</a>.<br /><br />The NoFreeLunch movement and its related anti-Big Pharma (spit) efforts have been covered extensively in the paper, so I shan't re-tread old ground other than to say that the website is thoroughly worth checking out. It has a specific section for medical students - you are identified as a key asset, after all, you have more prescribing years ahead of you than anyone else.<br /><br />I was a devotee and a committed NoFreeLuncher; I wanted nothing to do with the godless, evil drug companies (spit). I made sure to give a stern lecture to my colleagues who expressed even a passing interest in picking up a free pen. So why am I now munching on free lunching? The honest answer is because I'm weak. The supplementary answer is because it's far easier to stand steadfastly against the pharmaceutical industry (spit) when you are a student.<br /><br />The freebies are so diverse and relentless in their onslaught that it is nigh impossible to avoid utilising at least a pen, especially with the inordinate amounts of writing an F1 does. When a drug company offers you dinner in a restaurant so swanky that patrons are given four types of fork, it isn't easy to say no. They have free booze (now you understand).<br /><br />I tell myself that I'm actually doing the anarchic thing and consuming pharmaceutical company resources by eating their food and using their pens. But for every item of branded paraphernalia I accrue, I am subjected to a few minutes of rep-chat.<br /><br />They show me Fisher Price-style bar charts explaining why their drug is better than sex and everything else KILLS you slowly. I worry that no matter how hard I try not to listen before saying "yeah yeah OK, can I have a meal ticket?", some of their hard-sell has subconsciously filtered through to the prescribing centre of my brain. Indeed, observational studies have shown that promotions and interactions with reps does affect prescribing patterns.<br /><br /></span><div style="text-align: center;"><span style=";font-family:arial;font-size:78%;" ><img src="http://www.pjonline.com/Editorial/20060429/pictures/p499.jpg" /></span><br /></div><span style=";font-family:arial;font-size:78%;" ><br />Along with my firm-partner, Ellie, I'm trying to get a journal club up and running (mock me not, I have a CV to worry about here). As I'm sure you already know, doctors need an incentive to turn up to anything that removes them from the mess. Chiefly, food. Who is happy to provide Ellie and me with food? Those good old drug reps. What, free of charge? Nay! They want us to present a paper that just so happens to be pushing their latest pill. Funny, that. At the very least they would want to be present to leaflet attendees with 'evidence' concerning the drug they happen to be dealing.<br /><br />Our grand rounds are sponsored by pharmaceutical companies, as are the weekly GP lunches. Whilst admirable American bodies such as NoFreeLunch advocate a complete embargo on sponsorship from drug companies for talks and meetings, the British NHS does not have a vast pot from which to withdraw for such events. Use of money to feed doctors when alternative sources of funding are available might be seen as irresponsible.<br /><br />Comparing the profession we have chosen with others can be depressing. Those in the world of finance train for a shorter time than us and are wined and dined frequently. But the relationship they have with clients is not the same fiduciary interaction that exists between doctor and patient. A more apt comparison would be a politician and the electorate. As the Labour Party has demonstrated recently, politicians are not supposed to accept gifts from lobbyists. These are people who want to effect change in politicians' behaviour, much in the same way reps are trying to affect doctors.<br /><br />Where you stand is a decision you will begin making now, while you are a student. All I can say is, as I use my Imdur optical mouse, my Bisoprolol LED mouse-mat and my Viagra wrist support (hehe), that the person able to resist any of the goodies on offer may well be a better doctor than me. But hey, I'll have cooler stuff.<br /><br /></span>Rohinhttp://www.blogger.com/profile/06750260502455627449noreply@blogger.com3