juniordr issue 23
DESCRIPTION
The magazine for junior doctors by junior doctorsTRANSCRIPT
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THE MAGAZINE FOR JUNIOR DOCTORS
Presenting HistoryJuniorDr is a free lifestyle magazine aimed
at trainee doctors from their first day at
medical school, through their sleepless
foundation years and tough specialist
training until they become a consultant. It’s
proudly produced entirely by junior doctors
- right down to every last spelling mistake.
Find us quarterly in hospitals throughout
the UK and updated daily at JuniorDr.com.
Team LeaderMatt Peterson, [email protected]
Editorial TeamYvette Martyn, Ivor Vanhegan, Anna Mead-
Robson, Michelle Connolly, Muhunthan
Thillai
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What’s inside
04080916
18
22
26
LATEST NEWS
Photo FEATURE
BEST MEdical aPPS
WorkiNg Part-tiME: A GUIDE
CHRISTMAS IN SiErra lEoNE
dr. FairytalE: JAMES BOND
COURSES AND coNFErENcES
I n December the total number of mobile phone app downloads passed 22 billion - the equivalent of four for each person
on the planet. If you’ve got a smartphone it won’t be a surprise to you how addictive they have become. Whether you’re order-ing groceries, finding directions or revising for MRCP1 in the hospital mess - there’s now an app for everything.
Mobile apps have revolutionised how we use our mobile phones and are now starting to revolutionise how we practice healthcare. With four out of five medical students now owning a smartphone - three times more than the average person - medi-cine is a profession app developers are keen to exploit.
Current apps can enable you to view your patient’s live ECG trace from any-where with a mobile signal or complete instant blood analysis by plugging a small cartridge into your iPhone. In this issue we review the best mobile apps to help you decide what you should be carrying in your pocket (p9).
But where’s my JuniorDr app you might be asking? Look out for our new (and free) mobile app in the iTunes and Android app stores this Spring. As well as all the news and features you’d expect we’re using geolo-cation technology to offer some fancy new tools. We also have an iPad version in devel-opment which means you’ll soon be able to read JuniorDr wherever you are.
Also in this issue Mikey Byrant, our blogger from Sierra Leone, tells us about a Christmas where doctors desire more basic things than mobile phone apps (p18). Rath-er than playing Angry Birds on his iPhone Mikey’s holidays are spent dealing with
more unexpected arrivals into Freetown’s children’s hospital.
On page 16 we look at flexible train-ing and the opportunities for trainees who would like to work less than full time. As the demand for less than full time train-ing grows Emma Tyson and Ellie Galloway offer advice on how to set up and apply for a ‘slot share’.
Remember, JuniorDr is a magazine pro-duced entirely by you. We need you to get involved and make it your community. We’re planning a special section on junior doctor research in June so if there’s anything you think we should be including do let us know at [email protected].
MEDICINE - thErE’S aN aPP For that!
NEWS PULSE4
tell us your news. Email [email protected] or call 020 7193 6750.
T he number of consultants taking voluntary early retirement in 2011 increased by nearly three quarters
compared with 2010, according to a report published in BMJ Careers.
This high rate reflects the growing dissat-isfaction among consultants with the chang-es underway in the NHS says the BMA.
The data, from the NHS Business Ser-vices Authority Pensions Division, shows that the proportion of consultants taking voluntary early retirement before the age of 60 increased by 72.4% in the past year, from 98 doctors in 2010 to 169 in 2011.
Over the past five years the propor-tion of consultants taking early retirement has almost doubled from 7.3% in 2006 to 14.0% in 2011.
Ian Wilson, deputy chairman of the BMA’s Consultants Committee, said increasingly long hours and intensity of work, partly due to the drop in junior doc-tors’ availability following new working time restrictions; changes to NHS pen-sions; and reform of the NHS are col-lectively making many consultants opt for retirement at the earliest possible opportunity.
“Anecdotally doctors are telling us all the time that if they could retire they would retire, whereas in the past doctors tended to want to carry on for as long as they were able to,” he says.
“People are feeling disempowered by
NHS structures and NHS functioning, and there’s an attraction for people to retire from the rat race.”
Many consultants are frustrated with the way the health service is changing, partly as a result of the ongoing reforms set out in the Health and Social Care bill, and other changes that are taking place, said Dr Wilson.
Furthermore the changes planned for public sector pensions - such as increased contribution rates and the end of final sala-ry pensions - are driving consultants to take retirement now rather than stay while the government’s proposals play out, he said.
The NHS Business Services Authority
says this increase is driven in part by the rise in the size of the consultant workforce, which has grown by 4.5% year on year over the past 10 years, and the changing age pro-file of consultants.
www.bmjcareers.com
MORE CONSULTANTS TAkING EARLy RETIREMENT AS NhS diSSatiSFactioN groWS
NHS REFORMS
GMC
T he General Medical Council is cutting fees for all doctors - the first time the annual fee paid has been cut since it
was introduced in 1970.The Annual Retention Fee will be
reduced from £420 to £390 for doctors
holding registration with a licence to prac-tise, and from £145 to £140 for doctors holding registration without a licence to practise. Both will be effective from 1 April 2012.
Provisionally-registered doctors will pay £95 a year, down from £100 in 2011 and £145 in 2010.
It is estimated that the 245,000 doctors on the register will save an estimated com-bined total of over £6.5 million.
The reduction in fees has been made possible by improvements in efficiency, says GMC chief executive Niall Dickson, which has led to savings of over £8 million in 2011.
“We have a responsibility to provide value for money and, as far as we can, to control our costs. Last year we were able to freeze the annual fee paid by all doctors and cut the fee paid by newly qualified doctors.”
www.gmc-uk.org
Ian WilsonDEPUTy chAIRmAN, BmA coNSULTANTS commITTEE
“People are feeling disempowered by NHS structures and NHS functioning, and there’s an attraction for people to retire from the rat race.”
gMc cutS FEES FOR ALL DOCTORS
N ine out of ten GPs (88%) have reported that the intensity of their consultations has increased over the last five years, according
to a BMA survey of 18,757 GPs. 84% also feel the tasks they are required to do are more complex.
The results come from a major BMA survey of general practice in the UK on issues ranging from workload and morale to the potential changes from the Health and Social Care bill. 46,700 GPs were polled with a response rate of 40 percent.
“Much of the work we do now, such as look-ing after people with diabetes, used to be done in hospital and even though it’s work we want to do because of the clear benefit to patients, it has made it harder to fit a consultation into a ten minute time slot and it can make it more difficult to deal with surges in demand,” said Dr Laurence Buck-man, Chairman of the BMA GPs Committee.
Seven in ten (68%) GPs in England are
concerned about conflicts of interest inherent in the reforms, both for the impact they could have on the patient-doctor relationship (68%) and because of their role as both the commissioners and providers of care (69%).
www.bma.org.uk
gP coNSultatioNS INCREASINGLy MORE INTENSE AND COMPLEx
WORKING CONDITIONS
S ub-Saharan African countries that train and invest in their doctors end up losing billions of pounds as the clinicians leave to
work in developed nations, according to a study published in the BMJ.
According to the study, South Africa and Zim-babwe have the greatest economic losses in doctors due to emigration, while Australia, Canada, the UK and the US benefit the most from the recruit-ment of physicians educated in other countries.
The study by the University of Ottawa esti-mated the monetary cost of educating a doctor through primary, secondary and medical school in nine sub-Saharan countries with significant HIV-prevalence. These included Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.
The results show that governments spend between £13,600 (Uganda) to £38,000 (South Afri-ca) to train doctors. The countries included in the study paid around £1.3 billion to train their doctors only to see them migrate to richer countries.
The authors add that the benefit to the UK was around £1.7 billion and for the United States around £579 million.
The migration of health workers from poor countries contributes to weak health systems in low-income countries and is considered a primary threat to achieving the health-related Millennium Development Goals, says the study.
In 2010, the World Health Assembly adopt-ed the first “Code of Practice on the International Recruitment of Health Personnel” that recognises problems associated with doctor migration and calls on wealthy countries to provide financial assistance to source countries affected by health worker losses.
www.bmj.com
doctor MigratioN to dEvEloPEd NatioNS COSTS SUB-SAHARAN AFRICA BILLIONS OF DOLLARS
GLOBAL HEALTH
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NEWS PULSE6
D octors should be allowed to object to any procedure that conflicts with their personal, moral or religious beliefs
according to a survey of medical students published in the Journal of Medical Ethics.
Nearly half of respondents (45%) believed in the right of doctors to conscientious-ly object and refuse to treat a patient who wanted an abor-tion, contraceptive services, or who was drunk or high on drugs, or who wanted an inti-mate examination and was of the opposite sex.
In response to the question: ‘Do you think that doctors should be entitled to object to any procedure for which they have a moral, cultural or religious disagreement?’ 45% said yes; 14% were unsure; 40% said no.
Three out of four Muslim students (76%) responded in the affirmative, as did over half
of Jewish, Protestant and ‘Other’ students. The proportions of those with other faiths who said ‘yes’, ranged from 34% (Hindu) to 46% (Catholics).
Over 700 medical students at medical schools in Cardiff, London, and Leeds completed anonymous ques-tionnaires to canvass their views. Just under a third (30%) said they had no faith. Students on the tradi-tional five year course (21%) were more likely to raise objections than those on the four year course (3%).
“Once qualified as doctors, if all these respondents acted on their conscience and refused to perform certain procedures, it may become impossible for conscientious objec-
tors to be accommodated in medicine,” says the study author Dr Sophie Strickland, King George Hospital, Barking Havering and Red-bridge University Hospitals.
www.jme.bmj.com
coNSciENtiouS objEctioN Should bE right, SAy MED STUDENTS
ETHICS
M edical student leaders have called on ministers to ‘get a grip’ on the prob-lems allocating jobs to newly quali-
fied UK educated doctors after it emerged that there are more applicants than places available for the Foundation Programme for a second year running.
The UK Foundation Programme Office (UKFPO) announced that there were 81 more applications from final year medical students than there were places on next year’s Founda-tion Programme, which begins in August 2012.
“While it is a relief that the oversubscrip-tion is lower than in 2011, when 185 stu-dents were left in limbo about their first job, it is unacceptable that for a second successive year we are facing this situation,” said Mari-on Matheson, Co-Chair of the BMA’s Medi-cal Student Committee.
“It is worrying that the UKFPO and min-isters now appear to regard this as a routine problem that students will have to endure each year.”
The BMA has urged the government to
ensure all UK medical graduates receive a place on the Foundation Programme as soon as possible and that no UK graduate is left without a job next year. It is expected that vacancies will arise as each year a number of students withdraw their applications because of personal reasons or they fail their exams.
“Having a system that leaves some UK grad-uates unemployed after medical school would be a colossal waste of the £266,000 of taxpay-ers money spent training each medical student. It is essential that ministers get a grip on the factors behind this situation to ensure we don’t have a repeat of this situation every year.”
www.bma.org.uk
bMa: ukFPo MuSt ‘gEt a griP’ ON JOBS FOR NEWLy qUALIFIED DOCTORS
TRAINING Public health honoursThe number one medical specialty to
appear on the New Year’s Honours list
in the last decade is public health medi-
cine, according to research published in
the Journal of the Royal Society of Medi-
cine. GPs head the league table in terms
of numbers but when this figure is con-
verted to a percentage of all registered
GPs, a relatively small proportion re-
ceives honours. Public health medicine,
despite ranking fourth overall in absolute
numbers, comes out top in percentage
terms.
jrsm.rsmjournals.com
RIP from CPR less on TVThe public may have an over-opti-
mistic impression of survival and neu-
rological outcome after cardiac arrest
because newspapers tend to report suc-
cess stories, according to a study pub-
lished in the Journal of the Royal Society
of Medicine. Researchers looked at car-
diac arrests that occurred outside hospi-
tal which were reported in newspapers
in the first six months of 2010. Of these
17.7% survived to hospital discharge, al-
most all with good neurological outcome.
This compares with an estimated survival
rate of less than 10% for out-of-hospital
cardiac arrests in Europe.
jrsm.rsmjournals.com
Dirty med studentsOnly 21 percent of medical students
could identify five true and two false in-
dications of when and when not to wash
their hands in the clinical setting, accord-
ing to a study by the Association for Pro-
fessionals in Infection Control and Epi-
demiology. Additionally, the students
expected that their own hand hygiene
compliance would be “good” while that
of nurses would be lower, despite other
published data that show a significantly
higher rate of compliance among nurs-
ing students.
www.apic.org
Doctors for hireThere has been a 90% increase in re-
cently qualified doctors going freelance
or focusing on locum work, according to
a study by the contractor PAYE adminis-
tration company FPS. However, mid-ca-
reer doctors and nurses (those aged 29
to 49) are now less likely to take on con-
tracted work, suggesting they are holding
on to permanent positions in the health
sector.
www.nationalfreelancersday.org.uk
Marion Matheson co-chAIR, BmA mEDIcAL STUDENT commITTEE
“It is worrying that the UkFPO and ministers now appear to regard this as a routine problem that students will have to endure each year.”
Medical MasterclassMRCP(UK) exam revision and preparation materials from the Royal College of Physicians
Medical Masterclass packages are available for both individual and institutional sales and comprise:
• 12 printed modules covering the scientific background to medicine, clinical skills and the range of medical specialties in the MRCP(UK) exams.
• Online access to 3,000 MRCP(UK) exam type questions.
• NEW! PACES screencasts describing the format and stations of the PACES exam, giving examples of common scenarios and cases faced by candidates, and – most importantly – explaining what PACES examiners are really looking for.
• 60 PACES interactive case studies on 2 interactive CD-Roms.
For further details or to purchase online, visit www.medical-masterclass.com or email [email protected]
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M edical students from low income backgrounds are grad-uating over £13,000 more in
debt than their better off peers, accord-ing to a new report from the BMA.
The results from the survey also indicate that the number of students from the lowest income brackets in medical school has declined in the past 12 months.
The survey of more than 2,800 medical students found that the aver-age medical student debt on graduation has risen from £23,909 to £24,092. However, those from lower income brackets are gradu-ating with a projected debt of £37,588, up from £26,324 in the past 12 months.
The number of medical students from low income back-grounds studying in medical schools has dropped from 14% to 11% in the past year.
“It is hardly surprising that there has been a noticeable and worrying drop in the number of students coming from less well off backgrounds. With the government intent on allowing univer-sities to charge up to £9,000 a year in tuition fees from 2012 the picture for all medical students looks bleak,” said Elly Pilavachi, Co-Chair of the BMA’s Medical Student Committee
www.bma.org.uk
M ost of the 300 doctors in training rotas exempted from the 48 hour limit on working time imposed by the Euro-pean Working Time Directive (EWTD) are now compli-
ant, according to a report by BMJ Careers.Rotas at 77 hospital trusts in England were “derogated” from
the EWTD when it was introduced in August 2009, allowing them to operate at a maximum of 52 hours a week instead of 48 hours until 31 July 2011.
All of 57 trusts that responded to a freedom of information request confirmed that their training rotas are now compliant with the 48 hour limit stipulated in the directive.
Some trusts had made their derogated rotas compliant with the 48 hour limit as of 2009, whereas others, such as Peterborough and Stamford Hospitals Trust, had only ensured compliance by October this year.
Alder Hey Children’s NHS Foundation Trust reported diffi-culty recruiting for some posts, but said it expects the rotas to be compliant shortly.
www.bmjcareers.com
highEr dEbt FORCING OUT STUDENTS FROM LOW INCOME BACkGROUNDS
MoSt traiNiNg rotaS NOW EWTD COMPLIANT
FINANCE
WORKING CONDITIONS
DESIGNING OUT MEdical Error EXHIBITION
Infection ControlThe Carestation (now sold as the ‘CareCentre’
by UK manufacturers and partners Bristol Maid) is a unit placed at the end of the hospital bed, con-taining all the necessary equipment for common healthcare processes. It is intended to streamline staff workflow and improve access to equipment. It contains aprons and gloves, a medication locker, a flat surface for writing, a folder holder, alcohol hand gel, a clinical waste bin and cleaning wipes.
Hand HygieneBuilding on the successful National Patient Safety Agency ‘Clean Your Hands’
campaign, the research focused on reminders within the bedspace. A simple sym-bol, taking cues from construction safety signage, replaces the often ignored and confusing plethora of signage currently surrounding the alcohol hand gel dispens-ers. The clear sign is accompanied by a simple communications campaign to edu-cate staff about the symbol.
Vital SignsThe new trolley design features an improved cable
management system, making it much easier to clean between patients. The touch screen computer automati-
cally records the patient’s vital signs and displays them on a chart. This removes the errors in transcription and inter-pretation found in the research. This design is in ongoing
development with US manufacturers Humanscale.
Make it Better: Designing Out MeDical errOrTUESDAy 31 JANUARy - SATURDAy 04 FEBRUARyQvIST GALLERy, hUNTERIAN mUSEUm.FREE ENTRy
M ake It Better is an exhibition of designs for the clinical environ-ment aimed at reducing medical
error.Mistakes made in healthcare can have
huge human and financial costs. The design of much medical equipment and environ-ments is outdated, confusing and can lead to errors. Patient safety is a complex issue that needs approaching from different viewpoints.
A multidisciplinary team was brought together for three years to research medical error and involve front line clinical staff in developing new designs.
The results are a suite of research findings and innovative designs aimed at better sup-porting front line staff and reducing medi-cal error at the bedside.
Research undertaken by the Helen Ham-lyn Centre for Design, Royal College of Art and Imperial College, London. Funded by the Engineering and Physical Sciences Research Council.
www.domeproject.org.uk
HuNTERIAN MuSEuMRoyAL coLLEGE oF SURGEoNS35-43 LINcoLN’S INN FIELDSLoNDoN Wc2A 3PETUBE: hoLBoRNWWW.hUNTERIANmUSEUm.oRG
mEDIcAL APPS 9
BEST
MED
ICAL
aPPS
This is one of those apps that has the potential to change the world - or at least make on-calls a lot less painful.
AirStrip allows you to securely view live streaming patient monitoring data from wher-ever you are. You can check in on your patients and review their vitals, cardiac waveforms, labs, medications, intakes and outputs, and allergies - all within seconds of when they were recorded.
Unfortunately it does require your hospital to have purchased and installed AirStrip but this now spreading across the US and making a presence in the UK. In the meantime there is a demo built into the mobile app to let you see the potential of this new technology.
Whether it’s calculating gentamicin doses, checking the latest guidelines or practicing MCQs the smartphone has become an essential piece of medical kit for working on the move. As the number of medical apps breaks through the 10,000 barrier we test out the best apps for work, revision and play.
IPhoNE, IPAD, ANDRoID,
BLAckBERRy, WINDoWS moBILE
FREE
AIRSTRIP
Medscape is produced by US healthcare com-pany WebMD but don’t let the American back-ground put you off. This mobile app recorded has over a 1 million users and was the most down-loaded free medical app from iTunes in 2010.
As well as the standard news and alerts you can choose the specialities relevant to you for personalised content updated daily. You can view the prescribing information for 8,000+ brand and generic drugs - and impressively pill images for when you can’t work out what’s what.
There are over 600 educational videos and over 4000 learning articles to keep you busy between ward rounds, including a CME library. What’s also clever about this app is that both the clinical reference and drug data-base can be accessed anywhere without an internet connection or Wifi.
Overall it’s an indispensable app with so many functions you will for-give all the Americanisms.
Reading medical journals has never been a pleasant experience - there are the never-ending pages of text, tiny data tables and hours spent scanning through to find what you need. Then the iPad arrived.
No medical journal has managed to do the transition to the iPad as well as the BMJ. It’s graphical, well-organised and the research is a joy to read. As well as the full content from the week-ly version you’ll also find the blogs, podcasts and videos from BMJ.com
If you’re a BMA member you can get your iPad verion of the journal for free - otherwise it’s an expensive £2.99 per issue.
IPhoNE, IPAD, ANDRoID,
BLAckBERRy, WINDoWS moBILE
FREE
IPAD
£2.99 PER ISSUE
MEDSCAPE
BMJ
mEDIcAL APPS10
Although we wouldn’t suggest you pull out your iPhone at the next resus you attend we do think this is an excellent app for reviewing the guidelines. Produced by the UK Resuscitation Council it provides the latest guidance on your phone.
It’s automatically updated when guidelines are reviewed and you can also choose to receive alerts and news. Overall it’s a simple app well executed.
IPhoNE
FREE
IRESUS
We love this app. It’s a game that lets you investigate, deduce and diagnose complex clini-cal cases on your smartphone. Each case takes a few minutes and helpfully includes some learn-ing points for each scenario you complete.
Although the cases are aimed at board exams in the US you’ll find most of them suitable for UK specialties - though we did find many of them a little simplistic. It’s a great way to make use of those spare 10 minutes in the hospital mess or on the bus after a night on call.
A new case is added every weekend so it’s the app which you’ll keep on using.
A great free mobile app which brings Micro-medex to your smartphone - a comprehensive source of drug information similar to the soft-ware and web versions. There are over 4500+ search terms covering all generic and trade prescriptions.
As well as the standard information you’d expect there is comprehensive contraindications, dosage and pharmacokinetic information.
IPhoNE, ANDRoID
FREE
IPhoNE, IPAD, ANDRoID
FREE
PROGNOSIS
MICROMEDEx
BEST
MED
ICAL
aPPS
mEDIcAL APPS 11
It’s technically more of an online service than an iPhone application but d2u allows you to dic-tate speech and get an accurate typed version by a human within an hour. It’s perfect for lazy doc-tors who don’t have access to a NHS secretary.
Although we don’t recommend using it for patient information the service is reputed to be secure with 128 bit encryption. For short dicta-tions of less than 5 minutes you should receive your text back within an hour - more than 5 minutes and your completed files will be returned within 24hrs. The cost of dictation is £1.55 per minute of dictation.
IPhoNE, ANDRoID, BLAckBERRy
FREE
D2U
Visible Body is a 3D human anatomy app which allows you to explore the human body in a completely different way. The graphics in this anatomy app are stunning and the experience is unlike anything you could find in a traditional textbook.
There are over 2,500 structures which can be rotated, tilted and zoomed. Each has detailed shading allowing you to easily see different structures within the male and female models.
The app also has a useful search function which makes revising for exams much easier.
IPAD
£20.99
VISIBLE BODy
Diagnosaurus allows you to search over 1,000 differential diagnoses by organ system, symptom, disease, or browse all entries to help you reach an accurate diagnosis. Alongside each differential you’ll see the others to allow you to compare.
That’s it - nothing else - but it’s simple and effective.
IPhoNE, ANDRoID, WINDoWS, PALm,
BLAckBERRy
IPhoNE 68P, ANDRoID 64P,
WINDoWS FREE, PALm FREE,
BLAckBERRy FREE
DIAGNOSAURUS DDx
BEST
MED
ICAL
aPPS
BEST MEDICAL aPPS
mEDIcAL APPS12
One of the most frustrating things about being a doctor is having to learn and interpret ECG traces. We’re still waiting for an app that eliminates the need completely but in the mean-time ECG Guide will help you to improve your interpretation.
We found it a really useful learning aid as it introduces the approach to ECG interpretation and covers analysis of rate, rhythm, axis and waveforms. There are over 200 examples of common and uncommon ECGs and it has a compre-hensive section on arrthymias.
Once you’ve mastered reading ECGs there are 100+ multiple-choice questions to test your understanding and a ‘rapid reference section’ to help when you encounter difficult ECGs in clinical practice.
IPhoNE, IPAD, ANDRoID,
BLAckBERRy
IPhoNE/IPAD 69P, ANDRoID £3.02,
BLAckBERRy $9.99
ECG GUIDE
BEST MEDICAL aPPS
BEST
MED
ICAL
aPPS
Not strictly for doctors but we were very impressed by this app from NHS Direct. It allows patients to check their symptoms when feeling unwell and then offers advice on how to look after themselves whilst recovering. If they need input from an expert they complete some questions and one of the NHS Direct team calls them back. It’s not quite telehealth but a good step forward from the traditional NHS Direct service.
The app also offers a personalised guide to improving your health though we didn’t find this quite as useful.
IPhoNE, ANDRoID
FREE
NHS DIRECT
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14
T he saying goes “what happens on tour stays on tour”, but when post-ing online bear in mind that what
happens on Twitter stays on Google for-ever. Doctors should exercise caution when making entries on social networking sites - the internet is not a private space and noth-ing is truly anonymous, even if you use a pseudonym.
Recently, a hospital doctor’s tweeting sparked a national debate about what was appropriate for a medical professional to say on a social networking site. The trouble lies in that you never really know who is reading what you write; you could have a friend-of-a-friend reading your Facebook status, who might happen to be a patient or a disap-proving member of the public.
IN HOT WATER
MPS is aware of cases where junior doc-tors have discussed patients on social net-working sites, assuming that they would not be identified - but they were exposed
and those involved were disciplined. Similar findings were released by the
American Medical Association, who under-took research that uncovered online breach-es of patient confidentiality on social net-working sites by junior doctors. The research found explicit postings that revealed pri-vate patient information; most were in blogs, including Facebook, some containing enough clinical information that a patient could be identified.1
POSTING MATERIAL ONLINE
Social networking sites blur the bound-ary between an individual’s public and pro-fessional life. Be wary of posting inappro-priate material on social media sites, such as photos that may bring your professionalism or that of colleagues into question, even if they are taken in your free time.
If you do choose to post photo-graphs, then
DIGITAL docSyou should be careful about both their con-tent and your privacy settings - remember what happened to the doctors and nurses who took part in the Lying Down Game while at work and posted about it online?
However, tight privacy settings can create a false sense of security. Comments about your day-to-day work and the patients you have seen, even if anonymous, still pose a risk, as the information may be identifiable and so may breach confidentiality.
PROTECTING yOURSELF
Ways to protect yourself when using social media:
Medicolegal Advice - in association with the Medical Protection Society
Sara Williams explores the pitfalls of using social networking sites
14
•Remember to log out when you are mov-ing from one terminal to another.
•Check what levels of privacy you have set up.
•Enable secure browsing using https. This can be found under the account settings tabs of most social networking sites.
•Choose a password with a mixture of up-per and lower case letters and other char-acters, and change it as regularly as is practical.2
The appetite for social networking can only get bigger, so doctors should take advantage of its many benefits, as long as they are balanced against the risks.
FREqUENTLy ASkED qUESTIONS
blogs
q I work as a junior doctor in urology in a large teaching hospital; I’ve been
thinking of setting up a blog. What advice would you give?
A Our advice would be to tread cautiously and to consider all the following
pitfalls: breach of patient confidentiality; defamation; breach of contract (your trust or board may not be happy with what you have to say). It would be sensible to obtain the permission of trust/board management and your educational supervisor before taking the matter forward. Ensure you adhere to relevant GMC guidance, see Good Medical Practice.
Friend requests
q A former patient whom I saw when I was a medical student has approached
me on Facebook - they want to add me as a friend. What should I do?
A Don’t accept. Social network sites are called so for a reason. It is extremely
important that you retain professional boundaries between yourself, your patients and former patients. The GMC says that doctors who comment in the public domain about their work or the provision of healthcare must respect patient confidentiality. Should you post about a patient and they identify themselves, you could face a charge of breaching patient confidentiality and, before you know it, a GMC investigation into your fitness to practise.
responding to negative comments
q A patient has written negative comments about me on a social
Medicolegal Advice - in association with the Medical Protection Society
15
MPS is the leading provider of comprehensive professionalindemnity and expert advice to doctors, dentists and healthprofessionals around the world.
We actively protect and promote the interests of members and believe that education is an integral part of every healthprofessional’s development. As well as providing legal adviceand representation for members, we also offer workshops,conferences and a range of publications designed to aid goodpractice.
MPS is not an insurance company. All the benefits ofmembership of MPS are discretionary as set out in theMemorandum and Articles of Association.
About MPS
MPS Members who would like more advice on the issues raised in this article can contact the medicolegal advice line on 0845 605 4000.
www.mps.org.uk
The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS.
About MPS info for articles.qxd:MPS Checkup 12/2/10 10:05 Page 1
networking site; what should I do?
A It is often too easy to give a knee-jerk reaction. Although a negative
comment may be upsetting, and seen as damaging to your professionalism, or even possibly defamatory, it is important to keep a cool head and look at the issues objectively.
Initially, talk to senior trusted colleague or your medical defence organisation to discuss the situation and the best way for-ward. Think about what the patient has said and whether this is an indicator of an underlying concern that needs to be inves-tigated further. You may wish to consid-er treating this as a complaints, and invite the individual to discuss their concerns. By following this advice, the matter can be investigated, an explanation provided, les-sons learned and if appropriate an apology provided.
USEFUL LINkS
•BMA, Using Social Media (2011)•Williams S, Tweeting into Trouble, New
Doctor (3) 1 (2010) - www.medicalpro-tection.org/uk/new-doctor/january-2010/tweeting-into-trouble
•GMC, Good Medical Practice (2006) Pars 60-62
thiNgS to rEMEMbEr:•Do not accept current or former
patients as friends/followers.•Doctors and medical students who
post online have an ethical obligation to declare any conflicts of interest.
•The ethical and legal duty to protect confidentiality applies equally on the internet as to other media.
• It is inappropriate to post informal, personal or derogatory comments about patients or colleagues on public internet forums.
•Ensure that you do not inadvertently breach your contract of employment, by being aware of your local commis-sioning body or health board’s policy on blogging, etc.
•Defamation law can apply to any comments posted on the web made in either a personal or professional capacity.
•Have tight privacy settings, but be aware that not all information can be protected on the web.
•Be conscious of your online image when posting images on the web and consider how it may impact on your professional standing.3
1 American medical Association - www.ama-assn.orgii
2 Sophos, Facebook Security Best Practices - www.sophos.com/en-us/security-news-trends/best-practices/facebook.aspxiii
3 BmA, Using Social media (2011)
cAREERS16
A s of April 2011 there were 3777 trainees working less than full time (LTFT) in the UK - 6.6% of the total
number of doctors. Although 95% of these were women there were also a significant proportion of male doctors would also like to work LTFT in the future.
Helped by the changing demographics of the medical profession and demands for greater flexibility along with better work-life balance, the opportunities for LTFT have increased over the last decade.
Who can work part-time?All trainees are eligible to apply to train
less than full time and any ‘well founded rea-son’ which would prevent someone training on a full-time basis would be considered.
Doctors who wish to train LTFT main-ly fall into two categories which have been defined by the deaneries as -
Category 1
• Trainees with a disability or in ill health (may also include those on in vitro fertility programmes)
• Trainees (both men and women) with a re-sponsibility of caring for children
• Trainees with a responsibility for caring for an ill/disabled partner, relative or other dependant
Category 2
• Unique opportunities for their own personal/professional development eg. training for na-tional/international sporting events
• Extraordinary responsibility eg. a national committee
• Religious commitment - involving training for a particular religious role
• Non-medical professional development (eg. management/law/fine arts courses)
Trainees may train less than full time from the outset or transfer from full-time to LTFT (and back again if required).
Until July 2010 LTFT trainees could
train in supernumery posts which were funded from the deanery however the need to cut costs has meant the end of this oppor-tunity. Most LTFT trainees now work part time as part of a ‘slot share’ arrangement with the remainder managing to carry out reduced sessions in a full time post.
Slot SharingSlot sharing is when two trainees share
one full-time post and manage the out-of-hours between them. Slot share partners are not expected to cover unexpected absence, such as sickness or maternity leave of their slot share counterpart.
The deanery can sometimes provide the additional funding for slot shares where the total hours worked between the two trainees is greater than a 100% full time equivalent. This can act as an incentive to the employ-ing trust as they can end up with more clin-ical time, however the availability of this funding can vary between deaneries
In general slot share trainees need to work at least 50% WTE and this may involve shar-ing with a different person on each rotation.
reduced sessions in a full time postThis is a more uncommon arrangement
where a trainee occupies an established full-time post but works reduced hours. This is usually only agreed after repeated attempts at setting up a slot share have not been successful.
Experience of a slot shareWhen I qualified as a doctor my son was
six years old and I had initially thought that I would try and complete my foundation years before considering part time work for my specialty training. My ill patients tended not to be European Working Time Direc-tive compliant which made predictable fin-ishes difficult.
Although I was lucky enough to have excellent child care I found the first year a struggle, with balancing the demands of
WorkiNg Part-tiME: A GUIDEFoundation doctors Emma Tyson and Ellie Galloway talk through the process of applying for less than full time training (LTFT) after switching from full time to part time working and share their experience of a successful slot share.
work and home life becoming increasingly stressful. After a year of feeling guilty when leaving work and also feeling guilty for not being at home enough, I decided that my best option was to work less than full time hours.
Initially I was slightly embarrassed to admit that I was going to be part-time - wor-ried that I would be perceived to be ‘skiving’ and somehow not a ’proper doctor’. My con-cerns were unfounded however, as the words ‘I work part time’ seem to be met with posi-tivity and almost universal envy!
how it worksThe initial process of applying for LTFT
is fairly standard nationally and, although not complicated, it is a fairly paperwork heavy process. At a local level, once you’ve got deanery approval, there is a little more variability as some trusts may be able to be accommodating than others.
My FY2 post was at the Royal Surrey in Guildford and the coordinator there could not have been more helpful. There are two main issues that need to be resolved - firstly finding a suitable job share ‘other half ’ and secondly finding a job that lends itself to less than full time workers.
My job share partner Emma and I are currently working in A and E along with nine other SHOs. The shifts are each ten hours long and follow a fixed nine week rota with some weeks comprising 70 hours and others just 30 hours.
We are treated as one person so simply divide the line between us. Emma works half of the shifts and I do the other half plus three extra shifts over the nine week period thereby increasing my hours up to the 60 % of full time that I am contracted for. A and E is the perfect place to work less than full time as continuity is not an issue.
For our next job in medical edu-cation there will be a greater need for the two of us to share a single job. We have already discussed the work to be
cAREERS 17
done and how we intend to divide the tasks. For example, we have planned an overlap in our shifts so that we can spend some time together during the working week and will also create a shared email account so that we are contactable as one person.
Positive pointsWe were very fortunate that we were
allowed to choose our own shifts as long as we covered our allocated line of the rota. We particularly liked the fact that this allows us to be an integrated part of the team and also experience the full range of shifts - neither of us would feel that we had truly worked in
casualty if we hadn’t had our fair share of intoxicated Saturday
night patients and rugby injured Sunday ones.
The reduced hours that
Emma and I work means that we have much more flexibility for swapping shifts for child care reasons. Whilst this is obviously benefi-cial for the two of us it has had the unfore-seen advantage that we are invariably able to perform shift swaps with others. It is extremely difficult for the full time SHOs to swap duties due to the almost impossible task of finding a replacement shift that does not clash with the duties they are already rostered for. We are both really pleased that we are able to help in this way.
Another concern that we both had was that we would be adversely affected by our reduced exposure to cases. Although we clearly do see less patients than our full time colleagues, we do have the time (and ener-gy!) to read around the interesting cases that we have seen. Emma and I also meet week-ly to discuss the patients we have treated so that we each get the benefit of learning by experience - albeit indirectly. If one of us is unable to attend formal teaching we take notes for our ‘other half ’.
… and the negativesBeing out of sync with other trainees
does have disadvantages. The main one being the need to find a job to cover the ‘gap’ between the end of FY2 and starting core training. Although neither Emma nor myself are at this stage yet I can see that it may be problematic.
We have also found that although we are less than full time there is still the need to fit in formal training/audits etc and this has meant that we sometimes need to come in to work on our days off.
Finally, working reduced hours means receiving a dramatically reduced salary.
Words of adviceIf I could sum up how to make a suc-
cessful slot share work well it would be that there needs to be good communication, fairness and flexibility in division of work. We are fortunate that this has not been an issue between the two of us but as slot shar-ing is something of a lottery it could cer-tainly be a problem for some.
On balance, job sharing is a perfect solution that enables progression as a doc-tor without compromising family commit-ments. We would thoroughly recommend it.
If you want to find out more about flexible working and ask advice from others visit the careers section at JuniorDr.com.
1 Analysis of the bi-annual survey of less than full time training 1st November 2010 - 30th April 2011. West midlands Deanery
www.westmidlandsdeanery.nhs.uk/Linkclick.aspx?fileticket=wD
2 Women and medicine, the future. June 2009 Royal college of Physicians http://www.rcpsg.ac.uk/Fellowsandmembers/RcPSG_projects/Documents/Flexible%20Working/RcPLondon_Summary_Report.pdf
3 British medical Association cohort study 1995, eighth report http://www.bma.org.uk/healthcare_policy/cohort_studies/cohort8.jsp
4 kent, Surrey, Sussex Deanery LTFT Policy http://kssdeanery.org/sites/kssdeanery/files/kSS%20Less%20Than%20Full%20Time%20Training%20Policy.pdf
References
EmmA TySoN AND ELLIE GALLoWAy
JUNIoRDR BLoG18
CHRISTMAS INAs you sat down to your Christmas dinner our JuniorDr blogger, FY2 Dr Mikey Bryant, was in Sierra Leone with healthcare charity Mercy Ships. He has been volunteering in a children’s clinic for a year in a country where 1 in 5 children don’t live to see their 5th birthday.
In his Christmas update we hear how his usual quiet Welsh Christmas has been replaced by an altogether more chaotic affair.
SiErra lEoNE
DAy 23 - CHRISTMAS DAy
I wake up this morning to the sound of energetic singing from somewhere in my mind. I lie half-awake for a little while, my mind still in Wales with choirs singing Silent Night into endless dark evenings, Mum organising stockings and roasting turkey - I can almost smell it. I am woken into rude reality by the distinctive ‘green-swamp’ smell of cassava leaves coming through the mos-quito net, shattering any dreams of roast meat. The singing is real though as a distinctly Krio-sounding ‘Away in a manger’ rings out.
In some ways, Christmas here doesn’t feel that different; there are still plastic Santas everywhere with numerous streets decorated with lanterns and tacky lights. The biggest difference here is the lack of money being thrown around and most of the children who come in today are just glad to be surviving and eating from day to day. The thought of a child in Freetown throwing a tantrum about not getting the right colour dress or right make of shoe is unheard of.
I say Merry Christmas to everyone who comes in and try to find out a bit about what is going on with the multitude of ail-ments. There is no ‘granny-dumping’ here and very few signs of the winter sniffles I had grown so used to in Wales - instead we have a clinic where everyone who makes it in is incredibly unwell and often at death’s door.
The children are heartbreaking again today. I had thought I was a calm and unemotional lad but today I find myself taking impromptu toilet breaks to sort myself out.
It is just after one of these when Sarah comes rushing in, saying “Dr Mikey! We get dis one year old pikin, he hav only 4 kilos!” “He can’t be one year old!” I respond, stunned at what that meant. She doesn’t answer but just hands me a tiny bundle emitting a pitiful cry.
As I unwrap the layers, the tiny bundle gets depressingly smaller until there is just a collection of skin covering match-stick thin ribs. “Wetin don happen wi dis pikin?” I ask almost frightened to hear the response. It turns out this little girl has been unwell with diarrhoea and blood for over three months but dad was insistent on taking the child to local medicine men.
I can see the tell-tale signs of traditional healing, including a piece of string over the fontanelle ‘to make breathing fine’. Now
it may well be too late. She is painfully dehydrated; skin turgor having long gone, and our first priority is to get fluid in. Thank-fully, Sarah is a dab hand at putting in drips these days, and pret-ty soon we are doing all we can and can only hope it is enough.
DAy 24
It is Friday afternoon. I have decided that our nurses are a lot brighter than I had thought and that it would be great to be able to teach them a little more, so have arranged a few slides to go through some basic stuff.
Everyone is ominously quiet as I ask questions about blood cells and what they all do. I’d forgotten this is a generation of people who haven’t had the benefit of a secondary school educa-tion where everything was spelled out in simple terms.
Still, there is huge enthusiasm and I find myself wishing I had more time to go into more detail. I move onto worms and here everyone is in their element; I barely have to teach as I hear stories about how ascaris goes ‘walka walka’ around children’s lungs and stomachs, and how hookworms ‘don go insie de skin’ and cause ‘runnibelli’. I am astounded at this sudden burst of knowledge.
Afterwards, Kaddie runs up and shows me pictures they have all drawn of various species of worm from an ancient textbook. It turns out essential knowledge has been quite well-covered in the knowledge sieve of the civil war.
Later that afternoon we have the chance to visit the government children’s hospital. Theoretically this serves as a tertiary centre for the whole of Freetown. We have referred a number of patients there
“In England, children in paediatric wards have hundreds of cuddly teddies to play with. out here, the only cuddly friends are the rats.”
“I had thought I was a calm and unemotional lad but today I find myself taking impromptu toilet breaks to sort myself out.”
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ourselves and I am curious to see what happens to them. Sharon from VSO greets us as we come in looking worried.
She seems to have developed a permanently concerned frown since arriving. She shows us the ‘intensive care unit’ where she explains that the main difference here from the rest of the hospi-tal is that there are twice as many nurses.
I gaze around at the toddlers with ballooning bellies, the beds with five babies all sharing the same oxygen concentrator and the staff running around from one resus to another and realise how lucky I am to be working in a small NGO-led hospital where we have a reliable supply of medicine and equipment.
The constant sound of wailing comes drifting in from the corridor. Sharon tells me that after every death the mums cry for just a few minutes but give it all they can.
I can understand why Sharon looks as though she is carrying the whole world. Her last words before we leave sum up the visit perfectly, “In England, children in paediatric wards have hun-dreds of cuddly teddies to play with. Out here, the only cuddly friends are the rats”. Merry Christmas, I reflect, bitterly.
In the end everyone has left and a strange hush falls. Mandy smiles at me and thanks me for ‘making her day easier’. I can’t imagine what this must have been like with just one doctor here.
You can follow Mikey’s journey online at
JuniorDr.com by clicking on blogs.
Night sweats?It’s four a.m.
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You know what to do.
But it would be good to get a second opinion – just for peace of mind.
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FINANcE 21
F inancial planning for a new home should begin even before you start looking through the property pages.
In this article Wesleyan Medical Sickness gives you guidance on how to plan for your first mortgage.
Before you buy
The property market has suffered a slump during the economic downturn. According to the most recent Land Registry House Price Index, the average house price in England and Wales is still falling, with a 2.6% drop in the 12 months to September 2011 to £162,109.
While this may seem like good news for first time buyers, the downturn has also meant lenders are expecting buyers to put down a much larger lump sum than they would have done a few years ago. Over the past two decades, the average deposit has risen from an average of £6,700 to more than £65,000*.
First time buyers moving into a starter home generally won’t be faced with a deposit that big, but the fact remains that you will still be expected to find a sizeable deposit of about 15-20% of the property’s value, so it’s impor-tant to work out how much you are able to save towards it and other associated costs.
Effective budgeting will be vital: By mak-ing a note of your income and expenditure, you will be able to highlight areas where you may be able to cut back and save. When you put money away, try to find a savings prod-ucts with a good rate that will help your sav-ings grow quickly. A Cash ISA is a tax effi-cient option.
Finding the right mortgage
How much you need to borrow will depend on the value of the property, the
deposit you’ve accumulated, your income and other expenditures.
Getting the right mortgage is crucial as it will impact on long term financial planning. There are a variety of options available, with two of the most common being variable rate and fixed rate mortgages. A variable rate mortgage is linked to the rise and fall of the Bank of England base rate, while a fixed rate mortgage provides a set level for a designat-ed period of time.
For many first time buyers, a fixed rate mortgage will help them budget better. Pay-ments can be fixed for a set period of time such as two, three or five years to provide certainty. Others, with the ability to absorb increases and cope with varied payments, may decide they would be better off with a variable rate that usually fluctuates with the base rate but is generally cheaper than the fixed rate option. The base rate has been at 0.5% for the past two-and-a-half years and will inevitably rise, although when that will be is impossible to say.
Also gaining in popularity in recent years has been guarantor mortgages where, if you don’t earn enough to buy a property, a par-ent can step in and act as guarantor for the shortfall. Although with most guarantor mortgages your parent’s name does not have to appear on the mortgage agreement or the property deeds, they will still be liable for the loan if you do not keep up repayments.
Once you have decided on the kind of mortgage you will be having, you need to consider how you will re-pay it. The two main ways are repayment or interest only. A repayment mortgage means that over the length of the loan you will eventually pay off the full amount, plus interest. An inter-est only mortgage means you are only paying
off the interest accrued every month. The payments will be lower, but at the end of the loan period you will still owe the amount you origi-nally borrowed.
With so many mortgage provid-ers and deals out there, it is advisable to talk to a finan-cial adviser who can search the whole of market to find the best deal to suit you.
Other expenses to consider
The deposit and mortgage repayments will not be the only expense. You will need to pay for a solicitor to approve the paper-work, carry out land searches and arrange the contracts to exchange. In addition a survey is required to check the physical condition of the property.
Stamp duty, a government tax paid when you buy a property over a certain amount, may also be applicable. The amount of tax is a percentage of the property value, although first time buyers don’t have to pay it on a home under £250,000.
Conclusion
Buying a home is most probably the largest financial commitment and invest-ment you will make. By talking to a finan-cial adviser with expert knowledge of the medical profession you can ensure you get the deal that is best suited to you.
* First Direct research, September 2011
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hoSPITAL mESS22
jaMES boNd 007F or reasons of National Security, ‘Mr Smith’ would not
give me his real name. However, he informed me that he was “On Her Majesty’s Secret Service”.
He was of slim build, blue-grey eyes, a “cruel” mouth and short, black hair. There was a faint scar of the Cyrillic letter “?” on his hand - which he informed me came from Russia “with love”. On the surface, he appears to be a healthy, attractive man.
However, ‘Mr Smith’ has a number of dangerous vices that may seriously affect his life, namely smoking, drinking and sex-ual intercourse.
He is a life-long smoker, at one point reaching 70 cigarettes a day. In the past he has attempted to cut back himself, as this was affecting his job and that cigarettes were clearly a “Licence to Kill”. In the past, he was sent to a health farm because of his boss’s concerns about his habit. ‘Mr Smith’ smokes a blend of Balkan and Turkish tobacco with a higher than average tar content called “Morland Specials”. I attempted to advise ‘Mr Smith’ about his habit but he only replied, “Doctor, No. You only live twice”.
‘Mr Smith’ drinks alcohol to excess. His intake, since I have known him has been of 317 drinks of which 101 are whisky, 35 sakes, 30 glasses of champagne and a mere 19 vodka mar-tinis (which he claims are his favourite). ‘Mr Smith’ feels that drinking was an important part of his job (working at Casi-nos, Royal engagements, etc) and that alcohol gave him inner peace - eloquently described as a “Quantum of Solace”. It was not only the amount of alcohol that is a concern, but also his food consumption. I have advised cutting back on both but he refused saying only that he would “diet another day”.
As well as smoking and drinking, ‘Mr Smith’ claims to have had “pussy, galore”. He clearly indulges in meaningless affairs, mostly one night stands, with virtually every woman he encounters. He doesn’t seem concerned about STDs - sleeping with one woman despite her “Octopussy”. This may explain why he reports some genital itching and “Thunderballs”.
A major concern I had for ‘Mr Smith’ was of heavy metal poisoning. At various points he referred to his Goldfinger, his Goldeneye and to “The man with the Golden Gun” - which I presume to be a euphemism. Gold poisoning, like all very metals, causes headaches, irritability, insomnia and depression. In fact, ‘Mr Smith’ did feel that “The World Is Not Enough” which would suggest a low mood was present. This type of poi-soning can affect vision so I would suggest a referral to an oph-thalmologist “for his eyes only”.
In conclusion, I have informed ‘Mr Smith’ that if he contin-ues to behave in this manner he will be “living daylight” hours in a medical ward and, while “diamonds are forever”, his health is not and that I would be prepared for him to “live and let die” without an intervention.
Assessed by Gil Myers
MEDICAL REPORT1
2 3
4 5 6
7
8
9
10 11
12
13 14
15 16
17 18
19
20
Across
7Dilutional hyponatraemia is that resulting from an excess of this (5)
8Disease caused by the presence of ticks (9)
9The term used to describe individuals who readily develop antibodies (IgE) in response to common environmental antigens (5)
12Very rare symptom of mental disorder where the individual believes he or she can turn into a wolf (11)
13Individual in which a mutation has occured (6)
15Alkaloid derived from the leaves of the coca plant; can be used as anaesthetic (7)
17Inflammation of the windpipe (10)
19Blister or large vesicle (4)
20Air cavity within bone, especially in the face or skull (5)
Down
1The 'vu' that can be a manifestation of temporal lobe epilepsy, where things suddenly feel unfamiliar
(6)
2Forms the framework of the mouth and place for teeth to attach; beware the movie's shark attaching its teeth however (plural) (3)
3variety of white blood cell distinguished by the presence in its cytoplasm of granules that stain purple-black with Romanowsky stains (8)
4Primary polycythaemia is known as polycythaemia ____; occurs
principally in middle-aged or elderly (4)
5Drug that causes the pupil of the eye to dilate (9)
6Wart occuring on sole of the foot (7)
10This disorder is characterized by repetitive and persistent aggressive or antisocial behaviour, typically recognized in childhood; Daniel Barenboim famously likes to do this (7)
11Heel bone (9)
14State in which
reaction to the environment is diminished though awareness is unimpaired; can be heard in clubs (6)
16The membrane forming initially over the dorsal embryo, but soon expanding to enclose it completely within its cavity (6)
18Surgical removal, via a colposcope, of this-shaped tissue segment from the cervix; best with ice cream (4)
1 The ‘vu’ that can be a manifestation of temporal lobe epilepsy, where things suddenly feel unfamiliar (6) 2 Forms the framework of the mouth and place for teeth to attach; beware the movie’s shark attaching its teeth however
(plural) (3) 3 Variety of white blood cell distinguished by the presence in its cytoplasm of granules that stain purple-black with Romanowsky stains (8) 4 Primary polycythaemia is known as polycythaemia ____; occurs principally in middle-aged or elderly (4) 5 Drug that causes the pupil of the eye to dilate (9) 6 Wart occuring on sole of the foot (7) 10 This disorder is characterized by repetitive and persistent aggressive or antisocial behaviour, typically recognized in childhood; Daniel Barenboim famously likes to do this (7) 11 Heel bone (9) 14 State in which reaction to the environment is diminished though awareness is unimpaired; can be heard in clubs (6) 16 The membrane forming initially over the dorsal embryo, but soon expanding to enclose it completely within its cavity (6)
18 Surgical removal, via a colposcope, of this-shaped tissue segment from the cervix; best with ice cream (4)
7 Dilutional hyponatraemia is that resulting from an excess of this (5)
8 Disease caused by the presence of ticks (9) 9 The term used to describe individuals who readily develop antibodies (IgE) in response to common environmental antigens (5) 12 Very rare symptom of mental disorder where
the individual believes he or she can turn into a wolf (11) 13 Individual in which a mutation has occured (6) 15 Alkaloid derived from the leaves of the coca plant; can be used as anaesthetic (7) 17 Inflammation of the windpipe (10) 19 Blister or large vesicle (4) 20 Air cavity within bone, especially in the face or skull (5)
You can find the crossword solution by searching for ‘crossword answers’ at www.juniordr.com
Compiled by Farhana Mann
ACRO
SSDO
WN
hoSPITAL mESS 23
Goldilocks has corn flakes instead at -
£1.80 Royal Free Hospital, London
Tell the three bears about -
40p Countess of Chester Hospital, Chester
Better to copy it out by hand at -
20p St Bartholomew’s Hospital, London
Remember the trees at -
10p Royal Preston Hospital, Preston
Find some scrap paper instead at -
£1.49 Royal Free Hospital, London
Go note taking crazy at -
59p Weston General Hospital, Weston-Super-Mare
Next issue we’re checking the cost of a bowl of 4 AA batteries, a pocket sized pack of tissues and a hot chocolate. Email prices to [email protected]
W hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular
column of the best and worse hospital essentials you’ve reported:
Colchester Doctor’s Mess has a flatscreen TV with Sky, microwave, dishwasher, and coffee maker. Off the main mess is a room with three
computers. The usual tea, coffee, toast and cereals are provided along with daily newspapers. One plus is hav-ing a cleaner. Mess fees are £10 a month with occasional subsidised mess nights out.
JuniorDr Score: ★★★✩✩
Bowl of porridge
Jotter pad
‘Writing in the notes’ is our regular letters section. Email us at [email protected].
Writing in the Notes
look after the docs of tomorrow
Dear Editor,Why do junior doctors repeatedly get screwed
over? It’s just one new headache imposed upon us
after another. MTAS, the EWTD, lower pay, shift
working, ARCPs, revalidation … and the list goes
on. Then we find out we have to contribute an extra
£230,000 over our lifetime for a worse pension
(Junior doctors could pay £230,000 extra for a worse
pension; Iss 22, p4). There is a point at which we
have to say enough is enough. I think junior doc-
tors are collectively unappreciated for the work they
do to hold NHS services together whilst senior staff
get the credit. If consultants or GPs had to endure
what we have gone through in the last decade I sus-
pect there would have been a much larger outcry. The
other unions are protecting their members quality of
working for the future. BMA take note - I don’t think
we can endure much more!NAmE WIThhELD
LoNDoN DEANERy
No numbers doesn’t mean no problemDear Editor,
If you ignore a problem it doesn’t go away. That should be a message for the Department of Health on the EWTD debacle (Concern over working hours as NHS in England stops monitoring; Iss 22, p7). Being unable to state how many rotas are compliant with the European Working Time Directive doesn’t mean things are fine - potentially they could be much worse than we all expect. Considering the number of DH imposed directives to measure outcomes, shouldn’t the compliance with EU rules be one of the key measures they have to record?NAmE WIThhELD GP TRAINEE, SEvERN DEANERy
colchEStEr GENERAL HOSPITAL
inspiring junior doctors
Kudos to Steve Fabes! (Cycling the Six: Africa;
Iss 22, p3) It’s inspiring to hear of junior doctors
thinking of life outside medicine and following their
dreams. I only found out about your trip in the last
issue but have since followed your blog and it cer-
tainly hasn’t been an easy trip. I’m truly inspired by
your determination to keep going - not to mention
the impressive 450 gram bars of Dairy Milk you con-
sume in one sitting! Good luck with the next stage
of the journey.DALJIT SINGh
SURGIcAL TRAINEE, mANchESTER
A4 B/W photocopy
WARD EScAPE24
GettinG there
It may be close but being stuck in the middle of the Irish Sea makes getting there a little tricky. Flights from carriers such as BA and Flybe leave from most UK airports including London, Edinburgh, Manchester and Newcastle.
If you’re worried about your carbon foot-print you can take ferries from Liverpool, Belfast or Heysham - prices are from £39. Journey times can be a long 3 hours but it does leave you within walking distance of Douglas, the island’s capital.
WHERE TO STAy?
Douglas is probably the best base for a weekend trip especially if you decide against hiring a car. Trams and buses connect from here to all the main towns and tourist destinations.
For a cheap but comfortable stay try the Arrandale which offers rooms from £60 per night. Apartments are also available if you prefer more independence (www.arrandale.com).
Alternatively, you could try the Regen-cy Hotel in the centre of Douglas, which although mainly catering for business cus-tomers offers good weekend rates (www.regency.im).
EATING
Manx kippers are probably the island’s best know delicacy. Kippers - herrings that have been filleted and cured by smoking - used to form one of the islands biggest industries until fish stocks dwindled and now supplies are brought in from the North Sea. Try them for breakfast with bread and butter or take a tour of Moores factory (www.manxkippers.com) which has been ‘kippering’ since 1882.
For dinner try Ciapellis - rated as one of the UK’s top restaurants - serving great Italian and seafood (Noble’s Park, Doug-las). Alternatively try fish and chips at the Harbour Lights restaurant in Peel at the other end of the island (www.Harbour-LightsIoM.co.uk).
KEy ATTRACTIONS
Laxey Wheel - For such a small island it can be quite a surprise to find the world’s largest waterwheel with a diameter of 72ft. It was built in 1854 to drain water from the surrounding mining industry.
TT races - This, the island’s biggest tourist draw, brings over 60,000 visitors for probably the world’s most famous road motorcycle road race. It’s one of the most exciting spectator events which also makes finding accommodation from the end of May into early June tricky
Snaefell - An electric tram takes you 2,000ft to the top of the island’s largest mountain. On a clear day you get a magnifi-cent view of the entire island and can look out over England, Scotland, Wales and Ireland.
House of Mannanan - Located in the fishing town of Peel on the islands west coast is an interactive heritage centre which shows how the Manx Celts and Viking set-tlers shaped the island’s history. Perfect for when it rains.
Find the full Isle of Man guide at JuniorDr.com.
The Canary Islands have the sun, the island of Ibiza has the clubs and Malta has the history so why would you choose the Isle of Man? Well, if tail-less cats, horse-drawn trams and a big water wheel sound like a welcome change from sunburn, sore ears and showy sights it might just be the island getaway for you.
WEEkEND WARD ESCAPE TO THE
ISLE OF MAN
KEy FACTS
• POPULATION - 85,000
• LANGUAGE - ENGLISH
• CURRENCY - £1 = £1
cLASSIFIED 25
The Medical Journalist’s Association brings together medical writers, the media, health professionals, and health charity workers.
> Meetings on major health and medical topics of the day> A forum to meet colleagues> Recognition and cash awards for distinguished work> A website with your own address. Visit www.mja-uk.org> Professional advice when you need it
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To join or to find out about the many benefits SAM members enjoy visit www.acutemedicine.org.uk or email [email protected].
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EvENTSDR.com26
THE MEDICAL COURSE AND CONFERENCE DIRECTORY
A s doctors we hate scouring the web to find where and when we can attend the next exam revision course, training event or conference.
We think they should all be in one place - which is why we launched EventsDr.com as part of the JuniorDr network.
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Working overseas?MPS has over 270,000 members in more than 40 countries. If you are planning to work overseas we can usually help.
The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.
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3921 MPS A4 Advert V2.indd 1 10/03/2011 10:47