NHS! (again)

NHS demo yesterday was a success with a good number of people from the Greens there. Well done to all those who helped with the Green Party placards: they were out in force on the day! Wish I could have helped with them too!

The following motion in support of the demonstration and against private involvement in the NHS was passed at the Green Left meeting on Saturday last week. I am not sure if it has been publicised since (having been somewhat out of the loop with e-mails, aside from during procrastination time, due to a heavy week on the wards trying to finish off my A&E module! – also the reason I haven’t blogged for a while):

“Green Left notes the attempts at increasing private involvement in the national health service. Recognizing that healthcare commissioning is to be tendered to private companies (including some with a bad reputation in the USA) and that implementation of the Darzi plan for polyclinics will probably involve some private sector companies, we affirm that this is against the public service ethos central to an ecosocialist future.

We strongly encourage involvement and support of the Keep Our NHS Public demonstration on Saturday November 3rd 2007.”

Anyway, best get back to work… Have a dissertation to write and wouldn’t mind getting a bit further on the new edition of Joel Kovel’s book.

Off to the sticks

For the next 3 months (until the summer break), studentmedic will be off to a district general hospital outside the big city. This means 3 months of perhaps limited internet activity (although I am told they have a 24 hour computer room – ooh the excitement!), lots of hospital food and literally living my career choice. I will be living within hospital grounds, doing my daily tasks there and shopping not far away. By the time I come back to the city, I will have had the chance to spend a day with an ambulance crew, done a course on suturing (stitching up wounds, for those who don’t know), and spent almost every waking hour in the hospital.

Perhaps to some people this would be a vision of hell. It does have several appeals though: I was born in the city where I now study, I have never lived anywhere else for more than a 1 month holiday. Not only that, but living on hospital grounds means I can literally wake up half an hour before I have to be in each day (or even less if I rush). When I finish my day, there won’t be a massive journey back to my humble abode, it will be a 2 minute walk away.

Of course, during the weekends I will be helping the local Green Party with campaigns for the May 2006 elections. Anyway, I can’t say what will happen to my blogging frequency: depending on ease of access to the net, it could go up or down. I will try my best to keep things going.

I think I saw a bat outside.

I spent my first ever night on call last night. This meant I got about an hour of rest in 28-ish hours. The hospital was deadly quiet except for two key areas, the A&E and the MAU (Medical Admissions Unit, where all the patients to be admitted are sent after they have left A&E, ideally within the 4 hour target for waiting). It was definately a great experience, and a chance to get to speak to a number of patients I wouldn’t have spoken to otherwise. Reading up about Heparin and having teaching on X-Rays and ECGs at 2am was… different!

Presenting patients to the cousultant when that tired was an interesting experience – never had to do anything resembling logical thinking while that tired before!  I can’t help thinking what a priveledge it is to speak to patients during what is, in essence, a major life experience and then watch them being assisted on the road to recovery. (This is true about my whole experience of clinical medicine so far, but even more true when you get to see the patients at the moment they enter hospital.

I discovered an interesting blog after I woke up from my post-’on call’ slumber. the void is well worth a read and good fun too!

Competition

Long time no post, mainly because my internet has been down and I don’t think it is good use of NHS resources to use computers in hospitals for bloging!

I was thinking recently about competition. In Green Alternatives to Globalisation, Caroline Lucas and the late Mike Woodin posit the idea that economics should move away from competition for the cheapest to a system of co-operation for the best. I was wondering how far that idea is transferable. Is competition always a bad thing? Is it sometimes a good thing? Can it be made a better thing?

For example, if a group of medical students are left in a room, competiton will inevitably arise. Each student will try to show off their own strengths and come out the ‘winner’. On one hand, it means all the students work hard to reach the top and therefore  one could say that the overall standard is raised. On the other, it means that students at the top will want to maintain their position there. To do this, they will try to avoid providing other students with useful information that might help them become better; so, rather than the average going up as a result of competition, it would go down. Co-operation would mean that such information and knowledge would be distributed among all the students. Does this mean that competiton is inherently bad or does it mean that competition needs to be modulated to ensure it is healthy and that co-operation is facilitated within the competetive framework? How far can we apply these ideas – to learning? to sport? Perhaps competition is only good as long as the rewards are not so great as to make ”winners” value their own positions at the top too much and ensure that they are willing to co-operate to make others as good (or perhaps better) than themselves in that field. I guess that points to the idea of no monetary reward and back again to the idea of socialism, which lies partly on the idea that material reward shouldn’t be necessary to encourage people to work for the good of society.

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Other musings:

I spent two hours in a multi-discipinary meeting reviewing cancer patients today. It occured to me that in this day and age of patient involvement, a review of treatment for patients where there are no patients present might go quite against the prevailing ethos. I wonder if it is ok to make decisions about a patient while the patient is not present and (more importantly) not invited to be present. Of course, the logistical difficulties around having a multi-disciplinary team with patients while mainting each patient’s confidentiality make it practically very difficult (unless we have patients waiting to enter the room one by one, to be faced with about 20 consultants/nurses/students/radiologists/pathologists!). I just wonder if there is any way that it could be done more inclusively.

studentmedic

Clinical Medicine

Well, today was the first day of my real, clinical training. Away with the lectures I have had for the past two years and out into the ‘real world’ of learning from patients – although I had had quite a lot of patient exposure before today, it was always very structured – now it is truly a matter of directing our own learning through experience with patients. It was certainly daunting in the morning, as consultants seemed too busy to really spend much time giving us things to do. However, after a while we managed to find this amazing FY1 (i.e., first year post qualification) doctor who helped us work out how to use our time productively. I went into theater to observe some operations, which was really interesting. Hopefully tomorrow I will be able to try and take histories from a few patients, as that is surprisingly difficult! Patients have a habit of telling your everything except that vital bit of information which suddenly makes everything fall into place. It makes for a great chat, but it isn’t always the best way to work out how to proceed!

I often feel it must be really daunting for patients to have extra people in the room as they are being spoken to by a doctor. I have found, so far, that a smile and a quick chat can go a long way to making it fun – both for me, and (I hope) for the patients! BUT, after just one day, I feel completely and utterly knackered. Must remember to drink more water – I noticed I didn’t drink anything (aside from one sip from my bottle) between 8am and 5pm today! No wonder I have a headache…

I think I will try to blog a bit about my experinces of learning medicine at the same time as blogging about politics and other things. I don’t know if that will work, but I will try and see!