Archive for the ‘MediRants’ Category

Work Experience

Recently the SoR tabled a motion about whether to make work experience mandatory prior to commencing a radiography degree in the UK. Surprisingly, it failed to pass, even more surprisingly for the reason that apparently some students find it difficult to get work experience as their local hospital may not allow it.

I feel that this raises a few issues which need to be addressed:

1) Radiography degrees in the UK are funded by the NHS for domestic students. This means that upon graduation, you end up with an internationally accepted degree, with good job prospects, and nowhere near the £27k debt that your flatmates were lumped with. It also means that a lot of money is wasted when students drop out of the course, which happens, a lot. Attrition rates are around 40% nationally, which is shocking, and surely must be at least in part due to students not being prepared for what they’re expected to do.

In my year group, 53 started the course in September 2009, but only 39 graduated in 2012, and I know from talking to some prior to their departure that it was because they were not expecting it to be what it was. Our first placement was within 10 weeks of the course starting, and this was the point of the first exodus. Obviously the academic workload was a major factor for some people, but other reasons I’ve heard range from “I didn’t know I’d get vomited on” to “I can’t stand the sight of blood!”. Even a day’s shadowing would give enough insight into our exposure to bodies and their fluids. One student I spoke to recently asked me how long it takes to become a radiologist once you begin radiography training. I explained the difference, and she seemed genuinely surprised that one didn’t lead to the other.

Personally, I find this level of ignorance unacceptable; in the internet age where information is a few clicks away, and emails can be sent with minimal effort, it really isn’t difficult for people to show an interest in the career they’ve decided to pursue. Which brings me to:

2) Apparently some hospitals don’t accept work experience students. This is an issue which needs to be fixed but it can also be avoided; if a hospital isn’t interested in teaching the next generation of healthcare workers then quite frankly, it’s not somewhere a student should be interested in visiting anyway, because that’s a crappy attitude. I’d be interested to hear the reasons a department could give, so please, if you’re aware of any, leave a comment or two below.

So then it’s up to the student- if your local hospital won’t let you visit, go somewhere else! You’ll have to travel to your placement sites once you’re enrolled anyway, so this really can’t be regarded as extraordinary effort. I appreciate that people have jobs and kids and other commitments, but this is your future career we’re talking about. Is it really too much to ask?

 

As everyone is probably aware, the NHS is under constant pressure to cut costs, and like most huge organisations is quite wasteful in places. Stupid things like paying over the odds for toner cartridges, or allowing boxes of sterilised orthopaedic equipment to expire, unused, in store rooms, spring immediately to mind as things that I’ve personally encountered. On the subject of NHS funded education, one idea I’ve heard thrown around is to make drop-outs to pay the NHS for the tuition that they received, but I fail to see how that’s enforceable. Especially from students who drop out of further education entirely.

Another way of ensuring value for money could be to make it so that NHS funded students must work for the NHS for n years post graduation, something I assumed was already in place prior to fully researching the degree. This wasn’t an issue for me before signing up as I wanted to work within the NHS anyway*, but I was genuinely surprised to discover that the NHS would pay for your education and then you could bugger off to a private practice as soon as you graduate. Interestingly, in my research for this post I discovered from a UoP lecturer (thanks Mark) that of my year group only two graduates went into the private sector immediately, which isn’t terrible. Also, one went into the priesthood, so that’s… different. And apart from another graduate who left healthcare entirely, and one who has successfully avoided the Alumni’s radar, the rest went into the NHS for their first posts.

*There was a short period of time where after meeting Noel Fitzpatrick (the Supervet) at the UK Radiological Congress in 2012 and talking to his chief radiographer when I desperately wanted to work at a veterinary practice, but after composing an email to them with my (not exactly huge) CV attached, I let it sit in my drafts for a while before deciding to get some experience in the human world first.

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Differing Opinions

Uh oh,  it’s February and this is my first post of the year… Oops! I have a couple in my drafts but I need to let some time pass before publishing.

I just wanted to throw a quick question out there to my fellow health professionals as it’s an issue I’ve encountered a few times recently. What do you do when a patient says something you really disagree with, expecting a reply, and you know you’re going to be stuck in the examination room with them for an awkward few minutes?

I had to endure a patient’s hateful anti-cyclist diatribe shortly after attending a nasty cycling related trauma call. He even trotted out the ridiculous “they don’t even pay road tax” nonsense. I kept my mouth shut and refrained from providing my opinion because it wouldn’t have been appropriate, but it was a very uncomfortable experience for me.

How do you deal with these situations?

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Oh What A Night!

NB: This isn’t meant to be a rant at other healthcare workers in particular, just me venting about some of the issues relating to working in a “multidisciplinary team”. I completely appreciate that every aspect of healthcare presents its own unique challenges, and that the two overriding factors which affect and unite us all are the public’s high expectations of us, and the government’s “bare-minimum” approach to both funding and staffing.

So. Here goes. Last night was easily one of the worst night shifts I’ve had, if not the worst. Nothing especially awful happened, it was just a never ending stream of constant difficulties. Firstly, when I arrived at the department there were already three patients on trolleys lined up in the corridor and two wheelchairs in the waiting area. The day crew handed over and explained the chaos, and then I went to resus to do an urgent chest and pelvis which absolutely had to be done round there as the patient was too unwell to come round to us. Fair enough, it was a trauma call after all. So I get round to resus and my trauma patient wasn’t collared or boarded, and wasn’t even hooked up to any monitors. When I asked why he couldn’t come to the department the nurse replied “He’s too unwell.” When I asked the patient how he was feeling he shrugged his shoulders and said “Not too bad, foot hurts though.” In the end I did the x-rays in resus, as they asked, because yes, it was a trauma call, yes he did have bruises on his pelvis, and we didn’t have room for him in the department anyway.

It’s exceptionally annoying when our colleagues lie to us in order to make life easier for themselves though, and we always find out, so it’s pretty bloody insulting. Most of the times I get a crappy reason for doing a mobile x-ray I take the time to explain to the referrer why we prefer patients to come to the department; it’s not because we’re lazy (although some radiographers are), it’s not because it’s easier (that’s not always the case), it’s because we actually give a shit about the radiation that we’re exposing ourselves and others to. When we trundle up to the ward with our trusty AMX (other models are available) we’re putting ourselves, other staff, and patients at risk. A radiographer’s best friend is the inverse square law (the further you are from the source of radiation, the better) but not all wards are set up to accommodate us. Hospitals are encouraged to squeeze as many beds as possible into every available space (as a side note, one of Trogdor’s board rooms is actually being turned into a patient area and having beds put in it) meaning that there isn’t always the minimum recommended 2 metres between patients. I’ve occasionally refused to perform a mobile x-ray purely because of the logistics of the ward- in one case the wall separating the patients’ bays was so thin that I would have been directing the primary beam at the back of another patient’s head. Nope.

So when I’m told “Mrs Smith is desaturating rapidly and is too unwell to leave the ward”, and I close the department (because I’m the only one there) only to find Mrs Smith sitting up in bed with a cup of tea and no oxygen mask in sight, it’s more than a little frustrating. Add to this the sheer unpleasantness for the other patients being woken up at 3am because mobile x-ray units don’t have a silent mode. This is a point I try to make regardless of whether the request is for a mobile x-ray; I know the medical registrar said that the chest x-ray was urgent, but it’s for a PICC line placement and you don’t plan on using the PICC before 8am so how about letting the patient sleep?

I think that “bullying” might be too strong a word in this context, but I honestly think that sometimes junior doctors aren’t allowed to use common sense as the pressure from their superiors is too high. A while ago I was chatting with a junior doc in resus while waiting to do an x-ray. She’d just had to abandon an attempt to get blood gasses because the patient was squirming in pain, so I asked if there was a reason why no one here tends to use local anaesthetic for the procedure. Apparently a friend of hers had asked the same question a while back and was told that if you can’t do it without local you can’t do it at all, or words to that effect. Apparently the patient’s comfort is irrelevant.

While the Daily Fail loves to scream about “Killing Season” every August, there isn’t a huge amount of truth behind the scare stories about junior doctors causing loads of extra deaths in their first few weeks. Sure there’s a statistically significant rise of about 6% in death rates in early August, but mortality and morbidity figures fluctuate all over the place throughout the year for a variety of reasons, and this is something which requires a lot more research before wildly labelling all F1s as Harold Shipman. Not that the Daily Fail gives a shit about the truth, of course.

One thing which does increase in August though, is crappy x-ray requests, and while it’s frustrating and annoying, it’s our job as radiographers to vet these requests rather than blindly performing them. I know it must be hugely difficult to be an A&E doctor, especially early on in one’s career, but it’s almost comical how the requests pile in. So far I have seen two perforated bowels (colloquially called a perf) but I have probably done a few hundred x-rays with “?perf” on the form. This is basically like a cheat code for a chest x-ray, write “?perf” on the form, get  a chest x-ray. Write “?obstruction ?perf” and you’ll have an abdomen thrown in as well. And you can tell when the new doctors learn about this, because the requests come flooding in shortly after. Instead of properly examining the patient to give us a real reason for doing the chest x-ray (and there is usually a real reason) we get loads of these cheat-codes. A tip for spotting when this has happened: a genuine perforated bowel does not present with the patient strolling in to the x-ray room and making small talk. A real perf is generally accompanied by a patient curled into the foetal position, screaming in agony. Not always, but most times.

So as well as crappy requests we also had loads of patients turning up without wristbands, who we were unable to positively identify. Patients suffering from stroke, dementia, acute confusion (due to LRTI etc), and narcotic or alcohol abuse need to have wristbands on so that we can categorically confirm that we are about to x-ray the correct person for the correct body part. This is beyond essential, yet some of the nurses on shift last night didn’t seem to think so, and the worrying thing was that a few of these patients had clearly been administered drugs before coming to x-ray, something which really shouldn’t be done unless you can be 100% certain of their identity.

Then there was the abuse, a constant factor in this job, but it was particularly noteworthy last night. The first was from a group of “lads” who came along at about midnight with their friend who had banged his wrist earlier that evening: I was processing the x-rays of the patient I had just examined, and standing at the computer annotating the images. One of the “lads” loudly exclaimed that “she needs to get off Facebook and sort your wrist out cos I’m sick of waiting here”, a comment I had no choice but to ignore for the sake of professionalism. I helped my current patient put his shoe back on, and pushed his wheelchair out of the room, and was met with another “hilarious” quip from the group, which I won’t repeat. Then when I called in the injured boy for his x-ray, all of his mates tried to come into the examination room and didn’t like it when I told them that they couldn’t, so I said that he could have one companion to hold his hand if he was really that scared and that seemed to shut them up. The patient was actually alright when the door was closed, but then reverted to making obscene comments about me when he left the room. What a gent.

Not long after there was a middle aged man with a laceration to his arm, he wasn’t drunk (a usual factor in abusive patients) but he was really grumpy. I only had one image to do as we were just looking for broken glass in the wound rather than a fracture, but he was determined to make it a difficult one. First off he refused to let me remove the bandage, but his wife talked him round. Then he wouldn’t put his arm where it needed to be because he didn’t want me to touch it, and when his wife came to the rescue again, he got really arsey with me. I demonstrated with my own arm what I wanted him to do, but he wasn’t getting it, so I lightly tapped his (uninjured) elbow to show where it needed to be and he said “touch me again and you’ll regret it”. No swearing, no bravado, just a plain threat. At this point I figured that his position was good enough for what I needed so I set up the x-ray tube, ushered his wife behind the screen and took the image. Walking back towards him I gestured for him to lift his arm off the x-ray cassette so I could remove it for processing, he did so, but when I reached to pick it up he grabbed my wrist very tightly and said “put the bandage back on now”. I stood my ground and said that I’d like to make sure that the x-ray was ok before doing that, and he hissed something derogatory as I wriggled out of his grip and walked to the processor. His wife looked so embarrassed, I really felt for her. I only had to spend a few minutes with him, she was married to the guy.

Then at about 3am I had a patient growl at me when I asked his name. I phoned majors to ask if there was anything I should be aware of: “Yeah, he spits and will try to bite if you go anywhere near his head”. Thanks for putting that on the form, guys. I nearly found that out the hard way.

I also had a lady call me a stupid cow when I told her I couldn’t confirm whether her ankle was broken or not (it wasn’t), but she actually came back to apologise on her way out, which surprised me. Apparently the nurses in minors explained why I wasn’t able to tell her and she felt shitty about it so she wanted to make it right. That was nice.

So that was my night. Busy, but not the busiest. Just generally unpleasant even though I was working with fantastic colleagues (one with me, and one in CT), I dread to think how it would have been with others!

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Anything and Everything

I’ve spent quite a lot of time working in A&E recently as I’ve had a few night shifts and even a whole week of regular days there.  It’s one of my favourite places (along with theatre) and I really enjoy the challenges it throws at me. I’m also constantly amazed by what some people class as an “emergency” though (and yes, A&E stands for Accident and Emergency not Anything and Everything) and this can be incredibly frustrating.

The other weekend we had a paediatric trauma call; when a paeds trauma bleep goes out you can see the dread on the team’s faces while we wait nervously in resus for their arrival. Apparently a young girl had fallen quite a height from a tree and landed face down, where she remained unresponsive for a while. These were the only details we had at this point so it was hard not to worry about the state she might be in. The ambulance crew wheeled her in, neck brace, head blocks, parents alongside, and we were all quite relieved to see her conscious; at first glance it was obvious that she had broken at least one wrist so I knew that she’d definitely be coming round to x-ray very soon, and upon further investigation it turned out that she had not been unresponsive or unconscious for any amount of time. Due to this and the lack of any head injury she ended up coming round to x-ray for a full trauma series as well as some extremities.

Our A&E x-ray department has two examination rooms, and therefore we are only able to see two patients at a time; normally this is fine, and people only have to wait a short while, but this particular day was quite busy. Several patients were waiting to be seen when the trauma patient arrived and I heard a few tuts as we whisked her straight in to the examination room. I was honestly quite shocked, as one of the men who tutted was there for an x-ray of his ankle which he injured two weeks ago and had been walking around on ever since; how he got through triage I’ll never understand. Luckily the girl’s parents were too worried about consoling their child to hear such an inconsiderate man making his feelings known, but myself and my colleagues definitely heard him. One of them decided to make things clear by announcing that: “A paediatric trauma patient has arrived so there may be a delay in getting to you- I’m sure you all understand the urgency of the situation, thanks for your patience.” Hurty-ankle man tutted some more and looked at his watch dramatically, and then rolled his eyes when the patient in front of him was called in. I wasn’t there when he was eventually seen, but I do now know that he hadn’t broken anything (what a surprise!) and he was very rude to the radiographer who saw him. Meanwhile I was next door attempting to get some decent radiographs of a terrified child; we had to take x-rays of her neck, chest, pelvis, and both forearms, one of which was visibly deformed. She had never had an x-ray before so was understandably terrified to be strapped down flat to a stretcher and wheeled into a dark room while I shone a bright light at her and made her move her badly bruised arms.

In the end she “only” had a couple of fractures to one arm which was fixed in theatre that afternoon, so all in all a fairly good outcome.

So back to Hurty-ankle man. Someone in the triage stage should have explained to him that better care options are available (it’s possible that they did but he insisted on being seen- that happens too) but for whatever reason he ended up being seen through A&E. Apparently he had twisted his ankle two weeks before but hadn’t been to see his GP because apparently A&E is more convenient to get to.

You may think I’m being overly judgemental (and it’s likely that I am) but the NHS, and emergency departments in particular, are currently experiencing workloads which are simply unmanageable. The government’s answer to this is to add more targets and blame GPs and junior doctors for failing to meet them. The real solution isn’t that simple, but patients can help by choosing their care provider wisely; A&E is for acute illness and injury- things which cannot wait. Unfortunately it’s difficult to get this message across without risking scaring those away who genuinely need help. The elderly are especially at risk- “oh I didn’t want to be a bother” they say, having revealed that yes, they have been walking on a broken hip for a week, while the woman with cystitis calls an ambulance to rush herself to hospital.

NHS Choices is a good starting point for finding out who is best suited to look after you in your hour of need, but you should also familiarise yourself with which services are available in your area before you desperately need them. Some cities and towns have urgent care centres which are essentially diet A&E departments. These are a touchy subject politically, as they have sprung up in recent years, replacing real A&Es. They’re perfect for when you sprain your wrist, or cut your knee, but if you’re having chest pain, call an ambulance or go straight to a proper A&E. Some A&E departments are even able to book same day GP appointments for patients that are deemed suitable, so if your sprained ankle isn’t improving and you can’t get an appointment for a week, there might be other options available to you.

All I’m asking, as a healthcare worker and supporter of the NHS, is that you consider your options before going to (or not going to) A&E.

Thanks.

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What a PAIN!

I haven’t written a lot recently, although I’ve had more than enough material for a book already. The problem is, after a particularly heavy day at work (and those are the ones I’d be more inclined to write about) I usually just want to zone out when I get home so I usually do.

Anyway, so I’m now about 6 months into my first job and already my eyes have been opened more than I expected. I always knew that “how things should be” and “how things are” rarely follow the exact same tracks, but it’s disappointing, and I try to keep my standards as high as practically possible.

Nowadays some patients expect to be treated like customers (they’re even referred to as “clients” in some NHS literature) and therefore if they don’t get what they want, regardless of what they need, they get upset. This is something of a common theme; when a patient goes to see a GP they expect an intervention, whether it’s anti-biotics, an x-ray, blood tests, whatever. What they don’t want to be told is that their low back pain can be helped with exercise and posture improvement, or that their cold is not swine flu and doesn’t require medication. What this means for the radiology department is that we’re constantly getting x-ray requests for things that are just completely unjustified, and our job as radiographers is to weed these crappy requests out. Unfortunately a lot of people find it easier to just do it. I’m not one of those people; radiology referrals have fairly clear guidelines and they’re not difficult to find. I’d rather take the time to get the full story from the patient and determine whether the x-ray is needed instead of exposing a patient to unnecessary radiation. A lot of the time these crappy requests are actually fine, they’re just missing information- not surprising when GPs are only given 10 minutes per patient.

This is a difficult problem to tackle, as when you hand the request form back to the patient they are completely within their rights to take it to another hospital where they may not be questioned, and thus the fee for that examination goes onto someone else’s books. I have absolutely no doubt that this has happened to patients that I have refused to irradiate, even after explaining my reasons to them. But what can I do?

Recently I picked up a form for a 29 year old female patient which had only three letters in the Clinical Information section: LBP. This section is meant to contain relevant information so that we can justify the examination- things like fell onto outstretched hand or ?osteoarthritis are enough for the radiographer to understand why the examination can go ahead and which images they need to produce.

LBP means low back pain, an affliction suffered by many due to things like poor posture or years of manual labour. It’s unfortunately a sad fact of life, and the guidelines clearly state that there’s no need for x-rays except in certain very particular circumstances, none of which were applicable to this patient. She was young, otherwise fit and well, had no family history of osteoporosis or spine pathologies, and had suffered no trauma. Her only problem was that she was unable to sit in her office chair for more than a couple of hours at a time without feeling pain in her lower back. And this had been going on for two weeks. I explained why I wasn’t going to do the x-ray, and that even if I did it would have absolutely no effect on her future treatment; the GP would give her exercises to strengthen her back muscles and probably recommend a better office chair. She seemed annoyed and didn’t like my quick explanation of the ALARA principle, instead choosing to assume that I was being lazy because I couldn’t be bothered to do her x-ray. Sure, my laziness lead me to speak to her to find out more information about her pain, then phone the GP (7 minutes on hold after navigating their hideous phone menu) to ask if he was looking for anything in particular in this patient’s spine (I also took the opportunity to direct him to the Royal College of Radiologists’ guidelines which are freely available online), and then to explain the concept of risk vs benefit to a woman who just wanted to know why her back hurts.

I can’t say I made any friends in that particular encounter, and I’m pretty certain I was branded a jobsworth by all parties involved… I can see why the just do it attitude is so popular! Can’t say I’ll be adhering to it any time soon though.

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10 Week Update

I haven’t blogged in a while, partly because I’ve been busy / exhausted, but also because I worry that if I blog about specific events, even with details removed, patients and colleagues may potentially be able to identify themselves if I write about it straight away, and that would be unfair and unprofessional. But mostly, I’m lazy and can’t motivate myself to write after a day at work.

So I’ve been working for 2 and a half months now, and honestly, I’ve really been enjoying it. There are some stark differences between working in Hampshire and London; most noticeably, budget. I’d mentioned before that the imaging equipment was different to what I’m used to, but it extends beyond that. The rooms in general could do with a refurb; the paediatric room is quite an intimidating place for an adult, let alone a 5 year old with a broken leg. There’s also a dearth of basic accessories such as positioning pads and cassette holders; this doesn’t necessarily affect patient safety or the diagnostic quality of the resulting radiograph (assuming that the radiographer is determined and caring enough) but it can affect patient comfort, and it can also make the task for the radiographer much more laborious and require some significant creativity.

That said though, having the newest fanciest kit doesn’t solve everything; our fancy DR system in Resus decided to stop working on the morning of the Vauxhall helicopter crash, when we were on standby for some of the casualties. It turned out to be a very quiet morning in the end, but nerves were certainly frayed when one of the A&E rooms packed in at the same time! This all happened during my fortnight’s “training” in A&E (I’m still rotating through the various modalities so I can get a basic understanding of equipment, protocols, and working practices). Unsurprisingly, this was my favourite time period so far, and I can’t wait to get back round there.

So far, my shifts have been nice and easy; 9-5 every day, no weekends, but that all changes this month. Luckily I’ve only got one evening shift, one weekend long day, and two weekday long days in February, but it steps up further in March with night shifts thrown into the mix too.

So… what other news? Well I received a dose badge, but then that expired and I wasn’t on the list for a replacement so now I’ve got a temporary one; my markers finally arrived from the USA but apart from my A&E fortnight I’ve hardly used them; and I’ve received half of my uniform (the trousers) and when I collected them my colleague, who accompanied me to find out about hers, demanded that they give me a plain white tunic to tide me over til my proper ones arrive. Hopefully this will mean fewer incidences of being called “The Student” by consultants.

After all this behind-the-scenes waffle you may be surprised to hear that I have actually encountered some patients in my 10 weeks of employment, so here are some anonymised excerpts of the ones who have, for various reasons, stuck in my memory:

The 6 year old who barely even winced when I moved his obviously fractured arm to a more lateral position- brave kids like this just make me even more annoyed at perfectly well yet uncooperative adults who scream the place down over a slight sprain or bruise.

The elderly lady with multiple myeloma who had been booked in for a skeletal survey (a long list of x-rays covering basically the whole body, to assess the formation of any lesions in the bones) who not only repeatedly apologised for taking so much time (!) but also told me about the horrible experience she’d had at another hospital. Apparently the radiographer there shouted at her when she misunderstood his instructions and she cried on the bus home. I hope I’ve managed to show her that those types of radiographers are in the minority.

The young teenager who came into Resus following a collision with a vehicle; she sustained several injuries (luckily none were life threatening) including losing all of her front teeth only a day after having her braces removed. She was understandably devastated and kept apologising to the trauma team for crying. I think she made a lasting impression on all of us.

The gentleman who refused to take his necklace off for his chest x-ray and got very aggressive at the mere suggestion of doing so, telling me that if he takes it off “and something bad happens, it’ll be your fault” whilst standing 6 inches away from my face. More on this in a future post.

The father of the tiny baby on NICU who was born so premature that her lungs had barely formed. I felt awful asking him to step out of the room while I x-rayed his daughter, especially as he cleared his throat and tried to hide the fact that he’d been crying when he returned.

I’ll try to be more regular with my updates in future; I’ve got a few radiology related posts to write on a number of different subjects which have been on my mind recently.

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Missing, Presumed Dead: Revolution

Photo courtesy of the Society of Radiographers

I’m pretty pissed off. So pissed off that on Saturday I marched through London with 150,000 other folk who are angry at the way this country is being treated by the government. And now I’m even more pissed off that we were completely ignored by both the media and those in charge. Is because we didn’t smash shit up? Because there was a football match that day? Or is it because 150,000 people closing roads in central London and marching past Downing Street just isn’t a big deal? After all, back in 2003 approximately one million people marched through London to protest the Iraq war, and that still happened.

The facts are fairly clear: the NHS is being privatised, but apparently, not that many people care. In 2007 the American Filmmaker, Michael Moore, made a documentary investigating the state of insurance-led healthcare in the USA, and comparing it to the socialised medicine available in France, Canada, Cuba, and the UK. While the film isn’t exactly unbiased, as a Briton I find the concepts covered in it as alien as Alien. Concepts such as: people with unrelated pre-existing conditions (such as thrush) being denied health insurance cover for cancer; patients being bundled into taxis mid treatment and abandoned outside charitable hospitals miles away, confused, disorientated, and still wearing gowns and ID wristbands; patients with severe respiratory illnesses contracted whilst volunteering in the clear-up post-911 having to pay hundreds of dollars for an inhaler; insured patients having to pay for ambulance expenses because the emergency response hadn’t been pre-approved by their insurer.

Nah, scratch all that, those examples are disgusting, but they’re also quite extreme. Personally, I find it abhorrent that in a developed country, with such national pride and a history of incredible achievements its citizens are treated with such contempt. Michael Moore seemed shocked that our prescription costs were so cheap and could cover so much. He was surprised to find that the only thing stopping a patient from leaving the hospital was the state of their health, rather than their bank balance. He was confounded by the idea that the cashier’s desk in an NHS hospital serves to reimburse travel costs to poorer patients rather than to collect payment. I am shocked that this is not the case over the pond, and I am even more disturbed that we’re starting to copy them.

Leaflet announcing the launch of the NHS

Moore spoke to Tony Benn to ask about the history of the NHS, talking about the motivation behind it, and the love that the British people have for it. There was, however, one part which was especially poignant today, where he compared the NHS with democracy, saying that taking away our healthcare would be as ridiculous and incomprehensible as removing the vote:

Benn: “They wouldn’t accept the deterioration or destruction of the NHS.”
Moore: “If Thatcher or Blair had said ‘I’m going to dismantle National Healthcare’-“
Benn: “There’d have been a revolution.”

(See the full interview here)

Well where’s our bloody revolution? Seriously? The public reaction to the current dismantling of the NHS by the Conservatives has been, quite frankly, pathetic. Some people blame the media for the lack of coverage, but honestly I don’t buy that anymore. If there was a media blackout on the FA Cup, people would still find out the football results if they were interested; how can football be more interesting than your own health? There are even people working for the NHS who either don’t know or don’t care about the current threat to their employer; I know because I’ve spoken to them. I’ve had plenty of people ask me why I get so upset about this, and why I bother reading and writing about it. Well, I don’t know about you, but if I broke my arm tomorrow I couldn’t afford the bus fare to hospital, let alone the treatment.

People came up to us on Saturday’s march and (genuinely) asked what it was all in aid of (maybe they were illiterate, I dunno, we had plenty of banners). Back in March there were nationwide vigils and I went to one in Southampton and was disgusted with how few people turned up; I even grabbed the megaphone to express my disbelief.

Photo courtesy of Laur Evans

 

But honestly, what can we do? It seems that the only way to get media coverage is to destroy property, and that would be a wholly inappropriate response. I’ve tried telling people myself; I’ve blogged, tweeted, facebooked, accosted people in the street, written to my MP, attended events and rallies… what else can we do?

Answers on a postcard…

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Manchester Airport is a Health Risk

I arrived at Manchester Airport yesterday morning with plenty of time for my flight; I’d never been there before so didn’t know what to expect. It’s quite a large place with lots going on, so I figured it’d be easy to kill the hour before my flight. I had already gone through the rigmarole of separating my washbag so that all my liquids were in separate clear plastic bags, and I had my stuff all ready for inspection at the security area. When I got near the front of the queue I noticed that they had a fairly full-on security gate: there was a turnstile which let you through the initial metal detector, and once you’ve been checked for metallic objects, you are then presented with two glass doors surrounded by illuminated arrows; you then go through the door which lights up. One door leads you to your recently x-rayed belongings, and behind the other lurks a backscatter x-ray scanner. At this time I don’t know if this is a random allocation or if it’s due to Big Brother. Maybe if I’d been one place ahead in the queue I wouldn’t be writing this blog post.

So my turn comes and I go through the turnstile, through the metal detector, and stand in front of the doors, awaiting my fate, and hoping that the right hand door would light up and show me my freedom. Alas. I walked through the left hand door, where a kindly gentleman instructed me to place my feet on the marked circles. I calmly explained that I would rather not. He asked me to stay where I was and went to get a security officer (I’m not certain of her job title). She was a very friendly and not at all threatening lady, who walked over armed with information leaflets on the backscatter machine. I told her that I work with radiation, have spent the previous three years studying it, and that I had plenty of information on how the machines work and the radiation implications. Her body language changed slightly at this and she told me fairly dejectedly that unfortunately there was no alternative, as Manchester Airport do not allow passengers to opt out of the backscatter scanner. She asked me to email the Department for Transport and have it out with them; she said that maybe if enough people made a fuss, something might change. I’ll be honest and admit that I was so relieved to be met with someone so reasonable: I have never been on the wrong side of the law, and certainly never on the wrong side of airport security and I didn’t have the guts to get in trouble with both on this occasion. The conversation was very polite and considered, but she explained that the only way to avoid the scanner would be to not get on the flight. If I had the money I would have probably opted to take the train, but I’m still an unwaged student. I asked if they had any paperwork they could give me to prove that I had been scanned, but they don’t, which seemed odd; all she could give me were some leaflets on the machine itself. Maybe it’s part of the anonymisation process or something.

So I assumed the position, reluctantly. All the while very aware that I was being stared at by other passengers, as the entire charade was being conducted in a glass box in front of the security queue. It was quite humiliating to be honest, I know that assumptions were probably being made about why I was causing a problem, but I really don’t care. What worries me, is that there are no signs on the backscatter machine denoting what it actually is. It’s just two large black boxes which you stand inbetween with your arms in the air. At no point is it explained to you what the machine actually does or is. Is this because if they did, more people would refuse to enter it?

I’m going to do some more research, but for now I’ll leave you with these links:

http://www.bbc.co.uk/news/uk-england-manchester-15766544

http://www.bbc.co.uk/news/health-13990434

http://scrapthescanners.wordpress.com/2011/11/20/disgrace-and-debacle-euro-scanners/

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2012: The End.

No, not the apocalypse (do people actually believe that shit?).

This year will be the end of one way of life and the beginning of another, in theory.

If everything goes to plan, my final exam will be this Wednesday. The following day I’ll be celebrating the end of exams plus Portsmouth SitP’s first birthday (clicky for more info).

The next major milestone comes in March, which is when my dissertation is due in, and I am absolutely terrified. Shortly after is my final clinical placement, and hopefully the last time I’ll be working in a hospital without being paid.

And then that’s it. Finished. No more lectures, exams or presentations. No more staying up til 3am writing essays (I really can relate to Douglas Adams’ feelings on deadlines).

Apparently some people feel scared upon leaving academia; I wonder if this is because they haven’t worked before as I suppose that can be quite daunting. The scariest thing for me was starting the process. Giving up my job was the most unpleasant part of the whole affair, and I’m not just talking about losing a regular salary, although that was quite galling. There’s a certain safety in doing something you know you’re capable of, and you don’t tend to get that when you’re starting from scratch.

When I was learning how to use Linux for the first time, I did so at my own pace, and when it all got a bit much I’d retreat to the safety of Active Directory, something I could configure in my sleep (and frequently did so) which bumped my confidence back up.

There’s not been much in the way of safety or familiarity over the past 2 and a bit years; all of it (with the minor exception of the teeny bit of quantum physics in the first year) has been brand new to me, even down to certain aspects of essay writing (I put my name on the first essay I submitted, not knowing that this was an instant fail- oops!) so it’s been something of a journey.

The “working in a hospital” bit which comes next doesn’t worry me so much; from what I’ve seen, all newly quals start their first jobs like rabbits on a motorway, terrified about their first on-call or theatre case so I’m sure I’ll fit right in. The actual act of getting a job is pretty unnerving though. I had my first rejection last week for my “dream job” at King’s College Hospital. I didn’t expect to even be considered, but still. Sucks.

Anyway, I’m rambling. Back to revision.

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Inter-Professional Spurning

On Friday I finished the practical aspect of a degree module called “Inter-Professional Learning” (IPL). For two weeks every academic year, healthcare students from Southampton and Portsmouth University are bundled together into groups of 10 and given a project to do. IPL “strives to improve communication and working relationships between professionals, and helps them deliver high quality services in increasingly challenging times.” The idea being that if doctors, nurses, podiatrists, radiographers etc work together before they qualify, it will hopefully enable them to work together even more smoothly throughout their careers.

Unfortunately my experience of IPL has taught me very little about other healthcare professions (except pharmacists, which I’ll come to later) and in most cases it has reinforced some stereotypes that I know aren’t true.

For example, all of the medical students I have worked with on IPL have been incredibly self important and made it very clear that they had much better things to do (as if the rest of the group desperately wanted to be there) and in a few cases they even went as far as not bothering to show up. The male med student in the first year showed up on day 1 and day 14, and spent the time in between playing rugby somewhere in Europe.

Until this year, all of the social work students in my group have been paranoid and defensive, an attitude which can’t have been helped by the introductory lecture we had at the beginning of the first IPL which basically reminded everyone that people always blame social workers when a child is hurt or killed. I’m sure this was meant to be helpful, but it put my group’s social work student into a really foul and indignant mood.

The nurse from IPL1 was an alt-med nutter who insisted that humans don’t need vaccines as homeopathy is a much more effective and safe method of protecting yourself. Terrifying.

So yes, I am cynical about the effectiveness of IPL in its mission to improve communication and attitudes within a multi-disciplinary team. Especially bearing in mind I had the best IPL-like experience anyone could wish for whilst living in the Pokhara house; working, resting and playing with healthcare professionals from all over the world. I learnt more about what nurses and doctors do in that month that I have done over the duration of my entire degree so far. I was hugely impressed by their knowledge, and I really enjoyed our dinner conversations about the day we’d just had.

Last year on IPL2 I did actually learn a fair bit about pharmacy, but it had nothing to do with IPL itself. It was in the car journeys to the placement site, where the pharmacist and I had many really interesting conversations about the legal side to the profession, as well as discussing the vast amount of mathematical prowess required.

I follow a few medics on Twitter; some are students, some are long-qualified, and some have only just registered with the GMC. They all regularly provide me with really interesting information about their profession and healthcare in general, and there’s even a Twitter journal club where papers are reviewed and critiqued by anyone with an interest.

I have never felt compelled to stay in touch with any IPL group member once the sessions have finished, but this weekend I’m driving over 500 miles for a reunion with my Pokhara housemates (those on this side of the Atlantic anyway).

I suppose what I’m saying is that healthcare workers and students need to be personally interested in engaging with each other, as no amount of forced role-playing or ice breaking sessions will achieve a truly cohesive working environment. It is a sad fact of life that some people are content to go through their lives with the bare minimum of effort and interest, and I guess that’s why IPL has to exist. But at least those people will never become public health bores like me.

:-/

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