I've written before on the sadder parts of working in paediatrics, and how I think it's ok to find it upsetting (it's entirely coincidence that I wrote that post exactly one year ago). As I've got more senior and been more directly involved with patient care and decision making, I've found that the harder parts of my job have got, at times, even tougher.
I am quite involved with the medical student paediatric society (hi LUMPS) and as part of this I mentor students who are interested in paediatrics. One of the commonest questions they ask is "how do you cope with the sad bits?" - most commonly they wonder how I deal with deaths and child protection issues. The honest answer is that I'm not sure I do, at least not in any way that I can really express to anyone else. Paediatricians, on the whole, are a pretty nice bunch, so there's always lots of peer support. Even very senior and experience colleagues still get upset by horrible things happening, and the general consensus is that it's ok to be sad when sad things happen. Still, I find myself wondering whether it's "professional" to be upset by things I see at work.
Is it ok to feel sad when you see a child who has had injuries inflicted by their own family? Is it wrong to cry when a baby you've looked after since their birth passes away? Do these emotions, or expressing them, make me a bad doctor? I'm a naturally self-critical person and so tend to feel like anything I do, say or feel is an indicator of how terrible I am, and I guess this is just another example of this. In reality, I suspect being upset about a patient is no bad thing, as long as it doesn't influence how you treat the next one. So cry, take 5 minutes for a cup of tea, go home after your shift and have a glass of wine, do whatever you need to. But when the next patient comes along, they deserve the same care and attention as all the rest.
It's not unprofessional to be sad. But it is unprofessional to let that sadness affect the care you provide to others.
Showing posts with label Patients. Show all posts
Showing posts with label Patients. Show all posts
Friday, 7 April 2017
Sunday, 10 January 2016
Just Keep Swimming (Or Running...)
Back in November, I announced my somewhat ridiculous-sounding plan of running the London Marathon in April. I'll be honest, the idea scared me at the time and I wasn't entirely convinced I was going to manage it. As I embarked on my couch to 5k starters running plan, it hit home really just how unfit I was. Even the 60 second running intervals in the first week felt tough. I've tried couch to 5k in the past and always got stuck at week 5, where the running increases from 8 minutes at a time to 20 minutes solid. I wasn't sure it would be any different this time.
I'm happy to say that I finally broke the (mostly psychological) 8 minute barrier and yesterday managed to run continuously for over 30 minutes. I know I still have a very long way to go, but I think in getting to this point, I've realised just how much running is due to mentality. Although my fitness has improved, the biggest change has been in my attitude towards it. I've realised that previously, it wasn't being out of breath or achy legs that stopped me, it was not believing I could do it. Now that I've realised that, I'm hoping I can continue to push myself and will manage to complete the marathon (even if I have to crawl across the finish line).
I'm under no illusions as to how tough this is going to be, but I'm doing it for a very, very good cause. I'm raising money for CLIC Sargent, a fantastic charity who help support children and young people with cancer and their families. Anything you can spare in sponsorship would be greatly appreciated. I know money is tight at this time of year, but every penny really does count and will be put to excellent use. £15 pays for a copy of CLIC Sargent’s DVD to help families of a child or young person who has died of cancer to deal with their grief. £25 pays for an hour of a CLIC Sargent Nurse’s time, allowing them to co-ordinate a child's care and arrange for treatments to be given as close to home as is safely possible. £50 pays for three hours of a CLIC Sargent Play Specialist’s time, letting them use models, toys and photographs to prepare a child for their treatment.£75 pays for three hours of a social worker’s time, letting them provide practical, financial and emotional support to the family of a child or young person with cancer.
Every penny you can spare will spur me on with my training and help CLIC Sargent continue to provide their incredibly valuable services. Please go to https://www.justgiving.com/amanda-friend/ to sponsor me.
Thank you.
I'm happy to say that I finally broke the (mostly psychological) 8 minute barrier and yesterday managed to run continuously for over 30 minutes. I know I still have a very long way to go, but I think in getting to this point, I've realised just how much running is due to mentality. Although my fitness has improved, the biggest change has been in my attitude towards it. I've realised that previously, it wasn't being out of breath or achy legs that stopped me, it was not believing I could do it. Now that I've realised that, I'm hoping I can continue to push myself and will manage to complete the marathon (even if I have to crawl across the finish line).
I'm under no illusions as to how tough this is going to be, but I'm doing it for a very, very good cause. I'm raising money for CLIC Sargent, a fantastic charity who help support children and young people with cancer and their families. Anything you can spare in sponsorship would be greatly appreciated. I know money is tight at this time of year, but every penny really does count and will be put to excellent use. £15 pays for a copy of CLIC Sargent’s DVD to help families of a child or young person who has died of cancer to deal with their grief. £25 pays for an hour of a CLIC Sargent Nurse’s time, allowing them to co-ordinate a child's care and arrange for treatments to be given as close to home as is safely possible. £50 pays for three hours of a CLIC Sargent Play Specialist’s time, letting them use models, toys and photographs to prepare a child for their treatment.£75 pays for three hours of a social worker’s time, letting them provide practical, financial and emotional support to the family of a child or young person with cancer.
Every penny you can spare will spur me on with my training and help CLIC Sargent continue to provide their incredibly valuable services. Please go to https://www.justgiving.com/amanda-friend/ to sponsor me.
Thank you.
Friday, 24 July 2015
I'm A Paeds FY1... Get Me Out of Here!
With the much anticipated first Wednesday in August (for non-UK/non-hospital based folks, that's when all the junior doctors change jobs and our shiny new colleagues start their first roles as qualified doctors) fast approaching, I'm breaking from the EBM theme to write a #tipsfornewdocs type post for those who will be starting out in the crazy, scary, exciting world of paediatrics. I never actually did a paediatric rotation in FY1 but over the past year or so I've worked with numerous FY1 colleagues, some of them excellent and some of them a little less so. This is basically a list of the things I think really make the difference between the good ones and the rest.
If you're starting your first job as a doctor on paediatrics, lucky you! Whilst a lot of people are naturally anxious about working with children (yes, some of them are quite small, and they can be sticky and noisy, and worse than that, they come with parents attached!) you'll be working in a very well-supported environment with, on the whole, a very approachable group of senior colleagues. No one will expect you to be cannulating neonates or taking bloods from chunky toddlers on your first day! You also have the benefit, if you start in August, of working in a specialty with quite marked seasonal variation in admissions, so over the summer it should be relatively quiet on the wards and you'll have time to get your head around how things work before the winter chaos commences!
Paediatrics is a lovely, varied specialty with lots to learn. How much you do in terms of venepuncture, cannulation etc is largely up to you - if you aren't comfortable, no one will make you do it, but if you're keen then the SHOs and registrars will be more than happy to teach you. There should be lots of opportunity for getting involved in audit, if that's your sort of thing, and there's usually some kind of research going on if that's what interests you. So what makes a great paediatric FY1?
Be organised. This goes for every FY1 job out there, to be honest. If you know who your patients are, what's going on with them and when they might get home, you'll probably not go far wrong. If you know a patient might go home, get started on their discharge paperwork early. This is great for your patients, as it means they have less of a wait between being told they're fit for discharge and actually getting to go home. It also keeps the nurses happy, and frankly keeping the nurses on your side is one of the biggest things you can do to help yourself survive as a junior doctor!
Be interested. I get it, not everyone is keen on kids. For some of you, paediatrics will probably be your worst nightmare. We all do at least one job during our training we are not remotely keen on (FY1 general surgery, in my case), but these jobs still have plenty to teach you. The majority of you will end up having some contact with children during your future training, and even if you have your heart set on geriatrics from day one, there's a lot of opportunity for embracing multi-disciplinary working and improving your communication skills, which will be useful in any future career. You don't have to love it, but please don't treat your rotation as some kind of sentence which must be served.
Be able to spot a sick child. This is the biggest "clinical" thing expected of you if you're going to be involved in assessing children. Hopefully you'll get a chance to see new admissions to the unit and clerk them, as that's probably the best learning opportunity. No one will expect you to correctly diagnose everything you see, but it's important that you can recognise those children who look unwell and need senior review sooner rather than later. There is a really useful website called Spotting the Sick Child, which has elearning modules and videos of what to look out for and is worth doing if you aren't clear what a sick child looks like (you also get a certificate of completion which you can stick in your ePortfolio...). If in doubt, ask. Children can deteriorate quickly so if you aren't comfortable and feel something is wrong, get help sooner rather than later. Management priorities for someone acutely unwell follow the ABC approach, but you should never be in a situation where you're dealing with this by yourself. The DEFG (don't ever forget glucose) is particularly important in young children as they're prone to hypoglycaemia and it can have serious consequences.
Be friendly. Engaging well with a child can make a huge difference. Not everyone is naturally comfortable with children, but if you can chat about something that interests them, that's a great start. Knowing which characters frequently appear on t-shirts and pyjamas is useful, as clothes are a great starting point for conversation ("oh wow, that's Peppa Pig on your top, is she your favourite?"), as are toys and characters around the room. Frozen and Minions are particularly popular at present. If you can distract a child talking about whether they like Anna or Elsa best or how funny it is when the naughty Minions turn purple, you're much more likely to work out whether they have genuine abdominal tenderness, for example. Hi-fives after finishing an examination or procedure go down well, and if there are bravery certificates and stickers on the ward these tend to be good bargaining tools if you need to do something the child perceives as unpleasant (including looking at the throat; you would be amazed at just how much kids hate opening their mouths when you ask them to do it!).
Be professional. There's a fine balance between being child-friendly and being silly. Yes, parents want someone who's good with their child and knows how to communicate with them, but they also want a doctor. Being daft when you're examining and chatting to a kid is fine, but make sure when explaining finds and communicating plans to parents that you come across as the knowledgeable professional you are. This also goes for speaking with teenagers, who will be wholly unimpressed if you treat them like children.
Common things are common. Have a basic grasp of the common presentations and how to manage them. A lot of paediatrics is about simple things, done well. Wheeze and fever are probably the 2 most common presentations, so know your local investigation and management guidelines for these. You'll also probably see a a lot of jaundiced babies, rashes and gastroenteritis. If you can take a decent history, examine and work out which kids are the really poorly ones (see earlier point) you won't go far wrong.
Enjoy it! Paediatrics is fun and children are interesting. Plus, where else can you get baby cuddles, play with bubbles and watch cartoons whilst at work?!
Good luck!
If you're starting your first job as a doctor on paediatrics, lucky you! Whilst a lot of people are naturally anxious about working with children (yes, some of them are quite small, and they can be sticky and noisy, and worse than that, they come with parents attached!) you'll be working in a very well-supported environment with, on the whole, a very approachable group of senior colleagues. No one will expect you to be cannulating neonates or taking bloods from chunky toddlers on your first day! You also have the benefit, if you start in August, of working in a specialty with quite marked seasonal variation in admissions, so over the summer it should be relatively quiet on the wards and you'll have time to get your head around how things work before the winter chaos commences!
Paediatrics is a lovely, varied specialty with lots to learn. How much you do in terms of venepuncture, cannulation etc is largely up to you - if you aren't comfortable, no one will make you do it, but if you're keen then the SHOs and registrars will be more than happy to teach you. There should be lots of opportunity for getting involved in audit, if that's your sort of thing, and there's usually some kind of research going on if that's what interests you. So what makes a great paediatric FY1?
Be organised. This goes for every FY1 job out there, to be honest. If you know who your patients are, what's going on with them and when they might get home, you'll probably not go far wrong. If you know a patient might go home, get started on their discharge paperwork early. This is great for your patients, as it means they have less of a wait between being told they're fit for discharge and actually getting to go home. It also keeps the nurses happy, and frankly keeping the nurses on your side is one of the biggest things you can do to help yourself survive as a junior doctor!
Be interested. I get it, not everyone is keen on kids. For some of you, paediatrics will probably be your worst nightmare. We all do at least one job during our training we are not remotely keen on (FY1 general surgery, in my case), but these jobs still have plenty to teach you. The majority of you will end up having some contact with children during your future training, and even if you have your heart set on geriatrics from day one, there's a lot of opportunity for embracing multi-disciplinary working and improving your communication skills, which will be useful in any future career. You don't have to love it, but please don't treat your rotation as some kind of sentence which must be served.
Be able to spot a sick child. This is the biggest "clinical" thing expected of you if you're going to be involved in assessing children. Hopefully you'll get a chance to see new admissions to the unit and clerk them, as that's probably the best learning opportunity. No one will expect you to correctly diagnose everything you see, but it's important that you can recognise those children who look unwell and need senior review sooner rather than later. There is a really useful website called Spotting the Sick Child, which has elearning modules and videos of what to look out for and is worth doing if you aren't clear what a sick child looks like (you also get a certificate of completion which you can stick in your ePortfolio...). If in doubt, ask. Children can deteriorate quickly so if you aren't comfortable and feel something is wrong, get help sooner rather than later. Management priorities for someone acutely unwell follow the ABC approach, but you should never be in a situation where you're dealing with this by yourself. The DEFG (don't ever forget glucose) is particularly important in young children as they're prone to hypoglycaemia and it can have serious consequences.
Be friendly. Engaging well with a child can make a huge difference. Not everyone is naturally comfortable with children, but if you can chat about something that interests them, that's a great start. Knowing which characters frequently appear on t-shirts and pyjamas is useful, as clothes are a great starting point for conversation ("oh wow, that's Peppa Pig on your top, is she your favourite?"), as are toys and characters around the room. Frozen and Minions are particularly popular at present. If you can distract a child talking about whether they like Anna or Elsa best or how funny it is when the naughty Minions turn purple, you're much more likely to work out whether they have genuine abdominal tenderness, for example. Hi-fives after finishing an examination or procedure go down well, and if there are bravery certificates and stickers on the ward these tend to be good bargaining tools if you need to do something the child perceives as unpleasant (including looking at the throat; you would be amazed at just how much kids hate opening their mouths when you ask them to do it!).
Be professional. There's a fine balance between being child-friendly and being silly. Yes, parents want someone who's good with their child and knows how to communicate with them, but they also want a doctor. Being daft when you're examining and chatting to a kid is fine, but make sure when explaining finds and communicating plans to parents that you come across as the knowledgeable professional you are. This also goes for speaking with teenagers, who will be wholly unimpressed if you treat them like children.
Common things are common. Have a basic grasp of the common presentations and how to manage them. A lot of paediatrics is about simple things, done well. Wheeze and fever are probably the 2 most common presentations, so know your local investigation and management guidelines for these. You'll also probably see a a lot of jaundiced babies, rashes and gastroenteritis. If you can take a decent history, examine and work out which kids are the really poorly ones (see earlier point) you won't go far wrong.
Enjoy it! Paediatrics is fun and children are interesting. Plus, where else can you get baby cuddles, play with bubbles and watch cartoons whilst at work?!
Good luck!
Friday, 2 January 2015
Frequent Flyers
As it's winter, we are once again inundated with headlines about the impending NHS "disaster". There are no beds, more and more people are turning up at A&E and services simply can't cope. There is, of course, some truth in this. A particularly cold winter or an unusually aggressive strain of influenza can result on unexpected pressure on health-care services. That said, services are almost always under more pressure in winter so I'm not sure why the press jump on this like it's a new phenomenon.
As the pressure on health-care services mounts, people naturally start looking for "quick fixes" in order to relieve this. Recently, there has been a lot of talk about "frequent flyers" - an unpleasant term used to refer to patients who access health-care services more than others. There is a suggestion going around that if these greedy so-and-sos learned to self-manage better, the NHS would be in much better shape.
Although I've only been a qualified doctor for 2 and a half years, I've met a number of so-called frequent flyers. I recall a young girl with cystic fibrosis who I looked after during my respiratory rotation who had multiple admissions during the 4 months I worked there. I'm pretty sure that if she had an option, she wouldn't have been in hospital, but multiple spontaneous pneumothoraces are pretty hard to manage at home. There was a middle-aged gentleman who I met during my gastroenterology job. Despite everyone's best efforts, flares of his inflammatory bowel disease repeatedly landed him in hospital. Now I'm working in paediatrics, I can think of several patients who bounce in and out of hospital. A viral upper respiratory tract infection is generally something that can be managed at home, but if you have a rare metabolic disorder, chronic lung disease or a complex cardiac condition then it can be deadly. I can't think of a single "frequent flyer" who had multiple admissions for any reason other than that they were unlucky enough to have an unpleasant chronic disease.
Yes, keeping frequent flyers out of hospital would definitely relieve pressure on hospitals. Now, if the people who come up with these soundbites could come up with the medical advances required to cure these patients so that they don't need to keep coming in to hospital, then that would be wonderful. I'm pretty sure the patients would appreciate it too. In the meantime, let's stop blaming patients for pressure on our services and look at ways to better deal with increased demand.
As the pressure on health-care services mounts, people naturally start looking for "quick fixes" in order to relieve this. Recently, there has been a lot of talk about "frequent flyers" - an unpleasant term used to refer to patients who access health-care services more than others. There is a suggestion going around that if these greedy so-and-sos learned to self-manage better, the NHS would be in much better shape.
Although I've only been a qualified doctor for 2 and a half years, I've met a number of so-called frequent flyers. I recall a young girl with cystic fibrosis who I looked after during my respiratory rotation who had multiple admissions during the 4 months I worked there. I'm pretty sure that if she had an option, she wouldn't have been in hospital, but multiple spontaneous pneumothoraces are pretty hard to manage at home. There was a middle-aged gentleman who I met during my gastroenterology job. Despite everyone's best efforts, flares of his inflammatory bowel disease repeatedly landed him in hospital. Now I'm working in paediatrics, I can think of several patients who bounce in and out of hospital. A viral upper respiratory tract infection is generally something that can be managed at home, but if you have a rare metabolic disorder, chronic lung disease or a complex cardiac condition then it can be deadly. I can't think of a single "frequent flyer" who had multiple admissions for any reason other than that they were unlucky enough to have an unpleasant chronic disease.
Yes, keeping frequent flyers out of hospital would definitely relieve pressure on hospitals. Now, if the people who come up with these soundbites could come up with the medical advances required to cure these patients so that they don't need to keep coming in to hospital, then that would be wonderful. I'm pretty sure the patients would appreciate it too. In the meantime, let's stop blaming patients for pressure on our services and look at ways to better deal with increased demand.
Sunday, 22 June 2014
(Not) Just A Minion
There is a temptation as a junior doctor to refer to oneself as "just a minion". This is particularly true of FY1s/residents, but it persists a fair way up the food chain. After all, we just go around obeying orders and doing as we're told, right? WRONG.
A junior doctor tends to be the first person to be called to a sick patient, whether a new admission or a current inpatient who has deteriorated. Every day we make decisions about whether to start or stop fluids, analgesia, antibiotics etc. We are the ones who decide whether a new admission can wait to be clerked in by us or whether we need to intervene immediately. When we review patients, we are not robots, simply asking a series of questions. We are interpreting (sometimes vast amounts of) information and making complex decisions based on that information. We have spent many years training to become critical thinkers, analysts, problem solvers. It would be utterly ridiculous to then unleash us into a job where we are simply yes-men. Yes, we have limited experience compared to our seniors, but we are still expected to think relatively independently.
A lot of juniors are also under the (false) impression that senior = infallible. This is clearly not true. Sometimes, as juniors, we are the ones who alert the consultants to something important. Prescribing diclofenac as instructed is not a smart move if you recall the past history of gastric ulceration - something a senior may not be aware of (because you took the history, remember?). Your boss may not have seen the latest blood results and it may be up to you to point out the deteriorating renal function or rising inflammatory markers. There are also occasions where your seniors will make errors. Pointing them out doesn't mean being arrogant or argumentative, but a simple "I'm interested, why did you decide X?" or "I was under the impression that you do(not) do that in situation Y" could prevent a patient coming to harm.
One of the main reasons I (and, I suspect, some of my colleagues) dislike the "just a minion" attitudes is that it seems to remove an element of responsibility from the junior, as if their actions and decisions are meaningless. You worked hard at university for a long time. You are paid an enviable salary. You are a member of one of the most trusted professions there is. So stop with the "just a minion" talk. You're a doctor, and what you do matters.
(Thanks to @drbobphillips for suggesting I write this post)
A junior doctor tends to be the first person to be called to a sick patient, whether a new admission or a current inpatient who has deteriorated. Every day we make decisions about whether to start or stop fluids, analgesia, antibiotics etc. We are the ones who decide whether a new admission can wait to be clerked in by us or whether we need to intervene immediately. When we review patients, we are not robots, simply asking a series of questions. We are interpreting (sometimes vast amounts of) information and making complex decisions based on that information. We have spent many years training to become critical thinkers, analysts, problem solvers. It would be utterly ridiculous to then unleash us into a job where we are simply yes-men. Yes, we have limited experience compared to our seniors, but we are still expected to think relatively independently.
A lot of juniors are also under the (false) impression that senior = infallible. This is clearly not true. Sometimes, as juniors, we are the ones who alert the consultants to something important. Prescribing diclofenac as instructed is not a smart move if you recall the past history of gastric ulceration - something a senior may not be aware of (because you took the history, remember?). Your boss may not have seen the latest blood results and it may be up to you to point out the deteriorating renal function or rising inflammatory markers. There are also occasions where your seniors will make errors. Pointing them out doesn't mean being arrogant or argumentative, but a simple "I'm interested, why did you decide X?" or "I was under the impression that you do(not) do that in situation Y" could prevent a patient coming to harm.
One of the main reasons I (and, I suspect, some of my colleagues) dislike the "just a minion" attitudes is that it seems to remove an element of responsibility from the junior, as if their actions and decisions are meaningless. You worked hard at university for a long time. You are paid an enviable salary. You are a member of one of the most trusted professions there is. So stop with the "just a minion" talk. You're a doctor, and what you do matters.
(Thanks to @drbobphillips for suggesting I write this post)
Sunday, 23 June 2013
The Impact Factor
As a budding academic, I hear all too often about the importance of the 'impact factor'; that is, how likely articles from a journal are to be referenced in a later article. It's a somewhat controversial measure of how "good" a journal is, but the journals with the biggest reputations (eg Science, Nature) do seem to have the highest impact factors anyway. Frankly, at my stage, I'm still happy enough if anyone seems interested in publishing something I've been involved in writing so it doesn't particularly bother me if the impact factor is 0.01, but no doubt if things progress then at some point I'll probably have to start choosing to submit to higher impact journals.
Despite just writing a paragraph about it, this blog entry wasn't meant to be about the impact of journals and articles. It was about the impact we have on patients. Sometimes, I think it's easy to get wrapped up in the numbers and figures. A busy day of surgical receiving becomes 4 query appendicitis, 6 diverticulitis, a renal colic, the stab wound in A&E and 3 from GP still to be seen. Another 5 blood results awaited, 3 abdominal films to chase and would radiology please hurry up and report that CT scan. Yes, we care about our patients deeply, but sometimes what we do becomes so routine that we may forget that although this is our 24th acute abdomen, for the patient it's the first time in hospital or the most terrifying thing they've ever experienced. Even for those patients who we see regularly - the chronic pancreatitis after another alcohol binge, the poorly controlled Crohn's disease desperate to avoid a stoma - their interaction with the health service is likely to have a significantly greater impact on them than it does on us.
I was recently in a bar with a colleague when a lady approached us. "I know you" she said to him. He looked momentarily embarrassed and I assumed he had no idea who she was. Her next sentence took me (although I suspect not him) by surprise. "You're the doctor who saved my husband's life". I didn't go into details with him about what had happened, but it was clear that in the course of going about his daily work he had made a huge difference to this family (and, I suspect, many others). She was very pleasant, updated him with how things were, wished us a good night (and said it was great to see that doctors were humans who you saw drinking in pubs in town like normal people - but that's definitely a different topic...) and went on her way. I was surprised by how very uncomfortable my colleague seemed with this. He muttered something about "just doing my job" to me and returned to his pint.
The "just a job" attitude is an incredibly difficult one to get right. After more and more guidelines about what we can say on Twitter or the photos we shouldn't put on Facebook, many doctors have become fed up with the constant attempts to control our out of work lives. This has resulted in many of us (myself included) taking the staunch position of "it's only a job". I don't think that this is wrong. I go to work, do my job and hopefully do it well, and then I go home to the kind of social life I choose. I don't believe that drinking more than my recommended alcohol intake or (god forbid) having a cheeky cigarette makes me less competent at what I do. Where this attitude falls down, though, is that it makes us more likely to forget how important what we do is. We're privileged enough to be involved in some of the most important times of families' lives. Let's not forget the impact each of our interactions will have on a patient and their loved ones.
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