Saturday, October 27, 2007

Still here

Thank you for the encouragements to return. I haven't had much to say recently. Mainly because the things that I want to talk about are too specific to allow me and my place of work to remain anonymous. Work has been incredibly stressful but I have just had ten days of annual leave, which has improved things.

I have discovered that I am remaining in my current position until next October - fourteen months. This is so that we will be in line with the SpR (registrar) changeover dates. Although I am enjoying the obstetrics and gynaecology part of my job, I am unhappy in my position. I feel unsupported a lot of the time. Some of the Consultants bad mouth other Consultants in front of nursing and junior staff, which adds to the discomfort. There is minimal team feeling and a high sickness rate in nursing staff as well as two of the other junior doctors. The next twelve months stretch ominously in front of me and I am paranoid that my depression is going to return.

In happier news, the house is now starting to resemble a home. We are still carpet, paint and furniture short in one bedroom. The shower does not work and we need a new boiler. However, dramatic progress has been made.

Saturday, September 8, 2007

A Short Update

I have now completed a full rota cycle. I'm enjoying myself and I'm feeling that I have made the right career decision. I'm terrified about just how much I have to learn. I see the Registrars dealing with problems and I can't see how that will ever be me. It's a bit like when I was a medical student and could never imagine actually being a doctor.

The politics within the job are very odd, particularly with all the practitioners. I'm going to save writing about this for another day.

The caesarean section rate is very high and it's slightly disconcerting assisting at sections which would have been delivered vaginally in my previous job. Pre-term breeches being a prime example. A lady who was 27 weeks pregnant was admitted fully dilated and pushing. The baby was breech so they did a crash caesarean section under general anaesthetic. I feel that I am too junior in training to know what's right. I worry that I will never learn how to do a breech delivery though and that I will then have to section these people because I don't have the necessary skills to do otherwise.

Not that that matters yet - I have many other skills and attributes to learn first.

Monday, August 20, 2007

Day 8 of 12

Last week was on call - evenings all week and then long days through the weekend, which was busy. I'm extremely tired now and am covering theatres all week. My unfit body is crying out from the 10 hours stood in theatre today (surprise, surprise, the list overran but fortunately we didn't have to cancel anybody)

We move into our new house on Friday. I'm so excited. I can't wait for this horrible commute to be over - only four more days until I no longer have to buy petrol every 2.5 days.

Unfortunately, I am too tired to blog. I have replied in the comments below, thanks for all your thoughts, as ever.

JD x

Thursday, August 16, 2007

The New Job

I'm enjoying the new job, although its very different to my previous post in Obstetrics and Gynaecology. The bread and butter work is obviously similar and the staff are lovely so I'm happy.

There are a few issues with the rota and of course, I still have no contract or confirmation of pay and conditions. Nor do I have a parking permit, a full rota or even an end date! They are still unsure whether I am there for a year or six months. Hmmmph.

Educationally, I am slightly concerned. We are not doing enough hours and I am very much a service provider. Bloods, venflons and discharges. I notice that the extended role midwives are being trained to do ventouse deliveries and fetal blood sampling, whilst I sign off blood results.

The Gynaecology Nurse Practitioners are very good at their job but they have no knowledge of medicine and try to coerce me into dangerous practices. One asked me three times why I wasn't given fluids to an unwell patient. She had heart failure and was dangerously fluid overloaded. Later, she patronisingly asked if I had done some medicine "because I seemed to know what I was doing". Quite. I know I am young and inexperienced but I have been trained well in the basics. These people tell me regularly that they are the same as an SHO. Apart from the fact that they can't prescribe, order unnecessary tests and scans and won't make any decisions other than whether or not to bleep the Registrar. They are excellent at the Gynaecology though and a mine of information. It's just that they haven't been trained in anything else.

The other career trainee is also concerned. The GP trainees are happy because the job is ideal in that respect. It doesn't matter if they can't do an instrumental delivery or a caesarean section or interpret a CTG. It does matter for me. We are going to run a rota cycle (six weeks) and then discuss it with the Consultant in charge. I want to work and I want to train. Hopefully, they're going to let me!

Monday, July 9, 2007

Is it Wrong?

When asked what I had learned in my General Practice rotation, is it wrong that the first thing that I thought was "that I'm not cut out to be a GP?"

I find it really stressful. Lots of people, who can come and see you whenever they want. They fall into three main categories:

1. Need a sick note - this can be for actually being too unwell to work or that they are having difficulty with their current job. I find these a challenge.
For example, your boss is a bully so you go off work with 'stress' or 'anxiety' or more frequently 'depression'. Are you really depressed? Difficult to say as symptoms will often improve once you have escaped the monster and it rarely responds to anti-depressants. However, once you have to consider going back to work, the symptoms return: "I'm just not ready, Doctor". I am sympathetic, but I can't see how you're ever going to be ready. The boss is not going to have a personality transplant and you are going to be at a low ebb having just been off. Do you really need a sick note? No, you need a new job. Can you get a new job when you're crying all the time? Probably not, so you want a sick note. Argh.

2. Common self limiting illnesses - However, there's always that niggling doubt in your mind: Is it flu or is it meningitis? Is it tension headache or is it a brain tumour? Is it a chest infection or a first presentation of lung cancer? Are you tired all the time due to stress (most common) or is it your thyroid, leukaemia or coeliac disease or acute liver failure? Which people need reassurance? Which need bloods or an Xray or admitting or referral?
I think about this with every patient. It's exhausting.
I had a chap in today with a very complex past history including a shunt in his head, which moves excess fluid around his brain into his heart. He had what initially sounded like sciatica but he has had some change in his balance and gait. I am sorry to say that the words 'spinal TB' actually passed through my mind. It's blatantly not spinal TB. That's a crap diagnosis - it's extremely rare and it doesn't even fit his symptoms properly! I must have seen 30 people with sciatica / low back pain over the last three months but now I have this man with something random going on. That in itself stresses me out - what if I hadn't listened and had just given him some painkillers? Actually, he's going to see the neurologist urgently instead.

A lady the other week came in feeling tired and a bit sickly. She had had a bit of epigastric pain but it had settled with paracetamol. She had seen the out of hours people who had said she might have a virus. However, after four days, she still felt unwell so she came to see me. Observations were fine but she looked sallow. She was slightly tender in the right side of her abdomen and had a scar where her gallbladder had been removed. Nothing to put my finger on, but I did urgent bloods anyway. They came back that she had acute liver failure (Bilirubin 35, hence the 'sallow'ness, ALT 700 - should be 40!). I went straight round to her house at the end of surgery and arranged admission to hospital. These are the type of things that I worry about missing. I can't tell you about the ones I have missed because I haven't heard about them yet!

3. Random illnesses - This is the stressful bit. Now, there might be something serious going on, or it might be "just one of those things". People have a lot of symptoms, many of which are not medically explicable. That is not to say that they don't exist, it's just that there is no recognised diagnosis to tie them together.
Actually, that stresses me too. Sometimes I wake up in the night panicking that it's not that there isn't a diagnosis, it's that I missed that lecture in medical school... Honestly, I didn't miss many!

My GP mentor, who loves being a GP, can't understand it. He can't believe that this is more stressful to me than a woman who is bleeding all over the floor or a fetus in distress. Don't get me wrong, I find that stressful too. However, I know what to do about that. The problem is obvious. There is no doubt that I need to act. Even the actions are fairly well defined.

My problem with General Practice is that I cannot cope with the uncertainty. I like the satisfaction of massaging blood pressure figures. However, it takes a different breed to me to do it well...

Saturday, June 30, 2007

Bricks and Mortar

So, we have had an offer on a house accepted! He has no chain and we are first time buyers so hopefully we will be able to move in around about the time we start work in four weeks. Hopelessly naive, I know.

I have had to learn a lot about mortgages and types of insurance that I never knew I didn't need. Money Saving Expert has saved the day again though.

Regular readers will be unsurprised to hear that I still don't know where I am working in four weeks time. I don't know if I start on nights or weekends or what I will earn. Mr JD knows which hospital he will be working in, in Acute Medicine. Rotas and pay remain a dream. He is unlikely to find out prior to his first day.

The process of moving is proving to be both stressful and therapeutic. Lots of unused items have been freecycled or have gone to the charity shop. Others have been unceremoniously dumped. The remainder are being stored in my dad's garage. We don't own much as we've been renting furnished for the past 7 years. A few electrical items, a bed and a bookshelf - so it'll be an expensive few months whilst we 'make house'.

Wednesday, June 27, 2007

House Hunting

Mr JD and I are staying at my father's house whilst we hunt for a home in the new Deanery.

We are hoping to buy somewhere and the estate agents are foaming at the mouths like rabid dogs when they hear that we are first time buyers and want to move asap. We have trawled round 25 properties in three days (and many more on the internet). We have established that we don't like cat pee or cigarette smoke. We are not prepared to move into a new home and spend 25k modernising, whilst working 56hr weeks in the new jobs.

So, it is very stressful. We have possibly found a suitable place. It's nice. It's affordable and we can get to the far flung reaches of the Deanery within an hour. However, the house seems more expensive than it should be. We need to make an offer that is appropriate but we can't work out a suitable amount.

Difficult times.