So I'm a Doctor, Now What?

Life Plan

2011-03-03T21:19:00.001+00:00

So I'm going to be spending the rest of my life in a dark room being mean to juniors!

Happy New Year!

2011-01-01T17:28:00.003+00:00

Dear All,

Just wanted to stop by and say Happy New Year to anyone who is still reading or who has been waiting for an update. Sorry for the total lack of posts, you all know how it is, once you get out of blogging regularly you tend to forget about it.

I'm doing well, it is almost a year since I was diagnosed with Testicular cancer and everything is ok at the moment (touch wood)!

Fingers crossed 2011 will get off to a better start than 2010 did! In the meantime, Happy new year, and for anyone who is still interested in what I'm up to you can follow me on twitter by clicking here.

TLM!

CHECK YOUR BALLS

2010-02-02T21:38:00.003+00:00

I remember seeing this broadcast on TV but what do you think? A clever way of advertising the issue or liitle more than soft-core porn?

p.s there is no excuse for any men reading this not to have familiarised yourselves with your testicles recently!

An Update - Of Sorts

2010-01-30T14:47:00.002+00:00

It has been a week since my last post and essentially nothing has moved on in terms of my diagnosis. I have received my appointment to see the Oncology specialist next Friday morning, that will be when I find out exactly what sort of badness was lurking in my left testicle and what we need to do about it, so come back next week to find out more.

In essence this week has been about recovering from my operation. I stopped taking the painkillers (not that they actually gave me any on discharge) early this week. From that point of view I seem to be recovering well, I've just been getting on with it. My interview was postponed by all of about 18 hours but that did mean the journey to London and on the tube was slightly less uncomfortable than if might have been. My suit trousers were the biggest challenge though - not fun going from roomy PJs to a waistband that sat precisely on my inguinal incision. The interview itself; well I guess it is impossible to say, it could have been better, could have been worse.

In other news, we have our fingers crossed that we may have found a new flat. It has its compromises in terms of size and furniture (in that it doesn't have any), but it does offer a small garden which will be nice and is cheaper than our current place. It is about 50 metres from where we currently live so will be easy to move over a week or two and should provide a stable base where we can get on with more important things rather than having to worry about being made homeless.

By the way, if anyone knows of any lovely Scottish hotels, I'd be grateful for your recommendations. With all this, and going abroad pretty much ruled out, I think a tour of Scotland on honeymoon might be an excellent way to start married bliss.

Quite a Week

2010-01-24T18:25:00.001+00:00

The news that I had testicular cancer barely had time to settle in last week. After finding out on Tuesday afternoon, things moved rather quickly. On Thursday I had a CT chest/abdo/pelvis and on Friday I was admitted for an operation to remove the offending testicle.

It is probably a cliché to say that all this will make me a better doctor but it was a very peculiar experience to be in a hospital gown on a bed. It was a long wait in the morning before I was called down to theatre but when it finally came everyone was great. The anaesthetic trainee who put me to sleep was fantastic, I didn't feel her whack a huge cannula in the back of my hand and the next thing I remember was waking up in recovery. I was given IV fentanyl for pain relief which was the most bizarre experience of my life and wheeled back up to the ward where missbliss was waiting for me.

By that evening although I could barely move I wanted to sleep in my own bed, the surgeon had been to debrief me and was happy for me to go home and eventually I convinced the ward sister that I could walk without falling over and she let me hobble into a taxi.

I have a lot of sympathy for any patient having an operation, it is fucking painful. I spent all Saturday in bed and have just about made it to the sofa on Sunday with significant pain relief. I can just about stand up and hobble around. Although it is still very early days it feels good to be rid of my left testicle which was apparently mostly cancer. I have been told the CT scan was clear but I'd like to see the report myself.

In the midst of all this, as well as moving house, getting the car fixed and getting married I've just been offered an interview in London next Wednesday. I'm going to give them a call on Monday to see if there is any leeway to rearrange otherwise it will be a rather painful train journey. With regards to the cancer, repeat blood tests await and a review from the specialist oncology centre to advise on further treatment when my histology is back.

Finally, a big thanks for all the good wishes on my last post.

Breaking Bad News

2010-01-20T16:16:00.003+00:00

2010 has not exactly had the best start. Our landlords have just given us notice on our flat as they wish to return and I've been in a car crash which was the fault of some idiot who didn't even bother to stop to check I hadn't died. As they say, things come in threes and it was only a matter of time until something else happened...

Breaking bad news is never easy and is best done under controlled conditions by either a GP or a senior consultant ideally with the support of a specialist nurse. Sometimes it doesn't happen like this and it can be junior doctors who are put in a very awkward position but we're trained for that right? At medical school, a great deal of emphasis was put on communication skills, with particular emphasis on breaking bad news so it should be easy? I've had my own experience of breaking bad news to patients and relatives. Imagine breaking bad news to someone who is a doctor, would that be easier, harder, or perhaps just different?

Yesterday morning I had an ultrasound scan.

I can pinpoint the exact second I knew for sure I had it. It was 11:21 am and I was laid on the ultrasound couch chatting to the radiologist about my career aspirations as he probed my groin. The second he moved the probe up to look at my liver I knew, there could be no other explanation, he was looking to see if it had spread. He didn't say anything and nor did I, but he didn't have to. Although I remained calm, everything after that became a bit of a blur. When he'd finished I'm sure the radiologist already knew that I knew but he nevertheless confirmed my fear, I can't even remember how he broke the bad news but he almost didn't even need to. Before I knew it I'd had a chest x-ray too and was back to work on my ward. I sat there trying to to the simplest of jobs but 10 minutes later realised I hadn't actually done anything. At that point I knew I needed to go home, my consultant was great and I was soon back at home in desperate need of a cuddle or two.

So yeah, I've got testicular cancer, watch this space.

The Rota Saga

2009-11-26T19:53:00.002+00:00

Change jobs on Wednesday, still no rota so I've no idea what I'm doing for the next 4 months. Which weekends am I working? When can I take annual leave or is it allocated? Am I unreasonable in thinking we should have had this rota weeks ago? Not impressed.

Will really miss A+E, not looking forward to orthopaedics despite always having considered it as a career. Being the 'orthopaedic opinion' should be interesting, even more so on nights when I'm responsible for all surgical admissions too!

Quarter Life Crisis

2009-10-28T12:45:00.004+00:00

I should probably elaborate on my last post a little. According to wikipedia I'm having a quarter life crisis, a time usually in the mid twenties where one is no longer a young and care free individual but at the same time not quite ready to cross the line into being a true 'grown up'. It is perhaps a little cliche and even melodramatic to describe this as a crisis but there doesn't seem like a better way!

I'm currently working as an F2 in A+E, a job which I enjoy and dislike equally. It is tremendously interesting, varied and requires much improvisation but the shifts are a pain in the arse, some of the staff rather useless and I don't feel I'm particularly good at it. The reason for the last point is I lack the depth of medical knowledge (partly through being a lazy medical student and partly through being at a shit medical school) I also have a crisis of self-confidence in A+E, something I'm not really used to. Another thing that doesn't help is I'm staying in hospital accommodation during the week and only seeing missbliss when I'm not working (which is rare in A+E). I hate my prison cell room with a passion but it's the cheapest, most convenient option. One thing I do know is that I will really miss A+E as a job but will be glad to be rid of the shifts!

Careerwise, I'm pleased to say that medicine is for me, I just have no idea what specialty. I know I almost certainly don't want to do general medicine although I would love to have the level of knowledge that goes with being a medical registrar! I've always had a passion for orthopaedics but have next to zero anatomy knowledge and am not quite the right personality type. I've also always liked and been quite good at radiology but I suspect that would bore me and I miss the acute side of things. A+E is great fun but the politics and shifts are hurrendous! GP land would suit my personality and lifestyle but again I would find it rather dull. The option of being a GP with an interest in A+E might be a possibility to combine the best of both worlds, I have spoken to GPs who do this so I know it is possible but am not sure how easy it would be.

So where does this leave me? Well specialty training applications open in a month and I haven't a clue. The other option is New Zealand for a year but whether that would help I don't know, I suspect it would just be a postponement of the same issues but at least it would be an interesting adventure!

Crisis might be a strong word but it is all I can think about at the moment and it's driving me a little bit crazy and making me feel useless! Although I'm not quite at the stage of buying a bright red sports car (as much as I'd love to, I don't have the money). And the loose women? well that just doesn't appeal in the slightest, I'm quite happy with missbliss thanks!

Any advice would be grately appreciated.

Hi

2009-10-26T16:32:00.000+00:00

For anyone still reading - what shall I do with my life?

Alive

2009-05-18T11:43:00.002+01:00

I'm alive

Surgery is well over and done with now - It was a rather odd experience really but I miss it

My new job is a bit strange too, I feel like I've hardly worked this past month and a half but its because its a strange rota and all my leave is used up now

Medical nights start tonight for 4 nights - HELL!

Hope you're all fine and dandy

Time

2009-02-25T19:59:00.002+00:00

Work is hard at the moment, I'm working 11 hour days most days at the moment excluding on calls (EWTD my arse) and it's going to get worse over the next month as 1 of us will be doing the job of 2 people as we use up our annual leave! I'm working the weekend ( if I've not contracted norovirus) and frankly things are starting to do my head in - mostly incomptence an uselessness on the part of other people.

Anyway when is one supposed to do the things that everyone else always seems to have time to do?

Half Way

2009-02-07T18:14:00.002+00:00

This year's cohort of 'new' doctors have just passed the half-way point, this includes me. Six months down, six paydays celebrated, and a wealth of experience gained. They say time flies when you're having fun and time has certainly flown by, does this mean it has been fun? Well.... yes on the whole it has. I very pleased to say that I really enjoy what I do most of the time, in fact the only thing I hate about the job is pre-op assessment (where the surgical F1s see elective surgical cases a week or so before they are admitted to pick up any potential problems which might be encountered). I'm not sure why I hate pre-op so much, I just find the whole process horrendously boring.

Things I have learnt in the past 6 months include:

1. I don't enjoy being fast-bleeped - it generally means something catastrophic has happened

2. There are some awfully sad things that happen to people

3. Nobody else likes the crust ends of bread loaves - which suits me!

4. Bourbon biscuits are the most popular among doctors

5. Looking into someone's eyes as they die unexpectedly is something you don't forget in a hurry

6. Most surgical stereotypes are true

7. The way to a nurse's heart is chocolate cake

8. Medicine is infinitely more imprecise than textbooks would have you believe

9. I am stoical - apparently

10. I don't have the faintest clue what I want to do...

I wrote last just before I started my surgical post and frankly I was dreading it because of the reputation it has. The past two months haven't been anywhere near as bad as I was expecting. It is rather busy and I tend to finish later than I did when doing medicine but it could be much worse. Surgery is a lot different to medicine; medicine was busy but steady all day long but surgery, at least as a house officer, is chaos from 8 till 9am then ridiculously quiet for much of the day until about 4pm when things generally start to go tits up, blood results come back and patients for the next day come in.

Before I even went to medical school I wanted to be a surgeon, this ambition continued throughout medical school but I'm not a stereotypical surgeon and I'm now having somewhat of a career life crisis as I try and figure out what the hell I want to do. I really enjoy the practical aspects which points me towards surgery but there is this whole surgical ethos which I just can't find it in myself to agree with. A big consideration has to be the sort of colleagues you're going to have in future and I'm just not sure I'm a surgeon. After 2 months of surgery, I can see myself being absorbed by the attitude and I don't like it at all. I enjoyed my medicine job far more than I thought I might but the idea of being a medical registrar scare the bajesus out of me! The only thing I think I'm certain on is that I like hospital medicine rather than general practice - but I'm not even 100% sure of this. Some might say its a little early to be worrying abut this but in less than 12 months I'll have to apply for a specialty.

In the meantime I hope to continue having fun and gaining more experience.

Lost - Reward For Return: The Last 4 Months

2008-11-29T19:08:00.002+00:00

It has been over a month since my last blog, and after I promised an update within the week. For those of you that are still around I thought I'd pop by and say hello. The last 4 months have flown by, my first job is over and it is sad times indeed. It doesn't seem like 2 minutes since I set foot on the ward for the first time with no clue as to what I was doing. 4 months later and I was just getting settled and its time to move on. I've really enjoyed my first job, it has been interesting and a fairly gentle introduction but most of all, the team on the ward were fantastic. Everyone was lovely and it was a really friendly atmosphere, I think that is what I'm going to miss the most. I never expected to become attached to the job like I did.

Perhaps what makes it worse is that I'm going from probably one of the best jobs to probably the worst! Frankly, I'm shitting bricks and I'm talking breeze blocks here! On Friday evening as I sat talking to the outgoing F1 of my new job my worst fears became a reality. Whenever anybody has asked me what I'm doing next and I've answered, it has been swiftly followed by a sympathetic sharp intake of breath. I'd spent the last few weeks in denial thinking it was a long time before I'd have to worry about that but now I'm 24 hours away from hell. From what I hear, the job is a bitch, the people hostile and the atmosphere terrifying. I've seen many of my colleagues stressed, upset and crying (mostly the outgoing two who's job becomes mine on Monday).

I'm hoping things will be different, and I intend to be optimistic, at least till 5pm on Monday (although it'll probably be more like 11pm). On the plus side it might give me a bit more blogging material. Most of the other surgical F1s seem to spend most of their time chilling out in the mess, I've never, ever seen my 2 predecessors in the mess. I've spent the last 4 months enjoying myself and feeling sorry for those having an awful time but now I suspect it's my turn.

Oh, and in other big news, I think I might be a closet medic rather than a surgeon!

Cookie Adventure

2008-10-21T19:34:00.000+01:00

Check out my cookie adventure here

Time Flies When You're ..... Busy

2008-10-21T14:22:00.002+01:00

It has been 2 weeks since my last blog and now I begin to realise that a fair proportion of my time is being consumed by work. I can barely imagine how things must have been only a few years ago with 100+ hour weeks. This week though I am on holiday! By holiday I mean staying at home rather than going to work, this means I actually get some time to do things I would have normally done during the day as a student. It also gives me time to catch up with several thousand blog posts in my google reader, I've just spent the last couple of hours skim reading far too many blog posts! I'm now as up to date as I'll ever be. Now I've caught up the prospect of reading blogs again isn't quite as scary.

I've already been bleeped several times since being on holiday - I've not answered of course (I did that once as I was expecting a call and have been chastised ever since) but there is a sense of curiosity - who is it and what do they want?

Today I decided to bake double chocolate chip cookies (they are bloody good too). For no other reason than because I could. Perhaps working life is sending me slightly insane. I'm still enjoying being a doctor, although at times my job can be a bit stale (mainly due to the nature of my post). Nevertheless, during the day, time passes quickly and inevitably there isn't enough time in the day to do everything. When on ward cover - time either flies, when you're busy, or trickles by if you're sat in the mess. I definitely prefer being busy.

I have little else to say at the moment, although I do have plenty of potential blogging topics on the cards. I'm going to try a little and often approach to blogging to see if I can get back into the zone. I'll be back before the end of the week... I promise.

Oh, and finally, I bought myself an iPhone 3G - it rocks my socks!

Working Nine to Five - or not even close.

2008-10-05T19:09:00.004+01:00

Ok, so I promised to blog the weekend before last and didn't. The main reason for this is that we now have 4 dead laptops in our house (don't ask what we do to them - I've no idea). Anyway, we've just got a desktop courtesy of missbliss's parents (thank you :)) Of course there is also the other matter of being quite busy. This whole working thing is rather annoying, most of the time I'm only supposed to work 8 hour days, at least that's what the hospital would like to think (naturally we are EWTD compliant). This makes life difficult enough, especially when you consider I've not done an 8hr day yet! When the bloody hell are you supposed to go to the bank when you have a job? When are you supposed to go and spend your hard earned cash? I barely have enough time to wee during the day let alone leave the hospital! I don't mind being busy as it makes the time go quickly but I could do with a 4 day week just so that I can do everything I need to do outside of work. 24hr Manchester had its advantages in that respect. This makes time for blogging a little short - but now we have a computer which hopefully will work for more than 2 days, it should be easier!

I've just finished what should have been 12 days straight, actually I had friday off so it was infact only 11 days. My day off wasn't much of a holiday though, apart from a yuppie-esque lunch in town with missbliss who was working, I spent all day catching up on real-life admin - bore. It was my first weekend 'on call' (basically ward cover for about 200-300 patients) last weekend and it was genuinely the most stressful weekend of my entire life. Not in a oh my god I can't do this way but in a holy shit what the hell is going on way. The fact I had some really great senior staff probably prevented me from the complete emotional collapse that some of my colleagues have had. I can safely say that it isn't fun when someone is effectively bleeding half of their circulating volume out through their rectum right in front of you. Overall, apart from the fact it was a weekend, I quite enjoyed myself - although I'm not rushing to do another one! The responsibility is bloody scary but at the same time quite exhilarating, the chance to see and do some acute medicine is refreshing compared to my usually quite stable ward patients.

Inevitably, with independence and lack of experience come mistakes - I don't know whether or not I've made any yet, particularly as I rarely see again the patients I see when on ward cover. The hardest thing about being on cover is prioritising things, that is the key. In fact, the same can be said for the whole of medicine. When your bleep is going off every 5 minutes, not only do you have to be organised but you also have to have a way of triaging things in your head. Some jobs can be done in minutes but complex and ill patients can take hours. Am I supposed to run off and answer my bleep every time I'm in the middle of something? It might be polite, but it is completely impractical. For me this was one of the hardest things to get used to, although sometimes I regret answering - for example when switchboard have for some reason given my bleep to a very persistent job-seeking cleaner, seriously, like I don't have more important things to worry about!

P.S - when sorting through our music on our shiny (old) desktop I discovered missbliss has no fewer than 9 copies of Dolly Parton's, Working 9 to 5.

I hate to say I told you so...

2008-09-19T07:27:00.002+01:00

I know I promised that I wouldn't moan or mention Manchester again but I couldn't resist.

As I said in this post I have been eagerly awaiting the publication of this years National Student Survey results on the unistats website, particularly the student satisfaction aspect.

Manchester - 30th out of 32 medical schools who provided enough data.

Ouch - that has to hurt. At least now you don't just have to take my word for it. And when I advise potential students to avoid Manchester like the plague - I can provide a bit more evidence than just my experience.

More hospital tales this weekend.....

The first month!

2008-09-10T20:44:00.003+01:00

Ok ladies and gentlemen, it has been over a month since I started life as a real life doctor. We're now completely settled in our new flat and have the Internet up and running. I'm clearly out of practice when it comes to blogging and my Google reader says I have 857 unread items, at some point I want to catch up with at least some of them.

The first month has, as you might expect, been rather eventful. From writing my first prescription to my first on call, dealing with my first death (not my fault, I should add) to my first pay day, and PLENTY of hospital politics in between.

The first week was rather terrifying, and it wasn't made any easier by my consultant being on holiday for the first two weeks. Thank god for the rest of the team! - WRONG! Half of my registrar (yes half - there are two of them who job share) is on long term sick and the other half also just happened to be on holiday during my first week. And the SHO - well, somewhere along the line they seem to have forgotten about them entirely and replaced them with me!!! For those of you who don't know much about hospitals let me simplify things a little - I was left entirely on my own! Had I not done a few days shadowing prior to starting my role being left on my own would have been a rather catastrophic event. In reality it wasn't that bad at all (not from my point of view anyway - the patients might tell a different story).

I coped by stumbling around the ward attempting to do my own ward rounds - having no idea what the hell I was supposed to be doing. I don't think I killed anyone which is pretty remarkable considering. The other doctors, and nurses were great in helping me out as much as possible. I got very excited during my first day when I prescribed some antibiotic eardrops based on my own diagnosis (although I had to ask the pharmacist which ones to give) - so its not exactly a life saving decision but it was one of the first decisions I made all by myself and with nobody senior to monitor it!

There are so many stories to tell from those first few days but now they seem like a distant memory. The first month has certainly gone faster than I ever imagined it would, and of course with that came the first pay day - all I've got to say about that is that I'm now entitled to moan about being a tax payer - there are FAR too many deductions! Payday was very, very welcome indeed. It is well said that the worst time to be a patient in hospital is the first week in August when all the newbies start - whilst you would probably want to avoid that period I can now say with some certainty that the worst day ever to be ill in hospital is the day after the first pay-day for all the newly qualified doctors! Remember that at the end of August next year and avoid being admitted to hospital at all costs!

Following my first week, the staffing levels improved but only marginally - I had help from another team's SHO, and half of my registrar made it in for 2 days. When my consultant got back it was a huge relief although then came a huge exodus of all the patients I'd been looking after - who by now had been ready for discharge for about a week - I certainly wasn't going to send anyone home myself! Normally people leaving hospital is a good thing right? Well not for me, because every time someone leaves, another patient who is invariably sicker and more complicated takes their place!

My first month has had more than its fair share of 'office' politics, there has already been a resignation on my ward. I gained 6 extra patients to add to the 20-odd I was already looking after and the half of my registrar who wasn't off had a heart attack and is only in hospital as a patient! All in all - it's chaos. A nightmare for the nurses, dangerous for the patients and bewildering for me. Nevertheless, I'm actually really enjoying being a doctor. I don't feel I'm any good at it yet - hopefully that feeling comes with experience but it is certainly interesting, quite good fun and most of all (after five years just racking up debt)- PAID!

That's all for now folks but stay tuned for more stories now I'm hopefully up and blogging again.

Internets

2008-08-17T20:11:00.001+01:00

Due to fuckwittery on the part of BT, we're still without even a phone line, never mind broadband. Someone made a booboo which meant that we had to re-order, expecting phone line on wednesday and internets sometime shortly after that (fingers crossed). Apologies for the absence.

In the mean time, I'm doing ok. I now have a bit of senior support too which means I'm not running an entire ward on my own. More on that when we get connected.

Very Quick Update

2008-08-10T18:21:00.003+01:00

The lack of internets makes blogging rather difficult, especially when hospital computers seem to block everything that is remotely fun. We have at last moved into our flat and hope to be internetified in about a week. Until then, I am still alive, and coping ok so far.

Watch this space...

Not a Lot About Very Little

2008-07-23T20:57:00.002+01:00

Not a great deal to blog about at the moment. The last week has been taken up mostly with packing. The big move is this weekend so fingers crossed everything goes well, our stuff is going into storage for 2 weeks before we move in to our new flat.

It is now less than 2 weeks until I start work, I daren't think about it too much. Shadowing begins in a week, I'm hoping there is some kind of secret initiation during this period that turns you into a fairly competent doctor as I'm struggling to remember even the basics, never mind all the complicated rubbish I learnt for finals. I guess that gives me 1 more week of freedom, 1 more week before I finally become a grown-up? Best of luck to all the other bloggers out there starting work in 2 weeks, any plans for your last weeks of freedom, or any tips for our first week?

Will hopefully keep you posted on events over the next few days.

Reflections On 5 Years

2008-07-14T12:07:00.008+01:00

This post is so long it needs a contents page so you can skip to the relevant part if you can't be bothered with all of it.

CONTENTS:

Part 1 - Introduction

Part 2 - The first few years

Part 3 - The Preston fiasco

Part 4 - Other complaints

Part 5 - Graduation disaster

Part 6 - Disclaimer to potential students

Part 7 - Conclusion

If I'd learnt anywhere near as much about medicine as I have about life in the past 5 years I'd be a genius. Had I coasted through medical school without a single problem I'd still be as naive as I was 5 years ago. Maybe I should be grateful then that Manchester have 'taught' me so well. Ha. I am bitter about my time at medical school, but by being so I believe I'm far more prepared to be disappointed in the real world. It might not make much sense as I write about it but believe me, I'm a much harder person now, and hopefully, based on my experience will be far more able to accept the incompetencies of other institutions and organisations (*cough* NHS *cough*)

Just one worry, what will I have left to blog about?

.....................................................

I was 16 when I started looking at medical schools and only just 17 when I submitted my application. I was young and naive, perhaps even bordering on stupid. I based my university choices mainly on where I thought I was most likely to get in, that was my first, and probably biggest mistake. The first thing I always tell potential applicants is to apply to where they want to go, not to where they think they're most likely to be offered a place. The second thing I tell them is not to touch Manchester with a barge pole!

The first time I visited Manchester was for my interview and even though it was raining torrentially, it was the city, rather than the medical school that inspired me. Although I now harbor a passionate hatred towards the university, the city itself is move vibrant than ever and inspires me even more than it did 5 years ago. Maybe it was my expectations of what to expect from the whole university experience that were wrong to begin with. Maybe I would have been just as unhappy elsewhere, grass is always greener and all that. I've heard plenty about problems with other medical schools too so I don't expect that Manchester is unique in its inadequacy.

Had I been blogging in first year I would have had very little to write about, it went by with very little fuss. There were always rumblings of administrative incompetency from others but I was happy in my own little world. Without warning, problem based learning was thrust upon us. Fresh from spoon-fed A-Levels it was quite a shock to have to learn everything yourself. There were of course 6 or so supplementary lectures, although these were often irrelevant or cancelled, It was clear early on that PBL is little more than a synonym for DIY.

I made some great friends from all over the world in my first year and on the whole I really enjoyed myself. Despite the learning style, I even enjoyed the work, I found it interesting and was reassured I'd made the right choice of course, if not university. All that was about to change in what was a pivotal moment in my university years. I've written about this before and it may be a little bit boring so apologies if you're falling asleep already.

.....................................................

It was time to choose our hospitals for clinical years. I never imagined how important this would be. This process seems to vary from school to school, At Manchester, for the last 3 years, you're based at one of 5 hospitals, 3 of which are in Manchester, one being Keele (40 miles away) and the other being 40 miles in the opposite direction in a wonderful city called Preston often referred to as depreston. At the end of first year we ranked in order of preference those 5 hospitals and we were assured that the allocation process would be random and fair. If you don't know, I'm sure you can guess what happened next. I fell foul of this 'random' allocation and was allocated to Preston. The day after finding out, I handed my appeal letter in personally. Naively again, I didn't for one minute think my appeal would be unsuccessful and spent the rest of the summer safe in the knowledge that of course I wouldn't actually end in Preston, unfortunately the other 40 students allocated to Preston had exactly the same idea.

If my biggest mistake was choosing Manchester then my second biggest mistake was not having a clinical partner for this allocation process, i.e. a friend with whom you made a joint application to a hospital preference. At first I did have one but we wanted different first choices so in the end we applied alone. In my appeal letter I clearly stated that the process had been unfair. We had been told that whether or not you had a clinical partner you were equally as likely to be allocated a place at your first choice. When the allocation results were published this was clearly not the case. As sad as I am I used my basic knowledge of statistics to analyse the results and it was clearly skewed in favour of those who had clinical partners. To put this simply the algorithm used had clearly given a group of two students the same priority as a single student which is obviously unfair on the single student.

I complained and complained but to no avail. I know of at least one person who had their allocation altered on the strength of a falsified official letter. The vast majority of appeals were unsuccessful, after all, they can't just have an empty hospital. It wasn't until the end of second year that I even met another person going to Preston. Needless to say, none of the friends I'd originally made were. Fantastic. From that point onwards I decided that I was no longer there to enjoy university, I was there to endure it to gain my qualification. I met one of the senior staff (albeit not that senior, they're completely off limits) I cried, I shouted, I pleaded, I exclaimed how unfair the supposed random allocation had been why could they not see it? In the end, I was told just to deal with it. Gee thanks for all the support.

As second year went by, my disdain evolved to hate but I kept plugging away and had no troubles academically. By this stage, the glimmer of student support we'd been given in first year had disintegrated and we were left to fend for ourselves. Most of my emails and letters were now being ignored. Why I don't know, I was persistent, but had never been anything but polite in my requests.

One thing is for sure, I certainly wasn't moving to Preston. It might be 40 miles away, an hour's drive at the best of times but having fallen for the city of Manchester and expecting to be there for 5 years I wasn't about to upsticks to a city I already hated.

For reference, it was at this point, at the end of second year that I met missbliss. I decided to continue living in Manchester and commute to Preston, a few others followed suit but it was almost impossible to share lifts as everyone was doing things at different places at different times. Commuting, combined with visits to missbliss in Cambridge soon meant that I was often driving almost 1000 miles a week at a cost of about £100 per week. In January of third year I was forced to move to Preston for the rest of the year, it was every bit as bad as I thought.

You might think that by now I had accepted being in Preston and moved on and I just about had when I heard that a mistake had been made in the allocations for the next batch of students and the medical school were offering students £2000 if they would swap an allocation in Manchester for one in under subscribed Preston. In other words, they were offering £2000 to students who could be persuaded to go to Preston. WHAT THE HELL?!? Where was the £2000 for student who had to go against their will? What on Earth were the medical school thinking when they decided they could offer some students money and not others, had this happened in my year I would have taken legal action. Because it wasn't my year it just made me even more angry! It was at this point I submitted a freedom of information request so that I might see the algorithm or process used in the allocation of hospitals. They didn't even refuse because nobody ever actually got back to me, I should have reported them to the information commissioner at that stage for breaking the FOI act.

I let the subject drop again but worse was yet to come. The following year during the allocation for the new cohort of students the process had to be declared null and void. Can you guess why? It had finally been exposed as unfair, can you guess how? The process was biased against students without clinical partners, exactly as I had told them in my appeal letter 2 years previously! Now I was livid, I had always known the allocation process had been unfair, if I'd been allocated Preston by a completely fair system, I mightn't have liked it but I would have put up with it. I demanded a meeting with the dean of the medical school of course I was ignored, but this time, I'd been proved right and wasn't about to let it drop so easily. I had to make do with a meeting with someone else. I went to the meeting to ask if the allocation process that had been abandoned that year was the same one used in previous years. Unfortunately I was met with a very defensive woman who wouldn't tell me anything and if anything, wanted to intimidate me rather than explain things to me. The meeting didn't go well, I was polite but was clearly not being listened to. It was clear that the medical school wasn't about to admit that they were wrong, after all, hundreds of students had appealed against this procedure, to admit a mistake at this stage would have been a disaster. I asked if I could at least have an apology since my appeal was based on a claim the process was unfair just as it had now been exposed to be. I was told, in no uncertain terms that I could definitely NOT have an apology and, already having been deceived, ignored and lied to, was threatened that taking this topic any further could be detrimental to my place within the medical school. I was taken aback, this was a threat in all but words that if I carried on with this issue I could face being kicked out of medical school - on what grounds I'm not quite sure. At that point I realised I was fighting a losing battle and started blogging instead.

Before I draw a big black line under this topic, I need to cover a few of the potential counters to what I've said. Some of you might think I have a point, others might think I'm just a bitter individual, some might say 'it's only Preston' and most of you probably don't even care. You're all entitled to your opinion just as I am but let me explain a little about why this is such a big thing. I applied to Manchester University because I loved the city, having been sent 40 miles away to Preston there is very little chance to do anything in Manchester and you have very little access to the university facilities or support. It is my belief that you also miss out on educational opportunities by being in Preston although it is a good hospital which may make up for this in some respects. I decided to stay in Manchester, that decision cost me the best part of £5000 in fuel and £3000 in lost free accommodation in final year - despite the travelling it was worth it. You could say 'life is just unfair' - maybe you're right but at least now I'm much more prepared for it. You could say 'you're going to be a doctor, you need to be prepared to move wherever', again, I'm much more aware of this and willing to accept it but at the same time I would hope that where such a system is used to allocate jobs, it would be fair and at least in part based on input on my part, whether that be an application form or interview. Finally, I hear that in future, applicants are going to be told if they've been allocated to Preston when they apply to Manchester through UCAS. I suggested to them 3 years ago this was the only fair way of doing things. Preying on the desperate there Manchester - I'm sure there are plenty of people without offers who'd love a place at Preston.

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Now we've got that beast out of the way we can go back over a few other things that have happened in the last 5 years. Honestly, I know I'm bitter about the whole Preston issue but that isn't the only reason that I despise Manchester.

Almost more important than the Preston issue is something which came to light recently. Apparently the medical school had, in the past, restricted learning opportunities at particular hospitals because they couldn't ensure that similar opportunities could be provided at other hospitals. In one example where changes to the third year curriculum were implemented (whilst we were in fifth year) so that all third years would be taught suturing, the opportunity was denied to the fifth years on the grounds that it was for third years only. We had never been taught it despite it being a potential finals station, after pressing for it we did eventually get the same opportunity. Firstly, you should be doing everything you can to maximise learning opportunities and secondly where do you get off telling people who and what they can teach? Ridiculous. I know you don't care about your students but that is a whole new level.

That leads me nicely onto another issue. It was often said that Preston missed out on some of the opportunities in Manchester but in one case students at one hospital were given access to 14 questions on one of our exam. I'm pleased to say that after much complaining this issue was rectified in that these questions were excluded from the marking but it should never have happened in the first place. It was discovered this once but who is to say how many times it has gone unnoticed in the past?

This is just one of myriad issues that people have had with the examination system. I'm sure you all remember my OSCE fiasco. I'm not going to complain about that here because that is an academic issue and I'm bound to be biased against it. What I can say, having seen OSCEs (practical exams) from both both sides (being an examinee and a volunteer) is that in their current state at Manchester (and to be fair, at most places) they are a lottery. The exam cannot be run objectively at 4 different sites at the same time and the marking is so subjective it makes the whole thing almost pointless.

Next we have student support - or lack thereof. Manchester should be ashamed of itself in terms of this. There was some limited support in the first year but after that you may as well not even exist, nobody at the university cares about you. At Preston the support was good as the hospital staff were willing to listen, but centrally support is non-existent. I'm pleased to see this is something they're trying to address, whether it will be or not remains to be seen.

I'm sure you all know what I think of PBHell. I hate it. They may as well give you a list of things to learn on day 1, send you away and bring you back 5 years later to examine you on it. Conceptually PBL isn't bad, but it doesn't work when it is relied upon to be a substantial method of learning. You can't learn all you need to know without some sort of input. There isn't a lot of evidence out there comparing graduates of PBL courses against traditional courses but this is slightly concerning given that Manchester and Liverpool were 2 of the pioneers of PBL in the UK. PBL does give you the flexibility to learn what you want when you want but I'm gravely concerned about some of the graduates this course has produced. A much better approach would be a combined course featuring comprehensive lectures and PBL.

PBL can be effective if every required element is there, unfortunately where medical students are concerned this is almost impossible. Yes I might be bitter and angry but at least I'm not a bully. I've met some really great people in the last 5 years but I've also met some particuarly mean and nasty pieces of work.

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Finally I want to talk about graduation. A day where you are supposed to celebrate your achievement. As I've said before, for me it was less about the achievement and more about being free from this incompetent institution. The ceremony itself was so cringeworthy it was awful. The worst part for me was the main speech, it was given by a senior staff member who didn't introduce himself, we should probably have already known who he was but such is communication within the medical school, few people had a clue who he was. I'm still not entirely sure and I don't understand his nu-speak title anyway. I'm sure he is very good at what he usually does but he was definitely off that day. He launched straight into a completely irrelevant speech delivered with all the charisma of a dead aphid. If we're supposed to be proud of our achievement I would hope that the staff would be proud too, but the speech was delivered with such monotony that it was clear that the speaker didn't care and probably didn't want to even be there. Worse than the style of delivery was the content. The opening motif was introduced as we were told, "Although the University is rather old, it continues to benefit greatly from being new". The rest of the speech contained contrived examples of many old and new things, but we were graciously informed that we hadn't managed to deplete the knowledge stores of the university ("Is not knowledge the property of humankind?"). I could not engage with anything that he said. In another speech, the pinnacle had to be the mention of Harold Shipman (well I suppose at least he is a former graduate of Manchester) - what a fantastic way to celebrate a new generation of doctors! Perhaps I misread the atmosphere but everyone I've since spoken to felt the same about the whole thing - I didn't even notice the Shipman reference until later. At least when the names were read out by the Medical School Dean (again, I think it was him but I'm not too sure, having never seen him in the last 5 years) he delivered them with a bit of passion, as though he was proud of us all. The Dean also read well when it came to the affirmation, a modern day version of the Hippocratic Oath which we all affirmed in turn. When we finally got out, fittingly it was pissing it down and there were shouts telling us to "leave the building as quickly as possible".

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As a disclaimer - to prospective students, I should say that other opinions are available. At least a couple of (maybe even 3) people are very happy at Manchester, although I'm really interested to see how they do in the national student survey - 3 guesses for what I gave them. I'm afraid I won't be recommending Manchester medical school to anyone, in fact, where possible, I will actively discourage students who might be considering it. For anyone who is already at Manchester or who, despite my advice still insists on applying, the course has changed significantly in the past 5 years, and seems to have improved a lot. I hear they even 'teach' you anatomy these days. The faculty even have a new blog and I must say that this chap looks to going in the right direction so it might not all that bad if you do end up stuck there.

And that, ladies and gentlemen, is that. The end of a long journey, one that I'm very glad is over. I'm looking forward to a completley new chapter in my life, one with less bitterness and fewer grudges. To those of you that I like, you know who you are, the very best of luck. To those of you that don't like me, it has been a pleasure, I'm honoured to have had such an impact. Finally to Manchester Medical School, a good riddance for all.

If you read all that you deserve a pat on the back, for those of you from Manchester, I'm sorry but I've not said anything that isn't true.

edit: seems Shipman was indeed a Leeds graduate not a Manchester graduate, oh well.

I'm Free

2008-07-10T10:13:00.003+01:00

Graduation was just as ridiculous as I expected it to be! It wasn't just me who wasn't looking forward to it, many other people didn't want to be there but to keep their families happy obviously they had to be. For me, it was just as much about celebrating the end of being tied to an incompetent institution as it was officially finishing my degree. I suppose it is a bit sad that it had to end that way but I take solace in the fact I'm wasn't alone in my feelings.

The ceremony itself was awful, but more on that in a later post. Yes folks, I'm afraid you're going to have endure just one more exceedingly bitter post from me on my time at university. Whilst you might not be interested and some of you may entirely disagree with what I have to say it is important for me in terms of closure, at least from a blog point of view. It will only be one more post, I promise. I've have learnt some medicine in the last 5 years (I hope) but I've learnt more about life and people which will probably be a lot more useful in the future.

As I told the alumni association, I want nothing more to do with you, as far as I'm concerned I'm not a University of Manchester graduate, I'm a medicine graduate.

Watch this space...

Graduation

2008-07-08T18:08:00.003+01:00

Graduation tomorrow, couldn't be less excited if I tried. Lack of posts at the moment because although i'm quite busy, most of my time is being taken up by important but spectacularly boring stuff.

Are You Proud of the NHS?

2008-07-02T18:51:00.004+01:00

It was only relatively recently, at some point during medical school, that I learnt the NHS has only been around for 60 years. I was rather surprised, I had never particularly thought about it but if I had, I would've imagined it being around far longer than that.

In the press, rather than concentrating on the NHS's achievements to celebrate 60 years, much has been made about the future. Is the NHS still viable? Can and will the NHS survive and of course the 10 year NHS plan. I was recently asked if I was proud of the NHS, in reality this is a rather stupid question, after all, it isn't like I had anything to do with setting it up, nevertheless, some of the answers I've seen have been interesting.

I guess the main factor here is probably political affiliation, I suspect most labour voters would say they are proud, and most conservatives would say the opposite, if for no other reason than they are currently the opposition. This position is perhaps compromised if you're somehow involved in the NHS. I would hope that most healthworkers would be proud of the organisation they work for although I recognise that many have reason not to be. In this case, I would hope that they are proud of the idea of the NHS if not its current state.

Personally, as someone who is about to embark on a career in the NHS, I'm not sure where I fit in. I'm certainly proud of the foundations and ideas of the NHS and I find myself vigorously defending it to anyone who isn't. I don't know much about politics, to me, they're all as bad as each other, I don't think it makes a great deal of difference who is in charge. I don't think the Conservatives would necessarily do a better job with the NHS than Labour have, yes things might be different, but will they really be better? The conservatives will win the next election, of that I'm sure, and frankly that doesn't bother me. I have voted labour in the past but am quite willing to see what the conservatives can offer, so much so that I might even vote for them *shudder*.

So am I proud of the NHS? Yes, I am, regardless of what I think about its current state. I think many that aren't have been swayed by the media who tend to focus on the negative aspects after all its scandal that sells papers.

Are you proud?

Happy 60th!

what will you wish for?