Monthly Archives: March 2006

The imparting of wisdom

We had a medical student in the practice last week.  The job I did before this was in a part of the country devoid of medical schools, and, as it happens, this is the first student who’s had an attachment at this practice since I arrived here myself.  So, the last time I had any medical students around was in my paediatrics job, five years ago.

It’s something I’ve really missed – teaching was always a part of my job that I loved.  One reason for this, of course, is that it feeds my ego. One disadvantage of general practice is that you do spend a huge proportion of your life as the most junior person around.  Since your training is directed at making you a jack of all trades rather than a master of one, you never move up the ladder in any specialty because you’re always moving straight on to the next specialty to start from scratch.  When there were students on the ward, at least I could revel in the satisfaction of knowing there was someone further down the totem pole than me.  Not that I would ever have abused my position, you understand.  I just enjoyed the warm feeling of smugness.

Another thing I liked about having medical students around is that people who are totally new to a particular area and see it through fresh eyes play a vital role in stopping everyone else from getting into a rut.  One of the great things about teaching, I found, was that explaining what I was doing to other people reminded me vividly of how little I actually knew about it myself.  It made me realise that just because I’d learned to fake my way through did not mean that I actually had a clue about anything important.  (Much of hospital medicine at the junior doctor level consists of asking a bunch of standard questions, doing a standard examination, and choosing some standard tests from a mix-and-match set, and so faking your way through without knowing why you’re doing what you’re doing is scarily easy.)  It confronted me with uncomfortable questions about why I did things the way I did and whether, indeed, I should be doing them any differently.

(Incidentally, the absence of students was only one part of a huge difference that I noticed when moving from my hospital training into long-term general practice – namely, the absence of any sort of regular influx of new people.  In hospital, not only are there medical students around to fulfil this role, but there is also a constant turnover of junior doctors and student nurses.  In general practice, it’s a rare event for anyone new to be employed.  The same people are there year in, year out, with no new faces and, more importantly, no new viewpoints.  It was something I found quite difficult to get used to, and often stifling.)

But the most important reason I missed teaching is simply that I love it.  The reason I chose to have children is because they help you see the world through new and fresh eyes.  Medical students do the same thing on a smaller scale and without the sleep deprivation.  Explaining what I do, and why, to someone who’s new on the scene reminds me of something I do sometimes lose sight of when snowed under with paperwork, time limits, and a surgery full of people with inexplicable pains and insoluble problems – namely, that medicine is absolutely fascinating.

So, all things considered, when I found out that the job I’d thrown together a last-minute application for ("Oh, what the heck, it’s in <area of country we were trying to move to> and it looks like it’ll do and if I touch up my CV a bit tonight and bung it in the post tomorrow it’ll just make the deadline") was actually a teaching and training practice (a fact they omitted from their practice prospectus), I was overjoyed.  (As were the trainers in the practice, who were extremely pleased at the thought of having a keen young would-be teacher around to take on some of the teaching-associated duties.)  When one of the practice partners announced the imminent arrival of a medical student on the scene and asked for volunteers to take him for a session or two, I jumped at the chance.  I did feel a little nervous – after all, wasn’t this the point where I realised I’d merely been faking my way through all this time and didn’t have a clue what I was doing?

Apparently not.  In the distant days of my hospital training, I’d moved on every six months, apart from the paediatrics post that I stayed in for a whopping year.  I’d stayed in each place just long enough to get a good grasp of the basics, and since ‘the basics’ for a junior doctor unfortunately consists in large part of where to find the Venflons, what the procedure is for discharge summaries, and what time you’re expected to turn up for a ward round pretending to look intelligent, there somehow didn’t often seem to be much that I could usefully pass on to students.  But now, not only have I been in this career for four years since qualifying (plus the trainee year), but I’ve actually gone out of my way to get some relevant qualifications – not just the necessary ones, but also the above-and-beyond-the-call-of-duty ones.  Which, in turn, got me into the habit of trying to keep vaguely up to date and actually reading all the journals people keep sending me.  In short, it seems that along the way I’ve actually managed to learn rather a lot about my job.

This did not come as a complete surprise to me, because one of the other good things about this job is that it’s a medium-sized practice with a large spread of people of different ages and levels of experience.  After three years in a practice with only two other doctors, both middle-aged men, I found this refreshing, and one of the most refreshing things about it was that – after a mere decade as a doctor – I was suddenly not the most inexperienced person around any more.  That honour fell to the other doctor who was employed at the same time as me, a woman about my age but in her first general practice job post-training.  All of a sudden, I was the one being approached for advice.  What was more, I generally had some.  I listened, in a distantly amazed sort of way, to my voice saying things like "Well, if she’s got angina and CCF I’d definitely want to start one of the cardioselective beta-blockers.  Lowest dose to start with and titrate up slowly.  But do check her Hb as well," and thought that, blimey, that actually all sounded quite intelligent.

However, this is the first chance I’ve had to unload all this knowledge on a medical student.  I’m not sure the poor chap knew what had hit him – I talked my way solidly through afternoon surgery, with brief breaks to allow patients to make mention of symptoms that I could talk some more about.  Fortunately, he was the keen variety of student – interested in a career in general practice, in fact.  I do hope that’s still the case. 

And me?  I loved it.  I can hardly wait until we have another student around.  And it’s made me think about where I go from here in the field of teaching.  In case you were wondering about my previous mention of ‘teaching and training’ as separate entities, ‘teaching’ in this context, refers to undergraduate medical students, and ‘training’ refers to postgraduate GP trainees.  (I shall skip discussion of the somewhat worrying implications in that terminology.)  Now, being in a teaching and training practice means I can get involved in both in the sort of peripheral way that I did last week (taking the student for a session without having to do any of the organisational work involved).  But should I get more involved than that?  In short, should I, at some stage, go through the training to become an official trainer myself?

Previously, I’ve always rejected suggestions of so doing.  Yes, the teaching part sounds wonderful – but surely doing it officially, rather than just helping out with the odd session here and there, involves all sorts of boring stuff like buzzwords and paperwork mountains?  Well, yes.  But anything really worth doing is going to have its difficulties and drawbacks to deal with.  And I’m starting to rethink my previous embargo on trainership.  As someone employed by an officially accredited training practice in which the existing trainers have started to make noises indicative of a general desire to pass the torch on at some not-terribly-distant point in the future,  I’m in the ideal position to become a trainer in due course.  Somehow, the idea of taking advantage of that is sounding rather more attractive to me than it once did. 

Of course, we’re talking long-term plan here – the obvious way to go is to continue to be as involved as possible in the teaching and training here as more students and registrars arrive for their attachments in the practice, and make further decisions about my own training in the fullness of time.  But I have an increasing feeling that I wouldn’t be totally surprised if being a trainer was in my future.  Whether I’ll then live up to the title of this post is, of course, something we’ll just have to wait to see.

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Filed under The doctor is OUT. To lunch.

My son, the feudal activist

Back in the days before I had a child, when I had a functional brain instead, one of my hobbies was reading about history.  The history of the English Royal Family in particular, but I was interested in other key events.  I forget which gift shop of which site of historical interest it was in which I found a copy of the Magna Carta, but it seemed like a pretty cool thing to own and so I bought it.  So if anyone wants to know what grazing rights you’d have in England, or anything like that, then now you know who to ask. 

The copy I have is rolled up, together with the translation, in a black holder with red ends and ‘Magna Carta 1216’ embossed on it in shiny gold letters.  Very interesting-looking to toddlers.

Which is why Barry, after telling Jamie that, no, he couldn’t come into the kitchen when Daddy was cooking lunch, was greeted a few minutes later by Jamie turning up at the kitchen door brandishing a copy of the Magna Carta.  We’d always expected that our son would be the sort to stand up for his rights when thwarted, but we hadn’t expected him to start quite so thoroughly and so young.  Any despot monarchs around are clearly going to have to watch their step.

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Doctor Blogger

There’s an article in the BMA News Review this week on the subject of blogging (kindly made available to non-BMA members by Dr Crippen, one of the bloggers mentioned in it – I decided not to enquire too deeply into which copyright laws may be thereby being broken).  It’s apposite timing – due to a combination of the presence of a medical student in our practice and another recent article in the BMJ on internet use, it occurred to me this week that medical student blogs might make interesting reading, and, as I discovered in the few minutes I had for lunchtime browsing this week, they did.  (And, yes – adding a few more blogs that I can’t resist reading to my current long list is indeed exactly what I needed to help out my time management right now.  Thank you for asking.) 

The article said that Dr Crippen was, as far as he knew, the only blogging GP in the UK.  Which is, of course, technically not true – I mean, here I am.  However, my initial impulse to write in to the BMA News Review and let them know of my existence was tempered by the realisation that this blog isn’t what anyone looking specifically for medical bloggers would have in mind.  With a few brief and mostly unimportant exceptions, I don’t write about work on here.

This isn’t a deliberate decision to avoid the subject – after all, I mentioned it in my tagline and set up a category for work-related stuff when I moved to Typepad (with a tip of the keyboard to Julie, who inspired that particular category name).  It’s just the way it generally works out.  So this got me thinking about the reasons.

One important reason is that confidentiality precludes me writing anything about any actual patients I see.  With an annoying lack of foresight, those good people in the WMA who wrote our Oath neglected to include any clauses saying that I should respect the secrets which are confided in me except when to do otherwise would make for good blogging fodder.  So, that’s all my day-to-day material eliminated right there, unless anyone actually feels a burning desire to hear about details such as the precise number of letters I’ve had to write in the past fortnight (I have no idea – I didn’t even want to count) or the amount of my coffee break I wasted on Friday trying to chase up some results from the hospital (all of it, NOT THAT I’M BITTER OR ANYTHING).

But this wouldn’t necessarily stop me writing about matters medical.  There are all sorts of more general issues that I could blog about – the use of the NHS as political football, the attitudes of society towards health care, the moronity of Patricia Hewitt.  I don’t.  Why?

I suppose it’s because I spend so much of my life dealing with these issues, and reading about them in the medical press, that this blog is a break from them.  It’s become a separate section of my life.  Again, this isn’t a policy decision on my part – it’s just the way I feel in the day-to-day decisions about how my limited available writing time gets spent.  I don’t have enough time to write all the things I want to write about about stuff that’s happening online, and about Jamie (usually in that order of importance, wondrous mother that I am).  Adding yet another homily to all the articles already out there about the problems with medical care today just isn’t high on my priority list.  When it comes to blogging, I’d rather dwell on other things.

Having said all of that, coincidence has it that I had in fact planned to write a post about something work-related within the next few days.  So I just wanted to make it totally clear that, yes, I had planned this even before reading the article.  Bandwagon?  Me?

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Filed under The doctor is OUT. To lunch.

Ladybugs and owls

"So what does this person look like, anyway?" my husband asked me as we headed for the café where I’d arranged to meet Magpie.

"Tall, shifty, and looking as though she’d rather be someplace else, apparently."

"Hmm."

"Oh, yes – and her partner used to have a photo of her on his blog.  But I think he’s taken it down, because I couldn’t find it when I looked for it."  (Incidentally, either he’s sneakily put it back up again to confuse me, or else I am an idiot who can’t find a perfectly obvious link again on a webpage, since it was certainly there when I checked out the link just now.)

"Hair colour?"

"It was a black and white photo." (All right, so I am also an idiot who can’t remember whether a photo is in colour or not.")  "I think she had long straight hair.  So, given what my memory for faces is like, it was probably a tightly-curled perm."

"Bah."

Fortunately, Jo and Charlie were already there when we arrived, and accosted us with excited smiles and waves while we were still casting round looking for tall shifty-looking women.  Which is just as well, because Jo doesn’t look shifty in the slightest and I would never have recognised her from her description.  (She may well be tall, but since she was sitting down I didn’t particularly notice.  Besides, I live with a husband who is 6’4", which has reset my tallness perceptions to a whole different scale.)

And we had a wonderful time.  Well, I did, my husband did, and Jamie did (since the café had some decent toddler-appropriate toys and LOTS of good chairs and tables to climb on) and the other two certainly seemed to.  We talked about adoption, about blogging, about other bloggers, about random matters unrelated to the InterWeb.  It was a lovely relaxed get-together and I really hope we get to do it again at some not-too-distant point.

After which, my husband and I picked up a few things from the supermarket, headed home for lunch, and then drove to London to spend the rest of the weekend at my mother’s, being fussed over and cooked for and generally spoiled rotten.  And we found time for me to read her another couple of chapters of Harry Potter and the Goblet of Fire.  (I love reading aloud and my mother loves being read to, so we spent years of my childhood working through Diana Wynne Jones and sundry others before lapsing when I went off to university.  Then, because the Harry Potter books were crying out to be read aloud, I started reading them to her on weekend visits home, and we’ve been working our way through the series for the past… oh, goodness, must be a few years by now.  It’s highly debatable which of us is enjoying the experience more.)

So – no profound thoughts on life, the universe or anything right now.  Just a really lovely relaxing weekend.

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Filed under Family values, My (anti)social life

I’m not really a witty and sparkling person; I just play one on the Internet

Anyone making the obvious joke about the title will get Glared At.  Virtually speaking, of course.

Although I have been taking advantage of the anonymity of the Internet in order to maintain my devilishly deceptive identity as a person who actually knows how to string the odd sentence together, I am in actual fact a slack-jawed, vacant-eyed babbler who twitches and says ‘Er’ a lot.  Not that I’m complaining about this – we all have our crosses to bear.  I just thought I’d better come clean about it.

This is because Magpie and I, after several passing comments about how nice it would be to meet up, have had a sudden flash of organisation and actually gone ahead and organised a time and date to do so.  This coming Saturday, in fact.  I’m looking forward to it enormously, but it does occur to me that she might be expecting someone who can, I dunno, actually make coherent conversation or something, and I didn’t want her to be too disappointed.

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