Bloody GPs

I see that the old boot Carole Malone is having another pop at GPs again in the (Scroll down to third story) NOTW

This women is vile - her view is that GPs are now earning too much money for doing too little work. This other story in June is just as hateful.

I have followed her rantings for some time and can empathize a teeny teeny little bit. Her father apparently was very ill and got seen by an OOT locum who did not know his details. She feels that his care suffered greatly because of this. I can understand being distressed if you feel that a parent was not receiving optimal care...I have been in the same boat and it's horrid.

But this women has gone on a one women mission to attack GP pay, hours and reason for being: she is nothing short of spiteful and venomous in her writings. As far as she is concerned, medicine should be vocational and GPs should still be working day and night to ensure that their patients are always seen by their family GP. Oh yes....let me add that as well as GPs working day and night, they should go back to earning what they were five years ago. i.e. a hell of a lot less than now.

I wander how big a part vocation actually plays in people's decisions to study medicine? I don't think that there is any doubt that we all do this because we want to help people - I think the job would be un-doable without a personal need to try to help. But...and I know this will be controversial......If one has a vocation to help people, how do they choose between being a doctor or being a nurse? Nurses help people all day every day, work their arses off and earn around £25000. Doctors help people too and have potential to earn a lot more.

At my interview for medical school, I was asked why I wanted to move from nursing to medicine. This was hard! The old chestnut "I want to help people" wouldn't wash, because you can do this as a nurse. I gave a right old bunkum answer about wanting to help people at a "Higher level" (LOL!) The interviewer said to me "OK so you want to help people, but earn more money whilst doing it"

How can I argue with this?! Medicine for me is about providing excellent care but also about fulfilling my potential and earning a better wage than I could as a nurse. Admitting that good pay is one of the attractions of going into medicine remains a taboo area and not something I ever hear people talk about.

Another interesting point is that I know many nurses who are moving into medicine. I have NEVER heard of a doctor moving into nursing. I think this says it all!

When is it OK to hurt a patient?

As mentioned, I am LOVING this orthopaedics block! My consultant has a reputation of being a scary screamer but so far she has been brilliant with me and my clinical partner and so life is good.

What is good about this placement is that my consultant is a shoulder specialist which means that most people who come to see her have impingement, instability, a-c pain, humerus fracture or a frozen shoulder. This might not seem very exciting but it has meant that we have become good at diagnosing and managing these complaints. On my GP block, every bloody patient that came had something different...you got your head around working out what the chest pain was due to and then they left and a new patient came in with a toe problem.....I liken the experience to swimming backwards in poo.

Anyway - in clinic this week, a 50 year old lady attended with severe shoulder pain. Her passive arm flexion and abduction was 60 degrees, after which active movement was possible but with horrid pain. We were asked to take a history from her, examine her, make a diagnosis and then present the case to the consultant, who would then come and examine her again and discuss treatment options.

I took her history and then started to examine her. After looking at her cervical spine movement, I began the arm movements, managing to get her flexion to 180 degrees, albeit with clear pain. In fact, the pain was so bad that she started crying and she wasn't a wimpy lady - it was just clear that she was in agony. I decided at that point not to continue to abduct her arm because the other tests indicated that she had supraspinatus impingement which was likely to produce a painful arc. So I left the abduction and did some of the other examination which she managed, without reproducing too much of her pain.

When we left the room to go and find the consultant, my clinical partner voiced his concern with what I had just done. He felt that I should have continued with the full exam, despite the fact she was crying with pain. He felt that by not persisting, I had failed in my examination. I told him that I felt that continuing to examine her, despite pain and tears would actually be unethical. This didn't go down terribly well with him but I stood my ground because although I might not be a font of medical knowledge, my nursing background has given me a lot of insight into patient care.

Since my first contact with patients as a medical student, I have been very aware of the fact that when we examine patients, it is usually for OUR benefit, not for the patient's. We know so little that examining is how we learn, but in this case I knew that continuing with the exam was causing her significant pain and that once I had presented the case to my consultant, she would then have to go all through it again.

My clinical partner was not amused that I stood my ground on this one and I think the reason for this might be our backgrounds. He is an ex-physiotherapist and I think it's fair to say that physio's often cause pain, albeit for the good of the patient's recovery!

So was I wrong?

Back in action!

OMG - can't believe that it's October and two months have passed since my last post.

To bring things up to date.....I HATED GP placement because my GP was a bullying prat. After GP block, I had a three week "Elective" We had to choose between pathology, Haematology, Radiology or Humanities.(Pathology was my first choice - I fancied working with nice, quiet, dead people after seeing so many live, moaning, ones during my GP block)

Fortunately, or unfortunately (I'm still not sure) I got allotted to my last choice which was humanities. What an experience! Apparently there is a national movement towards trying to introduce humanities into medicine. By that, I mean poetry, opera, photography...all the arty subjects which I was crap at in school. There was no "Humanities" per se in the 1980's - I am told that this is now a GCSE subject.

Anyway...on the intro morning the chap running the course tried to explain what the humanities elective was trying to achieve i.e. broaden medical student's thinking by looking at areas we never normally would. We spent two hours discussing the word "Humanities" I think I give up the will to live after 20 mins.

The short of it is that we each had to produce a 15 minute presentation on subjects like "Was Hamlet mentally ill?"

I'm a bit rough around the edges and not usually into opera, radio plays or literature but I enjoyed the presentations and am not sorry I ended up on the elective after all! I have even found an arty medical picture for you (See above!)

After this, we had a month's holiday. I am being credit crunched to within an inch of my life so couldn't afford a holiday but had a lovely month doing nothing and watching Jeremy Kyle every morning.

Then, three weeks ago I started on my orthopaedics block and am LOVING it! Hells bells, that's the first time since I started Medicine in 2006 that I have said those words. So far the course has been anything except enjoyable - it's just one long slog really, with little bits of hope thrown in every now and then.