Monday, 28 March 2011

Vote Mick!!!

Don't vote Pedro, Vote Mick.

This post is a shameless plug for my friend Mick Molly, who's running for the Seanate in Ireland. Mick is the kind of guy we need in politics.

He's a doctor, who's worked in A+E for a long time, so he's knows all about Ireland and the problems facing our crumbling health system. He's been the president of the Irish Medical Organisation, and has been on the board of a regional health authority, so he also knows how health WORKS. he's been working in Harvard over the last 2 years or so, and has served on a pan-European body, representing the interests of junior doctors, so he knows how to navigate the global health environment.

As a person, he is incredibly helpful, incredible bright, and incredibly dedicated.

The Senate will hopefully start up Mick's career in politics, specifically in area of health politics.

For years, clueless politicians have run healthcare in Ireland.
This can change. Make sure that you check out Mick's site and make sure you give him your number one.

This is my 100th post, and I'm glad to use it to endorse Mick for the position of Senator, representing my family and I. Voting is now open, so go and vote :D

Dr. Thunder

Sunday, 13 February 2011

The downside of being down under.

This blog, and many others are full of the joys involved in a move to Australia and New Zealand. A region where work/life balance is (usually) possible, and where we don't have to routinely watch patients die while they wait for outpatient appointments, or operating theatre slots.

The weather is decent, there's lots to do, and our political masters don't seem to exist purely to screw up our education. Most doctors who come here never regret it.

But there must be a downside, right? Of course, and many of them. So, here is the Dr Thunder MD official "Downside of being down under" list:

1) Trying to get here: NIGHTMARE to get registered as a doctor. Very slow process, and they've outsourced the verification of medical qualifications to the USA!! This, of course, only prolongs the process.

2) Patient expectation is higher: In my opinion (and I've been disagreed with on this topic on the blog before) Australian patients are more aggressively demanding than those in Ireland or the UK, often to the point of being unrealistic. Having said that, I think it's because they're used to a health service of a high standard. Whereas in Ireland, especially, we accept that we'll wait in A+E for 16 hours before seeing a doctor.

3) Residents often rotate every 4 months: As opposed to 6 months in the European model. I don't think they get a good grasp of some of the specialties in 4 months. In fact, 6 months often isn't long enough for these junior doctors to get enough experience.

4) Cost of living: In my experience, it's higher than in most places in Ireland and the UK. Though I found New Zealand much more reasonable. There will obviously be some regional variation here.

5) It's a long way from home: Don't underestimate that side of it, especially if you're not used to living away, or if you're coming out for a long time. One of my grandparents passed away not so long ago, and I didn't get to say goodbye or go to the funeral.

6) There's a craziness about cross-recognition of exams: We have a lot of very highly qualified paediatric doctors who come to Oz, and they have to re-sit all their specialist exams, because Australia won't recognise the UK/Irish ones (and vice versa), which is madness. We're all developed countries, and someone who has their postgraduate paediatric exams in the UK should be given exemption from those exams in Australia (and, again, vice versa).

7) The place is full of GAMSAT course students: We won't go into this, as it's been covered to death on this blog, but we probably need to make the medicine course longer, not shorter, and I personally think that's reflected in the quality of many of the medical students. Though this is almost as much of an issue in Ireland too, as of recent years.

8) Primary care: In contrast to the UK, primary care here is basically a business model. GPs can (and usually do) charge more for a consultation than the government pays. They also usually insist on patients paying cash up front and then reclaiming the money themselves. I'm not having a go at GPs. Anyone who reads this blog will know I have much love for GPs. But they are forced into becoming business people, and the financial realities of that inevitably mean that our poorer patients often can't afford to see their doctor, and get poorer follow up. It also means paediatric A+E is like a GP surgery, with a huge amount of "primary care types" of problems showing up. This will come as a bit of a shock to UK doctors in particular, who are used to a free-at-the-point-of-care NHS.

9) Patients?: Not over here. Seems every second person is now referring to them as "clients". I heard some psych person call a patient a "consumer" the other day. I don't know why, but it boils my piss.

10) The bloody chocolate: it's DISGUSTING!

So, leave your comments below for the benefit of the hordes of UK and Irish docs fleeing their jobs. Remember, no positives. We've done them to death. This is all about the misery :D

Dr T

Thursday, 6 January 2011

the family doctor Vs the FAMILY doctor

I hate being the only doctor in the family. Aunts, grannies, nieces and friends of theirs all seem too keen to show me their bumps and bruises at any opportunity, in the hope of getting a quick diagnosis. I even had a relative show me his penis recently!

I hate this. Not because I don't understand their frustration at being stuck on a waiting list, or having to pay to see a GP. I hate it because I'm worried I'll get something wrong.

There's a meddling lady who lives near our family home, who brought her child around to my house when I was a 1st year medical student, and asked me to look at her injured shoulder. She'd fallen off a trampoline and landed on it. I'd never seen a broken shoulder before, and told her that.

"But what do you THINK might be wrong?"

I buckled and told her it didn't LOOK broken to me. But I told her I didn't know for sur, and that she should get it checked out in the emergency department.

IN her head that became "this shoulder is most definitely NOT broken, and there is no need to seek medical care for this child". Obviously, the pain persisted for a few days, and she got an x-ray....diagnosis = "broken" shoulder.

To this day she tells everyone who'll listen that it's a crime for me to be doing paediatric emergency medicine, as I can't even diagnose a broken shoulder.

So, today when my gran rang me to say she's getting "funny turns" I told her to see a doctor and she seemed disappointed that I wasn't offering a diagnosis. I don't want want to be that guy who can't even diagnose granny with x, y or z.

So, to the families of doctors out there, I ask you, on their behalf, to treat them like the clueless mucker you grew up with, and not as the professor of brain surgery that they actually are.

Happy new year to you all.

Dr. T

Friday, 5 November 2010

Kudos to you, Mr GP.

Overheard in the supermarket today:

Mildly coryzal staff member: I've had this cold for 4 days now, and it's pissing me off. I went to my GP, and the idiot refused to prescribe antibiotics.

Other staff member: Seriously?? That's awful. You should change doctors.

Mildly coryzal staff member: Oh you better believe I will. I gave him a piece of my mind and told I won't be back to his crappy surgery ever again. He didn't care, though, and pretty much told me it was my perogative.

So, there you go. Props to that unnamed, unsung hero of general practice.

The future MRSA patients of the plant thank you :D

Dr. T

Friday, 29 October 2010


Dear baby Jesus. Why.......

1) do the sickest kids have the most difficult veins?

2) do the the kids with nothing wrong with them have the most anxious parents?

3) do doctors forget all non-bone related medicine as soon as they become orthopaedic surgeons?

4) do the kids with cancer always come from the nicest families?

5) are people not bothered when the doctor looking after their unwell kid has worked more hours than a pilot or lorry driver are legally allowed?

6) do we employ doctors from developing countries, when we know children in their home nations die in their droves for want of medical attention?

7) do the politicians always know better than us when it comes to health policy?

8) do we laugh when a baby pees all over us, but rush to change our clothes when Albert on the geriatric ward does the same thing?

9) do some parents oppose vaccination so strongly, while parents in poorer countries routinely watch their children die of tetanus and pertussis and other preventable diseases?

10) are physiotherapists and occupational therapists so much hotter than the general population?

If you can answer these questions (and any others posted in the comments section), Lord, then I shall return to church :D

Many thanks for your time,

Dr Thunder.

Thursday, 23 September 2010

Long hours? Or a long time training?

I’m not a fan of too much work. Over the years, I’ve done my fair share of long shifts, nights, weekends, public holidays, and combinations of all the above.

I don’t function well when I’m tired and hungry and thirsty. And most patients don’t want to be seen by an overworked, sluggish, grumpy doc whose priority is a bed and some food. Certainly, I wouldn’t have wanted any member of my family to have depended on care from me after working 27 hours straight.

I always thought my colleagues agreed with me. Enough miserable faces on the corridors of the various hospitals I’ve worked in made me feel a collective yearning for better conditions.

I thought, therefore, that there would be widespread endorsement of the European Working Time Directive (EWTD) when it came into force in Ireland and the UK. The EWTD is designed to limit the working hours of doctors within the European Union. Depending on the stage of implementation, it can mean working a maximum of 48-56 hours per week.

Of course, here in Australia, they’ve managed to do that without relying on international law. Down under, the rules for doctors’ hours seem to be enforced on a regional basis. In fact, from what I can gather, the rules seem to be MADE locally too. But, by and large, it works. Sure, I’ve been miserable and tired and hungry working in Oz, but I’ve never had to work 72 hours on the trot, let alone do it on a regular basis, as happens in Ireland.

Forgetting for a moment that the Irish government has decided to simply ignore the EWTD, and continue to make their juniors work ridiculously long hours, I was amazed to learn that there are significant groups of doctors in the UK and Ireland who oppose the implementation of the EWTD.

These doctors argue that registrars, like me, and other junior staff, need to be exposed to lots of cases in order to become proficient consultants. They argue that patients come to harm at the hands of tired doctors, but also from inexperienced seniors.

I can see their point. However, I don’t buy it. I can’t accept that dangerously long hours are the only way, especially when urban Australia manages fine without total burnout of their medical staff. There has to be a middle ground.

My take on the long hours culture is as follows:

1) If we juniors want to reduce our hours then we have to expect it to take longer to become consultants. Everything in medicine is being streamlined these days, and that needs to stop. We need to return to 5/6 year medical degrees, and long apprenticeships as house officers and registrars.

2) A lot of doctors' time is taken up doing admin work that anybody could do (chasing xrays, filling out blood forms, chasing blood results on the computer etc). These tasks should become the work of someone else, so that doctors actually spend their time doctoring. I remember as an intern working out that about 60% of my tasks could be done by a competent member of admin staff.

3) Our training is important. But so are our lives outside medicine. I sympathise with the wannabe surgeon who wants to work all hours, learning how to do craniozygomatic surgery. But, there are those of us who have wives, girlfriends, kids, and a family life. I want to be a good consultant. But I doubt I’ll look back from my deathbed and say “I’m glad I worked so much”.

4) Patients need to do more. Relatives, friends, patients and strangers are almost always sympathetic towards me, regarding the plight of junior doctors. But how many have ever raised the issue with a canvassing politician? I don't expect the public to have our interests forefront in their mind at election time. But this is about patient safety, as much as it is about modern day slavery. As things stand, the politicos and the media often betray us as greedy and as a vested interest group, and very little of that gets refuted.

5) We have to be wiling to take industrial action. End of. I would be very reluctant to do so in oz, as my job is busy, but tolerable. But if a pregnant junior doc in Ireland who is working 48 hours solid, with no scheduled breaks, isn't entitled to strike, then who is. the media would love it. They would betray us as lecherous public servants trying to bleed the state dry. The media and politicians would distort the facts to make us look greedy. But screw them. I bet we could hold out longer being abused by tabloid readers then they could hold out with no doctors. Obviously, I would never advocate withdrawing acute services. But a work-to-rule or skeleton staffing would cause some browning of pants in the corridors of power.

The Australians do a good job of it (well, in the cities they do, their rural healthcare provision can be pretty piss poor). Ireland and the UK should learn from them. Mostly we’re rostered on for a 38 hour week. We do on-call and out of hours, of course. But those shifts tend to be interspersed with good weeks, where we can catch up with friends and family This is not the case in Ireland and the UK.

I know from experience that some Ozzies will post comments here telling me that they work terrible hours too. And of course that can be true. I once did a paeds emergency medicine job here where my partner was getting seriously worried about my health. I was literally exhausted all the time. I was grumpy, and never seemed to have any joy in my life. That’s not the way to live. And it’s not the frame of mind I want the doctor in when I bring my sick kid to see them.

I know everyone is an expert when it comes to public sector reform. Just look at the comments section of any newspaper article or blog on the issue. So I’ll keep my ideas about system change to myself. But Ireland, the UK and Australia need to wake up to this issue. More complex issues have been dealt with in the history of mankind.

All three countries have started the process of saturating us with medical school graduates. In Ireland and Australia especially, every man and his dog can become a doctor. Of course, there hasn’t been a sufficient expansion in the number of hospital training posts to cope with all these new graduates.

That will have the desired effect of making our young doctors accept crappy conditions, as it’s likely to be the only route to a scarce training post.

Perfect solution, if you’re an administrator or politician. Tough luck if you’re a doctor or patient.

Sadly, doing anything about it is a catch 22 situation. There are those who have tried. But what’s the most common response when you ask local juniors to engage on this issue, and stand up for their rights? Yep, you guessed it....”Sorry, I’m just too tired”.

Wednesday, 8 September 2010

Hi, I'm Dr. Thunder. What's your f*cking name, you little ****?

Maybe I'm getting old. Maybe the kids are getting a bit more ballsy. Maybe it's a bit of both!

This week I've been sworn at more in a single shift than ever before. This was a 10 hour paediatric emergency department stint, and there were 3 "incidents".

Normally a single episode of paediatric-potty-mouth is something you remember for a considerable amount of time, as it's reasonably uncommon. But maybe things are changing.

Episode one: I was putting a drip into an 11 year old. It went in nicely. Job done. Poor guy was a bit traumatised by the experienced, and when he regained his composure he screamed "Jesus fucking Christ, doc, that was fucking painful".

Episode 2: Another drip, this tie in a 9 year old girl. As it was going in, she screamed "SHITTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT" continuously. When it was all done, she turned around, with a big happy smile on her face and said "Thank you doctor", and started behaving exactly like a 9 year old girl should.

Episode 3: A teenager who just didn't want to be in the hospital. I came to speak to him, and he just ignored me. I asked his name. Nothing. Not a word. This wasn't unusual teenage behaviour, and it's relatively common. His mother got involved, and napped at him.."TALK TO THE DOCTOR NOW!". In frustration, He shouted "For F*CK sake, my name is Joe*. Happy now????".

You have to laugh, in all honesty. These are scared kids, who are all sick. It's a tough life being an unwell child. But I know I'd have felt an awful lot unwell if I'd sworn at an adult in front of my parents when I was their age!

But, as much as I'm supposed to be disgusted, they were the 3 most amusing interaction of the day :D

*Not his real name, obviously.