I wish I had something to blog about....

.....I really really do!

I've been in Australia 3 weeks now, and my license to practise still isn't ready to go. Seems the ozzies are a lot more strict about who they give work visas to than the New Zealanders were. Anyway, they promise me it should all be sorted in the next week or so. Then hopefully I'll be back to work, complaing about the lack of time off!

I never realised how difficult it is to pass the time when you're essentially unemployed. I mean, daytime TV just doesn't cut the mustard for me.

In a boredom-fuelled frenzy, I've taken up martial arts. A very very sore foot, courtesy of a huge eastern european, is testament to my lack of success in that particular field. I'm also back taking drumming lessons. And I've gotten involved with a local first-aid group.

That's a total of about 8 hours per week sorted, then :P

The good news, though, is that all this free time has given me lots of time to go to the gym, with noticeable gut-reduction already.

Right, time to get up out of bed and....well, do nothing. But at least I'm doing it in the sunshine :D

Wish you were here,

Dr. Thunder

Daily Mail journalist in sterilise-the-promiscuous-bastards shocker

Posted by: Dr. Thunder

So my medical license to practise in Australia still isn't ready.

Therefore, I have nothing to blog about on the coalface.

But, this extended holiday does mean I'm spending alot more time online. One of my favourite websites to hang out is http://www.boards.ie/

It's the message-board where this blog got started.

In the "ladies lounge" of boards (which, despite the name, is not a virtual pole dancing club. It's a forum where ladies' issues are discussed) the following Daily mail article has provoked a heated debate.

http://www.dailymail.co.uk/pages/liv...icle_id=514542

It's a bit long, so I've cut and pasted what i thought were the salient points, but you should read the whole article by following the link above.

"Last week, an intriguing proposition was mooted by Government minister Dawn Primarolo.
Teenage girls, she said, could be steered towards what is described as "long-term contraception".
This is now possible thanks to the development of contraceptive jabs and implants which can last up to five years.
In other words, there is a way of effectively sterilising girls for a lengthy period of time.
In 2005, there were 39,804 conceptions by under-18s in England - a rate of 41.3 per thousand.
The trouble for those who would tackle the pregnancy problem is that the very act of warning against pregnancy can be unproductive. "

"A certain proportion of teenagers like to defy fate - and the more you warn them not to smoke, drink, have sex, stay up late, join gangs, the more they will.
Defying authority, not doing what you're told, is, for many, part of growing up - the search for your own identity, a necessary preparation for leaving the nest. Persuasion doesn't work. The instinct to rebel goes too deep. "

"It seems that many of today's girls just like being pregnant, and emotionally and physically - not just practically - have more to gain than lose if they are. Sex education hasn't helped, and may indeed have harmed. "

"The Government says it has tried everything to stop pregnancy rates rising - from school matrons to a blizzard of sex education, to free condoms and morning-after pills.
But it's not working. That's why I think sterilising girls for a few years isn't such a bad idea after all - and, when you think about it, it's a tempting solution for the State, too.
Once you stop your under-20s having babies, there's no end to the social improvements you could make. "

"If girls go on to college instead of minding babies, fewer children overall will be born. The more educated a girl, the fewer babies she is likely to have - education and fertility rates being in inverse proportion.
The maternity services, now so very over-stretched, would be better able to cope. Young mothers would not have the priority they now do when it comes to housing, and accommodation would be set free for those unfortunates clamouring on the waiting lists.
Education would benefit, too. Classrooms would be less plagued by fatherless lads whose ambition it is to cause nothing but trouble.
So the children of teenage mothers can suffer, too. "

"Not having babies takes intelligence, planning, prudence and boring appointments with doctors. So what do we do? Deprive potential children of life by sterilising a few hundred thousand girls society has decided are "too young" to breed, regardless of their biological capabilities?
Go for the quality of child they might produce in their 20s or 30s, rather than the quantity they could create if they start at 14? That, let's face it, is what's up for discussion. "

"There is, I admit, a dreadful gender unfairness in the suggestion that teenage girls should be sterilised. Shouldn't boys under 17 have their tubes tied, too? It takes two to make a baby.
What's sauce for the goose should be sauce for the gander. Perhaps the Government should start thinking about how that would work.
Since science has now devised a way of stopping girls getting pregnant without damaging their longterm reproductive health, the idea of enforcing sterility on girls under 17 seems to me a least worst option

"

So, I thought I'd see what the blogoratti think of this proposal.

The minister in question, Dawn primarolo, is a Labour party minister in the UK, and minister of State for Public Health.

She has not advocated compulsory sterilisation of the UK's female teenager population. However, this journalist, Fay Weldon, has.

As a paediatrician, I have issues with both of their stances.

Firstly, the issue of compulsory sterilisation. This to me is one of the most outrageous suggestions I have ever heard in my life. I'm no lawyer, but I'd imagine it contravenes human rights legislation?

What would the reaction be if we proposed "tying the tubes" of teenage boys, I wonder?

What makes it worse is that our journalist friend wants us to give an implant, which last 5 years. Considering we (as far as I'm aware) don't have any solid data on the long term side effect profile of these implants in children of this age, I find the suggestion doubly galling.

Dawn primarolo is more restrained in her calls for teenagers to use long term implants, with their consent.

I'm all for greater access to contraception, in the quest to reduce the number of teenage pregnancies.

But I wonder at what age a girl is mature enough to give informed consent for an implant that will make her sterile for 5 years. We have the concept of "Gillick competency", whereby if we deem a teenager competent to make an informed decision about their treatment, then they can make that decision. But this will add a whole new edge to assessing this capability.

At what age can a girl assess the risks of an unknown side effect profile?

Would over zealous parents push their kids into having a 5 year implant, to put their own minds at ease?

Will, as the right-wing always argue, there be an extra level of complaceny amongst teenagers if they're "sterilised". Will this lead to a lack of condom usage, and higher rates of STIs?

Are the type of teenagers who are responsible enough to think about their reproductive health 5 years in advance the ones we should be aiming new initiatives at? Are these not the girls who are already using the shorter-term depot contraceptives, the pill, or condoms?

My take on the issue is that forcibly medicating teenagers is a huge no-no. I don't imagine you would find many doctors willing to do it, either. I would refuse to forcibly medicate most people who are ill, so I sure as hell wouldn't do it to someone who's well!

As for giving the option of 5 -year implants, I'm less sure. I'm not convinced of their benefits when compared to shorter-term injections, and I'm unsure about their safety profile. If I'm not sure about it, with my medical degree, is it fair for me to ask girls in their teens to evaluate the risks Vs the benefits?

I know it's just the ramblings of the usual marginalised Daily Mail types, but it's a topic that interested me a lot.

The original (and best) discussion, from the ladies lounge at boards.ie can be found at

http://www.boards.ie/vbulletin/forumdisplay.php?f=1011

Drop in if you fancy a chat and a pole-dance :P

So, has anyone else got an opinon on this? Is this the way forward in tackling spiralling teenage pregnancy rates? Or is the whole thing ethically and medically questionable?

On the Australia front:

1) It's way too hot here for a pasty paddy like me.

2) People are all very friendly here so far

3) Beware any docs coming out to this neck of the woods..medical registration is taking much longer than before for overseas docs. I've been here on a holiday visa for 2 weeks, and my license still hasn't been processed. I applied in november!

4) For the women: There are a lot of really nice parks and nature reserves here

5) For the blokes: Australian women are HAWT :P

Ask your doctor about starbursts for male pattern baldness

So, I've only been in Australia a couple of days, and feel unqualified to comment on their healthcare system as of yet.

However, enroute here from Ireland, I passed though the USA. Thankfully, I had no need to make use of their healthcare service either.

But, I did have ample opportunity to make use of the cable TV in my hotel during a 48 hour stopover in LA.

What amazed me was the amount of adverts for prescription drugs on television. All paid for by the drug companies, extoling the virtues of their particular drug, and usually rolling out some actors who claim to have used these medications.

After the actor (or sometimes genuine patient) tells you how their depression was cured by Sad-Gone, they urge viewers to "ask your doctor" about this wonder drug.

Almost invariably, this is followed by a guy speed-reading a disclaimer "drug X is not suitable for everyone. Side effects include liver failure, kidney failure, yellow teeth, arse falling off, cardiac failure, blindness and spontaneous gingerness".

I was flabbergasted. Evidence? Who gives a flying fuck about evidence when you have a happy post-coital elderly couple lying on a bed thanking humanity for viagra or cialis. They're right there in front of you, ON THE TV FOR GODSSAKE, so it must work.

So, what does the panel think? Is this fundamentally ethically wrong? Or are drug companies empowering patients?

I personally find the concept of a pharmaceutical company peddling drugs to people who usually have no access to data about the drug, or do not have the tools to interpret this data, pretty uncomfortable.

Also, are GPs in the states over-run by patients demanding a drug they saw on FOX TV?

I'd be very interested in peoples' thoughts.

Dr. Thunder

The sorryness

I would like to take a leaf out of the Australian Prime minister's book, and make an apology. I apologise for neglecting this blog for the last 2 months or so.

My (lame) excuse consists of a combination of being in hospital for a while, and being on an extended holiday.

I just didn't want to think about work, while I was hiking the length and breadth of New Zealand.

But I'm back.

I'm no longer in New Zealand though. For the next year I'm working in sunny Australia. It's really cool over here, and that's not a comment on the heat! My pasty paddy skin was never designed for 30 degree temperatures and high humidity. This has to be the first time in my life that I've gone IN to a neonatal unit to cool down.

Anyway, it's a little soon to be blogging about the Oz healthcare system, as I'm only in the door. I'll be very interested in seeing how it compares tot he New Zealand, UK and Irish systems.

So far it's looking good. But, for starters, the labour ward, the neonatal unit and the adult intensive care dept are all in the one location. This is something you don't always see in Ireland and the UK. All maternity departments will have a baby unit of some sort attached. But many won't have somewhere to put mothers if they become seriously unwell during their labour. We're heading in the right direction back home, but I'm glad to see the Aussies have it sorted,

I also noticed that I get paid by the hour here!! Like I have a timesheet. Getting paid for overtime will be a new experience for me. Not sure if I'll cope.

Anyway, more posts will follow as I settle into the job. I start with 3 months of neonatology in an enormous unit, so much fun and frolics are sure to follow!

Watch this space..............

To all our avid readers!

Two Weeks will be returning soon

Personally life has taken over for a few weeks, but within days you'll be happily (?) reading your latest post from us

Global Warming + Cutbacks + Night Duty = Grumpy Nurse

Well hello to anyone still there!

First up an apology.........2 weeks ago I spent a fantastic week in Lanzarote, doing nothing more than reaching for another beer or ordering another steak sandwich, since I got back I've been easing myself back into the daily grind and my obligations to the blog suffered too.

So I go away, and the weather here is pretty good, relatively warm and sunny for the time of year. Step off the plane in Lanzarote and spend a week in the balmy temps and generally get very brown. Come back, and in the space of a week......Ireland must have become member of the Baltic States Alliance. I thought it was supposed to be getting warmer. Now maybe my hypothamalus was needing a bit of time to re-adjust but in the past 2 weeks I can't get the heat into me......unless, I'm in work, which brings me nicely into the current condition on the ground in the Irish Health Service.

Some of you may be aware that recently the organisation that runs the public health service in Ireland has had to tighten its belt considerably as its facing a budget overrun of about €250 million for this year. With that in mind they've pulled back on a number of things to try and save money. Mostly their action is based around a total recruitment freeze. No staff of any grade or function to be taken on at all. Initially this was meant to last for a month, but as most of us expected its been extended to January. Supposedly, this will not effect patient care, and our glorious Health Minister has gone on record on this, though over the past week or so the news has reported several incidences where this is most definitely affecting patient care and service delivery. I've also heard that we're now at the stage, were nurse to patient ratios are rising, mainly because wards access to agency nursing staff to cover sick leave etc is being severely curtailed.

Basically we're all suffering now for the ineptitude of the service administrators and managers. Is it only a matter of time before patients conditions start detoriating and heaven forbid maybe die because the system is failing yet again. How long before we see large numbers of staff leaving, unable and unwilling to deal with the pressure and stress of the public service. Lured by the shiny and pretty well funded private sector hospitals that seem to springing up with increasing regularity around the country. Already 3 of my workmates are either leaving or in the process of interviewing for such places. If we start losing our brightest and best, where will that leave us?

I'm sure over the next while things will develop further, hopefully not for the worst, time will tell I guess. I'm starting a week of night duty now, so depending on how well behaved the patients are you might get another post this week. If there happen to be any regular readers who'd like to ask anything in particular, just leave the comment and I'll see what I can do.

Does a wrong cancel out a right?

This week I did what every doctor hates doing. I missed a diagnosis. I don't mean I missed an ear infection. I mean I missed seriously ill kiddy with a serious heart condition.

I was on-call for neonatology this week, and was called to labour ward for a delivery. They called me because they were using instruments to deliver the kiddy. When I arrived, the obstetrician was there, trying to haul this baby out of mum with a suction device. But the little one wasn't for coming. It took an age for him to come out. It was pretty horrific to watch. But i had the luxury of being able to stare at my feet, while mum was crying out for morphine.

Anyway, the baby eventually decided to pop out. Delivery had been long and difficult. Morphine had been given, which often has the effect of producing a sleepy baby at delivery.

This baby was indeed sleepy. His colour wasn't great either. But he was breathing, and had a good heartbeat. I needed to give him a bit of oxygen to pink him up, which worked a treat. Dad asked me why I needed to give his newborn oxygen. I replied cheerfully that the kiddy was just a bit stunned by the rough delivery, and the morphine had muted his natural responses. No probs, I'll have him right as rain in no time. And I did. I gave him back to his proud parents about 5 minutes after all the drama. Happy days.

Until the following morning, that is. One of my colleagues was on-call the next day. He was called to the post natal ward to see a newborn that the midwives were a bit concerned about. They had every right to be concerned. the baby was blue. Not a nice sight to be greeted with first thing in the morning.

So, everything kicks into action at this point. There's drips, there's lots of drugs, there's heart scans. Cardiologists turn up, and ventilator machines are rolled in. The parents were inconsolable.

It was the baby who's delivery I'd been at. I cowered in the corner. I couldn't look mum or dad in the eye. It was, shamefully, a relief to me when they were on their way to the local kiddies cardiac unit to be assessed for surgery. I don't know if I should have picked up the diagnosis at the delivery. I still don't know what the diagnosis is. I don't think there were any hard signs or symptoms at delivery. But would somebody else have acted differently? Would somebody else have referred this baby to the cardiologists earlier. Who knows? What i do know is that I didn't.

Later, in the same on-call shift, I was called to A+E to see a small baby. The GP thought he had reflux, and the A+E doc agreed. But he wanted me to see the kid "because mum is anxious and I'd like you to reassure her". I agreed. I always agree. I shouldn't, but I do.

The child had been vomiting for the last few weeks. He was now vomiting everything that he was taking in. He didn't look well. I made him nil by mouth, put in a drip and took some bloods. I suspected a condition called pyloric stenosis. I suspected he was in the very early stages. Pyloric stenosis is a condition where the muscles in the gut become so thick that food or liquid can't pass by them. It's a very serious condition, but with surgery, the outcome is very good. I did the tests, and my suspicion was right. So, I sent him off to the surgeons for his operation. Que 2 very grateful parents.

So, there we go. In one long long day I see a kid who's parents will forever regard me as the pillock who didn't ever notice their baby had a terrible heart problem, even when she needed oxygen. Then we have the parents who will regard me as the only doctor to take them seriously when their child was ill.

Can I really be both these things? Does my missed diagnosis cancel out my early diagnosis of the pyloric stenosis? Does that make me a doctor of "neutral" abilities?

At the end of the day, it's not about me. It's about getting it right most of the time, and making sure everyone gets a fair crack of the whip. I think we do that most of the time. But when we don't, it's the worst job in the world.