JuniorDr Blog

 This year's Modernising Medical Careers (MMC) recruitment round is almost over for this year. The majority of junior doctors were engaged with it. They had to submit separate applications for each Unit of Application, which could be up to seventeen this year. It puts junior doctors under immense pressure as they have to make applications and attend interviews whilst carrying out their normal clinical duties. Would it affect patient care? According to the General Medical Council good medical practice, patient care should never be compromised on any grounds. (2006)

Psychology behind

During this season of recruitment, some junior doctors experienced psychological symptoms of stress. It might affect the decision making faculties in patient care. Follow up cross sectional survey results show Applicants suffered significant psychological distress during and after the MTAS process. (Whelan P et al: Stress, Lies and red tape: the views, success rates: of the MTAS cohort. Journal of the Royal Society of Medicine. 2008; 101(6):313-318).There are other issues such as accommodation, family etc...

Practicality

Practical issues can be serious. Junior doctors may have to cancel some of their patient appointments in short notice. This reduces the effectiveness of important Psychology inputs that the patient had been receiving. A common complaint from patients is that they see different doctors in the out patient clinics every 6 months.

Positive move

On the other hand, this highly competitive recruitment process would have an indirectly positive impact on patient care. A junior doctor who is unable to live up to the standards of the recruitment process would be encouraged to gain the required skills. He/she may be motivated to do more audits, attend more courses and other training; which will ultimately contribute to improving patient care. Working for different deaneries during their training period enables junior doctors to gain new experience.

There is a significant indirect impact on patient care in consequence of the MMC recruitment process. However, there are some ways around: internal prospective covers, use of stress and time management techniques, consulting seniors, work load planning and access to psychological and other support services can potentially be helpful. New recommendations for next year's recruitment round were published by the Royal College Psychiatrists for 2009. It is a national recruitment process for 2009.

References

1. Good medical practice (2006) General Medical Council: 20-42
2. Wedisinghe L (2008) Recruitment lessons to be learnt from obstetricians. British Journal of Hospital Medicine, July 2008, Vol 69, No 7: M110-111
3. Brown W (2008) the web they weave. BMJ Careers 336:56-7       ( http://careers.bmj.com/careers/advice/view-article.html-id=2776)
4. Tooke, J.;Ashtiany, S.;Carter, D., et al. Aspiring to excellence. Findings and recommendations of the independent inquiry into modernising medical careers. London: TSO; 2007.
5. Whelan P, Jarrett P, Meerten M, Forster K, Bhugra D. MTAS fiasco: lessons for psychiatry. Psychiatr Bulletin. 2007; 31:425-7.

JARK Jayakody

Speciality Trainee in Psychiatry

Yorkshire Deanery

 

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Theres one thing i can do - and thats talk for England ( & Wales). The last few weeks have been turning into a bit of a drag where i feel like im learning very little and now that the whole excitement has died down about being a  FY1...things just seem to be dragging along.

So i just sat there on the ward , by the desk, jobs all done. Thinking what to do...i didnt really fancy going into surgery again and smell the stench of diathermy. So i walk over to one of my patients and say:

"Your being a right nuisance arent you?! We keep trying to discharge and you keep getting all sick all over again..."

He looks at me and chuckles. I sigh and sit down and ask "so how was last night?

He replies: " Had a bit of a funny turn, but its settling down doctor".

I say "O i" and scan his hourly obs...not looking great..but yes...settling down.. awaiting blood cultures results..."Pseudomonas"...

 Hmm....i think..i wonder what that word meant in med school...anyhow i prescribe the antibiotic suggested by Mircobiologist...ive been told i should be able to smell something nasty by the SHO. As usual i cant.

I look over my shoulder and see elderly old Tom (pseudoname) sat there smiling at me.. i smile back and say happily  "Your going home today!".

This man has had his suitcase packed from day one..explaining to me every evening his wife is going come pick him up and take him home.. every evening i convince him to stay  whilst thinking i would rather die then stay here overnight..

Over these few weeks ive heard many stories whilst i just wander randomly to and from my patients....stretching the time i take to do my jobs....in the process ive been offered pieces of jewelry, sat next to an old lady who explained to me how awful the schooling system is now in this country, been asked to get wed , been told by an 80 something year old man that i look like the spitting image of a girl he knew when he was 18...and the list goes on..

Some of which make me laugh, others smile.

Just plain old talking is helping me put Pseudomonas in the picture...better check that up!

Peace:)

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Ramadan ensues full steam ahead , days after days of no food and no drink have become routine now.

Ramadan i think to myself, is the month of ease. This month is much more than just giving up your food and drink for the sake of Allah (swt). This is a month of spiritual enrichment and being in touch with your inner heart. What does your heart yearn for? What are its focuses , its aims and ambitions?

 As i pass the day by seeing lists of patients, i thank Allah for giving me a body that is able and healthy enough to function. We all take our health for granted. Very little is for granted in this world. Our intelligence, our abilities, our livelihood , i believe they are all gifts and trials.  The next day in the morning ward round we get news that one of our consultants has just had an MI. I am shocked and feel sad. I think about how weak humans are; there is no warning and a persons health deteriotes , out of control.

 As food passes me daily i am not even tempted by its aroma. I think if someone was to pay me a million pounds to eat in these hours i would not eat for the peace and tranquility i am feeling is not a feeling that has a price tag. My whole body is at rest, i have no thoughts or worries about my world. I know that  things only remain to change. There is no gathering that is permanent.

I work very hard during this day. I am on call and for the first time i see 15 patients by myself. I get away for a few minutes to pray the midday prayer and return making sure my patients are ok. 

A fellow colleague who i didnt even realise was muslim asks me whether i had a chance to get away and pray today. I smile at his thoughtfulness and thank him saying yes.

The day is very long , the fast began at sunrise (5.00 am) and finishes at sun set (8.05). Before the consultant ward round i gather some dates quickly as the fast will open during the ward round. It is perferred not to delay the opening of the fast. The time draws nearer to open the fast and i begin to be quizzed about basics of bowel obstruction managment. Some how the right answers come from my tongue. At the time of opening the fast there becomes a moment between patients during the ward round in which me and my muslim colleague find ourselves outside the curtain.  I offer him some dates, he did not even realise it is the time to break the fast as time had gone quickly. He takes the dates , i take mine, ask for forgivness and patience and eat the date.

 I feel very grateful.

 

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A disaster at work. All my statistical analysis from the entire week is gone.

Apparently I should have backed it up as every now and again one of the servers goes down and is wiped. As the data were all in a numbers programme backing it up wasn't as easy as it sounds. I punch the keyboard with my fists and almost break it shocking everyone in the lab.

I decide to leave for a coffee and drink this calmly whilst considering my options. I could stay in all weekend whilst the data is still fresh in my mind. But I was supposed to spend it with James. I can always stay late during the week. I decide to go with the latter option.

The prof calls me into his office in the afternoon and we end up talking about a number of things. He tells me that he knows about James. He also tells me that he doesn't have a problem with inter-office relationships but he also tells me to be careful. I ask him what he means but he declines to elaborate.

It gets close to six and James calls to tell me that he's meeting friends tomorrow and asks if he can put our weekend away on hold. I reluctantly agree and decide to spend all weekend at my desk. Number crunching.

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I get in by eight and spend the morning in the lab. James' sister came over last night and it turns out he was having dinner with her. I would have loved to meet her but he tells me that he's not ready for this yet.

I have to miss lunch as I'm  running some experiments which can't wait. My cells finally seem to be making it through. I get a false reading at one point and want to throw it out but have to include it so I can't be accused of falsifying the results.

I stay late to analyse some more data. I end up putting in several hours of number crunching before leaving. James comes over to mine and we watch a movie, drink red wine and go to bed late.

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