You lack discipline - Daily Feats is the answer

I've found this today:

Daily Feats

It's excellent.  I've already set my goals for the day.

No doubt I'll spend a couple of hours tweaking this every week instead of going to the gym, drinking green tea, etc, but it might make me feel more productive at least.  It will hopefully help my self-discipline.  It's time to turn this mush into muscles.

About a Pomodoro

I've come across this technique and am really excited about it.  I'm going to try it out at home this week and then at work next week.

Pomodoro website



I remember coming across a version of it a few years ago when watching this:

Now I just need to find somewhere to get my hair carefully disheveled...

Go the F**k home

Great video here:




This will probably be useful to 98% of the doctors working in the NHS today.

Pension Tension

The BMA have come up with something useful.

Doctors interested in finding out exactly how much the government are screwing them for can check here:

http://pensiontension.co.uk/

Work harder!

I support the principle of hospitals being fully functional 7 days a week:  

http://www.telegraph.co.uk/health/healthnews/9146044/Hospitals-should-operate-seven-days-a-week-NHS-top-doctor.html

However, it will be interesting to see what (if any) financial compensation is offered to staff for this, given that it is not what the majority of NHS staff thought they were signing up to when they were considering their career options at age 17.  I imagine, as usual, clinical staff will roll over and have their bellies tickled without putting up much in the way of negotiation.

I have no doubt that the various tiers of NHS management staff will not be asked to work on weekends.  It will also be interesting to review the working patterns of those in the establishment who are advocating such a change to working patterns - will they be coming in to their offices on weekends too?  

Money money money

I have recently calculated that, since graduating, I have spent just under £24,000 on postgraduate courses, exams and various other fees.  Obviously my earnings since then have covered this, and I will be able to claim a small proportion of it back, but it would probably be fairer to all concerned to make these costs clear to those thinking of a career in medicine at the outset.  

I'd hope this wouldn't put people off, and I certainly don't regret any of my career decisions, but now that students have to pay £5000-£10000 per year just to go to university in England it may be a factor worth considering.  Particularly as pay in the NHS is being frozen for several years, pension contributions are being hiked up and pension entitlements are being slashed.  Combined with the new lack of job security, the botched NHS reforms and the progressive deterioration in training standards it is an interesting time all round...

Climbing back up the curve

I am busy. VERY busy.  A combination of assignments to write, a career to develop, clinical and managerial duties to fulfil, deadlines to meet, and various fantastic events in my personal life have all coalesced into one big "to-do" list.  Normally I work well under pressure (in fact sometimes that is the only way I can work), but I am concerned that at the moment I am drifting:

The Yerkes-Dodson curve

The graph above summarises my predicament very accurately.  If given a single project, I can leave it until the last possible minute and then work really intensely to produce something which is not only satisfactory but often of very high quality.  This seems to be because I need the "arousal" induced by an impending deadline in order to perform at my best.  This is clearly a result of self-conditioning over the last 20 years.  

The problem arises when I am confronted with many such deadlines (or one deadline for a very complex project) at the same time - my arousal level increases but I can't continue to increase my performance.  What then happens is I end up procrastinating and not actually getting any work done.  

How do I climb back up the curve?

I have several (4 to be precise) assignments, all due in ASAP.  3 of them are already very late.  The only way I can manage is to be confronted by a series of micro-deadlines, each of which massively increases my stress/arousal and gives me just enough of a performance boost to get each project done.  I therefore propose a series of micro-deadlines this week, beginning tonight:

Essay 1 to be completed before I sleep tonight (Monday).

Essay 2 to be started on Tuesday night (late as I have a full day of more interesting things planned tomorrow which is likely to involve at least half a bottle of wine) and completed by Thursday night. 

Essay 3 to be started on Friday morning and then put on hold on Friday evening, with a view to resuming on Sunday night to complete it (I will not let it get in the way of existing weekend plans to see family/friends).

Essay 4 (the BIG and final one) to be commenced on 4.4.11 and completed by 10.4.11 at the latest.

Then I'll be able to enjoy my 2 week holiday, and buy an iPad 2 when I get back as my reward.

Yuk

By way of further work-avoidance, I have been trawling the BBC news website looking for ways to keep myself distracted.

I came across this story whilst having a late-night snack and it nearly made me retch.  I'll let it speak for itself:

ICE-CREAM VIDEO

Structured procrastination

This is a superb article:

http://www.structuredprocrastination.com/

I read it, of course, instead of starting work on my latest assignment which is well overdue.  Then to put that off even further, I decided to write about it on my blog. This all comes after tidying my desk, cleaning the kitchen, cooking dinner, selecting the correct music to "work" to, organising all my belongings for tomorrow, etc.  It is now midnight.  I feel the need for an all-nighter coming on.

Just read my last blog post.  I've come full circle. Again.

Tick tock

It's 1am on Friday morning and I am rapidly approaching some more deadlines. 

Here's my plan for Friday/Saturday/Sunday/Monday:

01:30 - 08:00 Write a structured essay (3000 words)

09:00 - 17:00 Normal day at work
17:00 - 23:00 Get caned (drinks after work)
23:30 - 11:00 Sleep/coma
11:30 - 23:00 Start 2nd essay (6000 words)
23:30 - 10:00 Sleep
11:00 - 23:00 Continue essay
23:00 - 09:00 Sleep
10:00 - 23:00 Finish 2nd essay
23:01 Pass out

An open letter to the Pope










I've added my signature to this letter published in the Guardian last week:

We, the undersigned, share the view that Pope Ratzinger should not be given the honour of a state visit to this country. We believe that the pope, as a citizen of Europe and the leader of a religion with many adherents in the UK, is of course free to enter and tour our country. However, as well as a religious leader, the pope is a head of state, and the state and organisation of which he is head has been responsible for:

• Opposing the distribution of condoms and so increasing large families in poor countries and the spread of Aids.
• Promoting segregated education 
• Denying abortion to even the most vulnerable women.
• Opposing equal rights for lesbians, gay, bisexual and transgender people.
• Failing to address the many cases of abuse of children within its own organisation.

The state of which the pope is head has also resisted signing many major human rights treaties and has formed its own treaties ("concordats") with many states which negatively affect the human rights of citizens of those states. In any case, we reject the masquerading of the Holy See as a state and the pope as a head of state as merely a convenient fiction to amplify the international influence of the Vatican.

Stephen Fry, Professor Richard Dawkins, Professor Susan Blackmore, Terry Pratchett, Philip Pullman, Ed Byrne, Baroness Blackstone, Ken Follett, Professor AC Grayling, Stewart Lee, Baroness Massey, Claire Rayner, Adele Anderson, John Austin MP, Lord Avebury, Sian Berry, Professor Simon Blackburn, Sir David Blatherwick, Sir Tom Blundell, Dr Helena Cronin, Dylan Evans, Hermione Eyre, Lord Foulkes, Professor Chris French, Natalie Haynes, Johann Hari, Jon Holmes, Lord Hughes, Robin Ince, Dr Michael Irwin, Professor Steve Jones, Sir Harold Kroto, Professor John Lee, Zoe Margolis, Jonathan Meades, Sir Jonathan Miller, Diane Munday, Maryam Namazie, David Nobbs, Professor Richard Norman, Lord O'Neill, Simon Price, Paul Rose, Martin Rowson, Michael Rubenstein, Joan Smith, Dr Harry Stopes-Roe, Professor Raymond Tallis, Lord Taverne, Peter Tatchell, Baroness Turner, Professor Lord Wedderburn of Charlton QC FBA, Ann Marie Waters, Professor Wolpert, Jane Wynne Willson, Dr Vegas

In addition, this is what one of his henchmen, Cardinal Kasper, said recently:

"When you arrive at Heathrow you think at times that you’ve landed in a Third World country.”

The Vatican’s senior spokesman, Father Federico Lombardi, said he was simply commenting on Britain’s cultural diversity.

A drop in the bloody ocean?

This is what the people on the Faroe Islands do to whales

The world is a pretty fucked up place and most indicators suggest things are gradually going to get worse.  With this in mind, I have finally donated a few hundred quid to some charities. I've been thinking about these three issues for varying lengths of time, and felt it was time to do something about it.  I'm not telling people about this to make myself feel righteous and generous, but rather to try and raise awareness of these charities.  Since I'm anonymous on here I thought I might as well.  I'm not trying to preach at you to donate, but here are the links in case you are interested:

Clearing mines that have been laid by various governments:   http://www.maginternational.org/about/

Pakistan flood victims:  http://www.dec.org.uk/item/200

Stop the idiots that kill whales:  http://www.campaign-whale.org/faroes-whale-killings-condemned

Anyone fancy a holiday to the Faroe Islands now?

3 days of admin - woo hoo!

I missed out on a stag/paintballing weekend this week as I was feeling a bit ill. Although I'm disappointed I couldn't make it, this has turned out to be a fairly productive few days.  There are some major changes coming up in the next few months for me, all positive hopefully.  These changes will involve lots of preparation.  With that in mind, I have caned through a variety of outstanding admin tasks.  I have managed to squeeze in a couple of films and a new PS3 game of course.  Feeling generally productive and well enough to get stuck back into work tomorrow.  And there are a few beers scheduled tomorrow evening too which should be fun.

As usual, I have worked my through through all of the easy menial tasks and am left with the most important ones i.e. the ones I have been putting off for months.  And needless to say, the kitchen and my desk are well and truly cleared.  This is the classic work-avoidance strategy I'm sure many of you use as well. Better keep going with the list of jobs... One day I will achieve my aim:

A new treatment guideline

It seems that all medical and surgical specialties have their own protocols and algorithms for various situations, ranging from how to prevent DVTs through to stroke thrombolysis.  I am fortunate to be able to adopt a flexible approach to guidelines where I work, and use a lot of medications outside the box.  I enjoy the freedom this brings and it is an "art" as well as a "science".

Saying that, there is one flow-chart that I have recently found which could be extremely useful in an emergency:

I'm going to try this at work tomorrow, as long as I can find a suitable dog to pose with.

August already?

This year is flying by.  Fortunately it's been action-packed, with loads of cool holidays, a near-death mystery illness and an upcoming promotion (with some more travelling in between hopefully).  I still have an immense amount of work/assignments/reading to do in my 'personal' time, but most of it is self-inflicted with a view to improving my chances of getting a decent job at the end of my training.

No more major holidays, so better knuckle down for a few weeks and try and sort my career/life out.  Can't help looking lovingly at the PS3 in the next room though - not good news for someone with an addictive personality....

http://www.neoseeker.com/news/6555-gaming-can-kill-you/

As always, I'll attempt to post slightly more regularly from now on if I have anything interesting to say. Unless I die after a prolonged binge on the PS3.

A New Year. The same person.

Despite it being a new year and a 'fresh start' with the usual bunch of resolutions, some things never change.  One of those things is my tendency to leave all assignments until the last possible minute.  I don't just mean the day before.  I mean taking revision notes to the door of the exam hall with me, and staying up all night every time I have an essay to hand in.  This is not healthly behaviour, but the problem is that it works consistently with good results, so like Pavlov's dog I am conditioned to this.  I am able to minimise the time spent on assignments because I "know" that by simply doing nothing until the final week before any given deadline I can pick up a piece of work and cane it until it's done.  The difficulty is balancing this with my perfectionist tendencies - I somehow end up trying to perfect a piece of work that I have only allocated 10-20% of the available time to concentrate on.  This working pattern also gets much harder as I get older as I can't routinely stay up all night on willpower alone.  Coffee somehow makes me sleepy rather than alert and caffeine supplements like Pro-Plus (do they still make that these days?) don't touch me.  Oh, and of course I now have a demanding job to go to in the morning which is slightly different to being at university when you could realistically miss 50% of all the lectures and still pass provided you knew how to revise effectively.

Anyway, now is not the time to change the working habit of a lifetime.  Despite starting this project almost a year ago (or at least beginning to think about it), I remember adding a note to my calendar at that time for the day before the deadline (which is this week): "stay up all night to finish project".  I was never really going to work consistently on this project.  Instead, I had lots of fun last year, worked really hard when necessary, and left this project until the last possible minute.  And if I pass, I'll do everything exactly the same next time.

Temptation? Jesus had it easy.

Jesus spent forty days and forty nights in the desert. Big deal. I've got a massive project to complete in under two weeks and have just been given a 250Gb PlayStation 3 for Christmas with FIFA 2010, Assassin's Creed and Uncharted 2.

THAT is temptation.

Still got it

Nice to know I can still pull an all-nighter out of the bag when I need to.  I've been awake for about 40 hours now, having stayed up all night to finish an essay.  I handed it in this morning, then completed a full day at work, then got home and worked on my research project.  And then I caned the computer at chess on the hardest difficulty level:

GAMES
(caution - don't click this link unless you want to waste the next hour of your life)

I think I've managed to push on through the sleep barrier now so will probably be up for a few more hours. Better get on with some more work.  One project down, two more to go....

The world's favourite airline? Not any more

British Airways staff at work earlier this week

One of my patients has a few weeks left to live. He lives locally, about 20 minutes from where I work, and wants to get home next week to spend his final Christmas at home. He can only do this if his extended family can fly in from abroad to help care for him.

His family live in a country from which the majority of flights to the UK are run by British Airways (BA).  Since the threatened strike by the BA cabin crew which was due to ground all BA flights over the 12 day Christmas period, his family have been unable to get tickets for a flight as all the non-BA flights have been booked up already.

Even though tonight the strike is apparently being called off because it is illegal, it is too late for his family to get flight tickets and visas organised to get over here before Christmas.  In any case, all the confusion has caused ticket prices to rocket to nearly £2000 per person so the family would have to take out a loan to afford them (and they would be willing to do this if only there were tickets available).

As a result of all of this, the patient won't get home next week and will spend his final Christmas with us. He may die before his family arrive, and even if they get here in time he may be too unwell to return home.

I hope Lizanne Malone reads this blog and cries herself to sleep.

Have I got the X-Factor? No.

The new X-Factor song (which will hopefully be beaten to the Christmas number one slot by the Rage against the Machine campaign) is called "The Climb".

Not a bad tune, but I disagree with the lyrics.  To summarise, it essentially states that it is not your achievements that should be celebrated but rather the process of attempting to achieve them.  It doesn't matter what the end result is.

Bollocks.

This week I want to "achieve" writing a 5000 word assignment from start to finish in 5 days.  The "climb" will be a tedious, draining, exhausting process and the only motivation that keeps me going is the reward of finishing it.


Killing in the name of.....work.

Going for a hat-trick

Michael Owen is roughly the same age as me. He has been written off several times, but tonight he scored a hat-trick and walked off with the match ball. 

I've got three urgent project deadlines, all due at various stages within the next four weeks.  I haven't been written off just yet, but it is getting bloody hard to do a full day's work and then come home every night to work on essays/revision/research/whatever.  So I need a hat-trick of my own.  The deadlines are 1) this week, 2) next week and 3) in four weeks. 

If I get all three of these projects done there is no match ball for me to keep, but I will be able to get back to enjoying my "spare" time again. Roll on 2010.

Hedonism (just because you want ethical approval)

I've waited 5 months for ethical approval for my research project.

That leaves 2 weeks to do the actual research and 2 weeks to write it all up (15000 words required). There is also a 5000 word essay that needs writing in the next 3 weeks. As well as a small IT project I've been asked to help with. And a 50 hour a week job.

I saw Skunk Anansie last week. They were excellent. I've waited ten years to see them play. I think one of their songs was written about the Research Ethics Committee that dealt with my project:

I hope you're feeling happy now

I see you feel no pain at all it seems

I wonder what you're doin' now

I wonder if you think of me at all

Do you still play the same moves now

Or are those special moods

For someone else

I hope you're feeling happy now

Just because you feel good

Doesn't make it right, oh no

Acceptance

Over the last few years I think I have arrived at many conclusions about the state of the NHS. The juniors become less skilled each year, the seniors become more stressed and frustrated each year, and the day-to-day challenges remain the same. The BMA remains useless, the GMC is worse than useless, and doctors are either too fatigued or too self-interested as a group to change the system.

What has evolved and changed, though, is my ability to work in this system. I have realised that making small (achievable) changes that have a direct impact on the care of my patients is extremely satisfying and acts as a buffer between the hopeless inadequacies of the system and my mental well-being.

When David Cameron is elected next year we will inevitably move towards a more privatised system. Whether this is right or wrong will undoubtedly provoke a healthy debate. Do I think healthcare should be a basic right for all UK citizens? Yes. Do I think people should have to pay a small fee to see their GP? Yes. Do I think people should have to pay a small fee to attend A+E? Yes. Should IVF be free on the NHS? No. Should the NHS have to pay for all new treatments for all patients with cancer, whatever the cost? Pass. It's clearly a complex issue. I can't wait for the new Secretary of State for Health to come up with a barrage of white papers and a multitude of changes just to stamp their individuality on the post. In the meantime, we'll all just get on with it.

Ambivalence

So much for my "return"! It's been 3 months since I dipped my toe back in the blogging water. To be honest I'm struggling to find a reason to blog these days. Sure, there are a multitude of reasons to moan and complain, but ultimately I've reached the conclusion (rightly or wrongly) that the only solution is either to 1) join the BMA/GMC/Remedy/etc and try and change the world (whilst your tongue is halfway up someone else's arse) or 2) just get on with your own job, make your own department as pleasant and efficient as possible, and then retire and get the hell out of the NHS.

I'll try not to leave it 3 months until the next post...

Back from the shadows

Following a nudge from Calavera, I've decided to return following a prolonged break from blogging. There is plenty out there pissing me off....

Let's start with Bacon.

A new website has been set up that allows patients/stalkers/disgruntled colleagues/any old lunatic to write anything they want about individual doctors. The doctors themselves have no power to reply or edit any of the comments.

There is no doubt that appraisal is key to maintaining good medical practice. However, there are already a multitude of ways to ensure that this occurs. I presume that Dr Bacon has had his head stuck in a trough feeding on self-publicity for so long that he hasn't heard of multi-source feedback.

My only source of hope is that someone sues this self-appointed GMC-wannabe for libel before his website ruins someone's career. Funnily enough I couldn't find Neil Bacon on the list of doctors that have been reviewed so far. It would be a shame if people started leaving anonymous comments questioning his clinical acumen/ethical values/sexual orientation/ appearance/smell/etc. His new system is clearly open to abuse.

If you are concerned about this new development, please go and support this site.

I don't want your "great care" Dr Bacon. I just want colleagues who won't stab me in the back. The GMC and BMA do enough of that already. Oink Oink.

Adios

Since this blog started 2 years ago, I have derived immeasurable benefit from it during times of stress, worry and anger. Simply typing and releasing my thoughts was therapeutic, but the real worth was provided by the comments you left along the way. Thank you to everyone who has contributed during that time, either anonymously or otherwise.

Looking through some of my previous posts reminds me of some of the darker days during my career as a junior doctor. I still think the NHS is full of flaws, and if anyone asks me whether I would recommend becoming a doctor my answer will be no. I have nothing but contempt for the BMA and the GMC and remain frustrated that doctors are not allowed to work in decent and fair conditions.

Despite all that, I have been fortunate enough to find a speciality within medicine that I enjoy immensely, and am progressing well in my career amongst colleagues whom I admire greatly. My job is hugely satisfying both spiritually and psychologically, and since it does not present any major stresses or sources of angst for me I feel that my creative drive to write a blog has been removed. It is for this reason that I am drawing a close to Nip/Fuct. There are plenty of good blogs out there that I will continue to dip in to, and should the need arise I will chip in with my opinions.

Thank you all for your help in my journey towards job and life satisfaction - mission accomplished!

Organs wanted

There's been some (not enough) talk in the news recently about proposals for making organ donation in the UK an 'opt-out' system. This makes clear sense to me for several obvious reasons. You can register on-line at this excellent website (link)and obtain all the information you may need before making a decision.

How the NHS works

When a panel of doctors was asked to vote on adding a new wing to their hospital, the Allergists voted to scratch it and the Dermatologists advised no rash moves. The Gastroenterologists had a gut feeling about it, but the Neurologists thought the administration had a lot of nerve, and the Obstetricians stated they were all laboring under a misconception. The Ophthalmologists considered the idea shortsighted, the Pathologists each yelled "Over my dead body" while the Pediatricians said "Grow up!" The Psychiatrists thought the whole idea was madness, the Surgeons decided to wash their hands of the whole thing and the Radiologists could see right through it. The Physicians thought it was a bitter pill to swallow and the Plastic Surgeons said "This puts a whole new face on the matter." The Podiatrists thought it was a step forward, but the Urologists felt the scheme wouldn't hold water. The Anaesthetists thought the whole idea was a gas and the Cardiologists didn't have the heart to say no. The dentists clenched their teeth and showed their disapproval. In the end, the Proctologists left the decision up to some asshole in administration.

2012

Hi everyone. I've haven't had much time to blog recently - been contemplating the Hoff's demise (see last post) and life in general. Work is busy but still really rewarding.

The NHS/prisons/schools are in crisis, desperate for more resources, so what have the government done to address this? They have spent £450,000 paying someone to design a logo for 2012 that looks like Maggie Simpson buggering a small boy....

Good luck to everyone caught up in the MTAS/MMC whirlpool. For those of you that have been fortunate enough to be offered jobs for August, you should hand in your one month's notice now and get yourself off to a beach somewhere to chill out before then. Let's see how Mrs Hewitt sorts out 3 weeks without any junior doctors in the UK.

Oh my God

The Lost Doctor sent me an e-mail recently. I clicked on the link and was shocked to see The Hoff, off his face, filmed by his own daughter. I have never seen such a tragic fall from grace:

The Hoff drunk

I will never drink an excessive amount of alcohol again.

Facebook deactivated

I have deactivated my Facebook account (see post and comments below).

Facebook : Big brother?

Does anyone else have any concers about Facebook? I've immersed myself in it like everyone else, filling in all the sections and linking to all my friends. Last night, however, I had this vision of Mr Facebook sitting in a big swivel-chair stroking his furry white cat, and on the table in front of him was a huge spider-diagram inter-linking all of us - where we met, what our hobbies are, who our partners are, what our jobs are, the books we read, the music we listen to, our e-mail addresses, pictures of us, etc.

This information is boring and useless on its own, but link it all together and you could map out a whole society on your desk.

What if Mr Facebook gets a call from the FBI ordering him to relinquish information for the 'greater good'? What if your mortgage/insurance company gets access to see who your friends are and what kind of lifestyle you lead? What if someone hacks in and steals the information? Would your boss be interested to know what you do in your spare time? At the very least expect to be bombarded with e-mails which 'may be of interest'.


The more I type the deeper this could go. Better stop now and watch the snooker on TV instead.

Time to pick up the pace

Sorry for the gap - have been enjoying myself away on holiday. Back at work, enjoying it, and have found plenty of opportunities for mental stimulation which should keep my fire burning for the next few years at least. I've realised the importance of having a varied job to avoid burning out or simply getting bored. In my case, that will involve taking on a Masters degree next year, getting involved in audits (!) and stretching myself slightly more than I was planning to. I can only sustain this if I continue to enjoy my job as much as I do right now.

As well as striving to be a good doctor with a rewarding job, I'd also like to get rich. To this end, I am considering my first foray into the property market. I may end up living in a shoe-box, but I can't stomach the idea of paying someone else rent money any longer. More news to follow later in the year on that one. I just wish it was cheaper!

The ship is sinking and I don't care

Flicking through the blog today, I realised that I haven't moaned about my job since September 24th 2006. Sure, the NHS as a whole is going down the pan and is run by a bunch of incompetent lemons, but I've been lucky enough to find my own corner of it which I really enjoy. If the ship is sinking, either get off and swim (to Australia? to work in the city? to go into Public Health?) or find a nice cabin, open up a bottle of port and make sure you enjoy the ride. Captain Hewitt certainly is.

March 17/3/07

Great turnout for the MARCH on Saturday. I was pleased to see so many doctors uniting in protest against the shambles that is MMC/MTAS. I was delighted to be wrong in assuming that the only a few hundred of us would show up. It was a pleasure marching alongside Dr D&C, Layla and many of my anonymous blogging colleagues. Having spent the previous night getting caned with a Welsh dragon, D&C and I were particularly tired but after a strong coffee we were on our way. Here’s a video I shot at some point:

Unfortunately the event has been hijacked by David ‘son-of-Tony’ Cameron and his image consultants, but without him I fear the media coverage would have been minimal.

We await the outcome of the government’s review into the whole mess. We also await the emergence of Patricia Hewitt from under her rock so we can get rid of her once and for all - click here for some ideas on how we could do it.

Patricia Hewitt pictured on the march

Nice of the BMA to put their logo on a few placards and 'support' the march. If only they had been kind enough to support us over the last 3 years whilst we have been waiting for MMC/MTAS to be thrust upon us. If they had organised a march themselves LAST YEAR instead of simply jumping on Remedy UK’s bandwagon then something might actually have been done. Still, I’m sure they enjoyed all their committee meetings and canapés. I’ve decided to calculate how much money I haven’t paid the BMA in subscriptions over the last few years and donate it all to Remedy UK.

I still think the only way to get anything done now is for junior doctors (and ideally senior ones as well) to STRIKE. CLICK HERE FOR A GUIDE. That isn’t going to happen though. I am Dr Vegas’ apathy.

Confessions of the rich and famous

Ever wondered if the people who run the NHS are good clinicians or simply good at sucking?

Go to this link, print it out / read pages 9-22.

The Chairman of the BMA, pictured earlier today

These people are in charge. No wonder we have ended up with MTAS/MMC.

A restless soul

An interesting thing happened this week. I've had some time off. Now that I really enjoy my job, I've been struggling to entertain myself when I'm not doing it. None of my medical friends have been able to join me for a holiday due to interviews/exams/working nights, and my non-medical friends are all tied up with other plans. I have done the travelling-on-my-own thing before, and find it a bit boring. I ventured home and then to London briefly, but am now back home chilling out with a glass of Ribena and listening to some great music. Life is good. Funny how society pressures us into thinking we have to jet off/catch Eurostar/book a hotel every time we have more than a day off work.

(you can print this picture out and colour it in yourself)

Meanwhile the MMC train rumbles on with Colonel Hewitt at the helm. One of the NHS soldiers on the front line recently joined the blogging community again - welcome Layla. She, along with thousands of other doctors, are continuing to deliver outstanding healthcare even in the current climate of uncertainty. Dr Crippen, Remedy UK and many others are providing extra support. It's incredible that doctors are now looking to David Cameron for support! The government is killing itself day by day. They have at least responded to the matter - click here for the DoH statement.

STRIKE

The new MMC/MTAS application system for doctors is a disgrace.

• The whole administrative process is a shambles
• Talented doctors are being overlooked and not shortlisted
• The application form is a creative writing exercise rather than an accurate discriminatory tool
• Doctors are being offered interviews for jobs they haven't even applied to
• One deanery has allegedly not even bothered to look at half the applications it received as it was overwhemed by the volume

Please see this picture for an excellent summary of MMC courtesy of Dr Rant (enlarge it, print it out and pin it up in your mess at work).

It is all an exercise in reform for reform's sake. In 5-6 years we will have a bunch of sub-specialist senior doctors (who won't be allowed to call themselves Consultants) who will be inadequately trained to cope with the demands of their job. Patient care will suffer as a result. In the meantime, hundreds if not thousands of doctors and their families will be completely trampled upon for the sake of Patricia Hewitt's statistics. Who can we call upon for support? Step forward the BMA and the GMC.

The BMA is a useless self-serving organisation. All they do is offer discounted car insurance and a few publications every few months. It is a toothless entity which has neither the courage nor the capacity to stand up to these changes that are opposed by every single doctor I know. That is why I left the BMA several years ago. A decent trade union would have organized a ballot and strike many months ago.

The General Medical Council exist purely for the sake of drinking champagne and slapping each other on the back. All they do for doctors is charge them extortionate fees every year (which I cannot opt out of) and then strike them off when they see fit. Interestingly all GMC employees get private health cover...

I am not directly affected by the current shambolic process but many people I hold dear to me are. I would fully support a national strike by doctors with a view to overhauling the current mess. The problem is that there is no unifying voice within the medical profession calling for one. It may be time for doctors to stand up and look the enemy in the eye and force her to resign as soon as possible. There is a PROTEST MARCH scheduled in London on 17/3/7 - beyond that I would welcome suggestions/plans that may help. THE WORK BEING UNDERTAKEN BY REMEDY UK HAS MY FULL SUPPORT.

I have tried to write an emotionally balanced post in the context of a highly-charged situation. Enough is enough. My heart goes out to the many doctors who feel aggrieved right now - I have faith that things will work out for most people, but perhaps it is time for doctors to stop lying down and taking everything that is dished out to them.

Hugs and kisses

In the last couple of weeks I have been hugged three times: by one of my patients (who has terminal cancer), a relative of a different patient (who will almost certainly die this week) and a friend of another patient (who died last week). All this because they are grateful for the job my colleagues and I are doing. I leave work every day feeling full of energy and keen to squeeze every drop out of my own life. I aspire to be as courageous as the people I look after.

What a fantastic job this is! I had no idea things were going to turn out this way but I am very glad they have. My colleagues appreciate me, my patients appreciate me and I am full of admiration for all of them as they fight their individual battles. At the moment the grass is greener on my side of the fence. Long may it continue.

Dreams

My job frequently involves dealing with people who are dying or contemplating their own death. I've been intrigued by some of the discussions I've had with patients about their dreams. One guy explained to me how he dreamt he was climbing over a staircase bannister and each night he'd dream that the bannister was falling further and further away from the staircase. Other patients have had much more terrifying dreams about dying or even about themselves stabbing or shooting people they love.

Do these dreams correlate with their own dying process? Does the staircase represent that person's life that he is gradually losing grip on? Or is trying to interpret dreams this way a load of pretentious rubbish?

Personally I think that dreams are they way in which our subconscious mind deals with issues that we find too distressing to think about with our conscious mind (i.e. when we are awake). For example, imagine someone being told they have terminal cancer. If that person has problems accepting the fact that their lifespan is drastically limited, or if they feel unable to talk about it, they might have very vivid dreams and even nightmares in an effort to process that information.

I saw a lady the other day who had woken in floods of tears as she had had such a nightmare overnight. She felt and saw her own death in such vivid detail that even when she woke she thought she was actually dead. Once I explained what I thought the dream might be based on, she seemed to agree and we ended the conversation with her hugging me and smiling. Once she realised that she wasn't actually dead, she felt really positive and we made a list of all the important things she wanted to do and made sure she arranged to do them that day or the next day rather than putting them off. Dealing with death or the potential of dying has a wonderful way of polarising what is important and what is not.

Motivated by a smile

One of my patients is in her mid-40s and has a son who is not yet a teenager. A couple of months ago, having never had any serious medical issues, she was diagnosed as having extensive cancer and was told she only has months left to live.

Her courage and smile inspire me to be good at my job.

Job satisfaction AND life satisfaction

Hi. Sorry for the gap in posts. Have undergone some major life re-shuffles (none of which have involved gambling thankfully) and am now settled.

Have changed towns, been promoted (but no pay rise!), changed speciality and moved in with my girlfriend after 2 years of literally travelling all over the world to see her. Add to that my usual affliction with Seasonal Affective Disorder (SAD) and you can understand that it has been eventful to say the least. But now everything is calm and more importantly everything is good.

I am now enjoying my job. It's not quite better than not being at work but I do genuinely look forward to going in now every day which is a complete contrast to last year. What a difference a year (and some exams and lots of helpful advice and finally a bit of a gamble) makes.

I have even contemplated stopping the blog as I feel I have lost my creative (albeit negative) drive. But then I thought that perhaps now things are going well I could provide some light-hearted relief to all the negativity surrounding the NHS. Yes, it is still a crap organization in comparison to many others, and yes I probably won't be paid this month due to a Human Resources faux pas, but now that I'm working with genuinely nice people who will let me finish early if I need to drive home for Xmas/see a GP/go to the bank (hey - that sounds remarkably like a normal job at last!) I might be able to offer some hope. So I don't mind working on New Year's Eve this year. You see - if employees are treated well they will respond and respond with a smile on their face.

In terms of the gambling discussed on my previous post, I have spent some time reading and watching poker and decided to put it on the back burner for now. The Venial Sinner is right - I have already spent a few thousand quid handing money over to a faceless organization (the Royal College of Physicians) for a few hours of enjoyment (the bit between getting my results and waking up the next day with a hangover).

It's been just over a year on this blog, and I would like to thank the Lost Doctor for showing me the blogging light. I hope his blog provides as much help to him as this one does for me.

Season's greetings to you all, and hope 2007 is a great year for everyone reading this.

Not addicted?

Gambling is something I enjoy. A lot.

In 2002, whilst a student, I went to Las Vegas on my 22nd birthday and gambled for the first time. After four days I came out $100 on top, and walked out of the casinos after 4 days a very happy boy.

In 2004, as a doctor, I returned to Vegas. This time I lost $2000 over four days but made $2500 back, a nice profit of $500.

Both trips to Vegas have involved blackjack. Then I started reading about poker. The idea of winning money from other people seems much more attractive than taking a few dollars from a casino dealer who doesn't care either way (in fact, most dealers in Vegas help you if you tip regularly).

I've been to casinos outside Vegas but have left quickly as I told myself the way to contain my potential addiction would be to only gamble in Las Vegas and nowhere else.

I have always had the idea of going back there with $5000 to gamble. Luckily no-one I know has been stupid enough to join me yet. As I get older and priorities start to change, I've been thinking about spending that money on a house/car/etc. Although given that I have gradually saved the $5000 with the aim of gambling it, knowing full well I may lose it all over 3-4 days (but have a bloody good time doing it) is it really that harmful? I don't smoke or do drugs, I don't drink much (most of the time) and have no other real vices. So maybe it's OK to save a few thousand dollars over 2-3 years and then blow it in a week if I enjoy it and don't mind losing it? It is my money and I have worked hard to get it. But then does that make me even more stupid if I gamble it?

Today I had a day off work and was very bored at home. I played on-line poker for the first time. I invested $200 and they gave me an extra $50 as a way of saying 'hello'. Three hours later I had lost the lot, but had enjoyed playing.

So what next? I am tempted to put in another $200 and try to get my money back. I will be annoyed if I lose that money as well, but it won't be the end of the world. But this is how gambling problems start. The only way to control this is to set myself rules i.e. only gamble in Las Vegas, only gamble once a year, only gamble in real casinos, etc. Otherwise it will get out of hand.

That leads me to question why I enjoy gambling. Part of it might be because I am lazy and enjoy getting money without having to work for it, but that isn't the only reason. I get a buzz from playing with money that I can only just afford to lose. That's why I only gambled $100 as a student but then $2000 as a doctor. If it was the game itself that I enjoyed (poker, blackjack, whatever) I would be happy playing for pennies.

I have 2 golden rules when gambling:
1) When you lose, have the cahunas to put more money in and stay in the game
2) When you are up and have reached your pre-determined target, walk away

It is hard to pluck up the courage to put more money into a losing situation, and it is even harder to walk away from a winning situation. If I want to win $200 back now, I'm going to have to go back in with around $500 to give myself a good chance.

I just found this on the internet and it is very worrying indeed:

Robert Custer identified the progression of gambling addiction as including three phases:

During the winning phase, gamblers experience a big win ­ or a series of wins ­ that leaves them with unreasonable optimism that their winning will continue. This leads them to feel great excitement when gambling, and they begin increasing the amounts of their bets.

During the losing phase, gamblers often begin bragging about wins they've had, start gambling alone, think more about gambling and borrow money ­ legally or illegally. They start lying to family and friends and become more irritable and withdrawn. Their home life becomes more unhappy, and they are unable to pay off debts. They begin to "chase" their losses, believing they must return as soon as possible to win back their losses.

During the desperation phase, there is a marked increase in the time spent gambling. This is accompanied by remorse, blaming others and alienating family and friends. Eventually, the gamblers may engage in illegal acts to finance their gambling. They may experience hopelessness, suicidal thoughts and attempts, arrests, divorce, alcohol and/or other drug abuse, or an emotional breakdown.

My gambling experiences so far have exhibited many of the features of the winning and then today the losing phase. If I sign back in to the on-line poker room will I officially be addicted? Where is the distinction between an expensive hobby and an addiction?

A change would do you good

As promised, time for some changes. I've been promoted, I'm relocating south and I am much happier with life now that I have resigned from my current job.

It's difficult to go into details about what I'm going to be doing given that there are certain colleagues who would love to 'out' me to the nearest Consultant. Unfortunately the NHS is not yet as open as it may hopefully be in the future. Put simply, I've found a job:
a) I will enjoy and find rewarding for most of the time
b) The other members of staff I will be working with will be normal people
c) I will have a reasonable lifestyle outside of work
d) Is not General Practice, for those who may be wondering
e) (importantly) I will be able to make a unique contribution and not be just another monkey performing the same tricks as everyone else
f) avoids the MMC rubbish next year
g) allows me to move so I can be closer to loved ones

Is this the utopia I craved in my posts previously? Has Dr Vegas found the road to job satisfaction and life satisfaction? That remains to be seen. It is a step in the right direction though. And it may allow Vegas, The Venial Sinner and The Lost Doctor to have a few pints in the same pub together and incite the riot that will signal the downfall of Mrs Hewitt.

A good night at the office

I have just downloaded Mozilla Firefox and now I can update the blog from home. At last! For some reason Internet Explorer hasn't allowed me to do this. In any case, it's taken me a while to think of something to write that could follow on from the picture posted on my last entry.

On a week of nights. Going OK so far. I diagnosed a guy with Wegener's granulomatosis the other day which was cool (not for him). It's very rare and knowing what is wrong with this guy will save his life (90% die if not treated). Friedrich Wegener was a German pathologist who was working in Breslau when he described the condition. Dr Vegas is a British SHO working a week of nights in the UK when he recognised it. It is one of the rare occasions in medicine when I haven't just felt like another cog in the NHS machine. I'm looking forward to going in and seeing how he is getting on now that he has been attacked by lots of specialist doctors who are no doubt slapping each other on the back and writing their case reports based on the work I did. Good luck to them.

In a previous post I moaned about all the gigs I had missed out on whilst revising for the exam in the summer. I managed to see the Goo Goo Dolls the other week and they were one of the best live acts I have seen for years. The support (The Tender Box) were also very good and I reckon they'll do well.

Have got a week off soon and will be staying in the UK (for a change). Even though the nights are going OK so far, they will hopefully be the last set I ever have to do. More on that to follow. I am even contemplating revealing my secret identity to some of my colleagues but as long as I can stay away from the Stella Artois I should be safe.

I bet The Hoff never had to work on Sundays

On call this weekend. Has been quiet so far. Was on call yesterday as well. Oh yes, I am also on call on Monday and on Tuesday. Then, having worked for 97 hours in 9 days, on Wednesday I have to do a case presentation to all the Consultants. Fun fun fun. To make up for all of this I will be having a weekend break in Europe next weekend to relax.

Not much else going on. Considering my next career move, but just like any good game of chess you have to always consider what your opponent (in this case the government, the Health Minister and my own hospital administration) is planning. The answer is that no-one knows. A fundamental reform of doctors' careers is taking place over the next 6-12 months and it is going to screw up the NHS even further. I only hope I can sort my life out before it takes me down with it....

A major decision next week will be whether or not to buy David Hasselhoff's autobiography now or wait for the price (18 quid!) to come down. What price a signed copy...? While I'm at it, please click on the link on the right of this page to cast your vote.

Do as I say...

A funny thing happened tonight at work. I admitted a lady who had chest pain because I was concerned she may have had a heart attack. She is obese and has a crap diet (her bedside cabinet was laden with Coke/sweets/crisps and she had only been in hospital for a few hours). Her blood glucose was high so she probably has diabetes. To test for this, you check a glucose level when the patient has been fasted. So I told her not to eat or drink anything for the next 8 hours before we did the blood test. She agreed, and I thought nothing more about it.

About an hour later, her daughter and son ushered me into the waiting area and informed me that they had three large pizzas and wanted to give some to me and the nursing staff. This has never happened before. It's not that I expect patients or their relatives to come bearing gifts to show their gratitude, but doctors rarely get more than a 'thank you' on the way out. So I was pretty happy to munch away at the Vegetarian Deluxe and Spicy Chicken (I shared it with some of the nurses of course - always good to keep them happy...).

Then I found myself wondering if the pizzas had been ordered with their mother in mind? Were they expecting her to eat one before I gave her the order to be 'Nil by Mouth'? Was I actually eating her share? Am I going to be as obese as she is? Will I be in a bed one day being told I am too fat by someone 40 years younger than me?

So I did the only reasonable thing - I finished the pizza and left the garlic bread for the nurses.