Men: desist from this thing immediately please

Men: desist from this thing immediately please

Imagine the scene, you’re sitting listening to a speaker opine on a topic and when they reach their concluding slide instead of a great slide summing up their message they have a picture of their children. Pause for us all to admire Thomas and Em’s extreme cuteness. Then they make some annoying reference to their progeny being way smarter than they are or some other shitey humble brag. 

A certain subset of men then make reference to their amazing wife (a stay at home mum) who keeps them in clean shirts and feeds everyone. I don’t know how she does it! 

I feel the more kids they have the more likely they are to mention it. 

Why do they do this? Women don’t. Is it to brag about their overall successfulness? “not only have I conducted a randomised controlled trial but I have fathered three children”? It’s vile. If I ever get to the point where I am important enough to be chairing meetings I’ll start telling the offenders that it is pathetic. 

Take the slide of your kids out. Don’t ever make reference to them again in a talk. Nobody cares about your children. 

Management miss the point (again)

Management miss the point (again)

I was saddened recently to hear of the death of Kate Grainger, a doctor in palliative care who was also a blogger and campaigner for improved communication in hospital. She left a wonderful legacy in the form of her “Hello my name is” campaign. This involves all medical, nursing and support staff trying harder to always introduce themselves to patients. Bighospital, like other hospitals have been quick to adopt this brilliant idea and have issued everyone with badges that instead of saying just “Mrs KBW” they say “Hello my name is Mrs KBW”.

Which is quite clearly NOT THE POINT!!!

I have by some miracle avoided this badge and continue to introduce myself and my boss and my team, no matter how fucked off they all get with me doing it 30 times on a ward round

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Beware the patient you don’t like

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He’s not on my ward, nor is he ( I imagine to our mutual happiness) darkening the door of my clinic. But if he was, I would not look forward to seeing him. 

Generally speaking, I like all of my patients and care deeply for their well being, I also get a lot of satisfaction from looking after them and making them feel cared for. Some of that caring is tied up in my responsibility for their well being, but I genuinely do care for them, 99.9% of them. Sometimes you get a patient that you don’t like. It doesn’t happen often and it usually doesn’t matter as the appointment or the consultation is over rapidly and forgotten quickly. It becomes more of a problem when you have an inpatient that you don’t like.

One of my great leaders (who is in fact married to a nurse) likes to say that if the nurses like you all the time then you aren’t doing a good job;  this is true, my recent frustration with a ward’s inability to record a daily running total of a fistula has meant I have had to “have a word”. I’m not here to be popular and many of my male colleagues are not popular at all or particularly liked, but they are respected and admired. This doesn’t work so well for me, or most women, and whilst I don’t require to be adored by all those I work with and operate on, I struggle to cope with people I dislike or dislike me.

Patients disliking me doesn’t cause me too much bother, I can hide behind extreme frosty professionalism and generally have the upper hand. Pissing off the nurses (rarely) or radiology (weekly) also doesn’t cause me too many problems. Patients that I don’t like cause me problems for many reasons mainly because I don’t want to go and see them, and when I see them I want it to be over quickly. These two things in combination are doubly dangerous and bad and lead to mistakes.

Having insight into this is something that they never teach you at medical school, they don’t even mention it. Beware the patient you don’t like; the man who makes lewd comments when you examine his abdomen, the racist patient who insulted your colleague, the patient who refuses to wash, the lazy one who won’t get out of bed, the angry man who isn’t coping with his diagnosis. They deserve the same service as the rest, maybe even a better service, because they are the ones where you will miss a problem or a complication.

You will fail to detect trouble in the earliest stages that in your pet patient you would have picked up 12 or 24 hours earlier. It might not affect the outcome but it will make you feel terrible and it doesn’t do your patient any good. So if you feel a heaviness in your heart when you see a dreaded name on your clinic or postpone and put off until last on your ward round the one you don’t like, put that feeling aside and go and see them.

The GMC has the following advice:

Establish and maintain partnerships with patients

You must be polite and considerate.

You must treat patients as individuals and respect their dignity and privacy.1

You must treat patients fairly and with respect whatever their life choices and beliefs.

You must treat information about patients as confidential. This includes after a patient has died.10

You must support patients in caring for themselves to empower them to improve and maintain their health. This may, for example, include:

    1. advising patients on the effects of their life choices and lifestyle on their health and well-being
    2. supporting patients to make lifestyle changes where appropriate.

     

    You must work in partnership with patients, sharing with them the information they will need to make decisions about their care,15 including:

     

    1.  their condition, its likely progression and the options for treatment, including associatedrisks and uncertainties
    2. the progress of their care, and your role and responsibilities in the team
    3. who is responsible for each aspect of patient care, and how information is shared within teams and among those who will be providing their care
    4. any other information patients need if they are asked to agree to be involved in teaching or research.9

    You must explain to patients if you have a conscientious objection to a particular procedure. You must tell them about their right to see another doctor and make sure they have enough information to exercise that right. In providing this information you must not imply or express disapproval of the patient’s lifestyle, choices or beliefs. If it is not practical for a patient to arrange to see another doctor, you must make sure that arrangements are made for another suitably qualified colleague to take over your role.17

     

    Show respect for patients

    1. You must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.12
    2. You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.17
    3. You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you should:
      1. put matters right (if that is possible)
      2. offer an apology
      3. explain fully and promptly what has happened and the likely short-term and long-term effects.

     

    There are very few problems that don’t seem better after you have done a ward round.

     

    The rules apply to everyone 

    The rules apply to everyone 

    This week the department of surgery in Bighospital has a celebrity patient of sorts, one of our own. When we have one of our own on the ward they are treated well, a side room, no idiots sent to do your bloods, no medical students darken your door, you even get to abuse visiting hours as everyone pops in to wish you a speedy recovery all day long. 

    There is even a sort of polite protocol; door open means visitors are welcome, door closed means they are not.

    Some rules can’t be changed though and our wonderful ward clerkess, the sort of woman who calls a spade a “fuckin’ shovel”, was taking no nonsense from one visitor who was sitting on our patients bed. 

    Sitting on a patient’s bed is a crime, it would result in an instant fail of our hygiene inspection if the infection  police saw it. (You can read my views on health and safety in the NHS here and here). 

    Our very important patient had a visitor who was sitting on the bed,  the clerkess walked past and saw the besuited back and regal head of this person. “Oi, you can’t sit on the bed”. Patient spluttered “Don’t you know who this is?”  gesturing to the visitor. With a broad smile the visitor inclined their head “I am the chief executive of this trust”. 

    Not missing a beat and certainly not impressed, the clerkess said “even worse, it’s your stupid rule. Now beat it”. 

    This story has gone across the floor and made us all laugh and elevated the ward clerkess to celebrity status. 

    The chief exec is just a colleague of this patient, can they imagine how wives and husbands and children of our patients must feel when we tell them to get off their loved ones bed. I hope our “leader” has taken the time to reflect on this, I suspect they have not.  

     

    BMJ Breastfeeding

    When you are breast feeding you get a little bit crazy, it’s the oxytocin rush and the subsequent addiction and the intense physical contact and the mad love you feel for these tiny people that you have made and are somehow growing bigger with milk from your breasts. It seems a miracle and it is, a wonderful lovely miracle. I slumped into a sort of depression when I gave up breast feeding on my return to work and missed the little hand resting on my breast and the sound of their greedy, snuffling, gulps. Anyway, you get the idea, I am pro-breast feeding. It is also the lazy woman’s first choice; I could never have been bothered with all that sterilising and faffing about, breast is best for everyone.

    My Friday ritual is to read the BMJ whilst making dinner, TV being absolutely crap and not wanting to get grubby cooking smears on my iPad, I have found this habit an easy one to adopt. So just now, whilst making the family tea I came across an advert at the back of the BMA News (a supplement that comes each week with the BMJ). It is full of doctors moans and gripes, a trade union weekly round up of issues and news and it is read by most doctors.The back page features this advert, featuring the loveable Harry here.

    20140502-204349.jpgIt is an advert for formula milk, albeit a lactose intolerant form, as poor little Harry has a cow’s milk allergy.

    Here is the BMJ’s policy on formula feeding advertising:

    (iv) Baby milks

    All advertisements are to be submitted for editorial approval and have to comply with FMF Code of Practice for the Marketing of Infant Formulae in the UK, which states that “Information provided by manufacturers and distributors to health workers regarding infant formulae should be restricted to scientific and factual matters and such information should not imply or create a belief that bottle-feeding is equivalent or superior to breast feeding.” Such information “should accurately reflect current knowledge and responsible opinion.” All claims must be referenced to full length research papers published in peer reviewed scientific journals. (Abstracts won’t do.)

    Because advertising is tightly regulated and because readers know it is different from editorial material, BMJ Group has a liberal policy on advertising. The group’s publications will carry virtually all advertisements that are “legal and decent.”

    I disagree with this, they should not be advertising formula. I know they have to make money, I know the makers of formula milk have to advertise but they should not be doing it in the BMJ.

    A liberal policy indeed, they don’t seem so liberal about bossing people about smoking, obesity, exercise and global fucking warming; just 4 weeks ago they were telling us that every doctor has a moral obligation to counteract global warming and we must do something as a profession. Sorry BMJ, I think you should reconsider your liberal policy on advertising, if we have a responsibility as a profession to address all the many, many issues you rally us to support, then the journal and the trade union weekly should walk the walk as well as talk the talk.

     

    I need some new shoes

    Shoes and I have a long and happy relationship; I am never too fat to buy shoes, heels make me feel taller, they make me look thinner, shoes make me feel better, shoes are pretty, shoes can be fun, shoes are much better than a diamond seeing as sparkly rings are not allowed at work.

    Had I been wearing some decent shoes and not my theatre clogs I may have handled a recent row with a radiologist slightly better, seeing as I would have been a taller and more cocky version of me. Sadly I instead ran off near crying with frustration after a run in with the evil little doctor of darkness.

    Confidence in my ability to manage my job and the endless decisions I take used to vary in a sine curve fashion, moving around the midline as I made alternating good and bad decisions. Recently in spite of no real fuck up’s (tempting fate here I know) my confidence has been stuck at the bottom of the curve and doesn’t seem to be moving from there. I’m not sure why this is, normally it makes me feel quite down for a week and then the feeling usually passes with a good operation done well. I don’t feel too unhappy despite this current crisis of confidence but the mood isn’t lifting. I’ve had a lucky amount of time off this Christmas and hope that the break will have resulted in a new found surge of confidence, we will see.

    I discussed with a more senior female colleague the worries I have about complications and dealing with the range of emotions you experience when an operation goes wrong and even more so when someone dies. She nearly wrestled me to the floor and told me to shut up, lest a man overheard us. She said I should never feel like this, that the boys don’t feel like that and I couldn’t and shouldn’t doubt myself.

    I’ve progressed from 12 years ago when I used to lie awake imagining the vessel I had tied off was spurting arterial blood and the patient was exsanguinating as I snored. I’ve progressed from 7 years ago when I used to hover over patient’s beds and check on them repeatedly throughout the day. Now I check for readmissions on the computer of people I may be worried about, operations that were difficult to perform or people that have high risk factors for complications. The relief when the names aren’t there is comforting to me.

    So what I think I need, what surely will give me the balls I am currently lacking is some serious kick ass shoes, shoes that say “fucking right I am the surgeon on call, now do what I say and be quick about it”. One of my very junior colleagues has this attitude in spades, she has next to no experience and can’t tell her APER* from an EVAR** but my goodness, she is confidence personified.

    Red soles are called for, I feel strongly that red soled shoes were surely made for surgeons and that 120mm is in order. They have beautiful brown suede ones on net-a-porter I keep peeking at, how completely impractical for January in the UK but they somehow say authority and confidence, and I know they’ll fit despite the “mince pie half a stone” I need to lose.

    *abdominoperineal excision of rectum
    ** endovascular aneurysm repair.

    Nuclear Power Stations

    I had to make an unpopular decision today at work involving moving staff about to cover various duties due to sick leave of a colleague. I have inconvenienced a few people and apologised for this but explained that it had to be done. My decision isn’t particularly grand or important but it is part of having some responsibility that sometimes difficult decisions have to be made.
    This is a concept foreign to our own Prime Minister and government, though I can’t lay the blame solely at Dave and Nick’s door. They are slowly, slowly making their way to a low carbon economy; so slowly in fact, it is hard to see it happening, a bit like watching a glacier melt…
    The public want and need energy, constantly, loads of it. They do not want coal mining, they don’t want to pay for oil, they don’t want fracking (goodness no) they don’t want nuclear (mainly because of Chernobyl in 1983. Yet the same logic isn’t applied to air travel and Lockerbie) they don’t want wind farms anywhere near them, they don’t want hydro electric (they’ll have to buy it from Scotland), they don’t want solar panels on their roofs. In order to deal with this public disquiet about all sources of energy pissing off at least one group of voters successive governments have spectacularly failed to to address the nations energy needs and have made no plans at all so as to avoid making a difficult decision. Isn’t that what leadership is?
    So a deal has been struck with China by two dimwits of astronomical proportions George and Boris and never mind that China is as untransparent as they come and as dodgy (Amnesty keeps a list). How they have decided that this is the best option I don’t know, but presumably they’ve realised that economic reality means deals with China have to be made and chances are by the time these new power stations are contributing to the national grid George and Boris will be in opposition.

    “the thing is your super holiness, we know that China hasn’t been very nice to you but they’re so rich we can’t say no”

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