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JuniorDr is a free distribution lifestyle magazine produced by doctors for the UK’s Medical Students, Foundation Year Trainees, Specialist Trainees, GP Trainees and Specialist Registrars. You can find us quarterly in hospitals and medical schools throughout England, Scotland, Wales and Northern Ireland, and updated daily at JuniorDr.com.
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TRAINING IN OBSTETRICS ANDGYNAECOLOGY
Accurate and evidence-based, thistextbook for junior obstetriciansand gynaecologists contains all the material relevant to everyday
practice and the new RCOG curriculum. It has beenwritten and edited by inspiring teams that combine juniors, new and established consultants working across a range of settings, and many of the UK's top experts in obstetrics and gynaecology.
978-0-19-921847-9 | March 2009 | 528pp | £39.95 | paperback
TRAINING IN ANAESTHESIA
Training in Anaesthesia is a curriculum-based guide to the first phase of specialty training in anaesthetics, comprehensivelycovering the techniques, assess-
ments, and basic medical and physiological knowledge that trainees learn as part of their basic training, and whichare examined by the Primary FRCA qualification. The bookis authored by both trainees and specialists, and has beencomprehensively edited and peer-reviewed.
978-0-19-922726-6 | July 2009 | 672pp | £49.95 | paperback
TRAINING IN OPHTHALMOLOGY
This full colour book is the first totake account of the new ophthalmictraining structure and syllabus, asdefined by the Royal College ofOphthalmologists (RCOphth). As
a theoretical and practical aid for trainee ophthalmologistsand FY doctors, it is a guide through the initial years ofthe new postgraduate Ophthalmic Specialist Training.It will also appeal to candidates preparing for theFRCOphth exam.
978-0-19-923759-3 | February 2009 | 480pp | £49.95 | paperback
TRAINING IN SURGERY
A complete curriculum guide to specialty training in surgery,covering the material taught during the first two years oftraining, as well as the topics
examined as part of Royal College membership.Written by both trainees who are currently completingtheir specialty training, and senior practitioners, the information is accurate, comprehensive and at the appropriate level.
978-0-19-920475-5 | January 2009 | 448pp | £39.95 | paperback
OXFORD SPECIALTY TRAININGeverything you need for career and membership exam success
Oxford Specialty Training is a brand new series and the first to take account of the new training structure and syllabuses,as introduced by the Modernising Medical Careers initiative.
• • • COMING IN SPRING 2009 • • •
• • • forthcoming • • •TRAINING IN PAEDIATRICS | 978-0-19-922773-0 | August 2009 | £39.95 | paperback
TRAINING IN PSYCHIATRY | 978-0-19-922758-7 | November 2009 | £49.95 | paperback
TRAINING IN MEDICINE | 978-0-19-923045-7 | January 2010 | £49.95 | paperback
available in all good bookshops and directly from OUP at www.oup.com/uk/ost1
OST_advert_final.qxd 22/11/08 17:23 Page 1
TRIAGE 3
I t’s not easy being a doctor in December. Outside Britain is cold, wet and gripped by the never-ending pessimism of the credit crunch. Inside, the wards are
heaving with norovirus and your wind-chapped hands sting from the constant alcohol gel rubs.
You’ll be even more disheartened to hear that hun-dreds of British trained medics working overseas report they’re having a much better time than you are (page 12). They’re all off for a ‘barbie’ on Bondi beach tonight or busy waxing up their skis for a weekend escape to Whistler.
The even sadder fact is that those who have made the move have no regrets about leaving our beloved NHS for greener pastures - or nicer beaches. Since the MTAS malarkey thousands have travelled overseas, initially tem-porarily, but many fewer have returned.
This issue we take an objective view of working abroad and assess the perks and the downsides (page 13). We’ve asked doctors who have made the move to tell us about their favourite new workplaces and offer advice to make your transition easier.
If you are sadistically enjoying the cold and the thought of leaving for sunny New Zealand or Australia doesn’t get you excited we hear from Dr Ross Hofmeyr who practises medicine in icy Antarctica (page 9). With nearly 3,000 miles to the nearest hospital it’s perfect for doctors wanting to get away from it all.
We hope we’ll provide plenty of ideas to help you dream away those cold winter evenings – and you can find more career options on the JuniorDr.com website. All we ask is that you remember to send us a postcard if you do end up sunbathing on that tropical beach.
THE MAGAZINE FOR TRAINEE DOCTORS
Presenting HistoryJuniorDr is a free distribution lifestyle
magazine produced by doctors for the
UK’s Medical Students, Foundation Year
Trainees, Specialist Trainees, GP Trainees
and Specialist Registrars. You can find us
quarterly in hospitals and medical schools
throughout England, Scotland, Wales and
Northern Ireland, and updated daily at
JuniorDr.com.
EditorAshley McKimm, [email protected]
Editorial TeamMichelle Connolly, Anita Sharma,
Muhunthan Thillai
Advertising & ProductionRob Peterson, [email protected]
JuniorDrPO Box 36434, London, EC1M 6WA
Tel - +44 (0) 20 7 684 2343
Fax - +44 (0) 87 0 130 6985
Health warningJuniorDr is not a publication of the NHS,
Gordon Brown, his wife, the medical unions
or any other official (or unofficial) body.
The views expressed are not necessar-
ily the views of JuniorDr or its editors, and
if they are they are likely to be wrong. It
is the policy of JuniorDr not to engage in
discrimination or harassment against any
person on the basis of race, colour, religion,
intelligence, sex, lack thereof, national
origin, ancestry, incestry, age, marital status,
disability, sexual orientation, or unfavourable
discharges. JuniorDr does not necessar-
ily endorse or recommend the products
and services mentioned in this magazine,
especially if they bring you out in a rash. ©
Copyright JuniorDr 2008. All rights reserved.
Get involvedWe’re always looking for keen junior doctors
to join the team. Benefits include getting
your name in print (handy if you ever forget
how to spell it) and free sweets (extra spe-
cial fizzy ones). Check out juniordr.com.
TIME TO jOIN THE happy doctors overseas?
“Hundreds of British trained medics working overseas feel they’re having a much better time than you are.”
Ashley McKimmJunIoRDR EDIToR-In-ChIEf
What’s inside
0409121617
2022
LATEST NeWs
MEDICINE IN aNtarctIca
WORKING overseas
TOp CARDIOLOGY WebsItes
MEDICAL STUDENTS TO FACE vIrtUaL “oN-caLLs”
SECRET DIARY OF A cardIoLoGy spr
saNta GETS CHRISTMAS CHECK-Up
Correction: In the September issue we mistakenly printed an old version of the MPS advertorial ‘Sticky
Business’. We’re sorry if you had read this before. You can read the latest advice on ‘Working Overseas’
from the MPS on page 15 of this issue and find more support at www.mps.org.uk.
nEWS PuLSE4
a costed and agreed plan to meet the dead-line. Of those who stated they are ready it had taken them between six to twelve months to properly plan and implement the necessary changes. Hospitals face heavy fines if an employee breaches the working hours limit.
“If there is one lesson to be drawn from the data presented in this report it is that getting working hours down while offering proper, safe patient care and retaining medi-cal training is not straightforward and takes time,” said Royal College of Surgeons Presi-dent, John Black.
“With the deadline looming, surgeons and anaesthetists are worried that NHS Trusts will be tempted to simply cobble together rotas that fit the law but don’t take proper account of night-time staffing, ensure patients have as few handovers as possible or provide junior doctors with the varied training needed to give us the consul-tants of tomorrow.”
In their report, entitled WTD-Implica-tions and Practical Suggestions to Achieve Compliance, they warned that patient safety and medical training could be compromised unless there is adequate funding and engage-ment from senior NHS management.
www.rcseng.ac.uk
www.rcoa.ac.uk
www.healthcareworkforce.nhs.uk
tell us your news. email us at [email protected] or call 020 7684 2343.
j unior doctors are turning into a profes-sion of couch potatoes by taking much less exercise than the national aver-
age and well below recommended levels, according to a study published in the Brit-ish Journal of Sports Medicine.
Only one in five (21%) junior doc-tors met the recommended exercise levels - much lower than the national average of 44 percent. The study of 61 doctors at Bed-ford and Middlesex Hospitals found that whilst training as medical students almost
two thirds of the same group had met the Department of Health recommendations of 30 minutes of moderate exercise at least five times a week.
58 percent said lack of time was the big-gest single reason for not exercising enough after graduating but almost a third (29%) said they weren’t motivated to exercise, or were too tired after work to do so.
“This is very important, not only for the doctors’ own health, but also for the health of the patients. Numerous studies have
shown that students and consultant equiva-lent doctors who exercise are more likely to counsel their patients to exercise too,” said the study authors.
More positively, the study did find that doctors weighed and smoked less than the national average, with only seven per-cent drinking more than the recommended number of units of alcohol.
bjsm.bmj.com
O ver half of hospitals in England are unprepared for the 48-hour Europe-an Working Time Directive deadline
of August 2009, according to a study joint-ly published by the Royal College of Anaes-thetists and Royal College of Surgeons.
Only 49 percent of anaesthetic and 42 percent of surgical rotas were within next year’s limit. Taking Trusts as a whole the situation is worse still – only 18 percent of responding Trusts said their surgery staff were meeting the target; the figure for anaes-thesia was 33 percent.
Less than 15 percent reported they have
jUNIOR DOCTOR COUCH potato WarNING
COLLEGES WARN OVER eWtd readINess
Mr John BlackRoyAL CoLLEGE of SuRGEonS PRESIDEnT
“With the deadline looming, surgeons and anaesthetists are worried that nhS Trusts will be tempted to simply cobble together rotas that fit the law.”
HEAlTH
workiNG Hours
nEWS PuLSE 5
Over half of GP surgeries (51%) now offer patients extended open-ing hours, according to the latest Department of Health data. In the last six months there has been a 40 percent increase in the number of practices offering more flexible ear-ly morning, evening and weekend opening. It meets the government’s target of 50 percent of practices by the end of 2008.
www.dh.gov.uk
workiNG CoNDiTioNs
A four percent rise in the annual pay of doctors in 2009 would be ‘an appro-priate and affordable increase’ said the
BMA in its evidence to the UK’s Doctors’ Pay Review Body.
They demanded that public sector pay ‘should not be used as a tool to try to con-trol inflation’ and warned that the level of pay is beginning to affect school leavers’ career choices and doctors’ decisions to continue working in medicine.
“Last year’s below inflationary rises have failed to keep pace with the increase in the cost of living. Moreover, GPs received no increase in gross remuneration and with prac-tice expenses rising considerably, most of them had a significant pay cut for the second year running,” said Hamish Meldrum, Chair-man of the BMA.
“The loss of free accommodation for junior doctors also amounted to a pay reduc-tion and a substantial uplift in their basic pay
is essential to counter the effect this has had on their income.”
The Review Body previously used the argument of free junior doctor accommoda-tion for keeping pre-registration doctor pay lower than it might otherwise have been. Hospital Trusts have however called for a rise of no more than two percent in 2009.
Last year the government implemented the DDRB recommendation of just 2.2 per-cent for junior doctors - half that called for by the BMA. GPs received an average increase of 0.2 percent per practice.
www.bma.org.uk
O ver 200 ‘plastinated’ body parts from Gunther von Hagens’ Germany lab-oratory are on their way to Warwick
Medical School to aid anatomy demonstra-tion. It will be the first time Von Hagens’ plastinated specimens have been used for teaching by a UK institution.
The specimens cost £400,000 and are part of a Strategic Health Authority grant of £1.1 million for the School to create a centre for excellence in anatomy and surgical skills.
“Gunther von Hagens’ plastination tech-nique is the most effective and his specimens are of the highest quality,” said Professor Peter Abrahams, Warwick Medical School’s Chair of Clinical Anatomy.
“Our students can use these specimens again and again to understand how the body works, they will be a unique and invaluable tool for the training of doctors.”
Dr von Hagens’ plastination technique
involves removing body fat and water and impregnating a polymer to preserve the body or body part. The specimens originate from body donors to von Hagen’s Institute for Plastination in Guben, Germany.
www.warwick.ac.uk
BMA CALLS FOR 4 pERCENT aNNUaL pay rIse
£400,000 OF GUNther voN haGeNs’ body parts BOUGHT BY WARWICK UNIVERSITY
MEDiCAl sTuDENTs
Non-white medical students are more likely to embrace orthodox medicine and reject therapies tra-ditionally associated with their cul-ture, according to a study published in Medical Teacher. The study looked at over 600 students in the UK, USA and New Zealand and found that Asian and black students had the least interest in complementary and alter-native medicine.
www.medicalteacher.org
Happiness is infectious, according to a study published in this month’s BMJ. Researchers at Harvard Medical School looked at nearly 5,000 people and found that live-in partners who become happy increase the likelihood of their partner being happy by 8 per-cent. Similar effects were seen for sib-lings who live close by (14%) and neighbours (34%) – though they not-ed that happiness requires close prox-imity to spread.
www.bmj.com
The government and major drug firms have agreed a 3.9 percent price cut in 2009 followed by a further 1.9 percent from 2010. The deal also sees the genetic substitution of common drugs and introduction of a flexible pricing arrangement which will allow firms to supply new drugs initially at lower prices with the option of higher prices if the value is proven.
www.dh.gov.uk
Non-white students reject traditional therapies
More Gps work late
Get infected with happiness
prescriptions less pricey
Dr Hamish MeldrumChAIRmAn of ThE BmA
“Last year’s below inflationary rises have failed to keep pace with the increase in the cost of living.”
GunThER von hAGEnS AnD hIS ASSISTAnTS WITh SomE
of ThE BoDy PARTS on ThEIR WAy To ThE unIvERSITy of
WARWICk. © GunThER von hAGEnS.
nEWS PuLSE6
A new confidential specialist health service for doctors and dentists has opened in London. The DH funded ‘Practitioner Health Programme’ aims to encourage doctors to seek help rath-er than managing their own health concerns and self-prescribing. In ad-dition to providing support for phys-ical health concerns the service, based at Riverside Medical Centre in Vaux-hall, is also aimed at those with mental health worries or addictions.
www.php.nhs.uk
Obese diners tackle ‘all-you-can-eat’ Chinese buffets differently than normal weight individuals, accord-ing to Cornell University’s Food and Brand Lab. In the study of 213 diners they found that, compared to normal weight diners, overweight individuals sat 16 feet closer to the buffet, were twice as likely to sit facing the food, were three times as likely to use forks instead of chopsticks and were half as likely to browse the buffet before serv-ing themselves.
www.cornell.edu
Many US doctors regularly pre-scribe drugs, including sedatives and antibiotics, as “placebo treatments” but rarely tell their patients, according to a study published in the BMJ. Of the 679 doctors responding to the sur-vey over half (57%) prescribed “place-bo treatments” on a regular basis with 62 percent believing the practice to be ethically acceptable.
www.bmj.com
Patients are to be able to self-refer to services such as physiotherapy and podiatry without the need for a GP, Health Secretary Alan Johnson has an-nounced. Many of the UK’s 76,000 al-lied health professionals fear they may see a surge in new referrals following the change but Mr Johnson insists that it will further empower patients.
www.dh.gov.uk
When a fork is faster
Doctors for doctors
US docs regularly give placebos
patients to bypass Gp referrals
F ewer patients undergoing gallblad-der surgery had bile duct injuries or other complications when US junior
doctor work hours were limited to 80 per week, according to a study published in the Archives of Surgery.
The study by a team at the Los Ange-les Biomedical Research Institute at Har-bor-UCLA Medical Center looked at 2,470 patients and found fewer experienced bile duct injury (0.4% vs 1%) or any complica-tion (2% vs 5%) following the introduction of a 80-hour work week in 2003.
Previous studies using simulators have shown that sleep deprivation has substantial
adverse effects on laparoscopic skills, often resulting in bile duct injury.
“We observed improved outcomes in the era of restricted resident work hours in patients undergoing laparoscopic cholecys-tectomy,” reported Arezou Yaghoubian and colleagues.
“Despite the concerns that work hour restrictions may have deleterious effects on patient care and resident education, these results clearly indicate otherwise. Whether the better-rested resident surgeon leads to better surgical outcomes needs further study.”
archsurg.ama-assn.org
S hort term counselling and a modest cut in work hours can help reduce emotional exhaustion and sick leave
among doctors, according to a study pub-lished in this month’s BMJ.
The one year cohort study of 227 stressed Norwegian doctors found that a programme of psychotherapy reduced the number of doctors on full-time sick leave from 35 per-cent to 6 percent. Doctors have higher rates of suicide and depression than the general population and are less likely to seek help.
“Our findings indicate that seeking a counselling intervention could be condu-cive to reduction of burnout among doc-tors,” said Dr Karin Rø and her team at the Modum Bad Research Institute. “Consid-ering doctors’ reluctance to seek help it is important to offer interventions that facili-tate access.”
The team also found that the use of psy-chotherapy by the cohort had increased sub-stantially from 20 percent to 53 percent in the follow-up year. A reduction in work hours after the intervention was also associ-ated with a drop in emotional exhaustion.
On one year follow-up the stressed
doctors reported a reduction in emotional exhaustion and job stress similar to the lev-el found in a representative sample of Nor-wegian doctors. The study followed calls for early intervention programmes to help doc-tors with mental distress and burnout before their problems begin to interfere with the welfare of patients.
www.bmj.com
LIMITING jUNIOR DOCTOR HOURS pRODUCES FEWER GaLLbLadder coMpLIcatIoNs
treat bUrNoUt AMONG DOCTORS TO REDUCE SICK LEAVE
workiNG CoNDiTioNs
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Littmann Xmas ad 30/10/08 13:05 Page 1
T his groundbreaking exhibition considers the continually evolving relationship between warfare and
medicine, beginning with the disasters of the Crimean War in the 1850s and continuing through to today’s conflicts in Afghanistan and Iraq.
War and Medicine covers a wide range of subjects - from the pioneering plastic surgery techniques first devel-oped during World War I to treat dis-figuring facial wounds through to the recent controversies surrounding Gulf War Syndrome and the diagnosis of Post-Traumatic Stress Disorder.
The collection runs until 15 Febru-ary 2009. For more information visit:
www.wellcomecollection.org
RADIoGRAPhER WEARInG PRoTECTIvE CLoThInG
AnD hEADPIECE, WoRLD WAR I, fRAnCE.
(hJ hICkmAn, C.1918)
War aNd MedIcINe ExHIBITION wEllCoME CollECTioN
EXTREmE mEDICInE 9
S outh Africa is one of approximately 20 countries which maintain year-round stations in Antarctica, using
the unique conditions as a massive labo-ratory for research. Nothing in Antarctica is simple however. Research teams across the continent, which is 56 times greater than the UK in surface area, have to con-tend with living in the harshest environ-ment on Earth.
Antarctica is the coldest place on the sur-face of the planet with temperatures dip-ping towards -90°C near the South Pole; the windiest, with hurricane force winds an almost weekly phenomenon; the highest, averaging 1860m (6100 ft) above sea level; and despite having more than 70 percent of the planet’s fresh water trapped as 97 percent of the world’s ice, it is the greatest desert with the Dry Valleys area of Antarctica having not seen precipitation in millions of years.
In the frigid darkness of the austral win-ter the sea around the continent freezes for hundreds of miles doubling the surface area of ice. Less than 1000 people are to be found on the entire continent in winter scattered amongst the isolated research stations like tiny candles in the perpetual darkness. Dur-ing summer this number swells to some-where over 4000 as the influx of summer
field researchers, support and logistics per-sonnel and a rapidly increasing number of tourists (more than 40,000 in the last year) head south to enjoy the fine weather (‘bare-ly’ subzero) and long hours of sunlight.
Stations near the pole experience six months of perpetual darkness during win-ter and are completely isolated from the rest of the world. Flying into Antarctica in the winter is a near impossibility and it has been suggested that it is logistically sim-pler to evacuate a casualty from the Inter-national Space Station than from Antarctica at this time of year. While many would find providing medical care in this environment incredibly daunting, for a handful of adven-turous medics it is a dream come true.
The Antarctic General practice
Most expeditions favour a doctor with some surgical experience, particularly with an emphasis on trauma, along with good general practice and general medi-cine knowledge. Participants in the expe-ditions are usually very thoroughly vetted prior to departure but still the majority of the medical case load is similar to a gen-eral practice.
Minor respiratory and GI tract ailments are common. In addition, bumps, scrapes and scratches are regular occurrences. Psy-chological problems as a result of the iso-lation and physiological disturbances of working in such an unusual environment for long periods are frequent. Sleep dis-turbances due to the perpetual daylight in summer and darkness in winter are the most ubiquitous diagnosis.
Contrary to expectations cold injuries such as frostbite, hypothermia and other environment-specific illnesses like snow-blindness are rare because of the promi-nent educational programs for expedition staff. The most prevailing concern is that of significant trauma through ice-relat-ed falls or injuries from cargo handling - hence the preference towards doctors with
THE aNtarctIc DOCTOR
ExTREME MEDICINE:
Welcome to my A&E Department. Local population: 10 to 100 (dependent on the season). Staff: 1. Nearest referral hospital: 2800 miles (but no referral, transfer or evacua-tion possible for 8 months each year).
Welcome to SANAE IV Antarctica – my home for 15 months and the current year round research station of the South African National Antarctic Expedition.
DR RoSS hofmEyR
“It is logistically easier to evacuate a casualty from the International Space Station than from Antarctica at this time of year.”
EXTREmE mEDICInE10
good trauma experience. Other ‘peripheral’ skills of value on the continent are experi-ence with disaster planning and mass-ca-sualty incidents, aeromedical skills and the ability to use outside assistance via forms of telemedicine successfully.
Meningitis at minus 40
Famously, a Russian doctor removed his own appendix under local anesthesia at the Novolazarevskaya base about 300 miles from SANAE IV using various teammates as assistants. It helps to demonstrate how the expedition doctor in Antarctica has to be many things at the same time and requires the skills of an A&E doctor, gen-eral practitioner, psychologist, surgeon, anaesthetist, radiographer, dentist, phar-macist and laboratory technician.
Most expeditions include pre-depar-ture training which addresses these needs - particularly the ancillary roles which are not part of most doctors’ experience such as dental work and taking and developing
x-rays. Doctors with an A&E background are good candidates for this type of work where excellent diagnostic skills and a broad understanding of the full spectrum of disease can fill the void created by the absence of advanced imaging and labora-tory investigations.
For example, the most serious illness I have faced during this expedition occurred when a team member developed clinical signs of meningitis a few days after evac-uation of a minor dental abscess. Assist-ed by a diesel mechanic as my ‘nurse’, I made the diagnosis on clinical grounds then performed a lumbar puncture and started empiric treatment. In the lab using the centrifuge, microscope and some basic equipment I was able to establish a raised white blood count and erythrocyte sedi-mentation rate. I then performed a CSF stain and identified Staphylococcus as the pathogen. The patient recovered rapid-ly on the appropriate treatment. The epi-sode reinforced my belief that as doctors we should not allow ourselves to become distanced from clinical and laboratory
procedural skills such as microscopy that form an integral part of acute medicine.
The White Continent
Antarctica is without doubt the most beautiful place I have ever been. Even when the temperature is forty below zero it is a privilege to walk around the mountain or simply sit and listen to the ice crack as the glaciers move imperceptibly onwards. The frequent storms bring both terror and wonder, as the winds scour the landscape and static electricity sparks on every sur-face. The light is forever changing and it appears as if the stars are so close that one can almost touch them.
Simply to journey to Antarctica tru-ly takes one beyond expectations, beyond normality and into that place that ‘tran-scends reason’. Although not suited to everyone, to be able to use your career as a vehicle to see the White Continent in all her moods is an opportunity beyond your greatest dreams.
ExTREME MEDICINE: THE ANTARCTIC DOCTOR
THE ANTARCTIC a&e departMeNt
‘M y’ A&E department consists of three main rooms. A consulting room/office is equipped with the usual items: examination table, basic diag-
nostic equipment, computer, and modest medical library in a bookshelf. An interconnecting door leads to the clinic area which contains a single hospital bed with non-invasive monitoring.
A mobile x-ray machine allows me to perform plain films, which I develop by hand in an adjoining darkroom.
Across from the bed is my ‘lab’ which consists of a centrifuge, light micro-scope and all the paraphernalia to perform smears and cell counts. We are also lucky to have a test strip based machine to perform basic blood chemistry, although unfortunately not blood gases. A small autoclave allows sterilization of equipment. The other corner of the room is dedicated to dental work with a full-sized dentist’s chair, small instrument platform powered by a portable compressor and a mobile suction unit.
Leading off from the clinic area is the operating theater which doubles as a resuscitation room. Although austere, there is a basic operating table, a no-frills anesthetic machine (with one vaporizer containing halothane!), non-invasive monitoring and wall gases (oxygen and nitrous oxide). Suction is provided by mobile units and the dental light is used for additional illumination.
SAnAE Iv oPERATInG ThEATRE AnD RESuS Room
SAnAE Iv DoCToR’S offICE
The NHS PensionScheme has changed
Wesleyan Medical Sickness is a division of Wesleyan Financial Services Ltd.(“WFS Ltd”), a wholly owned subsidiary company of Wesleyan AssuranceSociety. Registered No. 1651212. WFS Ltd. is authorised and regulated by theFinancial Services Authority. Head Office: Colmore Circus, Birmingham B4 6AR.Fax: 0121 200 2971. Telephone calls may be recorded for monitoring andtraining purposes.
You are probably aware of some of thechanges to the NHS Pension Scheme,which came into effect on 1 April 2008.But do you know what they mean to you,and what changes, if any, you need tomake to your retirement plans?
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sANAE iV loCATioN
Image © NASA.
You can read the extended version of Dr Ross Hofmeyr’s experience online at JuniorDr.com and follow his Antarctic journey at www.doctorross.co.za.
Images used courtesy of (c) Dr Ross Hofmeyr unless otherwise stated. This article first appeared in the Association of Emergency Physicians First Line Newsletter Vol. 5, Issue 3, Fall 2008 www.aep.org
SANAE IVA s suggested by the name, this is the fourth SANAE base.
The first three were built on the ice shelf and were grad-ually buried by snow and crushed in the ice which forced them to be decommissioned. To escape this fate, SANAE IV was built inland atop a nunatak (mountain peak pro-jecting through the ice cap) known as Vesleskarvet in the Queen Maud Land region.
Several other nations have bases in this area. The Ger-man research station, Neumayer II, and Norwegian station, Troll, are to be found about 125 miles west and east of SAN-AE. Despite these ‘neighbours’, we are essentially isolated as to make an overland voyage to either station is a journey fraught with danger from crevasses and severe weather con-ditions. During the brief summer, however, the base popu-lation swells from 10 to nearly 100 persons and a local air network is established to move personnel and supplies. As a central location, SANAE is equipped with a larger than aver-age medical facility in order to provide medical support.
SAnAE Iv on vESLESkARvET
WoRkInG ovERSEAS12
AUSTRALIA
I worked in Mel-bourne, Austra-
lia, for a year and a half after my house
jobs and had the opportunity to do posts in Neurology, A&E and ICU. High staffing levels in A&E meant that we were able to investigate, diagnose and manage patients before referring them on for specialist treatment - in this way, I gained a wide range of clinical experience.
On my salary, I was able to live in a shared flat, with a pool and gym in the apartment
block. I also had the opportu-nity to travel all over Australia - my ICU placement was a 1 week on, 1 week off rota, so I went on holiday every other week!
My 18 months in Austra-lia has helped rather than hin-dered my career – it gave me an opportunity to work in a vari-ety of specialties, while I took my time considering what spe-cialty I wanted to train in. It also allowed me to compare and contrast healthcare systems in two different countries.
Melbourne has lots to offer – from city living, with access to a variety of sports and cultural
events, to the opportunity to see more of the wildlife and geog-raphy of the rest of the coun-try. I would highly recommend Melbourne as a brilliant place to work and play.
Since working in Melbourne Dr. Amanda Sinai has returned to the UK and is training in psychiatry.
Whether it’s Australia, New Zealand or Canada there are plenty of options for doctors wanting to escape the UK. We’ve asked those who have made the move to tell us about their favourite overseas locations and their advice on making the transition.
supported by
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doWN UNder coMes oUt oN top UK doctors prefer working in Australia and New Zealand to other overseas destinations, according to a survey of 138 British doctors by Wavelength. Most said they valued the change in lifestyle, the similarity of training schemes and the good whether.
NEW ZEALAND
A fter completing my medical degree and foundation years’ training in London, I decided to do my OE
(Overseas Experience) in New Zealand as I had never heard a bad word said about it. I went through an agency and land-ed myself a job in Rotorua working in A&E.
The most noticeable difference was that four-hour breach times were not an issue. Patients could therefore be more thorough-ly assessed and managed calmly without the harassment and bully-ing that is often found in the NHS. The only difficult thing to get used to was the rotten-egg sulphur smell from Rotorua’s geothermal environment!
I then moved to the sunny winery region of Hawke’s Bay obtain-ing jobs as a Psychiatry Registrar and then as an Ophthalmology SHO by directly emailing my CV to the RMO (Resident Medical Officer) Unit Manager.
Eight months later I found myself working as a Paediatrics SHO in Nelson with such a friendly and supportive team in one of the most stunning places I have ever lived in. There are few places where it would be possible to ski in the morning and kayak along beautiful beaches in the afternoon sun!
Even though the annual salary appears less than that in the UK, there are significant financial benefits to working in New Zealand. Medical council membership and indemnity insurance are reim-bursed, all courses and related expenses are paid for, as are textbooks and exams if on a hospital training scheme.
In all the hospitals I worked at I found morale to be higher, the atmosphere to be friendlier, and all staff more supportive towards col-leagues when compared to the UK. This coupled with the amazing lifestyle that New Zealand has to offer has encouraged me to stay here to complete my training.
Dr. Tanya Hussein trained as a junior doctor in London and worked in New Zealand up until Novem-ber 2008. She is set to return in January to continue her GP training there.
Wavelength International are looking for Junior Doctors with a desire to travel, for a variety of excellent training positions in coastal, city & country locations.
The combination of world class healthcare & unique range of lifestyle options makes Australia & New Zealand a great career move.
Our dedicated team give career & salary advice, assist with registration, migration & relocation.
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Variable start dates available from January through to August 2009 - it is not too early!
NZ and Australia offer unique and fantastic environments for Junior Doctors to live, work and play. Good supportive orientation programs and positive future career prospects.
Talk to us about fi nding the best jobs in the best locations for you – and the right support and expertise to move internationally.
Register today at www.genevadoctors.com call our NZ offi ce on +64 9 916 0150 or email [email protected]
For more information contact [email protected](UK) 0808 234 7853
Work and play in New Zealand for your 2nd or 3rd year
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BRITISH COLUMBIA
B orn in England, I went to school and did my medi-
cal training in London. Two years ago, my husband and I were look-ing to leave London when he spotted an advert. I had never been to British Colum-bia but had enjoyed Seattle, so we attended a Health Match meeting in London. They explained the requirements and since then have facilitated our move with ease.
We chose Sechelt because it’s the best of both worlds – you can easily get to Vancou-ver or Whistler, but it’s still rural. We have fallen in love with the Sunshine Coast - stunning scenery, a gorgeous summer, win-ter skiing and friendly people.
We are much better off - I am being paid more than in the UK with rent and petrol at substantially lower prices. We enjoy a good meal and the food is fantastic here, mostly fresh and organic produce. Some things are more expensive - such as car insurance.
Being a physician here isn’t that dissimi-lar to England - there are still waiting lists for
outpatient appointments and MRI scans. I enjoy being self-employed, although I still work within a practice with support around me. I also work in the local ER which gives great variety.
We have yet to have any regrets - it is hard to leave family and friends, but easy to fly here. If you are looking for a much bet-ter quality of life we couldn’t recommend it more.
Dr. Isabelle Hughan moved from London, England to Sechelt, BC, Canada with her sci-entist husband, Craig, and their infant son, Fraser, in June 2008.
WorkING overseas: YOUR ExpERIENCE
DR ISABELLE huGhAn
Smooth sailing More doctors are jumping ship to work abroad, but unchartedwaters present new risks, argues Sara Williams
Suitcase in one hand and passport in the other, Dr AshleyLeadbeatter, an F2 from Leeds, walks through the doors ofHeathrow Airport to check in for his one-way flight to Australia.As he stands surveying the queue of faces ahead of him, hewonders how many of them are doctors, like him, travelling to the unknown in search of fortune and glory.
Ashley will be working in Gold Coast Hospital in South Port,Queensland. So why did he leave? “It is the sensible time to leave, as specialist training is a treadmill that is difficult to get off. If I wentlater, it would interrupt my training and it would be harder to return. In February I had been a doctor for 20 months; in the UK system Ihad to decide on what specialty I wanted to do for the rest of my life. I want more life experience before I make that decision.”
Ashley is not alone. The GMC has issued 2,266 Certificates of GoodStanding so far this year, which is a standard requirement beforeembarking on clinical work in most countries, and is an indication ofhow many doctors are going to work abroad. Although the DH couldnot provide any figures, Remedy UK predicts that the numbers will besignificantly higher than last year because of problems with training.
Dr Clare Cooke moved to New Zealand last October because she was frustrated with the MMC “fiasco”. “When I was a third year SHOin a busy DGH in the Home Counties, I realised that nothing fazed meanymore; I was working on autopilot. I moved to the Antipodes andfound jobs that are without parallel in the UK. You could run a basehospital, work in a clinic 1,000 km from the nearest tertiary referralcentre, cruise with the flying doctors, act up a grade, make life anddeath decisions, and gain infinite clinical skills and life experience.”
Thinking aheadClare left the UK confident that she could achieve her dreams ofworking as a foreign doctor, but she now knows only too well thenumber of boxes she had to tick to realise them. From expensivemedicals to police checks, it can take a long time to secure a ticket to work in another country. Thinking ahead is the key to organising a successful trip – getting important factors like travel insurance,flights, vaccinations and professional indemnity sorted early will help avoid problems at the last minute.
IndemnityBefore practising protect yourself: new countries mean new risks.Having a patient’s best interests at heart will not always protect thatpatient from harm. Likewise the best intentions will not always protecta doctor from human error and professional scrutiny. This is whyhaving indemnity and access to 24-hour medicolegal advice is vital.
NHS indemnity is limited to clinical negligence claims arising from NHShospital care and the claim is made against the trust. It is essential for all doctors to have additional professional protection for the othermedicolegal risks which can arise from practice. The NHS scheme doesnot extend to doctors working abroad, who will therefore need to maketheir own arrangements to ensure that they have adequate protection.
Dr Pallavi Bradshaw, MPS Medicolegal Adviser, says that whenconcerns are raised, having the reassurance that someone willsupport you and protect your professional interests is invaluable.“Junior doctors must be alive to the ever-increasing risks of clinicalpractice. Doctors travelling abroad should be alert to the current legal and ethical climate within a particular country. Being aware and managing these risks will safeguard you for the future.
“Without a doubt, patients should be protected, but equally, webelieve, so should doctors. MPS’s role is to protect the interests of members when concerns are raised about their practice, in any form – claim, complaint, medical council investigation. It is a commonmisconception that MPS deals mostly with clinical negligence claims.This kind of work represents only about 20% of our caseload.”
Clare Wolstenholme is Team Leader for the International MembershipDepartment at MPS. She urges junior doctors to take advantage ofoverseas membership, as MPS now operates in more than 40countries. “Some countries have state or government indemnity, but it is usually limited to negligence claims, so it is advised thatdoctors retain their MPS membership whilst working overseas. Members should contact the membership department with details of their scope of practice and where they intend to work, so we can confirm the correct subscription rate for their work.”
Off the beaten trackThe Antipodes is a mecca for graduates from all trades, but ClareCooke argues that a lot can be gained from exploring far-away places. “It depends on who you are, your seniority, your outlook on life and your breadth of experience, but if you really want to, go for it and get a great experience.”
Different countries have different requirements for the type ofindemnity provision which are acceptable. For example, in Germany and Australia, it is a legal requirement that doctors areindemnified through a contract of insurance and discretionaryindemnity is not recognised in these areas. MPS does not offermembership in USA and Canada, or countries operating under their jurisdictions. But it does offer membership for voluntary workoverseas for organisations such as Voluntary Services Overseas(VSO), and those who accompany travel groups and expeditions.
MPS’s protection allows members to request assistance withmedicolegal problems arising from Good Samaritan Acts in any part of the world. This is where a doctor provides medical assistance outside their usual clinical employment or workenvironment in a bona fide medical emergency, such as when passing a roadside accident, emergencies at public events and on aeroplanes.
Useful linksTalk to a membership adviser before travelling, if you are planning to work overseas. Use the helpline number 0845 718 1787, or email [email protected].
MPS professional support and expert advice
For more information call 0845 718 7187Or visit www.mps.org.uk
24 hour medicolegal emergency advice line
Medicolegal publications – Casebook and New Doctor
Risk Management materials includingmedicolegal booklets
Online resources including factsheets andcase scenariosEducational support through discounts with leading publishersLargest international protection organisation
The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS.MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association. MPS0745
MPS0745 Working abroad.qxd:Template - Junior Doctor 12/11/08 11:49 Page 1
mEDICAL STuDEnTSTEChnoLoGy16
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‘Google Flu Trends’ is the latest proj-ect from Google’s philanthropic arm Google.org. By combining influenza-like search symptoms such as ‘cough’ ‘flu’ and ‘fever’ with a computer’s IP address they are able to locate and plot searches on a city-by-city basis.
Over the last five years Google Flu Trends has been closely correlated to the flu incidence recorded by the US Centers for Disease Control and Prevention. Tra-ditional flu surveillance has a lag time of 1-2 weeks - the hope is that Google Flu Trends may provide an almost instanta-neous early-warning system.
“For epidemiologists, this is an exciting development, because early detection of a disease outbreak can reduce the number of people affected,” said Google.org develop-ers Jeremy Ginsberg and Matt Mohebb.
“Our up-to-date influenza estimates may enable public health officials and health professionals to better respond to seasonal epidemics and — though we hope never to find out — pandemics.”
Currently Google Flu Trends pro-vides data only for the United States but the programme is expected to roll-out across other countries shortly. They also hope to extend the prediction software to track other diseases.
www.google.com/flutrends
CRTonlinewww.crtonline.org
A not-for-profit site created by the Cardiovas-cular Research Institute at Washington Hospi-tal Center. Check out the CardioTube section for education videos and seminars on the lat-est in research and cardiovascular technology.
European Society of Cardiologywww.escardio.org/knowledge/guidelines
Comprehensive guidelines on pathogene-sis and how to treat wide variety of cardiol-ogy conditions. Access is free after registration with the option to download a PDA version to carry with you.
British journal of Cardiologywww.bjcardio.co.uk
Get free unrestricted access to the bimonth-ly BJC online along with a searchable archive dating back to 2002.
Cardiosourcewww.cardiosource.com
The website of the American College of Cardi-ology and the JACC. Homepage includes a use-ful review of cardiology articles in other jour-nals and a wealth of case studies.
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mEDICAL STuDEnTSTEChnoLoGy 17
I t’s 4am and sleeping medical students at the University of Central Florida College of Medicine are woken abrupt-
ly by a call from a “virtual patient”. The computer-generated patient, speaking like a real human being, complains of chest pain. Bleary eyed students then need to advise and treat their “virtual patients” – the results forming part of their course evaluation.
This high-tech teaching program, called MyCaseSpace, is being launched next year at UCF with more than a dozen further uni-versities interested the software. It was devel-oped by UCF Assistant Professor David Segal, who developed the program for his health classes so students could learn how to properly evaluate and diagnose conditions.
“It’s interactive and a way to make it fun for students while they learn to make bet-ter decisions,” said Segal. “And they learn. There’s an assessment tool built into this program to validate that the technology is enhancing their learning.”
Throughout their four years of medical
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school students will have to advise “virtu-al patients” with symptoms ranging from a common cold to cardiac problems. The sys-tem allows tutors to add basic science and clinical cases to each scenario to supplement the curriculum.
Interactive patients
The “virtual patients” speak 13 languag-es with varying accents, can sneeze, cough and even go into cardiac arrest. The symp-toms displayed relate to the lesson plan for a particular week or conditions that students have learned recently.
Segal also points out that the system can be programmed for the “virtual patients” to make emergency calls to students in the middle of the night or to visit a virtual clin-ic for a check-up. Patients can even have demanding family members for the stu-dents to contend with.
“This is an amazing program that brings learning alive for students,” said Jim Wol-ford-Ulrich, an associate professor at Duquesne University in Pennsylvania. “This model allows for experiential learning for students on line.”
The software is due to be rolled out as part of the UCF teaching programme in autumn 2009.
www.ucf.edu
Images courtesy David Segal and Thomas Alan Smile
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DIARy20
* Names have been changed to try to keep our cardiology SpR in a job - though she’s doing a pretty good job of trying to lose it without our help!
MoNDAy If you’ve been following this column you’ll realise that I only
have six months before I become a consultant. Try as I might I can’t put it off any longer. This, plus I found out that my last boyfriend, David, has ended up married with children has led me to seriously evaluate my life. When I left medical school I was convinced that I’d have my own family by this time, be working in a small district hos-pital, own a land rover and maybe even a dog. I always wanted to do cardiology but somewhere along the way between my MD and the angio lists I forgot to get the husband and three children.
On Monday morning I made it through the ward round rela-tively painlessly. Surprisingly the FY1 didn’t mess up too much and had even arrived early to type up a nice list of the troponins on CCU. Bless his little heart. I spent the afternoon dictating letters and doing paperwork. I left by five and went home for a long bath and an early night.
TuEsDAy On-call today. Shockingly I’m on with my own team which has
never happened since I’ve been working here - I feel like checking with the BMA to make sure we’re not violating some sort of rule! The morning is spent doing rubbish but in the afternoon we get a little busy.
I send a fifty-year-old lady with sepsis secondary to a UTI up to intensive care after much argument with the ICU consultant. He suggested we take her to CCU as, in his own words, all she needed was ‘a little drop of noradrenaline to make her happy again’. Not on my watch. Later we had a Guillain-Barré who needed non invasive ventilation and a young man with a good going infarct that we took straight to the cath lab.
By the time I got home at eleven I ate a slice of cold pizza and crashed into bed. I’d always told myself that I would stay away from general medicine but if I did end up in a teaching hospital doing pure cardiology then I’d definitely miss it.
wEDNEsDAy I have an angio list this morning. Douglas, my boss, is nowhere
to be seen. I know he’s around somewhere though so I start and subsequently end the list without him. After lunch I do a quick ward round and a couple of echoes. I finish off a paper I’m writing on the use of drug-eluting stents before Douglas calls me into his office. We start chatting about jobs and how things are in general when he suddenly drops a bombshell. The hospital, now a founda-tion trust, has been given funding for a new consultant post starting in six months. Am I interested? If I were I’d be the only woman on a team with five men, not to mention the youngest by more than two decades.
I tell him that provisionally I am before asking him whether his question was a polite enquiry or a firm job offer. He smiles as his mobile goes off. One of his private patients has developed chest pain post cath. As he leaves he tells me to give him a firm answer by the end of the week. That’s the problem with being a cardiolo-gist. You feel the pressure to do private work and then as the money rolls in the problems stack up and you soon find yourself on call 24 hours a day, seven days a week.
I get home by six and spend the evening making calls to all the friends I’ve been neglecting over the past few weeks. I tell no one about the job offer.
THursDAy The day goes by pretty quickly. None of the bosses are around
apart from John who’s a complete idiot having a permanent mid-life crisis. He puts his arm around my shoulder and tells me to give him a call if I have any problems. This is pretty unlikely as he knows less cardiology than me and even less general medicine than my FY2.
I spend the afternoon doing echos before going out with the team for a drink. It’s the monthly mess night and they persuade me to follow them to a dingy bar. Peroni, red wine and vodkas with grapefruit juice are a bad combination for anyone - but disastrous for me. I end up pulling two guys one of whom looks suspiciously like a cardiology HCA. I go home alone and fall asleep immediately but not until I have thrown up in bathroom.
FriDAy Surprisingly I only have a little hangover but I guess that’s part-
ly due to the fact that much of the alcohol ended up in the toilet. I get through the ward round with two litres of Evian and spend the afternoon reviewing patients on CCU. One of them decides to have another MI so I take him to the cath lab and do the angio myself. He should make a good recovery.
That’s why I love cardiology. Unlike much of medicine where you have to wait to see if your potions have worked, when someone comes in with chest pain you open up their heart vessels and they’re cured - at least until they have their next one.
But I’ve always told myself I’d never end up in a teaching hos-pital mainly as working here wouldn’t be the best environment to meet someone and settle down. I spend rest of the afternoon in a nearby cafe drinking lots of coffee and even more water. I go back to see Douglas before the end of the day. I knock on his door and as I walk in he looks up and smiles.
I’ve made my decision.
SECRET DIARY OF A cardIoLoGy spr
fInAnCE 21
is there a change in the retirement age?For members of the original scheme,
normal pension age remains at 60 with the option to retire earlier on reduced benefits. Under the new scheme the normal pen-sion age is 65 and early retirement is only allowed from 55.
Do i get a higher pension if i work beyond my normal retirement age?
Under the new scheme you receive extra pension if you continue working beyond normal pension age. Under the existing scheme there is no enhancement in your pension if you delay your retirement, other than normal pension accrual.
Do i have to pay higher pension contri-butions even if i stay in the existing pension scheme?
Yes, both schemes cost the same. Instead of the previous flat rate contributions, a sys-tem of tiered contribution rates based on earnings now applies - 6.5% if you earn between £20,225 and £66,789. The new contribution rate will apply to the whole of your earnings.
Do i get more pension for my money?
The accrual rate of 1/80th of final salary
for every year of service remains the same for the existing scheme. The accrual rate under the new scheme is 1/60th.
How is the tax free lump sum calculated now?
Under the existing scheme there is an automatic entitlement to a tax-free lump sum of three times your annual pension. You can now top this up to a maximum of 25% of your total pension benefits by ‘commut-ing’, or giving up, part of your annual pen-sion for cash. For every £1 of annual pension you give up, you will get £12 of lump sum. Under the new pension scheme, there is no automatic lump sum entitlement but you can also commute your annual pension and take up to 25% of your benefits as cash.
Are there any changes in the way that my final salary is calculated for pension purposes?
Under the existing scheme, your pen-sion is still based on your best year’s pay within the three years prior to your retire-ment. Under the new scheme, it is based on the average of the best three consecu-tive years’ pay within the last 10 years. This makes it easier to reduce your responsibili-ties and take a lower salary in the run-up
to retirement without damaging your pen-sion. Under the existing scheme this has also been made easier through new “step-down” arrangements.
Can i still buy added years to top up my pension if i stay in the old scheme?
Added years contracts are no longer avail-able although existing contracts will contin-ue to run. Instead, under both the old and new pension schemes, you can buy a fixed amount of extra annual pension up to a max-imum of £5,000 in blocks of £250. The extra pension is increased in line with inflation but it won’t be related to your final salary.
Any other changes?
Survivor pensions are now also payable to common-law spouses or same-sex part-ners where a relationship has lasted at least two years and are payable in all cases for life, regardless of any future relationships. Chil-dren’s pensions will be paid until age 23 in all cases or indefinitely if a child is disabled.
Members of the existing scheme will have the option to switch to the new one between July 2009 and June 2010. Once the transfer terms have been published, dis-cuss your options with a financial consul-tant before making a final decision.
Specialist financial services for doctors• Savings and Investments
• Retirement Planning
• Life and Income Protection
• Mortgages and Insurance
• Personal Loans andBank Accounts
0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk
focus on finance - in association with Wesleyan Medical Sickness
NHS pENSION SCHEME CHANGESWhat they reaLLy MeaN
A new pension scheme was introduced for members of staff joining the NHS from 1 April 2008. The original pension scheme continues, with some modifications, but members will have the option to switch to the new scheme if they prefer.
The above information does not constitute financial advice. Wesleyan Medical Sickness provides specialist financial advice for doctors. Telephone 0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk
Let MPS take care of your protection
For more information call 0845 718 7187email [email protected] Or visit www.mps.org.uk
� Largest mutual medical protection organisation operating internationally
� 24 hour medicolegal advice line
� Operates in more than 40 countries around the world
� Risk management resources available online
2504 magazine ad 190x60 10/11/08 13:55 Page 1
Mr s cLaUsOBESITY
S anta isn’t just big-boned. He isn’t ‘jolly’. He is obese, with a BMI of well over 35. Obesity, espe-
cially central or waist-predominant obesity, is an important risk factor for ‘Syndrome X’ - the clus-tering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These include diabetes mellitus, high blood pressure, high blood cholesterol and combined hyperlipidemia. Apart from metabolic syndrome, obesity is correlated with a variety of other complications (all with TLAs), ranging from cardiovascular (CHF) to gastrointesti-nal (GoRD) and psychological (BDD). The answer is clear: Diet or Die Santa.
CYCLOTHYMIA
S anta locks himself away from the world for the majority of the year, not speaking to anyone
(except for his ‘elves’) and then appears incredibly happy, overjoyed with everything and unable to stop laughing. He doesn’t sleep, excessively spends his money buying presents for all and then jumps in his vehicle and speeds off - all the while dressed in bright colours. A word of warning, high mood such as this is followed by irritation, recklessness and sexual disinhi-bition – so watch out Rudolf!
ALBINISM
H is head, beard and eyebrows are white as snow. The most likely diagnosis
would be Albinism, a genetic abnormality where no pigment is found in human hair,
eyes or skin, making the eyes blue, the hair white, and the skin pale. It would also explain why he is only seen at night - he lacks mela-
nin, a protective pigment in his skin, burning eas-
ily from exposure to the sun and suffering from photosensitivity.
RED FACE
A ll those years of children leaving out ‘a little glass of whiskey to keep Santa warm’ may have left him
with a problem. Long-term alcohol use causes cirrho-sis of the liver. As this stops working and begins to shut down the results are multi-systemic signs. The tiny blood vessels in his face burst leaving a perma-nent red face, nose and cheeks. This would go well with his jaundice, clubbing and gynaecomastia. It would also explain why he always wears gloves and baggy clothes - and why the glass you left was always empty in the morning.
HAEMORRHOIDS
S anta’s sleigh doesn’t look very warm and cosy. Assuming he starts off from snow-covered Lapland
and travels all across the world he must spend an awful lot of time sitting on a cold, hard seat. He doesn’t appear to have much time for toilet breaks either. Too much pressure on the rectal veins due to poor muscle tone or poor posture, coupled with obesity, sedentary lifestyle and postponing bowel movements has been proven to cause haemorrhoids. It must also be very difficult for Santa to get help - he can’t exactly pop down to his local chemist for a tube of Anusol.
SExUAL FETISHES
H e is a grown man who is always seen in the com-pany of elves, children or a red-nosed reindeer.
But just in case he happens to be reading this I’m not saying anything else. I wouldn’t want to go on his naughty list ...
Assessed by Gil myers
MEDICAL REpORT
hoSPITAL mESS 23
Enough to make your top pop at:
£1.20 UCH, London
Fizz-tastic prices at:
90p Royal United Hospital, Bath
Prices to get you in a flap at:
£1.10 Mayday Hospital, Surrey
Fill yourself up at:
75p Bronglais Hospital, Aberystwyth
Slipping up on healthy eating at:
60p Whipps Cross Hospital, Leytonstone
Potassilicious:
30p Royal Free Hospital, London
Next issue we’re checking the cost of Celebrations Chocolates (460g), Bic ball pen and a ‘Get Well Soon’ card (cheapest). Email prices to [email protected].
W hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of
a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:
royaL free hospItaL, LONDONOur own staffed lunchtime kitchen serv-ing hot food. A bar (yes, an alcohol serv-ing bar!). A balcony to enjoy the summer sunshine when it arrives. Newspapers. A stocked machine dispensing Marks and Spencer sandwiches and ready meals. Tea/coffee. Reasonably comfortable sofas for on-calls. £10/month.
JuniorDr Score: ★★★★★
Coca-Cola (500ml bottle)
Chocolate flapjack
Banana
‘Writing in the notes’ is our new regular letters sec-tion. Email us at [email protected].
Writing in the Notes
fewer hours but falling salaries
Dear Editor,
I am repeatedly troubled by policy suggestions
that doctors’ hours should be reduced further (‘Few-
er working hours could dramatically reduce mistakes’
Iss 10, p4). The EWTD has seen our training slashed
and I have not noticed any analysis of whether that
alone is putting patients at risk. Doctors should be
able to cope easily with a 56-hour week – those who
cannot should seek employment elsewhere. Haven’t
we also seen our salaries plummet enough? It was fine
when we were banded but as this gradually disap-
pears I feel unvalued and unmotivated. That alone is
enough to affect our care.
SARAh LIDDon
ST3 SuRGERy, LonDon
hard to find bad doctors?Dear Editor, As a GP I was initially worried by the launch of a website that allowed patients to post negative com-ments about their doctor’s care (‘Doctors fear abuse of ratings website’ Iss 10 p4) but after visiting the site I am more worried that they are not! There is an over-whelming lack of critical comments and the cynical side of me feels that patients views are either being censored or doctors are rating themselves. The site could be a useful resource but it shouldn’t be a way for doctors to inflate their egos.
nAmE WIThhELDGP, WoRCESTERShIRE
dr Nick riviera is a fake!
Dear Editor,
I think you have been fooled (‘Dr Fairytale
is a fake’ Iss 10 p23). Nick Riviera stated that Dr
Fairytale could not have assessed Homer Simpson
as he has ‘not once attended a doctor’. As is evident
from Mr Simpson’s poor physical condition he has
seen many doctors – not least when he underwent a
triple bypass operation (Episode 11, 4th Season). I
should also point out that Dr Nick Riviera himself is
a fraud and has a ‘Club Med School’ degree hanging
clearly on his wall.
ThAnAm vISvAnAThAn
mED STuDEnT (AnD SImPSonS fAn)
MPS professional support and expert advice
� 24 hour medicolegal emergencyadvice line
� Medicolegal publications– Casebook and New Doctor
� Risk management materialsincluding medicolegal booklets
� Online resources includingfactsheets and case scenarios
� Educational support throughdiscounts with leading publishers
There are many benefitsto membership:
The Medical Protection Society is the leading provider ofcomprehensive professional indemnity and expert advice todoctors. MPS offers support to members with legal and ethicalproblems that arise from their professional practice and activelyprotects and promotes the interests of members and the widerprofession.
For more information call 0845 718 7187Or visit www.mps.org.uk
The Medical Protection Society Limited. A company limited byguarantee. Registered in England No. 36142 at 33 CavendishSquare, London W1G 0PS.
MPS is not an insurance company. All the benefits ofmembership of MPS are discretionary as set out in theMemorandum and Articles of Association.
2504 junior doctor ad A4 10/11/08 14:00 Page 1
