Category: nhs

health, nhs, Uncategorized

Lovely day

clcopeland

It’s that time of year again – changeover week. This changeover, more than others, is a particularly busy time.  It’s when our new FY1’s start.  No longer are they on the wards or in libraries learning the theory. Now it’s time to put it into practice.

It’s both terrifying and exciting!

This year I was again involved in the ‘Preparation for Practice’ course that our Resuscitation team and Simulation Centre organise.  The day takes our new doctors through an array of simulated scenarios using Forth Valley specific paperwork and protocols.

The team involved is huge and varied reflecting the breadth of the expertise involved in caring for our patients and keeping them safe.  What I particularly liked was the involvement of our current FY1’s.  They were brilliant in offering practical tips but more importantly reassurance that it will all be fine. It was also lovely to see how far they’d come since taking part in the same program the year before.

For some though the reality of it all became a bit much. The day came at the end of a long week of induction and shadowing. The scenarios are specifically designed to be as realistic as possible but with an emphasis on a safe learning environment.  However no matter how much you tell yourself the ‘patient’ bears a striking resemblance to your FY1 shadow buddy the situation is real.

There was a dawning realisation that patients don’t behave like they do in textbooks.  They don’t tell you what’s wrong straight away.  You have to work it out based on the clinical exam. You have to have the confidence that you are hearing crackles in the chest and not just the rustle of the sheets on the bed. Then there’s the tests.  Why do they not come back straight away?  Of course that’s assuming you can get bloods off them – some don’t have great veins or are so confused they wont let you near them.

However there’s a sigh of relief when it becomes clear what’s wrong. A plan can be made and treatment started.

In my scenario however our patient didn’t respond to treatment and began to deteriorate.  In real life that happens and it is stressful.  As a doctor (or a nurse) to try your absolute best and see it not working is the worst feeling.  The time that you were willing to speed up to get the person better you now wish would slow down to give you more time to fix them.

One of the objectives of our scenario was how to have those difficult conversations when things are clearly not getting better.  My role was to demonstrate a positive discussion about a treatment escalation plan. Any conversation that involves resuscitation has to handled with great care and sensitivity but always with the intention of doing the right thing by your patient.

After the scenario had finished we had 15mins to debrief and discuss what had just happened.  Pretty much everyone thought they had done terrible.  Of course this wasn’t true but that’s what this particular stress does to doctors and nurses.

In real life what also tends to happen (especially out of hours) is they will be asked to immediately go straight into another high stress situation.  There is precious little time to write up notes never mind reflect on what went well and check everyone, including yourself, is ok.

This kind of chronic stress was something that was never really talked about or acknowledged when I first qualified.  Some twenty years on and induction programs now include sessions on well being and stress management.

As I was writing this Bill Wither’s song came on the radio with the lyrics:

‘When the day that lies ahead of me
Seems impossible to face
When someone else instead of me
Always seems to know the way’

I took this as a sign!

So as our new doctors take to the wards I can’t make the patients behave in a more predictable fashion.  Nor can I take away the feeling of nausea.  I can however ask how it’s going and buy the coffee. So to that end I know it’s going to be – a lovely day…..

 

geriatrics, nhs

Free, free, set them free

clcopeland

 

This week I’m in Nashville for the American Delirium Association Conference (#ADS2017).  Day one was heavy on education and although I was familiar with most of the content I always find it interesting to hear how others interpret and explain things. One session on delirium in the Intensive Care got me thinking:

Screen Shot 2017-06-04 at 19.30.04

Now when you mention restraints to people in healthcare they will generally think about the kind that have people strapped to a chair or cot side.  Thankfully these types of restraints are no longer routinely used in the NHS.

There are some kinds of restraint that can be a good thing for example, the plaster cast that stops a fracture becoming displaced.

However what about the restraints we use by proxy?

As I sat in the lecture I got to thinking about what happens to a person when they are in hospital.  Last week I talked about the role of the environment in particular how it can be damaging to the person with delirium or dementia.  By making simple changes there is evidence that the person will get better more quickly, so of course the environment was number one on my list.

The #endpjparalysis campaign on social media also highlights it.  I recently had a patient comment she would like to get dressed but unfortunately her family had only packed her a nightdress. Most equate a hospital admission with serious illness however the aim is to get the person better as quickly as possible so we do need to see beyond that.  One could argue that a person’s dignity is restrained by having them rehabilitate (walk, eat etc) only in nightwear.

Which brings me on to 7 day access to a multi disciplinary team (MDT).  We know that early access to physio and occupational therapy can have huge benefits not only on the physical but also cognitive health of a person.  Could limited access to the MDT be a restraint by proxy?  I’m not so sure.  I do think they are spread far too thin.  I also think that some of the tasks could be done by others, in particular, our healthcare assistants.  I just wonder if they perhaps need to be more empowered to do so instead of just doing unto the patient….?

One thing that does not help in the early mobilisation of a person is the use of sedation.  It’s not just an issue for ITU, many of our older people are on medications that actively sedate them e.g. the ‘little sleeping tablet at night’, strong painkillers even some antihistamines.  I would argue that Geriatricians in conjunction with our pharmacy colleagues are good at trying to rationalise medications.  The community, especially care homes are not quite as good.

So coming back to the hospital setting both in acute and rehab here are a few other things that could be considered restraint by proxy;

  • urinary catheters
  • hearing aids that don’t work or are not fitted
  • no glasses
  • buzzers that are out of reach
  • empty water jugs and cups
  • inappropriate walking aids
  • no walking aids
  • no ‘getting to know me’ or ‘what matters to me’ discussions

Most would be horrified at the idea of going back to the use of physical restraints but I wonder if we realise all the other ways we achieve the same effect? Perhaps we ought to reframe the discussion so that as with straps, belts etc other restraints by proxy can become a thing of the past….

nhs

Go with the flow

clcopeland

laxative-articleMonday morning, post weekend on call. It’s not been the best in terms of bed capacity and ‘flow’ but we’re all still here.  Good enough?  Well possibly not. As I started my ward round I was paid a visit to tell me we were minus many many beds.  ‘Was I aware of that? It’s simply terrible. Please do whatever you can to make more beds become available’

‘No problem’ I replied.

There isn’t any point getting annoyed.  It’s not the first time I’ve been interrupted simply to tell me how busy it is.  I’ve even been summoned to meetings to tell me in person. After a fashion you tune out the white noise.

However I have had trainees and nursing staff remark to me;

‘What difference is sending one person home when we are minus 50+ beds?’

‘What I hear is I’m not working hard enough.  What about the times when everything is going well?  You don’t get pulled into a meeting to be told good job’

‘Do they think I’m sat on my arse twiddling my thumbs?’

So reflecting back on the weekend, it had all started so well.  The sun was shining and we had beds.

There was nothing especially remarkable about the case mix or the volume coming in.  This continued on into Saturday but by lunchtime it became apparent there was a problem.  No one was moving out of the acute assessment unit.  By teatime things were stuck.

It was clear that we were experiencing a severe case of constipation.  Every attempt to discharge precipitating colicky pain in the system. It was just too hard. By Sunday we had some flow but not the good kind.  It was the kind of overflow flow that goes into all the wrong places.

So how do you manage a bowel impaction secondary to constipation?  Well sometimes you need to decompress the situation through a naso gastric tube.  It doesn’t clear the blockage but it does make you feel better and able to cope with the pain.

So how do we achieve this in the NHS?  Well, we don’t really.  We just remind people how uncomfortable they are and imply it’s their own fault as they aren’t trying hard enough to move things along.

I think we should instead allow people to ‘decompress’ naturally. I’m talking about listening and acknowledging how hard it is. Allow people to vent. Once rid of all that hot air and bile you might find people are much more willing to offer practical help and suggestions.

Now that of course still leaves the constipation blocking the natural flow of things. I would recommend a variety of laxatives for this.

There’s the gut stimulant – perhaps the multi disciplinary team (MDT) in this situation.  Get more physio and occupational therapists. Or perhaps offer a targeted and focused MDT to get people up, help them with their walking, offer adaptations and support at home.

We have the stool softener – making the journey out that bit more pleasant. Our ward teams including pharmacy are key here.  Taking the time to explain to the person and their families what has happened and what to expect on discharge.  All of this neatly packaged into an immediate discharge letter and sent to their GP.

You also need to tackle things from the other end through a high phosphate enema.  To me that’s social work.  Get the assessments done, secure funding and either get the person home with the care package or into a care home as quickly as possible.  You will get an almost immediate result with this.

Employ all these strategies, flow returns, pressure is relieved and everything is that much better.  Ah…..

Of course as many of my older patients tell me, it’s best not to get constipated in the first place.  I am constantly being told that prunes are the answer. They are tasty, effective and cheap.  I guess that’s what integrated health and social care aspires to be (just not as cheap).

So will tomorrow be any better?  Marginally.  Will I do anything different to what I already do? No. Sometimes it’s best to just go with the flow…..

Leadership, nhs, Uncategorized

Everything is awesome

clcopeland

I have always considered myself a positive and naturally optimistic person but several events this week sought to test that.  To be fair some were truly awful. However there were some things that, in my opinion, restored an equilibrium.

The first was the news story about mental health as championed by William, Harry and Kate:

https://www.theguardian.com/society/2017/apr/17/prince-harry-grief-revelations-praise-mental-health-experts

I quite liked the honesty with which they talked about the British ‘stiff upper lip’ culture. This is such a ridiculous notion when faced with the tragedy of losing your mum at such a young age.  There is no silver lining or looking on the bright side.  It’s just bloody awful and should be treated as such.  That said I do think how they have channelled it into something good is remarkable.

https://www.headstogether.org.uk/about-heads-together/

They are not the only people who are able to do such things.  Look around and you’ll see people from all walks of life trying to create something good from terrible circumstances. It could be running a marathon for charity or volunteering.

There are parallels with our daily NHS life.  Recently I helped one of my trainees complete a near miss incident form. There was no harm and the patient and family were informed. The main thing from my perspective was to identify exactly what went wrong and more importantly how to make sure it doesn’t happen again.

The process of documenting failure is, by its nature, long, depressing and overwhelming negative.  There is no way to make it a positive experience for anyone. What you have to do though is pick everyone up and somehow turn it around. It’s a difficult one to balance as you want people to feel empowered to make a change but equally you’re trying not to diminish the mistake in the first place.

I believe we managed to achieve this balance.  A plan was made and over the next few weeks I am optimistic we will have something in place that ensures this particular incident will not be repeated.

Which then brought me to this quote that I saw the following day on my twitter feed (thank you @johnwalsh88): C91f2UvW0AAZKbu.jpg-large

This to me is much more reflective of who I am nowadays. I think it’s what we should all be to be honest. So with the glass half full I would argue that for every situation you hope for the best but plan for the worst.  To me that is about having plan A, B, C, D etc etc

This philosophy is reflected in a postcard I have on my wall at work that says ‘Failure is not an option’  It’s from the Apollo 13 mission. It makes me smile every time.  Now you may think I am deluded or living in denial but I agree with the statement. Failure is not an option.  You just haven’t found the option that works.  It is true of the NHS and in life that you will need to try out many different options until you find the one that works.

So on that note I go into another week with my eyes wide open, optimistic that it will be a good one. If it’s not, well, that’s just a chance to try out Plan B…

sc00633c8a

 

 

Leadership, nhs, Uncategorized

Enjoy the Silence

clcopeland

IMG_4402

I’m on holiday. Hallelujah!

When I eventually got home on Friday night I felt like I had literally crawled over the finish line and collapsed in a heap.

Cross covering colleagues immediately increases your workload however there is an understanding and clarity of what is expected during this time. My job is to keep our patients safe and lead the team.  I become much more directive Dr Copeland in order to manage my time to its maximum efficiency. This is especially important given I work 3 days. I also expect the team to know their role.  What is crucial is that we check in with each other just to make sure.

This clarification of understanding and expectation is something I do whenever I meet a new patient too. If you don’t and instead assume you will get something wrong.  I’m not talking about clinical mistakes where patient harm occurs. What I mean is the type of mental harm that comes from not explaining things properly or giving opportunities to ask questions.  Most importantly it is about setting expectations e.g. when a test will happen or when you might get home.

It also applies to non clinical situations.  This week I had the joy of manning the middle grade rota for the first time.  When I say manning, fire fighting is probably a more accurate term.  Without getting into detail, there have been issues.  I’ve done rota management in all of my jobs so this one didn’t particularly phase me. Yes, it’s complicated with all the rules around rest days, number of hours worked, days in a row, etc etc but not overly so.  What was surprising to me was the virtual tsunami of emails that came after it was distributed. No one was happy.

After a while a pattern emerged. It seemed to me what was missing was this fundamental clarification of understanding and expectation.  The specifics of promised swaps and annual/study leave requests while obviously important did not seem to be as important as acknowledgement of the request and when to expect a definitive answer.

I have come to hate the ‘death by email silence’ that occurs in the NHS.  In that vacuum a person can create all kinds of scenarios that may (or more likely) may not be happening in response to sending an email.  These assumptions can lead to all kinds of behaviours.  In a rota situation some may take that silence to mean ‘yes, have that week off’. Or it can have the opposite effect so the person can’t get to a family wedding, for example. Either way it leads to both an unhappy workforce and rota management team.  In my experience a simple ‘your email has been acknowledged. We hope to have an answer for you by X date’ can go a long way to defusing a volatile situation.

So as I put my out of office on there is an understanding that I will not be checking my emails.  My annual leave week is a time to relax in the company of family and friends.  The expectation is that when I get back to work I will be refreshed and ready to go again…

nhs, Uncategorized

It’s all about you….

clcopeland

The-World-Revolves-Around-Me

I’ve just finished another weekend on call.  They are increasingly a test of endurance.  I always feel not just physically tired but mentally drained after it. Perversely though I’ve always quite liked the acute receiving aspect of my job.  When you speak to medics they will say that it’s not the work they don’t like but the intensity of it.

It’s this intensity that has lead me to reflect on some people’s behaviours and attitudes when on call, myself included.

This weekend was not as busy as some have been lately. That said there was the odd surge in demand. During one of these our Emergency Department began to struggle as they were short staffed.  The solution?  Pull one of our middle graders through to help cover until their shift change and staffing numbers would be restored.  Sensible? Yes, very.  We were managing just fine.

However this was not greeted with universal agreement or understanding. There was a huge sense of injustice about it ‘no one helps us when we’re short!’ This carried on into handover with mixed responses from the rest of the team.

It settled quickly and life went on as before.  I did debate at the time whether to get involved in the discussion but I didn’t.  In part I was mid writing up my own notes and also being tired I had a sense I may be somewhat clunky in my feedback.  I may have been thinking:

’Quit moaning, think about the patients, it’s not all about you, so can it!’

However there was a danger that with my feedback filter turned off I would actually say just that so I stayed mute.

Also I’ve been there myself.  I understood where this person was coming from.  As a middle grader I was, at times, the biggest pain in the arse when on call.  I couldn’t see further than my own nose never mind thinking about my colleagues.  I did however put the patient at the centre of my various rants.  I also thought for a long time this would make me beyond reproach when it came to the effect I had on others.

While I accept the patient’s needs are paramount I would strongly argue do not forget about your colleagues.  This point was reinforced with a stroke thrombolysis situation I had recently.  The phone rang at 4.35pm just as I was starting a mountain of paperwork.  I wasn’t on call that night so was hoping to get away on time.  I was told there was a person in the emergency department who was FAST positive. Realising that I was going to be at least another couple of hours I actively sighed down the phone at my colleague. I was also about to start moaning when I decided to button it and go downstairs. My ED colleague was also a little fed up.  They’d had to come in on a non clinical day to cover staff absence.  All our issues were put to one side however as we focused on dealing with the person who was having an acute stroke.

The treatment went very well and the family were delighted.  It was at this point I felt I could leave.  I thanked everyone in the room and went to chat to my colleague.  We chatted about each others pressures and frustrations long enough to feel equilibrium had been restored.

At times all I hear is staff saying ‘what matters to me’ but not asking their colleagues ‘what matters to you?’  We need to realise that its likely to produce the same response.  Be person centred but not to the extent that it’s all about you….

nhs, Uncategorized

I like to move it, move it

clcopeland

IMG_4723

 

A phrase I often use in the TIA clinic is ‘you’re getting an MOT of sorts’.  What I mean by this is I’ll take a history, carry out an examination, check some bloods, do a few scans and get an ECG. It’s a pretty comprehensive assessment.  People seem to like that turn of phrase – it’s familiar and it’s reassuring.

With this in mind I decided it was probably about time I carried out a similar type of MOT on myself. Like medicine you need to know what specialty to refer to.  To my mind life MOTs fall into 6 main areas:

  • health
  • fitness
  • financial
  • legal (POA, wills etc)
  • spiritual
  • relationships

I’d pretty much done the health MOT to death in recent years so figured I could skip that.  Other areas are also in good shape so I turned my attention to fitness.

Since changing jobs a year or so ago I now get loads of fresh air and exercise thanks to all the walking I do in my commute.  However my favourite thing to do is swimming.  The problem is that my local pools are all quite far away and usually shut on weekends for lessons.  So I joined a  gym. Well, technically I joined a swimming pool I suppose.

Included in my gym membership was the opportunity to undergo a fitness MOT.  Being in the proactive/worried well section of the population I signed up immediately.  My first assessment was last week. As excited as I was to know what my VO2Max was (?!?) I just  wanted to know I was generally in ok shape.  Turns out I am. Hooray!  However my celebratory mood was cut short when the assessor said ‘aye but you doctors never stick at it’ This mildly irritated me although I wasn’t entirely sure why.  My response at the time was to point out that the gym is intensely boring and I’ve no idea why anyone would want to ‘stick at that either’.  I felt I had the moral high ground with that…

For me exercise has never been about the fitness side of things – I use it as stress relief and relaxation.  If I get fit, so to speak, it’s purely by accident.  I know many medics who view exercise as something else to be wildly competitive at.  There are others who periodically train for something e.g. a triathlon or 10K and then not go back to it.  For the rest it’s simply that they do not have the time or the energy to do anything other than pour a glass of wine or flop into bed.  I would argue that it’s this type of fatigue that can lead to feelings of guilt which in turn can make stress levels worse.

One thing I would like to do is suggest medical staff wear pedometers. To start with I think it would surprise many to see just how far they walk in a day.  During an average on call  I can walk 4 – 5 miles yet somehow it’s not perceived as exercise. My legs would argue otherwise!

So while I entirely support initiatives to improve the health of NHS workers I do think we need to better recognise covert exercise. The type that many do everyday but don’t realise. With this in mind I’m going to get my colleagues some pedometers to see who is the most traveled within the realms of FVRH. I suspect the notion that we doctors don’t stick to any kind of exercise program is a misnomer.  It’s just our gyms are the corridors of the hospital…

nhs, Uncategorized

Human touch…

clcopeland

michelangelo-creation-of-adam-index

When you’re asked to give a presentation on something they tend to come in runs.  Some are easier to prep and deliver than others.  For example I’ve spoken about delirium on many occasions. Usually I just need to tailor the format and content to suit the audience.

This time I’ve been asked to speak about social media and its role in medical education to colleagues at the Scottish meeting of the British Geriatric Society. The meeting isn’t until 3rd March but starting to prepare early is always a good thing.

It’s a bit difficult to know how to pitch it to be honest.  There will be some who are active users but just as many who view social media with an element of both suspicion and derision. It’s also the last session of the day which is always a bit of a tough gig.  Usually by the end of any conference my concentration is waning and all I’m thinking is ‘Can I get home ahead of the traffic?’ I suppose given the topic it shouldn’t matter when I’m speaking.

Getting down to business though, if social media thrives on discussion and sharing, then why was I trying to prep this talk by myself? I decided to turn to the ‘Twitterati’ and ask this question:

screen-shot-2017-02-19-at-19-41-26

Of the 23 replies I received, there were only a couple of negative comments, although you could argue I was somewhat preaching to the converted.

One of the themes coming through seemed to be its role in developing resilience. For all we talk about team work in the NHS there is a degree of silo working that still occurs. It’s not always through choice but usually as a result of time and geographical limitations. Social media, in particular Twitter, manages to breakdown these barriers.

I also presented a very rough draft of my talk at our departmental meeting. I figured there’d be a good mix of people from which to gauge opinion.  Of course, any talk about social media relies on connectivity. Working where I do however, is like working inside a nuclear bunker with its lack of mobile signal and WiFi.

We talked about it rather than engaging with it – not ideal when trying to promote its educational benefits. The lack of WiFi is already a contentious issue and not just with staff and students. Many patients also don’t understand why they can’t just connect. This lack of connectivity can make a hospital stay seem longer and more lonely.  The current vogue for single rooms in new build hospitals only perpetuates this.

There is an advantage to patients being able to get online to look at resources relevant to their illness or condition in real time.  Although I always ask if they have any questions on my ward rounds the ability to look online (or ‘Google’) may further improve the persons’ hospital experience. It would also allow me to signpost them to various websites.

To my mind you then have an educational ward round that meets the needs of everyone, not just the doctors or nurses but also the patients and their relatives.

Technology and social media may blur the lines between virtual and real life but the basic human need for connection will remain the same. In my opinion it is this that makes social media and medicine so intertwined. And so necessary……

education, nhs, Uncategorized

Man (or woman) in the mirror….

clcopeland

img_4962

Last night I went to see the Lego Batman Movie – it was hilarious! Like most multi layered kids movies there was something for everyone.  The main message however was around reflection. Just incase it wasn’t obvious the soundtrack included Michael Jackson’s ‘Man in the Mirror’ just to hammer the point home.

So as I start the week as faculty on the RCPSGlasgow Clinical Education Certificate course, reflective learning was very much at the forefront of my mind.

The course itself is targeted at all grades from FY2 upwards and across the medical and dental community.  We had 12 delegates on the course predominately dental and surgeons.  The aim is to teach several aspects of clinical education including things like the clinical environment, techniques on delivery and feedback. Throughout the course reflective practice is incorporated at every opportunity.

One of the big questions on the first day was how do we turn superficial learners into deep reflective learners? Or to put it another way how do we facilitate the transfer of learning from the classroom to the real world?

It prompted a fair bit of discussion.  There was general agreement that we should be moving away from didactic teaching to a more applied, problem based learning.  This isn’t exactly a new concept. Quite a few medical schools have done this already with varying degrees of success. Most agreed that at undergraduate level a balance needs to be struck but how do you incorporate reflective learning? More to the point what are you reflecting on at this level?

So mulling on this we moved to the postgraduate world where the problem seems to be the other way round.  I had previously commented that in my experience doctors ‘expect to be taught’. There are teaching programs across the specialties with defined learning objectives delivered by senior medical staff in a lecture style.  Departmental teaching is also pretty didactic (with the odd bit of discussion at the end, usually Consultant lead).  Even conferences are turn up, sit down, listen, tick your CPD box, move on.

Where is the reflection?

Now I appreciate that CPD diaries and e-portfolios do ask us to reflect ‘what did I learn?’ but do they really capture those practice changing moments? Or is the reflection merely dictated by the predefined learning outcomes?  Do I really care at the end of the day…?

I think proper reflection should at its heart have continuous professional development and patient safety. There is the process mapping and dissection of a clinical skill or scenario.  What I like to call the mechanics of learning.  I think though what we struggle with in the medical profession is the softer side.  For example we spoke about different learning styles.  To some a this was a revelation in itself.  Are you a visual or an auditory learner? Do you operate in the cognitive or the psychomotor domain?

For me the discussion brought out other thoughts. I came to the conclusion that I need to come out my comfort zone and use learning techniques that I find hard.  If we believe that education should be taught through the learner perspective I think I might be disadvantaging them by only using techniques that come naturally to me.

And so this is why I love education at the end of the day.  It has the power to challenge preconceived notions and learn new skills but most of all it has the power to refresh the mind.

So….

‘If you want to make the world a better place

Take at yourself and then make that

Change

(nah nah nah nah nah nah nah nah nah….)’

nhs

‘Choose your future. Choose life.’

clcopeland

mp550x550mattefffffft-3

Over the last few weeks I’ve had conversations with several of our middle graders about their career path.  They’ve spoken candidly about uncertainty and doubt in their choices.  There’s a sense of feeling rushed into career decisions.  There’s also the perception that once you’re on that path you can’t change.

Our junior doctors are feeling trapped.

I’ve talked before about how training has changed even in the time I’ve been qualified.  However even by the end of my PRHO year I felt that I should have a vague idea of what to do.  The options put to me were not that great.  I was not a ‘high flyer’ so a medical or surgical rotation was unlikely.  I also wasn’t academically minded so research was out too. My choices were go to Australia or get on a GP rotation.

Back in the mid 90s general practice was thought of as the career choice of women wanting to be part time and/or have families. Nor was it a speciality that many got excited about. Now before I alienate all my GP friends and colleagues that was not how I viewed it but it was how many saw it back then.

I wanted to become a GP as I was attracted to the diversity of work it had to offer.  I was however a little hesitant about going straight into being a GP registrar with only a year of medical experience.  I worked in rural Northumberland doing a 1 in 4 on call and Saturday morning emergency surgery.  We weren’t part of a co-operative so all the out of hours were managed solely by the practice.

It was one of the hardest jobs I’ve ever done.  There was no learning curve per se – it was a straight up line.  It was however where I learnt about perspectives, the patient/doctor/carer agenda and safety netting.  It’s also where I learnt I did not want to be a GP. I didn’t think it was the right fit for me.

However bearing in mind what I said earlier I felt I had little option but to continue doing jobs that might get me to the end of GP training.  At the back of my mind I also wondered if it could help get me on a medical rotation.  So I went freelance.  I resigned from the rotation, moved to Glasgow and started doing a variety of jobs.

I look back on this time with great fondness. I like to call them the ‘faffing about years’.  In that time I did jobs in several different hospitals in Geriatrics, A&E and General Medicine.

I toyed with Cardiology as a speciality but research put me off.  It wasn’t until some 4 years later I thought about Geriatrics.  I think bringing that degree of life experience and professional maturity really helped.  I’d never considered Geriatrics before.  I brought with me a wealth of understanding that stretched from primary care to the ED and into the rest of secondary care.

So as I listened to people talk at a recent education meeting how ‘broad based training’ is simply wasting time and lacks focus I became a bit depressed. I found myself  back in 1996 and our Dundee Medics review. It opened with the now infamous monologue from Trainspotting.  It was given a medics spin though:

‘I chose not to choose life.  I chose something else.  I chose medicine’  

Choose your future indeed but perhaps that ought to include time to faff. Try out different specialties, see what one fits. Choose life.