An article in the BMA newsletter today says that 23% of the junior doctors in paediatrics in NHS Lothian are apparently on maternity leave at the same time. Same problem in Dundee's GUM clinic by the looks of things, yet another teaching session cancelled today, and it seems to be all of the important one's I'm missing too! Will need to catch up at a later date.

Sat in the gynaecology out-patient clinic today and saw three patients:

1) Investigations for ovarian cancer: CEA, Ca125. Follow up appointment, previous 'borderline' ovarian tumour. Found out that 15% of epithelial tumours are 'borderline', they show epithelial proliferation but no stromal invasion, tending to behave as a low grade malignancy. Removal of these tumours is ususally curative, as in this case.

2) Patient with a large anterior intramural fibroid in her uterus. Discussed with her and her partner the various surgical treatment options avalaible to her and talked about some of her concerns about having a hysterectomy. Found this really interesting and discussed it in greater detail in my RoCE.

3) 73 year old female patient complaining of faecal incontinence and bilateral leg oedema. This was a follow up appointment following wide local excision of a vulval carcinoma in '07. Unfortunately the patient was quite embarrassed by her problem, understandably so, and I felt quite awkward discussing it with her. Need to work on that because it probably doesn't leave a particularly good impression to the patient if the doctor finds talking about their problem awkward.

The registrar recommended a useful website to me, www.scan.scot.nhs.uk
It stands for the South-East Scotland Cancer Network and provides excellent guidelines in the management of not just gynae cancers but covers all specialities.... worth a look!