Keeping up with the NEWS

The London Olympics kicked off in dramatic style this weekend with a stunning opening ceremony. I've been hooked to the TV all weekend - hopefully some gold medals to come for Team GB! Apparently the GMC has granted temporary GMC registration for 849 doctors from 141 countries to help support the athletes. France has sent the most doctors (58 to support their 333 athletes). Compare this to the 18 doctors who are going to be supporting Britain's 542 athletes! We must be confident! It was good to see the NHS represented in the opening ceremony - the trampoline hospital beds for the kids was a fantastic idea.

Tomorrow is my last day as an FY1 doctor and I'm about to start at a new hospital at the dizzying new heights of FY2 (foundation doctor two). It's been a good year, ups and downs but overall enjoyable. Not long now until the serious matters of application to specialty training come into the fold. I'll probably put that off until AFTER the marathon (running 5 times a week and working full time doesn't leave much time for anything else!).

New Maggies Centre at Gartnavel, Glasgow

 <----This is the new Maggie's Centre which has been shortlisted for the Royal Institute of Architects' Stirling Prize. I visited the Maggie's centre in Dundee which I'd probably describe as a resource or meeting place for patients with cancer, offering a tranquil and relaxing environment away from the miserable hospital wards which can be depressing places to spend time, particularly I'd imagine for patients visiting regularly for chemo/radiotherapy. I think that these buildings are fantastic and looking at the photos of this new centre in the Glasgow's west end I think it will be equally successful. 

An article which I read in the BMJ News caught my attention this week. This was the proposal that a national early warning prediction score is adopted which is the same in all NHS hospitals. When I learnt about improving patient safety as a fifth year medical student, much emphasis was placed on the importance of reducing variation to improve patient safety. Currently in the Victoria Infirmary we use a "SEWS" (systemic early warning score) but in other parts of Scotland a "NEWS" (national early warning score) is being introduced. I think that this is a great idea. There must be more areas where we can reduce variations in our hospitals, such as with national agreements on evidence based best practice. With Wednesday being the big 'change-over' day, many doctors will move to new hospitals in new cities and health boards. If everything was standardised, less mistakes would be made and no doubt patients would benefit. I am a big believer in reducing variation to improve patient safety in our hospitals.

Sports Energy Drinks

Bradley Wiggins - Amazing Achievement!!

It was great on Sunday watching Bradley Wiggins cross the finish line of the 99th Tour de France as overall winner. What made the day even better for Team Sky was that Mark Cavendish won the sprint on the day, his 23rd stage win. While Bradley Wiggins took much of the attention, Team Sky showed that it really was a team effort in the end. Wiggins could have just let up in the last few laps of the Champs-Elysees, savouring the moment, waving to the crowd - but instead he was leading the peloton into the final sprint to help tee up Mark Cavendish to sprint to the finish for the win. It was an amazing achievement for British cycling and with Chris Froome finishing second overall, I don't think we'll ever see such a dominant performance from a British team in the Tour de France. It's incredible to think that some of these guys will be getting up, dusting themselves off and starting training for the Olympics, which starts in just four days time.

Keeping on the subject of sport, the BBC's Panorama ran an episode last week in conjunction with the BMJ about "The Truth Behind Sports Drinks" (it'll still be available on BBC iPlayer for a week or so). Sports marketing is big business, praying on the needs of sportsmen and women seeking to improve their performance, or just as a "fashion accessory" to be seen using whilst taking part in sport. Energy drinks such as Lucozade and Powerade make claims on the adverts and packaging about "boosting performance" and are becoming an "essential piece of sporting equipment". They advise people to drink before they feel thirsty. This is all a new concept. In the 1970s, runners were discouraged from drinking too much for the fear that it would slow them down. When the evidence is carefully scrutinised, it doesn't hold up. A lot of the studies cited are sponsored by the companies wishing to promote their products and the evidence is weak. What the promotion of these products has achieved is to undermine the importance of thirst. This is the basis that the only symptom of dehydration is thirst. Drinking too much can lead to exercise associated hyponatraemia, with 16 marathon deaths recorded due to a drop in sodium levels. The most effective way to prevent hyponatraemia during marathin running is said to be to prevent having a positive fluid balance. When the BMJ asked the major manufacturers of sports drinks to supply evidence, only GSK (who make Lucozade), supplied evidence. Other problems arising from sports drinks are the risks of obesity (people drinking too much - one in four American parents believe sports drinks are healthy for their children), and increasing numbers of patients with diabetes. So in conclusion, the evidence is not all there - sports drinks are not all that they are cracked up to be, and only drink water when you're thirsty. Plus it'll save you a lot of money!

The Challenges Facing New Doctors

Only one more week until the changeover and the new FY1s step up and take over. The media seem to take of advantage of this, by coming up with 'shocking' headlines and describing August as "the killing season" in NHS hospitals. This doesn't really help the confidence of the new doctors who will already be nervous at the prospect of taking on massive responsibility. A column in the BMJ this week written by an inter-calating medical student talks about exactly this. What people often seem to forget is that we've been at medical school for 5, 6 even 7 years sometimes working up to this point, and the new FY1s will be much more prepared than they realise. Studies have shown that the care given by new doctors in training is comparable with that of their senior colleagues. I'm giving a talk to the new FY1s next week to give some advice on how to work as a save, effective FY1 doctor and I'll try and remember how I felt when I was in their shoes only a year ago. I'll be moving on to a new hospital on the 1st August and no doubt I'll have plenty of new challenges to get my head around. 

I presented the gentamicin audit which I talked about in the last post before the wedding to the department in June and it seems as if it was good timing to do an audit on gentamicin because the new prescribing form is being rolled out across NHS Greater Glasgow and Clyde next week. No doubt there will be a few speed-bumps initially as doctors and nurses get used to it but hopefully it'll lead to safer prescribing and closer monitoring of IV gentamicin in the long run. I'll try and recruit some of the new doctors in the hospital next year to repeat the audit next January to see if there really is an improvement with the new prescribing form.

The president of the Royal College of General Practitioners (Dr Iona Heath) this week spoke out in praise of young doctors. In a letter to the BMJ she wrote that too much emphasis from an early stage of training new doctors is on science and understanding. However science is never enough in a profession which seeks to try to alleviate human suffering. Students and doctors are not being encourgaed enough to think and question assumptions about the nature of science and medicine. She continues in the letter to talk about the erosion of continuity of care, and the lack of a 'team based' attitude to practicing medicine (only this week we had to our FY1 end of year ball due to a lack of interest from our senior colleagues). She highlights that with shift patterns and the European Working Time Directive, it is difficult to learn from our actions (I used to see patients on night shift and then wonder what had happened to them the following day - I would sometimes go and check out patients at the start of my next shift to see what had happened but often time wouldn't allow). 

She also argues that there is a rapidly changing culture in medicine of 'protocol and guideline medicine'. Many doctors are now afraid not to follow the guidelines and although I've only had one years experience, I am already starting to feel that there is a great deal of "over-treatment" and "over-diagnosis" in the NHS at times such as end-of-life care which can be dangerous and un-necessary. According to Dr Heath this is "destroying the confidence of many young doctors, so that they no longer feel able to make the courageous professional judgements necessary to tailor treatment to the needs, aspirations, value and context of individual patients". Finally she says "as I grow old and frail, I want a doctor who thinks and questions, not one who feels obliged to blindly follow protocols".

Wedding and Honeymoon Photos!

It came and went in a flash - the wedding was an amazing day. Great to see so many family and friends on the day, it seemed like all of the guests enjoyed themselves as much as we did!
 

Brig O'Doon, Ayr, Scotland - Saturday 23rd June 2012

Reethi Beach Resort - The Maldives