Now Ye're Talking - to a Junior Doctor (Children's Medicine)

Gloomtastic! wrote: »

Morning Doctor!

My first question is how many points did you get in your leaving cert? And did that dicate what course you would take or is medicine something you always wanted to do?

Hi Gloomtastic, that's a question on many young minds at present! I did my LC in 2006 when the HPAT didn't exist. I got 600 points and went to UCD. I was influenced in that there were doctors in my family, but originally I wanted to be a teacher! Life is full of second chances and with postgraduate medicine there are many routes to being a doctor. It's important that you pick something you think you will enjoy, don't be pressurised by dreams of money or respect. Doctors, unfortunately, in this climate have very little of either!

Drumpot wrote: »

Good Afternoon Doctor,

I agree that priority, care and attention should always be given to the patient, in all circumstances.

But in training what consideration is given to family/friends of patients? Particularly when trying to find out information before/during/after operations?

I find that family/friends can interpret information better then the patient. Like when you are telling somebody bad news or information regarding their own illness, an impartial friendly observer takes more in then the person being diagnosed/informed what's wrong.

With regards to treating patients in A&E, are doctors supposed to be in some way empathetic to children or are they supposed to treat them like another number and be cold?

I had an experience where I brought my 3 year old into A&E with a nasty cut on his forehead. After hours waiting, the doctor who actually checked him, investigated the area of the head like he was squeezing a spot on somebody's face. He was squeezing the skin to see the bone (at least that's what it looked like). He actually didn't say anything to my son or myself at the time. Walked over, squeezed his head (and my child howled) and casually walked off chatting with random staff about different things. Around 10 mins later somebody (a nurse) finally told me the story.

I appreciate many in the healthcare system are overworked and need to keep their emotions in check for professional and self preservation reasons, but is it really hard to show a little bedside etiquette? I wanted to punch that doctor. I was already stressed and worried about my child, this makes non violent (like myself) people on edge. I am glad I didn't lose the head, but surely there is some training put into showing some sort of compassion for patients and their families?

Hi Drumpot, firstly I'm sorry to hear of your negative experience. Whilst I would never condone a lack of empathy (and have often pulled colleagues, juniors and other staff up on it in the past), we are all human. When I trained (2006 onwards), we were only beginning to be taught empathy and professionalism.

I know you may say you either have it or you don't, but these days medical students are being taught skills which enhance their own natural empathy and which enable them to recognise and respond to other people's emotions.

Many paediatric trauma cases outside of Dublin are dealt with by adult trained staff. They may not have the skills to interact with children or may be too busy to take the time to interact - a failing of the system, not the individual. Certainly if one of my staff behaved in the way that you describe I would have very, very stern words with them.

Specifically, children's doctors should, by and large, be able to calm a child of any age (within reason). A hospital experience should be positive for a child regardless of the reason for visiting. I have often found myself belting out songs from Frozen as I take blood from a childs hand so that they are distracted! I regularly go hunting for carrots when looking in ears, or bunny rabbits in mouths in order to get things done without frightening the child. Hospitals provide stickers, teddies and DVDs for childrens wards.

If anyone reading this is thinking of a small, worthwhile, 100% direct charitable act - buy a portable DVD player for your local emergency department along with a few children's DVDs. Or perhaps crayons/stickers/books for kids to read. The impact these things have is immeasurable and will change a childs experience from negative to positive.

GLaDOS wrote: »

What's the longest continuous shift you've ever done?

What's the most amount of hours you've worked in a week?

What was your most memorable experience of successfully treating a patient?

Thanks!

On my first day of work (newly qualified, green behind the ears) I arrived to work at 0545 in the morning. I worked, with 15 minutes for a hurried sandwich, until 9pm that night. At 9pm I had another sandwich, wolfed down in the canteen, before working continuously until 4am, where I got to sleep for 90 minutes. At 0530 the next day, I got up and worked until 7pm. I worked over 36 hours on 90 minutes sleep. On my first day.

I couldn't remember anything from the second afternoon. Nothing. I must have cared for over 30 patients without retaining much memory of what I had done.

I did one of those shifts every 10 days or so for 6 months. I did 110 hours one week.

One of my personal reasons for striking, was so that my younger brother who had followed me into medicine would never have to do that sort of work. Thankfully, he graduated into a much improved system of shift work and has never worked more than 24 hours in a row. Isn't it warped that I would consider that a success :P

Probably my most memorable stories would have come from my days on the delivery wards. I would have been called if babies were born in difficulty - i.e. not breathing. I remember rushing to a baby who was limp and not breathing. A hairy 90 seconds followed when I did everything I could (almost starting CPR), only to hear the most beautiful wail from this little thing. I explained to the parents what may have happened, only to be hugged by a sobbing father. At this point I broke down myself and we just had a good cry as I hadn't been expecting this story to end well at all. Things like that make the 36 hour shifts and the personal abuse that we get regularly worthwhile.

I could tell you just as many stories where I've made mistakes - I'm only human. Thankfully no bad endings from those!

XxMCRxBabyxX wrote: »

How do you find treating older patients who are verging on adulthood (mid-teens) in comparison to younger children? Is it easier and would you prefer it?

I ask this as a former paediatrics patient who used to spend many days in waiting rooms and hospital beds surrounded by much younger patients. I always imagined that there was a huge difference depending on what age group you were treating.

Absolutely - changing your approach based on the age group is essential. I'll give some examples.

4 years old - Story time! Launch into a completely nonsensical story, usually involving Daddy having smelly feet, or how tall and strong the boys are, or involving their pets.

9 years old - treat like an adult but not quite. Address them directly but not in a complex fashion - simple questions and let them feel like they can make decisions.

14 years old - Often very difficult to manage. I personally sometimes draw on my own experience "Oh my mother still does that to me" or might make fun of school/parents (a little, not stand up comedy here) all to break the ice. The worry is if you give teenagers too much autonomy, they'll rebel in order to have some control over their lives.

There's a burgeoning area of Paediatrics called Adolescent Medicine. This caters for young adults who have chronic diseases as they are worlds apart from an 8 year old or a 28 year old.

XxMCRxBabyxX wrote: »

Interesting! I'm trying to remember how my Doctor dealt with me now as I only began attending hospital at 14 or so, though I do know that I was never much of a rebel.

On that same point, when do you stop dealing directly with parents? I know that you mention 9 there, but if you had bad news who do you speak to and how? Do parents ever get told first or are all spoken to together? Do you think that children can deal better with the news?

That depends on the diagnosis. It's a judgement call - if you're telling parents that their child has cancer, you'll often take the child away to play so that the nuts and bolts can be discussed and that the parents can decide how much they want their child to know. If I'm telling them that their 12 year old has pneumonia, I'll tell the child directly in a simple fashion before explaining further to the parents.

I think that some of the Transition clinics which prepare teenagers aged 16/17/18 for the adult services e.g. in CF or Diabetes will often make them come into the room on their own as a practice run, before bringing the parents in at the end. I'm sure it's torture for the parents but it's the only way that teenagers will take full control of their illness!

big syke wrote: »

Firstly I think anyone in the medical profession in particular working with young children do an incredible job, with limited resources, working crazy hours in a stressful environment - thank you for helping the children of Ireland you guys truly are amazing.

Onto my questions:

Do you ever regret becoming a doctor?
If you could change three things about the Irish system what would they be?

Yes, I've often regretted being a doctor. Most of my non-medical friends earn considerably more than me and never work weekends. I work a minimum 1 in 3 and can often work more than that. The stress can get to you as well. I would often lie awake thinking about a child I had sent home and worry that I had missed something. I sent a child home recently with a tummy bug - he came back 4 hours later with appendicitis. It's important to not let those things affect your work but it can be hard.

1. More Consultants
2. More resources for smaller hospitals
3. More community funding.

See? It's all more more more. We simply don't have enough - enough nurses, enough doctors, enough money... World class healthcare is bloody expensive.



Its abundantly clear - we are trying to match the NHS without having the NHS conversation - "What do we need to sacrifice to pay for this service". The NHS talk about cost all the time. We should too.

Mr Rhode Island Red wrote: »

Do you think the HPAT is an effective "cattle-grid" of sorts to keep certain people who wouldn't be suited to medicine out of the profession or do you think it's unnecessary?

What is your normal working week in terms of hours?

At what stage are you no longer considered a "junior" doctor? Is it after a certain number of years or is there another way it's defined?

Has your profession made it difficult to develop and maintain relationships with family, friends and otherwise? Does all the moving about completely eliminate the feasibility of long-term relationships? Is it possible to have a social life in med school and afterwards?

Did you do a "premed" year? If you were given the choice would you choose to do premed or hit the ground running in first med?

When do you choose your speciality? (paediatrics, emergency medicine etc.) Which specialities lend themselves to having the best work/life balance?

If you weren't a doctor, what would you be? Or is it something you've always wanted to do?

Sorry for all the questions...

Personally, I feel the HPAT is completely unneccessary. My class only did the Leaving Certificate and the majority of us were compassionate human beings. Of course, some people lacked social skills but they were few and far between. What creates "rude" or "uncaring" doctors is a system that doesn't bother to develop skills to deal with exposure to pain and suffering, often when you're the one who says "this can't be done, there's nothing to do". What sane human being wouldn't say to themselves "it's easier to just not think of my wife/brother/mother/son" because if you can just compartmentalise, then you won't find yourself crying in the car park as I have on a few occasions. Combine that with doctors being the ones to decide whether Mrs. Murphy gets her cancer op tomorrow, which means that John who has been delayed 3 times waiting for a gallbladder op is now delayed again... why voluntarily expose yourself to that suffering? Can you see how that's a slippery slope to not caring at all?

Currently my working week might swing between 40-70 hours. The aim now is to have an average 48 hour working week as per EU directives.

When I become a consultant, i.e. not a junior doctor, I will have trained for approximately 18 years since completing my Leaving Cert. 11 of those in Paediatrics. Junior doctor implies that we require supervision/lack skills - whilst that may be the case with some, it's far from the truth. For example - I have examined probably approaching 2000 newborn babies. When I come to check your new son/daughter and introduce myself as a "junior doctor" (which I don't), would you be filled with confidence?

I'm sure a few of my ex-girlfriends would have very pointed views on that subject! :pac::pac: What I have come to realise in the throes of maturity is that the pressure of my first few jobs (as described in previous posts) made me a dislikeable person. I drank too much at the weekends, I became more arrogant, brash and generally wasn't a very nice guy. My relationships with friends, family and my girlfriend suffered as a result. I'm actually still dealing with the fallout almost 3 years later! It certainly is possible, I probably feel that my personality made me vulnerable to high pressure as I didn't enjoy my job. Fast forward to Paediatrics where I love every day in work - I'm pretty confident that I wouldn't return to that place in my life.

I knew the Student Bar in UCD pretty well during my time and there were more lectures missed in favour of FIFA tournaments, hangover chicken rolls and sheer boredom that were actually attended! I have a great bunch of friends from college and we get together as regularly as we can.

Premed year is essential. If you skip it, your peers will have had an entire college year to form relationships and enjoy themselves. It's one of the easier years and allows you to develop as a young person outside of the home.

Specialty choices can be difficult. Unfortunately no job has a good work/life balance, and some are worse than others. I would advise students to consider what they don't want to do, that should narrow the list down. Often the specialities are quite similar and its the act of specialising and becoming an expert which gives you the job satisfaction.

I'd be a teacher. I've always loved teaching throughout my career and get really good feedback from my students - it really animates me!

KonFusion wrote: »

Any opinions on the national EHR programme / eHealth strategies coming down the pipe/already in place?

I'm quite optimistic as in New Zealand we had a system which utilised ehealth and it was a dream to work with.

In reality, the key issue is access. How will I type my notes? How will 5 of us type our notes at the same time? Paper charts dont require plugs, seats, monitors, batteries... It would require a huge budget for IT and I'm not confident it will be done well...

Data protection is always an issue but I'd say they'll restrict access to patients who might be currently admitted/seeing your consultant in clinic or something to that effect.

Deleted User wrote: »

I see that you work in oncology. I am a hospital pharmacist over in Manchester. How involved is pharmacy (in Ireland) in trials, direct involvement with patients general paediatrics?

I fear my irish colleagues aren't as involved as they should be. As somebody who will probably move back to Ireland in the next couples of years, I fear that the hospital pharmacy profession is more of a hindrance than a help to improved patient care.

As an example, I know a junior pharmacist who was checking chemotherapy in the south east who made a massive error in the chemo dose( a 10 times overdose). Luckily the consultant caught it, (I am not sure how) but essentially, she was told to not worry about the mistake, that it would be grand. Just don't do it again. No effort to further educate the pharmacist.

Whereas in the UK, you would have been taken off those duties until you showed that you were competent.

Sorry about the rambling.

Hi Dazzler, what you're describing is a more systemic problem that the NHS has engaged with earlier than ourselves - Healthcare Improvement.

How can we remove human decision making from the system as much as possible to ensure all patients receive safe, standardised care? It's a really difficult question to answer sometimes and there are a lot of vested interests.

One thing I always tell my juniors - there are three sides to every story.

I would be extremely confident that a behind-the-scenes informal investigation was carried out and that if your friend was suspected of being at risk of making another error, she'd be retrained. Look at it this way, the system caught the error. That's why we have checklists and restraints. If the error had made it's way to the patient then the system clearly isn't fit for purpose.

As for pharmacy involvement in patient care, It does occur to certain extents in adult medicine and certainly I've had my bacon saved by a savvy pharmacist who noticed potential drug interactions a few times! However the expertise in paediatric pharmacology mightn't be there to the same extent as in the UK.

Pharmacists are heavily involved in oncology research here - Ireland takes part in international trials all the time.

sullivlo wrote: »

Thanks for the AMA. I love anything medical related. If I wasn't such a wimp who passes out whenever she sees blood/a needle, I would probably have made an alright doctor.

My question, whilst not strictly related to childrens medicine, I'd be interested to hear your opinion on it. I have a friend who is a junior doctor in a childrens hospital and I have spoken to her about it but she could just be an incredibly positive person! What do you think of the new/proposed roles of having clinically trained scientists on a consultant led team? I've heard murmerings of the HSE bringing in a plan similar to that of the scientist training plan within the NHS, where scientists get clinical training. They won't be able to diagnose or prescribe, but they'd be able to consult on potential treatments or perform basic procedures.

(For example, during my PhD I did some human work. We used nasogastric tubes but needed a nurse to insert them. In the NHS scientist training program, scientists train in their field of interest - in my case it would be gastroenterology - and they can do basic things, like NG tubes, but also be involved in any clinically relevant science that's done)

I'm not entirely sure what a clinical scientist would add to our work, to be perfectly honest. We'd be perfectly happy to show you basic skills but what would your role be, ultimately, in a clinical team? If you gave me more information on what a clinical scientist does I'd have more of an opinion

Mr Rhode Island Red wrote: »

What do you think is the reason for there being less and less Irish medicine graduates being turned out by the colleges? International students seem to make up well over half the classes. My uncle who works in a hospital said that he sees the student doctors doing the rounds with consultants/Dean of medicine and notices that Irish doctors are in the minority by a large margin. Why is this?

How do you go about getting a job in a hospital abroad, do you head out and jobhunt once you're there or do you have it lined up beforehand?

It costs approximately 13,000 per year to train a doctor (give or take). The Government provides roughly 7,000. Universities then cover the cost, plus profit, by charging non EU students up to 40,000 per year. Its simple mathematics. Give a spot to a non EU student and they'll earn you 5+ times what an Irish student would give you.

There are recruitment agencies who would headhunt Irish doctors as, and I realise I'm speaking from a bias here, Irish doctors are internationally regarded as being without equal. I did also have to bombard Hospital HR departments with emails as well however!

masterboy123 wrote: »

Hello Doctor,

I am working in HSE as Psych SHO and wondering what's the average working hours in NZ? And what's the monthly take home salary for SHO 3 grade?

Many thanks

Psychiatry would be in Band C - 40-50 hours per week. Works out at approximately 55,000 NZ Dollars per year... and at 33% top rate of tax, you're laughing