Traditional and GEM entry to Medicine

tallaght01

It certainly isn't anything close to a majority. I have to admit, on a long A+E shift I've done it myself a while back. Had an argument with the surgical reg, and afterwards turned round to a nurse and said "I wasn't going to take that crap from a kid". It happens. medicine is a career where a decent proportion of your on-call is spent exhausted, and all you want to do is go home. So, things that wouldn't normally bother you get magnified. It can all be a pressure cooker sometimes. It's not like other jobs, in that a significant proportion of people you interact with at a staff level will be miserable and tired and cranky.

That's when you hear the calls of "That kid is asking me to do 10 cannulas, while he sits on his ass in the mess", "Did you hear the way she spoke to me?? I'm 10 years older than her" etc etc.

It's not so much a problem on the ward rounds, when it's a bit more relaxed. But it does become an issue in the busier times.

But that won't be the worst kind of things to happen, by a long shot. Like the poster above said, you need to be just ready for it by not romanticising what you're getting into. We all did it. No one ever really understands what they're getting into with medicine. BUt I guess you just have to prepare yourself for an environment that can be pretty testy. Although some places are great to work, and it almost all gets less testy as you get more senior. Tat kind of thing forms really no part of my life these days, thank god.

MicraBoy

Have to say these are all questions I have asked myself over the last while. I can see how in a fraught environment one might snap at a younger person out of frustration. I don't think I'd have any problem with being instructed or told what to do by someone younger so long as I felt they know what they were talking about.

I have often wondered if GradMeds are discriminated against by younger doctors or indeed even by traditionally educated doctors. I'd be afraid that there might be some sort of two tier system that would develop over time. I'd be interested to hear what tallaght01 and Narkius Maximus think about that.

To answer some of your other question Narkius Maximus, I feel that while I would (this is all theorectical coz I haven't gotten into Medicine yet) have a shortened career as a doctor (36 year old intern), I also can't fathom doing the type of job I have at the moment. I want to work at something challenging, that will possibly consume my entire life

Jessibelle

That post above is how i feel in a nutshell. I don't care that I'll be a 36 year old intern, but I do care that I'll be doing something which I love, and that will make a bit of a difference to the people I interact with. All I need now is to get in....

Narkius Maximus

Thanks for the replies.

If you do your job well then all will be happy. I don't think discrimination will be a problem if you work hard. If I were to put myself into the position of a 36 year old intern, I don't know if I would tolerate the s*&t that I took as an intern and sho. I don't think I could do the 36hr shifts so well and I know my family life would go down the toilet.

Yes it is also fun, it's the greatest job in the world and i'd never change. However I don't think I could go in as a GEM. I don't think I'd have the fortitude or the desire.

So I wish you all the best and prove me wrong I suppose. Perhaps we'll meet as colleagues, just don't try refer me crap or you will get it in the neck. My top tip for avoiding a bollicking is always have an attempt at a reasonable diagnosis-Abdominal pain is not a diagnosis!

Good luck!

sam34

Narkius Maximus wrote: »

Perhaps we'll meet as colleagues, just don't try refer me crap or you will get it in the neck. My top tip for avoiding a bollicking is always have an attempt at a reasonable diagnosis-Abdominal pain is not a diagnosis!

to be honest, i find this attitude insulting. you are talking about your professional colleagues, not school children or your subservients. as such, they deserve respect and common courtesy, not a "bollicking" becasue they dared ask you to see a patient that they feel requires a surgical opinion.

as a surgeon, you are a specialist - ie you have knowledge and expertise that your non-surgical colleagues don't have. therefore it is not unreasonable to expect that they would seek your opinion on a case when they dont know whats going on. they might not have made a diagnosis precisely because they dont know what teh hell is going on, and thats why they're asking you!

how valid would their diagnosis or attempted diagnosis be anyway? im sure if someone was being pushed to give a stab at a diagnosis they could always say "cholecystitis" or whatever else comes into their head, just to get you off your back - are you going to let that guide you in your examination and assessment? really?

lastly, it's ironic to see a surgeon moaning about crap referrals, when they themselves are notorious for sending ridiculous and poorly thought out referrals.

Vorsprung

Narkius Maximus wrote: »

So I wish you all the best and prove me wrong I suppose. Perhaps we'll meet as colleagues, just don't try refer me crap or you will get it in the neck. My top tip for avoiding a bollicking is always have an attempt at a reasonable diagnosis-Abdominal pain is not a diagnosis!

Cos I've never had a surgical reg ask me to get a cardiology consult for a patient with hypertension!

tallaght01

I guess we're all guilty of crappy referrals.

In paeds I get DIRE referrals. I mean people are referring just because someone is a kid.

When I did surgery, they would ask me to get a medical referral form anything.

Having said that, "abdo pain" is a particularly frustrating for surgeons to get. Medics do ask for surgical input inappropriately at times. When I did surgery, A+E had a terrible habit of referring just random undifferentiated ado pain. I think it is important to have a stab at what's going on, as the surgeon is often in theatre when you're making the referral, so you need to start management in A+E.

Same with psych. They get it bad, but they also call us for very little. Last referral I had from a psych was for a "failure to thrive", who was normal weight and height, and was essentially healthy.

But regardless of the referral, a bollocking is really never in order. I've been on the receiving end of it. I don't take it any more. But I used to feel I had to.

I've spoken to a few registrars about hassling SHOs on my team. I think the team is important, and you have to look after yours. I once had a radiologist go mental at me. I had made a very appropriate request. I happened t mention it to my consultant, who stopped what he was doing, picked up the phone, rang the radiologist and told him that if he has a problem with referrals in future to take it up with him. That's what should happen. I have a quiet word a few times since, and it's almost always been sorted easily.

Easier said than done, though. I know I've been woken up many times in the middle of the night on a 24 hour shift to go and see a kid n A+E who has a viral illness, and I've felt like smacking the SHO. But it's all about deep breaths sometimes.

tallaght01

Jessibelle wrote: »

That post above is how i feel in a nutshell. I don't care that I'll be a 36 year old intern, but I do care that I'll be doing something which I love, and that will make a bit of a difference to the people I interact with. All I need now is to get in....

That's brave talk! I've never met a 36 year old intern, but the thoughts of still doing 7 nights in a row when I'm in my early 40s. I would really struggle with that.

Jessibelle

ah now thats why they invented superstrong coffee
In seriousness, I have no doubts as to the difficulty of it, but it's a case of needs must. This is my passion and if long nights on the trot with very little sleep are what it takes to get there, then get there I will. Luckily this far in life I've managed with very little sleep generally (I usually average 4-5 hours a night) so hopefully it'll stand in my stead, if not, there will be a human-caffeine hybrid walking the wards

nesf

sillymoo wrote: »

Correct me if im wrong but im pretty sure it takes mare than cramming to get 550+ points in the leaving cert. When I did my LC I put in 2 years solid work to get 550+ with a lot of sweat and tears shed. I think you would have to be exceptionally bright to cram for a LC exam and come out with an A1.

Just a point to think about.

Did it in two subjects, came very close to doing it in four (A2s instead of A1s). Didn't many points to get into Physics in those days in UCC (300 odd would get you into the general first year and then you specialised in second year), so was part of a curiosity project during my LC days to see how many point you could get with minimal effort when points weren't an issue to get into what you wanted.

These days, from looking at how they've dumbed down some of the subjects, it should be even easier to do I think.

nesf

With regards to medicine, personally I think screw fairness or equal treatment, I want the brightest and best entering training for the profession. I'd much prefer a get a 1st in a related degree then impress us in an interview and then do well in an aptitude test style of entry. Make it bloody hard to get into (550+ points while hard is far too limited and general a tool tbh, it's too easy to stack LC subjects to maximise points using trivially related subjects etc).

I can't see this happening any time soon, but a guy can dream can't they?

Narkius Maximus

sam34 wrote: »

to be honest, i find this attitude insulting. you are talking about your professional colleagues, not school children or your subservients. as such, they deserve respect and common courtesy, not a "bollicking" becasue they dared ask you to see a patient that they feel requires a surgical opinion.

as a surgeon, you are a specialist - ie you have knowledge and expertise that your non-surgical colleagues don't have. therefore it is not unreasonable to expect that they would seek your opinion on a case when they dont know whats going on. they might not have made a diagnosis precisely because they dont know what teh hell is going on, and thats why they're asking you!

how valid would their diagnosis or attempted diagnosis be anyway? im sure if someone was being pushed to give a stab at a diagnosis they could always say "cholecystitis" or whatever else comes into their head, just to get you off your back - are you going to let that guide you in your examination and assessment? really?

lastly, it's ironic to see a surgeon moaning about crap referrals, when they themselves are notorious for sending ridiculous and poorly thought out referrals.

Easy daisy! Think I hit a nerve! I'm happy to see anyone and once a referral is made you must see it, however nobody likes a bad referral, especially one in which the case is a badly worked up patient. I would hope no one would ever just 'have a stab at a diagnosis' or 'whatever comes into your head' in any field in medicine. That's simply bad practice and irresponsible.

That last statement annoys me no end because it is true and drives me bonkers. I despise inappropriate and inaccurate referrals. Sadly it is common place. Fortunately those registrars whom I've worked for demanded that the appropriate tests be performed prior to referral and I carry that through to my practice with interns and shos.

sam34

Narkius Maximus wrote: »

Easy daisy! Think I hit a nerve! I'm happy to see anyone and once a referral is made you must see it, however nobody likes a bad referral, especially one in which the case is a badly worked up patient. I would hope no one would ever just 'have a stab at a diagnosis' or 'whatever comes into your head' in any field in medicine. That's simply bad practice and irresponsible.

That last statement annoys me no end because it is true and drives me bonkers. I despise inappropriate and inaccurate referrals. Sadly it is common place. Fortunately those registrars whom I've worked for demanded that the appropriate tests be performed prior to referral and I carry that through to my practice with interns and shos.

nobody likes a bad or inappropriate referral, thats obvious.

but even if a referral is inappropriate, or not properly worked up, that doesnt mean the referrer deserves a "bollocking" from whomever they referred to. maybe the referral is poor because they dont know what information you require - wouldnt it be more beneficial, courteous and pleasant to educate them and tell them what info a surgical referral generally should comprise of, instead of just snapping at them? as colleagues, they deserve respect.

im not advocating that anyone would "make a stab" at a diagnosis, or say "whatever comes into their head" in their own practice, of course not. that would be irresponsible and bad practice indeed. but when they are referring onwards to someone better placed to deal with the issue, than does it really matter what someone with only undergraduate training in that specialty thinks? if they're being hassled by someone on the other end of the phone to come up with a diagnosis, and they genuinely dont know whats going on, what do you want them to do? if they say they dont know, they'll probably get "what do you mean you dont know, what do you think etc etc etc". if they knew, they might not be referring in the first place. they are neither general practitioners nor surgeons, so i dont think its unreasonable for them not to be able to make a diagnosis. it has no impact on me if people referring to me can make an accurate (or even inaccurate) stab at diagnosis, it really doesnt matter, as long as they can describe symptoms and signs. im certainly not going to let the opinion of someone who hasnt studied psych since 5th med guide me in my assessment of a patient.

inappropriate referrals annoy me as much as the next person, but i dont go around bollocking my colleagues about them, there's no call for that.

Narkius Maximus

I'll put it to you this way-would you want me to refer you a 'crazy person' and leave it at that without at least attempting to describe mood, affect etc, after first ruling out an organic cause for his/her craziness of course? It is 5th med after all since I studied psychiatry -i'm presuming that you are a psychiatrist from what your reply, us surgeons ain't so smart and need blatant, obvious information).

I like the best information available, simple as that. Surgical diseases are, in the majority, simple to diagnose: good history, good exam, rational investigations. If I don't get these I get moody, it's not because the case is difficult, it's because the referrer is incompetent, or my bete noir, lazy! It takes a lot to get me really grumpy and that's really what does it for me-laziness.

Perhaps I was a little harsh to say I'd give someone a bollicking-rather a curt response. And we are all guilty of that!

sam34

Narkius Maximus wrote: »

I'll put it to you this way-would you want me to refer you a 'crazy person' and leave it at that without at least attempting to describe mood, affect etc

of course not, but you're being facetious now. referring me a "crazy person" would be akin to referring you a "sick person" and would be unacceptable.

i would not have a problem being referred someone where the referrer had made an effort to descibe symptoms and signs eg, telling me that someone is paranoid, hallucinating and agitated would be perfectly acceptable to me. i wouldnt particularly care if the referrer thought it was schizophrenia, schizoaffective disorder, monosymptomatic delusional disorder, psychotic depression, schizotypal disorder or anything else, it really wouldnt matter to me, i'll be doing an assessment myself and making my own diagnosis.

i would think an adequate surgical referral for abdo pain would consist of details about the pain(the 9 or 10 descriptive terms we were all taught as med students) as well as relevant history, physical exam, lab results and imaging results. if there isn't a provisional diagnosis tagged onto that, well, so what? how about this - you're the surgeon, you make the diagnosis?


*mod hat on, you and I have derailed this thread a bit, so if you want to discuss this further we should create another thread.

El_Dangeroso

Just out of interest is the 2:1 requirement a hard and fast rule?

Are, or could exceptions ever be made on the basis of lets say postgraduate qualifications?

MicraBoy

Just out of interest is the 2:1 requirement a hard and fast rule?

Are, or could exceptions ever be made on the basis of lets say postgraduate qualifications?

It is a hard rule, and post graduate qualifications don't count. Also interestingly it must be a 2:1 in the FIRST undergraduate degree undertaken.

Pleo

I was completely against the 2.1 rule, until I got a 2.1 , tbh its kinda silly when you think of pharmacists and vets with 2.2's being unable to even apply for GEM or sit the GAMSAT. Also I think its rediculous that GEM places arent increased to full capacity. But then again if I get in, I might change my mind on that again.