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

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.

I'm a Junior Doctor, AMA

Sapphire wrote: »

Have you ever had a 'House' moment where you solved a really obscure medical puzzle before anyone else?

What's your unforgettable case and why?

Are the on-call rooms a hive of amorous activity like on Grey's Anatomy?

I've certainly had a few moments where I've blurted out an obscure medical diagnosis before receiving an exasperated look from my senior... The actual diagnosis was much more common

Probably one of my unforgettable cases was a wee boy who was diagnosed with Leukemia. He was so sick - we weren't sure if he would make it. He was in hospital over Christmas and I worked a lot over that time - we would hang out on my breaks and my most vivid memory is putting him up on my shoulders to hang the star on the top of the Christmas tree on the ward. He had this way of making all my problems seem insignificant!

I can't bring myself to ask how he's doing because, even though the survival rate for Leukemia is greater than 90%, hearing a bad ending to that particular story would be personally quite devastating for me.

I wouldn't say quite on the scale of Grey's Anatomy but if you're asking... been there, done that

Gloomtastic! wrote: »

Have you ever witnessed a 'miracle' recovery?

Yes. I remember one child who was admitted before the summer with a nonspecific illness - high temperatures and some diarrhoea. Over the course of about 2 hours she just went off the cliff - unrecordable blood pressure, multi organ failure, comatose... We stabilised her and got the Chaplain in before transfer. Two days later we got a call from the team in Crumlin - she was up and chatting and playing with her siblings. Nobody knows why she got so sick - or why she recovered!

I'm a Junior Doctor, AMA

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!

helimachoptor

Firstly thanks for taking the time to do an AMA.

As a dad to a just 26 month and 7 month old I've been lucky enough not to need to see a doctor for either of them.

However, how do you cope with seeing a child severely injured or with a childhood cancer on a daily basis?

I'm a Junior Doctor, AMA

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.

I'm a Junior Doctor, AMA

helimachoptor wrote: »

Firstly thanks for taking the time to do an AMA.

As a dad to a just 26 month and 7 month old I've been lucky enough not to need to see a doctor for either of them.

However, how do you cope with seeing a child severely injured or with a childhood cancer on a daily basis?

Hey Helimachoptor, it's a great time to be a child in Ireland. Deadly diseases are at a minimum, there's free access to GPs and therefore hospitals for under 6s, and because parents are better informed, we're seeing sick kids at an earlier stage of their illnesses.

I think the hardest thing for me is the suffering. As a team we would do anything to take a childs mind off their pain/illness - obviously good painkillers are a must, but members of the general public come in and play music, therapy dogs visit, celebrities visit... On a professional level I've described before just doing anything silly to distract them. Most of my brain is coldly analysing the child whilst I appear nonsensical on the outside.

The vast majority of children get better and go home. We have to see the positives in our work. If we diagnose a brain tumour in a child, I take comfort in the fact that we caught it early, giving him the best chance. If a baby is admitted with severe meningitis, then we caught it early - she has the best chance.

Pushing for 100% success in anything is pointless. It can't be done. We just take satisfaction from winning even a little bit - making a child with a severe disability's stools softer so he doesn't hurt when he's pooing, making a child's asthma better so that he can take part in Sports Days, or even diagnosing a 3 year old with Autism because at least then she can get help in school.

Cookie_Monster

Why did you leave NZ in the end and what did you think of it compared to Ireland (not strictly work related...)

I'm a Junior Doctor, AMA

Cookie_Monster wrote: »

Why did you leave NZ in the end and what did you think of it compared to Ireland (not strictly work related...)

I'll answer that completely outside of work - New Zealand is stunning, it's got a great way of life, very relaxed and laid back.

Its not Ireland.

I decided to go because I was going to quit my job from unhappiness, I needed some time away to clear my head and decide what was for me.

I didn't really enjoy it. I really love Ireland, we have probably the best standard of living I've ever experienced and I missed my family and friends. It was an 18 hour flight and 12 hour time difference, quite isolating when you think about it particularly as I couldn't come home for Christmas.

It' also quite backwards in some ways. They have adopted a lot of Americanisms and the rural isolation is pretty severe (voluntary actually).

Outside of the "omg Xmas day on the beach #yolo" moments, It was pretty bleak on a rainy dark Tuesday evening as... wait for it... the Kiwis don't believe in central heating. Or concrete buildings. You had a heater that switched between air con and warm air, that was it. Because of the fear of earthquakes everything was wooden or prefabricated.

I did experience a pretty bad earthquake actually. I was hungover on a Friday morning in work, talking to a colleague on the phone when I became dizzy and had to sit down. I excused myself and hung up thinking that I was more hungover that I thought. When I turned around I realised everyone else was either under a table or in a doorway... staring at me in sheer panic. We were on the 7th floor and had just experienced a 6.1 earthquake originating in Wellington, 6 hours drive away!:pac:

I left because I wanted to help Irish children get better, I wanted to advance my career and I wanted to be closer to my family.

sullivlo

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)

Mr Rhode Island Red

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?

masterboy123

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

sullivlo

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?

I'm sure this answer won't be politically correct, but as someone who works in academia and works with undergraduate med students, the simple answer doesn't even need a word. A symbol will do.

€.

Academic institutions can charge non-EU fees to applicants from outside of the EU, therefore a certain % of places go to international applicants.

I'm a Junior Doctor, AMA

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

Gloomtastic!

You were encouraged to study medicine by your family. Would you encourage your kids to do the same?

Mr Rhode Island Red

How do doctors avoid getting colds, coughs and other contagious diseases when they're surrounded by illness every day. Do ye have special tricks to avoid it or will frequent hand-washing really cover you?

Do you find time for hobbies and interests when you aren't working?

I'm a Junior Doctor, AMA

Gloomtastic! wrote: »

You were encouraged to study medicine by your family. Would you encourage your kids to do the same?

I would encourage my kids to do whatever career they'd love - the only thing I'd ask is that they be able to support themselves financially by doing it. My entire family are doctors - it's pretty boring at the dinner table! I'd far rather my children loved their jobs be that teaching, plumbing or medicine.

Cookie_Monster

I'm a Junior Doctor, AMA wrote: »

I did experience a pretty bad earthquake actually. I was hungover on a Friday morning in work, talking to a colleague on the phone when I became dizzy and had to sit down. I excused myself and hung up thinking that I was more hungover that I thought. When I turned around I realised everyone else was either under a table or in a doorway... staring at me in sheer panic. We were on the 7th floor and had just experienced a 6.1 earthquake originating in Wellington, 6 hours drive away!:pac:

We still react the same way to any quakes, "wow this is weird & cool" everyone else getting into doorways and the like

It' also quite backwards in some ways. They have adopted a lot of Americanisms and the rural isolation is pretty severe (voluntary actually).

Outside of the "omg Xmas day on the beach #yolo" moments, It was pretty bleak on a rainy dark Tuesday evening as... wait for it... the Kiwis don't believe in central heating. Or concrete buildings. You had a heater that switched between air con and warm air, that was it. Because of the fear of earthquakes everything was wooden or prefabricated.

Ah, it's not that bad, ever been to New Plymouth

I take it 6 hours to Welli means you were up North somewhere.
Friend of mine works in Welli in cardio and while he likes NZ he thinks the health service is pretty 2nd world and compared to the NHS where he worked previously and thinks its a bit of a disaster in certain respects. We've seen similar stories here in New Plymouth where there has been several high profile midwifery and childbirth related stories of bad practice/decision making, to the extent that I have friends who will go to Hamilton if they can manage it if they have any pregnancy complications.
Any similar experiences where you were?

Cookie_Monster

I'm a Junior Doctor, AMA wrote: »

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

1) that's surprising low!
2) That top rate only kicks in at 70k, so even better.

cyning

How do you deal with parents googling?!

Also from a parents point of view my daughter has been seen by 4 different hospitals and because of the fact there is no centralised system she has had to have tests repeated as doctors cannot access the results. Do you think there is anyway to avoid this without spending millions?

Thank you for doing this AMA, most paed docs I've met are fantastic it makes life easier

masterboy123

Well that's more or less the same as in Ireland. Am I right? Except I do 60 hours per week on average here.

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 [/quote]

I'm a Junior Doctor, AMA

Cookie_Monster wrote: »

We still react the same way to any quakes, "wow this is weird & cool" everyone else getting into doorways and the like

Any similar experiences where you were?

I'd have said the same for Hamilton. One of the downsides of being so laid back is that it's difficult to get Kiwis to understand that things can, and should, be done better.

Maternity services were based around home and community birthing centres - and what I saw in 3 months of working in that system would have turned you grey. I'm surprised more mums and babies didn't die, to be honest.

cyning wrote: »

How do you deal with parents googling?!

Also from a parents point of view my daughter has been seen by 4 different hospitals and because of the fact there is no centralised system she has had to have tests repeated as doctors cannot access the results. Do you think there is anyway to avoid this without spending millions?

Thank you for doing this AMA, most paed docs I've met are fantastic it makes life easier

Hi Cyning, that's just as frustrating for us as it is for you! Unfortunately we need to spend millions on a centralised system that allows peripheral hospitals to share information with bigger hospitals and vice versa.

I actively encourage parents to google as long as they tell me about it. There's no point googling if you're not going to talk to your doctor about it.

Take anti-vaccination opinions, for example. When I get a mum who has refused to vaccinate her child in front of me, I ask her what's her worry. We tease it out. I print out labels, product info, research - every question she asks, I attempt to answer.

At the end I put the same question to them: "Look, you've met me, face to face. You trust me to help your child with chest infections, asthma, meningitis etc. Why do you trust these people with internet opinions more? What have they told you that makes you mistrust me even though I'm sitting here in front of you answering all your questions? All I'm asking is that you give my opinion, that you should vaccinate your child, the same respect as the Facebook group of "Concerned Parents About Vaccines" seems to have."

I really don't understand why a parent brings me her 6 week old boy to cure his raging kidney infection which would probably have killed him in another 24 hours and then accuses me of attempting to harm him with dodgy vaccinations

I'm a Junior Doctor, AMA

Mr Rhode Island Red wrote: »

How do doctors avoid getting colds, coughs and other contagious diseases when they're surrounded by illness every day. Do ye have special tricks to avoid it or will frequent hand-washing really cover you?

Do you find time for hobbies and interests when you aren't working?

Sorry I seem to have missed that question! I currently have a head cold from those pesky kids :pac: but my immune system is pretty strong...

https://www.youtube.com/watch?v=FYFcT9sDSBs



We wash our hands constantly but it's almost impossible to avoid getting sick.

I personally try to keep fit, but it can be difficult to partake in team sports as my weekends off and evenings can be taken up with work!

Zaph

I'm afraid the doc has run out of time and has some non-Boards stuff to attend to, so it's time to close this thread. Thanks to everyone for the questions, and a particular thanks to the doc for taking time out of their busy schedule to answer them.