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Wilkommen to my blog - if you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in the UK after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Tuesday, 13 September 2016

Sick of striking

Well now I'm really hacked off.

Striking, again?  Arguing, again?

As someone who can't strike (I'm doing research at the moment) I am somewhat spared the dilemma of every junior doctor in the UK of whether to go on strike or not - the relief is nonetheless palpable following the cancellation of the September strikes.  What I'm not spared is another round of pan-media debates of junior doctors on the one side being pushed and prodded to the end of reason with an ill-(/nil?)-funded plan for a 7-day NHS, and journalists/politicians/whoever-else-wants-to-have-a-go on the other side telling me about the immorality of doctors striking.

I am sick of it all.

I am really sick of the media circus that has this has become.  I am sick of people who do not spend their working days in hospitals telling me what my job as a junior doctor is like.  I am sick of people telling me that I lack vocation.  I am sick of people telling me it's about the money.  And I'm sick of what this is doing to the morale of my profession, and the far, far greater damage that is doing right now over anything else.  I probably wouldn't go on strike on this occasion, as is the feeling among most of the juniors I talk to, but that's not because we agree with the contract or are happy with how things are - there is just a feeling that the continuation of this argument is doing more harm than any anything else right now.

Ultimately, the effects of this will not be seen for another few years, but then it will not be salvageable.  The majority of junior doctors will see through their contracts, which are anything from two to eight years long (plus time out for research/babies/other), and then will simply apply to work elsewhere.  The real disasters will then be seen in the specialties that are already having a recruitment crisis - emergency medicine, acute medicine, obs and gynae - the truly out-of-hours specialties.  Rural areas that are already struggling hugely to retain any permanent staff will be in this situation across the board.  That isn't because people want to make a ton of cash.  It's because (according to Article 8 of the Universal Declaration of Human Rights) having something that resembles a private and family life is a reasonable need.  Working every other weekend simply does not make that possible.  Covering rota gaps is not safe and it's soul destroyingly dangerous.  Your body does not function the same when it's working at 3am versus 3pm.  And year after year of appraisals, exams, moving hospitals, audits - these things also have to be squeezed in somewhere, and for what?

The bottom line is, if these anti-social specialties get any worse in terms of rota-gaps/training gaps/terrible rotas/antisocial hours, people will just move with their feet.  Departments, like the maternity department in the Horton Hospital in Banbury, where I used to work, will close.  Communities and MPs protest about the unfairness of this, but the problem is simple - jobs are advertised, and no-one applies - because there aren't enough doctors to apply for these jobs.  Perhaps whole hospitals will close.  The rubber band will have been stretched too far, leading to an irreparable snap.

As a half-German Junior Doctor, it's starting to feel a lot like this little country is none too keen to have me around any more - and I know I'm not the only one who feels like this has just become too miserable for words.  Come on, government, doctors, people of England.  Get it together and end this battle so the NHS can win the war.
That 'work-life balance' lark in action in the Brecon Beacons

Tuesday, 16 August 2016

Doctors Fail Stuff Too

Hello, blog pals!

Apologies for my absence from the blog world.  It turns out full-time clinical medicine and blog writing on a regular basis are not wholly compatible.  Plus, to be honest, it's been rather a depressing few months, hasn't it? Junior doctor strikes, Brexit, the implosion of any sort of political sanity...  Every time I tried to write something I just had to stop - it felt like I was adding to the country-wide exasperation.

But in all situations one should try to see the positive, right?  Another year, another flurry of bright-eyed, bushy tailed new junior doctors have just started their working lives on the oh-so-optimistically-named Black Wednesday.  Working over the change over days of new doctors is always a good time to be re-energised by fresh enthusiasm, and I guess also realise just how far you've come in the last few years.

But one probably learns more from failure than success - I failed the first thing I've fully failed since 18-year-old Karin failed her driving test - I failed my final exam for my Membership to the Royal College of Physicians (PACES, for those familiar with the lingo) by a big fat... 2 points.  Not surprised, but also interesting to observe and understand my own response to failure.  The main challenge has been managing others' expectations (weirdly not my parents/family's, but those of my friends!), and of course a little smoothing over of one's pride.

I share this largely because doctors SUCK at talking about failure.  Certainly people seem to look at me and seem to think it's something to which I'm immune.  The worst thing about failing is actually the thought of doing it all over again - the revision around a full time job, saying no to seeing friends and family (I've seen my parents twice in the last 6 months - TWICE! - and they live barely an hour and a half away!), the tension and nerves of the exam waiting area, the money (altogether it cost me about £2000 to sit, as will the resit..!)...

If that's the worst thing that's happening in my life right now though (and it really isn't that bad!) then frankly, I think I'm doing pretty well.  It may not be the last time I fail it, and I need to be ready for that possibility too.  I'm back in the lab for a year which is hugely exciting - I'll miss patients a lot but frankly after working at least 1 in 4 weekends plus evenings/nights on call for a year, I'm looking forward to being a little less sleep deprived.  The NHS is a rather tense, over-stretched place to be at the moment, and I think it's safe to say that many of my NHS friends and colleagues are feeling at something of a crossroads.  To come back to the lab feels a bit like returning to a land of optimism and excitement.

Optimism and excitement is also fully present in 'life' in general.  I've hopefully just moved house for the last time for the next couple of years, and nest-building is just pretty darn wonderful.  The 'woah-there-it's-actually-summer' weather means life is being lived outside as much as possible - from slothing to swimming, blackberry picking to bicycle rides - who knew we could genuinely achieve al fresco dining with such regularity in the UK!

So there we go.  I, Karin Purshouse, failed an exam.  But it's really not so bad.  I feel reasonably reassured that I'm still an OK doctor.  I'm just going to try and convert that into a decent cancer scientist for the next 12 months...

A li'l bit of the North East coastline earlier in the summer

Friday, 6 May 2016

On Kindness

River deep and mountain high!
Work recently has been tough.  Working as a junior doctor on an acute cancer ward is never likely to be stress-free, but add in a couple of folks down on the on-call rota, a rota that already involves working 1 in 4 weekends and ever-escalating strike action - well, it makes things rather epic.  A lot of our patients are young and all of them are pretty sick.  There are often days when we feel like some of our patients have just had a pretty crap deal with life, and we can't really do much to take that away other than to do our work as best we can and be as supportive as possible.  Recently I was called to see a young patient who was a similar age to me who was dying of cancer - I think there would be something wrong with me if that didn't affect me.  I finally cracked after a long weekend where a lot of patients had become very unwell and passed away, and tried to support some very distressed patients and relatives.  It's just as well I don't wear much make-up, eh?  

A lot is made of the stress of the actual job of being a doctor, although I'd probably describe the above as emotionally consuming rather than stressful (and sometimes it's good to 'feel' - reassures me at least that I'm still human!).  In some ways, of far greater stress to me is my looming end-of-year appraisal, trying to get all my competences/outcomes done for my portfolio (e.g. assessments from other doctors, attending enough clinics, doing enough procedures), doing an audit/quality improvement project, somehow getting to weekly teaching, doing a massive exam, doing edits on a paper, organising my research project for August...  Without that lot, being a junior doctor would be a very different thing!

From the last of Winter's snow...
Morale is certainly at an all-time low amongst junior doctors with the current contract situation but what's awesome is a) how much I fundamentally enjoy my job, b) I'm starting to think I'm ok at it and c) how much being a doctor means to be part of a team that looks out for each other.  This big ol' exam? I've only got a bunch of 7 other junior doctors who are teaming up to help each other pass the damn thing.  Getting my stuff done for my appraisal? It turns out people are very willing to help you if you just ask.  And as for the emotional challenges at work - well, we look out for, and are kind to, each other.  Kindness - to yourself and to others - under-rated, if you ask me.  Life is just too short to tolerate its absence and live negatively!

In addition, life outside of work (for me at least) has been very kind to me indeed, blossoming and blooming apace with the Spring that is also finally making an appearance.  Even though I am both time and money poor (try spending nearly £2000 on your last (hopefully) big postgrad exam... gulp), I feel rich in laughs, love and adventures right now - what a lucky bean! A potent reminder of the importance of work/life balance which my old housemate generously said I 'seemed to be getting better at these days' - praise indeed!  My job may be tough but life is pretty wonderful right now :)

And so - to night shifts once more this weekend.  Hope you're able to spend yours in the same wonderful sunshine that is to be found in my corner of the world right now - I'll look forward to sleeping through it!
... to the fresh blossom of Spring!

Naomi Shihab Nye (1952) - 'Kindness'
'...Before you know kindness as the deepest thing inside, 
you must know sorrow as the other deepest thing. 
 You must wake up with sorrow. 
You must speak to it till your voice 
catches the thread of all sorrows 
and you see the size of the cloth. 
Then it is only kindness that makes sense anymore, 
only kindness that ties your shoes 
and sends you out into the day to gaze at bread, 
only kindness that raises its head 
from the crowd of the world to say 
It is I you have been looking for, 
and then goes with you everywhere
like a shadow or a friend.'

Sunday, 13 March 2016

Open Access – where did all the doctors go?

The wide-open skies of America are a very happy place to which I have returned after an absence of nearly 8 months.  It’s amazing how quickly the reflex ‘hi there, how are you?’ rolls off the tongue and is greeted by an equally enthusiastic response (as opposed to British looks of confusion!).  It is pretty special to be back in the land of endless optimism, my home for nearly a year, and still feel like I belong!

A few of the OpenCon alumni at SPARC MORE
Endless optimism was certainly the vibe that was being channeled at the SPARC Meeting on Openness in Research and Education (MORE) in San Antonio, Texas, where it was my very great privilege to be speaking about developing an Open Access policy.  Standing in front of a group of field-leading librarians and policy makers as a doctor and L-plates-level scientist and telling them about your somewhat haphazard attempts to navigate the crazy world of policy development and research publishing was… well, oddly exciting.  Why? I found myself representing a voice that I didn’t even really realise was missing from the discussion.

MFA Likes Bicycles, Boston
Doctors. Where are the doctors? And I’m not talking about doctors who have joint clinical/research contracts, and I’m not talking about senior consultants or professors (amongst whom many amazing advocates of OA can be found).  I’m talking about baby doctors like me, for whom things like publishing a case report or an audit or maybe even a little clinical research project (probably in that order of likeliness) can not only provide important info to the medical community, but also add vital points to a job application, especially if you’re applying to a competitive specialty.  I was discussing this with the rather awesome Roshan Karn, a fellow junior doctor in Nepal, and we agreed these things were key stepping stones, and also provided a valuable opportunity towards more formal research.  Not only that, we SHOULD be writing these things up and sharing them with our community – if it's good or important, it should be shared, and surely it’s about a thousand times more efficient to try and develop/enhance a tried, tested and effective audit or Quality Improvement Project rather than starting from scratch. 
Spring came early this year to Yale-town!
 More than that, doctors and clinical practice are probably the most commonly cited case examples in favour of open access.  It’s a no brainer really – evidence-based medicine requires, well, evidence.  If we can’t read it (because it’s behind a pay wall), we can’t practice it.  And yet I’m not sure whether many junior doctors are aware of open access, let alone open data (which surely has its challenges where patient-based clinical data is concerned, but shouldn’t be dismissed as a whole on that basis).  We’re a bit different from researchers and scientists in that we don’t have specific funding – just our salaries – and therefore there is no mandate or direction when it comes to publishing open access.  Even if we are aware and want to publish open access, it’s not like we have any funding for any open access journals that charge an article processing charge (APC), aware as I am that some OA journals have a waiver or an alternative (much cheaper) system to APCs.  AND referencing my pre-conference article, we would still have to persuade our co-authoring consultants/attendings/registrars/
residents towards a journal or output format that is open.   

In short, junior doctors should be amongst the loudest voices in favour of open access, and yet we’re barely opening our mouths or being handed the microphone. 

Magic as ever, NYC
Now, I’m absolutely ready to be wrong about all of the above, and if you’re reading this as a junior doctor and thinking ‘hey, that’s totally not true’ then I would be positively delighted to hear from you!  Notes on a postcard J

There’s no value in complaining and not doing something about it, so I’m going to investigate… I’ll keep you posted.  Junior doctors should have a voice in this, even if we don’t have all the answers, and we should be aware of how to be more Open. 

Some fortunately-timed annual leave post-SPARC MORE means I've been lucky to have a whistle-stop return tour of the East Coast before hopping back across the pond - one week, four cities, four States, lovely friends, jet lag +++, epic skyping/whatsapp-ing = happy Karin! Open Access/Data/Education is about squeezing every last bit of juice out of the immense amount of information and knowledge out there  - I like to apply the same principle to every aspect of my life! Off I skip back to the hospital wards...
Old pals, new city!

Sunday, 6 March 2016

Open Access isn't easy - let's talk about that

A li'l bit of mountain magic from the last few weeks
Greetings, blog readers! Somehow nearly 3 months have passed and here we are – the flowers of spring have blossomed earlier than ever, the winter darkness is lifting and I’m now to be found as a junior doctor on an acute oncology ward. My absence from my blog has been for very happy reasons of work craziness and life loveliness, but finally I've found a spare hour for me, Spotify and a birds eye view of the snowy wilderness of Canada en route to San Antonio, Texas.

Chaps, it's SPARC MORE time!
(Read: YAY! Conference on Open Access – Meeting on Openness in Research and Education)

It feels like two seconds since OpenCon2015 in Brussels – as inspiring an event as one could ever hope to attend.  I was lucky enough to be invited to speak on a panel about the work Fulbright have been doing to develop an open access policy, and that’s what I’ll be chattering about in San Antonio, Texas this week.  More than that, I’m hoping to hear how we can keep moving forward with all the exciting open access/data/education developments that are happening all over the world. 

…Because Open Access – well – it’s bloody hard.  There, I’ve said it.  I am totally team open access.  When I need to know the latest evidence on a certain disease or treatment, I want to know without having to struggle past pay walls.  When I’m planning experiments in my research area of cancer biology, I need to know what’s been tried and tested, or how to implement a particular method, without selling half my grant funding for the privilege.  When I have something to publish, I want to know that people won’t experience barriers in accessing the information I’ve generated (bearing in mind that I am yet to be anything other than essentially government funded for all of my exploits). 

But as a junior doctor, I don’t have funding to pay open access fees, and I’m not sure my study budget would make much indent in Article Processing Fees (APCs) even if I could use them for that purpose.  Even now that I’m starting to be first author for a couple of papers, I still need the support of people far more senior than I who have their own careers to worry about, and therefore have their own ideas about where we should publish (although I will say people are broadly supportive when I raise the issue).  It’s really quite intimidating to raise your hand and tell a bunch of co-authoring Consultants that actually you’d rather this paper be published openly.  It’s also scary when you realise you might know the most about open access amongst your authoring team, and even then feel like you know very little.  Pre-prints, post-prints, embargo periods, green, gold, repositories, APCs, licenses, copyright…. Yikes!! I barely know enough about how to write and publish a paper, let alone all of that! 

We are working in an imperfect system of Impact Factors, Research Excellence Framework (REF) assessments, annual appraisals (in my case, both clinical and academic) and research output hierarchy.  We’re rightly asked to think outside the box and lead the change in publication culture by leaders in the open access field, but when you’re at the bottom of a very, very long ladder, it’s quite a daunting ask.  As a doctor, I find myself faffing around my need to competently do things as diverse as chest drains, talk to patients about terminal cancer diagnoses and manage patients who become acutely unwell, whilst simultaneously doing cancer research and being at the forefront of a new culture and direction for cancer research publishing.  Something amongst all of this has got to be easy, right?!

But as I’ve said before – just because something is hard doesn’t mean we should run away.  Open access is important in every field (science, humanities, the arts) and I’ve learned a great deal more about the nuances of this in helping US-UK Fulbright to develop their policy.  As a doctor, I see it in every patient for whom we care. The vast majority of what we do in hospitals is derived from some kind of research study – everything from the drugs we use to the types of beds we have, the dressings we use to the methods by which we do any procedure.  I look into the eyes of patients for whom we’ve reached the end of the line in terms of treatment for their cancer and wonder what therapy is being developed right now that might one day treat the same patient? Why should such knowledge be hidden behind a pay wall, or the data protected by copyright laws?

If that can’t drive me forward, then nothing can; but that doesn’t mean it’s easy.  This conference comes off the back of a rather intense few weeks at work – this junior doctor loves her job but working on an acute oncology ward of course comes as a package deal of giving something of yourself.  Perhaps that’s something that all things worth doing require?  

Check out the SPARC website and twitter (@karinpurshouse) to follow the latest news from the SPARC MORE conference.  Digestible potted highlights to follow!

Sunday, 27 December 2015

#ImInWorkJeremy Junior Doctor Christmas Special

Working late but looking great! 
I think it would be hard to find someone more excited and happier this festive season. What a year 2015 has been!  I can hardly believe this time last year I was calling America 'home'.  A Masters thesis was written... Gary the brain cancer cell was born... Many, many adventures were had - so many adventures! And halfway through the year I returned to my little island, and spent a great deal of time feeling like a resident alien on home soil.  But this extra-terrestrial feels a lot like she's come home, whatever that means, even with a bunch of Christmas night shifts.

Sometimes I just can't believe how lucky I am to be a doctor.  No matter how much I might miss the relative freedom of research (in terms of planning your own time - not necessarily fewer hours!), the last few weeks in particular have been an absolute joy.  And that's despite a solid dollop of challenging professional situations - flying solo as ward doctor for a week and a half, a number of difficult deaths, countless complicated medical situations to tease apart, diagnose and manage, many 'I don't think your relative is going to make it' discussions, several complex family set-ups to navigate, new procedures to learn, and some really sick people during my Christmas night shifts.  Of course I've not been alone, working with other junior doctors (could you ever meet a more committed, fun, all-round awesome bunch of people?) and nurses, and of course the awesome consultants for whom I've been working - no matter how miserable the situations we've had on the ward, we've found a way to laugh ourselves silly everyday and I'm learning an enormous amount. Surely the wonderfulness of working in a hospital is exemplified at Christmas time - no-one is grumbling when they're leaving late on Christmas eve, and no-one is whining when they arrive for their 13 hour shift on Christmas morning.  What a special place to work!

Christmas, honest!
A key part of this is clearly balancing your life outside of work too, and on that score I *think* I'm finally getting the balance right.  From art galleries to string quartets, climbing walls to more than a few mulled wines, I am so lucky to have friends old and new with whom to share these adventures.  I started the year a scientist in America, and I finish it a doctor in the UK - and the life that has embellished that transition has been a rollercoaster of a ride.

I am celebrating Christmas and New Years with a stethoscope around my neck, working my way through the holiday season with many other junior doctors, consultants, nurses, physiotherapists, occupational therapists, radiographers and many other hospital workers.  In the nicest possible way, I hope I don't see you - instead, I hope you're sharing some good vibes with the people you love.  Merry Christmas and a Happy Hogmanay! 

Friday, 18 December 2015

Til Death Do Us Part

I see bodies at the very edge of life.  

I see bodies when the hearts within them are barely able to send the blood they pump to the tips of fingers and toes.  I see bodies whose lungs are squashed, scrunched and crispy from a lifetime of whatever air and debris has reached and settled within their alveolar spaces.  I see bodies riddled with cancers that are known, and I’m the one who’s broken the news, and those that will never be known about because the owner of the body is happier not knowing.  I see bodies full of infection, which in older people often means an associated delirium which renders the recipient a different, distressed version of their known self.  I see bodies of patients who cannot get out of bed without people or equipment to help and look into their eyes as they beg me to let them go home.   I see bodies that have long since lost the memory of who they are, who I am and what this world is that they inhabit.   And, finally, I see bodies where life has gone completely and their last medical rite is for me to confirm that this is so. 

Of course, these are not bodies.  These are people, wonderful human beings, with all the laughs, frustrations, tears, joy, sadness and adventures that life has thrown at them.  Most of my patients are around 90 years old.  If I have a patient in their 70s, that’s young.  I often remind my parents of this; retiring in your 60s, you still have at least 50% of your life to do again.  I may have romantic notions of adventuring and then growing old in a house by the sea, reading, painting, playing my violin, writing, playing games and drinking tea, all surrounded by family and friends until one day I simply fall asleep, never to wake up.  But you don’t know what your old age is going to look like.  To look after older people is to consider your own life and death, because you are experiencing that of others on a daily basis.  

So when I read that I’m supposed to be having an epiphany about giving ‘individual’ end of life care, I can only assure the rest of the world that this is no epiphany at all to any junior doctor.  Who could love a job like mine, where so much of it requires looking death in the face, were it not for the care of the individual?  If I am lucky I will be able to do discuss a patient's diagnosis with them and plan their final weeks, days or hours as they would wish.  But I, and they, am not always so fortunate.  I recently was called to see a patient who was clearly going to die within minutes of my arrival - as the on-call doctor, we were meeting for the first time.  That did indeed require a 'snap decision' that meant I could give this patient the dignified death they deserved.  It meant I could look the relatives in the eye and say truthfully that their loved one had died in peace and without pain.  It meant that this patient had two of us holding their hands when death parted our worlds.  I know the conversations I had with the family during and after that time will never be forgotten - strangers before, I am now and forever part of that life.  

People often think I’m a bit weird for wanting to be an Oncologist because of the close professional proximity I will have to death.  This belies the fact I already look death in the face in some capacity on at least a weekly, if not daily, basis.  Each conversation and experience is different because each patient is different - that’s what being a doctor requires in life as well as in death.  Perhaps I should be relieved that there is a bit of government guidance that tells me to do what my colleagues and I are already doing?  Instead I feel a little bit of my heart sink; a disappointment that patients from my past might think that I didn't see them as individuals because only now am I being explicitly told to do so. 

Don't tell me I don't know what death looks like.  I see bodies at the very edge of life and see the individual underneath.  I'm not sure my fellow junior doctors and I were ever in any doubt about the importance of that.