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Saturday, March 19, 2011
Sunday, October 17, 2010
Long hours? Or a long time training?
I’m not a fan of too much work. Over the years, I’ve done my fair share of long shifts, nights, weekends, public holidays, and combinations of all the above.
I don’t function well when I’m tired and hungry and thirsty. And most patients don’t want to be seen by an overworked, sluggish, grumpy doc whose priority is a bed and some food. Certainly, I wouldn’t have wanted any member of my family to have depended on care from me after working 27 hours straight.
I always thought my colleagues agreed with me. Enough miserable faces on the corridors of the various hospitals I’ve worked in made me feel a collective yearning for better conditions.
I thought, therefore, that there would be widespread endorsement of the European Working Time Directive (EWTD) when it came into force in Ireland and the UK. The EWTD is designed to limit the working hours of doctors within the European Union. Depending on the stage of implementation, it can mean working a maximum of 48-56 hours per week.
Of course, here in Australia, they’ve managed to do that without relying on international law. Down under, the rules for doctors’ hours seem to be enforced on a regional basis. In fact, from what I can gather, the rules seem to be MADE locally too. But, by and large, it works. Sure, I’ve been miserable and tired and hungry working in Oz, but I’ve never had to work 72 hours on the trot, let alone do it on a regular basis, as happens in Ireland.
Forgetting for a moment that the Irish government has decided to simply ignore the EWTD, and continue to make their juniors work ridiculously long hours, I was amazed to learn that there are significant groups of doctors in the UK and Ireland who oppose the implementation of the EWTD.
These doctors argue that registrars, like me, and other junior staff, need to be exposed to lots of cases in order to become proficient consultants. They argue that patients come to harm at the hands of tired doctors, but also from inexperienced seniors.
I can see their point. However, I don’t buy it. I can’t accept that dangerously long hours are the only way, especially when urban Australia manages fine without total burnout of their medical staff. There has to be a middle ground.
My take on the long hours culture is as follows:
1) If we juniors want to reduce our hours then we have to expect it to take longer to become consultants. Everything in medicine is being streamlined these days, and that needs to stop. We need to return to 5/6 year medical degrees, and long apprenticeships as house officers and registrars.
2) A lot of doctors' time is taken up doing admin work that anybody could do (chasing xrays, filling out blood forms, chasing blood results on the computer etc). These tasks should become the work of someone else, so that doctors actually spend their time doctoring. I remember as an intern working out that about 60% of my tasks could be done by a competent member of admin staff.
3) Our training is important. But so are our lives outside medicine. I sympathise with the wannabe surgeon who wants to work all hours, learning how to do craniozygomatic surgery. But, there are those of us who have wives, girlfriends, kids, and a family life. I want to be a good consultant. But I doubt I’ll look back from my deathbed and say “I’m glad I worked so much”.
4) Patients need to do more. Relatives, friends, patients and strangers are almost always sympathetic towards me, regarding the plight of junior doctors. But how many have ever raised the issue with a canvassing politician? I don't expect the public to have our interests forefront in their mind at election time. But this is about patient safety, as much as it is about modern day slavery. As things stand, the politicos and the media often betray us as greedy and as a vested interest group, and very little of that gets refuted.
5) We have to be wiling to take industrial action. End of. I would be very reluctant to do so in oz, as my job is busy, but tolerable. But if a pregnant junior doc in Ireland who is working 48 hours solid, with no scheduled breaks, isn't entitled to strike, then who is. the media would love it. They would betray us as lecherous public servants trying to bleed the state dry. The media and politicians would distort the facts to make us look greedy. But screw them. I bet we could hold out longer being abused by tabloid readers then they could hold out with no doctors. Obviously, I would never advocate withdrawing acute services. But a work-to-rule or skeleton staffing would cause some browning of pants in the corridors of power.
The Australians do a good job of it (well, in the cities they do, their rural healthcare provision can be pretty piss poor). Ireland and the UK should learn from them. Mostly we’re rostered on for a 38 hour week. We do on-call and out of hours, of course. But those shifts tend to be interspersed with good weeks, where we can catch up with friends and family This is not the case in Ireland and the UK.
I know from experience that some Ozzies will post comments here telling me that they work terrible hours too. And of course that can be true. I once did a paeds emergency medicine job here where my partner was getting seriously worried about my health. I was literally exhausted all the time. I was grumpy, and never seemed to have any joy in my life. That’s not the way to live. And it’s not the frame of mind I want the doctor in when I bring my sick kid to see them.
I know everyone is an expert when it comes to public sector reform. Just look at the comments section of any newspaper article or blog on the issue. So I’ll keep my ideas about system change to myself. But Ireland, the UK and Australia need to wake up to this issue. More complex issues have been dealt with in the history of mankind.
All three countries have started the process of saturating us with medical school graduates. In Ireland and Australia especially, every man and his dog can become a doctor. Of course, there hasn’t been a sufficient expansion in the number of hospital training posts to cope with all these new graduates.
That will have the desired effect of making our young doctors accept crappy conditions, as it’s likely to be the only route to a scarce training post.
Perfect solution, if you’re an administrator or politician. Tough luck if you’re a doctor or patient.
Sadly, doing anything about it is a catch 22 situation. There are those who have tried. But what’s the most common response when you ask local juniors to engage on this issue, and stand up for their rights? Yep, you guessed it....”S
I don’t function well when I’m tired and hungry and thirsty. And most patients don’t want to be seen by an overworked, sluggish, grumpy doc whose priority is a bed and some food. Certainly, I wouldn’t have wanted any member of my family to have depended on care from me after working 27 hours straight.
I always thought my colleagues agreed with me. Enough miserable faces on the corridors of the various hospitals I’ve worked in made me feel a collective yearning for better conditions.
I thought, therefore, that there would be widespread endorsement of the European Working Time Directive (EWTD) when it came into force in Ireland and the UK. The EWTD is designed to limit the working hours of doctors within the European Union. Depending on the stage of implementation, it can mean working a maximum of 48-56 hours per week.
Of course, here in Australia, they’ve managed to do that without relying on international law. Down under, the rules for doctors’ hours seem to be enforced on a regional basis. In fact, from what I can gather, the rules seem to be MADE locally too. But, by and large, it works. Sure, I’ve been miserable and tired and hungry working in Oz, but I’ve never had to work 72 hours on the trot, let alone do it on a regular basis, as happens in Ireland.
Forgetting for a moment that the Irish government has decided to simply ignore the EWTD, and continue to make their juniors work ridiculously long hours, I was amazed to learn that there are significant groups of doctors in the UK and Ireland who oppose the implementation of the EWTD.
These doctors argue that registrars, like me, and other junior staff, need to be exposed to lots of cases in order to become proficient consultants. They argue that patients come to harm at the hands of tired doctors, but also from inexperienced seniors.
I can see their point. However, I don’t buy it. I can’t accept that dangerously long hours are the only way, especially when urban Australia manages fine without total burnout of their medical staff. There has to be a middle ground.
My take on the long hours culture is as follows:
1) If we juniors want to reduce our hours then we have to expect it to take longer to become consultants. Everything in medicine is being streamlined these days, and that needs to stop. We need to return to 5/6 year medical degrees, and long apprenticeships as house officers and registrars.
2) A lot of doctors' time is taken up doing admin work that anybody could do (chasing xrays, filling out blood forms, chasing blood results on the computer etc). These tasks should become the work of someone else, so that doctors actually spend their time doctoring. I remember as an intern working out that about 60% of my tasks could be done by a competent member of admin staff.
3) Our training is important. But so are our lives outside medicine. I sympathise with the wannabe surgeon who wants to work all hours, learning how to do craniozygomatic surgery. But, there are those of us who have wives, girlfriends, kids, and a family life. I want to be a good consultant. But I doubt I’ll look back from my deathbed and say “I’m glad I worked so much”.
4) Patients need to do more. Relatives, friends, patients and strangers are almost always sympathetic towards me, regarding the plight of junior doctors. But how many have ever raised the issue with a canvassing politician? I don't expect the public to have our interests forefront in their mind at election time. But this is about patient safety, as much as it is about modern day slavery. As things stand, the politicos and the media often betray us as greedy and as a vested interest group, and very little of that gets refuted.
5) We have to be wiling to take industrial action. End of. I would be very reluctant to do so in oz, as my job is busy, but tolerable. But if a pregnant junior doc in Ireland who is working 48 hours solid, with no scheduled breaks, isn't entitled to strike, then who is. the media would love it. They would betray us as lecherous public servants trying to bleed the state dry. The media and politicians would distort the facts to make us look greedy. But screw them. I bet we could hold out longer being abused by tabloid readers then they could hold out with no doctors. Obviously, I would never advocate withdrawing acute services. But a work-to-rule or skeleton staffing would cause some browning of pants in the corridors of power.
The Australians do a good job of it (well, in the cities they do, their rural healthcare provision can be pretty piss poor). Ireland and the UK should learn from them. Mostly we’re rostered on for a 38 hour week. We do on-call and out of hours, of course. But those shifts tend to be interspersed with good weeks, where we can catch up with friends and family This is not the case in Ireland and the UK.
I know from experience that some Ozzies will post comments here telling me that they work terrible hours too. And of course that can be true. I once did a paeds emergency medicine job here where my partner was getting seriously worried about my health. I was literally exhausted all the time. I was grumpy, and never seemed to have any joy in my life. That’s not the way to live. And it’s not the frame of mind I want the doctor in when I bring my sick kid to see them.
I know everyone is an expert when it comes to public sector reform. Just look at the comments section of any newspaper article or blog on the issue. So I’ll keep my ideas about system change to myself. But Ireland, the UK and Australia need to wake up to this issue. More complex issues have been dealt with in the history of mankind.
All three countries have started the process of saturating us with medical school graduates. In Ireland and Australia especially, every man and his dog can become a doctor. Of course, there hasn’t been a sufficient expansion in the number of hospital training posts to cope with all these new graduates.
That will have the desired effect of making our young doctors accept crappy conditions, as it’s likely to be the only route to a scarce training post.
Perfect solution, if you’re an administrator or politician. Tough luck if you’re a doctor or patient.
Sadly, doing anything about it is a catch 22 situation. There are those who have tried. But what’s the most common response when you ask local juniors to engage on this issue, and stand up for their rights? Yep, you guessed it....”S
Kaplan Medical School Admissions Panel Discussion
By now, the metaphors for entering the health care profession are common and clichéd: the journey, the mountaintop, the door. But one metaphor is less common, and in fact it is actually quite literal: the conversation. To enter into the medical profession is to enter into conversation – many conversations – with colleagues and patients about the most fundamental questions of being and human existence. To be trained in the art and science of medicine is to be trained to ask – and seek answers to – questions about life and death, disease, pathology, illness, sadness, and also wellness, completeness, satisfaction, and peace. “Every journey starts with one small step” in medicine is translated to “Every journey starts with one small question: What brings you in to see me today?”
Premedical students – you – have many questions: about your goals, your dreams, the challenges and opportunities before you, near and far, as you enter into your chosen profession. Sometimes you know what questions to ask, and sometimes you don’t. Sometimes you know whom to ask; and sometimes, you don’t. The important thing here is this: you have to talk through this. You have to talk and ask questions, and listen and think. You have to be in conversation with your mentors and your peers. To that end, we invite you to join us in a special evening of dialogue on the issues that impact your entry into the healthcare profession.
Kaplan Test Prep, in partnership with the American Medical Student Association, Phi Delta Epsilon International Medical Fraternity, and the Student Doctor Network, will present a live online medical school admissions panel discussion called the Medical School Insider on Tuesday, May 11, at 7:30 pm ET. This two hour event will feature a panel of leading experts in medical school admissions, premed and medical education, and life in medicine. Following the panelist presentations, attendees will have the opportunity to engage with the panelists in an hour-long moderated Q and A session.
Confirmed panelists include:
Dr. Carlyle Miller
Associate Dean for Student Affairs
Weill Cornell Medical College
Dr. Karen Hamilton
Assistant Dean for the Office for Diversity and Community Outreach
University of Pennsylvania School of Medicine
Dr. Adam Aponte
Associate Director for Recruitment and Retention
Mount Sinai School of Medicine
Mr. John Brockman
MS4, Case Western Reserve University School of Medicine
President
AMSA
Dr. Emil Chuck
Health Professions Advisor
George Mason University
Mr. Budge Mabry
Director, Texas Medical and Dental Schools Application Service
Director, Joint Admission Medical Program
Doctors Miller, Hamilton, and Aponte have long individual histories of student advocacy and, in particular, addressing the challenges of under-represented minorities in medicine. John Brockman is the newly elected National President of AMSA, the largest medical and premedical student organization in the country. Dr. Chuck is a pre-health advisor and a popular professor of biology. He is well-regarded by national medical and educational organizations, such as AAAS and AACOM, who invite him to speak and present at annual conferences. Budge Mabry is the director of the TMDSAS, the centralized application service for all eight of the Texas medical schools. He is also the director of the Joint Admission Medical Program (JAMP), an academic pipeline program in Texas for under-represented minorities and economically-disadvantaged students in medicine.
Click here to enroll in this exciting event. This is a great opportunity to converse with medical education experts to learn from their perspectives about all the factors – your curricular and extracurricular activities, the MCAT, your personal statement, the primary and secondary applications, and the interview – that contribute to your success in gaining admission to the medical school that’s right for you.
Premedical students – you – have many questions: about your goals, your dreams, the challenges and opportunities before you, near and far, as you enter into your chosen profession. Sometimes you know what questions to ask, and sometimes you don’t. Sometimes you know whom to ask; and sometimes, you don’t. The important thing here is this: you have to talk through this. You have to talk and ask questions, and listen and think. You have to be in conversation with your mentors and your peers. To that end, we invite you to join us in a special evening of dialogue on the issues that impact your entry into the healthcare profession.
Kaplan Test Prep, in partnership with the American Medical Student Association, Phi Delta Epsilon International Medical Fraternity, and the Student Doctor Network, will present a live online medical school admissions panel discussion called the Medical School Insider on Tuesday, May 11, at 7:30 pm ET. This two hour event will feature a panel of leading experts in medical school admissions, premed and medical education, and life in medicine. Following the panelist presentations, attendees will have the opportunity to engage with the panelists in an hour-long moderated Q and A session.
Confirmed panelists include:
Dr. Carlyle Miller
Associate Dean for Student Affairs
Weill Cornell Medical College
Dr. Karen Hamilton
Assistant Dean for the Office for Diversity and Community Outreach
University of Pennsylvania School of Medicine
Dr. Adam Aponte
Associate Director for Recruitment and Retention
Mount Sinai School of Medicine
Mr. John Brockman
MS4, Case Western Reserve University School of Medicine
President
AMSA
Dr. Emil Chuck
Health Professions Advisor
George Mason University
Mr. Budge Mabry
Director, Texas Medical and Dental Schools Application Service
Director, Joint Admission Medical Program
Doctors Miller, Hamilton, and Aponte have long individual histories of student advocacy and, in particular, addressing the challenges of under-represented minorities in medicine. John Brockman is the newly elected National President of AMSA, the largest medical and premedical student organization in the country. Dr. Chuck is a pre-health advisor and a popular professor of biology. He is well-regarded by national medical and educational organizations, such as AAAS and AACOM, who invite him to speak and present at annual conferences. Budge Mabry is the director of the TMDSAS, the centralized application service for all eight of the Texas medical schools. He is also the director of the Joint Admission Medical Program (JAMP), an academic pipeline program in Texas for under-represented minorities and economically-disadvantaged students in medicine.
Click here to enroll in this exciting event. This is a great opportunity to converse with medical education experts to learn from their perspectives about all the factors – your curricular and extracurricular activities, the MCAT, your personal statement, the primary and secondary applications, and the interview – that contribute to your success in gaining admission to the medical school that’s right for you.
Erectile Dysfunction can be countered by adopting a healthy lifestyle
I am an aspiring urologist. I find that there are countless people suffering from erectile dysfunction and impotency and are ashamed to talk about it.
ED is curable, so please consult a doctor. ED is often a result of some underlying root cause.
Diabetes, high cholesterol etc contribute heavily to ED.
Patients should also
1. Drink lots of water.
2. Work out 20-30min a day, basically running skipping, aerobic etc.
Splut it into 10min sessions if you must.
3. You could even try penis rings.
Improving life style can help a lot and at the very least you will find that the PDE5 inhibitors like Cialis and Viagra work better.
These days one can even buy Viagra without prescription, but people suffering from heart and kidney ailments must not try self medication.
Posted in Pharmacy Blogs
ED is curable, so please consult a doctor. ED is often a result of some underlying root cause.
Diabetes, high cholesterol etc contribute heavily to ED.
Patients should also
1. Drink lots of water.
2. Work out 20-30min a day, basically running skipping, aerobic etc.
Splut it into 10min sessions if you must.
3. You could even try penis rings.
Improving life style can help a lot and at the very least you will find that the PDE5 inhibitors like Cialis and Viagra work better.
These days one can even buy Viagra without prescription, but people suffering from heart and kidney ailments must not try self medication.
Posted in Pharmacy Blogs
Acceptance to medical school for non-science major
I am a junior at Univ of WA deciding on a major.
If I did well on the MCAT and maintained about a 3.7 GPA, would an East European Language, Lit and Culture major be considered seriously by medical school admissions?
I have A's and B's in Bio, Chem and Organic and plan on taking Physics this year.
My father is from Eastern Europe. I visit family there pretty regularly and I spent a year in high school as an exchange student in Europe. I speak German and with this major I would be learning Czech.
Thanks.
If I did well on the MCAT and maintained about a 3.7 GPA, would an East European Language, Lit and Culture major be considered seriously by medical school admissions?
I have A's and B's in Bio, Chem and Organic and plan on taking Physics this year.
My father is from Eastern Europe. I visit family there pretty regularly and I spent a year in high school as an exchange student in Europe. I speak German and with this major I would be learning Czech.
Thanks.
Managing medical practice overhead expense
Shrinking reimbursements are a progressive reality of the healthcare practice environment. Under these conditions private practices need to make smart decisions about how to manage their overhead expenses. Reduced growth in income means that previously manageable expenses may envelop a larger percentage of potential earnings.
In addition, normal business expenses are expected to rise naturally through inflation and other factors affecting price indexes. There a number of ways to reduce overhead expense but a few which come to mind are A) lease re-negotiation B) vendor contract re-negotiation and C) practice expense sharing arrangements or medical practice mergers.
Many private practices lease the office spaces in which they are located. These leases may have been negotiated in more favorable economic environments. Reduced demand and lower occupancy has persuaded many landlords to be flexible to new and existing tenants. If possible, practice owners should approach their landlords for reductions or other concessions, even if their practices are faring well. The uncertainties of healthcare payor reimbursements going forward may make this a wise future option while still potentially available in today's environment.
Another step which practice owners may consider is the renegotiation of contracts with vendors and service providers. This can be helpful in reducing a wide range of practice expenses. The outsourced medical billing company may be one place to start, especially if their percentage fee of collections has not been adjusted to account for changing norms in the medical billing industry.
An additional option which may be helpful to some medical practices is entering into an arrangement with another medical practice. This can range from a basic cost sharing agreement between practices to a full-fledged business merger. The medical practice merger is a way to leverage economies of scale, negotiate more favorable payor contracts, gain unique competitive edge in a particular market, or extend reach into new markets. A less-binding alternative is cost sharing with another medical practice. This could be as simple as a single shared expense or common piece of equipment, or as involved as a full split of all practice expenses including staff and lease. Major factors to consider when entering into such arrangements are the financial health and staying power of the practices involved as well as the business strategy, trust level, and risk threshold of the respective practice owners. Naturally, a competent medical practice mergers and acquisitions team should be involved in such dealings.
In addition, normal business expenses are expected to rise naturally through inflation and other factors affecting price indexes. There a number of ways to reduce overhead expense but a few which come to mind are A) lease re-negotiation B) vendor contract re-negotiation and C) practice expense sharing arrangements or medical practice mergers.
Many private practices lease the office spaces in which they are located. These leases may have been negotiated in more favorable economic environments. Reduced demand and lower occupancy has persuaded many landlords to be flexible to new and existing tenants. If possible, practice owners should approach their landlords for reductions or other concessions, even if their practices are faring well. The uncertainties of healthcare payor reimbursements going forward may make this a wise future option while still potentially available in today's environment.
Another step which practice owners may consider is the renegotiation of contracts with vendors and service providers. This can be helpful in reducing a wide range of practice expenses. The outsourced medical billing company may be one place to start, especially if their percentage fee of collections has not been adjusted to account for changing norms in the medical billing industry.
An additional option which may be helpful to some medical practices is entering into an arrangement with another medical practice. This can range from a basic cost sharing agreement between practices to a full-fledged business merger. The medical practice merger is a way to leverage economies of scale, negotiate more favorable payor contracts, gain unique competitive edge in a particular market, or extend reach into new markets. A less-binding alternative is cost sharing with another medical practice. This could be as simple as a single shared expense or common piece of equipment, or as involved as a full split of all practice expenses including staff and lease. Major factors to consider when entering into such arrangements are the financial health and staying power of the practices involved as well as the business strategy, trust level, and risk threshold of the respective practice owners. Naturally, a competent medical practice mergers and acquisitions team should be involved in such dealings.
Some advices from my doctors !
1. Before giving any test, make sure you study all the notes at least 3 times.
(Dr.Shatha, HOD community medicine)
2. In most of the exams, you are supposed to know something about everything, not everything about something.
(Professor Kumar, HOD anatomy)
3. Before answering any question, make sure you understood the question very well, then stop, think about the answer, then look to the answers, if you don't find the answer choose the most similar one.
(Professor Ramesh, HOD of Gen. surgery)
4. Don't act dumb & stupid, please use your brain and read more. believe in yourself and remember there is only one way to get better marks and increase your knowledge: repeat & repeat & repeat.
(Dr. Nasir A.K. surgeon)
5. always look in the center of the slide and see what's abnormal, don't waste your time on other things, always look in the center. if you follow this rule in everything in your life, you will reach your target faster.
(Dr.Kazim, Pathologist)
6. when they give you a case, think about the main signs and symptoms, don't make yourself and everyone else look like pagal* !!!!!!!!!!!!!!
(Dr. Hebah, microbiology lecturer)
7. If you are not in the mood to study either sleep or read the easiest chapter. don't waste time.
(Dr. Bader BT, Medical Student - my buddy)
8. If you wake up and see you are not in medicine, never make this mistake. once you enter medical college you have no life and there is no way back.
(Dr.Kacy, Medical Student - my ex gf)
-* I think "pagal" means crazy or idiot !!
(Dr.Shatha, HOD community medicine)
2. In most of the exams, you are supposed to know something about everything, not everything about something.
(Professor Kumar, HOD anatomy)
3. Before answering any question, make sure you understood the question very well, then stop, think about the answer, then look to the answers, if you don't find the answer choose the most similar one.
(Professor Ramesh, HOD of Gen. surgery)
4. Don't act dumb & stupid, please use your brain and read more. believe in yourself and remember there is only one way to get better marks and increase your knowledge: repeat & repeat & repeat.
(Dr. Nasir A.K. surgeon)
5. always look in the center of the slide and see what's abnormal, don't waste your time on other things, always look in the center. if you follow this rule in everything in your life, you will reach your target faster.
(Dr.Kazim, Pathologist)
6. when they give you a case, think about the main signs and symptoms, don't make yourself and everyone else look like pagal* !!!!!!!!!!!!!!
(Dr. Hebah, microbiology lecturer)
7. If you are not in the mood to study either sleep or read the easiest chapter. don't waste time.
(Dr. Bader BT, Medical Student - my buddy)
8. If you wake up and see you are not in medicine, never make this mistake. once you enter medical college you have no life and there is no way back.
(Dr.Kacy, Medical Student - my ex gf)
-* I think "pagal" means crazy or idiot !!
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