Why I can't watch movies where people collapse

Before I start ranting, let me make a plug for why everyone should learn to do CPR (cardio-pulmonary resuscitation)- not just healthcare professionals. Here are the Top 10 reasons to take CPR or First-Aid Training. "Over 70% of all cardiac and breathing emergencies occur in the home when a family member is present and available to help a victim". I'm not sure that statistic is entirely accurate but the point is that lay-people are usually first at the scene and every second lost is crucial. In the UK, there is a campaign to get CPR taught in all schools as a mandatory skill. That can't be a bad thing.

Now, on to my rant. Consider the following generic scene from a movie: Person collapses. They are unrousable. Friend or by-stander jumps in heroically and does a couple chest compressions and the victim magically recovers. I find such scenes laughable for many reasons but I'll just pick a couple.

1. How often do people stop to assess a victim's pulse or breathing?

Fair enough, it probably takes up too much time on screen for what should be a fast-paced, dramatic scene. But seriously, just shouting at someone is not going to tell you if they are breathing or have a pulse. In addition to which, if the rescuer does stop to assess the pulse, he might as well just stick his finger in the victim's nose. I'm sorry, you are not going to get a good pulse by practically occluding a person's windpipe. If the victim is breathing or has a pulse, there is another reason why they are momentarily unrousable. CPR is therefore inappropriate. Maybe they've fainted and need a drink of water... But that wouldn't do very well at the box office would it?

2. What's wrong with the above picture?

Rescuers in movies often do these really wishy-washy, spineless chest compressions with bent elbows while looking into the distance with desperate eyes full of tears. Well, first of all, by this point, you probably should have called 999 shouldn't you? But again, why waste time when you can clearly handle this yourself.... not. If you bend your elbows, you are doing more to tone your upper arms than you are to help the victim.

3. Trying to inflate someone's lungs is not the same as kissing them

Usually if the rescuer is a man and the victim a woman (or vice versa), they more often than not have a romantic connection. Him saving her life is meant to prove his undying love. He, therefore, does these dainty breaths that look like delicate kisses. You are meant to seal the other person's mouth with yours and adjust their neck so the air actually gets down their windpipe. But why mess her lipstick up? She needs it for the next scene.

So I hope I have convinced you that Hollywood lies and that you should learn to do CPR the right way. Here's a good place to start if you want to be trained. And if you haven't been trained, anyone can do hands-only CPR. Learn how to do that with this funny video.

Privileges you earn when you become a consultant

A consultant is the most senior doctor on a medical or surgical team (also known as the 'attending' on Grey's Anatomy for those who need a more contemporary reference). First and foremost, consultants are people. Therefore, there will be good and bad, nice and not so nice consultants just as there are people. But there are some things that just come with the title. They are living the dream.

1. You don't have to use punctuation in your emails

Come on, we've all had that experience where you spend an hour trying to word a really important email in exactly the right way. You try to keep it succinct but not abrupt, have a tone that is keen but not does not make you look like a kiss-up and most of all, you check and re-check your grammar and spelling. Only to receive the reply a week later:

Hi ruth

Yes thats fine

BW (i.e. best wishes)

TRM (i.e. consultant's initials)

Seriously? You've obviously typed that on your iPhone walking into the hospital from your car.

2. You are not expected to remember anyone's name, but everyone should know yours

Classic. You join the ward round 2 mins late- after all the necessary introductions. So no-one knows who you are and you don't know who anyone else is. Is that the intern or the registrar standing next to you? Panic. You introduce yourself to the consultant. He obviously doesn't catch your name and doesn't bother telling you his. Next dilemma: Do you ask him his name? Is that impertinence? I am just a lowly medical student.... It probably doesn't matter much because he'll walk straight past you in the corridor the day after anyway.

3. You don't need to carry anything with you anywhere

So the consultant does not know your name. But that does not stop him asking you to borrow your stethoscope on a RESPIRATORY ward round. Obviously you must oblige. Then when he is finished listening to the patient's chest and walks away absent mindedly, you pick up the notes, redress the patient, pull the curtains open and also let him borrow your pen. By this time, he's already forgotten the stethoscope isn't his. Follow him like a hawk.

4. You are excused for being up to 20 mins late to almost anything

Anyone who has had teaching arranged with a consultant knows that teaching arranged for 10am may not actually start until 10.30am or may not happen at all. But it's fine. They were probably busy cutting someone's chest open.

5. You get paid to work a full day but you can spend most of it in your office

Now this is not entirely true. And makes all consultants sound lazy. But whereas junior staff have to do paperwork stood in the middle of a busy ward, a consultant can retire to their comfy swivel chair in a quiet office- sometimes complete with personal coffee maker. The rest of us swap spit on half-washed coffee mugs while fighting over the last free computer.

We've got a lot to look forward to!

"Are you telling me this as a friend or because you want medical advice?"

I have had countless encounters with friends who bring up their recent physical ailments in casual conversation. When this happens, I have to choose which hat I am going to wear: the friend hat or the medical student hat. Consider the following 2 scenarios, both of which start with the same complaint.

Scenario 1

Friend: "Omg you know I have had this annoying headache last couple of weeks. I can't take it anymore."
Me: "Oh no that's too bad. How are you going to go on holiday then?" *Allows friend to keep moaning*

The downside of this approach: GUILT. Oh, the guilt! Suppose because you did not attempt to assess your friend, she had a delayed diagnosis of something really dramatic and it was all your fault! A recipe for sleepless nights.

Scenario 2

Friend: "Omg you know I have had this annoying headache last couple of weeks. I can't take it anymore."
Me: Launches in with "How long exactly have you had the headache? Can you point and show me where it hurts most? Do you feel nauseous?" bla bla bla

The downside of this approach: TOTALLY INAPPROPRIATE. Where is the compassion? Where is the empathy? Your friend called you for a little TLC and you and go straight for the jugular! Probably lose a friend or 2.

The Compromise

Friend: "Omg you know I have had this annoying headache last couple of weeks. I can't take it anymore."
Me: "Oh no that's too bad (empathy). Are you telling me this as a friend or because you want medical advice? (safety net)"

Of course even if they decline my pseudo-medical advice, I'm already building a differential diagnosis and structuring the sequence of questions I would ask if I got the opportunity. All medics know we only have non-medic friends so they can be our guinea pigs. I also tend to include some carefully padded screening questions in the following conversation. For example- "Oh let me get that off the floor for you. I'm sure your headache gets worse whenever you bend down...."

The answer: Just ask! 

This improves patient- I mean friend!- satisfaction. And for all friends who do the casual "talk about my problem" thing, just be aware you have triggered a reflex response and we WILL try to assess you without you knowing it.

Myths about being in final year (and, well... medical school in general)

"Bow down"

1. You know everything

False. To those in younger years, we walk around with stethoscopes not because we might be called on to assess the next patient that is short of breath, but because of this ridiculously insatiable need to reassure ourselves that we a worth having one. Many of us just about know how to put it in our ears (yes there is a right and a wrong way to do that). To those family and friends that insist on asking us to diagnose them: we *barely* know what we have read in textbooks. Our powers of clinical judgment are pretty much infantile. Please contact your GP. Please.

2. Passing a competency test means you are competent

NO NO NO! You passed a competency test because you checked some boxes on a pre-printed mark sheet and got a signature for completing a task like taking blood. This is not the same as being able to find a slippery vein in someone's arm while your bleep is going off and the patient is practically pushing you away because they are a needle-phobe.

3.  You have absolutely no free time

Not true. However I see why people quite easily get this impression. After a long day of being told why you will never be a good doctor and being an epic fail in general, the natural response is to retreat to the haven of your bedroom with a cup of hot chocolate and a cheesy movie. So when we say we are 'busy' it doesn't always mean 'busy doing work'. It's actually quite time consuming trying to piece together the shreds of your dignity.

4. You have to give up all your hobbies to give your course priority

Well, within reason. But I do have a medic friend who is training for Olympic rowing and hasn't dropped out #justsaying. Medical training is more flexible than you think.

5. By final year you know exactly what specialty you want to go into

By final year, most people at least have an inclination as to whether they want to be a medic or be a surgeon. It sometimes doesn't go beyond that. Some people just have a light bulb moment (like I did) but others will be going back and forth up until the day they have to apply for specialty training. Sorry to disappoint those who make it a point to ask us what we want to go into. You probably won't get an answer for a while.

So hope this clears things up a bit. But at the end of the day, the BIGGEST MYTH OF ALL is that we are super human. We need to cut ourselves some slack and stop being so intense. And I've found the people that most help me to do that are my non-medic friends and family. You are irreplaceable and your contribution is invaluable even though we might not always say it. Thanks for not giving up on us!

What it means when medics say "I had a bad day"

Why bother

Well I suppose this means different things for different people. But because I spend most of my day in my head, processing everyone and everything (and sometimes over-processing things), it doesn't always mean that something bad has happened to me. I find it really draining talking all day to people I don't know very well or sitting in lectures for more than an hour or spending a morning studying a topic and still not understanding it (grr). But for a medical student, having a bad day has a significance all it's own. Below is an example of a 'bad' day based on true events.

6.30am: Wake up to travel an hour and a half on 2 buses to get to the hospital I am placed at. It is never a good idea to start the day sleep deprived. Cup of coffee #1.

8.30am: Ward round (WR). More than just an educational experience. This is an opportunity to look like a fool in front of not just 1, not just 2, but maybe up to 6 other healthcare professionals. Keep your iPhone close and bookmark Wikipedia.

9am: Consultant asks me to listen to a patient's chest on WR (while everyone watches of course). He asks a question I should know the answer to. I get it wrong. He laughs. He does not even give me the answer.

10.30am: Lecture on a topic I am not very confident about. Consultant asks me a question. I get it wrong. Perhaps forgivable if it was a difficult question no one else knew the answer to. But when she asks if anyone else knows the answer, the WHOLE class answers in unison. This obviously compounds the shame acquired earlier in the morning. I can feel everyone's eyes burning into my back. But maybe they'll forget by lunchtime?

12pm: Lunchtime. Forgot lunch. Enough said. Cup of coffee #2.

1pm: Practice taking a history from and examining a patient on a ward. (Realise I left my stethoscope on the previous ward I was on) Spend an hour talking to a chatty elderly lady who gives me her frustratingly convoluted version of events leading up to her current hospital stay. Present her history to registrar (senior doctor) on the ward with no clue as to what her diagnosis was. Only to find that what I wrote was all nonsense. She has dementia.

3pm: Observing a Consultant in clinic known for his biting sarcasm. (Consider cup of coffee #3?) He ignores me for 2 hours and belittles all the nurses and patients he sees. I tremble in a corner hoping he won't remember I'm there. At the end of the clinic, he says to the patient "Oh look at her over there. She has no idea what's going on." Definitely makes you question your self-worth.

5pm: Home time. One and a half hours home on 2 buses.

**Insert non-medic friend who asks how I'm doing** Fine I guess?

8pm: Cram the anatomy of the whole lower limb into a couple hours in preparation for the following morning to be spent in surgery. I question whether I should bother continuing with my course, but realise I spent too much time and money to get to where I am now. *Sets alarm for 6.30 tomorrow*

The Implications of being a young, black, female medical student in the NHS

Does this picture look familiar? If you did not know that nurses in England actually have a uniform, you might be tempted to say it matches the description given in the title. Add a strange accent (like mine) for good measure and you would be 99.999999% convinced that I was a nurse if you saw me on a ward.... Right?

Well you would be wrong. Like many of the older, Caucasian patients I see everyday. Perhaps that is an unfair stereotype but I suppose that is the point I am trying to make.

Your experiences shape your expectations of the world around you. 

Patients expect me to be a nurse because I fit the profile of those they have encountered, while I usually brace myself for the tentative enquiry about what I 'actually do' or 'what I am going to become when I graduate?' They tend to give me a range of options at this point: a pharmacist, a nurse or a physiotherapist (if I am lucky). They almost never include the possibility that I might become a doctor and are more often than not shocked when I say that a medical student is a student doctor. If I was a 6 foot tall, Caucasian, British male, I wonder whether I would have to have this conversation as frequently as I do now.

Some may take offence and say this is a remnant of a time where racism was commonplace and few women were physicians. But I would not go so far as to label it as frank racism. Thankfully, after 4 years in the system I have never experienced discrimination as a result of these well-intentioned assumptions. However, I cannot say it has had absolutely no effect on me. One medical student friend of mine says she tries not to wear navy blue (the colour senior nurses wear) so as to avoid confusion. I have adopted this approach and as a rule, I always, ALWAYS introduce myself as a student doctor to avoid the ambiguity of the title 'medical student'.

In no way do I belittle the role of nurses in providing care but it seems we have a bit of catching up to do with a profession as dynamic as medicine.

Why would anyone want to pursue Haematology?

Sickle cells under a microscope

“So what specialty would you like to go into?”

The all-too-familiar conversation starter on a coffee break or between patients during a lazy clinic. For the best part of the last 2 years, I have been able to answer confidently that I would like to pursue Haematology. This has been met with shocked, disappointed and confused expressions from seniors as well as peers.

Considering the Clinical Haematologists I have met spend most of their time on wards and in clinics, their average day is not much different from any other medical doctor. However, most medical students and doctors envision them as having purely academic interests and deplorable social skills, perpetually crouched over a microscope investigating rare diseases.

Perhaps these persistent, pervasive misconceptions are partly due to how Pathology is taught in general: dismissively pitched to medical students as the underbelly of medicine. 

The DH Workforce recently categorised Haematology as “oneof the most deficient specialties.” This is not only an issue within the UK but appears to be a worldwide phenomenon. One Student BMJ article on careers in Haematology suggests that “Many modern undergraduate courses fail to provide students with adequate exposure to the various pathology specialties” and I could not agree more. I would be first to admit that my pre-clinical Haematological teaching was less than stimulating.

I recall the printed Haematology lecture notes handed out by my medical school were no more than 10 pages while our copious Neurology notes were so heavy I was unable to carry much else in my bag once it was packed. Not to mention the bore of sitting in front of a microscope on a hot afternoon a couple days before summer break, looking at a blur of red and white cells, enthusiastically agreeing you could distinguish a neutrophil from a basophil when really you wished you could just bring the slide into focus. To supplement my limited knowledge, as well as to explore a budding interest, I applied to spend my Special Study Module in General Haematology. This was arguably my most enjoyable placement so far even though I was pitied by all my peers. Surely it was a great misfortune that I was presumably allocated my lowest ranked option.

While the quality of undergraduate teaching is not entirely responsible for attitudes toward Haematology, I would like to suggest that it is a significant contributing factor. Perhaps it is time to start asking questions about the origins of these misconceptions and what can be done to ensure the future of a specialty essential to clinical medicine.

How to be the kind of Consultant every junior wants to become

This 'guidance' may be a bit premature... But hey, just because I haven't had a consultant post does not mean I have not encountered the best and worst the fraternity has to offer.

"I speak to you not as medical students, but as my future colleagues."

This is potentially the most inspiring quote from the most inspiring consultant I have ever had. I tell you, I would have gone to the moon and back for this man. He was probably one of the few seniors that treated us as people with skills and opinions that mattered, rather than the nameless, faceless minions that we have been conditioned to believe we are. Apparently, we are the future of medicine. Who knew?

Now, there are many ingredients to make the perfect consultant. These would include lots and lots (and lots) of experience, good communication skills, extensive knowledge on, well.. everything.. in life in general, and maybe buying your juniors a round of coffee after ward rounds to secure their undying allegiance. However, in my limited experience, the 'best' consultants (i.e. not the ones I liked the most but the ones who had an efficient team and provided high quality care) were the ones who placed value on everyone they worked with- as well as their patients.


They thanked their secretary for ringing to remind them of a meeting. They gave constructive feedback to the intern who put the drip up wrong. They let students suture patients in theatre even though the last and only time they ever sutured was on a manikin. They believed the people they worked with were competent until proven otherwise.

And last but not least, the patient. The patient was always part of the team. True, they did not come to MDT meetings to discuss their latest histology results. But they were always treated with respect and dignity. Always. Their opinion had value and weight, rather than being a check box at the end of a consultation.

I probably won't be a consultant for a while. But it helps to have good role models. Thankfully, they still exist.