Burning The Clavie

Just finishing O+G before moving back to Grantown for my GPST3 year. O+G has been a really outstanding job, which I will miss. Though I am on the four year programme, the end of hospital jobs seems to have come round incredibly quickly and the question of what to do after completion of training seems a short time away. Before that, there is my ST3 year which is all general practice based in Grantown where I did my first block and, of course, the small issue of the CSA exam, for which I am doing some preparation with a group of other GPST3s. There is some formal preparation for this exam within the GPST3 course and a separate two day preparatory course is offered at Nairn every year. Most people however, also find themselves a group to work with. I am lucky to have found a group who work well together, and have a bit of a laugh and offload a few work gripes as well.

Snow Is Here!

 It’s been a while since my last blog posting and much has happened since.  My first six months of GP in Grantown was seems a while ago now but was a good experience.  All too often in secondary care, I have made plans and written prescriptions, but have no clue as to whether either were actually effective.  Six months in GP was long enough to see patients for review and find out if changes I had made to treatments had actually been of any benefit.  Of all the transitions between specialties, I found the biggest drop off in confidence and knowledge was that from hospital into general practice.  Fortunately, I also found it a good environment for structured teaching and access to seniors for support and guidance.

One of the problems with some of the GP programmes is that you have spent a fairly long time in training before you get to GP practice.  For those who have not done a GP job in foundation, there is the inevitable worry of ‘what if I hate general practice when I get there’? I think one of the biggest adjustments to GP in comparison to hospital medicine is the sense of working alone; something which other GP trainees I have spoken to have also found.  Most practices, my own included, meet daily to discuss issues which have arisen with particular patients or in the practice in general.  I find this really useful, even if it is just a chance to have a chat before the start of the working day.  I also found when on GP placement that the fortnightly groupwork meetings were an important chance to chat with other trainees, as much for the chance to compare experiences as for their educational value.

My six months of A+E was a great experience. At Inverness as a junior, you work most closely with Emergency Practitioners, who staff the middle grade rota.  These are GPs, who although they have experience and skills in A+E are not Emergency Medicine trainees.  They also staff the out of hours GP service overnight.  It looks a great job to me and one which I would be keen to do at some point in the future.  Some might say ‘why train as a GP when you want to do something else’, but actually I think these jobs offer the best of both worlds for people who enjoy general practice, but also want to stay involved in the more acute aspects of medicine.  Actually there is variety of jobs you might do as a GP other than see patients five days a week in a GP surgery.  I have worked with GPs who work in General Medicine, Anaesthetics, Paediatrics and Dermatology in addition to staying involved in General Practice.  Highland is not unique is having GPs with specialist interests working in secondary care, but the difficulties of attracting specialist trainees to the region do seem to open doors to GPs who wish to have another string to their bow.

This week has brought the first snow of the winter.  The high points of this have been downhill skiing on lovely fresh snow at Cairngorm yesterday and cross country skiing round Glenmore forest today.  The low point was being stuck in snow on the A9 for three hours on my afternoon off; not what I was planning to do with my precious free time.   Other good outings lately have been kayaking at Findhorn Bay in the morning after a night shift and watching seals feed on the incoming tide.  Cycle touring around Aberdeenshire a few weeks ago was fun.  From the rolling hills of Deeside to the chocolate box prettiness of the of Pennan village and on to post-industrial deprivation of Peterhead and Fraserburgh; it was probably our last tour of the winter and good to see places that are often spoken of, but seldom visited by tourists like us.  Haven’t taken any snowy pictures yet, but I’ve decorated this post with some pictures of Carn Mor Dearg and Ben Nevis a couple of weeks ago.  Beats working!

Rural GPST workshop 14th and 15th November 2013

Having missed out on this gathering last year due to rota commitments, I was very keen to go this year.  Having been held in the not so remote location of Inverness in 2012, this year it was to be hosted by Western Isles Hospital in Stornoway, on the Isle of Lewis.  The timetable included a visit to the Bristow Search and Rescue Team, who are based at Stornoway Airport; surely not an opportunity for a joyride in a helicopter, I thought.  Well, no actually there was no helicopter ride, the weather put paid to that, but the high winds also ensured a very interesting flight from Inverness.  With wings flapping and the angry sea boiling just a few feet below us, you could tell the locals on the approach to land.  They were the ones reading their papers whilst the visitors were looking out of the windows contemplating the end and hoping it would be over quickly.

We were made very welcome and the course was great, with talks on forensic medicine, the aforementioned Bristow Search and Rescue team and the new role being taken by Western Isles GPs in staffing the hospital Out of Hours .  More than anything else, it was interesting to hear from other trainees, how they were getting on and what challenges and opportunities their different placements were bringing.  Being based in Grantown-on-Spey, I feel a lot less remotely placed than I did last year in Oban, so it was great to catch up with a few old video conferencing faces from last year.  It was a reminder that rural practice is really the most exciting option out there.

Having pestered them to do it for two days, a few of the other trainees agreed to say a few words on camera about their life and work in some of the more remote parts of the region.  Apologies for the level of background noise on some of the clips.  Friendly though they are, I didn't feel I could go into the kitchen of the cafe and ask them to keep the noise down.  Heres a link to the film.

https://www.youtube.com/watch?v=FCrMOqHWZ7g

Farewell to Oban.

Been a while since I posted anything.  Finished in Oban in August and I am now in GP at Grantown-on-Spey.  I was much sadder on leaving Oban than I had expected.  Though I had a good time and learnt a lot, I didn't realise how settled I had become until it was time to go.  One of the nice things about the four year programme is being in one place for a whole year.  Having been on the move every four months for the previous two years, being in one place long enough to learn everybody's names was a nice change.  Oban was a great place to be for several reasons. Working in a small team and being the only doctor in the hospital at night meant lots of good learning opportunities. It was a bit scary occasionally, but there was always good support.  By the end of the year, I felt comfortable handling situations which would have had me shaking in my shoes at the start. I would thoroughly recommend it.
 It was also a very sociable place to work.  The fantastic summer brought many a barbeque, initially at the doctors accommodation until an unfortunate incident lead to a NO BARBEQUES dictat from on high.

http://www.bbc.co.uk/news/uk-scotland-glasgow-west-22780842

After this, we were forced to find other locations which included one of the consultants front garden and Tralee beach, which is also a nice place for a swim or a mess about in kayaks whilst the burgers are cooking.  There was also a bit of a junior doctor's craze on juggling and something called poy, which is basically a bit like being a cheerleader, except there is a risk of hitting yourself in the face (or even setting fire to yourself if you are very daring). So a very jolly end to what was a great year.

Having left the West coast, we seem to have brought the sunshine away with us.  I was back in Oban doing a locum shift last weekend and basically, it has rained since we left.  Shame for the new team over there but we can't complain over here.  We have had some great days out in the Caringorms both cycling and walking and also some kayaking in the Moray Firth, which has been amazing for wildlife spotting, with lots of dolphins and seals around.  Working at the GP practice here is good so far but feels like a massive change from hospital work and I spend a fair bit of my time asking for help.  I find myself thinking 'I would be OK if you were really sick, but I'm afraid I don't know what to do about your spots' .  Luckily, help is available and I feel like I am learning a lot.  The practice has about 5000 patients, mostly from the communities of Grantown, Nethybridge and Boat of Garten.  In addition to the practice, the GPs also staff the adjoining Community Hospital and Minor Injuries Unit.  They also answer the occasional BASICS call-out, which for those who do not know is a pre-hospital emergency service which all the GP partners at my current practice participate in.  All of this means there is a fair bit of variety in the day.  Whilst in general practice, there is also a requirement for working out of hours (36 hours in the first 6 month placement).  So far, I have done mine in the local OOH service.  Based at Aviemore, this has been good fun and also varied, from medical problems to the bumps and scrapes that one would expect in a centre for outdoor activities. 

Will post again soon, maybe with some stuff about GP life or maybe just another ramble about what we did on our days off.  Thanks for reading.
 Mike

Dr Fattah and (some of) the Oban Hospital Class of 2013

I Do Sometimes Go To Work.

Ardnamurchan From Ganavan

Lest I create the impression that all I ever do is ride my bike or go walking, I felt I should probably write a bit about the job at Oban and why it is a good for a GPST1 year.

 I did my foundation jobs in the two enormo-hospitals in Sheffield, Englandshire.  As a result, my exposure to lots of really common medical and surgical presentations was limited to what I saw when carrying an out of hours on-call bleep.  I have therefore, prescribed IV fluids and chased serum rhubarb for patients with everything from epistaxis to epididymitis, without learning much about the management of these conditions. 

Happily for me, the relatively small number of patients and the non-specialist nature of care at Oban means things are very different here.  In my first six months, I had really good start-to-finish exposure to all the commonly presenting medical conditions and I am finding the same, now that I have moved over to surgery (or the dark side as the medical nurses refer to it). 

The same is true of my experience in A+E.  I have never done an A+E job before, so I am finding the smattering of A+E that you do whilst on call here a great experience.  It presents situations where I don't have a clue what I am doing (otherwise known as learning opportunities) every day.  This has really brought my knowledge and confidence on.  This is also true with very unwell patients in A+E.  Out of hours, for at least a short while, when a sick patient comes in, you are it.  When I have called consultants in at night (which has NEVER been a problem),  I have never been pushed out, rather I have supported and guided through management of the unwell patient.  It is rather like being thrown in at the deep end, but with a good lifeguard on the poolside. 

I made a film last year about training here, in which some of the consultants and juniors talk about why they think this is a good place to train.  Have a look.  It's a bit long, but I hope it gets the message over that if you are looking to get a very broad base of exposure and some experience of being under pressure, then you could do a lot worse than Oban.

MAMIL sighting on Mull

Hello and sorry it's been a while since I last posted anything.  Just got back from an excellent weekend off cycling.  The first whiff of spring has brought everything back to life and there have been sightings of a rare mamil on the Isle of Mull.  For those who do not know, mamil is not a spelling mistake but an acronym, standing for 'middle aged man in lycra'.  Rather than tell you how lovely it was, I have made a little film for you to look at.  Tried to upload it directly to the blog but it didn't like it so here's a youtube link to it.  Bye for now, 

Mike.

 

 

Dog Bites and Nurse Practitioners.

Was awoken from my post night shift unconsciousness (I won't call it sleep) by my wife Janet this morning, as she had been bitten by a small, terrier whilst out running.  Although it would be very fitting if it had been a West Highland, but the description sounded more like one of those yappy brillo pad type dogs who's name I can't remember.  Happily, beneath the fairly alarming streak of dried blood lay only a very minor wound.  Unpleasant though this incident was for her, it gave me an opportunity to do two things; firstly to breach patient confidentiality without being sued (she knows I have no money), and secondly to talk a bit about nurse practitioners and how indispensable they are to the workings of the hospital here at Oban.

Janet's Leg; after dressing.

West Highland terrier; not guilty.

I wondered about her tetanus status as she had her last booster over three years ago after another running mishap.  Living 30 seconds from A+E does occasionally have its benefits and I suggested we go over and get a more informed opinion on the matter.  On arrival, Jenny one of the ENPs was on hand.  Whilst cleaning and dressing the wound, she reminded me that 5 tetanus toxoid injections are regarded as giving lifelong cover and additional cover would only be required for highly contaminated or devitalised wounds. " Of course", I said, "how could I forget". 

Perhaps because I have mostly been in big city settings prior to moving to Highland Region I have never worked in a hospital which was so reliant on nurse practitioners to run the show.  As a new junior here, the nurse practitioners in A+E keep you on the right track.  Never having done an A+E job before, I find that they are way more knowledgeable than I, especially on things like minor trauma.  I used to think I didn't like nurses telling me what to do, but now I have discovered that I love it.

There is also a ward based advanced nurse practitioner on every shift.  In addition to participating in ward rounds, helping with admissions, coordinating beds, liaising with ward staff, keeping an eye on patients with potential to deteriorate, spotting any problems which have gone unrecognized by others (sometimes me) and generally helping wherever needed, the ANPs also carry an arrest bleep and attend all resus calls to A+E.  On a hectic day on call or a busy night shift, they make a massive difference to how your day goes and they come and have a cup of tea and a chat when it is quiet.  Here is Jilly, the ANP who is on call with me tonight talking about what they do. Bye for now.


Mike.