Train your trainees

I’ve been spending a lot of time in labour ward anaesthesia this past month. It’s great, because I get all the gratification of the caesarian sections (I remember it well from internship), without having to wade through blood and amniotic fluid and human excreta myself.

This tweet in part inspired this post.

Another thing I remember well, is the tension in theatre when the intern is cutting. I had such difficulty getting my ten caesarian sections for our logbook signed off, because so few seniors were willing to let an intern cut. It’s not only the obstetrician – often, it’s the theatre nursing staff. To be fair, nobody likes to be scrubbed in for a routine caesarean that lasts ninety minutes. Other times, it’s the anaesthetists. Because nobody likes to worry that their spinal anaesthetic might wear off before the surgery is over.

I have had a taste of the same with my new position, too. Not having done anaesthesia in four years, there is a lot I have had to relearn. My “teachers” have been great, and I seem finally to be finding my feet, but there have often been grumblings from surgical teams when I was slow. As an intern, I might have minimised myself and declined to perform the procedure. But now, I need to learn, and quickly. So I have been pushing back harder (when not to the patient’s detriment) – and to my new colleagues’ credit, they have supported me.

Check the replies on this tweet – they made me feel so much better.

Having experienced this, I will always be the annoying medical officer who encourages the intern/student/newbie to perform procedures. Not because I think I’m so wonderful, but because I want trainees to feel as nurtured as I have felt these past few months, and not as burdensome as I sometimes did as a student and an intern.

Sometimes, I think clinicians forget that they were inexperienced and under-qualified juniors once, too. There is nothing admirable about learning to place an intercostal drain on YouTube, without senior supervision, as many of us like to brag. That is a sign of a failing system. We should be taught and guided by others with experience. We deserve that. Our patients deserve that.

I also know that it is a system that fails not only interns. I know that demoralised doctors have little interest in training juniors. (But that is a discussion for another day.)

Interns who are not competent become dangerous medical officers, wherever they may go for ComServe. They have both the right and the responsibility to be trained. We have the responsibility to ensure that they attain their very best, even if they are afraid while doing so. We do it to pay forward the teaching we have received. Or if we were not so fortunate, we do it to improve where others failed us.

Train your trainees. It kind of goes without saying.

General Practice and Emergency Med: A Bad Combination

Since the beginning of the year, I’ve been working semi-permanently for a private family practice. More recently, I’ve also started doing shifts in the emergency centres of both private and public hospitals.

While doing each of these separately comes with their own challenges, doing them together has proven to be a demoralising combination, because they highlight the failures of each field, and our inability to fix them.

Being a good general practitioner is damn hard. The pressure to see patients quickly is high, and spending 15 minutes per patient is the norm. This means that a lot of health promotion cannot happen. It takes a while to counsel about smoking cessation, when the patient’s reason for visiting is a stomach bug. Perhaps you tell the patient to come back for a Pap smear (because her consultation time is up), but she never does, because she can’t afford another consultation. Continue reading “General Practice and Emergency Med: A Bad Combination”

Global Day for Safe and Legal Abortions

4e1359d8e206b850346e738d142216cdThe young woman left my consulting room after protracted counselling, with a completed J88 (a medical report of assault), a prescription for anxiolytics and pain medication, and a referral to a therapist. She was six weeks pregnant, but would not be for long. Her husband had inserted misoprostol tablets in her vagina, without her knowledge or consent. She was already in the throes of uterine cramps. Continue reading “Global Day for Safe and Legal Abortions”

Are We Secretly Our Own Worst Enemies?

If you’ve been reading South African news, you’ll know that at least 300 interns and community service doctors stand to be unemployed next year, due to a lack of funded posts at accredited institutions.

Perhaps you read about our inhumane working hours last year.

Perhaps you have read about the overflowing hospitals where patients pile up in the corridors.

These are not new problems, we just hear about them more because doctors and patients have phones with cameras, and social media accounts.

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Continue reading “Are We Secretly Our Own Worst Enemies?”

The Threat of Fun-employment

In final year, we thought that getting an internship post at our desired hospital was the hardest – and most coveted – thing.

Two years later, we all tried to find a community service posting that would give us a foot into the door to our future specialties.

But we didn’t know that those were the easy parts. Then, we still pretty much had guaranteed employment (most of us, at least).

Then came the end of Community Service, and reality hit us in the face: we were on our own.

* * *

That’s where I am now. The government no longer “owes” me a job, and unless I find one, I’ll be unemployed come January 2018. People used to say, “There’s no such thing as an unemployed doctor.” These days, there are plenty of them, because freezing posts is a done thing. Continue reading “The Threat of Fun-employment”

Mental Health Begins With Medical Students

Every few months, the mental health of doctors/medical students makes it to popular media. It seems like these spikes in attention occur, and everyone shouts YOU SHOULD CARE FOR YOUR DOCTORS! and then we write blogs and we tweet and we make youtube videos and eventually we go back to work, and nothing has changed.

I think we are the missing link. And by “we”, I mean qualified doctors. And also, you, the older doctors. Continue reading “Mental Health Begins With Medical Students”

My Evolving Opinions About Doctors’ Working Hours

I started working on this post two days ago. Since then, I have received news of a colleague who died in an accident while driving post-call. She went to my alma mater and graduated last year, and though I did not know her personally, my heart breaks. A country with a shortage of doctors has lost a young doctor who was just starting in her career. She was well-loved, and we will all feel her absence.

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 * * * Continue reading “My Evolving Opinions About Doctors’ Working Hours”

Threatened By The People We Serve

A few weeks ago, the community around one of the hospitals where I work picked up their torches and pitchforks (well, sort of) and protested again. I’ve written before about South Africa’s protest state of mind, and about working during a riot.

As it stands, when this specific community protests, they protest right outside the hospital. No matter the reason for protesting, they block all entrances to the hospital and threaten anybody who tries to circumvent them.

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Police told us to turn around. We called our superiors. They told us to come to work. Continue reading “Threatened By The People We Serve”

Unrealistic YA Fiction Is Not Such A Big Problem

Young Adult fiction treads a fine line. On the one hand, it needs to be in touch with its audience. YA readers want to see protagonists who speak realistically, eat realistically, and act realistically.

On the other hand, reading offers us the opportunity to live different lives; to travel to places and settings and adventures that we may never have, and very few people want to read about a normal, boring setting. (Although I am told that Patrick Ness’ The Rest of Us Just Live Here addresses this very well, I’ve not yet read it.)

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Not the topic for this discussion, but I do want to read this book.

Continue reading “Unrealistic YA Fiction Is Not Such A Big Problem”