#GP Locum

[mercurygray]

Could you do 13. Picture (One-Word prompts) for Isabel Corbett?

Isabel Corbett comes to us from All Creatures Great and Small, where her father is the Darrowby GP and she herself has just finished medical school and is now navigating the heavy world of job hunting.

Norfolk certainly wasn't Yorkshire.

But a job was a job, and small towns in England were the same the whole island over, even if the folks down here looked at her funny and called her accent strange, and asked a second time exactly where she'd done her schooling, as if they weren't sure what folk knew about anything up 'up north'.

It was London, if you must know, and Doctor Harrison hired me to be his locum, so if you have some issue with it I suggest you take it up with him in three months. But until that time, I'm rather afraid you're stuck with me.

That was what Isabel wanted to say, but sharp words made terrible neighbors, so she kept her opinions to herself, and focused on things she could control - the state of the surgery waiting room, and making sure Mrs. Mendel, the secretary, was paid on time so that she'd at least have that to say when it came to recommendations.

"You sound lonely," her dad remarked, as she made her weekly call from the phonebox in town. "Are you getting out at all?"

"I walk Poppy twice a day!"

"That's not what I meant, Iss. Are you meeting people? I thought there was supposed to be a - an RAF base thereabouts or something. Norfolk's supposed to be filled with fliers."

"If you're trying to find me a boyfriend, Dad, I have to tell you -"

"I'm telling you you need to find some people your own age, Iss. Have some fun! You're only young once and there's a war on."

She'd never been more grateful to hear the tones go. "That's the pips, Dad. I'm out of change. Love you!"

"Love you too, Isab-" and there was the tone, indicating that the call had dropped. Isabel sighed and hung the handset back up on the phone, pushing the well-thumbed book back into its slot under the and trying to rearrange Poppy's leash, which had wrapped around her owner's body twice while she'd been standing there talking.

"Come on, Pops, let's get home."

It wasn't just finding a fellow, was it? It was going out and being seen with him, when she was supposed to be the doctor, supposed to be above reproach. If she were seen in the pub they'd say she was loose, that she was young, that she shouldn't be trusted with such an important thing as the general health of Brockdish and Needham and Thorpe Abbotts. Well, I'm terribly sorry, but there's a war on, and most of the young men are being snapped up by the army, and most of the older men are what's left, and they need vacations the same as anyone, so I'm about all that's left.

Her father was right - she was lonely. She was on her own, after they closed the surgery for the day, and there wasn't much doing in Needham that wasn't the pub. She was reading a novel and trying to get better at darning. There was always the Lancet to catch up on. The BBC had a very good hour of music after dinner, and she was getting rather good at cottage pies, after she scorched a good half-dozen of them and nearly destroyed a pan boiling the potatoes. Poppy was just about the only source of conversation - and being a dachshund, she wasn't saying much.

She was glad she'd brought the dog, though. People liked Poppy - and how could they not? She was small and different and mostly friendly, once she'd had a sniff around.

Poppy let out a bark, and Isabel looked up to see what was either a large white dog or a very small polar bear bounding down the walk, tongue lolling in perfect pleasure, straining at the leash. "Meatball, calm down, will ya? Maybe she doesn't want to meet you, you big dummy. Sorry, miss, he's a bit - of a one track mind today, if you follow me. You might want to keep her back a bit."

"How very American of him," Isabel replied, feeling more than a little prickly at the moment. One of them, Dad? Is that what you want for me?

The American looked for a moment like she'd punched him, and then smiled, wrapping the dog's leash around his hand to rein him in a little. "Fair enough, miss," he allowed with a shrug. "She have a name?"

"Poppy," she offered, not really sure why she was answering his questions. "Like the flower. Dare I ask how he came by Meatball?"

"Not really sure, miss, he came to me with it. But sometimes a meatball's a - a dumb guy, you know?" He was smiling about it. "And he's smart, when he wants, but he's - he's dumb, too. Kinda like his owner." He pressed his lips together for a moment,thinking about something. "Does - ah - does her owner have a name, too?"

"Not one she feels like sharing at the moment."

His face fell a little. "Oh. Well, ah - if Poppy is free on Saturday night, there's a - a dance at the base. Meatball's probably gonna be outside. If she wanted she could, ah. Could join us. Since she's better behaved than he is. There's snacks, kitchen's doing a whole spread, and a bar."

Her stomach almost rumbled at the thought of what a full stocked American spread would look like - there were already tales in the surgery of unheard wonders from the kitchen at the airfield over at Thorpe Abbotts. And there was something endearing about the question, about the way he'd ducked his head and reined in his smile, as if he, too, perhaps, were from a small town, and knew something about how people could judge, and all the things he'd probably been told by the army about first impressions.

"And a lot of guys would be - be real glad to talk to a girl for a change," he added, which somewhat soured the picture as her father's words came back in full force. You're only young once and there's a war on. "Especially a pretty one."

Don't push your luck. "I'll see if she's free," Isabel offered, still feeling prickly. He nodded, feeling that this was a fair answer and touching his cap so he could tug Meatball on their way,the dog still straining on the leash, trying to get a sniff in at Poppy.

The dog watched the pair go and then looked up at Isabel as if to say, with her woeful little brown eyes, "Well, mom, can we?"

Isabel frowned. "Oh, not you, too."

[beingdreeyore]

Oh my gosh! I’m so excited bc I’m in Aust too! Would you say the training programs for psychiatry are difficult to get into, or if they want particular experiences (I.e research, leadership)? How are the training programs themselves? What would you say would be a day to day schedule? (ahaha sorry for all the q, I just haven’t met that many people who are interested/doing psych in my medschool)

The training programs are getting much more competitive now as they're oversubscribed in some states. So it is moving more towards the surgical path of needing to do SRMO years in psychiatry or unaccredited registrar years to get onto the program. I don't know anyone that did research and benefited from it though. They value time in the game over the fluff stuff that doesn't have a lot of clinical application.

Honestly? The training program is horrific. No one tells you that the five year program will take 7 years for most people because you can't actually get your compulsory terms. The assessments are also relentless. We do them constantly through each and every term as well as the five keys assessments (that each require several months of study), so it's pretty rare to meet an accredited reg who hasn't taken a break to locum because they can't handle the workload. Psychiatry beats a lot of specialties in terms of the number of different assessments required. I don't know a single psychiatry registrar who isn't burnt out. You do a minimum of six assessments per term, as well as the five key major assessments that each require several months of study. The pass rate for one of those is only 30% so chances are you're going to be dropping over $1K for that assessment more than once... And in my health district the college can send us to one of 7 different hospitals every six months and we just have to be okay with that. No say in the process and no concern for how that might impact the rest of our lives.

It pitches itself as the work/life balance friendly specialty, but it's not. You will get paid less than all your colleagues (except maybe GPs?) and you will work just as many hours. Psychiatry registrars aren't actually recognised as registrars on the pay scale until they hit their fourth year.

Just be very aware of what you're signing on for before you do it. Use your intern year to get a feel for everything and know what psychiatry actually is. During your compulsory ED term as an intern see psych patients on every shift, because that is what you're actually signing up for. If you come in blind to what it is, chances are you will leave.

Probably not what you want to hear, but everyone I know is so burnt out from trying to get through this. If I could go back I'd just do orthopaedics or GP. I'd never put myself through this if I'd known then what I know now.

[ukftm]

Sorry this is so long. In 2017 i was seen at london gic, given the go ahead for testosterone gel. My gp refused at the time. I tried 3 different gp’s and the 4th agreed to start (now 2020) but she was a locum. When she left my gp cancelled the prescription i was only on it 3 months. I begged my gp to continue but got nowhere as she “didn’t believe it was right thing to do” her words. So i changed gp surgery. It took me so long to change as i felt like giving up, but i finally thought i’d try again. Just had a appointment waited 8 weeks for it and all i got was a referral back to gic London which is 5 year long wait list. I’m going to try another gp at this surgery another 8 week wait. If they refuse to starting a prescription, i’ll have to wait the 5 years again and even then a gp can refuse to prescribe again like the first time. I came out when i was 16 it’s 10 years later and medically i am no further forward. I am so frustrated at the whole system. It feels like i will never be able to medically transition. I want to give up completely. I’ve done everything i can transition wise (documents ect). What are my options if i still get refused from every gp i see, i can’t afford private care. I know legally no gp has to prescribe on recommendation of a specialist but if that’s the case then every gp i see won’t prescribe. I can’t keep trying, it’s exhausting and i haven’t got anywhere in 10years. What can i do?

Hi Anon,

My advise would be to write a letter of complaint to your local NHS board, detailing the fact that you have been prescribed T from your GIC and your multiple GPS have refused you treatment (detail the specific GPs by name). These GPs are acting against the recommendation of the GIC and refusing you care/treatment.

Before you write your letter of complaint, do some research on the NHS website and look at their care statements and policies for patients. This will help you use some of these points in your letter.

GPs may have their own opinions about trans health care but they CANNOT refuse you treatment especially when you have been prescribed T by your GIC. GPs cannot decide who they will and will not treat. This is discrimination. You must say very clearly in your complaint letter that you are being refused treatment as a trans person and you are therefore being discriminated against due to your trans identity. Using words like ‘discrimination’ and ‘refusal of access to medical care’ are really important when writing letters of complaint.

The General medical council clearly state: “That GPs must co-operate with gender identity clinics and specialists to provide effective and timely treatment for trans and non-binary people.”

You may also want to get in contact with your GIC and ask if there is anything further they can do.

You would however NOT be put back to the bottom of the waiting list so you would not have to wait another 5 years for further letters or appointments with your GIC. You would just need to email/call them to discuss your situation.

You should also reach out to your local MSP and tell them about your situation and that as a trans person you are being refused treatment.

Citizens advice are also a good place to contact for advice. Their website states: “if GPs refuse to accept you, they must provide reasonable grounds and give you their reasons in writing”. This will apply to refusing treatment also. I have attached the citizens advice website as it provides a few options to get help.

There are too many trans people having bad experiences like this with their GPs, but writing formal letters of complaint highlighting their discriminatory practises are essential here.

https://www.citizensadvice.org.uk/scotland/health/nhs-healthcare-s/nhs-patients-rights-s/#:~:text=If%20they%20refuse%20to%20accept,first%20choice%20has%20been%20refused.

I have also attached a document that Mermaids created about GPs and their duty of care as well as a link to a website discussing trans healthcare, so you may find this information helpful:

https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/managing-patients-with-gender-dysphoria

[deweydecimalchickens]

Actually thinking about pursuing some kind of assessment for my Probably Not On Team Neurotypical, because of reasons.*

Desired response from listing Murderbot under the heading Media Characters I Identify With And Reread For The Comfort Of A Thought Process I Understand: Shortcut to comprehension

Likely response from listing Murderbot under the heading Media Characters I Identify With And Reread For The Comfort Of A Thought Process I Understand: Exhausting and time-consuming fixation on the word 'murder'

*Including but not limited to:

Realising my 44 on the Cambridge AQ was out of 50 not out of 100 and immediately wanting to fight the writer of such a poorly-planned and time-wasting test

Everyone I have instantly bonded with turning out to be some flavour of neurospicy including at last count my wife, my best friend, most of my other friends, and the mountaineering instructor I developed an instant crush on

Finding social distancing, quarantine and mask-wearing much easier than a) the general population or b) normal life

Finding understanding what's going on in Japan, a country where I am not expected to speak the language or understand the cultural norms, slightly easier than doing it in England

Incoherent tears of relief when expressing this possibility to a poor baby locum GP who didn't ask for this and thought she was just doing a meds review

I'm so fucking tired

[med-przemek]

Book review: In Stitches by Dr Richard Edwards

An easy yet intriguing read, “In stitches” is an A&E testimonial of an accumulation of cases (not chronologically arranged) and how A&E departments run in conjunction with hospitals. Although, there are a lot on interesting cases denoted in the book, there is a pattern or common trope to patients presenting with an issue - the only thing that realistically changes is the patient itself. Therefore, I will be honing in on two points that stood out significantly which relate back to how the NHS is run. 

Firstly, we all know of the four hour A&E target, where 98% of patients should be seen and treated within this rule to streamline the admission process. Although over the many years this system has brought along some efficiency, such as through the use of triage and specialist nurses so that doctors do not have to become involved, raw data fiddling still exists. In fact, the BMA and BAAEM presented that 31% of A&E doctors have admitted to working in departments where “data manipulation was used as an additional measure to meet emergency access targets”. This is to prevent the hospital being financially penalised by NHS managers when several breaches occur and lowering its ‘star performance score’ . Strategies embraced by departments to meet the 4 hour target include:

Patients being discharged on the computer before they have left A&E. 

Patients being admitted to A&E by the computer but not physically as there are more beds on the system than there are in real life.

If patients appear with a referral from the GP, they are admitted to the admission ward, not A&E, so no target is assigned. 

If a patient is referred to a specialist after being seen by an A&E doctor, they can be left waiting for hours since they are not assigned similarly to the 4 hour target.

On days when the target is being assessed, elective operations may be cancelled to free up beds and the hospital employs locum doctors and nurses to appear as if targets are being consistently met.

Have you ever wondered why you have to be referred by the GP to a specialist first and not directly by the hospital doctors, who may in fact know your case better? The reason being, and my second point in play, is that accountancy yet dominates clinical rules. A&E doctors cannot easily make referrals, instead they have to send the patient back to the GP for the referral too be made. Yes, the NHS still bears the weight of the cost, but referrals from the GP come from a different pot and the hospital instead is paid by the primary care trust. This comes at the expense of the patient, and in some cases may cause further damage; such as when a patient has a TIA (transient ischaemic attack), they should be seen in a TIA/prevention stroke clinic within two weeks according to evidence based medicine to prevent a stroke. But this is not always the case. Doctors are taught the gold standard of care but often due to management structures and rationing of resources leads to a realistic silver and bronze quality of care being delivered. The NHS in sectors is disjointed and separate parts work independently: accountancy here unfortunately wins. 

“In stitches” and my short book review are just continuous arguments that the NHS needs more resources; that targets should not be solely made by politicians without the input of doctors working in the clinical environment and that hospitals should not be penalised for failure of not meeting these unrealistic targets as it only adds pressure to the already pressurised NHS. 

[galunacycheckyourheadtour]

Letting the right one in Counselling - the good, the bad and the ugly

Counselling, has many different connotations. Media has depicted the visuals: you go into a well designed room recline on a sofa, whilst the good ol' head shrink smokes a pipe, sagely nodding at you whilst you carefully spill your life story and vasts sums of money. Juxtaposed with the image of the clinical doctors office where you are shown a rorschach image and inadvertently describe a fluffy bunny as something much more sinister, get thrown into an institution, stuffed full of brightly covered pills, get a jacket to hug yourself and a padded cell for one.

But what realistically happens is an inbetween of these two things, because as with everything and every profession there is good and there is bad. There is well meaning and good intentions but like a long term relationship, sometimes there are red flags that should not be avoided. My blog today is about my somewhat colourful journey with counselling, cheating the process and eventually finding the right one.

My experience with talking therapy started in the mid-90s, when I was a teenager. Damn, I feel old. To give a bit of background, I had my first (now I can clearly recognise) mental health episode when I was 15. One day I went to bed, and I couldn't get up, I did not have any energy, my brain didn't seem to work and I just felt ill. This continued for 3 months, all in the lead up to GCSE's, with constant visits to the doctors, blood tests. They suggested M.E., glandular fever, but one locum had a quiet word with my mum stating that he thought I had depression. My mum was astounded and I don't think told me for a couple of years, and it was pushed to one side.. You have to remember that at this point depression was never thought about/ discussed/ diagnosed in reference to children/ teenagers or even really adults for that matter. I slowly started to get better but these episodes would return again and again until by my early twenties I was diagnosed with clinical depression and sent for therapy.

I remember feeling terrified, as I had visions of emptying my head and ending up in an institution, I had seen Return to Oz! I already felt so different to everyone else, no one around me had been referred for therapy, maybe that is where I needed to be? My dad at this time, also pulled me to one side one day and told me that I needed to buck up my ideas, and pull myself together there was no such thing as depression, I was making it all up, attention seeking and I was disappointing him'. He used more colourful language than that. It absolutely destroyed me and I genuinely thought I was I was putting it all on - the grandest lie of all. But I didn't want to live this lie, so why was I doing it?

That is when I met Jerry. Jerry the counsellor had a small room at the GP surgery that smelt of stale sweat. He was in his mid-50s, and had teeth that moved and bled when he talked. Within the first minute I knew I had nothing in common with this man. But, I also had no previous experience of counselling, so nothing to compare it to - I was in it for the long haul. He talked about my past, about my illness but was obsessed with my dad and that is where we stayed. He had me writing letters to my dad, angry letters about how he made me feel, he wanted me to get the strength to give one of these letters to my dad. Role playing scenarios, that made me cringe with embarrassment - it felt like GCSE drama class rather than a grown up conversation. Plus my dad did not look like a character from a horror film. I got more and more angry with my dad, and actually probably more truthfully at Jerry. 12 weeks later, I walked away - thanking Jerry and him probably thinking he had solved everything but really I was feeling more lost than ever…plus furious at everything.

And so it went on, there were more Jerrys, when I allowed it. Some had better techniques, but all shared the same fascination with my father. Now, I don't have to tell you my dad was a complicated man. I have some stories to tell and boy did I tell them.

I realised that I started to really push those stories, as the counsellors lapped them up - they would write furiously in their notepads, shaking their heads and nodding sympathetically. This stuff was therapy gold! Was I trying to entertain the therapists? I have no idea - but I was cheating the system. But I knew, I just wasn't sure about any of this, it wasn't helping me. It was just making me angry, resentful of my decisions, resentful of my childhood and far too backwards focussed. I was not moving forwards in a positive motion. I would leave each one of these experiences disappointed mostly at myself, for sticking at it hoping that something would be different. 3 years ago I decided I needed to take matters into my own hands and search actively for a private therapist. I was much more self aware at this point and knew exactly what I wanted and what my intentions were. I researched, really trying to get a feel for each person before booking. I stumbled across my therapist and I met with her. This was different, we sat and talked like adults - it felt natural and not forced, the silences were good contemplative silences, I never felt undermined, or like a good case study for the journals, it just felt right. She challenged my thinking, my habits and I loved that. She taught me the phrase to be curious about something, so when I am angry/ or thinking bad thoughts, i do that - I am like an undercover detective for my own mind. Now, of course my dad came up but we worked through that with what I felt was positivity. I had already closed off so much anger for him when he sadly passed away 10 years ago. This was about me, the way I dealt with things, the choices I made, my lack of confidence in myself. Through all the highs and lows we have worked together through it all, and it is the best money I spend. It is the only place I am truly honest and open, I don't censor or lie - I just am. She is my person and I am very grateful to have her. So I want to share 10 things that I have learnt: 1. There is no harm in trusting your instincts, if you don't think a therapist is for you - Walk away. Both NHS and private therapists understand this might happen and respect your decision. This is one of your most important relationships, it has to work for you and also for them, but you are investing the time - don't compromise 2. There are lots of different types of therapies now compared to what I initially received, so definitely look into what is available and what appeals to you and your situation. The MIND website has some terrific resources for some options. 3. Never lie. Never cheat the process like I did. If you are doing this - what is the point? That person is not your person, walk away. 4. Don't have any expectations. Remove what you have seen from the television, read in books. These therapists are here to listen to you. To dedicate time to your story. They don't have a bias. Their only confidentially rule break would be if they were concerned you were going to hurt yourself or someone else. 5. If you have concerns about first appointment, jot a couple of things down in advance - what do you want to get out of that experience? Has something triggered you? Do you have any questions about counselling? Take the notebook, it will give you some kind of back-up should you feel like you are shy or not sure what to say. 6. My personal choice is for a private counsellor and at the time, I was lucky enough to be able to afford it and it was my personal choice. I struggle a little more now, but I also know that it is an investment into me moving forward, so I do anything to ensure I have that money, even if it means selling some dresses or shoes. I have built that relationship with my counsellor and it was a lot, and I am still on the journey. The NHS has some incredible free services and I have friends who have gone through the process of CBT and have had life changing experiences, so don't be afraid to self-refer or ask your GP for more help.

7. Give yourself time and space around appointments. Give yourself at least 15 minutes of quiet head space before you go in - don't rush around or you will find it takes longer to settle into the process. The same goes for after the appointment. I always allow an hour if I can to process, take a walk along the beach, just let it digest.

Sometimes, you just don't want to be around people and that is fair enough. Some sessions can be massive and you feel like you have run a marathon, some you don't feel like you have made any progress at all. Don't judge!! those smaller sessions are often the ones you don't realise that you have moved mountains in.

8. Keep your process to yourself if you can. I am not saying don't talk about it if you want to but honestly, I found it better not to. It was my personal thing and if anyone always asked I would say fine. The problem with sharing with other people, especially when you are in the middle of some big stuff - it could skew the way you are thinking, or they could say 'oh well with my counsellor we did this' or many things. So I try to keep this part of myself closed off. 9. Similarly to above, don't let the haters get you down - some people just don't understand counselling, and that is for them - they are entitled to their opinions. They might have had bad experiences themselves. Funnily enough, my dad saying counselling was useless all those years ago stuck with me, hilariously he watched the Soprano's and guess who went to see a therapist, and found it to be beneficial....there we go!!! 10. For those of you, that think you know people, who should go to counselling. Be warned, each person has to find their own way, you cannot make them, and they will resent you for suggesting it. Think about it - do you want to be told you should go to therapy??. It is a hiding to nothing, and you might find that you are no longer one of the people they confide in a result. As the saying goes you can lead the horse to water.... I hope this was useful....

[krisinthefalklands]

It Begins...

"I've applied for a school in the Falklands", Sara tells me. ".... Huh!? Oh? Right... OK", this comes as a bit of a shock to me, we've previously spoken about the possibility of us returning back up north, where the quality of life is better than where we currently are, just outside of 2023's Worst Place To Live, Luton, and where the cost of living is significantly cheaper, but at the same time, I was also somewhat unsurprised, Sara has always had itchy feet (I'm talking about a desire to travel, not a long undiagnosed skin condition) and was ready for a new school to teach at.

We'd previously visited an island with a small population for her to attend an interview weekend, where partners were also invited, and please, do read the next bit in air-quotes, with as much sarcasm as you can muster, "but partners aren't being interviewed, just invited so they can get a feel for the island", sure Jan... and just days before the 2020 COVID-19 lockdown measures were introduced in the UK, we visited the tiny island of Sark in the Channel Islands.

Not only is Sark a tiny island, it also has a tiny population of about 500 people, where people are outnumbered by the sheep, and the coastline is frequented by funny looking black and white birds (just remember this information for later) as puffins can be spotted on the sheer coastal edges of the island in Spring.

During our time on Sark, when Sara wasn't preparing a lesson to give to her potential future class, we went up and down their bustling high street, avoiding the local traffic of tractors, horse and carts and bicycles...there are no cars allowed on Sark (despite how much my friend Victoria keeps suggesting that if you squint, you could mistake a sports car for a small tractor), not that you would need a car given the size of the island! We also had a lovely curry at the seigneur's home with the other candidates, headteacher of the school and his wife, and a few local residents, including the locum GP, who I may have landed in hot water when I was "absolutely not being interviewed" by the island's vicar and his wife.

The current seigneur of Sark is the delightful Christopher Beaumont, the 23rd person to take up the mantle, a former officer in the British Army, but despite his highfalutin sounding status is down to earth, and happy to chat away with visitors to his beautiful gardens, especially about his newly installed solar panels and electric tractor (the first of it's kind on Sark!)

Sadly, it wasn't to be for our dream of a few quiet years on Sark, and we returned to empty streets, loo roll shortages and queues outside supermarkets, as we took our singular government approved walk of the day. Life moved on, just day after day after sodding day. The more things changed, the more things stayed the same.

There were other attempts to move to Sark, the teacher who did get the job decided it wasn't for them and returned to mainland UK. I guess choosing small island life requires a certain kind of hardiness, pig headedness and a desire to be part of a small community who will know everything about you after a certain amount of time. We have those qualities (we hope), but again, the job was offered to another applicant.

So after a couple of attempts of moving to one small island, and it not being successful, I pessimistically assumed it would be the same here, Sara would go for the interview, impress the panel, but there would just be that one sodding person with a smidge more experience, who would get the job and leave us stuck on rainy Brexit island.

The big day came, Sara set off to London for the interview, you see, whilst for Sark they flew us to Guernsey and then put us on the cute little ferry to the small island, the Falklands is a 16 hour flight across the Atlantic, and a bit far to go for an interview, so the interview panel came to the UK, at Falkland House, the Falkland Islands London address, where you can visit to discuss all manner of things, so long as those questions are about the Falkland Islands. Of course, things didn't go smoothly, as her tube decided to stop in the middle of a tunnel between stations, unable to contact the office to say she was delayed as this was a line that did not yet have 4G signal installed throughout, but she did make her interview in the nick of time, and on exit was told she'd hear back within a week.

At this point my pessimism had kicked in. They had clearly given the job to someone else, and we were doomed for another year in the London commuter belt. Another year of eating fish fingers whilst watching Pointless. Another year of breathing in the polluted air from the main road we lived next to. Another year of...

"ring ring¹"... Sara's phone is ringing, it's a +500 number from The Falkland Islands... I listen in...

"Hi, is that Sara?", asks the caller, she confirms, and the voice on the other end replies, "Sorry about the delay in getting back to you, when we arrived we needed to have a week to rest from the exhaustion of flying and to have a think about the candidates we saw. We were really impressed with your"... I could sense the "but", again, I'm a pessimist by nature... "and we'd like to offer you the position of class teacher at the Infant and Junior School starting in September" - for once, my natural glass half empty, cheery outlook on life, was unfounded.

I went to Tesco to get cake to celebrate the news, although the choices were rubbish and I came back with mini Millionaires Shortbread bites rather than actual cake, but now we had to let it sink in that we were going to have a very big journey ahead of us.

What follows is that journey²...

¹it didn't actually go "ring ring", we're millennials and as such our phones are permanently on mute, and just went "vvvvvvb vvvvvvb" but that would have looked like a cat walked across my keyboard if I'd put that.

²It's worth noting up to now, this has mostly been about Sara's journey, but from hereon this will be a shared journey

[wags-confessions]

Not studying but I work in a minor injuries unit at a hospital which also doubles as a rent a room private GP/other medical clinic type thing if that makes sense? But one of the locum doctors (it’s a little like freelance) is a forensic medical examiner as well as a General Practitioner, so we talk lots about various things when it’s quiet and waiting for closing time.

They’re different to pathologists who usually will do a sort of A-Z of the body during post mortem, assess injuries and causes as a general thing which would then be passed onto a FME who can examine reports more throughly within the context of whatever it is that’s happened for an FME to be required in the first place, they’re almost exclusively used when there is some suspicion surrounding someone’s death or if something is going to court, they’re effectively a medically trained legal witness/expert testimony, they help to bridge the gap between the legal arguments and the medical facts of a case and are tasked with re-examining all the reports and sometimes will go back and re-examine bodies to look for something specific within context of the crime and also because not all injuries will appear right away, some can take a week or more to appear after a person has died.

They’ll often be called to court to explain medical findings in detail and clarify any legal questions I.e “is it possible that X and Y injury could have been caused by something other than Person A beating the crap out of him” and they’ll go “no it’s not possible, because the bone is broken in this specific way that’s only caused by this specific thing and this specific type of force” and that sort of thing. So they’re incredibly important. But they can also be psychiatrists too, they can testify as to how someone might have arrived at the point of hurting someone because x y z happened in their past and other circumstances etc.

They must have finished medical school, be a practicing medical professional (except in some circumstances, I think if someone has retired but are still clocking in a certain amount of hours of “continued professional development” which all doctors are required to do throughout their careers) and at a minimum, be considered a “senior” doctor in whatever specialisation they’re in. I think you also need an additional degree that’s specifically for forensic medical sciences too but I’m not sure, possibly just a certain amount of training.

I’m a bit of a true crime bod so it’s super interesting but it’s a very stressful job for her at times, as a GP it’s never usually anything too sinister but the FME work, it’s all violent crime of some kind, so r*pe, domestic abuse, gang related attacks and unfortunately a lot of children who have been abused in some way or another.

Sounds very interesting!! — Belle

[obstinatecondolement]

When I was at the GP's office on Friday, I was seen by a locum and he was looking at my chart and asking me about one of my meds like, "Is this for epilepsy or do you take it as a mood stabiliser?" and I said, "As a mood stabiliser." But then he didn't hear me and, like, I worry about repeating the same thing with the same inflection, etc., because my auditory processing issues find that really hard to penetrate when I can't understand someone, so I tend to just use different wordings entirely when someone doesn't understand me in case they have the same problem, so what I said next was, "Um... not epilepsy." Which I think came across as rather more meek about my probable bipolar disorder than I actually am.

[gponthemoveyt]

Telehealth can be useful! :)

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[thatshouldgoonahat]

had the most magical experience at the gp yesterday where i didn't actually feel the needle going into my arm for my bloods it was so gentle

but the doctor doing it was a locum and doesn't actually work at my local practice so now i've basically had "getting blood taken" ruined for me, and i'm never going to experience something as beautiful again

either way i'm very excited because i'm going to see another doctor on wednesday and he's going to have actual blood results to tell me what i already know! (that i'm having a flareup and also very likely anaemic again)

i just can't wait to get a lovely little bag of iron pumped into my blood so i can feel awake and aware of my surroundings again for the first time in weeks

[kierasmith]

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[drsonnet]

EIGHT DAYS IN GAZA - A Doctor's Diary

Eight Days in Gaza by UK-Med on on Exposure

[fernbankhealthcare]

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[biotech-news-feed]

British Medical Association blames ‘employment crisis’ on funding shortfall and move to hire more non-doctors in practices GPs across England are struggling to find work despite patients waiting weeks for appointments at practices buckling under dem #BioTech #science