We need to talk (more)

We as humans are a social species. By that, I mean, we have the intrinsic need to meet and engage in conversation. Even people who call themselves ‘introverts’ have the innate requirement for social interaction. It is a physiological phenomenon, which eons of evolution has not gotten rid of. Or more precisely, eons of evolution has preserved our ability to connect to one another. Despite that, the modern human is not very good at engaging in conversation with another human, effectively. Continue reading


The worried luddite

Living in a post google search world means that the answer to every question is not only within reach of a 10 second computer search but also the answer can be a multitude of different things.

Take this question for example: ‘what is the use of Gabapentin?

This question produced 5,800,000 results in 0.92 seconds. That’s crazy. It would take me a life time to read through each one of these entries. So obviously I don’t. In fact I already knew the answer vaguely and just needed reconfirmation. But what happened is that on 5 different webpages, I was given a slightly different answer. Not only was I confused but also frustrated. Was the question I was trying to answer worth the twenty minutes of trawling around? Wouldn’t an old-fashioned look up in some book been easier (Yes: this is why the BNF exists).

Technology offers us so much. Hi-tech equipment to do routine surgeries. The concept of e-consultations where the need for doctor and patient to be in the same location is gone. The robotics used in complex surgeries. Even the blood pressure machine is no longer manually used. Let’s face it, technology has revolutionised medicine forever. And we don’t want to go back! We’re far connected, stable and stronger as an industry than we have ever been before. We are saving more people, treating more families and overall achieving higher feats on a day by day basis.

However a talk with my brother (and then subsequent many chats with many engineers) had me wondering what direction our beautifully expanding technological field will take us. We are already in the era of driver-less cars and 3D printing.  Surely it is not too incredulous to imagine a near future where routine check-ups are done by artificial intelligence? Or coughs and colds be automatically diagnosed through a system of exclusion criteria. I used to work for a service which used algorithms to come up with a likely diagnosis. Effectively using the knowledge of many doctors and compiling it into a workable computer program. How long until our machines start doing what we already do. This already has a name: machine learning. Recently a machine beat a human at the game ‘go’. A game far more complex than chess and undefeated by a non-human since its conception centuries before. And when our machines are as good as we are, how long until they get better? What will be the role of doctors then? Will we be there to provide moral support and talking therapies? Won’t that be a good thing? Doctors are always saying how over-worked they are!

But surely humanity cannot be replaced? Can it? What makes us humans so? What makes us tick? Why do we emote and feel? No one has completely figured this out. The more I study the more I feel that medicine is absolutely not just a science. It’s an art. Ask any doctor and they will give you examples of where they’ve not relied on computer algorithms and text-book learning. They’ve relied on compassion, empathy, communication and most importantly experience. Nothing in medicine is cut-clear. There are areas of grey, scales and degrees to diagnoses and disease. The reasons is because the human brain and body is complex. Far more complex than any machine ever built. We, the flawed, egoistic, narcissistic humans are the perfect example of the epitome of creation. We are also the creators of machines. We created machine learning and artificial intelligence and it is here to stay.

There may be a day many many years in the future when instead of seeing your doctor, you’d be seeing a machine. We are racing and advancing ahead in the field of medical-technology at a rate greater than ever before. Making leaps and bounds but is the future where humans are no longer needed really a future we want to jump towards? As the creator of the TV show ‘Black Mirror’ said: ‘I’m not scared about the future of technology but I am worried about it.’



Killer toothache

My grandad was a dentist. My cousin is also a dentist. I study medicine. And yet I’m on NHS Choices frantically working out why my tooth hurts. (and getting horrified by photos of terrible teeth)

We know very little about our teeth. I don’t know when teeth and gums divorced themselves from the rest of the organs and went off on their separate ways but it is a shame because the last time I had any official teaching on my teeth was back when I was 7 years old and in primary school. I think dentists and the field of dentistry is great. But isn’t the glorious oral cavity – the entry to the human GI system, still part of well – the human? Why is this not part of being a doctor? Why is dentistry its own vocation? Why did we draw the line with teeth?

Perhaps its because I have a toothache and am suddenly very aware of my aching teeth but I’m now trying to do all the things the dentists always tried to tell us to do. Here’s a reminder incase you also forgot:

  • Brush teeth twice a day
  • limit the sugary foods (this includes fruit, chocolates, juice and even bread!)
  • floss!!
  • go see the dentist regularly (last time I went was years ago)

Thing is in most countries healthcare is free. Take the NHS for example…if you have any kind of pain all you have to do is get yourself to the doctor and everything is fine. But for dental care you have to pay. You have to actually find a dentist and it’s a bit like looking for the perfect cake – you’re never satisfied because you paid for a particular type of cake and its not there. The point I’m trying to make is that dentistry is privatised and with it the sense of entitlement goes. And perhaps the state’s vested interest. If the government has to pay for our health then it is in the interest of the government to keep people healthy. Not so much the case with dentistry.

The second reason why I think the general public is so ignorant (like me) is because everyone for some reason seems to emphasise the importance of having ‘good looking teeth’. Now lets get real. Teeth are not meant to make you attractive. They’re purpose isn’t to bag you a marriage but to help you chew foods and remain healthy. So the idea that your teeth should be pearly white and straight is great; but also a bit misleading. They should also be cavity free, not have plaque on them, not be infested with bacteria and not developing gum disease.

Teeth are much more interesting than just providing you with a good smile. Look after them – they’re just as important as your heart, lungs or brain!

Click here  for a dentist’s parody of Ed Sheeran’s ‘Shape of You’ And Click here for Ed’s original song.



Transcending the role

A week ago I met with a patient who was staying in hospital for a few days after having had bowel surgery. He was upbeat. Telling me about plans for when he would go home. Telling me about various events in his life. I took a history. In medicine, ‘taking a history’ basically means finding out as much as you can about a patient, as efficiently as you can, so that you can plan their treatment and hospital stay optimally. It requires practice and there is a technique so I thought I’d get some practice in. I was feeling quite happy by the end of the chat. The patient was jovial and I had done my duty. I got up to leave, smiled briefly and he went back to reading his newspaper. I went home that night, narrated my experience to my family and thought nothing more of it.  Continue reading

And when our brains just don’t want to cooperate…

I write when I’m excited. I write when I’m sad. I write when I cry. I pretty much write with the easiest of triggers. And yet I came here today to write about my surgical placement and found that I just didn’t want to. I actually came to my blog as a way of trying to get myself in the mood for studying. But I’m in this strange limbo where I want to work and I just can’t convince myself to actually open my books. I want to become a doctor and yet I just don’t have the energy to look at yet another x-ray, another blood result, another exam question. I feel as if my life is a video and somebody has turned the speed down to 1/2 speed. And the weird thing is I don’t feel particularly sad, happy or anything really. I’m sort of in an apathy. This is certainly not the first time this has happened. In fact I struggle with this pretty much all the time.

The thing that always gets me going is that I’m scared to fall down a path of darkness and despair. I feel like an ex-smoker who desperately wants another cigarette but knows damn well the consequences of cancer and COPD and that’s their single motivator to not do it. And my motivations are that I want to be a doctor. I love being with patients, talking to them, finding out about their life. I’m well aware that I’m not at all an unfortunate person. I have a roof over my head, a family, food and education. Not everyone is as lucky.

Rationally, I know all this. And yet I still feel this way and I can’t explain it. I’m sure in a little while I’ll be fine. It’s just a passing mood but what if one day this mood is here to stay and its staying becomes a permanent part of my life? It’s strange because all this is in my head and it is my own mind that scares me the most.


Ward Rounds, Bloods and flying stethoscopes…

Medical dramas on TV were my favourite because I always imagined myself to be like Turk from Scrubs – cool and smart, or Dr. House – grumpy but loveable or Meredith from Grey’s anatomy – dramatic and brilliant, her hair always perfect.

This was me Monday morning: Stethoscope falling out of my bag, having no clue where the patient files are kept and forgetting my water bottle so that by 5:30 pm on my first day on emergency medicine placement, I looked more like a drowned rat than a medical student on placement.

Placement is essentially practical, hands-on experience at doing what doctors do. Except I know less than half of what the most juniour doctor knows and I’m pretty sure that I’m getting in the way more than I’m actually helping. Not to mention being a medical student qualifies me to be able to do exactly nothing on my own – and patients know this!

Take this morning, for example. I was sat in an acute ambulatory unit in the acute medical unit, waiting to take blood samples (venupuncture) for the first time ever on a real patient. Previously I’d always practiced on a mannequin. The first patient just flat out refused. The second one looked a little dubious but agreed in the end but his arm kept shaking, revealing his inner doubts on my ability (not entirely misplaced!). The thirds patient was eerily calm. That was good and I managed my first ever independent venupuncture. There was red stuff coming out…pretty sure it was blood!

Hospitals are busy places. You have acutely sick patients. Porters moving beds and patients around the wards. Nurses caring for their patients, doctors doing this that and other. And the bustling wards are a beautiful place to learn about the weird, common, rare and simple interesting pathologies of the human body. A sick heart can make so many sounds. Just a quick listen can illicit if somebody has a pleural effusion or more like a pneumonia. A quick chat to a nurse will tell you whether the patient is a returning patient or a new admission. The juniour doctors always know what management plan a patient is on. You simply can’t get bored. I do feel selfish in the knowledge that whilst I am here I’m really only helping myself learn.

But there’s always a moment that you remember. And I think for me today it was a small fraction of a second that sealed the deal for me. We were on ward and I wasn’t doing anything particular. All I did was look up whilst I was examining a patient and smile. I apologised for taking so long and not letting the patient finish a sudoku puzzle.

The patient just smiled back and replied: ‘you are the future. You’ve got to learn somehow’

It occurred to me quite suddenly that placement is fun and enjoyable and really exciting. But at the same time I’m not just learning for myself. By ensuring I know my medicine properly today, I’m having an impact, however small, on the lives of real people. They’re not just a disease. They’re a person.

I walked out from the ward whilst relatives were visiting. And as I walked near the doors, the patient from this morning recognised me and said ‘goodbye’.

I don’t know why but it made me smile. I might not be Turk or Dr. House or Meredith. But these small moments make me feel even more cool and smart and on top form than any doctor I’ve seen on TV.

After all, TV is fiction and hospital medicine is reality!



De-cystifying Poly cystic ovary syndrome…

In the past I have written about the clinical picture of PCOS and why it happens and all the pathophysiology of it. I’ve written about treatments and management and the psychological impact. In the past I’ve talked about my own battle with the condition (still have it 😀 ) and so today I’m trying a different tack…I’m attempting to bring PCOS back on the table but in a celebratory fashion as opposed to a problem.

I love PCOS. And studying it at university yet again has only served to reaffirm my love! It’s not a particularly pleasant condition to have. But it has brought me more in tune with the inner, finer working of the female human body. And our bodies are miraculous. Perhaps massively inefficient – after all other species don’t have periods and they can certainly get pregnant more often than for a few days a month. But the beautiful, complex and intricate nature of our reproductive cycles never ever ceases to amaze me. Starting from the maturation of our eggs (follicles) to ovulation, to fertilisation (that glorious moment when sperm and egg meet) and if allowed – to pregnancy and the birthing of a newborn human. We do that. Us. Women. So many things can go wrong with the process. And normally things don’t go wrong. A gynaecologist once said to me that if a woman never sees her gynaecologist during the nine months then that’s actually a good sign. After all babies have been born for generations. Gynaecologists only came around in the era of modern medicine.

The other reason I absolutely love PCOS is because it has made me more willing to accept unusual things about people. So you stutter? That’s okay I only menstruate a few times a year. So you have a facial deformity? That’s okay, I have hair on my face. So you worry about what other think of you? That’s okay – we all do. And that’s absolutely acceptable because we’re humans. We’re not perfect.

Also PCOS is all about hormones. And about women having hormonal problems. It combines (IMO) the two best specialities in medicine: Gynaecology and Endocrinology. If I could, I would totally create my own speciality called Gynaeo-endocrinology. Here I’d celebrate the different and wonderful and exciting world of hormonal problems that women can have.

Most of the time having health problems is sad. But when our health problems help us become stronger, better individuals, that’s something to celebrate.

I’m proud to be De-cystifying PCOS.



P.S: I have a massive rant about the importance of consent in clinical settings coming up, so watch this space.