Book Summary: Trust Me I’m a Junior Doctor by Max Pemberton

Trust Me I’m a Junior Doctor is a diary of Dr Pemberton’s first year as a junior doctor in which he reveals the truth about what it is to be a doctor and how his work makes him feel  through description of real patients’ conditions which he had to face in his first foundation year.

“Competent”, “confident” and “loves the pressure” are three phrases which describe the qualities needed to be a successful and inspiring healthcare professional, showing that the qualities of a doctor are partly natural, with increased resilience being taught through five or six years at medical school. Following my hospital work experience, this book reminded me about the fact that doctors must not become emotionally attached to their patients, and that there must be a differentiation between the doctor and their patient – “usually good at being detached; clinical”, “everything moves on” and “not carrying any drama of the previous one”. The book also proved that being a doctor is far from easy and showed that even after the training at medical school, you will not know everything about every condition (“I felt out of my depth at times”) as there is such a large variation in presentation of conditions, in different people.

The job of a doctor is not only in a surgery or hospital, but in all of society as shown through the quote “‘I’m on holiday’ I felt like screaming” when someone fell under a train, Dr Pemberton realised that he was expected to attend to this casualty even though he was on his way home after a very long and tiring shift at work.

It is important to remember that your own health is just as important as your patients’ health. I believe that this is often forgotten by doctors as they work endless hours, making them extremely tired and therefore dwelling on the negatives of their job. This can be seen through the fact that he could tell that his colleague felt “inadequate” and like a “failure” and exclaimed that he often felt the same way as a junior doctor. The feelings as a junior doctor are often negative due to the extensive hours of extremely concentrated work leading to many people quitting the job – “spent the weekend backtracking on all her career plans”. ‘She’ did not end up quitting due to her love for the job and satisfaction that she gets out of her job. This shows that many doctors realise the positive impact they have on people, further reiterated in “I don’t do it for the glory, I do it for the love of seeing my patients’ faces when they are well.”

Many qualities of a doctor cannot be taught like kindness and bedside manner, supported by the quote “there’s no assessment of whether someone will hold your hand and stay with you when you’re upset”. This highlights the importance of the interview in medical school applications to show your natural love and care for people.

A love for being busy is also very important and being able to stay organised as shown through the quote “constantly having to think ahead, juggle and plan the jobs that have to be done while moving effortlessly between patients”. In addition, this quote reminded me of what I saw at my hospital work experience where I noticed that however stressed and busy the doctors were, they always made time to speak to their patients and comfort them – not letting them know how truly stressed they are. Doctors are prepared to sacrifice their social life for their patients as they spend any time off “recovering from working”.

Problems in the NHS are highlighted in this book as Dr Pemberton explains about the strong emphasis on reaching NHS targets, taking over medical professionals’ ability to care for their patients – shown through an ambulance driver not being able to drive a man home when there were many ambulances not in use, “the mountain of paperwork and protocols means there is less and less time to spend with the actual patients”. Furthermore, we must provide better care for discharged patients in the future as many people, such as the elderly and homeless are extremely vulnerable once released from the safety of a hospital as shown through “Domestic violence is not medical. A head injury is. But teasing the two apart is incredibly difficult to do.” This leads to reoccurring patients in hospitals who use lots of the NHS’ resources. Dr Pemberton suggests that neglect may not be a case of poor healthcare assistants but of the NHS system due to its focus on meeting targets as “nurses’ time is increasingly taken up with reams of paper work rather than the job of actual nursing.” I found it extremely interesting that Dr Pemberton believes that nurses cannot prescribe medicine due to “cutting corners to reduce waiting times, to meet targets” “at no extra cost” rather than due to “clinical ability.”

I was reminded that getting into medical school is such an enormous challenge due to the fact it is impossible to be completely prepared for the interviews as there is “no set formula that can be easily copied” in approach to interaction with people. People must be understood in their “entirety” in order for a doctor to completely understand their medical condition, and to get them to open up to and trust them. Making a patient feel comfortable enough to speak to a doctor whom they may be meeting for the first time takes incredible “people skills”.

I learned so much from this book and would recommend it to anyone interested in finding out the true feelings of a doctor when treating patients.  It is easy to read as is written day by day in very short chapters and is very funny.

 

Emily Buchanan

MRI – magnetic resonance imaging

This week I went to a Physics talk at my school where a teacher spoke about MRI scans, their uses and the images produced.

Scans are mainly used in order to monitor or diagnose neurological, brain or muscular conditions. At this talk I noted the interdisciplinary skills used to create and use an MRI scanner including physicists for the mechanism, electricians for the servicing, mathematicians for quantitive analysis, radiologists for running the machine and doctors for overall analysis of pictures, before patients receive their results and prognosis.

I noted that MRI scans show up areas that are ‘soft’ as light grey and ‘hard’ materials in black eg. the brain looks light grey whilst the skull looks black. This directly contrasts images of X-Rays and CT scans which are lighter shades where ‘hard’ material is found in the body. The reason for MRI showing lighter colours in ‘soft’ areas is due to it highlighting areas of the body containing water and fat. The image is made by shooting low frequency and long wavelength radio waves at the cells – those containing water (H2O) absorb some energy due to the proton in each nuclei of H-atoms, and then reemit the waves at the same wavelength.

The MRI scanner looks like a large donut with a bed which slides in and out of the central hole. Along the bed is a very strong uniform magnetic field, like that of a coil, which must overcome the thermal limit of the body to magnetise the body (it is never turned off). The current flowing through the machine is very high, in order to significantly increase the magnetic field and create a ‘superconductor’ (a metal which does not have any electrical resistance), so liquid helium is used to ensure the scanner does not overheat.

The loud sound during an MRI is due to the magnetic field and fast flowing current making a loudspeaker. Ear muffs must be worn to protect eardrums from permanent damage. Magnetic objects must never be bought near to the machine due to the extremely strong magnetic field of around 1.5 teslas (on earth the average background magnetic field strength is 50 microteslas), which would attract them into the machine, where the person is lying, at a very high speed.

Current research using MRIs includes its potential use in monitoring neurological conditions associated with losing muscle function due to fat coating the muscles. Researchers are looking for ways to monitor this condition using numbers (quantitive analysis) to get a more accurate representation of improvement or deterioration, as opposed to making a judgement using the less informative black and white pictures (qualitative data). They are looking at finding a way to count protons in the nuclei of fat molecules by monitoring the amount of radio waves reemitted from the body.

 

Emily Buchanan

 

Down’s Syndrome

Down’s syndrome is a learning disability caused by an extra copy of chromosome 21, making total chromosome count 47 instead of the ‘regular’ human count of 46. Physical characteristics are very recognisable of a broader, flatter face, smaller ears and nose and more space between the eyes whilst an associated medical issue is an increased risk of heart problems.

There are three ways in which Down’s syndrome can occur; through non-disjunction of chromosome 21 (94% of cases), by translocation (4% of cases) or mosaicism (2% of cases). Non-disjunction of chromosome 21 is when chromosomes do not separate properly during the anaphase stage of the cell cycle, translocation is when a part of a chromosome breaks off and attaches to another chromosome, and mosaicism is when people’s cells vary in number of specific chromosomes.

Translocation occurs specifically with the breaking off of part of chromosome 21 and it attaching to a different chromosome in the parent. After receiving two copies of chromosome 21 (one from mother and one from father) and an extra chromosome 21 attached to another chromosome by translocation, total count of chromosome 21 equals three in the offspring, causing Down’s syndrome. People with translocation do not always show Down’s syndrome characteristics but do pass on translocation, giving their child the extra chromosome 21. Translocation can also occur during meiosis, when the parents do not have translocation themselves.

Mosaicism occurs either by the fertilised ovum having three copies of chromosome 21 and losing one during mitosis, or when the ovum originally has cells with two copies of chromosome 21 and during mitosis gains an extra copy of this chromosome by mistake. If the ratio of cells containing three chromosome 21s to cells containing two chromosome 21s is large then Down’s syndrome is likely, and if the ratio is small, Down’s syndrome is less affective, shown by the person having fewer of the characteristics linked to Down’s syndrome.

The biggest risk factor of conceiving a child with Down’s syndrome is a women’s age with risk increasing with age. Figures by the NHS currently stage that maternal age of 20 gives you a risk factor of 1 in 1500, age 30 of 1 in 800, age 35 of 1 in 270 and age 40 of 1 in 100. Risk is also increased if the person has already conceived a baby with Down’s syndrome and further increased (up to 1 in 10) if one of the parents has translocated genes.

In today’s NHS, foetuses are tested for Down’s syndrome by amniocentesis and ultrasounds. Amniocentesis is the removal of some amniotic fluid which is taken to a laboratory to be stained and looked at under a microscope to look for extra copies of chromosome 21. However, some women choose not to have this test as it increases chance of miscarriage so other less invasive tests are taken first such as ultrasounds and blood tests, before referral for amniocentesis.

Ultrasound is high-frequency sound waves to create a moving image in order to see thickness of fluid between skin and foetal neck (taken between weeks 14 and 22), with a thickness greater than 3mm likely to imply chromosome abnormality. Taking a blood sample from a pregnant mother is another less invasive and therefore less risky test, from which alpha-fetoprotein concentration can be measured. If the mother’s concentration is 25% less than normal, it is significantly more likely that their child will have Down’s syndrome so will be referred for an amniocentesis for a more reliable test.

A test that may be available in the future is the analysis of a foetus’s DNA from their mother’s placenta by week 10 of pregnancy. It is currently 99% accurate at detection which is not considered high enough to be widely available on the NHS.

Test results give people a choice; to terminate or continue with their pregnancy – an extremely difficult decision for many.

 

Emily Buchanan