The Bed Crisis and Phone Triage

The fact that the NHS hospitals are short of beds isn’t something that few people know about, many people are well aware of the constant high demands placed on the NHS, you only need to sit in a waiting room at your local GP or nearest A&E to know this (and that’s without a global pandemic).

In winter, the NHS use ‘Escalation Beds’ to meet the increased demand of patients. However, these escalation beds are being used throughout the year. The problem is,  bed occupancy in a hospital shouldn’t be 100%, the NHS have set a target of 92%, but in an ideal world it would be 85% to reduce any risks of infection. When bed occupancy becomes dangerously high, escalation beds are required, and this problem is becoming more frequent.

This is an issue that I understand, but also wish I had an answer to. I think that educating people about how to effectively use our nation’s healthcare service is something that’s very important, for example at my local GP there are signs explaining that colds cannot be treated with antibiotics, so in the nicest way possible, don’t book an appointment asking for them! I do believe advertisement and education is important and not too costly, however it’s not necessarily the most effective solution to the problem.

Something I have read recently, is an article on the BBC about a Welsh hospital that’s developed a phone triage scheme for A&E. Those without life-threatening illnesses will have to call to be assessed by a clinician to stop overcrowding. The patient can be booked a slot in the Emergency Unit or Minor Injuries or even be given advice on alternative options if an appointment isn’t necessary. Although this has been created to prevent overcrowding, allowing people to socially distance during the pandemic, I think it will also work to prevent people coming to A&E unnecessarily and will make them aware of their alternative options. This helps to educate people and encourage them to use other services provided to them, as well as reducing pressure on A&E staff. Obviously, it’s not without it’s flaws, there are people who don’t have access to a phone (crazy, I know) and so this may not work for them. However, if those that do have a phone use this service, it means that there is still reduced pressure, even if those without phones don’t use it. This system still means that clinicians will be needed, but instead of seeing patients physically, it’ll be over the phone, which will still take up their time.

I’m intrigued to see if this system does work, and what impact it has. It’s not something made to directly target the bed crisis as such, but it could still have an impact nonetheless.

 

My Experience with Broken Bones

Growing up I always thought I was invincible. I was rarely ill, the hospital wasn’t a place I regularly visited and I never broke a bone. Well, that was until March 2019…

It was a Sunday and I’d just finished playing a rugby match for county. I’d walked away from the game unscathed and player of the match – I was feeling pretty good. I went back to the changing room and got ready for the Rugby sevens part of the tournament – which I played all of about 30 seconds of. This is how the game went: the opposition kicked off, my teammate caught the ball, passed it to me, I made a run for the try line, got tackled, SNAP. I fell to the ground and just shouted “it’s broken!”. The game stopped, the physio ran over and I burst into tears – not because it hurt – because I knew that I’d broken my ankle and I wouldn’t be able to play.

I waited for an ambulance for nearly two hours, I was chatty but the pain had kicked in. Although I was in pain, I didn’t mind waiting, as I knew there was someone else out there who needed medical attention more than me. Eventually the paramedics arrived and I was taken to Walsgrave Hospital in Coventry, my friend came with me in the ambulance as she wants to be a paramedic in the future – and she wanted to be there for me of course. When we arrived at the hospital I was put into a wheelchair and taken into the paediatrics A&E waiting room, where I received a lot of stares from some very young children and alarmed parents. I was triaged quickly and taken to a room to wait for an X-ray. I’d snapped my lower left fibula, chipped off a section of my tibia and had a talar shift (this is essentially where the tibia and fibula move apart). My ligaments and tendons were also badly damaged. So not great but could’ve been worse!

I had an operation a week later to have a plate and some screws put in my ankle and was in a cast for three weeks after that. I was then put in a boot for 7 weeks and I remained on crutches after the boot was taken, but I worked hard to come off them ASAP as I was doing my GCSEs at the time and wanted to be off my crutches during summer!

I’ve never opened up too much about this experience, and I’ve always tried to make it seem more positive than it was. I was very down as I was missing out on rugby, I was in lots and lots of pain and the painkillers made me very unwell and so revising for my mocks and GCSEs was challenging at times – but I still managed to get all As and A*s. My ankle caused me lots of pain even after I got rid of my crutches and I walked with a limp for a while – which was very frustrating! However, it also brought me opportunities. I went to Twickenham to watch England vs Scotland and I got to meet the entire England squad after the match, I got photos and autographs which was amazing!

I definitely returned to sport sooner than I should’ve, but I’m stubborn and if I believe I can.. I WILL. However, just when I thought my days of injury were behind me, I broke my right Fibula in December 2019 – just 9 months after I broke my ankle!!!! The story is pretty similar, it involved rugby, me running and a snap. One of the paramedics was quite rude to me, as he felt we had called the ambulance for no good reason and that I should’ve been driven to the doctors. We later found out that such a course of action would have been a big mistake!

Crutches and a cast.. again! However, my cast got changed to a walker boot after a week and I was only on crutches for 4 weeks in total – considering my previous experiences, that was seen as a HUGE win!

My left leg still causes me pain, usually during exercise that involves running and jumping (not that that stops me running or jumping.. or playing rugby for that matter!) but I know one day it’ll get better.

My whole experience has definitely made me more fearful of breaking my legs, I have moments where I nearly go over my ankle and my heart does skip a beat, but I’m still playing rugby which is the main thing. My desire to be a doctor and study medicine is still strong, but I currently feel like orthopaedics isn’t the speciality for me – it brings too much back. This could change as I get older, who knows?!

Fingers crossed for no more broken bones, twice is definitely enough!

Cancer vs Covid-19

At present, Covid-19 has taken the lives of over 500 thousand people worldwide, leaving families devastated. The number of cases, deaths and recoveries in each country is a heavy point of focus for many. However, we mustn’t forget that although our lives have temporarily been on hold, diseases such as cancer stop for no one.

Last night I watched a Panorama documentary on the BBC, discussing the effect of the virus on those with cancer, and how an additional 35,000 people could die of the disease. A very important part of cancer diagnosis is catching and treating it early, but many people have been discouraged from going to the doctors due to the virus and so referrals have decreased and screening has been put on hold – allowing any potential cancer to spread further before being found, which in turn can reduce chances of survival.

The documentary also discussed how radiotherapy machines hadn’t been used for a large amount of time during the pandemic, but we now know that their use is perfectly safe and so people have been missing out on potentially life saving treatment.

During the documentary, it was pointed out that a balance was attempted to be made between the risk of catching the virus and the risk of patients’ cancer worsening. No medical professional would ever want to stop or reduce life saving treatment, the four pillars of medical ethics ensure this. When watching this documentary, I recognised that this situation is far from simple, cancer treatments such as chemotherapy weaken immune systems, meaning that those with cancer would struggle to fight the virus if they contracted it. At the same time, stopping chemotherapy can increase the spread of cancer within the patient to a point where treatment may no longer be a viable option, or their chances of recovery or survival are reduced. It feels like a lose-lose situation, and the pressure on the medical professionals to make the right decisions must be immense.  As someone who wants to become a doctor, it can really test your want to study medicine, as you realise that you could be the next person to have to make these decisions.

This documentary definitely brought a tear to my eye, seeing the indirect effect of the virus made me realise just how great it’s effect has been. Although cancer can be diagnosed late at any time, there are people who are going to lose their lives, children who are going to lose their parents, parents who are going to lose their children, because of a late diagnosis that was caused by Covid-19.

Junior Doctors

Being a junior doctor is draining for many reasons. You work long hours and are often on-call, there are many things medical schools don’t always prepare you for and you are under lots of pressure, everyday. I’m not a junior doctor, although it may sound like I think I am, but I have read books and watched documentaries that have shown me the harsh reality of life after medical school, and that although it’s not all doom and gloom, a medical career doesn’t get off to the easiest of starts!

Last summer, I read ‘This is Going to Hurt’ by Adam Kay, a hilarious book with a serious message behind it. It’s a read I’d recommend to anyone, but especially to someone considering medicine. Adam used to be a doctor and the book is full of his experiences, including those as a junior doctor, and he doesn’t sugar-coat a thing! I found the book incredibly helpful, choosing medicine is a big decision and you need to be fully aware of what you’re letting yourself in for, otherwise you could end up making a big mistake!

I’ve also watched the documentary ‘Junior Doctors: On the Front Line’ and I’m currently reading ‘Trust me, I’m a (junior) doctor’ by Max Pemberton, which isn’t too dissimilar from ‘This is Going to Hurt’ but it’s solely focused on his experience in his foundation years as a doctor, rather than his later experiences. Gaining an insight into the work of junior doctors isn’t only beneficial, but it makes you appreciate the medical profession and it breaks down false images created by hospital dramas, that being a doctor is a glamorous, heroic career.

I’ve taken it upon myself to do some further digging into this hot topic, as I remember the junior doctor strikes, but I was a bit younger at the time so never really did too much reading into it. First of all, the term ‘junior doctor’ is often associated with students who’ve graduated from medical school and are in their foundation training years. This is not true! You are a junior doctor when in speciality training too, however the pay increases. In 2016, changes were to be made to the junior doctor contract. The pay was to increase by 13.5%, but what constituted of ‘unsociable hours’ was going to change, for example, daytime hours on a Saturday were to be paid at a normal rate, rather than an increased one. This was very controversial and people felt it was done to make it cheaper to have doctors working on weekends, as it was said that patients admitted at the weekend are more likely to die and so the government wanted to improve patient care by having more doctors working. This was challenged by junior doctors and it was felt that the reduction in pay was clearly for financial gain.

In 2019, negotiations ended and some key changes were made: an increase in pay for weekends and nights, guaranteed lift in pay of 2% each year for the next 4 years, limits on the number of long shifts taken and much more. It’s definitely an improvement, this deal brings a £90million investment into junior doctors for the next 4 years. I do think this deal is a step in the right direction, treating NHS staff fairly is very important, not only because doctors provide an important service to us all, but because we need to encourage young people to study medicine and become our doctors of the future.

Alzheimer’s and Dementia

I recently watched a documentary by actor Ross Kemp, called ‘Living with Dementia’ about different people who suffer from dementia and how it effects their families. It was recommended to me by my mum, she knew it would be something of interest to me as my Nan has Vascular Dementia and Alzheimer’s disease. This inspired me to do a little more digging into dementia and Alzheimer’s.

Dementia isn’t a disease, it is a term that describes a set of symptoms such as memory loss, confusion and issues with problem-solving. There are different diseases which cause dementia, Alzheimer’s being the most common. Other conditions such as Parkinson’s disease, Huntington’s disease and brain injuries can also cause dementia.

Alzheimer’s is a disease caused by a build up of proteins around brain cells that are abnormal. When the brain cells become affected there are less neurotransmitters and over time, certain areas of the brain will shrink. Age, genetics, Down’s Syndrome and risk factors that are often associated with cardiovascular disease can increase the risk of someone getting Alzheimer’s.

The dementia my nan suffers from is Vascular Dementia. This essentially means she experiences memory loss and cognitive problems, but this is as a result of a lack of blood flow to her brain which causes brain cells, responsible for certain cognitive processes, to die. Vascular Dementia is the second most common cause of dementia, after Alzheimer’s. This can be developed after having a stroke, fortunately she didn’t have one of those.  Due to my Nan also having Alzheimer’s disease, she can be said to have mixed dementia. Alzheimer’s and Vascular Dementia are the most common combination for mixed dementia. Symptoms of mixed dementia differ between patients, and often one form will dominate. For example, I find that my nan suffers from more symptoms of Alzheimer’s than Vascular Dementia.

Alzheimer’s patients can be prescribed with medications known as Cholintesterase inhibitors. Someone suffering from Alzheimer’s often has lower levels  of acetylcholine, which helps nerve cells to communicate. The inhibitors prevent the enzyme acetylcholinesterase breaking down the acetylcholine, increasing its levels in the brain. This doesn’t cure the disease but can help with symptoms in the mild/moderate stages of Alzheimer’s. Unfortunately there is still no cure for the disease. However, living a healthy lifestyle can reduce risk.

As difficult as Alzheimer’s and Dementia can be for those who suffer from it, it has a much wider impact on their loved ones. When watching the documentary by Ross Kemp, I found there was a common theme amongst those caring for those with the disease, and that was guilt. Dementia is an exceptionally frustrating set of symptoms that can cause people to lose patience, which consequently leads to an immense feeling of guilt. Carers can also feel guilty for enjoying themselves and for choosing to put the patient into a home. Although this is often a choice in the best interests of their loved one, it can feel as though you are abandoning them when they need you the most. Not only do people feel guilty, but watching their partner, parent or even child suffer from dementia can be heartbreaking and often people feel as though they’re losing the person they love.

Another feature of the documentary, was the story of a young girl who suffers from Sanfilippo Syndrome. This is a metabolic disorder which is caused by the lack of an enzyme that normally breaks down a sugar molecule called ‘heparan sulfate’ which is stored in the lysosome of cells. Sanphilipo is a part of childhood dementia and causes hyperactivity, loss of speech, intellectual disability and many other symptoms. In the first stage of the disease symptoms are mild, but behaviour becomes increasingly difficult and the patient’s lifespan is decreased significantly. Dementia is often associated with adults and so finding out about a child suffering from it was saddening and made me realise that Dementia effects so many more people than I first thought.

Dementia and Alzheimer’s is definitely something I fear. My great grandma and nan have both had the disease, and I do wonder if it’s in my genetics and it’s something I could develop as I grow older, but there could be a cure or more effective treatment by then. Who knows?

During this lockdown, I wanted to do something worthwhile and realised I could put the incredible amount of baking I have been doing to some good use. Alzheimer’s society host a Cupcake Day each year, and I decided to get involved. I baked enough cakes to start a bakery and also reached out to the local neighbours. I had a big cake sale outside my home and raised £480 for Alzheimer’s Society. I was incredibly proud and even surprised, £480 is a lot of  money for some cake! My Nan lives quite far from me, but she was incredibly happy when I told her over the phone.

Alzheimer’s and Dementia may not have a cure just yet, but there’s no reason why you can’t do some research into the condition, or raise some money and know that it’s going to benefit such an important cause!

 

Organ Donation

Ethics. We all have them. They govern our behaviour and ultimately decide how we choose to live our lives. Our ethics can be the same, and they can differ. There are some topics that highlight our ethics, organ donation is one of them.

In England, the law around organ donation changed in May of this year. We have now adopted an ‘opt out’ approach, whereby if you are 18 or over and aren’t a member of one of the ‘excluded groups’ you are an organ donor unless you register and state otherwise.

I am a member of one of the ‘excluded groups’, due to my age I’m not registered as an organ donor automatically and have to register myself as one or wait until I’m 18. I registered quite some time ago to be an organ donor, it was a pretty easy choice for me. However, I understand why it’s a hot topic for debate.

From my ‘pro organ donation’ point of view, my death could potentially save the lives of nine other people, which is something amazing and almost gives my death a sense of purpose. As well as this, I feel it’s important that as many people are organ donors as possible, only 1% of people who die are in circumstances that allow them to donate their organs and so the more people who are registered, the more chance we have of saving the lives of those waiting on transplant lists. I could go on and on about the advantages of organ donation, but the main reason I researched this topic, is to gain some more perspective on why some people ‘opt-out’.

So, why disagree to donate? Lots of people fear that if their doctor was to discover that they’re an organ donor, they would be neglected and not given the best treatment in the hope that they die and their organs can be harvested. I don’t necessarily agree with this, but it’s an interesting point of view. Other ideas, are that people are psychologically uncomfortable discussing death and thinking about their organs being removed from their dead body – fair enough I suppose. Some feel that those in need of organs may be sick as a result of their poor lifestyle choices, and so they don’t want their organs to go to someone who has no respect for their body.

There is also some confusion around death itself. Medics believe that when a person has suffered irreversible brain damage that results in them not being able to respire independently, they are legally confirmed as being dead. However, because the rest of their organs still function, family members often argue the doctors’ decisions and state that they don’t know the person is dead, so their organs shouldn’t be removed and they should remain on life support. This is a situation that is understandably difficult for the family of patients in particular, letting go is hard.

I’m sure there are plenty more counter-arguments for organ donation but I can’t write forever. What matters is that, although I am still for organ donation, I can see both sides of the debate.

Virtual Work Experience

Whilst stuck inside during lockdown, I decided that aside from studying, workouts and baking cakes, now is the time to do something a little more productive whilst I have the time.

I realised the importance of gaining work experience when applying to medical schools, and the panic of not having any soon struck. I had read on various university websites that they will take into account the difficulty of gaining work experience at present, which relaxed me slightly. However! Brighton and Sussex medical school came to the rescue with their virtual work experience course.

I won’t lie, I wasn’t sure how much of an ‘experience’ I’d get from an online course, but it was a pleasant surprise and I’d definitely recommend it.

There are 6 modules on the course, each giving you an insight into different aspects of medical care such as mental health or emergency medicine.  The course contains various powerpoints, interactive presentations and quizzes (there was no pressure to get all questions correct, you can still pass the course regardless, it just helps to apply knowledge). The time it takes to complete the course is completely up to you so there’s no pressure and you can take your time. At the end of the course you need to submit a  small piece of work, just reflecting on what you’ve learnt. I submitted mine a few weeks ago, the course has a high demand so it’s still under review.

The first module of the course was on general practice, a specialisation I’d never previously considered. I always said I wanted a job where I could be on my feet rather than always sat at a desk, and I felt emergency medicine would be more interesting than general practice. However, the course gave me an insight into the reality of primary healthcare, and that being a GP can be intense, you will encounter a wide variety of medical problems, everyday. Now I know more about it, being a GP is a career path that I would take into consideration.

The course also taught me about palliative care and it’s importance, how to take a patient history, the impact of mental health and how difficult treating elderly patients can be. Unfortunately, the elderly often suffer from multi-morbidity and so they have various illnesses that need treating at once, which is often challenging to do. 95% of the primary care population aged 65 and over are affected by multi-morbidity – a not so fun fact for you.

Overall, my experience may not have been quite so hands-on but I learnt something from it and it furthered my insight into a medical career, which is the main thing.

Solid 10/10 would recommend.

 

 

COVID-19 and Surgery

Recently, I’ve been looking into universities that I’m considering studying at in 2021 and whilst I was doing this, I found an article on the University of Birmingham’s website about how surgical patients who had been infected with the Coronavirus experienced significantly worse outcomes post-surgery.

All types of surgery: elective, emergency, minor (e.g. hernia repair) and major (e.g. hip surgery) had disproportionately high mortality rates in patients who had/have the virus in comparison with those who don’t.

It’s a normal expectation that patients having minor or elective surgeries would have a less than 1% chance of death, but this is not the case for those with the virus. Not only this, the mortality rates were greater for Covid-19 patients than those reported in extremely high-risk patients prior to the pandemic.

It definitely didn’t some as much of a surprise to me that patients with Covid-19 would have higher mortality rates post-surgery, the seriousness of the disease isn’t unknown (despite some people behaving like it is). However, I didn’t expect them to be quite so high in comparison to those without the virus.

This study is the first piece of evidence that discusses the impact of Covid-19 on surgery, in particular. Personally, it was a quick read that gave me more of an insight into the impact of the virus on something that I hadn’t thought about before.

 

 

 

References:

Aneel Bhangu and Dimitri Nepogodiev, Co-Authors  (29th May 2020) https://www.birmingham.ac.uk/news/latest/2020/05/covid-19-patients-who-undergo-surgery-are-at-increased-risk-of-postoperative-death-global-study.aspx

The Start!

Studying medicine has been a constant consideration throughout the past few years of my life; initially, I was the ultimate cliche.. ‘I want to be a doctor because I want to help others’. Original if you ask me.

Now I realise you can help others in a whole host of careers, it isn’t something that’s exclusive to being a doctor. I could help someone by being their banker, lawyer, waitress; the list is endless.  Furthermore, I’ve come to the conclusion that despite always being aware that studying medicine isn’t easy, I never fully understood quite how difficult it is, until now. Bring on the challenge.

Being in lockdown has given me more than enough time to make some life decisions, and deciding to study medicine and become a doctor was one of them. For real this time, rather than being inspired for all of 3-5 business days and then moving on.

I’ve started preparing for the UCAT (despite being told it’s something I don’t need to worry about, I want to be prepared), I’ve completed the Brighton and Sussex Medical School Virtual Work Experience Course, started planning my personal statement, looking at universities and now I’m writing this blog! Big shout out to my chemistry teacher for recommending this to me, by the way.

I’d be lying if I said the thought of UCAT exams, MMIs, traditional interviews, personal statements and straight As doesn’t make me want to scream with stress and fear, but I’ve proven to myself before that my ability is far greater than my confidence, it just takes some extra hard work and to dig deep.. really deep. But if I can play rugby and survive two broken legs, I can do this! 

Right?