United Kingdom - a country under a cloud

For the last several months, all we have been hearing is bad news - bad news of the worst kind. First, there were the Manchester attacks, then the London Bridge attack, then the Grenfell Building fire, and now, an attack on London on innocent Muslims by a white man who muttered that he wanted to kill all Muslims.

Whatever is happening? I think there are rumours working overtime. Before the elections, I heard an Englishman say that the attack just before the elections at London Bridge was orchestrated by the sitting PM herself to garner more votes in the name of shock. After the elections, someone else said that the attacks were orchestrated by Jeremy Corbyn's Labour party. This confusion makes me realise that both contentions are wrong and that all these attacks are as proclaimed - either terrorist attacks or a grossly unfortunate accident (the building fire) or simply bad racism (the attack outside the mosque). 

I am certain more bad times are to follow. Economically, the UK is going through a bad patch as well. Brexit negotiations have begun today and the UK will have to give in on many issues, thanks to the lack of a clear parliamentary majority by Theresa May's Conservative (Tory) party.

Nothing much to add here. A reflection on the troublesome days is much in order.

Working Registrar shifts this weekend

Yes, that happened this weekend. I had originally a 2-day off, but I had booked a locum shift in Bolton NHS hospital in Neonates. I received a request to work as a registrar within my own trust as they had no one to cover the shifts. I agreed and worked these two days with Dr. Mohammed Ahmed as my consultant. I think it went well. 

The result of my accepting these two shifts will, of course, be good for my wallet, as I will get paid for them. For my work-life balance, though, these two shifts were poorly placed. In fact, I have been doing continuous duties from the 10th of this month. In the week from last Monday to this Sunday, I did nearly 80 hours of work! That is at least 11 hours per day! I feel fatigued. 

However, professionally speaking, the two duties I did will count towards improving my confidence of working as a middle-grade doctor, so I have no regrets. All credit to my head of the department for allowing me this as it is only thanks to him and his other colleagues that I was allowed to work in the capacity of a registrar. 

The best thing about working as a middle grade, though, was the fact that I was working with my own colleagues who were filling in as SHOs while I worked as a middle grade. Their inputs were precious and very useful in making my job look much easier than it probably is. It also helped that the nursing staff was very supportive. There were a few quibbles with my writing down the doses that they thought were "unconventional", but Dr. Ahmed was supportive and helped clear such hurdles.

All in all - a very good pair of days indeed. 

Thank you for reading!

#LondonAttacks

Once again, extremism has raised its ugly head and wiped away 7 lives, destroyed the hopes and aspirations of all those connected to them - and injured almost 50 others, at least a dozen of them critically. 

Three men, travelling in a large vehicle, first rammed this into a crowd of innocent pedestrians atop the London Bridge, then took the vehicle into a market area and, parking it, got off the vehicle and began to run around, randomly knifing people going about their usual lives. Within 8 minutes of the police receiving news of the attack, they were killed in an intense round of police fire. They were found to be wearing what seemed to be jackets rigged with explosives. However, the tin cans attached to their jackets proved to be fake ones. 

As I write this, the police investigation is ongoing. Patients are admitted to five hospitals in the vicinity, among them the King's College and the Guys and Thomas' Hospitals. Nearly a dozen of the injured victims are critical, while the rest are recuperating. 

Among those dead is a Canadian citizen, a New Zealander and two Frenchmen. 

A quick thought: this is the third attack by terrorists in three months in the U.K. The last attack was just 12 days ago in the Manchester Arena. What is happening? 

I was talking to a British lady today while walking in Stanley Park. We agreed that Britain was reaping the effects of what it was sowing all over the world, blindly following the United States of America. The picture of Theresa May being led by the hand by President Trump symbolises this more than anything else. 

May and Trump (click this link)

If only the U.K. government stops meddling in the affairs of the various countries it is engaged with, Islamic extremism will stop attacking it - at least this is my opinion. It has become almost impossible for terrorists to attack the U.S.A. That is why, they are now targetting the softer option - the United Kingdom. This is a war, and the U.K. should start protecting itself rather than try to "restore" peace, democracy etc. in other countries. 

The lady I was talking to is an ex-journalist who was shooting birds with her Canon camera. We both felt that the people of U.K. are becoming increasingly frustrated with the way things are going. Racism is making a comeback, she said. While she was putting this down to politics, I felt that people were basically relinquishing common sense and attacking anyone not their own without understanding that without immigrants, the U.K. would be finished as a world power. 

Back to the attacks: there will be a general election in the next four days' time. The Tories may well continue to be in power, and May will then have the power to negotiate hard with the European countries to retain its value in a post-Brexit world the way she wants to. Or, as a dark horse, the Labour Party may win and Jeremy Corbyn will be swept into power as the new Prime Minister.

Only time will tell - within a week, we will know the outcome.

The election comes at a time when the people will still be reflecting on the London Attacks. May the souls of those who died rest in Peace. Amen.

Medical Education and Practice - India vs England

One of my Facebook friends has asked me to pen a post on comparing the teaching system in the U.K. with that from India. Frankly, there is no comparison. Firstly, the kind of illnesses we see in India and the ones that we see in the U.K. are quite different. Secondly, our healthcare systems are completely different. In India, we work with limited budgets, whether in government/municipal hospitals or in private clinics/hospitals. 

In the U.K., too, there are some budgetary constraints, but the supplies are all top-class, and there is no shortage of essential as well as non-essential stuff, except for the items which are in the very expensive range. 

Thirdly, and this is the most important difference: the system is driven by evidence - the kind of evidence that comes from research and trials - and is completely based on protocols that are specific to each institution but framed from national and international data that is published by national-level agencies. Such evidence is periodically reviewed so as to be abreast of the current knowledge. This kind of evidence is completely lacking in India. Individual doctors may, from time to time, update their knowledge base and use this to help their own patients. Devising of hospital-wide uniformity of treatment never does occur, so that every doctor treats the same condition differently, based on their own learning, experience, and hearsay from their peers.

Coming to teaching: We have excellent teaching in India as well, but it is fragmented. Doctors learn from their seniors when they are students, but as soon as they start a private practice, they give secondary importance to continuing education. The Medical Council of India and state-level bodies like the Maharashtra Medical Council etc. have recently moved to enforce that every registered practitioner should have a certain number of points to be able to stay registered on the professional register. However, the points can easily be collected by sending the money to the organisers of teaching programs and then receiving the participation certificate in absentia. Many a times, doctors will attend a conference or learning seminar just to get the points, but not use the learning to improve their practice. Occasionally, doctors will, for reasons of expediency, join programs that are not even from their own speciality, just to gather the required points.  

In the U.K., learning is referred to as teaching! Thus, when a student says that they are going for teaching, they are actually going for learning. While I haven't done my formal medical training here and cannot, therefore, comment on how their teachers are, I can definitely say that medical students here are far more experienced than Indian medical students are, in practical, hands-on experience. This is because, from their third year onwards, when they attend the wards (just as we did or do in India), they begin to clerk patients in a proforma, taking the patient's history, examine them, etc. and they will, in their fourth and fifth years, be expected to give a differential diagnosis, and formulate a plan of management for that patient. This allows them to think like practicing doctors years before they actually will practice clinical medicine. 

What really makes the difference in their training, however, is the fact that they have to collect, and later produce, evidence of their learning. This has to be uploaded by them electronically, and I have often had students presenting a medical case to me and then coming back a few minutes later to take my digital signature on their mobile phones to collect the evidence that they did, in fact, present a case to me. They will also sometimes send us a link to give a feedback on how their performance went. This is a requirement for them and not an option. This enables them to advance professionally in a more structured, evidence-led method than the kind of haphazard learning that we have in India.

I hope this answers the question for my friend, and helps others too, to understand how the system works in the U.K.