On Whether To Support The #JuniorDoctorsStrike

Tuesday 26th April will see one of the largest doctors strikes in living memory in the UK. And of course, the evening prior is the perfect time for my knee to slip out. (It’s been bothering me all day, then in bed I looked down and thought “bollocks. That kneecap isn’t meant to be there.”)

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Of course, faced with a trip to A&E on the eve of a doctor’s strike,  I mused over whether the vague inconvenience to me was worth having a grump about…

On the face of it, this seems a simple issue. The politicians saw data that shows people are more likely to die if they go to hospital at the weekend : solution – a 7 day NHS where there are no ‘down days’. To create this, junior doctor contracts are being changed to require them to work shifts covering 24 / 7 available care. Doctors are not pleased by this.

But what about the finer points of what’s being played out?

Firstly, what is a junior doctor? That’s not age or longevity – a junior doctor is anyone who isn’t a specialist consultant or GP.

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More people die when admitted to hospital at the weekend.
My inner mathematician loves this argument. It’s like giving a Bible to Tim Minchin; nothing good will come of this, but it’ll be funny to watch from the sidelines.
Now stats can prove anything. Using this most basic of correlation vs. causation argument,  we could argue that shark attacks cause people to eat ice cream. People eat more ice-cream in better weather. They also swim in the sea. By being in the sea, there is a higher risk of shark attack. There is a correlation in the data, but one does not cause the other. Using the same logic, it may be that people who go to hospital at the weekend are already more unwell, or that people put off going until the weekend, or that the injuries caused at the weekend are more life threatening, or indeed that hospitals are more dangerous to enter at the weekend. Without the relevant data analysis, all we can infer is that there is a correlation of data between it being the weekend & mortality rates.

There are fewer doctors working longer to cover the shortfall
Right now, doctors already work 7 days. Yeah, ok, it might not feel like it when we’re playing GP appointment roulette at 8am, but when their funding is based on a numbers game & appointments must be “made available within 24 hours”, if you’re that unlucky bastard that is on hold for 40 minutes & there’s no appointments left, you’re not part of the all hallowed waiting time statistics. Not so long ago, Mr Hunt himself took his child to A&E for neither an accident or emergency as he had no desire to wait patiently.

Hospitals are falling into debt left, right, & centre due to mounting private contracts and the staff are told there just isn’t the money to keep going. (For the record, public sector workers have seen little more than a 1% pay rise in over 4 years compared to the 11% the politicians awarded themselves last year).

The Contracts Are Not Safe?
There’s a lot of misinformation being whirled about in the press. One message that isn’t very clear from the doctors is that the contracts they aren’t happy about include some rather worrying adjustments to working conditions. So far, the BMA (British Medical Association) have been negotiating for:

no doctor to work more than 72 hours in a week; With an EU working directive of no more than 48 hours, how is the government demanding more than 72?

no more than four nights in a week on-call; This would be in line with most private industry. We’re all perfectly aware of the strain shift work puts on people. The proof of this is the special consideration given to MPS working past 7.30pm, or on Saturdays.

a rest day either side of nights before starting back on day shifts;  Again, a similar shift pattern to private industry where the physical and mental toll of shift work is considered.

facilities to sleep-in for those who otherwise make a dangerous long drive home; Not often something that is provided for others, but clearly not a bad idea to prevent extra emergency patients.

So far, this doesn’t appear to be anyone asking for a “cushy number”. And a working week of less than 72 hours for £23 – £45k seems quite reasonable. Especially when making a mistake might actually kill someone.

And possibly here’s the crux of it. Doctors are generally paid above the national average wage. And we Brits do love a stereotype to rage at. Some genuine comments I’ve heard:  “Why are they complaining? They earn enough!” – are we suggesting there should be Tesco Value X-rays? Essentials stitches? Everyday Value apendectomies? If we hate everyone that earns more than us, why are we not lynching the footballers? The politicians? Pretty much anyone who works in the investment banking sector? It’s not a race to the bottom. Just because someone else’s job is worse, we shouldn’t lower the bar!

“They don’t live in the real world. Private workers do shift work.” – and they do, however when you suggest The real World is a factory as opposed to fixing a bleeding human I’m not wholly sure you’re right. What doctors (nurses, physios, etc) do is very real indeed. In fact so real that it’s best not to think about it.

I’m very open that it took me many years to be diagnosed with my own chronic illness, and my diagnosis came too late. By the time we realised what it was, I had dislocated & subluxed so many times that my nerves were trashed. I could easily rage against the NHS, but do you know what?
It wasn’t their fault that my GPs only had 10 minutes at a time to discuss my rare condition.
It’s not their fault that the only specialist clinic has such a long waiting list right now that they have closed their doors.
It’s not their fault that they can’t provide long term physio.
The buck stops with the Minister For Health. With an appropriate funding structure & money not being wasted on private investment and gimmicks to make the government look good, treatment could have been available.

My personal view is that strikes don’t help matters. It’s too easy to use them as a stick against those trying to get their voice heard. Just like when you’re battling Voldemort, patience is required. And the ability to use the power of his own wand against him.

With that said, I’ve done my bit to lighten the load & physiotaped the hell out of my wonky kneecap. It can wait until their voices are heard. So my leg is coming out in support of the doctors. You do a good job of fixing people, but you need better PR people.

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Adventures With Roboleg Part 2 – Roboleg is back & this time he has company

It’s been a week since my kneecap decided to fall off because I turned around. That’s a week in a straight splint. A week of me openly swearing at my inability to bend my leg. A week of having a battering ram at the front of my wheelchair. A week of using crutches where possible, but trying to keep the weight off of the left knee whilst simultaneously making sure roboleg prevents the right knee from giving way and my SI slipping. I think we can agree that I failed on all counts there, but I’ve kept my legs moving and I haven’t completely lost my temper, so not a total fail.

I have a lot riding on this appointment (probably more mentally than anything) – mainly the decision to ditch the splint so I can return to some kind of normality (and work as I can’t get the chair + leg riser around my classroom).

What I’m hoping for is:
– removal of the “bloody splint”
– replacement with hinged brace (to prevent more bending backwards / rotating)
– no care free manipulation of joints
– not being fobbed off with tubigrip

Running nearly 90 minutes behind schedule was doing very little for my nerves  (or those of my poor dad who was looking after the munchkins).

What happened was:

Initial recoil when I mentioned EDS (at least she knew what I meant) & comments on how over extended my knees are. Well yes…  To give her credit, she was very cautious when manipulating my knee.

– “bloody splint” was removed + ceremonial placing of it in the bin! (Apparently the NHS do not recycle)

– leg is now supportless and wobbling free.

– warning was duly given to me that the joint is so wobbly that it’s inevitable that it’ll happen again. (Joy)

– Having another hinged brace is up to occupational health as it can cause muscle wastage. Referral will be made, but there’s an 18 week waiting list (or I need to buy one privately )

– made a referral to the Physio team who didn’t want to see me before because EDS was too complex. Could be interesting. Will take at least 3 weeks to get in contact for an appointment, unless I dislocate again, because then the clock resets and a new referral needs to be made.

…and then…. are you ready? … are you sure?… hold onto your pelvic floor…

The Dr says “Walk on it as much as possible” to the woman sat in a wheelchair.

Yes, I laughed (because tbh, we’re at that point). Dr looked at me & said “Ah yes. Good point”.

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So second roboleg is winging it’s way from Amazon as I have no intention of pushing my kneecap back into place again unless it’s totally necessary thank you very much.

The Machine That Goes BING!

Today was ‘doctors day’ with three different appointments all booked throughout the day. This meant taking the day off from work, but they were very kind to put it all in on one day to minimise disruption.

We started off with some blood letting, for no other apparent reason than I haven’t had a random blood test since June and let’s cause some new bruising. Hey, at least this time I’ll know where the bruise came from…

The nurse was a bit confused as to why I was there and asked if this was a diabetic review. Err no? She mumbled something about it looking like it because of the types of tests that the doctor had asked for. I suggested that it was probably because of trying to rule things out from me being dizzy. “Are you ok with needles?”. “Yep, I’ll just wish you luck finding a vein in there”. And so it came to pass that another medical professional spent 10 minutes slapping my arm to try to get to a vein. Eventually, were were in and it dripped out into those tiny tubes for some lucky soul to gaze at.

Next came my mystery appointment with the Registrar after the physio had a panic at the GPs.

I have to give the guy his due – he was fantastic. He listened, he looked through my notes and he winced when I showed him the photos on my mindmap. He asked if they were all me. I said yes & bent my thumb behind my hand to show him. “urgh!… Oh god, sorry. That wasn’t very professional.”. I assured him that it was fine. And yes, it’s ok to use the word ‘abnormal’. I’m pretty sure my hands aren’t mean to do that.

After looking at my notes, he agreed that the weight loss was indeed down to me just being stressed and dragging myself about despite more pain and who wants to eat tonnes when you have reflux anyway? He also said that he wasn’t an expert on EDS – instant win. I’d way prefer you to accept your limits than try to be an omnipotent GP with me the lowly patient.

We discussed whether the gabapentin was a goer, and decided that it was messing with my head and stomach, so he added another pill to the daily doses for the reflux and upped the gabapentin. Apparently the idea is to hit a fine balance between being able to tolerate the pain and being incoherent. Just to add insult to injury, he also suggested a flu jab. Before I could smile and nod (and put it on the ‘to do’ list), it was there and I’d been stabbed.Yay, no flu for me 🙂

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I, on the other hand have added the TENS machine back into the mix to see if I can try something that isn’t mind bendingly narcotic. I bought some new pads and plugged myself in. It basically feels like a massage from bees, but is nicely distracting as long as I have it on the setting which switches around every 10 seconds. It’s a good way to get through the final few hours before the next set of drugs.

We looked at the timescales for the referral to musculoskeletal people at the hospital and he raised eyebrows about not hearing from them yet. We agreed that they’d probably been chased enough, but we’ll give it another 2 weeks and if I’m still waiting after half term, then he’ll light a fire under them. Apparently this will also apply if I do hear and the appointment is some point after I retire.  So, now we wait. I have painkillers. referrals have been made to everyone. And everyone is awaiting a message from the heavens from Rheumatology.

The final appointment of the day was an ECG. Again, because of the dizziness on standing. The Registrar contradicted the GP I saw earlier in the week when we talked about this saying that dizziness on standing would usually subside if it was blood pressure related. Whereas I am ok on standing, but it creeps up on me after a while and doesn’t fade. Instead we go all tunnel vision and dark until I sit down. Apparently, the ECG will rule out anything horrendous, and is a gateway to asking for a tilt table test. Boxes must be ticked.

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Later on, whilst sending back student work from home (I love Google Classroom – they can’t escape me even when I’m hooked up to machines!), the hospital physio rang back. It’s been agreed that I’m too complex for them and I need to go to the Pain Management Team. So… the physio has referred me to my GP who referred me to the Physio, to refer me to the Pain Management Team. I’m reasonably sure that wouldn’t make sense even off the painkillers!