Tackling LGBT+ Youth Healthcare Inequalities

For those of you with access to academic journals, take a look at my article published in Archives of Diseases in Childhood, Education & Practice Edition, this month. The article discusses the various healthcare inequalities faced by LGBT+ Youth in both their experiences of and access to healthcare services, and offers tips on how to improve individual practice as well as implement system wide changes.

http://ep.bmj.com/content/early/2017/05/11/archdischild-2016-311449

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Stonewall School Report

Paediatricians are, of course, very good with kids. However, there’s still a population of young people that we are letting down, and that’s our LGBT+ youth. We aren’t good at recognising or appreciating many of the specific issues facing gay kids, and this can lead to suboptimal care compared to their heterosexual/cisgender peers. I’m currently working on a project to improve this, but in the meantime I gave a talk to some paediatricians and paediatric trainees at the Royal Hospital for Sick Children, Edinburgh about just some of the issues facing out LGBT+ patients. I used Stonewall’s School Report to focus my talk, given during our weekly Journal Club meeting. These are the slides I created (using the drawings from Stonewall’s publication). I’ve also made a YouTube video based on the report, which can be seen below.

The YouTube Doctor

So some of you beady eyed folk who haven’t muted me yet may have noticed a slight change in look to my twitter profile. The Saved-By-The-Bell-esque cartoon version of me (by the wonderful web designer William Leeks) is part of my little experimental journey into the world of YouTube. Always up for adventure, I have no idea whether this will work but I thought I’d see what happens anyway.

yt mc dr thom headerThe world of YouTube, or more specifically YouTubers, is fascinating. There are many talented creators that I admire and have followed for years, but compared to the amount of YouTube the kids I work with watch, I barely even scratch the surface. Young people across the world now watch more YouTube than they do TV. The early adopters out there have picked up on this, and realised that for younger viewers this also means less time spent watching educational TV content. It’s what has led to incredibly clever and technically brilliant educational YouTube series such as Wonder Quest (a series of educational Minecraft videos!). There are a number of superb popular YouTubers making challenging and educational content (such as Hank and John Green aka The Vlog Brothers along with a band of Nerdfighters) who enrich the viewing experiences of millions of young minds across the globe. From science to beauty, there are plenty of prominent voices to be found in YouTube, but one area where reliable voices are lacking is health.

The big names amongst YouTubers are starting to make videos to help educate and inform their many millions of viewers. For example, the Australian YouTuber Troye Sivan has made videos about HIV and safe sex. They’re made for a generation born into Web 2.0 – where information is pushed at viewers rather than being sat idle waiting for someone to search for it. In health, we haven’t caught up to this.


So my aim as a kids doctor is to make YouTube videos for young people that are interesting and useful, that might educate or add to existing knowledge, and might just entertain along the way. It’s early days, but the messages and comments I’ve received for my videos so far (especially those for mental health awareness week this year) have been encouraging. With a heap of sex education videos in the pipeline too, I hope this wee experiment adds a little bit to the YouTube world, and if it entertains even a handful of people then it’s totally worth the many hours of trying to convincingly say hello to a camera in my bedroom.

Have a watch, maybe give me a thumbs up, and if you’re feeling extra generous hit subscribe. Until next time, be good.

90 Ways Star Wars Can Help Junior Doctors Survive Foundation Training

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A long time ago, in a medical school far, far away…you started your journey to becoming a doctor. But wait, shit, someone punched it into hyperspace without you realising. You’ve avoided flying right through stars, or bouncing too close to a supernova, but your trip at medical school is over and now the real battle is about to begin. Foundation Training is tough, but with the help of these 90 (I’ll stop soon, I promise!) Star Wars quotes, you might just make it through the Kessel Run of being a junior doctor.

1. “Do. Or Do Not. There Is No Try.” – Yoda

Star Wars Junior Doctors.004As a medical student, you took some blood, you put in some Venflons. Tricky veins? Oedematous arms? No problem, the magic blood fairy will do them if you leave it long enough. Well not anymore. Someone is going to have to get that access, or organise that MRI. There are many tricks for making veins better for blood or access, but one way or another, blood needs got.

2. “Your Focus Determines Your Reality.” – Qui-Gon Jinn

Star Wars Junior Doctors.003Medical school, with all its targets and logbooks, very much shapes your output as you progress. Once graduated however, the spoon feeding stops. You’re in this pod race by yourself, with the freedom to explore your own interests and development. What you put into Foundation Training very much determines what you get from it.

3. “It’s Not My Fault.” – Han Solo

Star Wars Junior Doctors.002Everyone makes mistakes. A good junior doctor will be able to minimise the mistakes they make by paying attention, using common sense, and listening to the advice of others. If you do make a mistake, raise it early, sort it and learn from it. If the mistake affects a patient, be open and honest about it. And apologise. It’s true that Trusts are responsible for their FY1s, but that doesn’t mean you can be complacent.

4. “Somebody Has To Save Our Skins.” – Leia Organa

Star Wars Junior Doctors.005Sure it’s not always possible to do things yourself, but it’s still your responsibility to make sure things happen. Refer up, then chase up. If someone’s sick, there is always help available from somewhere. Ask for it.

5. “Uh, Everything Is Under Control. Situation Normal.” – Han Solo

Star Wars Junior Doctors.001Seniors will check in on you. If everything is fine, that’s great. If not, say so. They will come and help. A quick bit of help is better than struggling on when things aren’t going well. Hospital is hard.

6. “Help Me, Obi-Wan. You’re My Only Hope.” – Leia Organa

Star Wars Junior Doctors.002When you phone for help, advice or to make a referral, say this up front. Be clear what you want first, and then give the details. “Hello, I’m looking to refer a patient to you, can I tell you about them?”. “Hello, I’m just looking for some advice please.”. Starting with “Hello I have an 85 year old man with…” etc etc might end up being a waste of time if you’re not through to the right person. The clearer the better when it comes to phone calls.

7. “In My Experience There Is No Such Thing As Luck.” – Obi-Wan Kenobi

Star Wars Junior Doctors.006…but you can make your own luck. A good mix of positive ‘yes’ attitude and healthy scepticism can go a long way. Being open and approachable will help attract the more interesting projects and opportunities.

8. “I’ve Got A Bad Feeling About This.” – basically everybody.

Star Wars Junior Doctors.008Listen to your gut instinct, it knows more than your brain is currently processing. If you’re not comfortable with something, if the numbers don’t add up, then do something about it. Ask. Ask again. Junior doctors often pick up on subtle clues from patients and ward staff that seniors can miss. This is an important part of your role in the ward, don’t be afraid to speak up.

9. “It’s A Trap!” – Admiral Ackbar

Star Wars Junior Doctors.009Nobody is trying to trick you. Except sometimes patients. And “I don’t know” is a perfectly valid answer, as long as you then go learn something.

10. “Your Eyes Can Deceive You. Don’t Trust Them.” – Obi-Wan Kenobi

Star Wars Junior Doctors.011Or in other words, “think with your hands”. The endofthebedogram is very useful, especially in the Emergency Department, but doesn’t count for shit if you don’t properly examine your patient. An early warning score means nothing out of context. Look at the numbers in the context of the patient in front of you.

11. “I Find Your Lack Of Faith Disturbing.” – Darth Vader

Star Wars Junior Doctors.007Trust the local guidelines and policies, they exist for a reason. Give treatments and therapies time to work. Not everything happens at lightspeed.

12. “Never Tell Me The Odds.” – Han Solo

Star Wars Junior Doctors.012Common things are common, but rare occurrences happen. Don’t rule unlikely conditions out without proper thought.

13. “Mentors Have A Way Of Seeing More Of Our Faults Than We Would Like. It’s The Only Way We Grow.” – Padmé Amidala

Engage with your supervisors. Some of you will be lucky to have truly great mentors who will influence your practice and shape your being. Some of your supervisors won’t be as good. I’m still in touch with my first mentor of FY1, and he still offers invaluable advice and guidance. A good supervisor can help you become a great doctor.

14. “Sometimes We Must Do What Is Requested Of Us.” – Anakin Skywalker

Star Wars Junior Doctors.013The best piece of advice I received for FY1 was “it’s only for a year and you’re paid to do it.”. Yes some of the jobs are ridiculous, but they have to be done and there’s nobody else to do them. The good FY1 will crack on and get the crappy stuff out the way so they can focus on training. The reward for the menial tasks is good training, but if you’re in a job where the training is minimal or non-existent then you need to address this with supervisors, programme directors and if necessary, the deanery. Earlier is better than later or not at all.

15. “Stay On Target.” – Gold Five

You will only pass Foundation Traning if your ePortfolio is completed on time. DO NOT LEAVE IT TO THE LAST MINUTE. Do it as you go. Annoy people for assessments. Add in any additional things you do. Upload (anonymised) thank you cards. Link to the curriculum at all opportunity.

16. “Search Your Feelings.” – Darth Vader

Star Wars Junior Doctors.049Reflection is a key part of ePortfolio. It’s also a key part of growing and developing as a doctor. Portfolio reflection and real life reflection do not always match up. Make it your own, don’t feel you have to fit reflective writing into the allocated boxes of whatever reflective cycle is currently on trend. Write the feels. That’ll do.

17. “They’re Tracking Us!” – Leia Organa

Star Wars Junior Doctors.035Monitoring forms are used to assess rotas, not your ability to comply with your rota. Fill them out truthfully. They will ask for consultant signature whenever you stray outwith hours, but this is categorically not a requirement, and is actually a conflict of interest. There’s more guidance on this on the BMA website.

18. “You Will Never Find A More Wretched Hive Of Scum And Villainy.” – Obi-Wan Kenobi

Star Wars Junior Doctors.038Management, basically. OK – this isn’t actually true, but I like the quote. There are occasionally battles with management. Know your rights. Don’t be coerced into doing things you shouldn’t be doing.

19. “Mind Tricks Don’t Work On Me.” – Watto

Star Wars Junior Doctors.013Don’t lie, just don’t do it. Sometimes you’ll need to sell a story, to radiology or to labs perhaps, but don’t lie.

20. “Great Kid. Don’t Get Cocky.” – Han Solo

Star Wars Junior Doctors.014Nailing procedures and technical skills is a great feeling. In some jobs you can get pretty good pretty quick. Be confident, be pro-active. Don’t be cocky.

21. “There’s Always A Bigger Fish.” – Qui-Gon Jinn

Star Wars Junior Doctors.015 Another reason to avoid arrogance, at any level.

22. “You Should Learn To Shoot First, Solo.” – Boba Fett

Star Wars Junior Doctors.017Medical school can only teach you so much. The real learning comes with on-the-job experience. Nobody is expecting you to be perfect from day one. As you go through Foundation Training, you’ll gradually become able to manage more complex situations, but get the basics down first. An FY1 starting with ALS, APLS and ATLS already on their CV is doomed to fail. They’ll also be a twat. Fact.

23. “Twice The Pride. Double The Fall.” – Count Dooku

Star Wars Junior Doctors.048Take pride in being a doctor, you’ve worked hard for it, just make sure it’s the right kind of pride. Take pride in your work and your relationships.

24. “It’s Against My Programming To Act Like A Deity.” – C3PO

Star Wars Junior Doctors.036Nobody is a god, so don’t act like one.

25. “Boy, It’s Lucky You’ve Have These Compartments!” – Luke Skywalker

Star Wars Junior Doctors.047Some FY1s will adorn themselves with tape and tourniquets, with pockets stuffed with needles and venflons and tubes. Some will go even further and carry a ‘Twat Box’ (if you don’t know what one is, you probably own one). In truth, if you know where things are you need only carry a pen and paper. Not everyone will agree with this.

26. “Sorry About The Mess!” – Han Solo

Star Wars Junior Doctors.037The nurses are not there to clean up after you. Tidy your own mess.

27. “Come On. You Know How I Grew Up. I’m Not Used To All These Rules.” – Ezra Bridger

Star Wars Junior Doctors.024It’s easy to view Foundation Training as a machine that churns out identically tick-boxing juniors, but there’s room for creativity. You can be a rebel in your own way. Medicine still needs mavericks. ‘Being A Maverick’ should not, however, become a box to tick. Then we really know it’s all gone to shit.

28. “Give Yourself To The Dark Side.” – Darth Vader

Star Wars Junior Doctors.019Night shifts. Oh night shifts. These vary wildly depending on hospital, department, season and if the moon is out in full. Busy or quiet, they will affect your sleep patterns. Sleep is an important part of functioning well and a lot of doctors have poor sleep hygiene. Understanding your natural sleep cycles is important and will help you survive night shifts and the switch back into days. Everyone will have their own sleep patterns, and the key is to know your own sleep patterns well. The following tips are a general rule of thumb, but won’t apply to everyone.

29. “I Don’t Sleep Well Anymore.” – Anakin Skywalker

Star Wars Junior Doctors.020Shift work, especially if little pattern to it, will mess with your sleep. There’s no escaping this, although you can take steps to improve your sleep hygeine to minimise disruption. Your body clock and natural sleep cycle will not be altered by shift work, it will stay fixed to a light/dark cycle. Your sleep pressure will change with your shifts. After a run of nights, if you try to stay up to then sleep at a ‘normal’ time, your body will try to catch up on missed sleep as an emergency. Your sleep latency is significantly less, so go to bed when you get home. Total sleep time, if uninterrupted, will be longer (12-15 hours) and you will tend to catch up of deep sleep first.

30. “Soon Will I Rest, Yes, Forever Sleep. Earned It I Have. Twilight Is Upon Me, Soon Night Must Fall.” – Yoda

Star Wars Junior Doctors.021Between about 2-5am is the biggest sleep pressure compacting an out of sync rhythm. Try and avoid complex tasks and difficult decisions during these times unless an emergency. The last few hours of a night shift feel horrible. Drink water, have a snack. Don’t be tempted to fill up on coffee. Handover effectively and leave. You should not be made to do join morning ward rounds after the shift has ended, this is why we have handover. Raise this if it becomes a regular problem. After a run of nights, try to catch up on sleep as best you can. Bright light will delay your sleep latency so wear sunglasses on the way home, and avoid unecessary screen time. If you drive to work, at the start of a night shift make sure to reverse park your car in a bay so that in the morning when you’re tired you’re not having to reverse out of a bay. This is compulsary practice for many safety-orientated industries such as the oil industry. If you think you are too tired to drive home, DON’T. Walk. Get a bus. Get a taxi. The school run usually coincides with shifts finishing. People are rushing to get to work. Lots of obstacles a tired brain could miss.

31. [Sad Beep] – R2D2

Star Wars Junior Doctors.042The bleep will go off in the middle of the night. It will make you sad.

32. “DIE Jedi Dogs…Oh, What Did I Say?” – C3PO

Star Wars Junior Doctors.022When your sleep pressure is greatest it’s easy to do and say things you wouldn’t normally expect. Everyone will have snapped at someone, or been overly rude. ALWAYS apologise and make up for it.

33. “Never Ignore A Call For Help.” – Roa’s Rules

Star Wars Junior Doctors.040It is almost always better to assess things in person than over the phone. If you can’t help, find someone who can.

34. “Watch Your Mouth, Kid. Or You’re Going To Find Yourself Floating Home.” – Han Solo

Star Wars Junior Doctors.023Everyone will forgive the occasional lapse in politeness as it happens to everyone. There’s no excuse, however, for simply being rude as a default. The only way to get by is as part of a team, and it’s ultimately what is in the patients’ best interests. Don’t exclude yourself from this by generally being a dick.

35. “Meesa Sorry!” – Jar Jar Binks

Star Wars Junior Doctors.001Most complaints are centred around communication issues. Being open, honest and upfront can avoid many common complaints. A simple apology can make a big difference, even if you’re not directly at fault/involved.

36. “You Came In That Thing? You’re Braver Than I Thought.” – Leia Organa

Star Wars Junior Doctors.023Don’t judge your patients for their actions or life choices. Just don’t.

37. “Sometimes There Are Things No One Can Fix.” – Padmé Amidala

Star Wars Junior Doctors.025Although there is usually something, however small, that you can do to make things better.

38. “You Don’t Know How Hard I Found It Signing The Order To Terminate Your Life.” – Govenor ‘Grand Moff’ Tarkin

Star Wars Junior Doctors.017DNACPR forms are important and should never be a momentary decision. You may have to gently nudge seniors to think about them in timely fashion. DNACPR and End Of Life Care decisions should involve relatives whenever possible. Arranging the logistics of this often falls to the junior. Do it well.

39. “Death Is A Natural Part Of Life. Rejoice In Those Around You  Who Transform Into The Force.” – Yoda

Star Wars Junior Doctors.018You will face death and everyone reacts differently when they do. Show respect to your patients even in death. Learn from each death. What was good? What could have been improved? When confirming a death, treat the deceased as you would have in life.

40. “And Sometimes, When I Don’t Plan It, Something I Do Hurts Somebody.” – Anakin Solo

Star Wars Junior Doctors.029We all make mistakes. Learn from them. Apologise. Don’t beat yourself up. Share things with friends, you’ll find they’ve made all the same mistakes you have.

41.  “I Feel Like An Idiot.” – Lando Calrissian

Star Wars Junior Doctors.045You will do, often. We all do. There’s no such thing as a stupid question.

42. “Lesson One From This Experience: Realize Just How Much You Don’t Know. Lesson Two: Make Sure To Learn From Lesson One.” – Jacen Solo

Star Wars Junior Doctors.041There will always be more to learn. Unlike medical school, you have a little more freedom and a little more time. Enjoy the learning curve. If you make a mistake or miss something then learn from it – flll that gap in your knowledge and carry on.

43. “You Have Forgotten Me, But I Will Never Forget You.” – Darth Maul

Star Wars Junior Doctors.028With time, memories of your patients will blur. This doesn’t make your time with them any less significant. Your patient will remember you and how you made them feel.

44. “There’s Always Time For The Important Things. The Trick Is To Recognize The Need, And To Create The Necessary Time.” – Luke Skywalker

Star Wars Junior Doctors.039This is equally true in and out of work. Find what is important to each of your patients and make time for that in their care. Giving yourself time to relax and enjoy other thigns in life is also of vital importance.

45. “Overwhelming Odds, Tough Target, Scant Chance Of Survival. Business As Usual.” – Corran Horn

Star Wars Junior Doctors.043Some jobs will feel like this most days. These are bad jobs, but do them well. Four months and you’ll be in a completely different job. You’ll get through.

46. “Why Would I Risk My Life For A Bunch Of Strangers?” – Ezra Bridger

Being a junior doctor is tough. It can easily take over your life if you let it. We are privileged to help people in their most desperate times of need, but make sure you look after yourself also. Junior doctors have died travelling home late from shifts. Be good to yourself. Be wary of the risks you’re taking. Be a hero for your patients, but be your own hero too.

47. “Oh, Switch Off!” – C3PO

Star Wars Junior Doctors.044Switch off when you leave work. If you find yourself taking your work home with you, or worrying late at night about work, speak to someone. You should be able to relax outside of work.

48. “One Thing’s For Sure, We’re All Going To Be A Lot Thinner.” – Han Solo

Star Wars Junior Doctors.019Being on your feet is good for you, but you need to support the intense effort of hospital work with a decent intake of food and fluid. Drink plenty on long shifts. Avoid stress eating as much as possible. Unless it’s a clinical emergency, be firm about having time for food in the day.

49. “This Is A New Day, A New Beginning.” – Ahsoka Tano

Star Wars Junior Doctors.020It’s the first day of the rest of your (working) life. Stick with it. Give it a chance. As an FY1 it’s easy to see yourself as lower than an Ewok’s loin cloth, but remember: it’s only for a year and you’re paid to do it.

50. “The Circle Is Now Complete. When I Left You, I Was But The Learner. Now I Am The Master.” – Darth Vader

Star Wars Junior Doctors.021You’ll never be a master of anything in medicine. You can’t be. Deal with it and move on.

51. “These Are Your First Steps…” – Obi-Wan Kenobi (in Rey’s vision)

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In retrospect, Foundation Years are all a bit of a blur even though I’m not long out the other side. Take it one step at a time, and try and enjoy the ride (well, bits of it anyway!). You have a long career ahead of you (until you’re 70…80…90 who knows when retirement will end up being?!). Each stage is special in its own right.

52. “You Can’t Be So Stupid As To Think This Will Be Easy.” – Captain Phasma

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Foundation Years aren’t easy, no matter what anyone says. But they are definitely do-able. Some find them easier than others, and that’s fine. Take it one job at a time. Help each other out, keep mind of your own physical health and mental wellbeing, and know that you’ll get through.

53. “You Need A Teacher.” – Kylo Ren

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In each job, foundation doctors are allocated clinical and educational supervisors. Whilst the educational supervisor makes sure you’re on track for meeting competencies and can offer career advice etc, clinical supervisors vary from job to job in what level of input is offered. If you identify someone who is a good teacher, and who you learn well from, then cling on to them as a mentor. I’m still in contact with my first ever clinical supervisor as I learn well from them and trust their advice.

54. “Don’t Do That.” “What?” “Anything.” – General Organa to Han Solo

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Early on (and depending on job, later on too) it can feel like you’re in the way more than you are useful. This is more perception than it is factual, but whilst you’re still getting used to things it can be tricky not to fee this way. Be confident, you’re more useful than you know.

55. “Hey! Can I Try That?” – Han Solo

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Seniors are usually good at offerring learning opportunities to juniors, but sometimes it’s worth poking your head above the parapit to ask if you can try something or if they can supervise you doing something. The same applies for learning assessments and other portfolio items.

56. “The Belonging you Seek Is Not Behind You…It Is Ahead.” – Maz Kanata

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Some people will know exactly what field of medicine or surgery they want to go into, form day one of medical school (or even before!). It’s fine not to know, and it’s fine to think you want to do a particular specialty and then find you really don’t like it when you do it for foundation. It’s find to change your mind and it’s fine to explore things you hadn’t considered before. Use taster sessions at the end of F1/start of F2 (try for both!), and if you’re lucky enough to get training days/personal study days in your rota, then you can use these to explore different specialties – just ask doctors if you can shadow them for a day or so! Also, remember that just because you might have hated a job as a foundation doctor, it could be very different as a specialist or core trainee, so don’t necessarily completely write it off.

57. “Don’t Shoot! I’m An Innocent Pawn!” – Viceroy Nute Gunray

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As juniors, we often work by guidelines and protocols. Senior doctors can stray, quite rightly, from guidelines in particualr clinical scenarios. It’s not uncommon to find yourself trying to explain one person’s clinical decision to another person who has different ideas, and get the flack for it. “Why have you prescribed this?!” “Well, Dr X told me to…” “Do this instead!”. If in doubt, just document “…as per Dr’s instructions.”.

58. “Water! Water! Is There Water?” – Finn

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Keep hydrated. This cannot be stressed enough. And remember to pee. Doctor’s seem to have miraculous ability not to go to the toilet for entire 12 hour shifts, but it’s probably not a great idea.

59. “The Light – It’s Always Been There. It’ll Guide You.” – Maz Kanata

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And by The Light, I mean the Oxford Handbook Of Clinical Medicine. OK, so I don’t actually have a copy to hand anymore. Everyone will have a preferred reference resource. During Foundation Years I was lucky enough to work in a Trust that subscribed everyone to UpToDate, which was invaluable (it’s rumoured that the Trust tried to discontinue the subscription, and the consultants all threatened to leave because they relied so heavily on it, so they voluntarily took salary docking to cover the subscription cost!). Other places will have local publications which are excellent (take Glasgow’s Therapeutic Handbook for example. It’s basically a foundation doctor’s bible). Know where to look things up. No harm can come from double checking.

60. “I Know How To Run Without You Holding My Hand!” – Rey

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You may do, but not everyone does, and (especially at first) seniors and supervisors have a duty to make sure everyone is safe and working to a minimum standard. The severe hand-holding stage doesn’t last too long.

61. “Stop Taking My Hand!” – Rey

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That being said, you don’t have to jump in at the deep end before you’re ready. If you start off being supervised, and then build competence, you can transition by asking a senior to come along but not actively do anything unless you ask them to. You have the safety net there but can still practice autonomously. For example, with neonatal resusitation we start by having a senior come to every resus, and then if we want we’ll have a short period of having a senior come along but stand outside the resus room unless you call them in. They’re still immediately there to step in, but allow you to start to spread your wings.

62. “Reckless.Aggressive. Undisciplined.” – Mon Mothma

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Don’t be any of these. It sounds silly to say, but occasionally you meet doctors who are all of these.

63. “I Rebel.” – Jyn Erso

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Rebelling clinically is probably not a great idea, but in the wider role of a doctor a bit of a rebelious streak can be advantageous. I’ve had a number of great opportunities, as have colleagues and friends, come about by doing things a bit differently and ‘not in the usual way’.

64. “We’re Gonna Do This.” – Poe Dameron

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For procedures, especially things like venepuncture and cannulation, success often depends on how you approach them. It’s very frustrating when a patient or relative says “Ooh yes the veins are ever so tricky! The last doctor took five attempts!”. Be positive. Presume you will succeed.

65. “You’re Late. Never Keep A Lady Waiting.” – Asajj Ventress

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It’s OK to be late once in a while (don’t make a habit of it!). If you’re running late, let the team know. Phone the ward, send a message to a colleague. More than anything, they will want to know you’re OK.

66. “All Teams Give It Everything You’ve Got!” – Poe Dameron

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Once in a while, you’ll get to see and be part of the most incredible team work possible. There’s nothing quite like it. It doesn’t much matter whether your role is right int he centre, or out at the periphery. The machine moves as a whole, and to see it and feel it is amazing. A multiple casualty major traume came into our already full A&E one Sunday. The rapid set-up of patient teams in resus, the delegation of guard duties for firefighting the majors area of existing patients in both adult and children’s department, and the slick interface of other professionals like radiology moving between each patient in resus, was incredible to see. Everyone got excellent care, nobody outwith the major trauma came to harm from waiting due to safe delegation and monitoring, and even then each member of staff managed to rotate round and get quick breaks for comfort and hydration. We’re very lucky to do the job we do.

67. “Escape Now. Hug Later.” – Han Solo

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Emergency situations, such as resuscitations, are intensely stressful and often take all the energy you have got. Once through the other side of a critical scenario, there can be a backlog of less urgent clinical tasks which juniors need to catch up on. Remember to still take time to debrief and reflect. The team involved should properly debrief – make sure as the foundation doctor you are included in the debrief, even if you didn’t do much during the resuscitation. It’s an important process and also good debrief skills will be useful as you become more senior.

 

68. “So Who Talks First? You Talk First? I Talk First?” – Poe Dameron

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Studies in acute settings show doctors, especially juniors, wait less than 30 seconds from when a patient starts talking before they interupt them. The history is the most important diagnostic tool, and it is not possible to get a good history if you are talking more than the patient. Wait until there is an almost uncomfotable silence after a patient has finished telling you why they are presenting before you respond.

69. “Kid, You Wake Me, You Die.” – Zeb Orrelios

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On call seniors overnight, be they at home or resident, are there to be called upon. Some are less happy about it than others, but waking them up is sometimes a necessity. As a foundation doctor, go up through your registrar first, but at some point you’ll be phoning a consultant at home. Tell them why you’re phoning and the exaplin the background. SBAR (Situation, Background Assessment, Response/Reccommendation) is a handy tool to use for communication, but first and foremost state: “I’m calling for…advice/to update you/because I need you to come in.”. If you’re needing the consultant to come in, then some might prefer you give them the clinical details once they’re on their way so no time is wasted in them getting to you.

Also, it takes an average of 20 minutes from when someone wakes up before they can think coherently and rationally. Worth bearing in mind when waking people up for critical decisions.

70. “Any Mystery Can Be Solved Through The Application Of Knowledge And Unrelenting Effort.” – Darth Plageuis

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There’s always more to learn, but that doesn’t mean studying continuously, doign exams at the earliest possible opportunity and reaching each stepping stone as quickly as you can. It can pay to take your time and to vary the pace. Everyone will do it differently and everyone will have different experiences. You are your own yardstick. An FY2 in North London who has not yet had to work a nightshift before will be different to an FY2 on the West Coast of Scotland who runs the hospital overnight. The one in London might get their exams first, but I know who I’d rather have seeing me at 3am.

71. “Every Question I Ask Is A Trick.” – Vergeres

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Someone consultants and seniors ask questions in a style that feels like they’re trying to catch you out. They’re not. Well, most of them aren’t anyway. A few will, but they’re not good teachers. And it’s OK to say you don’t know.

72. “Do You Know The Difference Between An Error And A Mistake?” – Grand Admiral Thrawn

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Do you know the difference between an error and a mistake, Ensign?
No sir.
Any one can make an error, Ensign. But that error doesn’t become a mistake until you refuse to correct it.
―Thrawn and Ensign Colclazure

We make errors all the time. Knowing this and taking steps to prevent or reduce errors is important. Adressing them, correcting them, askign for help with understanding or prevention etc are required to stop errors becoming mistakes.

73. “You Could Warn Me When I Do Something Bad.” – Darth Revan

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If you think something is wrong, speak up. There are countless stories of juniors or students noticing things such as left/right surgical mix ups, or x-rays for the wrong patient being reviewed, and not speaking up for fear of reprimand.

One method, particularly useful for juniors, is the PACE system. Probe, Alert, Challenge and Emergency. At the ‘probe’ stage gently ask “what is it you’re thinking here?” or something to that effect. If still uncomfortable with the situation, ‘alert’ allows further “are you sure?” and so on. Phrased in the right way, an unsure junior can challenge an apparent mistake/problem from a senior without having to worry about it reflecting badly. If needs be, based on the responses, a proper challenge (“I think this is a mistake”) can be appropriately facilitated.

74. “I Won’t Have You Question My Methods.” – General Hux

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If you’re worried that someone isn’t acting on highlighted errors, there a number of ways to raise patient safety concerns. Try approaching them directly, but failing that, a good start is to speak to your own educational or clinical supevisor for advice (you can keep it anonymous). You can also speak to the person concerned’s supervisor. There will be various set-ups locally, but essentially patient safety should be the number one priority.

75. “Even Stars Burn Out.” – Anakin Skywalker

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Everyone is at risk of burnout, no matter how competent or brilliant. Emotional and physical exhaustion can have monumental effects on an individual’s health. It is ok to recognise this and it is ok to take steps to prevent burnout.

76. “What Will You Do If They Break You?” – Saw Gerrera

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There’s no escaping the fact that unforunately there are still some jobs in some foundation programmes that are just horrendous. You’re health is more important than anything. I’ve had friends and colleageues quit medicine compeltely because of particular jobs. If you speak up, especially as a group if a certain job is particuarly dreadful, things can sometimes change (sadly this doesn’t always work). Departments can have trainees pulled or rota breaches can eventually be re-banded and backpaid. Not that either of these are good solutions, but they are something. If individually you are finding things too much, pressure is mouting, or you think you’re burning out, then seek help. Take time out, have considerations put in place, or whatever necessary to allow you to continue doing what you want to do without risking your own health and wellbeing.

77. [Thumbs Up] – BB-8

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Be positive. Be optimistic. It really does make things easier.

78. “Hope Is Not Lost Today. It Is Found.” – Maz Kanata

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Seek hope in the bleakest of situations. For our patient, for their family and for yourself. Hope for a good death (and how it can be achieved) is an important gift to give a patient and a family. Hope for yourself for next stages in career or in life is key to self-motivation and avoiding burnout. Be an optimist, find the silver linings.

79. “Some Fights Must Be Fought Whether You Believe You Can Win Them Or Not.” – Chancellor Valorum

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There will be many occasions where personally you don’t think continuing care is in a person’s best interest, but where others (family, other colleagues, the patient) don’t agree. Fight for the patient no differently to how you would for someone you believed had a better chance.

This mantra applies outwith the clinical environment too. Just look at the recent Junior Contract battle.

80. “We Don’t Have To Win. All We Have To Do Is Fight.” – Mace Windu

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Whatever the case, keep on fighting. For your patient, for their family, for your community, for the public, for your profession and for yourself. You won’t always win, but you’ll never win if you don’t fight.

81. “I Find That Answer Vague And Unconvincing.” – K-2SO

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If a consultant asks you a question, in an educative capacity, and you’re not sure of the answer, just say. If a patient asks you a question and you’re not sure, it’s important to be open and honest. Tell them you’ll go and find out, or will get a senior colleague to come and discuss things further with them. Don’t fudge it. Misinformation and misunderstanding can have significant impacts on how patient expectations and self-management of disease.

82. “It’s Not A Problem If You Don’t Look Up.” – Jyn Erso

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It can be really easy to ignore a small problem, or something that’s not quite right. If you keep your head down and act like you never noticed it, it’s not your problem, right? Admittedly it makes for an easier life, but you might be the only person to have noticed something amiss. Look up. Speak up. It might just make a huge difference to a patient or a colleague.

83. “He Tends To Say Whatever Comes Into His Circuits.” – Cassian Andor

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If, like me, you like to make jokes and quips in conversation, you’ll need to develop a filter. It’s surprisingly easy to become more than a little disinhibited after long periods at work (the end of a long week on-call for example), and the chance of accidentally making an inappropriate comment or joke in front of a patient or colleauge increases. It happens, and it’s usually harmless. Just be aware if you’re the kind of person who tends to become a little frontal…

84. “I’m Capable Of Running My Own Diagnostics, Thank You Very Much.” – K-2SO

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Listen to the suggestions of others – in particular nurses and nurse practitioners. They know they’re stuff and are usually spot-on with what needs doing. Also, accept help. If someone is offering to run a gas for you in an emergency situation, grab the chance – it will let you think and stay with the patient.

85. “Let Them Pass In Peace.” – Chirrut Îmwe

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People die. As doctors, we like to try and save people. In hospital, we can all too easily lose sight of what is best for the patient. This is especially true in the case of the dying patient. Futile resuscitations, over-zealous investigating despite hopelessness of treatment, and mishandled DNACPR discussions can all distract from providing a good and comfortable death for patients. Add in conflicting views of family members and differing opinions of other specialties, and we move further away from the best interests of the patient. Get to know your patients. Know what they want and how they feel. Be guided by this. And involve palliative care early.

86. “Your Concern Is Hardly Warranted.” – Orson Krennic

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Sadly, the concerns of juniors are sometimes ignored. If you are genuinely concerned about something, be persistent. There are lots of different ways to express concern, and if there is something that’s not right, you might just be the only one to have noticed.

87. “Your Work Exceeds All Expectations.” – Wilhuff Tarkin

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Occasionally, you will do something really great. You’ll manage a complex patient in the night with a spot-on plan. You’ll lead a resus when the crash team are already tied up somewhere else. Or you’ll just get that scan organised far quicker than expected. Keep track of your victories. Reflect on them, use them as reminders when times are tough. Jump at the opportunity to record excellence on your portfolio. It will accumulate.

88. “Congratulations. You Are Beig Rescued.” – K-2SO

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The feeling experienced when the crash team arrive after your 2222 call is something that can’t be artifically reproduced. The cavalry arriving, with extra hands and extra decision-makers, is a huge relief in an emergency. Have a low threshold for calling them, especially early on. They’d rather come to a false alarm than arrive late to a catastrophe.

89. “We Are On The Verge Of Greatness.” – Orson Krennic

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The start of your career as a doctor is daunting, but you are about to start something brilliant. It’s tough, and stressful, and you’ll need to keep swimming to stay afloat. But being a doctor is great (mostly) and you’ve worked hard to get here. So remember…

90. “Breathe. Just Breathe.” – Luke Skywalker

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Take time to just sit and breathe, even for a minute or two. It clears your head and settles your heartrate. Have a look at simple mindfulness techniques. But above all, just breathe.

 

 

A Flash of Discovery

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(names of campers have been changed to protect identity)

This is Jake. He’s a sibling camper with Over The Wall, a children’s charity which provides free therapeutic camps for children affected by serious illness. This photo was taken by his fellow team mate Charlie, a camper with a natural talent for photography who I’d entrusted with my camera whilst I filmed the rest of the Blue Team (made up of 15-17 year olds) tackling the climbing wall. Charlie was snapping away, producing some great shots, but here I believe he has captured one of the best photographs to have come out of camp since a group of us created the Camp Recorder role a few years back. Charlie has captured something that we’ve only managed in a handful of our shots; something that encompasses everything we as volunteers aim for at camp; a moment of discovery, the key element of the Therapeutic Recreation programme underpinning every minute of camp.

On the surface, camp looks like a week filled of fun and laughter. Look a little deeper and you see a one-to-one camper to volunteer ratio with highly trained team mates enabling campers to push themselves, achieve more than they thought they ever could, and then crucially to reflect on these successes in deep and meaningful ways. Look deeper still, and you might just find the pot of gold at the end of the rainbow. The end-goals of constantly reflecting on endless successes and achievements are profound breakthrough moments for each and every camper. By combining challenge-by-choice, success and reflection, we can lead our campers towards discovery. A realisation within of something lost, forgotten or not previously there. Discovery of childhood milestones stolen by illness and missed opportunities. Discovery moments don’t always happen whilst we’re at camp, but we know from extensive feedback and now reproducible international research that they happen and that, importantly, they last. This photo beautifully captures one of these moments…

This is Jake. He’s a sibling camper with Over The Wall, and has returned again this year for another week of fun and games with other siblings of children affected by serious illnesses. His fellow team mate Charlie has captured a single moment of discovery in this candid shot; a moment to which all the support, positivity, challenges and successes of the week so far have been building. Jake and Charlie are the the climbing wall along with the rest of the Blue Team. Charlie has been snapping away, honing his already-great photography skills, having zoomed up the climbing wall numerous times already. Jake is in his Honey Monster onesie cheering on the other campers whilst they climb, getting fully into the supportive nature and ethos of camp. Although keenly enthusiastic for the success of his team mates, Jake has declined attempting the wall himself. Afraid of heights to the point of not wanting to step foot on the wall, Jake’s challenge-by-choice for this session is being as supportive as he can to the other campers, donning a harness and helmet so he can get up close to the wall to do so. Usually quiet, Jake is finding his voice from the foot of the tower.

With him in the photograph is Giulia, the Blue Boys team leader. Giulia has spent the week along with the Blue Boys team mates enabling success and facilitating deep and meaningful reflection in the boys, though informal discussion and structured cabin chats each evening. For a while before Charlie took this photo, Giulia had joined Jake on the opposite side of the tower to the rest of the group. Between cheering and whooping the climbers, they chatted about camp, about life and about the nature of challenges and successes. We like our campers to be in their stretch zones (it’s where the magic happens), but we never want anyone in a panic zone. We like campers to choose their own challenges that we can then support in whatever way possible. After their chat, Giulia goes back to cheering on the climbers as the session draws to a close. Jake looks quietly up at the tower. Charlie presses the shutter button.

The mini-bus arrives to take the team up to dinner. There’s not enough space for everyone, and Jake opts to wait for the bus to return, along with Giulia and myself. As the bus drives off, Jake approaches the climbing instructors. Before we know it, he’s hooked up to the ropes and placing a hand and foot on the base of the tower. In seconds he’s halfway up the wall. I grab my camera just in time to film Jake reaching the top, triumphantly hitting the last hand-hold. Beaming the entire way up to the dining hall, Jake turns to Giulia.

“I never thought I’d be able to do that. You showed me I could Giulia. Thank you.”

That evening at cabin chat, talk turned to the huge impact childhood illness has on the siblings of sick kids. A camper points out that many people don’t think siblings need extra support, and even suggest they wouldn’t need a camp such as Over The Wall. They couldn’t be further from the truth, as the campers and volunteers discuss the impact illness has on the family, and the significance of al the achievements and successes they’ve had in spite of this over the week. The volunteers hand out ‘Brilliance Beads’ to the campers. Simple beads, colour-coded to represent achievements. Fun, Support, Positivity, Team Work, Courage and Creativity. At the end of every day, each volunteer awards each camper with a specific bead, positively labelling something from the day, represented by the Brilliance Bead. It doesn’t sounds much, but even the older boys value these tokens of their successes, deepening their own reflective processes. At the end of the week, a camper can turn their unique combination of beads into a bracelet or anklet, many wearing them year-round.

That night Jake was given a Courage bead. Charlie go a Creativity bead. We got this photo: a breakthrough moment of discovery, captured beautifully by another camper. It’s everything we aim for at camp.

Camp truly changes the lives of everyone involved. So much more than just a week of fun, the intense therapeutic model we use has profound effects. I think this photo captures a breakthrough, a discovery. It’s in these moments that the magic really happens.

After the campers had left, as the volunteers were packing up the camp bubble, our Camp Director shared with us a phone call he’d received from one of the bus drivers. The driver, along with a chaperone from camp, had driven a single camper back home. They’d been stuck in bad traffic the whole way, and the journey was hours long. The same driver had driven the child to camp at the start of the week. After he’d dropped the camper off home, the driver rang to express his disbelief. “What do you do at camp? How have you done this? It’s a different child. Unrecognisable. The child I drove here was shy and quiet. They hardly spoke. They never smiled. The whole way back they were sat up front, laughing and joking, singing and dancing in their seat. Entertaining us in traffic, filled with joy. A different child.” The bus driver has applied to volunteer at camp next year already!

There have now been two international outcomes studies at SeriousFun camps across the world, including Over The Wall, conducted by the Yale Child Study Centre. They show the significant lasting benefits of camps using therapeutic recreation.

  • 79% of parents reported noticing an increase in their child’s confidence;
  • 77% reported an increase in self-esteem;
  • 75% reported an increase in maturity;
  • 74% reported an increase in independence;
  • 76% reported an increased interest in social activities;
  • 80% reported an openness to try new things.

I’ve been a volunteer with Over The Wall since 2009, and with somewhere in the region of 25 camps behind me I’ve seen hundreds of wonderful discovery moments in our campers. Seeing campers return each year, watching them grow and flourish unrecognisably is a privilege and something I’ll be forever indebted to camp for, as it’s truly enriching and life-changing. Even if the campers are better photographers then me.

See if you can spot Jake reaching the top in the film below!