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practice of medicine

Happy holidays everyone

5 Aug, 16 | by Bob Phillips

There will be a lull in blogging as a variety of people are off doing other things.

Have a lovely summer (N hemisphere folks) / enjoy the rigours of Winter (S hemisphere chaps).


(Guest post) No more broken backs

24 May, 16 | by Guest Post

131001donkeystraw1In this guest post, Gabriella Morley reflects on her experience as a just-qualified doctor in paediatrics in Birmingham, UK, and what the experience of the “Learning From Excellence” model feels like to those under the greatest strain at the moment – junior doctors in England.

It could probably be said that this was one of the most turbulent and uncertain years for doctors in the NHS. Yet the contractual dispute was the proverbial last straw causing the final break in our backs. For a long time now, morale in the NHS has been fading.

I didn’t really get this though before I started life as an FY1 back in August ’15. How could people be dissatisfied, frustrated or, frankly, just down right fed up when they are doing, what I perceive, is a very meaningful job?Of course that’s naive, but until you’re in its hard to fully appreciate just how stretched the system is. Now I know, there is a constant in our hospitals which is a backdrop to our day: tension. It’s almost palpable. We feel under pressure constantly quite simply because there is demand greater than our supply. The beds are full, the A and E swamped and ‘crisis’ is becoming a norm. We worry about what our next shift might have in store for us as the rota gaps get more prevalent and the workload intensifies. We are scared that this struggling system may mean we slip causing damage to the very people we so badly want to help. It’s thus not surprising that morale, “the level of psychological well-being based on such factors as a sense of purpose and confidence in the future”, is looking a bit peaky.


Child Well-being

4 May, 16 | by Bob Phillips

Acorn_PNG743We, the child health community, are proud to focus on ‘well-being’ much more than numerical things, like fractional shortening, GFR or HbA1c*.

In a recent discussion, it was identified that there has been a sociological academic discussion on looking at how interventions in childhood are more about well-becoming rather than well-being.

Which intrigued me … more…

Of Vets and Paediatricians

15 Apr, 16 | by Ian Wacogne

giphyI’ve heard it said, by those ignorant the joys of working in paediatrics, that our chosen speciality is “a bit like veterinary medicine”. Presumably this is a dig at both parties – at paediatricians because our patients couldn’t possible give us a history, could they? And also at vets because, well, their patients really can’t give a history either.   more…

“I don’t want that needle!” (AKA Do fewer things)

8 Apr, 16 | by Bob Phillips

We (doctory, paediatric types) tend to pride ourselves on minimising distress to children and young people wherever possible. A couple of social media interactions over the last few days have made me re-question that – this one

and the follow-up



Being a (part time) Consultant

30 Mar, 16 | by Bob Phillips

Dr Phillips, part-timer and fraudInspired by the wisdom of @ian_wac in the previous post, I wracked my brain to think of five top tips that I would give (if ever asked) on “How to be a Consultant”.


Being a Consultant

25 Mar, 16 | by Ian Wacogne

Bio PicA colleague recently asked me, because he’d been asked to give a talk, what my top five tips would be regarding being a consultant.  I thought that crowd-sourcing your talk was a bit cheeky, until I realised that I could spin off a blog post about it.


Work-Life Balance

16 Mar, 16 | by Ian Wacogne

originalOf course, you’ve got to maintain a work life balance.

Of course you have.

Of course.

And, while we’re at it, we should discuss getting a life.  We discussed just that down at my local “Get a life” club recently.  (Joke courtesy of Barry Crier).

But I’d like to put forward a different perspective.    more…

Guest post: The scary thing about research

8 Jan, 16 | by Guest Post

The_ScreamYou know that question that always comes up after a journal club/critical review of a paper session – “so where do we go from here?” and you also know the standard answer – “more research is needed”.  Have you ever thought about why you use that answer? Well, firstly, its what we were taught from the moment we first started appraising papers, but, moving past that, could there be other reasons too?

Of course, in many cases, we may actually need to do more research but, in others maybe… just maybe… we don’t need more research. Maybe we say we want more research for other reasons.

Evidence on the floor of my kitchen

22 Dec, 15 | by Bob Phillips

Every year when the shops fill with Slade, calendars count down in chocolate to an absence of cereal on the morning of the 25th December and male faces fill with desperation at present buying, my mind slips back to my kitchen, about a decade ago.

It’s an unremarkable kitchen, but had in it a large plastic birthing pool.

This symbolises to me the clash of evidence (‘water births are safe for low risk pregnancies’), patient choice (‘i want a home birth’) and paediatric medical experience (‘EVERY WATER BIRTH IS A NIGHTMARE THEY ALL DO REALLY BADLY AND THE FLOOR IS SLIPPY’).

The upshot was, at 7.30 am, the filling of the aforesaid bath on 25th December, the birth of a perfectly healthy and un-drowned baby at 11.30am (ish) and a Christmas lunch of bacon butties with two very relieved midwives, a weeping Grannie and a perfectly peaceful Mother resting on an inco-sheet covered couch by a decorated tree.

Merry Christmas everyone, and may you follow the evidence that suits your patients and place all your prejudices to one side.


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