We're all learning

I'll try a bigger font for this one, I think...

Anyway, time for another clinical session, this time on skin lesions. A familiar clinical tutor appeared, this time he's a resident rather than an intern. He had lined up some excellent, and very helpful, patients for us to see which must have taken considerable time on his behalf. Each patient was well prepared for our visit so rather than the usual shocked / surprised individuals we saw cooperative people.

Interesting to see how he's progressed: his bedside manner was excellent and he seemed to have much more patience with us this time, stressing less about the small things. Perhaps before, he was in the middle of his intern blues, perhaps like us he's developing and improving.

Either way, I was impressed with his approach. Best we've had so far.

Lessons in irony

The most stilted and uncomfortable part of the MBBS are the communications skills classes. Worse even than the ethics classes.

The twenty-odd students sit around for a three hour session, looking unhappy and uncommunicative and annoyed that it's Friday afternoon and they're learning to be empathetic. Of all classes, you need some kind of dialogue or contribution for the session to have any kind of meaning.

Some of the approaches taken by the facilitators doesn't help. Having had a consistently sympathetic discussion around the social situation of a facially disfigured person, he was keen for us to come up with some less kind judgments to make. It was clearly against the nature of everyone in the group to say unpleasant things... I'm not sure that by stimulating this kind of response the guy was raising an awareness of its inappropriateness. From what I saw, no one would have dreamed of being so insensitive... until the facilitator had egged them on.

He then said: "Please don't react like this when you see a patient like this".

Not a chance of that happening.

Great days

A friend of mine (oldest friend when I think about it) sent me a link yesterday to some digitised photos from a holiday we had together a long time ago. I never saw myself as the kind of person who had a photocollage noticeboard in their living room showing me with a bunch of great mates doing great mates things, but blow me down if there isn't a photo of a skinny teenage me jumping into the Mediterranean from a pier accompanied by five or six school friends. Perhaps I wasn't always such as curmudgeon.

Anyway, the photos also showed a very long haired me and my (now) wife looking young. It's quite confronting seeing a photo from ~20 years ago all of a sudden, particularly when you were a few kilos lighter and with hair to your shoulders. Can't say it was such a bad look actually... I thought I'd show my young colleagues a couple of snaps (particularly one guy who is looking to grow some length before the hard core clinical years) and the response was quite reassuring!
Anyway, cue plenty of reflection and introspection, mulling over the person I was then, the person I was now and how the years between have affected and changed me. The young fellow in the picture probably would have been surprised to have seen his older self make a decent fist of I Banking... although whenever I was at my desk my music tastes would have been recognisable. As is not uncommon, tastes tend to ossify around the 17 - 25 years which is the case with me.

One album I was listening to for the first time in a long time, before even the photos appeared, it the Ultra Vivid Scene album Joy: 1967-1990. This was released in 1990 and was very popular amongst the hip young things of the time. Even though I was more of a SubPop fan (probably the more listenable stuff I was into), for some reason Kurt Ralske's poppy- noise(ish) music fitted my mould, and that of my friends too. Probably due to his being a New Yorker (I was very keen on Shimmy Disc at that point), the fuzz on his guitar, the odd lyrics and a song with the same title as a very popular Nick Cave song (Mercy Seat).

I never subscribed to Ralske being 100% derivative of MBV, JAMC and the rest despite him confessing to similar VU roots on a SNUBTV clip I saw. He's pretty original and the mix and the production are so layered you can listen to each track numerous times and spot a different instrument that you've been listening to passively for 20 years suddenly come to the fore.

Back in the jug agane

So - the start of my second year. Finally, some uncharted territory.

Except not. The way this course is structured, save content my second year is a carbon copy of my first year. This isn't the most inspiring thought at the moment. Group projects and assignments have already become routine, formulaic and rather a bore as I think I've mentioned before.

The question is, how can I maintain my own motivation and what will the university be doing to maintain the engagement of the second years? From conversations with and observations of the second years when I was a first year, the answer to the second question is "not a lot". Looks like I'll have to dig deep and find myself some intrinsic motivators from somewhere.

It'll be interesting to look back on this year in 12 months time: ha I been a bit pessimistic, or was it indeed the slog I anticipated?

Private Eye and MMR

Oh, look. My letter to Private Eye on their MMR performance did get published and the mag's response seems to be cause for comment.

Thing is, looks like they still can't see how their credibility is being damaged by not admitting they were in error. My copy arrives a bit late here in Australia so I haven't read the full mea culpa-ish so I can't comment much until it arrives.

Lonely at the top

So... finally had an email exchange with the only other "proper" mature student on the course (ie over 30). He's an overseas student and he went home over the southern summer.

For one reason another it looks like he won't be coming back next year which (from a selfish standpoint) leave me as Mr Outlier. Staying solipsistic just for a moment, he's the guy I sit next to in lectures so I'll be feeling a cold draft all down one side (c. Eric Morecambe).

No time to ruminate now.

MMR & autism - hogwash

Living in the UK in the late 90s (as I did) it was hard to avoid the MMR scandal. I won't go into the details here. This link will tell you what you need to know and concentrates on the part played by the press in the whole palaver. Suffice to say, they did not cover themselves in glory and undoubtedly influenced a large number of parents not to use the triple jab thereby endangering the children of those parents who immunised their kids but for some reason the jab didn't work.

Now that the dust is settling, that the GMC verdict is in and that the Lancet paper retracted, some reflection is appropriate.

Despite the Bad Science link above suggesting that the autism / MMR link is a UK phenomenon, in my young student cohort one person put their hand up in a tutorial to remark on the link when MMR was mentioned. So, the damage has spread globally.

The other entity that comes out of this mess poorly is the magazine Private Eye. Although it is typical for the magazine to take an automatically contrarian view, their lack of understanding of the data disproving the autism link went on for far too long. Even today, there seems to be a reluctance to accept that they were duped by the lobbyists on this one. I sent them a letter post GMC to see if they'd publicise the safety of MMR as thoroughly as they did the imagined dangers, but normally when the letter is accepted you get a "I've passed this on to the editor"... nothing this time. And there's nothing on their website at the moment when you search for 'MMR'.

Oh God, and I forgot about their special report in 2002. 2002! Geez. The BMJ produced an interesting review here.

The problem comes down to the media's lack of understanding of science. Being largely art grads, this is not surprising. Other skills, such as understanding how the biases of sources can bias a piece of work, you would have thought to have been in an experienced journo's tool kit... but in this case the author of the Private Eye report, Heather Mills, even goes so far as to thank these sources on the back cover of the report..!

Following this debacle, a demonstration of little self-awareness of one's limitations amongst the fourth estate is warranted.

Multitasking

See: I'm already making no effort with my pics (the one above is the first that comes up on a Google image search for 'multitasking').

Crap, isn't it?

Anyway, this year, now that I'm a bit settled / stuck in a rut, and what with the economy improving and all, I've started to take on a bit of work based on my previous experience. A bit of cash will be nice and it makes me feel like a grown up again. I've snagged a chunk of research work as a visiting fellow in the local university and am working with a professional services firm (as it were) to help out with a few management consulting projects in the CBD. Not sure whether this work will detract from my strict flash card-based exam technique, but so far I've gone well enough and frankly I quite like having a CV without a four / five year medical school-shaped gap in it.

I've also had conversations regarding going back to the bench for some wet science. I'm in two minds about this. On the one hand, it would be nice to maintain a bit of momentum on the (hard) science side: may help my clinical career although I have published ok over the years so I'm not sure what that would prove. On the other, it was my dislike for bench science (or rather, the crap career structure surrounding bench science) that led me to leave altogether ten or more years ago.

The clincher may be how much time I can spare. There's also a financial consideration of what is the best use of time plus the fact that I would like to use this highly unusual career break to see as much of my family as possible.

We'll see... perhaps the two small roles are fine as they stand.

Deja Ecoute

A Facebook friend was tagged in a photo last week, looking all proud in his A&E gear having spent his NYE rotation there. Thing is, he started med school 18 months after my first go in the UK and he now seems to be racing ahead which triggered a bit of (yay) reflection.

Some of the delay in my training is clearly my fault for messing around changing countries after my first year, deferring my Australian start date due to commitments made prior to receiving the offer etc. However, some of it is due to the structure of this course, which is beginning to get me down a tad.

On this course, the first two years are combined which means that, save for some exams and, of course, the actual content, the second year is largely a carbon copy of the first. Although it's nice to be in a routine, it's taking all of my gumption to maintain a high level of enthusiasm for undertaking ten or so more reflective paragraphs, five more examinations with the same format, working in groups doing largely interchangeable tasks with the same people, etc.

I'm not looking for endless variety, but this next year is going to lack the novelty of the last which probably was last year's saving grace given the other hassles associated. On the other hand, there is a degree of comfort to be gained from not having to go through all the same crap with a new bunch of people, explaining why I'm so old etc.

So perhaps, on balance, yr 2 will be less uncomfortable than yr 1.

Changing views

Worryingly, and from what I can see, typically for a med student, I'm having people asking my opinion on medical matters a task for which I am singly not qualified and tell them so, pointing them in the direction of Wikipedia (joke). Here are some of the complaints I've had to avoid professing an opinion on so far other than go to the doc's ASAP (there are more but I forget):

- Any number of rashes. Nowhere embarrassing yet, though.
- Whether a US based relative should ditch his expensive heart pills and buy some generics. Different formulations, not quite the bioequivalent formulation. Crikey - it's your heart for God's sake, why are you cutting costs there! Buy one fewer watches or go skiing less or something.
- Chest pains (chest pains!).
- Rectal bleeding (proper blood in the water, not the tissue) lasting for a couple of years (years!). I did have a clear recommendation this time: get to the bloody doctor; why are you sat here in a pub quiz night when you could be having this problem looked at?!
- Something that looked like a BCC.

Some if not all of these could well be serious - go to the GP if you have these problems rather than relying on some part qualified idiot like me. Goes to show, perhaps, the importance of trust between the advisor and advisee in a clinical relationship I suppose.

Sad and obsessive behaviour

I must admit to being a bit of a Joy Division tragic. Although I was very young when they turned into New Order, the re-release of their albums in the late 80s found me at an impressionable age and an indie kid to boot. The only JD you would hear typically came at an "alternative" dance night when you'd badgered the DJ for hours to put some on then yo'd be treated to Love Will Tear Us Apart... and a largely empty dance floor.

The sad and frustrating story of the lead singer Ian Curtis' suicide is part of popular culture now having been turned into a film on at least two occasions quite recently (C0ntrol, 24 Hour Party People) but when I started listening to JD it was all very confusing adding to the mystique of the band (give me a break, I was an adolescent...) Living within driving distance of Manchester meant that I could head over to visit the town regularly which cemented a love of the city's music that began with the Smiths and continues to this day. It was an odd experience to walk through Afleck's Palace, loading up with JD posters and a copy of the Komakino flexi disc to take off to college and stick on the walls (the posters, not the disc) . Felt like proximity to the band. Hard to explain but strongly remembered times for me. Probably due to me being 17.

Anyway, this Christmas I received a copy of Who Killed Martin Hannett? , a painfully complete description of the relationship between the man who produced their albums and the band seen by his "best friend" (it says here). The full story of Martin Hannett would take a book to go through (as you can see from the fact that someone has written one) but suffice to say he was credited with the band developing a unique sound, of being a control freak / perfectionist and being increasingly fond of heroin as the albums progressed. Martin H died in 1991 and his story reads like Wired, the John Belushi biography where, even if you didn't know the Belushi story and question the veracity of Woodward's account, you just know the guy has to die soon the way he's going on. I had the same vibe about the author of the Hannett book whilst reading it... imagine my lack of surprise when I found that he had passed away in September last year, poor guy.

Leaving this ghoulish aspect of the Factory story, this brings me to the album of Martin Hannett's Personal Mixes, the cover of which is at the top of this piece. Browsing through a vinyl shop in the CBD, I came this vinyl (mmm... 180g) and having heard about it elsewhere, I laid out the frankly painful $39.98 to buy it. The music here falls into three categories: different mixes, some sound effect recordings (interesting.... having heard them so often as part of a JD song) and a couple of interview snatches (not worth discussing). This album has had mixed reviews, but for a sad man like me it's been an insight.

Basically, it looks like Hannett's reputation for a love of delay and treble is well founded. What is more surprising is the amount of bass that is in the front of the mix. Almost capable of causing nausea. The top end hiss on the recordings of Autosuggestion plays from left to right and causes more disorientation. Two of my favorite tracks on Closer, The Eternal and Decades (which I used to listen to so much as a teenager it still causes my father conniptions) are provided in mixes which only show their differences if you've heard them a thousand times before. The sounds seems comprised of only top and bottom end (bass drum and snare, bass guitar and strange trebly jangling guitar parts) which may have been the idea: to let the singer's voice stand alone in the middle ground with only the sibilants venturng out of this territory.

At the end of side four comes a probably intentional piece of iconoclasm added to provide some contrast: someone telling Ian Curtis to "F*ck off".

Summer is a bummer

Halfway through the summer break here. I have to say, I wasn't looking forward to it a much as my younger colleagues were. I can't help but see these two big breaks in the first two years as being two three month delays in getting through the course. Due to having Christmas away from home, it's tricky to get a chunk of work during this time too so probably the best thing to do is to sort out the odd jobs around the house.

Not sure I have six more weeks of them left in me, though.

Big return

Things that stopped my blogging:

- having to find a relevant image to illustrate a posting
- excessive quality control re referencing my posts
- general busyness

Well, I can rectify the first two and we'll see how the third goes.