Drs are anonymous, trying not to be is a dangerous potato

~~ This was meant to be a response to Dr Cunningham’s post on the GMC social media guidance: I’m also cramming for finals so its not a complete view yet. ~~

The GMC have issued guidance on social media, it has got some people upset, particularly 17, which has changed between draft and final guidance, below.

Final
17  If you identify yourself as a doctor in publicly accessible social media, you should also identify
yourself by name.Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.
18  You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.

Draft
17 If you are writing in a professional capacity, you should usually identify yourself. Any material written by authors who represent themselves as doctors are likely to be taken on trust and/or to represent the views of the profession more widely. You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.

I think the change between the draft and final guidance is the correct one, to identify as a doctor online is to be doing so in a professional capacity. The only reason to identify as a doctor in a public space is to use that aspect somehow, whether to network and discuss with other medical professionals or to use it to give weight to what you’re saying. To overtly identify as one on a personal account doesn’t make sense to me, its either a type of boast post to your readers/followers who will either know that already (people you know privately) or not care (people reading for other reasons). A personal account cannot be as much if you identify yourself as a doctor, you are then expressing opinions in a professional capacity By identifying as a doctor, all the responsibilities of a doctor in a clinical setting come with it, its as if you are sitting in the hospital canteen with a stethoscope around your neck.

 So, who’s ready for anecdotes?

 3 years ago, at the height of my political career, I was running for local authority council, I had badge saying vote for me and everything. I was also a 3rd year medical student, on placement at a hospital within the local authority boundaries, I had a tutorial with a consultant and was told to take off the small pin badge. The consultant made a good point that you can’t have patients seeing you with overt political opinions, theirs might be different, even polar opposites and a part of the relationship would be ruined right from the beginning.

 Society’s image of the doctor, while esteemed, is essentially inhuman: an anonymous cog of the healthcare system. Impartial, non-judgemental, fresh, skilled and unaffected by their surroundings: they deliver care. Any deviance from this in the public domain risks undermining the perception and interaction between the public and doctors.

 This is not to say that doctors should make their profession their life, more that when the profession’s mask (or shall we say stethoscope around the neck) is on, the personal cannot exist, to do so would be an affront to some, if not all, patients.

 Using social media to public debate with others (and by its very nature allow lay people to be witness) is very beneficial, but while differing opinions within the profession can exist because they are still bounded by this professional sphere. However, being professional opinions the speakers must be held accountable for that they say, the easiest way of this to encourage real name use, as while we would hope that all discourse would be constructive there is a real risk the reputation of the profession could be damaged by some.

Some have said they feel they wouldn’t be able to state they had a bad day as a doctor without putting their name, I think is is entirely appropriate for a public forum. The natural response would be for people to enquire as to why, which would fall down to either bad experiences with colleagues, patients or something personal. The first two are entirely inappropriate to be discussed in public in such a way, the latter distorts society’s view of the doctor and damages this notion of what the doctor is.

 My father, a barrister, gave me two pieces of advice before starting medical school, the first “don’t piss off anyone on your course or in hospitals, you never know when they might be interviewing you in the future” and the second “never write anything down you wouldn’t want to be seen by a judge”.

 There seems to be a misconception that somehow social media is not proper public forum, or that it is possible to remain anonymous within a public forum. I have taken part repeatedly in the World Naked Bike Ride (one of the best experiences by the way), the first times I didn’t tell my parents who I normally wouldn’t balk at informing of me demonstrating, celebrating or protesting. The slight embarrassment of explaining myself put me off, while neither of them check my online profiles, this got back to them after a few years, it made for an awkward conversation but I won them around to how it didn’t matter who knew I went on the ride, as I feel I can justify my behaviour to my peers. If you believe in something strong enough to say it, stand up and say it, the profession and public will judge its appropriateness and if you’re not willing to have it read in court you probably should step away from the keyboard.

 I’ve already altered my tweeting behaviour since Dr Cunningham and others retweeted a blog I wrote about lecturers at my university and follow me. Not only do I wonder “what will they think if they see this” but also “what will their followers think if they RT”, I see a former supervisor follows her, someone I might want to have a reference from, this makes me think twice when I tweet personal experiences of my university experience. This is a form of self regulation enforced by the profession already, and by reducing the use of pseudonyms encourages accountability and reflection of what you are saying before posting. Consider any twitter spat between MPs to see that while this is not a guarantee of good behaviour, I think it would be well to tamper people into being more constructive.

I do believe you can be a doctor on twitter, not identify as such and follow the guidance, even if you are identified as one by readers, so long as its not a central focus of the persona on the social media. All those identifying as doctors, however, I feel are rightfully going to be limited to interprofessional debate and benal small talk about the weather. Much like it is in the concourses of the hospitals.  

 If you want to tweet in a personal and professional capacity, the adoption of twitter apps allowing for multiple accounts exist and will be beneficial; but unless the profession redefines itself anonymity is unsuitable and impossible. To set about this new image of the doctor will be easy, write it down, publish it, be judged by your peers and the public, it is they who decide if it’s appropriate or not.

 Much of the above relies on the continuation of current standing of the doctor, which while I might want to change, I’m not sure is possible given such prescriptive choice of healthcare patients have (being almost entirely geographically based). Should the profession collectively decide to come out, I still believe one should have the strength to put a name to a view and either accept or challenge the consequences.

Come August I’ll keep tweeting about my bowel habits, I’ll probably create an account for use in a professional capacity and use an app to manage the two. But if there was something I believed that both Mr Gibbons and Dr Gibbons should be saying, I’ll pick up my badge from 3 years ago, and engage my peers and patients.

 

 

Boycott finals revision courses

Having passed my resit and got my demotivational e-mail of where I rank in the year (350/377 since you ask, big up the tenth decile massive), I feel relieved to be able to say I’m a final year medical student without my heart sinking. My first act as final year student was to attend a small talk on the preparations for finals. Exams which seem to be disproportionately taken seriously, unless I missed a memo, these wont decide where your first jobs are, those being decided by 3rd and 5th year exams, and even failing them has less of an impact now the exam is earlier, allowing for resits before the time of jobs starting. Yet, six months before they are held, you can already smell the whiff of competitive panic, not that people are worried about how much they know, but how much others are preparing. Tutorial groups are forming, evening lecture series are being held, books bought and revision courses sold.

I’m opposed to these revision courses, in general and one more than the rest, and I speak only of my knowledge at Imperial, though no doubt the same occurs at every medical school. They come in two flavours, medicine and surgery, and are delivered by doctors and surgeons who invariably have teaching positions at the medical schools of the students they are charging for extra tuition.

Cost
The courses range in price, from some sounding fairly reasonable (£5) to others being prohibitively expensive. There is one above £200 (even with discount) and others in the mid 100 and others at the £50 mark. Some people don’t have this money to spare, especially as few of the courses cover more than one big subject (ie, medicine vs surgery) so there’s a good chance people will buy multiple courses. Some seem happy to give money for every course, to make sure they don’t miss any nugget of advice an individual might impart. I know some see it as an investment into their future career, that this amasses to less than a month’s future salary and if of use, a benefit to buy. Which is nice, the people who say this are seem lucky enough not to have rent problems (live at home or own their own house), but most people laying out £200+ for a course is not possible. If I were to go on one of these I’d probably have to ask my parents for the money, which is still a fairly privileged position to be in, and one not one open to most. This reinforces an unacceptable plutocracy that remains in medicine. While finals has relatively less impact on first job applications, if these courses are of use, they consolidate and hone knowledge within those who can afford it, at the expense of those who cannot.

In previous years, the exam results have “counted” for relatively more, I’m sure there are some prizes, merits and distinctions to play for, yet have not had these revision courses. So why the sudden urge to give people who should teach you anyway money to do so in your spare time?

Peer pressure
The myth of finals being more important than they feel, previous years and the fear that you’re going to miss out some nuggets of information, exam secrets (some are rumoured to tell attendees what’s in the exam) and everyone around you justifying the expense leads to a perfect storm of peer pressure. Most people seem aware of the massive peer pressure effect, but still feel unable to not go on them, because of the fear. Every year this seems to happen, as the courses are run by the same people year on year, and apparently always a scramble to get tickets, yet talking to junior doctors who have been on them and those who have not (who, incidently still passed) tells a worrying story.

They’re apparently shit
Previous years are even more frank about the peer pressure effect, but with the added hindsight of having attended the courses to tell people what they have experienced. I’ve yet to meet any one who has attended them and found them to be crucial to their year, some of the more expensive ones are derided for their poor teaching style and that their only use is for the handouts (available as hand me downs or for a tenth of the price) as the lecturers don’t stray from the slides or generally wax lyrical about themselves in some sort of ego masturbation to a paying audience. Some are even described as only being tangentially relevant to the finals. Considering I have a very poor link to other people in medicine, I can’t believe those paying for them haven’t heard the unanimous inditement of the courses.

Lack of incentive to teach
I’ve been taught by some of those giving these courses, some are excellent teachers. Others take time out of the lecture to explain how failing one exam is a very good predictor of failing another, to an audience with people who had recently failed exams. Styles aside, I struggle to find it acceptable to charge for extra tuition that should be there already. The myth of the courses implies to not attend is to fail, implying that the university doesn’t teach the syllabus, despite the lecturers giving the revision courses. Allowing this, I can’t help but feel that the quality of education of those unable to attend suffers. Either the revision courses are very important to final year exams, and therefore highlights a dire lack of teaching within the university such that a revision course is deemed necessary to get enough knowledge, or its totally superfluous and these doctors are taking advantage of the fear and peer effect for financial gain, which is also unacceptable. I fear that these teachers lack incentive to teach as much and well to the general student population, when they will get paid to do so better by the few.

Barry Paraskeva’s
Beyond my standard issues with the revision courses, the MDU course delivered by Mr Paraskeva for £200 is the one I can’t understand is allowed to continue. By far the most expensive, and hyped (despite the most useful information on the handouts) is held at a different university, yet it draws a huge Imperial following. Paraskeva doesn’t just examine during Imperial’s Finals, nor is he a well known lecturer in the school, or hold head of teaching position, he writes and sets the exams. Then charges £200 to the lucky few who can get a place. I am fundamentally opposed to his course, its exclusivity from someone with so much knowledge of the exam is unacceptable. I’m sure it must have been cleared by ethics committees, to not have done so would be even more galling, but I would like to see their rational, and that it’s offered at another university is not acceptable, because it is primarily attended by the soon to be examinees and unsurprisingly so.

The frightening aspect of the courses is how mandatory they are hyped to be, which represents a failing of the medical school to teach properly. In which case the best way to change the status quo, rather than continue to pay would be a mass boycott of the courses, to force the teaching to improve. While I still pay the relative modest fees, I resent the implication that I need to pay further to get appropriate education, and I fear that unless something is done, those paying the much higher fees will end up in the same position.

Garmin eTrex Vista HCX, micro sd, img and open cycle maps.

I done bought a gps navigator type thing, to geocache on my commute and when I’m sent to the sticks, and more importantly to not get lost on long bike rides. In particular, long bike rides at night with very few other people. The prospect of getting lost at 3am in Suffolk and needing to use a map is not entirely appealing, mainly the 3am part. So I treated myself on recommendation to a Garmin eTrex Vista HCX, and then wanted to put open cycle maps on it, for cheapness and convenience.

Problems on the way: the UK based site seems to want to sell downloads of the map. Its freely available as an img file and for adding to garmin mapsource (weirdly, being open source) from the here.

I then foolishly wrote it to an SD card instead of copying it across, mainly because my only experience with img files is putting operating systems onto sd cards for a raspberry pi. But you can just copy it across. If you do, put it in a folder “Garmin” then it’ll be read, and this bits important apparently. A lot of forum posts say to keep the title as it is, but this led to the vista recognising there being map files on the sd card but not allowing them to be selected. Change the name form “gmapsupp” to anything else, and hey presto working. Oh, and should you be using something without a cd rom drive, download basecamp from garmin, then update it with mapsource and bingo.

Birmingham referendum

Other than the niggling feeling that elections were coming up and worrying about Liam Burns throwing his hat into the ring for Labour candidate before the referendum has been decided, the only opinions I have on directly elected mayors is based on my experiences in London. Which are post-mayor, and I’ve become more interested in incumbents and candidates than whether an elected mayor is a good thing. I feel myself leaning to approving of them in London as an over arching figure over the many boroughs but there are many aspects I’ve come to hate about the position and the assembly (ignoring assembly members votes and assembly members walking out over petty name calling).

Being not in Birmingham that often lately, both campaigns have passed me by, as they have most other voters as a BBC WM poll showed 59% of people were unaware of the referendum, and even cursory searching found little especially for the No camp. Today’s Guardian has an article critiquing the assumption that elected mayors are a given, and other than the reminder of the farce occurring in Doncaster and pitiful representation of women and minority groups on candidate lists thankfully linked me to the No campaign for Birmingham.

Having just come out from student Union elections with pretty badly designed websites, I am pretty appalled at the quality of the No campaign’s one. It reminds me of a website I used to find out more about a 40 year old bicycle frame, other than the aesthetics the navigation is faff and not at all appealing. However, you can’t help but notice the no ‘manifesto’ has been stretched to 10 points and most of it is waffle and some perplexing to read (I’ll come back to these points). To contrast this is a much nicer looking on, which apologies to Alex (but congratulations on winning) is much nicer and easier to navigate student union website.
The Yes group have a nicer website and clicking to their “why” section you are greeted by eight points of inconsequential platitudes that don’t really stress why at all you should vote yes. They have a facebook group with a 140 likes and some folk on twitter reacting to comments, but so far neither group appear to be mounting any attempt at courting voters one way of the other. The Yes group appear confident of their success that they now moving on to husting-esque style debates to decide what a mayor should be like rather than whether one should be present in Birmingham.

Reasons to vote Yes: (Italics them)

Yes to Democracy: You can directly elect your leader and if they fail, you can get rid of them at the next election.
Currently leaders of the council are selected by councillors who are voted in and who require broad support from their peers, and can be got rid of.

Yes to visibility:You will know who your mayor is and the rest of the world will too.
You should know who your councillors and leaders are, an elected mayor for the sake of a figurehead is weird.

Yes to change: Birmingham is struggling and a leader with a genuine mandate can drive positive change.
Annoyingly neither Yes or No website stated what voting system will be used should the referendum pass but I guess it’ll be the supplementary vote which while not FPTP isn’t true PR. A genuine mandate, dear lord, I wish that was the case, but a November election for a mayor would probably have a very low turn out (even London mayoral and assembly elections have less than 50% turnout, essentially making the Mayor having barely 20% of votes) and to imply someone would have a genuine mandate when the majority of people would have voted for them or not voted at all is almost certainly not got going to happen.

Yes to transparency: You’ll be able to see how decisions are made and who makes them.
No change here really.

Yes to local decisions: A mayor can make sure decisions are made closer to you and your community.
As opposed to councillors who will have a much lower ratio of voters to representatives and a slightly greater chance of being from a political party you approve of?

Yes to less beauracracy:A whole layer of unaccountable government bureaucracy can be removed by combining the Leader of the council and the Chief Executive.
Fair enough, we’ve got point to make half way through.

Yes to Birmingham: The mayor can celebrate our successes and bring people together to solve problems by being a recognisable leader.
Again, suggesting a mayor for the city to rally around as a figurehead, more a critique of current situation.

Yes to success: A directly elected mayor can help Birmingham fulfil it’s potential. Nearly every major city in the world has a directly elected mayor. Birmingham deserves one too.
How this will happen is not at all clear to me.

So voting Yes seems to be “Let’s have one person we can call our own and be a vocal, in the media spokesman for Birmingham”, experience of London’s cult of personalities really does not make me desire this.

Now the No arguments (linked to because why more text)

One person cannot listen to a million
This is a pretty good point, in terms of representation mayors are pretty poor, as mentioned above they will be elected on very low numbers of support
It will cost more in hard times 
I hate critques of the cost referenda and elections as I tend to think more of them the better, and the mayoral salary might be obscene or not, but chief execs are often paid a lot to be “competitive”, I believe running for mayor for the salary is a bad way to go so feel this probably wont be the case.
It is not within the british tradition
Uggghhhhhhhhh what? 
It leads to corruption
Ugggghhhhhhh what?
It takes attention off important issues and concentrates on personalities
Big fear of this, and with the likes of Liam Burns I would really fear the spread of personality contests or small “big statement” parties crowding in like Doncaster.
Birmingham’s villages will be ignored with concentration on the City Centre
Hard to see how this would be different than councils.
The mayor is likely to spend a lot of time travelling outside Birmingham and less time in Birmingham
Oh councils are famous for their needless excursions here and there but the reinforcement of the mayor as celebrity spokesman rather than legislator is valid.
The pro campaign cannot explain how it will improve things
Very true.
People normally vote against it and Stoke got rid of one
Not a reason, mentioned Doncaster but doesn’t explain the gerrymandering and collapse of local government there since the English Democrat came to power.
Birmingham’s successes in the past came without a directly elected Mayor
This section literally makes no sense and could be used as a good argument for Birmingham removing the right to vote from most of the electorate, “Birmingham was good back in the day, why change anything”.

Overall I feel that they at least put forward some arguments against it although gloss over the major issues with elected mayors and elsewhere and how it will probably not lead to better representation within Birmingham

Its hard to see how an elected mayor could have stopped or mitigated the economic problems undergone and continuing within Birmingham, and on their arguments I feel the No vote come out in front. However, most people wont be able to get to them and would be excused of thinking they stumbled into a late 90s site.

As I mentioned above the Yes have a minor online presence and seem to be excusing their lack of concise reasons to the small campaign, and the total lack of No presence is worrying that it will be a bit of Yes-wash for people seeking more information. Furthermore there is a real risk of most people just knowing what the arguments are.

I have a real fear that a low turn out referendum will lead to a cycle of low majority leaders who will be vacuous waste of space and no one seems to be bothered to try and campaign on way of the other. While I’m veering very much to voting against it, I am still very much within the undecided camp but the Yes group are going to need to actually try some convincing… And for the love of god make the websites nicer and be more audacious than £10k campaigns, the Yes campaign seem to think that they can lead to a less partisan politic in Birmingham but living in London makes this claim laughable.

Opening urls in python makes baby jesus cry

A thing I’m doing involved a lot of finding websites on search engines and looking at them for some things that are fairly dull, to make the process a little easier and less infuriating I used seoquake to get a polite looking csv file list of the urls to look at again later after all the searches complete. As I am currently looking at playing with csvs and manipulating them I wondered if I could get something to open the links without copy and pasting.

So, having difficulties understanding what format python reads csvs in I moved to attempting lists and dictionaries and getting no where particularly interesting, I tried double ended queue as I understood it as having the potential to recall rows one at a time. Errors abound I got to this, I got to a point of understanding that d[0] printed the last row, rejoicing I tried a script to open it a tab of a browser.

This was the script:

import webbrowser
derp = csv.reader(open(“derp.csv”, ‘rb’), delimiter=” “, quotechar=”|”)
for row in derp:

d = deque(row)

webbrowser.open_new_tab(d[0])

With great joy I saw “true” print in the python shell thing, and then another, and another and with horror realised it was attempting to open all 170 entries. I wandered away to allow chrome to have its merry way with error messages and was wondering if anyone could shed some light as to what happened.

“This seems like a complete waste of time” weeeeeeeeeeeeeeerll, probably not as much as it sounds as I just copied to clipboard the csv without trudging through the searches then used excel to remove duplicates without having to look up to see if I’d already gone to that website.

A shroud of darkness.

The first time I came into what was to be my room I looked into the eyes of the estate agent and asked “looks like the landlord needs to put the curtains up in this room”, about a month later I moved in and rang the landlord to enquire when would curtains or blinds be put up. He said a few days time. Peeved I erected a shower curtain rail and draped a blanket over it.

When the blinds came, at first I was happy to have something blocking the outside world a little better than my makeshift shield that was prone to falling down and a bitch to put up. The first night I came to remember most landlords have never slept in a room they are letting. Because if they did, they would realise most blinds are totally unfit for blocking out light. My room is a third floor extension in a block of mainly 2 floor houses, and while backwards facing the street lights are at the perfect light to shine over the houses to the back and into my room. Every room I’ve lived in in London has had serious light pollution problems and it upsets me so and stops me sleeping. At first I kept putting the blanket up to block out most of the light, but it was still a bitch to put up, even after buying more velcro to make it easier.

While I’m quite fond of the blanket, its not the prettiest curtain material.

The blinds were also too big for my window, so when pulled up took up a large part of the window space. In essence, during the day I had the amount of window space reduced, and during the night too much fucking light. As you can see below, you can definitely see outside with positioned to be ‘closed’.

A few years ago my mum bought me a sewing machine, it lay gathering dust in Birmingham and having brought it down recently, I only just started using it. Youtube has successfully taught me to sew, I say successfully, as I’ve made a christmas present and now some curtains. Blackout material on one side and blue and white gingham on the other, hung up by the faithful shower curtain rail (with a fixture from the blind for added support).

So far it looks nicer, better insulation and looks like a better light blocker, although I might have to sew the “hooks” again lower down bringing the curtain higher up.

Only slightly wish I’d gone looking for some more imaginative fabric, although the gingham was cheap bringing the cost of the whole thing to roughly £25.

Sweet jesus its working.

I don’t pretend to know what I’m doing with this whole arduino project, I have a rough idea of what I want it to be and going along there. Having not done any electronics since… year 9? I must say its all a bit sketchy on even the most basic stuff so I was a bit perplexed about why the data logger stopped working the other day. I say stopped working, it was fine when attached via USB and making files and logging data happily. Apparently 9v batteries are not as good as 4AAs and while the board was getting power there wasn’t enough for all the other things. But now we know, I also got the sketch to use some LEDs should errors be occurring so in future I hope to avoid going on a long ride and finding I have no data.

Also, the gps module arrived, for a while it was saying I was located somewhere outside the M25 but after changing the battery I went for a walk (convoluted one) to the shops and it worked fine.

There are a few issues regarding the sketch only logging rtc (bit redundant now there’s gps) and distance once then logging GPS a lot, but in serial monitor that’s not a problem so I’m guessing that just a sketch issue and I doubt I need to know the location every second but would like distance from hard things much more frequently. Which again is a sketch issue.

And then we cycle away and see what happens…