#askdx

[dxmedstudent]

Hi dx- I don't know when you will see this but I have my OSCE resit in 3 days. I am feeling deflated and burnt out, and believe my performance last week was affected by a lot of nerves. I panicked, stumbled and messed up. These are my finals and so I basically need to know everything and anything but now that I've failed, my imposter syndrome has really kicked in and I just know I'll be even more nervous. Do you have any tips directly for the OSCE itself... How do I remain calm when I'm there. What do I say to myself. It doesn't hellp that the patient's and examiners always seem so deadpan.

Hey, I'm so sorry that your first exam didn't go well. Nerves are real, they can be an absolute nightmare, and they don't define who you are, or how good you are. In an exam like this, it's very easy for us to stumble a bit and for our minds to go blank. This doesn't make you a bad clinician, and lots of people fail an exam or two! You have every right to be there, and you have EVERY right to pass the exam. You're not an imposter, you're just another student who doesn't love exams - and many people who have struggled and passed felt exactly the same as you. Probably most of the doctors you've shadowed or even admired have been in your shoes and felt the same. I know that I have! I don't know if it's happened yet, I check my messages reasonably often, but time is weird. On the chance that you see this before your exams, I'd say this:

Take your time. Take a moment to breathe before you do anything. Take a moment to read the brief, and then read it again. Before you speak, take a moment to gather your thoughts. If you are stuck in the middle of something, it's OK to simply say that you need a second, and then move on. It's fine to say "OK, let me just take a second to make sure I haven't missed anything". And then take that minute. Or to summarise what you've done/learned so far. You don't' get marked down for repeating something twice, you get marked down for forgetting it altogether. I hate that examiners seem so deadpan, too. But they ARE human, underneath that. They've all likely been there themselves! Just remember that they've had a long day, they are probably tired, and if they seem a bit bored, it really isn't you! There's nothing you could do to make the process thrilling for them - you just need to make it easy for them to tick things off their sheet.

Good luck! I hope that you give it your best shot, and I hope you can believe in yourself. I know medblr will be rooting for you!

[wetchickenbreast]

you seem like a very happy drunk!

you know whar casasie o i appriciate ythat so muchn you are like a brother tp me

[dxmedstudent]

Hey dx. Seeking comfort. I'm a final year medical student and a few days ago my dad needed to be hospitalised for what was a bleed on the brain (I believe a subdural). I was very panicked and emotional speaking to the neurosurgeon and never told him I was a final year but felt reassured speaking to him. He explained the bleeding was on the brain and not in, and they'll drain the excess fluid because his ICP is rising. Those were words that provided reassurance but I spoke to my cousin who's a doctor and have just realised I didn't ask anything relevant or important... I feel so stupid and embarrassed that I'm in my final year and I couldn't even ask what sort of bleed it was or anything relevant... I don't even know what's going on and I'm embarrassed to even speak to my cousin. I don't even want to seek comfort because everyone will just think I'm stupid. It's such a stupid thing to be upset about but I can't help but feel guilty and embarrassed about all of this, that my dad is hospitalised and I can't even tell people what's going on. How am I supposed to be a doctor when I can't even help my own father. I just feel so exhausted and drained and I am starting a new placement today which my dad really wanted me to go to so I'm not even near him. I feel so guilty I just wish I was smarter and a better daughter. I know he doesn't care but my cousin asking me so many questions and I can't answer anything and I know she's probably so confused as to how I'm in my final year.

I'm sorry to be answering these out of order. I actually had an answer penned for this, and I'm sorry it disappeared - I honestly thought it had been posted! I'm sorry my reply is late, and couldn't help you when you felt down. But I'm glad your dad is doing much better now. Nevertheless, it's HARD to be us when someone close to us is sick. It's hard to be two things at once - both a loved one and a doctor. I really wouldn't beat yourself up about not being able to remember all the things you wanted to ask, that's an extremely normal reaction when you're put in a stressful situation in which a scary diagnosis and lots of information is given. It happens to most patients and family members, even fi they are medical staff. We're trained to understand medicine, and to react quickly and decisively in life and death situations, but it's still completely different when it's our loved ones - and that's why we're not allowed to go operating on our mum, or treating our husband's cancer or treat ourselves. I have to admit, there are times when I feel like a bad daughter, too. Like maybe I should keep a closer eye on my dad's HBA1c, or make sure my mum gets her moles checked. Maybe I check in with my relatives and their health problems more. When you care about people, you also run the risk of feeling like you have to take on worrying about them all, too. Ultimately, I've come to accept that whilst I can touch base, I can't micromanage everyone's health. That'd be a full time job in itself. But I think I know the feeling, and I know it's hard to deal with. I'm so sorry that you went through such a stressful situation, and that on top of that you felt guilty and bad for your response. It's up to the medical team to tell you the relevant information, but also to give you time for it to sink in if needed. And it's OK fi you couldn't think of questions or absorb it all at the time. I think you're a wonderful daughter, and I'd be proud of you. You went through a very stressful time doing the best that you could, and I'm sure he's really proud of you. We're usually our worst critics. But I think you've done admirably. I'm really glad that you shared your story with me, and that your family is doing better.

[dxmedstudent]

hi dx-! How are you spending this weekend- anything you are looking forward this fine February? :)

Hey! I've had a bit of a cold so I've been trying to take it fairly easy. I've been watching Dx Dude play God of War whilst we mused over menu choices for the wedding and make sure there are enough vegan (and kosher/halal friendly) choices. I should be picking one of the hair and makeup artists I contacted for availability, but it's hard to pick because they all seem fine, so I've put it off a little to mull it over. My dress arrived, and I had my first fitting this week! I'm just glad that I managed to fit in it! It's going to need a few alterations - like a bustle and hemming, plus I'm adding a little bit of lace to the plunge neckline because otherwise I'd be showing an *obscene* amount of cleavage. I'll still be showing plenty of cleavage when it's done... but a less....distracting amount XDI'm pretty happy with my dress, it's got the flowery, ethereal vibes I wanted, AND it was an affordable price (I even got it at like 20% off as the boutique were having a sale). There are some very beautiful dresses out there, but most of them cost like 2 or 3 times the price of my dress, or more. That said, I've had to accept that I may need a dress for later in the evening if much dancing is to ensue. We got our engagment photos back - and they were taken in the cold snap recently when everything was snowy! Absolutely coincidental timing, but it does make them look lovely, even if we are wrapped up very warm. I'm tempted to anonymise a couple and post them here. I did have a cancer scare recently, but it's all good news, in the end. It's not my first, and at this point I know the drill, but it's still an anxious couple of weeks until you find out if there's something serious to worry about. I tried to focus on the positives during that time, but I've not been online as much lately. We have lots of friend and family birthdays coming up this February so it's going to be fun and busy :) DxDude and I aren't massive Vday people, so if we do something it'll probably be just have a quiet dinner at home.

[dxmedstudent]

Not too sure if you will want to answer this but I saw you wrote you went to a London medical school- I just was curious where. I'm at a med school in London too! I'm currently applying for jobs and I've put EBH down first because I felt London will be a) too long to commute to and b) too brutal of a city to work in, I've heard it's v busy and not as social. Any thoughts on this having worked here for your F1/f2?

Hi, Yeah it used to be something I hid back when I was in med school/first started here, as it felt rather identifiable. Nowadays, where I went almost a decade ago doesn't feel quite so current! I went to Barts, but I had friends or family at all the London med schools at some point, so I feel like I have a good grasp of how they all are. I did FY in and out of London - most posts had one job inside and one on the outside. London CAN be brutal - I definitely have friends who hated working in some of the big centres. That said, I've known people to have great experiences in some of the London hospitals. I do think that people are more likely to live further away from work in London, and may be less social after work for distance reasons - whereas if you are all stuck in a little DGH in a small town with nothing else to do, you're much more likely to socialise with your FY group a lot, out of necessity. This might be less of an issue if you have a lot of friends (or family) in London and so have a ready made support group. My FY1 was in a london placement, but technically at a DGH outside of London, and I feel I personally benefited from that "we're all stuck in this place" cameraderie. That said, having worked at hospitals in the Southeast that aren't in London, I can say that you have busy, disorganised, understaffed hospitals everywhere, and you can be unlucky enough to have a horrible placement anywhere.

I find big hospitals can be very anonymous and impersonal, and often invest a lot less in their trainees - especially if they are popular due to research etc. Sometimes it can help to be part of a more specialised department that does its own thing (for example, when I worked in paeds or renal), because then your working life is more self-enclosed rather than dealing with the entire hospital. I've always preferred a small DGH - they can be busy, but if they are well run there is usually much more of a team feel, particularly in medicine where you spend most of your rotations. I feel that when evryone knows everyone, people are a lot less likely to be rude or unhelpful.

[dxmedstudent]

do you enjoy working? I'm feeling more and more Pessimistic about my job as a doctor (I'm a final year) and just seeing these strikes and people accepting they will leave the NHS/the country/the job... It's all starting to take a toll on me and I feel like idk what on earth I want to do if not medicine.

I do, probably most of the time. BUT it's not always easy. Sometimes I mentally take work home (tonight was one of those nights), and some days are just busier. Some days are more satisfying. And some days you do what you can to tide things over. You don't have to choose now - it's perfectly OK to try medicine and see how it suits you. Some kinds of chaos are the kind that we get used to, or even thrive in. There ARE people happy in medicine. I'm not saying people are happy with everything - pay is a real issue across the public sector (it'd be nice to y'know, not be earning like 30% less than we were several years ago, in real terms!), and work is stressful and understaffed. But there are good times, too. The relationships you can build with your colleagues, and your patients can be rewarding. We medics also like to complain- it's our way of de-stressing. Every guy I new at one point was talking about how their mates in consulting got a ton more $$$ nd how badly they wanted to jump ship but realistically if you don't want to put the work in medicine, you probably don't want to put the work into consulting. If you do, great - but I think sometimes some medics idealise other jobs. Other jobs have their own issues - even if they are less stressful or better paid, that doesn't mean your daily work life will be easy! That said, it's probably fair to say that for someone who is highly motivated (enough to be in medicine, at least), there ARE ways to earn more money, or have a better work-life balance. We COULD all find jobs that make life easier or pay more. But we need to put it in context - there are other options, but the grass isn't always greener. You don't have to know what you could do in the future right now - but you can always talk with friends and others and see what the other options are. It can be important to know you have a potential door out. If medicine gets to be too much, you're allowed to leave.

I give myself the luxury of knowing that I don't have to stay in medicine. Then I brush myself off, and get ready to do it again tomorrow.

[dxmedstudent]

How do you deal with like simulations- am in final year and we are getting them more regularly which is great because I know they are really useful. Thing is these situations really triggers the imposter syndrome in me and I despise it. I feel anxious about it from the day before, literally have palpitations and most of my simulations honestly go so badly like it knocks my confidence further. Luckily I feel like my doctors/nurses have always been kind to me but it almost feels like a pathetic- hey it's okay, you did your best, you will be fine sort of comfort. The sort of comforting you give a small child who you feel sorry for. I hate it, I never know how to prepare, I might as well end up being the patient because that's how stressed I get and it's so humiliating. It's made me so so nervous to become an F1 and being on call (and on nights). I have mine in 3 hours so will update you but eurghdufkjdhfgks I am so nervous dx!!

Simulations can be tough! They are meant to put you on the spot a little bit, to represent how you might respond to an emergency situaiton, with the aim of ironing out mistakes we don't realise we are making, so that when we ARE faced with a real serious situation, things go more smoothly. Now, I don't know about you, but I find myself feeling a LOT more self conscious in a simulation than I ever felt in a real cardiac arrest situation. There's something about being on show, to a crowd of people with clip boards ready to give feedback, that's more stressful than dealing with the dying! I know you'll be OK in FY1. You'll get there. It's a scary process but even as the FY1 on call, you're never alone. You have a team you can ask for support. And gradually you become more confident. Until you get to the point where you ARE the senior and your FY1s are asking you what to do! I think a lot of us have impostor syndrome in medicine - the standards are so high that none of us really feel we are reaching them. Hell, I have impostor syndrome. Some of the comments from the most toxic staff I've ever worked with are lying around in the back of my mind, making it hard for me to believe the many, many more people who thought I was doing a good job! I don't think your colleagues' words about you are meant to come off as patronising - I suspect that they genuinely want to reassure you that you'll reach the standard you are aspiring to! I think giving people encouragement can be hard because you don't know exactly what the best way may be to make it feel genuine for that person. I also think that perhaps they see a much younger themselves in you - when I deal with students or juniors, I see myself and how nervous I was, and how hard I wanted to work to be good. I suspect they jsut want to find a way to reassure you that if they got through it, they believe you will too. To answer your question, doing more sims makes it feel less pressured, bit by bit. Mostly, like you I feel nervous beforehand, because they very much feel like a test, and you're worried you're somehow going to do something very very stupid under the pressure. I'm gonna answer your update in a minute!

[dxmedstudent]

feeling really embarrassed dx- final year medical student. But I just have a rude consultant and although he is rude, and everyone knows it, he's also just right... I couldn't tell him what p pulmonale was and he asked me how I don't know this at final year. He expected a third year to know. Questioned me about my university which surprised him, as he said don't you take major exams in fourth year. I said yes. I just feel deflated and my imposter syndrome is just really being triggered. It's clear that I should not be here, and he's just confirmed it. He is right, I should know and I just couldn't tell him. Now I feel like I can't even function the anxiety is so bad have escaped the hospital and feeling sorry for myself in my bed.

I'm really sorry that your consultant was rude. Medicine is about learning a LOT of things. We all have gaps in our knowledge - literally nobody can know everything! Even that consultant, will, I promise you, have forgotten some embarrassingly basic facts about specialties that aren't their own. I can say that having rotated through working through most specialties at this point. The things cardiologists have asked me to query with other medics, let alone non-medics? Stunning, sometimes. We all have things to learn - and it's important to learn to grow the right attitude about it. We should focus on learning it and moving onto the next thing we don't know. Instead, experiences like this just encourage us to blame ourselves or not feel good enough. To be honest, I've never thought putting people on the spot is a good way to teach things - the pressure often makes people forget things thet DO know, and the real purpose of being a doctor isn't to regurgitate facts or put on a show of impressing your seniors or your peers. It's about having a good bedside manner, knowing the basics, knowing when you don't know, and where to get that information, and knowing when you need help. I don't think quizzing someone about their university or exams or why they don't know something after they got the question wrong is helpful, at all. It puts all the emphasis on blaming you, and in your memory, the experience is just going to make you feel bad about yourself - which achieves nothing. Quizzing you about your university was bitchy of him and kind of pointless. It doesn't matter WHY you're not sure of a particular fact right now, and hammering that in isn't constructive. In the time he was being petty, he could have explained the thing several times over. He should have turned it around as a chance to explain P mitrale in more detail - it would have reinforced everyone's learning, would have made it a memorable learning experience for you, and wouldn't have humiliated you at the bedside. A good teacher actually teaches. Fortunately, his kind are dying out. I don't think you did anything wrong - we all have things we don't know. Please don't let one bad teacher make you feel like you don't have a future in medicine.

[dxmedstudent]

Heya. It’s been over a year since I messaged you with the MRI/anxiety post. I thought I’d offer an update; we still have no idea what’s going wrong.

I ended up needing to leave med entirely because of the pain and brain fog. So far I have seen Neuro, Rheumatology, and my GP. As it stands we touch bases about every 2-3 weeks. The neurological issues I have don’t seem to be progressive but rather just something COVID-19 had dragged out. Furthermore the unbearable joint pain isn’t coming up as anything notable. I have been checked for all manner of arthritis and nothing is coming back along with a myriad of other diseases and disorders.

So yeah. I just thought of you and I know I thought of all the patients I worked with over my time in med. A sense of “oh thank goodness you are alive” is super nice to get every now and then. I’m alive and happy actually for what it’s worth…I’m optimistic. I really believe we will find what’s wrong. Even if if takes a while or I have to go about things differently I will be okay.

Hey, thanks for the update! I saw your message soon after you sent it - I hope you've been doing better recently. I'm glad that they haven't found anything bad at present and that it isn't progressive, but I'm really, really sorry to hear that your teams haven't gotten to the bottom of what is causing it. In itself, that can be an incredibly frustrating thing. Have they looked into hypermobility or rarer syndromes? I know it may take time to get to the bottom of it, but I'm glad that they are working with you to find the answer. I always love to hear how someone's doing! Genuinely, who doesn't occasionally wonder if that person is OK and if things are better? I'm glad you're happy and looking forward to the future.

I hope you have lots of things to look forward to, and I'll always be happy to hear from you if you have something to share, or need to get something off your mind!

[dxmedstudent]

Hey- this is an update from the OSCE retake anon. Thank you for your kind words, and I did see them before my exam. Unfortunately the exam did not go as well as I would have liked... The things I spent most time revising and covering didn't really come up and things such as clinical procedures which my university never normally does did. They were very very basic and not difficult at all (first year skills) but I could not do it properly and definitely failed them. I already know I failed 3 from how it went and that's cutting it close as it is... I just feel so deflated. I know this does not mean anything in the grand scheme, I know and have met brilliant doctors who have been forced to retake years. I know humility is important and I know this doesn't dictate my worth or ability to become a good doctor. But I am so tired and deflated, I try and try and keep failing. And I just want to enjoy the next few months, like the rest of my year group. Instead I will be forced to be one of the handful of people who will retake in April, which feels embarrassing. I feel people will judge me for it too, and assume me to be just slower/not good... I already do have a reputation for being a bit slow and awkward when in group settings/doing group sessions making it more 'oh yeah makes sense she's retaking'... Long rant and just can't stop cringing at the stations. The fact those were simple passes had I simply not overthoight but just done them and failed it...

Hey, friend. It's OK to feel deflated and upset. It's OK to feel like perhaps your choices of what to revise were unlucky, and to feel frustrated that all the stuff you DID revise didn't come up! I remember feeling exactly the same after some exams - it feels like such a waste! It's OK to feel upset that everyone else gets a break and you don't. I've only ever had to retake one exam - finals which was the Finals OSCE because of ONE station. I'd always sailed through OSCEs every year until then! I had one particularly nasty examiner who threatened to fail me for a station MID STATION like the asshole pulmonologist that he was - for standing too close to the patient's bed, of all things! I can't even remember if he failed me for that station, but he certainly left me shaken after that. In the grand scheme of things, nobody will remember or care who had to retake, or even resit a year - it's extremely common and it's just one more annoying thing you have to go through in university. On the positive side, you've got time to work on everything that can come up in an OSCE now. If you draw yourself up a list, you can practice every possible station until you feel that bit more confident. I find that the key to overthinking is to simply do something enough times to turn it into more of a routine, to the point where your brain no longer thinks it through! Easier said than done, I know. But it CAN be done.

I believe in you! This is just an annoying detour. Give yourself a little while to be annoyed, and then brush yourself off and start anew.

[dxmedstudent]

Had my Sims and it was alright- I feel very bad at taking good feedback because I don't believe it. I think I really want someone to look me in the eye, recognise how insecure/imposterey I feel and tell me I am literally fine and I think I really need validation to make me feel less like an imposter any positive feedback I get feels like a 'giving positive for the sake of giving positive'. I always overthink and always try to read people's minds into what they're thinking.

Ah, sometimes the good feedback can just be shocking! Do you have a supervisor or mentor to talk to? Because the most straightforward way for someone to recognise how impostory you feel would be for you to confide that to them. Would it help if I told you I also feel like an impostor sometimes? Sometimes a friend or colleague will say something nice, and my first throught is that somehow, the truth is going to come out and people will realise I'm just not a good doctor. REalistically, I accept I'm an OK doctor and do a reasonable job. And that's fine. I think medicine is tough because you spend your childhood and teens working hard to be the best, working hard in med school to meet incredibly hight standards. Then you start working, and, welll, it can be impossible to feel like you can excel.

Have you tried talking to your other medic friends? Because I doubt you are the only one feeling this way. Maybe we can get a medlbr discussion going! Which can be hard because in medicine you're drilled to act confidently, which TBH I think is sometimes a bit of a sham. I think sometimes we need to be able to admit we aren't sure. But if you're someone who isn't very assertive, you get told that you need to act much more so. Unfortunately, the bullheaded people who are overconfident (and wrong) aren't told to become less assertive, and tend to do quite well sometimes. I think we'd get better doctors if we valued being cautious or thoughtful more than being assertive. I think you're right that people want to give positive feedback - but I think a lot of that is because we want to think the best of people, and we want to encourage them. That doesn't mean that we lie to people, necessarily - people work hard to stick to what they think is true, most of the time. I think that a lot of people's thoughts, even about us, are really about them. Someone can see a student and think "that reminds me of Me/my friend at that age", or "I wish I knew this at their age" etc. Their thoughts might be rpetty influenced by how they usually interact with people like you, or other experiences they've had with students, or young people, or whatever. I wouldn't try to second guess what they really think of you because I think that a lot of it isn't really about you. And a lot of their thoughts don't matter. The more I accept that what most people think of me doesn't matter, the happier I am. Learning not to focus on what people think of you is useful as a doctor because sometimes consultations go well, and soemtimes they don't. Whilst it's good to try and reflect on what happened, how you build a rapport, how you address concerns, how you ensure patients feel listened to and respected, ultimately they still have a million things going on that have nothing to do with you, but that may be colouring the whole process. And the same thing is true of colleagues.

[dxmedstudent]

Hi dx- I'm the anon that told you about my dad and his bleed. I wanted to let you know he is recovering well. I've been busy this past month and am back on placements today which is nerve wracking. I feel like I've forgotten all of medicine but I'm going to be a doctor in around 7 months! Anyway, I don't know if you answered the anon (I don't think you did I went through your blog- but I hope I didn't miss it). I imagine you're busy right now, especially with wedding planning. Hope all is well.

Hey, yest I had forgotten that I hadn't replied! I do always read every message and think about what someone has shared. But quite often if I'm out and about I make a plan to get on my computer later and reply properly, and often forget that I didn't send a reply. Sorry :) I hope your dad is doing better now. How are you finding placements? I hope people have been supportive after everything that went on. Always remember that no matter how shaky you feel going back affter a difficult experience, you have as much right to be there as everyone else! Congrats on being almost a doctor! You can do it! I'm sure it'll come back to you. And having gone through both sides, you'll be well placed to understand patients and their relatives better than many who haven't experienced these kinds of things. Yeah, you're right that I don't have quite as much time to spend online lately. Planning and life are going OK - turns out theres's a lot more toing-and-froing and emailing back and forth than i expected, and everything in wedding land moves far slower than medicine land. Which is frustrating when you just want to book things and make things happen. But things are slowly moving forward :) I hope that despite the challenges you and your family have faced, you feel like life is moving forward, too.

[dxmedstudent]

Any advice for a final year med student taking up the F1 role a little earlier than anticipated ? P.S hope you’re keeping sane during self isolation :)

Hey, friend.Thank you. I’m feeling it a bit more today - I’m all aches and coughs, but it could be much worse. I’d be interested to know if we’re doing testing in my trust, but I suspect that despite all the drama on TV, testing healthcare workers hasn’t filtered down to the trusts, yet. Congratulations on finishing med school! I know it’s somewhat overshadowed by everything that’s going on, but it’s still a huge achievement. You’ll probably be hearing often that we’re in an unprecedented situation. I’m already sick of hearing it at work. But it’s true. However, some things remain. You’ll be working as part of a team- you’re the juniormost part of a group of people working together. Which means you should still have your SHOs and your registrars and your consultants to ask for advice. I suspect that teams will change - we’ve been threatened with that in my hospital. I myself was redeployed to the suspected COVID-19 ward as we had staff to spare (according to new minimum staffing), so it may well be that teams have to change quite a lot through this thing - at my hospital we already expect a lot of changes to rotas and being moved around at short notice. But in effect, it’s just like being oncall - you need to liaise with whoever your senior is to work out what you’re meant to be doing at that point in time. It may be clerking, it may be ward cover. The substance of medicine will be the same, and you’ve already been well prepared for that. There’s a lot we don’t know about COVID-19 so we’ll all be learning together. It’s OK if you feel unsure or a bit overwhelmed - starting as a new doctor is always a little chaotic. Much of my advice would be the same to FY1s regardless; look to your team. Ask for help early if you’re not sure. Check in on each other. Listen to your colleagues. Only now, I think it’s extra important to look after each other and ask for help. We’re all facing something none of us have done before, and that’s scary - hey, I’m scared, too. I’m worried we’ll be faced with more than we can cope with. But we can’t change the circumstances right now, we can only try to look after each other and do our best.  Stay safe, and do your best. Let me know how you get on!

[dxmedstudent]

Hello, I‘ve always wondered about medical confidentiality. I have two main questions: 1)when a minor teenager is diagnosed with an STD for example, and they ask the doctor not to tell the parents, what does the doctor, legally, have to do? Does he tell the parents or not? 2) when someone is diagnosed with aids and they ask for it to be kept confedential aka not tell their spouse, what does the doctor legally have to do? does the infected need to tell all of their sexual (even past) partners?

So a lot depends on the country - I can only speak for the UK, and the rules can change over time. If you asked someone from the US, you might get very different responses. In the UK, the age of consent is 16. A teenager doesn’t just ‘test positive’ for an STD, they have to go to a GP or GUM clinic for the test - that’s the time when the decision is made about their safety. This means that the doctor or nurse will talk to the teenager about sex - who they are having sex with, is it an abusive or inappropriate situation, what support they may need, and make a decision regarding whether they are vulnerable and need referring for safeguarding and social services which they may do if they feel the child is vulnerable, at risk of abuse or is actively being abused. A lot depends on the situation. In these situations parents may be informed as part of a wider action to protect the child. Now, there was a landmark test case in the UK that established that minors under 16 can be competent to make decisions regarding their sexual health. So it’s legally possible for a child under 16 to be deemed mature enough - though in practice few would find someone under 13 to be mature enough to make decisions about sex. If the child is considered Fraser competent, their parents do not need to be informed, as they are thought to be mature enough to make their own decisions. However, if they are not considered mature enough to make those decisions, their parents may need to be involved. So for example, I think most would be fine with a reasonably mature 15 year old with a 15 year old partner making their own decisions regarding sex, but not say a 12 year old with a 20 year old ‘boyfriend’ who gives them money for cigarettes.

If someone is diagnosed with HIV, in the UK we always encourage them to tell their sexual partner first and foremost. But we are legally allowed (and usually expected) to tell their partner if they do not. It’s not an easy situation, and we’d probably take legal counsel first. As things stand, people aren’t allowed to infect others willfully from a legal point of view. And having unprotected sex with someone when you know you have an uncontrolled communicable serious disease. There are laws in place for this in the UK, although they are not frequently evoked, people have been prosecuted in the past. From this British HIV Association leaflet: Usually this process is voluntary and the clinic will not breach your confidentiality without your consent.  But if you have a current or past sexual partner who is at risk of having or getting HIV and you refuse to consent to them being contacted, then the healthcare worker may decide to tell them anyway even if you don’t consent.  This is permitted under General Medical Council guidance.  They will first try to secure your agreement and will normally tell you if they decide to notify the person of the risk without your consent.

[dxmedstudent]

In your opinion, how would you rank med specialties in terms of surviving an apocalypse? (vector/spread/apocalyptic scenario of your choice)

That’s a funny question. I haven’t thought about it too much, but a quick attempt at such a list might look like: Cope well:

Ortopaedics: good with blunt objects and smashing things. You don’t need to knwo any medicine to fight a zombie apocalypse. They wouldn’t do so well in an infectious outbreak situation, though.

ID: hey, they rule infections with an iron well-gloved fist. Avoiding contamination is second nature to them; what they lack in real world experience they make up for in knowing germs.

Obs and Gynae: you’re gonna need someone who can deliver a baby without breaking a sweat. They have seen things... bloody things and they have no fear.

Radiogists will be locked away in their dark rooms. They won’t even know there’s an apocalyptic scenario happening. Not sure they’d care.

Paediatrics; used to avoiding getting bitten/fending off thrashing toddlers, and fighting off lots of germs brought in by kiddies.

Veterinary medicine. For similar reasons.

Sexual health/HIV: nothing is too gruesome. They understand infection and human behaviour like almost nobody else.

Cope OK

Pathologists: Locked away from clinical areas gives them a certain amount of safety.  Very likely to crack some important information that might help get a cure. They won’t even know there’s an apocalyptic scenario happening. But if they do autopsies, high risk of getting infected before they realise what’s happening.

ITU. Super good in the controlled environment of their ITU, and have lots of useful skills.  But psychologically would cope very badly with a zombie apocalypse. They might hold their nerve against a more ordinary pathogen, though.

Respiratory. They know germs, they could set you up with some NIV or some fancy masks if you need respiratory treatment or precautions.

Gastroenterology; they are used to body fluids, so not easily fazed.

Palliative care; beware those who deal with death every day.

Oncology; they deal in toxins, and treading the fine line between poisoning and keeping people alive. I am not sure if they’d be as useful with infections as with zombies, but they have no fear of death.

Rheumatology. They might diagnose a zombie with lupus, but they’d probably figure out how to handle it in the end.

Nephrologists; they are used to keeping people alive via machines and dealing with the consequences.

Cope badly:

Surgeons. Yes, they are good with sharp objects, but on a tiny, tiny scale. They like a controlled environment. Likely to confuse a zombie for an anaesthetist and start barking orders.

ENT: great skills on a tiny, tiny scale, but can you imagine placing an otoscope in a zombie? I think not. Might be handy if they can use it as a boomerang. 

Opthalmologists ditto.

Anaesthetics. Cool skills, and very useful in a pinch. But can they emotionally deal with the pressure of giving up sudoku and having to, you know, actually run around frantically doing things.

GPs: it’s not that they will cope badly. It’s that their patients bring in ALL the germs, even when they should probably be in hospital. So they’ll no doubt be the first to be infected when someone thinks that their GP can treat ebola with some lempsip and a sick note.

Cardiology. Is anyone having an MI or arrythmia? No. Oh well, too bad, because that’s about all they want to be dealing with. They might be much more useful in any scenario where delivering electric shocks to patients (or zombies) is useful.

Geriatricians: lovely people, but how will they cope with an outbreak killing like 90% of their patients?

Endocrinologists. I don’t know, I can’t see them having any special edge.

Feel free to add to the list :)

[dxmedstudent]

The ask meme: amber and lantern.

amber - share an unpopular opinion that you may have. I didn’t like the vagueness and arbitrariness of the lockdown relaxations the other day. Nobody NEEDS to travel to a park many miles away, or even half the country away. Nobody NEEDS endless exercise - not in a pandemic. Garden centres are nice, but frankly not that important. I resent that cleaners and nannies are allowed, but seeing your family or boyfriend isn’t. Or, I mean, you can techically travel as far as you like to exercise and are allowed to meet them in an outdoor space from 2m away.  I had a pretty depressing conversation with the boyfriend about how I could technically see him legally, but the rules would mean it’d require a lot of travel and effort  (out of my valuable free time) for a short time together - well not together, unless you count standing 2m apart to be together in which case you must be from an Austen novel. We decided it’d be best if we spent that time together virtually instead, until the rules would allow us to spend more time together meaningfully. I felt pretty guilty because of course if I *can* see him and want to, then I’d feel bad for not trying - whereas  he doesn’t want me to go to an excesive effort to visit him when I’m already tired and stressed as is. Not when we can continue to have fun via video chat and doing stuff together every day. I don’t see how we’ll keep people adequately socially distanced at work. I know that lots of people desperately need to work - but I worry that their sectors will still struggle. I worry about all the people with health conditions that will feel forced back into work. I’m glad the furlough scheme is extended til October - it’s going to take tiem for a lot of industries to bounce back, and it’d be really bad if lots of people were made redundant. we’ll really struggle if the economy grinds to a halt - there are so many people whose employment and living conditions are precarious, and who could end up jobless and homeless.

I think the UK’s lockdown restrictions being loosened is going to result in a second wave of infections - and maybe even more waves. I suspect our social distancingmeasures will need to continue for some time - months at the very least. I would much rather that we had caught this all early so that we had many less cases. Right now, I worry that people are going to take these rule relaxations as the chance to socialise much more freely, and that the freedoms we’ve been given aren’t the ones that matter the most - but we’ll still pay the price and probably get a new peak in deaths. The things that are allowed? Garden centres, travelling to national parks, nannies, cleaners? This definitely feels like the upper middle class politicians selecting things that they personally want and not considering that many of us live in different worlds. I’m certainly expecting to be busier in a few weeks’ time.

lantern - how did you meet your best friend? What were your first impressions of each other?

I’ve never had one best friend - not at primary school, not at secondary school, and certainly not afterwards. My oldest friend that I’m still in contact with is a girl I’ve known since primary school. When I was being bullied by the class as the new girl, she was the only one who still wanted to be friends with me. She’s moved abroad for work several times in our 20s and 30s so I can’t always see her often, but we’re still very much in touch and I see her whenever she’s in town. My sister’s the person who’s known me the longest and who probably knows the most about the convoluted workings of my mind. I met her when I was little - she startled me because I was not prepared for how pink and wrinkly little babies were! I have no idea what her impression was of me, given that she was a neonate. We’re still very close, having somehow survived our teens without killing each other XD Our brother came along later, and he’s pretty cool to chill with. I hope I’m a good influence XD The Guy is the person I talk to the most, and we confide in each other the most, probably. He's good at making me feel better when I’m worried or sad, I’m lucky that he’s a pretty calm soul. That said, he’s not a medic, so I try not to overwhelm him with medical stress. We don’t share a long history together yet, so we’re always learning more about each other. So far it’s been fun. We met via online dating, though due to my shifts it was a couple of weeks before we could meet in person, and I was really hoping that we’d get on as well in person as we did online. My first impression was simultaneously “Oh, he’s cute!” and “Sh!t, he wasn’t lying about being tall”. I don’t know what his exact first thought was when he saw me, but he was grinning, and he’s still around for some reason, so I’m guessing he has no major complaints.