Wednesday, 23 November 2016

Surgical Training?

Why is Surgical Training so Brutalising?

Surgical training is learning how to be abused. Registrar's are treated like subhumans.

Often they are treated to such conflicting advice as:
"In my day we didn't get trained like you guys do. We just had to learn from our mistakes"
"I did hundreds of hours more of operating than you - how on earth are you going to be experienced enough?"

So what do they want? Hundreds of training cases or thousands of non-training cases? I would suggest that like in sport, a few hours with an appropriate trainer unleashes far more than many hours with an inappropriate trainer.

As one of my excellent trainers has said to me (and he learnt it from his golf pro):

"What does practice make?
Perfect Practice Makes Perfect!"

So why do we persist in making surgical registrars run the gauntlet? Long hours, aggressive trainers, service provision in clinics and lists, administration duties and a wish to break them down? Is this a plan to make the infantry better?. Except with (in theory) the brightest and best?

Now some places have moved into the 21st century with supported training, gradually increasing responsibility and appropriate compensatory rest.

It is inevitable that trainees do more and more as the time goes on, but there has to be give and take - the boss still needs to supervise, and maybe take on more of the admin duties so that the clinical aspects can be taken care of. This is done by the very best trainers and trainees in tandem. They understand that time has moved on and that medical expertise is far more in depth in certain areas, and what they were taught is often no longer of interest or importance. Instead of one option we now have 10 or 15 to know and understand. Intensity of work is far higher with huge levels of oversight and reporting of outcomes. There are no dark little corners anymore.

So where does that leave us then? With hundreds of type A personalities that have ground their way through to be at the top, training a cohort of people who have morphed from pure type A to a more relaxed (but still intense) generation. This is a generation where work does not equal life. Where family is important. A generation who realise that they have to work until their 70s, and yet will still be poorer than their parents. A generation where nothing is certain or triple locked.

The balancing will happen, but it will take time, and there will be significant wastage of excellent trainees who are not willing to put up the abuse and mundane. The ones who will trade long hours and no recognition for high salaries, happy lifestyles and stress due to poor sales not dying patients.

One day we will look back and wonder if we could have seen it coming. We could and we did. No one was listening to the canaries.

Wednesday, 7 September 2016

Cleaning Up London’s Air - What Should We Do?

Living in London and walking my daughter to and from the childminder with a current chest infection makes me acutely aware of the difficulties smog poses in London at the present time.

London is a busy place, with millions of people milling around.  Buses and cars take many people to office jobs that could be done from home.  Lorries deliver produce and goods in addition to huge carbon loads and smog.  The new bankside towers prevent any form of airflow, whilst encouraging massive polluting trucks.  To show how bad things are we have the [The London Air Network]( which has an updated daily pollution map.  Not sure however how this correlates with the ridiculous humidity that 8.75 million people generate - currently 60-80% every day.  This is why so many articles pop up in regards to early deaths and long term morbidity due to the air: [The London Standard in April 2016 for example](

So what is the much vaunted devolved Mayor doing about it?  Well let's see - the [Mayoral Website](  and the [Mayor's Air Quality Fund](  It *looks* as if things are being done.  Slowly.  And frankly **not** enough.

What do I think should be done?

1.  I think that all internal combustion engines should be banned from within the M25.  Within the M25 only zero-emissions vehicles are allowed.  [Tesla]( has shown what is possible with its amazing cars and its development of batteries and solar grids.  Obviously this will require some changeover time.

2.  All taxis and buses should be converted to zero-emissions.

3.  All new private hire licences (and renewals) must to have zero-emissions.

4.  No parking permits or registrations are allowed for emission cars in London.

That sorts the cars (in theory) but what about the electrical use of these huge glass tower blocks?  There needs to be a requirement for them to use glass such as these [Solar Panel Windows](  The Solaria ones look especially good [Solaria](  Now if all council buildings and new developments were to use these the amount of energy generated would be immense.  And reasonably free in the long term scale of things.

We really need to be pushing forward on this and frankly no one in government has any idea or any will to do so.

Tuesday, 6 September 2016

Read by QxMD another app of use

I've been using this as a journal article reader for some time now and think I should probably tell you all about it.
"Read" by QxMD - really good place to select the journals you want for it to scrape the online first sections and bring you up to date and fresh research. Works on iPad and iPhone.
Overall it's actually really nice - you need an Internet connection to use it, but it caches each journal as it goes. Not perfect, but definitely the best I've seen for discovery.
Download here:
From there bit:
"'Read by QxMD' provides a single place to discover new research, read outstanding topic reviews and search Pubmed.
A really simple interface that drives discovery and seamless access to the medical and scientific literature by reformatting it into a personalized digital medical and scientific journal. Only 1 tap to download full text PDFs!
Free iPad and iPhone download:"
21° Mostly Cloudy

Thursday, 11 August 2016

Apple MacBook

New MacBook…

My wife needed a new computer. So we eventually decided on the excellent little MacBook. It is a remarkable device and truly the future for Apple Laptops. Tiny, with excellent battery life and wonderfully quick, despite the size limitations. Keyboard is actually really good and takes no time to get used to. The SSD is a revelation, despite me having an air and a pro with a hybrid drive.


I expect the next fews years to be split into:

MacBook Pro (suspiciously similar to Air)
Mac (previously 5K iMac)
Mac Pro (with multiple 5K screens).

17° Mostly Cloudy
London, England, United Kingdom

Sent from my iPad mini

Tuesday, 9 August 2016

Xenosys Surgical Loupes

**Xenosys Surgical Loupes**

R & D Surgical and Xenosys have just supplied me with the most amazing set of loupes.

They are not free, but you get what you pay for.  Beautifully light, perfectly adjusted for me and frankly a snip at the price.

I got a pair of the Looks 2800 - 2.8x with a massive field of view, and only something stupid like 50-60g!

I would recommend them unreservedly and R&D were fantastic.

Stitching is already better!

Saturday, 9 July 2016

RSM Venous Forum 2016

Busy day indeed.

Final sessions of the Joint meeting of the Royal Society of Medicine Venous Forum and the European Venous Forum held at the RSM in London this year.

An excellent meeting with lots of delegates (it was full!) and I had to judge a session of eposters. Still in the teething stages that session, but some excellent presentations.

The big thing this year, as in recent years, is the explosion of treatment options and rationale for deep venous disease. It's a little like the Wild West, but now with the internet nowhere is can go off-piste. Which is definitely good, but also hinders development as often the mistakes and hunches are the options that prove the best.

Overall though a really good meeting, which will hopefully encourage more younger trainees and fellows into the venous world.

A good bit of coffee networking and catching up prior to hot footing it across town to get my shoes fixed and phone repaired.

22° Mist and Fog
51.4724° N, 0.122501° W

Arrival of the LOOPY Case

Arrival of the loopy…

Only just got it (and smashed the screen just before it arrived too) but already I think it's a keeper - excellent feel and great little stand. Not sure what I think about when I want to put it down properly, but so far has worked very well.

I got the green one.


51.4529° N, 0.147573° W

Sent from my iPad mini

Monday, 20 June 2016

Loopy Case - the new future?

Date: 20 June 2016 at 16:53
Location: 96 Topsham Road, London, England, United Kingdom
Weather: 21° Light Rain

So now it's a Loopy case.

Whilst I wait for the popSlate2 of course.

Don't really want to drop it again before then…

Try it and see - looks so much more awesome in person…

Monday, 21 March 2016

popSLATE 2 - indiegogo

popSLATE 2 - seemingly the best phone case in the world…

Worth a shot I reckon.

It's an e-reader case for your iPhone.

Might just work…

this is my referral link BTW.

Saturday, 6 February 2016

Baby Swimming

Baby swimming is great fun. Lovely to do and lovely to watch. We're very lucky in Tooting to have a nearby pool and a scheme that gets our little one used to swimming. She's come on so much, it's lovely. Plus it's an excuse to get out of the house and spend some fun time.

Swimming - great fun whatever the weather (tm)!