12 April 2008


It's Dr Grumble's 12th day at work. He's been 'on take' which is not without its stresses. But the weather has been warm and the number of admissions very manageable. It's actually been enjoyable. And, of course, even at his great age Dr Grumble is still learning. Medicine is like that. You never know it all. There's always something new.

On today's ward round we had a lady who Dr Grumble thought had acute coronary syndrome. Nothing unusual about that. She had developed severe chest pain while getting upset about something. One of the joys of the take is that you are surrounded by bright, everchanging (shiftworking) young doctors. This week's were excellent. Today's were all were female. It's nothing to do with the Grumble attractiveness. It's everything to do with the feminisation of medicine. And some women in medicine are concerned about that. One of these ladies suggested an alternative diagnosis for the woman with the chest pain. Dr Grumble never minds helpful suggestions but it is a little awkward when the suggested diagnosis is not a condition he knows much about. And Dr Grumble does not know much about takotsubo syndrome. He did not even know what a takotsubo is. But he does now. It's an octopus trap. And here is one:

Now what do Japanese octopus traps have to do with Dr Grumble's patient? Does the picture below help?

Perhaps not. You can read all about takotsubo syndrome here.

And, in case you're wondering, the patient had acute coronary syndrome and is doing very well.

This was first posted on 4th May 2007. It has been republished now because Dr Grumble has just seen a more convincing case of takotsubo syndrome on his post take ward round and there seemed to be some ignorance about the condition amongst those accompanying him. And it's a harmless enough post. Nothing remotely political or critical here.


Anonymous said...

But don't forget, Dr G, that the Trust has blocked access to your blog!

s said...

I can't understand why myself! Dr G is is very pennine. The type of Dr who actually cares about his patients and his workplace.

Dr G, this bit was in the first link in your post:

'The mental health of British consultants has been giving concern for a while.3-5 A survey of 1133 consultants in various disciplines revealed psychiatric morbidity in 27%.3 There was a consistent relation between burnout (emotional exhaustion, depersonalisation, and feeling of low personal accomplishment) and job stress, irrespective of specialty.'

Very sad if true IMO

Anonymous said...

Does feminization lead to madness in a profession?
well from the fotherings of NUT - it does.
Things were better when real doctors smoked pipes. More gravitas and less hurry.

Dr Grumble said...

It's Sunday morning and I am just checking to see if anybody still reads the blog before starting my post-take ward round at 0800hrs. I used to be responsible for 20% of the acute medical admissions to the hospital where I work so I know about burnout. Fortunately things are now very much better. I hope I will enjoy this morning's round but I know that at weekends there is less support than during the week. There are figures which show the consequences of this but that would be another post altogether and I have stopped posting anything new for the time being.

S said...

Of course we still read your blog Dr G, over and over again, the little we have access to anyway!

Perhaps you could just write about the seniors morale, nothing political. It just seems like when morale is the issue, the seniors don't even get a mention.

Elaine said...

Enjoyed this post. Usually, I am a lurker, but your blog is marked in my favourites, and I check it regularly.

Never fear, your audience loves you.

Dr Grumble said...

Thanks Elaine and S for your kind comments

Perhaps you could just write about the seniors morale.
If your morale is low it is best to conceal it. Whatever walk of life you are in it's best to look enthusiastic and happy in your work and not flag up problems. People do not like having problems brought to them. This is what leads to people at the top of organisations thinking everything is fine when it is not.

I will just touch on a local topical issue connected to this. I recently had an email from the management implying quite strongly that they did not think meetings with the consultants was something that needed to be continued and that in future they would just send out emails telling us what had been decided. I regret to say that I did not reply. In part this was because I was shocked that they were even contemplating taking such an approach officially but it was also because they had signalled the answer they wanted so clearly that I did not feel inclined to be seen as a distrustful rebel. I was also aware the proposal had already been adopted de facto as meetings are now very infrequent and often cancelled at short notice.

Of course, it is this sort of feeble response from people like me that has led to consultants being collectively ridden over roughshod. Like others I have a family to support.

S said...

It seems that this type of behaviour is the norm nowadays Dr G, no dialogue, just imposition, remember MMC? Only, I think dictatorships alway fail spectacularly at the end.

And, of course you have a family and they must come first. We do understand. We also understand you have to be comfortable with whatever you do too ... so, we'll just have to wait .. :-)

PhD scientist said...

Speaking as a life-long distrustful rebel and noted "morale problem", Dr Grumble, I know just where you're coming from.

In my case I am a second generation awkward s*d. It seems to run in families.

Good to know you're still lurking in the blogosphere, BTW.

PS My favourite description of myself from one of my bosses, applied to me by a Faculty Dean/Professor I still work with on occasion, was "barrack room lawyer". I felt rather proud.

Dr Grumble said...

Society needs disgruntled people. It also needs people who question things. Even the cranks. Cranks make the wheels go round.

Dr Grumble said...

Would you believe it? Within days of this post I have admitted a patient with inverted Takotsubo cardiomyopathy. I did a post once on why rare things come in runs. Perhaps I'll republish it.

PhD scientist said...

Finally got around to reading the page about Takotsubo cardiomyopathy. Fascinating stuff. Wonder what the underlying mechanism of "regional stunning" is? All my academic friends with large British Heart Foundation research grants got very excited about "myocardial stunning" about 10-15 years ago, but I haven't heard that much about it recently.

PhD scientist said...

PS Aha. I see that an eminent Professor I once used to go to the same conferences as has an interesting theory.