We were out to dinner tonight as a family, and right at the end, Emma was combing through Sam’s hair.
Our little friends are back.
Yes… the nits.
Now, we have been going pretty well so far this year as I believe this is only the second time we have had to deal with them.
As Sam is 11, we have had about 6.5 years of experience with the nits.
For some reason, he never got them at daycare, as far as I can remember.
But within 2 weeks of starting primary school… there they were.
The first ones were almost cavalier in their approach, dancing over the top of his hair as if nothing could touch them.
So, we are no strangers to the nits and we have tried a LOT of options.
Some seem to work.
Some definitely do not work.
And then we found Nyda.
That stuff is the best.
The nits just die.
It is incredibly frustrating to pay money for nit cream and have it not work.
Or even worse, to think that it has...
The RACGP has definitely been subject to widespread criticism of its 3 Fellowship exams.
Doctors who sit the exams feel they are at times unfair, irrational and more like a “Guess the Examiners Mind” than an actual exam.
The RACGP hold that the exams are validated and fair and access the competency for doctors to be recognized to be able to work independently as a GP in Australia.
Now any doctor who passes tends not to question the process.
“Ok, that was pretty fucking horrible, but I made it through. Thank God and now I can get on with the rest of my life as a GP”.
But for those that fail, what awaits them is a whole different experience.
And here is where the real problem actually lies.
For doctors that fail, they get two major pieces of feedback.
1. The exam report.
These are released after each exam and have common errors for questions.
They are definitely helpful.
So my father has early onset dementia.
Signs were probably present from around age 65.
He is now 73 and late stage.
It is a very tough disease.
People say it is not hard on the actual people with dementia.
But I do wonder if there is still some remnant of his spirit still trapped inside, deeply frustrated with his inability to have any significant cognitive function.
Then again… perhaps it is ok for him...
The world just existing solely at the moment with no capacity for recall of events and just a continual sense of wonder that he finds himself in this new location with no connecting events of how he got there.
There does seem to be some faint emotional memory of who I am.
He says “yes” when I ask him if he knows who I am, but that is all he can answer.
I don’t know if he really does know me, his eldest son, or whether he just says yes to most things these days.
Perhaps I am just...
Basically, all of the patients are on long term S8 medications.
NSW has requirements for any patient who is on S8 regularly for more than 2 months to have approval from the Pharmaceutical Regulatory Unit.
Part of the application is that the patients are reviewed by a pain specialist.
The interesting thing is that opiates are clearly out of favour for long term pain management as the pain specialists are continually recommending to reduce to zero.
This is great of course in theory.
The only problem is, what to treat their chronic pain with?
Most often I am asked when will Medical Marijuana be available.
I say go head up to the Gold Coast… there are clinics up there.
What about you? Why won’t you prescribe?
My answer… we already have enough problems with chronic pain and opiates…
I have ZERO interest in prescribing marijuana unless it is recreationally legal.
Up until that point… Its just not worth the hassle.
There are already enough challenges in GP...
So last night we had some friends come over.
They own a pub so they often bring exotic or unusual beers.
I have been working on drinking minimally for the last couple of months.
We had people over Saturday night and I had 5 Peroni leggera.
I felt average for most of Sunday morning and recovered after planting about 12 trees on my property with my wife.
This was definitely a good outcome and significantly reduced the number of unplanted trees on the property…
And landscaping is HARD work.
I was sweating a lot!
Anyway, later that afternoon our friends came over.
They had helped out with loaning me a spare car when my starter motor blew up and I didn’t have a car for 3 days.
I had two of these special IPA type beers.
Then I had 4 red wine glasses.
The impact of this decision was fine last night.
The drinks tasted pretty good.
The buzz was fun.
Then the consequences kicked in.
One of the other GP supervisors has been away for two days, so I've been looking after two registrars.
It is a interesting experience - just in taking all of the phones calls, and fully experiencing the demands that are placed on GP supervisors.
It's definitely an extra level of skill set that's required compared to not being a GP supervisor.
I think one of the big challenges is the interruptions.
Leaving the case where I'm dealing with my patient, then going and sorting out the other patient that the registrar's working with...
How do I help them sort out their patient?
How do I help the registrar to learn?
How do I make sure that they're safe, make sure that we're not missing anything?
Then coming back and then hopping back into my patient and helping them.
It's quite a demanding experience, and the hope is that despite this I can still go home confident that I've done my work for all my patients, as well as provided a growth experience for the registrar.
So how am I...
Okay, hi, it's Tom Rolley here for Graduate Medicine.
I've just completed my day and it was a pretty good day.
We had some interesting cases, but what I wanted to talk to you about is that some of you may be approaching the final hurdle in your path to fellowship, which of course, is the OSCE.
And if you're going to pass the AKT and pass the KFP, then you might think, "Hey, this OSCE thing, it should be pretty easy."
And you'd be right, because of course it is closest to how we actually work.
Yes, it's a little bit stylized, because it's eight minute cases, or it's the two long OSCE cases, which are 19 minutes.
But, you still need to know how to perform well, and also of course, it is quite a serious investment.
I think it's up around $4,000 plus mark at this point.
It's a long day as well, so you really want to have the capacity to step in confident, and actually know that yes, your money is well invested into getting this for RACGP and you've put the time in so you pass!
Well, hello everyone.
I'll see if the signal works.
I just got home.
It's been a long day because I did a nursing home visit and also a visit to one of my patients who's had a crush fracture and is recovering in her home.
So it's like ten past six, it's date night and I'm going to take my wife out for dinner tonight .
If you're a GP and I'm going to strongly recommend you try out weekly date nights to preserve your relationship with your significant other, your wife or your husband or whoever that is in your life.
I'm finding it pretty helpful so that's the first tip for tonight.
What I wanted to cover is how exam performance can be impeded by poor preparation across clinical knowledge, critical skills and clinical reasoning.
So I was talking to a doctor yesterday and he said, "You know, Tom, I've know I've failed 2018.2."
I said, "Well, how can you know that?" And he said, "Well, the night before I hardly slept."
So I said, "Okay. What happened there?"
And as we dug a little...