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Delivering heartache

How many times am I the person who gives the news that destroys someone?

How many people in the area we serve, remember my face as the one who broke them? I wonder if they ever recognise me in the line at the post office, or passing by them in the supermarket aisle.

A man's wife calls an ambulance after he has a seizure and a scan shows a brain tumour pushing his grey matter tight against his skull. My words are careful, practised in my head before we meet, calibrated with each experience. The hospital is noisy, always moving, but in this room time stands still. 'I am so, so sorry' I start and his wife inhales deeply and closes her eyes. My face at this moment is her worst nightmare.

We're trained in breaking bad news from the time we start medical school. There are formats to follow and studies that teach us that after we say terrifying words like cancer, little else will be heard. We deliver information in small pieces, answer questions, give time for reflection. Ea…

10 years after Cyclone Larry: Dad's Altruism

On March 20, 2006 my hometown was destroyed by a category 5 cyclone. Cyclone Larry took away a lot of things - our houses, our school, our farms, our banana crops, my ability to fall asleep without sleeping tablets. But this is a story not of taking away, but of giving back.

When the winds and rain died down 2 days after the cyclone hit, my dad, a pharmacist, announced we had to go to town to open the pharmacy. I was unimpressed - we had a destroyed house, a destroyed farm, no electricity, no food- why couldn't we stay and fix things for ourselves? Dad said that people, especially the local nursing homes needed their medicine, and he needed me to help him.

We had to take one of the four-wheel drives from the farm rather than dad’s car as the roads were covered in water and dangerous. At one river crossing we had to sit and wait for an hour for the water to recede. I kept suggesting we turn back home but Dad was insistent - there were people who needed us.

The pharmacy is in the ma…

Dr Ash's Twitter Rules.

Social Media exists and will not go away, it's time to start participatingAs health professionals we have a duty to participate in public discussion about health. If we don't the chiropractors, celebrity health hacks and snake oil salesmen of the world will answer our patients questions for us. Our duty of care is always to our patients
To discuss a case, take away the patient. Instead of posting about an '89yo lady with a renal abscess', ask twitter what their experiences in the management of renal abscess are (tag a nephrologist and an ID physician for extra learning).
Don't mention the date. Say 'I once saw a patient', not 'I saw a patient today'. The date adds nothing to your story but is an identifier.
Remember that patients as well as health professionals will engage. Don't use demeaning terms 'old people' or 'GOMERS' or 'opiate seekers'. Imagine youre presenting to a conference that has patients with the disease in th…

Doctors, why aren't you on twitter yet?

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Our presence as doctors online is no longer optional. This is a lesson the college of obstetricians and gynaecologists (RANZCOG) learnt on January 2. The Australian Doctor posted this, and the internet exploded:
Unfortunately, as RANZCOG had no media presence and very few actively tweeting fellows, there was no one to rebuke the claims that the college was 'sexist, misogynist and ignored trainees human rights'. RANZCOG is actually the college that allows the most flexible training regime for doctors becoming parents -but on twitter, as in real life, you can't defend yourself in a conversation you've declined to participate in.The best summaries of the events are here by Dr Eric Levi and here by Dr Nikki Stamp.

We've all seen the dangers of using of social media, but to me this highlights the risk of not using it. Whilst there are many 'guidelines' available, very few do anything to convince doctors to join the conversation. A few of these guidelines include th…

Doctors share their tweet-sized mental health stories

A recent discussion through a series of tweets started something wonderful.
In response to our dear twitter friend @ERGoddessMD sharing her brave mental health story here, a discussion about doctor's mental health began. @iGas2 and myself (with some creative help from @_thezol) dreamed up a hashtag doctors could use to share their tweet-length mental health struggles & triumphs. The hashtag #MH4Docs (mental health for doctors) was thus born. I didn't think we'd get this large response - from medical students, to registrars, to consultants in all fields of medicine, from all around the world.

This is the reminder you needed that (despite how it may seem) we all struggle. Whether it's with that nagging social anxiety, those antidepressants no one knows about, the struggle to keep your head above water during exam time, or how much you need cycling to stay sane. Despite the fact that we might look like perfect, type A, overachievers; doctors are human too.
Here is a gro…

Do Not Resuscitate

The day you meet me in the emergency department with your sick parent is probably one of the worst days of your life.   
'My name is Ash and I'm the medical registrar on duty. I'll be your mum's doctor tonight. Mum is very sick. Please sit down so we can talk about what's happening.'
This is usually how I meet people. It's 9pm in our chaotic emergency department and you've brought mum in after she had a turn. The ED doctor has done some tests and has called me to admit her to the medical ward.
Your mum is 89 and getting progressively more frail. She has her share of medical conditions and has a long list of tablets. Her memory is starting to fail her. She might live alone, or with you, or in a nursing facility. Those details don't matter as much. She's your mum and she looks so sick. You're terrified you're about to lose her.
You tell me the story and I add those pieces of the puzzle to the ED doctor's handover and the blood results I…