RCEM Learning Podcast. 6th of December, 2018 ANTE·MERIDIEM 12:35

I worked as an SHO in the Mater Emergency Department in Dublin from July 2014 when Andy Neill was a registrar there, and my thinking then was ‘this man is clearly great as a doctor, I am glad of any input from him on almost any presentation, my one concern is not to overload him with questions, I’d prefer him not to burn out while I’m here.’

The Irish secondary care system is, let me phrase this diplomatically, uneven, and when I was working as an SHO in non-central-Dublin hospitals the guidance from registrars was of limited benefit to the patient or to either of the doctors. There was no whisper of this situation from Andy, and from most of the registrars in MMUH.

The correct specialty (in terms of benefit to patients and long-term quality of life for the doctor) for most of the doctors most of the time in the Republic is General Practice. And so I applied for the training scheme, and have been in Donegal since July of 2015; I thoroughly recommend the Donegal Specialist Training Scheme in General Practice, I have spoken at length with trainees across the Republic and the North about their schemes, and in terms of almost anything objective, the Donegal scheme comes out best.

But; the first specialty I worked in post-intern-year, early 2013, was Emergency Medicine. And, well, I really enjoyed it. I enjoyed how general it was, I enjoyed randomly having to deal with an Afghan refugee where my Persian was of some use, knowing that نقرس is gout was of actual help to the patient, I enjoyed managing patients well through French without issue when the triage nurse in Blanchardstown (closest hospital to the airport!) was worried about the need for an interpreter but hadn’t actually organised an interpreter on triage. I even enjoyed that anyone who had put up with the fourteen hour wait was actually sick enough to need to be in hospital, and so I knew how to manage them from my intern year! I didn’t know much about sprained ankles or migraines, but I did manage to learn it.

And I still like it. Five years later, I am still consistently seeing ED patients a proportion of the week and enjoying it, there is no prospect of me stopping ED work in the medium term. I’m not doing it in Dublin, but that is mainly a constraint of my registration rather than an explicit choice.

Which is a roundabout way of saying I listen to the RCEM Learning podcast because I enjoy it and it is relevant to my day-to-day work. I write this post today because I now contend that it is a high point of human learning.

I attended some local teaching in Donegal yesterday from a medical specialist, about one of her areas of interest and the appropriate management and approach to referral; and it reminded me of how bad medical teaching can be. She used data from the US population that differed importantly from the Irish population to make decisions; she appeared to have no insight into the day-to-day pattern of presentations to GPs in general and how her recommendations would impact on her clinic numbers, when making a presentation to GPs in large part advertising her service; practicality and pragmatism were at no point involved in the presentation. It was as bad an experience as any of the bad presentations involved in my experience of Computer Science lecturers, and those fellows had the theory of mind of a four-year-old Sheldon Cooper.

Nothing like the above ever happens with the RCEM Learning podcast, of which Andy is the backbone. Doctors’ weaknesses of understanding are usually with formal statistics; the RCEM Learning podcast gets this right consistently. Practicality and pragmatism are front and centre. The variation in speakers, from the UK to ourselves to Australia, a little bit the US (certainly not a massive cultural variation, but a big variation in how health care systems are funded and how the associated incentives play out), mean that the decision-making cul-de-sacs that give bad outcomes for economic reasons are mentioned as avoidable.

I listen to lots of North American podcasts relevant to Emergency Medicine, and they’re great, much better than our medical specialist above. RCEM Learning still edges in front of all of those I listen to. If you are a doctor who drives and has anything to do with Emergency Medicine (whether working in it, taking referrals from it, or making referrals to it), make your car handle podcasts in some way, and listen to the RCEM Learning. podcast when it comes out. You will make better decisions, you will have a better understanding of the decisions made when you refer, and you may incidentally start rhyming ‘now’ with the French word for ‘eye’, which will be entertaining for everyone.