Overtime

My girlfriend is also a junior doctor.  She still works shifts at the hospital and whenever I can, I pick her up from work.  

We noticed that if her shift finishes at 5pm then I should aim to pick her up at 5.15pm otherwise I’d just be waiting around as she never finishes on time.

It’s now 5.20pm and I’m still waiting for her as a patient had an unexpected heart attack on one of the wards.

You could build a city with the amount of overtime doctors do in England.  

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Uber For Healthcare!

Sure it will have its place in healthcare, but in my opinion it really won’t have very much of an impact in how things are already done.  If you really are ill then you can always ask for a home visit from your GP, go to the out of hours services, go to pharmacy first or go to A&E.

I think fundamentally there are two problems with all these “Uber For Healthcare” apps and why they will never really take off.

It’s A Bad Business Idea

It’s essentially a really bad idea.  Not because it won’t work, but because everyone has already thought of it and is doing it.

There are already dozens (if not hundreds) of these startups in the UK.  Some CCGs are even trialling their own versions of it in and around Yorkshire!

Uber for Healthcare will happen.  But there will likely be a dominant service for each area of England as the landscape of healthcare is very different to the taxi landscape.

It’s a very crowded market.  Sure some of these companies might be successful, they might even be quite profitable.  But none of these companies will likely have a big share of the pie.  A share of the pie that will likely be eroded over time as more and more of these startups appear.

Doctors Are Unlikely To Work For “Uber For Healthcare”

Doctors are definitely undervalued in the UK.  We are undervalued monetarily as market rates do not apply as much in a socialised health system.  Most doctors are ok with this.  Most doctors became doctors because they genuinely wanted to help others.  And in any case we do get paid a pretty good salary as junior doctors and we get a really good salary as a senior doctor.

However, we are currently being extremely undervalued by the NHS as human beings.  Not a day goes by where yet another newspaper article doesn’t appear about this.

The question is, would doctors prefer working for a piece of software rather than the NHS?  Uber is not particularly well known for treating its drivers well.  I’m sure there are plenty that would.  But, doctors are much more skilled than your average taxi driver.  If we were going to work in the private sector why would we choose to work for a piece of software that would try to take a large percentage of our salary, potentially treat us really poorly and treat us like a cog in a machine?  There are already established firms out there that would happily recruit experienced doctors, pay them up to £100,000 for a 37 hour week, pay professional fees, give us our allocated time for essential training to keep up with revalidation and treat us with some respect.  Why then would highly skilled professionals choose to depend on a mobile phone app for their livelihood?  (Also, I don’t particularly find the idea of being beckoned by a random person with a smart phone, while carrying controlled medications with me appealing!)

But the main reason that most doctors would not sign up for this kind of technology is indemnity fees.  GPs who do exclusive out of hours work and locum work, pay around £25,000 a year to avoid litigation.  As society becomes more litigious these fees have been getting higher and higher over the last few years and is one of the many reasons why out of hours services are closing across the UK.  These fees are already this high when we have the patients medical records, past medical history, drug allergies etc. right in front of us and also the support of all the other NHS allied healthcare professionals.  The risk of just seeing a random patient with none of this support will make indemnity sky-rocket as well as massively increase the chances of being taken to court.

On Leadership

I’m having an interview tomorrow to formally become a “Clinical Entrepreneur Fellow” and be part of NHS Innovation.

To be honest I don’t know if I’m already in as I’ve already been invited to the NHS Innovation Expo (for free!) this week.  Nonetheless, I suppose it is a formality that I have to go through.

I received a brief for the interview and I will be asked questions on leadership, innovation, my current start up etc.

The leadership question seems to be the hardest to answer in my mind!  What is leadership and when have I actually leaded people?

There is definitely one instance in my life where I have truly lead people.  This was actually when I was in high school.  I was a guitar player and loved heavy metal and rock music.  Because I went to a high school that was up its own bum and had delusions of grandeur, this was generally frowned upon.  I wasn’t playing the “right type” of music and wasn’t learning music in “the proper way” as I refused to sit exams for it (I play guitar because I love to play, not to get a certificate saying I can play).

When I was 16, I don’t know why, but I decided that we needed to throw a rock concert.  I told my band about it and we got to work.  Later in the year we played to a full house.  We had about 6 or 7 other bands play as well and we were the final act.

It was the most successful concert in the history of the school and we raised more money for charity than any other school concert before it.

Looking back at it, it seems absolutely nuts that we just decided to do something and did it.  People were so convinced in our certainty and conviction that things just naturally fell into place.

I suppose more recently, with my start up, I have been doing the same things without even noticing.  People are doing things for me, for no real objective reason.  They believe in my conviction and certainty.  It’s almost like I’m selling ether…

Perhaps that’s what leadership actually is.  It’s the ability to sell ether.  To get people to believe in you for no real objective reason.

The last thing I’ve realised is that to lead, you have to put yourself out there….things might not work.  Being a leader means you have to put yourself out there and if you fail then accept full responsibility.  I guess this last point is why most  people aren’t leaders.  Not many people can accept criticism and put themselves in that vulnerable place.

How to Lose Weight

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Obligatory fat person photo

Introduction

I’ve had loads of people ask me how to lose weight.  With one quarter of adults in the UK being classified as obese it is not surprising that people all over the country are looking for realistic methods of weight loss.

In my experience the public generally have a very poor understanding of nutrition and exercise.  Also in my experience, doctors have a very poor understanding of realistic, implementable methods of weight loss for their patients.  From what I have seen a lot of doctors understand the theory and how the body actually works, but do not know what to recommend for their patients.

One of the reasons for this difficulty is that everyone is different, in so far as their preferences to food choices, activity levels, co-morbidities, peer group, employment etc etc.

I hope that the following blog entry will help a few people out.

The Only Way to Lose Weight

The only method of losing weight, that has been proven in study after study is to sustain a caloric deficit.  That is, that the total number of calories that you burn in a day should be more than you consume in a day.

Most fad diets (low carb, gluten free when not suffering from Coeliac’s Disease etc.) work as they produce a calorie deficit.  However, these fad diets are not sustainable and most people fall of the band wagon after a little while gaining back their weight.*

Caloric Deficit ≠ Eating Less

Let me say that again.  Eating a caloric deficit does not mean that you have to eat less food!

This is where most people mess up.

Let’s take a quick example.  Let’s say that you have the inkling for a McDonalds Big Mac menu with a diet Coke.  According to their calorie calculator this would come to a total of 845 calories.

Now let’s say the following night you feel like eating a home cooked Chicken Parmesan with some beans, an avocado, a boiled egg and a side of green leaf salad.  This meal would come to a total of around 900 calories.

The second meal option has pretty much the same number of calories as the McDonalds however, the total volume of food is much greater in the second meal option.  Arguably the second meal option is also all around healthier as it would be full of healthy fats, a balanced amount of carbohydrates and a decent amount of protein as well.

How to Eat More and Eat a Caloric Deficit

So here are the key points on how to eat more food and still be in a caloric deficit:

  1. Pick single ingredient foods

If you can look at your plate and name each component just by looking then you’re most likely eating nutritionally dense, low calorie foods

2.  Protein fills you up

Protein is the most satiating macronutrient and will keep you full.  When trying to stay in a deficit it is important to pick good sources of protein – chicken, beans, fish, whey protein, eggs etc.

How to Calculate Your Caloric Intake

Use an online calculator.  For a quick guide here are a few pictures from a well known home workout programme to help you:

 

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Outro

This is essentially all you need to know.  In the future I will post more on how to create a diet that you can enjoy and can stick to which will help you lose weight/maintain weight.

*One point to note is that eating carbohydrates causes your body to retain water.  Quickly moving over to a low carb diet can produce a quick reduction on the number on your scale, however as soon as you eat some carbs the number will go up again.  This is quite clearly not fat loss, but a lot of people end up claiming impossible weight loss results due to this reason.