I'm finished work for the year, so today I'm gonna talk about Cricket instead. This is an Australian summer after all.

The Australian Cricket team just lost its first test series at home in 17 years. They've been at the top of world cricket for at least fifteen years on the trot. The victorious Sth African team has played very well and in combination with an underperforming Aussie side, they've claimed the series 2-0 with the Sydney Test still to play.

For me, this has well and truly signalled the end of an Era. The voters on a Channel 9 poll agreed with me (54% vs A "Blip" at 46%). The writing has been on the wall for about fifteen months, when the retirements of five senior players required the selectors to plan for the future.

In my opinion, they have failed to do this; there has been no openly touted road-map. To exacerbate the situation, the current senior players are (with the exception of Ricky Ponting) are drastically out of form. From an organisational point of view, it looks as though the team has sprained it's only good thumb whilst cautiously trying to re-grow an arm and a leg.

Now the Australian team needs to regenerate itself, but there's got to be some trust in the newer players. In the last twelve months, there has been a stupendously high turnover of players, and not just due to retirement or injury. Many are because the selectors will give a player a wee trial and then drop them.

I don't know if the revolving door policy is like the All Blacks', where they have many excellent players, or because there's no-one who's putting their hand up and scoring runs or taking wickets.

All this comes across at a last grab at the dominance that Australia has enjoyed for the last fifteen years. I feel it would have been better for the selectors to just bite the bullet and stick with a few new players. Y'know, a new spinner, and two young quicks. Just field them for a while and see what happens. If they have the potential to take twenty wickets with some experience then keep them, grow them.

The selectors must have some faith in their new selections and appreciate that, for the mean time, Australian cricket is not the force it once was. With time, training and heart (that is often only garnered through hard-fought wins and thrashing losses), the team will return to its former glory.

And next time, when the warning signs of the 'end of an era' are visible, younger players will be nurtured and established to reestablish the team. Just like every other selection panel has done since Allan Border's Captaincy.

This was the first trip I've been on in about five years with no pharm/medical reading. Instead, I managed to churn through large amounts of other 'media'. These are my twelve word reviews:

Film:
Hancock - Will Smith's invincible antics, jeopardised by intense love, tragedy. Charlize equals hottie!

Get Smart (2008) - Anne Hathaway is a honey. 'Brick' does the old favourite well. Just.

Lost in Translation (w/ Polish subtitles) - Third viewing, watched with my zero-english speaking Polish cousin. Deep, hilarious.

Shin ge jeon - Inspiring but ironic Korean hero story about the greatness of science, missiles.

Books:
Self ; Yann Martel - Male or female? A tricky and elobarate exploration of the conscious mind.

Books vs Cigarettes ; George Orwell - My first Orwell. Simple observations, readable logical essays. Would make excellent blogger!

Days of Reading ; Marcel Proust - Struggled through noun-less sentences. Some beautifully painted scenes. I lack 'Ruskin' knowledge.

Girls of Riyadh ; Rajaa Al Sani - Cleverly crafted insight; all societies have foibles, some more unspoken, misunderstood, tragic.

The Rum Diaries ; Hunter S. Thompson - Twisted morals and aimlessness leads down a path versus self-discovery.

Of Mice and Men ; John Steinbeck - Ethical dilemmas and hicks. George isn't lovable, but possibly a good man.

Lonely Planet's Europe on a Shoestring ; Various LP Editors - Scratches the surface of an entire continent, maps included. Sometimes witty!

Albums:
Only By The Night ; Kings of Leon - Usually I'm anti- 'number one' albums. Soulful or snappy, thoughtful travelling rock.

Details ; Frou Frou - Beautiful music and haunting lyrics. Psychobabble is a disturbing ballad. Buy it.

Optimist LP and Ether Song ; Turin Breaks - Light music that you can bop or sleep to. Solid iPod fodder.

Viva La Vida ; Coldplay - Saw the album cover at the Louvre; the music is more revolutionary!

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Not a bad wee haul for a month, I reckon. Especially if you include the Sudoku books I trawled through. As far as reading for the next few weeks goes, it's back to the land of medicine to prep for my first rotation; Internal Medicine. The list includes Davidson's IM, Harrison's IM, some Talley and O'Connor and whatever else feels high-yield. And you know what? After six weeks of no medicine, I'm champing at the bit to read some more. Yus.

And yeah, work on Christmas day is going pretty well, too!

Need I say more...

So, I'm working Christmas Day. I've known it for a while. Actually, since February when I asked my boss if I could have the 25th, 26th and 1 Jan.

Why in the hell offer to work Christmas Day? In all honesty, I enjoy it. My Christmas-celebrating family is all overseas or interstate (which is out of reach, this year), and having lived well beyond my means for the last five-or-so weeks the money's a bonus. Being Bar-Mitzvahed also helps to rationalise it, too.

Who needs a pharmacy on Christmas Day? There's a lot of indigestion out there from about 2pm; and a fair number of over-50s have been known to confuse this with a heart attack. Allergies to packing materials are also pretty common. Sun-burn is all too common in this neck of the ocean (I work in a holiday 'destination', after all). But, for most people, here's what Public Holiday and Sunday Pharmacies provide:

"Hi, I've got XX symtom, and I just want to know if I need to see a doctor?"

Around these here parts, it's an expensive exercise to see doctor on a Sunday. A few months ago the only all-hours place for an hour in either direction closed down. There is a group who do 24-hr house calls, but they charge like a wounded bull (for top-notch service, mind) and the wait is usually a few hours. The hospital, not surprisingly, is quite effective at prioritising MIs and the like, but if you're a Cat-5, feel free to join the 5 hr queue to be spoken with. Here at the Pharmacy, we're open 14 hours a day. You might wait twenty minutes to talk to me if it's busy as hell and you look comfortable, and I'll be genuinely apologetic if it takes that long.

Being able to prioritise is a big deal; the ED is damned good at it when it comes to medical emergencies, but there's zero differentiation from one Cat-5 to the next. Here we at least offer some sort of advice, because more often than not, the kind of things people are asking about at 8pm on a Sunday night actually need to be seen by a doctor. Not necessarily today, probably not tomorrow and rarely by an Emergency physician in the next thirty minutes.

Little Frankie's eczema is pretty bad, yeah, so we can give him a wee steroid cream to tide you over until, say, Wednesday, when your GP's receptionist decides that there's a spot free. No, it doesn't look infected.

You even throw out a cheeky wee safety net about infections and the like and away they roll, quick fix in hand.

In my opinion, the lay public isn't fantastic at triaging themselves or their kids, and why should they be? From Joe Public's point of view, there's not much difference between a kid who's cranky with Chicken Pox and a kid who's suffering a deterioration of consciousness from post-VZV Encephalitis.

So, people come to the pharmacy because;

Have a safe Christmas, all.

A year ago, exactly, I arrived in Mumbai. On the third day I was there, I decided to go down to the Cross Maidan to try and get a game in one of the many cricket matches going on down there. In Mumbai, when you play cricket, you play properly.

Two groups of men were shaping up to play a match. It was to be eight overs a side, and there were umpires. A man says to me, "You want to bowl?" and throws me the ball. I roll my arm over a few times, and he says, we play match now; you're on my team.

The man's name is Pradeep. Pradeep, like his teammates is dressed in formal white pants, and a white shirt with gold buttons. He, along with his team mates, have removed their nice white shirts and round caps, so they're bare headed and wearing sweat-stained singlets. Usually, I use fake names, but Pradeep is indeed his name.

Pradeep introduces me to his team; he wasn't the captain (Patrick, a younger guy, right arm quick bowler and keen batsman, was in charge of the on-field stuff), but he's organising a team for a tournament in a week's time, for which the first prize was about $600US for the team. That amount is the equivalent of twice the average yearly Indian wage. This is the first of two trial matches.

We won the toss and batted. In the third over, Patrick holed out to mid-wicket, and I was handed a bat. Number Three, I thought, I'd better make some sort of showing! The first ball was a yorker, and I dug it out and fair grazed the bat on the pitch. The opposition laughed. The next ball wasn't quite as full, and I managed two runs to mid-on. The opposition laughed at the Aussie who felt the need to run two. And so on. To illustrate the level of intensity, one of the umpires called my batting partner for a 'short run'. Eventually, a yorker went through me and took middle.

Pradeep gave me a pat on the shoulder, and we soon went into the field. We put the squeeze on in the first four overs, and with two overs to go, the game was effectively won. I was thrown the ball, and had an over. Some kids watching asked if I was Daniel Vettori, funny considering I bowl the same style, wear glasses and played most of my cricket in New Zealand.

After the game, both teams shook hands, and we went to the Sugar Cane Juice cart for some freshly pressed juice, which Pradeep shouted me, as I'd left my wallet at the hotel with Batman. We chatted about cricket, India, his job and family and my other travels.

He offered to give Batman and me a ride to a shop near his next job. I gratefully accepted, and the two of us picked up Batman and headed to the Pashmina Bazaar, hidden in a tiny corner of Mumbai. There was no pressure to buy, and the goods were top notch. Like, Pradeep, this was the real deal.

On the way there, Pradeep told us about his daughter, then eleven, and how she went to school. He was so proud of his little girl for getting an education; it was obviously very important to him. Pradeep is a good man.

The cricket match I played in was between Pradeep's team - the Drivers from The Oberoi Hotel - and their cross-town, friendly, rivals - the Drivers from The Taj Mahal Hotel. These were good, friendly, honest men.

Until this morning, I hadn't read any news since Tuesday. The happenings in Mumbai are shocking and tragic. I really hope that Pradeep, Patrick and the rest of the drivers from both Oberoi and Taj are alive and unharmed. Take care lads. Shabash!

A few weeks ago, I posted about clinical coaches and said that I'd mention a particularly dodgy one; it all started out in the first week of first year...

Along with my five classmates, we met our first clinical coach. She was lovely. We talked about the meaning of the word touch. Sometimes touch is gentle, empowering and comforting. Sometimes, touch can be cold, rough, fearsome and harrowing. She impressed upon us the importance of using the right touch whilst examining a patient. After eight weeks, we moved on.

On this particular Tuesday, Dr Rotter was waiting for us. A man in his early sixties, he sat in the corner in his blue shirt, moleskins and cowboy boots with his legs crossed and his comb-over slightly ruffled. He introduced himself briefly, saying that he'd "Done it all" and was "here now'" in a somewhat forceful and bitter tone. He then proceeded to give us his version of life the universe and everything, making know his distaste for hospitals, the minister of health, long working hours and the tough life of a doctor, adjusting his small spectacles on his round face throughout. He expounded his views on women in medicine and the role of indigenous Australians within society. He mentioned he'd worked in the Army for many years, and been rural for several. I, for one, was not surprised. He had, so far, epitomised all the typical negative stereotypes associated with either. Except one. Then he asked us which high schools we'd attended.

So, he says, what am I supposed to teach you lot? We briefly explained that the current block was on the Respiratory system; we'd had at least three weeks of classes on such, and in a months time we needed to be able to competently run through this aspect of a physical in front of an examiner. He informed us that there was very little to the Respiratory exam at all, really, and that we'd have a talk about it first. Have you heard of asthma, he asked.

Dr Rotter finally got the message that he needed to teach us some physical examination techniques. Someone at the SoM had given him Talley & O'Connor, and when we arrived for session two, he was flicking through it, enthralled. I got the feeling it was the first textbook he'd read in about fifteen years. You should read this one, he said. We had. In fact, we were so disillusioned from the first session, we'd held a 'catch-up' session amongst ourselves. Self-directed learning win. Again, rather than actively teaching us how to perfect our examination techniques us, Dr Rotter began to wax lyrical about Pulmonary embolus, and rattled of some risk factors. He talked about weight being a factor, and pointed to us in turn, descibing our body types. Thin, normal, normal, thick, thin. Yup. He said a girl in my group had a 'thick' body type. Unprovoked. Then he told us that it would be harder to examine her and not to bother. In fact, he said, women are hard to examine because they have breasts. Then he mockingly told a story from his medical school days to illustrate his point. He must have been such a hero to have 'examined' one of the ten girls in his class.

In the third session, Rotter arrived ranting more than usual. He'd stormed up and down the corridor like a petulant child cursing about not being paid. He also berated the medical school and it's teaching practices, and suggested we'd all get a better education by going to Med school in Samoa. Then, against all odds, he decided to actually demonstrate just how examinations roll. He selected the other male in the group (Daredevil) and sat him on the couch, and got him to take off his shirt. He began to tell us about the importance of General Inspection, noting that Daredevil was skinny and then moving to examine Daredevil's hands. He neglected to mention the Daredevil's ten-inch median sternotomy scar. We had, by now, established Rotter as both offensive and incomptent.

At this point we complained to the school; the guy was obviously not fit to be teaching, and I, for one, was going to spend as little time in his presence as possible. At the meeting, it was also mentioned that he'd patted one of the girls on the bum. Not for the last time, unfortunately.

Our fourth session was with real patients. This 'clinical visit' was a big treat for us fresh and enthusiastic first years. We arrived at the private nursing facility at the appointed hour, to be greeted by the unit manager and her friendly do. She was most pleased to have a doctor looking around, because the regular clinical wasn't due until Friday. I knew the regular clinician from my pharmacy work, and whilst nearing the end of his professional life, he was a pretty switched on cat and a nice guy. Rotter would be late as he was still with his other group of students.

Forty-five minutes later, a blaise Dr Rotter strides around the corner, ushering the other group out. So, he says, I see you've met Nurse Wilson, he mocked, she's a very special lady, Guffaw Guffaw. Follow me. And he walks off. We catch up and he tells us that he's a long way behind time and that we're going to see one of the "old biddies" on the second floor, because she had some good lungs for listening. If we were lucky, we might see two patients, he said. But remember,

"THEYRE ALL REALLY HARD OF HEARING, SO MAKE SURE YOU GET RIGHT INTO THEIR EARS!" he demonstrated into Lickety-split's ear.

Rotter strides into the patient's room without knocking;

"Hullo dearie, it's me again. I've brought some more students."

A frail lady in her eighties looks a little frightened and the slowly recognises Dr Rotter. She begins to say, "Oh, well, dinner...."

"Yes! I know that dinner is soon. We won't be long. It'll just be the same as before." Rotter booms.

The lady begins unbuttoning her shirt.

"No No. Ha ha! Haw haw! You don't need to do that just yet."

My colleagues and I are shocked. This isn't right. We crowd around the woman's chair and Daredevil, begins to examine her. When, at the appropriate time, he asked Mrs. Z to remover her shirt just enough, and the patient says "Pardon?" Rotter mocks him and reaches for her buttons with one hand and sleeves for the other. Wonderwoman says; "Perhaps we should close the door?", and extricates herself from the circle. To this Rotter replies,

"What on earth for? No-one's going to walk past who cares." We soon completed our examination and walked outside. Rotter decides that the best place to talk about this patient is in the common area with five other residents a full four feet away.

Rotter notes that the next patient has changed her jumper since the last group, and when she removes it she's not wearing a brassiere. Rotter is flustered, and asks her to "cover yourself up, love". She put on a thin singlet, and I begin to listen to her lungs. The next patient also had some resiratory crackles. She, too, was a thin religious lady whose only sins were a seventy-pack year history of smoking.

"Gee, it's hot in here. Where's the aircon remote?" He grabs it and dials the temperature down to 18 degrees C. The already frail and wasted patient begins to shiver about twenty seconds later. Batman subtly retrieves the remote and switches the A/C off.

In doing so, Batman had moved herself out of the circle. Rotter was unhappy with the new dynamic and man-handles each of us into the best position. Wonderwoman is seething. She sort of steps back. "Oh," says Rotter, "you go there then, there's a good girl.", and he guides Batman forward. Batman walks out to use the bathroom. It was later revealed that Rotter's method of 'encouraging' a step forward was a pat on the rear end.

We'd flown through the first two examination (out of a desire to keep these poor ladies away from Rotter), so we were given a 'treat', and allowed to see a third elderly patient. Rotter took a cursory history, which elicited the question "I think that one of my medicine's making me sick. Could it be giving me nausea?"

Rotter: "No, love, your medicines are to help you."
Patient: "Have you seen my list?"
Rotter: "No, I'm not familiar with your case. But your medicine is to help, so just keep taking it, alright, dearie."

Rotter summarises his disgracefully inept history "So, this patient reports some muscle weakness and arthritis, but as we've heard, her cardio and respiratory systems are just fine." Meantime, I have noticed both several Ventolin inhalers, and a glyceryltrinitrate spray at her bedside table. Rotter, smugly, asks if there's anything else we would have asked. Big mistake, Doc.

Capt. Atopic: "Ms. Y, I notice you have a pink bottle there [indicating]. What's that one for?"
Ms Y: "Of course lovey, I take that one when my neck and shoulders get really sore."
Me: "And how often is that?"
Ms Y: "About once a week."
Me: "Have you ever been to hospital for it?"
Ms Y: "Of course, my doctors said that I have something called 'Angina', I was there about a month ago for two weeks, and they said..."
Rotter [interrupting]: "Well, these things are hard to diagnose. The doctors there are treating it as cardiovascular, but it may be that she's pulled a sternomastiod." He spent the next ten minutes trying to save face, including mentioning that I'd gotten lucky in seeing the medicine. Not surprisingly, this annoyed me even more. I'm usually a very respectful guy. Particularly when it comes to the elder and the wiser of the world. I quietly read through the patient's chart and decided I'd put the boot it.

We moved to a corner area and sat around to discuss the patient. He mentioned her Angina and arthritis, and asks if there are any questions. The others look awkward. I say,

"Dr. Rotter, I noticed that the patient had a pack of ibuprofen next to her bed. She's already on 1200mg of ibuprofen daily, as well as a diuretic and an ACE inhibitor. The extra ibuprofen puts her at an increased risk of renal failure. Shouldn't you mention something to her?"

Rotter: "Well, Capt., as you know, there are many different combinations of drugs and we sometimes prescribe them."
Me: "I understand that Dr Rotter, it's just that if this were my patient, I would consider this to be a significant interaction."
Rotter: "I'm sure her doctor knows about it."
Me: "I'm pretty sure he doesn't, that's a supermarket-sized brand of ibuprofen."

Rotter: "Well, she's not my patient."

I was flabbergasted. Despite his rudeness, sleaziness and incompetence, for me, this line told me more about Rotter than anything else before. He was a mysoginist, reticent, moronic self-protector, who didn't give two shits about anyone but him. He was fired from the SoM soon after this clinical visit. Hopefully he's been deregistered by now.

Last Friday, I went for my first bike ride in about two months. It was probably a terrible idea to start with; I was hung over to hell from Half Way Dinner, and the temperature was nigh on 30C in the shade.

Still, I needed to do something and since study's off the menu for a while and I wasn't really looking forward to packing, I borrowed The Laser's bike and sweated out the excesses from the night before.

Rather than set a cracking pace, I eased around the Kangaroo Point Cliffs and across the Story Bridge, before turning for home along Riverside. I was pleasantly surprised at the vast numbers of people out and exercising. Especially as it was a weekday lunchtime. There were droves and droves; young men and women in sneakers and lycra, mums and their toddlers walking through the gardens, suits strolling the boardwalk to and from lunch, families picnicing. It wasn't a public holiday and K-12 are still in school; but the city was just alive! I'm pretty sure that I'm going to miss this aspect of big city life next year.

Next year the outdoors will be well catered for next year; I'm planning on finding myself a roadbike and clocking some kms. I'm working towards a few fitness milestones including having another crack at the Kokoda Challenge.

I'm also dedicating it the year of medicine. Study will be ramped up and, well, more frequent, regular goal-directed learning is now the priority. This medicine gig is something I want to be damned good at, not just a participator sailing through. The relative isolation of the Coast and the much smaller number of classmates is going to lend itself to more constructive work, and dare I say it, a bit of healthy competition.

Meantime though, the rest of this year's well mapped out, starting with the great European adventure, which begins today. I'll have some good stories in a few weeks, I'd say.

I don't write much on politics. I have many opinions on the matter, but, well, I'm not the most eloquent with some of my arguments. I love the democratic process, and I think it's pretty cool that voting's compulsory here in Oz. So, in the last twelve months, there have been four elections that I've been quite interested in. Three in the southern hemisphere, and given lip service by the international media, and one in the northern hemisphere which the world has watched with a microscope...

The first was last November the Australian Federal Election. Australia took a step to the left and voted to support K. Rudd and his 'working families'. I voted at the Australian Embassy in Vietnam, which was a truly novel experience. In the last twelve months, Kev's achieved quite a bit. He signed Kyoto within a fortnight of taking office, he's said 'Sorry' to the indigenous people of Australia for the 'Stolen Generation' and maintained his appeal to both the mortgage belt whilst still being, as Wonderwoman says, 'down with the kids'.

The second election of note was the situation in Zimbabwe. The opposition MDC narrowly beat the incumbent Xanu PF in the first round; but in the second round, amid reports of violence, kidnappings, false arrests and threats, Mugabe and Xanu PF were reported as the victors. After nearly a month. Ex-President of Sth Africa, Mbeki attempted, and failed, to facilitate a deal. The power-broking shudders and lurches 'forward'. Zim really is a nation in strife; its population are starving.

Thirdly, as most of the world is aware, on 4th November Barack Obama smoked home in the US. The laughable Sarah Palin did 'Maverick' McCain no favours in what should have been a much tighter race. America was ready for Change, and that's what Obama promises. McCain has been tarred by the brush of his exteremist colleagues, a necessity of them giving him any semblance of support. Obama has, in many ways, created new hope for Americans. Out here in Oz, there's a lot of talk about the guy; he's appears charismatic, a little unconventional, down to earth and direct. I'm more than optimistic about his role withing the global community, particularly on the back of pressing economic times. I hope that he can help to reform the US health system from it's current situation; it's absurd that a nation doesn't offer some of the most basic healthcare to all and sundry. A Change we need, indeed.

On Saturday the 8th November, as a result of the General Election, New Zealand took a leap to the right. The new National party-ACT coalition is, without a doubt, the most conservative in more than fifteen years. The centrist and leftist parties have been left out in the dark, and Ms Clark has resigned as Head of the Labour party. New Zealand, lead by mercurial Mr Key, in for a period of economic change after a well-engineered decade of social development (and, my brother tells me, near zero unemployment). As traditional 'early-adopters' of technology, this will bode well for the middle- and upper- classes, but considering the lashing the economy is currently copping from the global climate, it'll be a hard ask for those not so fortunate.

In summary, Yay K.Rudd, Boo Mugabe, Yay Obama, Boo US health system, and Hmm to NZ and the challenges it approaches. Hmm indeed. In the words of the Beastie Boys; Voters of the world.... Unite!

The Emergency Contraceptive Pill, or 'Morning After Pill', is a pharmacist-prescribed medication. The pharmacist ensures, to the best of their skills and knowledge, that the treatment is appropriate for the patient and dispenses it. Some features which would result in the patient being unsuitable for the MAP include age <>48hrs since intercourse and a history of other OB/GYN or endocrine abnormalities. These patients are referred to a doctor.

Many patients requesting the MAP are nervous or embarrassed; It's not an easy thing to ask for. On Weekends, there's maybe five requests a day. Most times, the patient is counseled and the drug dispensed without problems. Sometimes, it goes a bit... differently...

• It's Monday morning; a private school girl timidly requests the MAP. "It was Friday night." Hmm, that's more than 48hrs, so I'm going to refer you to the Doc next door... "But I don't have time to see the Doctor, I've got to do a speech in front of the whole school in like five minutes!"

• This one's happened a few times. It's some variation of a bloke walking up to the counter and he just casually says, "Yeah, g'day, just a morning after pill thanks." Sometimes, the lady in question will be in another part of the shop, but usually she's at work. In both situations, the bloke looks shocked when I don't just hand it over.

• A common change-up on the previous scenario is a couple where the female has a very basic grasp of english. This situation is always challenging; it's important she understands what she's asking for, and how it all works. Often, diagrams are the way to go.

• A girl in her early twenties strolls in, looking unimpressed. "I need the morning after pill." The story comes out that she has an Implanon(R); a subcutaneous progesterone device. It'd been working without any problem for a year. It had another year to go, at least. "The guy I slept with last night told me to get it; he's waiting outside." Welcome to one-night stand couples counseling and basic science. No egg means no baby. Irrespective of sperm presence.

• "My piercing cut the condom." Rookie mistake, I guess.

• A very nervous 16 year old girl sidles in. Like, really nervous. There's something not quite right about it; so I ask her straight out. Is this for you? "No; it's for my sister." How old is she? "Thirteen"

• So, have you used this one before? "Yeah" Is there any chance you are already pregnant? "Hell no! I've already taken it three times month..."

• A woman loiters around the counter for about ten minutes. She's short, and I reckon in her fifties. She asks for the MAP. When was the first day of your last period? "I guess, maybe four years ago." And before that? "About ten months, I think." Do you mind if I ask how old you are? "Fifty seven."

My Anatomy colouring book arrived in the mail. I bought it for myself to celebrate turning 25 and not having had a colouring book for around 20 years. I predict that I'll be slightly better at staying inside the lines this time. Or maybe not; those pictures are small.

Anyway, where I'm heading with this is that I was first introduced to the idea of an Anatomy Colouring Book when I was fifteen and studying 'Human Biology' at high-school. Specifically, I remember being told by teacher about it being used to train medical students. At the time I thought, hey, that's really cool. I want to do that. But the part of the memory that is the strongest is the teacher himself.

Mr T was both a science teacher and our yeargroup's dean. He loved the outdoors and could tell a story. He, like most of my science teachers, was into performing odd experiments that would get us out of the classroom. They might involve walking up and down steps so we could calculate how much actual 'work' we'd done in an hour, or holding a member of the class upside-down whilst he drank water through a straw to illustrate the difference between pressure and gravity.

I was a tad saddened today to discover that the first pharmacy I worked at is closing (it was sold nearly a year ago to new owners). There, my mentors opened my eyes to some of my own strengths and weaknesses and gave me solid advice and suggestions on how to develop as a professional, both at work and in having a more 'professional' attitude to life in general. They also pointed my passions for pharmacy in the right directions, including how to provide the best level of patient care without sending the business broke.

So far in medicine, however, I haven't really had a strong mentor. The construct of the 'self-directed' curriculum, huge class size and disgracefully low hours of contact has meant that my interactions with clinicians have actually been quite limited. Moreover, at least two of my clinical coaches have been less than satisfactory. My most recent clinical coach received an evaluation from one student that read "Rude. Inappropriate." Which I thought was pretty gentle. A conversation I had with a colleague about him went like this...

Capt Atopic: "How'd you rate Dr. X on the evaluation form?"
TVOR: "I gave him solid ones."
Capt Atopic: "Out of five?"
TVOR: "As percentages."

One of my coaches from last year was so offensive that he'll be getting an entire post of his own. The long and short of it is, of the doctors I've come into contact with since the beginning of the degree, there have been three whose practice ideas, knowledge, behaviour and interest in teaching, as a combined package has been inspiring. I guess that makes me sound like a bit of a brat, but seriously, coaching runs for ninety minutes a week. My coaching groups have been cluey; we don't stand around like idiots and we know what we're there for. We're excited to learn; we want teaching!

A few days ago I was talking with my grandfather about mentors. He mentioned several from different stage of his life; noting that in some cases a mentor doesn't have to know they're even in the role. Their behaviour and ideals just seem to rub off on you. We also discussed, at length, the role of teachers in the formative years. My grandfather listed a number of qualities that good teachers help to instill in us. The list included the following;

respect and concern for others

compassion

loyalty

anger at injustice

love of life

By the time you hit medical school, many of these characteristics should be well installed. Some other traits are essential to be a good clinician; these include decisiveness, ability to work in a team, to listen, to prioritise, to remain ethical and to rise to meet adversity. A mentor should challenge you, should draw out the best in you and pass on the 'little secrets' of medicine.

The 2008 AMSA Intern and Resident's guide advises budding young docs to "Hang your hat on a star." Find a consultant or registrar that inspires you, whose style you like and who makes you want to be better at what you do. Mentors are important characters to have around, especially in those formative clinical years. To put it bluntly, I'm in the market for one.

This is how the last day of pre-clinical classes finished. Huzzah!

Last time, I wrote about moving from just being able to make simple decisions to more complex situations, and how we become more comfortable with making said decisions with experience and confidence.

With experience and time, one operates at what is essentially a higher level of thinking. The majority of questions are essentially 'no-brainers'. You're flying on autopilot, you do the safety checks and keep zooming along. Being aware that you're on autopilot is essential, because then your sensors are on; if a warning pops up; you'll notice it.

When you're unaware is when danger strikes. My pharmacist colleagues agree that the most dangerous phrase in pharmacy is "That's fine." It's so easy to say that you barely notice any of the surrounding warning signs. A good example of this would be a shop assistant asking; "This bloke's on Coversyl(R). Can he take Nurofen Plus(R) ?" You glance up, he looks about fifty. It'd be very easy to say 'That's fine', and that may well be right. But, has the pharmacist considered: a) What strength is the Coversyl(R)? It's seldom prescribed alone in the higher doses. b) Diabetes? c) Diuretics? d) Renal failure(!), e) What's the Nurofen Plus(R) for? and so on. It's important to think about, if it's a fast, effective consideration of the information, then so be it. Just because you know the odds, doesn't mean you need less information.

Sometimes a situation arises that requires faster or more complex decisions, or both. These are stressful situations, where if your basic game isn't sound, you're most likely to wobble or screw up. Or get flustered. When this happens, it's essential to keep cool and revert back to first principles, because they don't change. One of the first pharmacists I worked with said to me;

Capt. every time you look at a 'script, read out the name, doctor, drug, strength, quantity and directions out loud. It can be in a tiny voice in your head - just make sure you say it. Don't stare at it. Say it. Say it once for the original, once for the label, once for the box and once for the repeat. If you do this every time, you will never make a dispensing error. No matter what else is going on in your life, all you have to do is say it out loud.

This is possibly the best advice I received as a pre-reg. Obviously, there's not a lot of reasoning happening when you check a script. Clearly, though, it's essential to be able to perform the core tasks. In Medicine, clinical reasoning is one of these tasks. Your skill in weighing the relevance and mechanisms behind this information is key. Sometimes there will be huge amounts of information, much of it conflicting. What to do first? What about the Sodium channels? What's with the tachycardia? (Flustered, much?) How to prioritise?

With no formal clinical experience and not much direction, it's an ongoing challenge to sort the sweet chocolaty goodness of information from the other brown stuff. And it seems sometimes that one can morph into the other without a moment's notice. Again, Murtagh's General Practice has come to the rescue; the first page of the emergency care section states;

1. The practitioner must be aware of life-threatening situations.

Gold. After seeing relatively sparse numbers of patients to this point in medicine, all of which had multiple, complex comorbidities and were managed by various specialist teams, this single sentence really crystallised what's most important; to simplify. Work out what the primary complaint is, and then everything else. On the myriad of information to be processed, I was offered this salient ray of light by one of my Docs;

In medicine, you only have to think about one decision; the next one.

And that's what I will remember; Remain unflustered and simplify.

Some people are always in a rush. The smallest thing becomes a huge problem. Everything is busy, they need to be somewhere, like five minutes ago. They can't sit still for more than a few minutes; there's always a question or directive on the tip of their tongue. Their manner spreads panic and uncomfortableness. And, when they leave, things are tense and agitated. The situation disintegrates. They are, in short, forever rattled.

Some people are never perturbed. They're so under control, they're relaxed in really stressful situations. Things appear to be a breeze, and the closest they get to really stressing about something involves the brief interjection 'Hmm' at the start of a sentence. The answer comes in good time, and it is well considered and comforting, it assesses the present, appreciates the past and plans for the future. They are, in short, unflustered.

When I first began team sports everthing felt like a rush (except fielding at cricket, of course). I'm a pretty keen sportsman, and, well, I'd put myself at above average coordination. Still, until I hit the age of nineteen I never felt like I had time on the ball. I was competent at drills and training, and now and then I'd have moments of serendipity. Generally, though, I'd marvel at my colleagues and 'the time' they had over the hockey ball, or at picking the gap on the rugby field. I could still do it, but well, things felt rushed. Most average sports-people have the set of issues; taking your eye off the ball, fumbling under pressure and the like. By second year Uni, my sports skillset had changed markedly. On the hockey field, many of the blokes I played against were a bit older (they didn't chase young 'uns), and I didn't feel pressured in the way I had at school. I matured as a player and had more time on the ball. I still ran around as I always had, but thanks to some sporting self-confidence, I could think about where the pass was going or 'hold up the ball'; I began to enjoy my hockey much more.

When I started as a pre-reg pharmacist, I went red a lot. Not at home mind, and not when I was doing mundane work like stocktaking. Only when I was doing 'Pharmacist' jobs. If there was a line-up of 'scripts, or making a cream or even selling paracetamol, I would turn crimson and get my mist on. Comparatively, I almost never went red when I was talking on the phone to patients. I rarely felt 'flustered' as such, but the apparent physiological response indicates otherwise; still, I didn't go about my business in a mad rush. As I approached Registration, I realised the flushing had gone. I rarely needed to look up doses and I could pick OTC drug-drug conflicts at thirty metres. I knew the answers to questions about Warfarin and other relatively complex interactions, and was able to rationalise the steps to each solution. Explaining concepts like blood pressure and allergies to Joe (? the Plummer) became part of my everyday thinking and communication style.

This post is the first of two in a series on Clinical Decision making. Predictably, making clinical decisions is one of the most challenging aspects of early practise in both medicine and pharmacy. Being able to weigh up the information for relevance and importance, then act on it. With time and experience one develops knowledge and understanding about the decisions they make. One must still remember the facts and reasoning behind their advice, and apparently, the more decisions you make the less red you turn!

This morning there were about a twenty Anti-abortion protesters outside my medical school. Now, I'm used to seeing protesters on my way to PBL. There's usually one or two camped outside the local clinic, a few blocks away, holding their signs and getting cars to honk. Not many cars honk. But protesters outside Uni was something entirely different; they were coordinated, and chanting and really waving those signs with enthusiasm. Ironically, we were learning about STIs, hydatiform moles and the like. These protesters annoyed me, not just because their loud chanting disturbed my learning, but also because they're pushing their views onto other people.

Of the women I know who've undergone a ToP, none of them did it lightly. They are aware of their choices, and the options available aren't ideal. There is much guilt. They don't talk about it freely. Each week when I drive past the old, stagnant men, shoving their placards at the women who've made their choice, I get cranky. These blokes have no idea about the woman's circumstances. They're simply hurling abuse and idealistic viewpoints at a vulnerable young women. It's always good to kick someone when they're down.

What winds me up is that is that the people harranguing the patients are invariably men. They haven't been in this situation; they don't live with the consequences of their point and shoot activities. If they have endured some semblance of the emotional turmoil involved, they'd sure as hell have some sympathy.

I appreciate that abortion is not an operation that should be performed 'on demand'. It's not a form of contraception, it's not the 'morning after' pill. ToP is morally serious. The moral debate centres on the rights (if any) of a foetus vs the rights of the woman.

There is currently public debate about the issue in Victoria. Pending a vote in the Upper House, abortion will be removed from the Crimes Act. Currently, as with most Australian states, in Victoria "unlawful" abortion is illegal. However, "The “Menhennitt ruling” (as mentioned by de Crespingy and Salvulescu,) stipulates that an abortion is not “unlawful” if a doctor believes that the abortion is necessary to preserve the woman’s life or her physical or mental health. The upper limit of gestation is undefined."

Some doctors and academics have vociferously opposed the changes; One doctor has placed the a sign at the door of her surgery announcing that she will not be complying with the new laws. How does the new law effect doctors? Two main points; firstly, that abortions may be legally procured before 24 weeks. The opposing doctors argue that the cut-off should be twenty weeks. I don't consider myself informed enough to argue one way or t'other on this point.

Secondly, the opponents argue that the bill does not adequately deal with doctors whom object to abortion on moral grounds. In medical school, we are taught that the patient has a right to be made aware of all their options, and if a doctor is unwilling to refer a patient for a ToP, they should refer the patient to a doctor who is willing to explain all possible options. In this way, the patient's autonomy can be fully exercised. The opponents of this Bill appear to not currently do this. So, do they believe paternalism or patient autonomy, or even womens' rights? Hmph. Isn't it good to see how times have changed.

As far as those protester blokes at the clinic go, I enjoy imagining someone lobbing eggs their way in a drive-by. I doubt they'd get the irony.

---

Some other resources:

Abortion: time to clarify Australia's confusing laws, Lachlan J de Crespigny and Julian Savulescu, MJA 2004; 181 (4): 201-203 http://www.mja.com.au/public/issues/181_04_160804/dec10242_fm.html

The house up the road from mine just got hit by lightning. The storm that's been threatening all day came across an hour ago. I knew it was coming, not just because of the weather and wind warnings all over the TV and radio, but also because my sinuses have blocked up and I've been clenching my jaw all day in an effort to clear out my ears. Fruitlessly.

The pounding headache that's ensued has given me sufficient excuse to procrastinate, culminating in sitting outside for the last hour watching the heavenly fireworks that were previously South-west of here, and are now overhead. The international match between the Socceroos and Qatar has even been delayed.

It's the first major storm for the Queensland season; it's hosing down and the sky's like a strobe flare. Despite being well after dark, the orange electric glow hangs across the skyline and that crackly feel dances on the skin.

The electricity in the air reminded me of a similar storm a few years ago; in Pre-reg. Mr Wills had been an off- and on- patient for nearly a decade. He'd travel past about four other pharmacies and pop in for medications for himself and his housebound wife. He wasn't a big talker, Mr Wills.

On this particular day in October, the storms had been forecast to hit in the afternoon. It was midday and, much like today, the air crackled and fizzed. Mr Wills waited patiently for his 'scripts and the sky opened.

When the meds were ready, I handed them to Mr Wills in a plastic bag, and he mosied through the now pelting rain to the bus-stop about fifteen meters from the pharmacy door. A few minutes later, Mr Wills stumbled back inside. He'd missed his bus by a full forty seconds and the next one was due in three-quarters of an hour.

It was a quiet day at work; for some reason, the hail, drenching rain and lightning were keeping people away from the pharmacy, doctor and shopping in general. I conferred with the boss and ducked out to fetch the delivery car.

All the way to his house, Mr Wills and I had a good chat about his family and the area and all that sort of thing. It was a very different side to a bloke who was usually so quiet. He warmly thanked me as I dropped him off. I low-geared the deliver car out the muddy driveway, and headed back to the dry, quiet, pharmacy.

In the meantime, tonight's storm has begun to subside. The lightning's fizzled out and the rain has eased. Australia won the football, 4-0.

Academic institutions are well known for their amazingly frivolous and ineffectual expenditure. Mine is, of course, no different. Here in Queensland, we are party to twin, equally brilliant wastes of money, the Turkey Patrol and the UQSoM Balloting process.

UQ has a resident population of Bush Turkeys. The Turkeys roam the grounds, scratching up their piles. To aid these wee bird, we have Turkey Patrollers. They're groundskeepers. The Uni kindly provides them with a ride-on lawnmower with a trailer. In the trailer is a shovel, a rake and a leaf-blower.

The Patrollers' job is to clean up the piles of bark and leaves that the turkeys scratch into mounds and piles across the campus. On the roads, footpaths and walkways, these mounds ebb and flow. A constant battle between the anarchistic Turkeys and the orderly Turkey Patrollers. Funny to watch; preposterous to pay for. Especially the leaf-blowers.

A few weeks ago, I posted about the impending Clinical Rotation selection process. This week, a nightmare has, for some, come to fruition. Gloomy fruition. People are wandering around PBL in a daze; to stressed to study. But why? Whyyyyyyyy?

About a month ago the SoM proposed an electronic method whereby my colleagues and I could harmoniously select our Clinical School preferences for next year. Distance wise, there's about 800km between the two furthest Clinical Schools (CS), so it's not a small division. Each CS had a chance to promote itself, and then for a while, nothing happened. We were supposed to log on one day and have it all be wonderfully peaceful and collaborative.

What actually happened was *quite* different. Instead, the SoM reverted to a paper format, and asked us for three preferences. After two chances to change our preferences and a butt-load of wrong information, we were told the final time to change by. For this last change, only changes into the Rural School would be accepted. Next, it was announced via email that all students should have their mobile phones handy for the next few hours, as it would be necessary to allocate some students to rural locations. And, with all the transparency of obsidian, a ballot occurred. The entire class was tense, nervous and frankly, either treading on egg-shells or trawling facebook and the UQMS forums for information. Woe betide he whose phone rings.

And with that, it all began. 370+ Med Students scratching around for information, feeling like turkeys.

At about 9.20pm, I was out at dinner with Batman and some others, and the word came from Lickety-Split (c'mon people, haven't you seen My Little Pony?), that she had been called by the SoM. It went like this...

SoM1: "Hi, this is student rep. from the SoM. I'm really sorry to inform you that your preferences have been filled and you've been balloted. You choices are; Tinytowns one, two and three."

LS: "What? I can't go rural... that's not fair. Ow."

SoM2: "Hi, this is staff administrator person, your choices are; Tinytowns one, two and three."

LS: "Can I find out where my friends are going, or who else is going somewhere?"

SoM2: "Absolutely not. We cannot provide that information."

LS: "Well, I have The Laser sitting right next to me, can you tell me where he's going?"

SoM2: "No. That would breach privacy. Have you made a choice?"

LS: "I have to decide now?"

SoM2: "You've got five minutes to decide before I call you back." *click*

About 90 seconds later, Lickety-Split's phone rings again.

SoM2: "Okay, so have you made a decision?"

LS: "I'll take tinytown two, I guess... but... what happens now?"

SoM2: "More information will be provided in the next two days. Goodbye." *click*

Ridiculous. I guess, if you're unfamiliar with this kind of situation, it's pretty hard see what all the drama is about. For most people, their first preference is likely to come through...

In the case of some students, there's a very real possibility of people with spouses, families and mortgages getting sent somewhere they didn't bargain for. And people with three+ years of a relationship, apparently counts for nothing. Ditto organising any major Med.School-related events. Goneburger.

Also, in Australia, if you've flown the nest, you need to earn to learn, unless you're on loads of scholarship money. Being put in the situation where you've gotta relocate or drive for an extra 3hrs a day can reduce someone's ability to go to work., and relocation provides substantially more challenges. The SoM geneously pays the rent, but you've still got to have the cash to drive, clothe and feed yourself. Sensible, right?

No one has any idea what's going on. Everyone is stressed about missing out on their choices and the process feeling well out of control. This is most unwelcome for us med-school-types who like to be in the driver's seat. Raw emotion runs riot!

Ironically, the people getting shafted are those who expressed the biggest desire to remain metropolitan. Lucky sausages like me, who put Coast, Rural, Rural didn't get a call to say, "Sorry, it looks like someone needs to be closer to the city than you... Are you okay with your second preference instead?" Far too diplomatic for the SoM's liking.

I was intending on finishing this post off by detailing my plans, complete with a celebratory smiley face, but I can't, really. There's two reasons for this; firstly, the announcement has been delayed until next Monday, and secondly, despite my first preference being reportedly under-subscribed, I still have this sinking feeling that I'll get the shaft to Woop Woop (and not in the method as for 4.). As my previous post will contest, I'm actually unopposed to going rural - finding a job being the primary challenge. It's more that the School would be saying one thing and doing another. Right now, I'm sitting as pretty as possible; I really feel for my colleagues who are getting swept into a sea-change by a king tide.

Until next time, then, when my plans may indeed be revealed! Meantime, I'm going back to watch those Turkeys.

Something that strikes fear into any medical practitioner are Errors and Mistakes. In their worst form, Mistakes can kill people. Mistakes can end your career. In their gentlest form, a Mistake saps your confidence and brings self-doubt raining down on your every clinical decision.

On the Medical/Doctoring front, I'm yet to make a mistake. This is because I've not yet had one iota of responsibility in this setting. Comparatively, in Pharmacy I have made mistakes. From a purely mathematical point of view, it would be nigh on impossible that I haven't. Today, I'm going to discuss a some of my 'errors', and how they fit into the context of both medical and pharmacy practice.

My first error of the dispensing kind was aged 12. I was organising a basketball team, and I'd typed out a phone list and distributed copies to all the kids in the team, so we could find out who was playing each week. Unfortunately, despite being captain, I was never contacted. I had unwittingly swopped the last two digits of my phone number on every sheet. I guess I didn't read my own number, if I read it at all!

More recently, I was due to attend a mate's Birthday Dinner after work. I was planning on swinging in for a full ten minutes before crashing out at home, as I was working a marathone weekend. I'd spoken to the guy a few days earlier, and he'd sent me a text with the restaurant's details; King of Kings. I parked in the Valley, and strolled to Chinatown. I looked inside and couldn't see any of my friends. I phoned him to discover that he and the crew were at King of Kings in the City - about 15 minutes away. I went home to bed, quietly pretty cranky at myself.

Basic 2: Communication between pharmacists, pharmacy staff, doctors and patients is essential in reducing mistakes.

Mrs Watson answered the phone. Thank goodness she was at home. I asked if she had the box with her, and she says, "Yes, yes, it's right here." I checked which strength it was; the wrong one. "Okay, don't take any." I asked if she was going out in the afternoon; she wasn't. I explain that I need to get the medication somehow...

A few years ago, I lived a pretty slovenly flat, in which the cooking was quite sporadic. One night, my flatmate cooked a delicious Thai Green curry. Yum! After the meal, the dishes accumulated as they always do; about two weeks later someone decides to do the dishes. Lastly, the dishwasher gets to my rice cooker and reveals a pungent green mess of mould, rice and some sort of orange fetid water. There was gagging. It was stuffed. I had seen the rice cooker there for all that time. I'd even thought, "I should clean it up." But, hey, it wasn't my turn. Someone else would do it.

The three non-pharmacy incidents I've mentioned merely annoyed me. I felt dumb for making a silly mistake, but I knew that it wasn't anything more. I may have even looked stupid. Whatever. But a mistake that potentially causes physical harm and/or loss of life, that's a different story. Whilst the majority of pharmacy mistakes aren't clinically significant, when your job is to make sure errors don't happen at all, it results in a bit more self-reflection.

Last weekend was the Australian Rules Grand Final; it's one of those odd sports that one country is obsessed with and no-one else plays. Like American Football or Jai-Alai. This year, the underdog Hawks upset the incumbent Cats in a gritty match. My team, the Sydney Swans were bundled out of the finals with two rounds to go, finishing a credible fifth.

In AFL, there's a 'five-minutes remaining' siren for each quarter.

Since final exams are fast approaching, this is my five week siren. These are what the SOM calls 'Hurdle exams', and they're the summation of all the pre-clinical years. They will be the usual pair of three-hour writtens and a marathon OSCE (called MSAT in this neck of the woods).

My guess is that blogging may be a tad lighter for the next month and a little bit... but don't worry, I guarantee at least one story a week!

I well remember the words of one Pharmacist I worked with during my pre-reg. She was a mother of two kids under five, and when it came to kids, mums and the like, she knew her stuff. She was also a wee bit into the natural medicine, but not in a complete hippy way, more in the educated, professional, informed opinion way. Anyway, we were talking about medications for kiddies and pregnant mums and she said;

A few weeks ago, I found myself explaining how homeopathy works to a med school colleague. Here's how it went;

So, in homeopathy, there's two principal theories; Firstly, that like cures like, and secondly, that a little does a lot. For example, to stop vomiting, there's a herb called Nux vomica which is in most of the anti-vomiting homeopathic preparations. Nux vomica is derived from the Strychnine plant, which in typical doses acts as a laxative, a poison (that makes you vomit), and well, it kills you. But, in these preparations it's diluted; invoking both priniples of homeopathy.

The ingredients are typically listed on the pack with a strength along the lines of "Each 2mL contains 2microL of each: Higgildus pillgedum 6X, Randomus plantium 5C". The C and the X mean that the ingredient is diulted by 100- or 1000-times, respectively. On top of the initial mircoL/mL dilution.

So, roughly from these numbers, we've mixed all these herbs together, then taken about a gram of the mix and thrown it into the middle of an olympic size swimming pool. Then, we fill the swimming pool with water and alcohol, and stir. Next, we take a sample the size of a shot glass and tell the customer to spray about 0.5mL in their mouth.

Now, I'm not one hundred percent sure of the properties of this stuff, but a quick and fanciful calculation using Avagadros' number would show that there's almost no chance of any molecules (other than water or alcohol) being in that spray. Call me crazy.

Recently my mum, a teacher, related to me a story whereby one of the pupils in her primary school, was receiveing 'homeopathic' injections for ADHD. This worries me most of all. Surely the negative psychological connotations of a needle in the arm, (or bum, or whatever,) far outweigh and possible placebo effects. Who knows what's being injected into the poor kid; not him, that's for sure. What of the risks of an infection due to poor sterile technique and skin puncture and pain? Or the pain? It's so highly dubious it's not funny.

I've had an interesting run with Methadone patients recently; I've been threatened, abused and generally spat at by 'Regulars'. Don't get me wrong, I'm a strong advocate for the Methadone/Suboxone programme. On top of the typical attempted manipulation and deceit, I've just had some slightly more confronting stuff than usual; the kind of nonsense that tests your patience.

Firstly, though, here's my two cents. Methadone's an essential harm-minimisation tool, which I firmly believe makes a difference. It's seriously important in rehabilitation and addiction medicine that these patients have an avenue for supervised dosing. I appreciate it's pretty good of the owners out there to cop the associated theft, admin hassle and associated stresses, because many people wouldn't give some of these characters a second look. In my first year on the job, I saw at least one person get completely clean. For me, that was enough to justify the programme; if I owned a pharmacy, I would take Methadone/Suboxone patients.

So, a few weeks ago, the regular shows up. He's pretty calm, as per usual. In fact, the area the pharmacy's in has a distinctly relaxed, holiday feel to the place. He was wearing clothing with an extremely offensive message emblazoned across the chest, arms and back. I suggested that he would be unwelcome the next time he wore the shirt, and gave him his dose. He complained quite bitterly, in most colourful language, that we were discriminating against him (highly ironic, considering the shirt's message). He did, however, apologise to my boss the next day.

Of course, few incidents end with anything even close to an apology. Today, for example, I took a call from another client. Not a nice guy. He used to collect his dose up until last week, when he was banned from the Pharmacy, for reasons I'm unaware of. He phoned to ask if he could get his dose. He wasn't pleased to hear the answer, and swore blue murder down the phone. Here's hoping he doesn't try to come in later today.

These events have reminded me of an incident that happened a few years ago; a regular patient was getting miffed. I think he'd missed a few doses, and as there are restrictions on how many you can miss, his dose was declined. Just to aid in negotiations, he grabs the receipt spike , jumps up on the counter and lunges at the shopgirl. She's fine. He wasn't dosed that day.

And, just to cap it all off, there was a drugs-but-no-cash armed robbery about 800m up the road last week...

When I was offered a place in medicine, my boss predicted that my style of pharmacy would change markedly. He predicted that I'd move a lot more toward self-management of many conditions, that I would maintain patients on OTC medication, and that due to an enhanced knowledge, I could throw caution into the wind...

Half of the prediction was true; my pharmacy style changed markedly. Far from taking risks, however, my style, as such, has become more conservative. How did this happen?

At pharmacy school, we are indeed taught to refer conditions which fit the following; a) conditions which require obvious treatment by a doctor, b) anything we can't diagnose and c) symptoms that may have variable causes, one of which may be dangerous. Thus, sticking to these rules hard and fast in your early practice will make you a safe pharmacist.

Once you hit the workplace, though, things change it up a little. Safety, of course, is paramount. But the patient in front of you wants an answer and a solution. Now. Your experience adds up, and you know what's probably wrong and even how to treat it. Oftentimes, the patient might not understand the gravity of the situation. This is pharmacy's greatest challenge; often you're telling someone that they're seriously sick, but that you can't tell them what's wrong. If the patient has some odd symptoms, you might choose to treat them if you're convinced that all is safe and well.

Medicine teaches an entirely different kettle of fish. We have drilled into us that safety is in the understanding. According to Dr Murtagh, we adopt five principles; a) what's likely, b) what's deadly, c) what's often missed, d) the seven masquerades and e) what is the patient trying to tell me? As students we are taught to always consider the worst case scenario.

Consequently, that's exactly what I do at work. A good example unfolded last weekend; a middle-aged patient presented onchyolysed fingernails. She hadn't seen them for two months thanks to her french tips. Usually, I'd be thinking fungal infection, but two days earlier, I'd read up on thyroid exams. It seemed like it could be a case of Plummer's nails. Plus, she was in the demographic for hyperthyroid. So, I suggested that perhaps she'd want to see a doctor... just to check it out.

Ironically, my boss' prediction was in fact the opposite; my style is now much more careful, and markedly less maverick. Far from throwing caution into the wind, I'm hearing whispers of warning through the breeze.

Presently, my year group is in the process of selecting rotations for our final two (clinical) years. This has resulted in a heap of complaints and uncertainty and general bitchiness in the direction of the administration. This surprises me very little, as the general consensus from the students is that the admin couldn't organise a shag in a brothel. So, the crux of this post is to discuss some of the options for years three and four, and what I'm gonna do.

Option 1: Large Metropolitan Hospital (LMH)
This is the hospital I've been at so far. It's big, super specialised, and the 'promotions officer' from the Uni said that it's for those students who appreciate 'Self-directed learning', and may or may not be looking for research opportunities. The Paeds hospital is attached next door, and, well, every speciality is covered. General reports are that the students do lots of watching and not much doing; there's a lot of competition for the little things. Still, I can live in my current house, and still work all the same jobs; I'm well set up. I guess my concern here is that LMH I'd get lost in the buzz, and not get the chance to do anything in the first place!

Option 2: Conglomeration of several Medium sized urban hospitals
I'm somewhat familiar with these hospitals; the group I'd look at more seriously than the others are variously 10, 20 and 50 kms from my current house, all against the flow of traffic, but still within the city limits. Just. They have variously different reputations for patient care and relatively unremarkable teaching records. Summarily, they are all close enough that work etc., wouldn't have to change, but there appears to be quite a bit of changeable travel involved, particularly for certain specialities.

Option 3: Regional Hospital, Coastal location
This hospital is just over 100km away from my current house, and would involve a relocation. No dramas, though, because it's 100km closer to one of my existing jobs, where I can get more hours next year if I want 'em. Obviously, 100km isn't too far to head into the city every now and then. Plus, it's by the beach. The location itself has a population of several hundred thousand, and is rapidly growing. The clinical school is only a couple of years old, and I think because of the size of the school, it's quite close knit.

Option 4: Rural Hospital, semi-coastal.
There are two choices in this category; both towns are around 50k people, with all the kinds of services you'd expect. The clinical schools there have pretty excellent reputations; their by-line involves teaching not "medical students", but "doctors in training", and they have high practical involvement from an early stage. The Uni also reports that Rural students get better marks. The drawback? Well, the schools are 350 and 650 kilometers away, and that obviously requires a relocation and finding a new job. But, rent is free for the whole year! And they're nearly on the coast; just a short bike-ride...

Option 5: Regional Hospitals, inland.
This town also has a population into the several hundred thousands; and the Rural School is based there. It is, in fact, the best established non-metropolitan school, and has a very good reputation for teaching. It's also over 150km inland, and for my mind, not quite within striking distance of the City. Rent is free here too, and I'd need a new job. This school will be very popoular with the large number of students from this area, and hence oversubscribed.

What about my priorities? My requirements are such; I want a well rounded, semi-didactic, hands on education. I need to earn to learn, so work is essential - free rent would certainly take some of the heat out of this. I don't want to get stir-crazy; so ample opportunites for leisure and headspace in the few hours off each week will be relished; for example swimming, walking, maybe even team sports.

When I began Med, I envisaged spending all my time at LMH, but after two years there, I'm read for a change. So, given that I'm prepared to step outside my comfort zone, what next?

The regional, inland hospital holds no appeal. I like the beach, and I'm not that keen to choose a school I don't really want that will be oversubscribed. So that's out.

The urban conglomerate is a safe choice; no moving, a bit of travelling same job. What of the teaching? It seems like a slightly diluted version of LMH. I'll make it my safety option, I think.

The regional hospital on the coast is the most promising; work's already laid on, and the school's new yet promising reputation make it a good choice. The beaches and local national parks are fantastic, and rent is at least $30/wk cheaper than the City. I could head back for social events as required; I know the drive pretty damn well.

The rural schools also hold some appeal. The teaching reputation is widely touted, and colleagues in previous years speak very highly of the experience. Free rent is a big hit too, and would ease the pressure of finding a job so quickly. The tyrrany of distance will be the main challenge; I'd barely see my friends at the metropolitan schools.

After some firm thinking and discussion with Batman and other friends, here's my list:

1. The Coast
2. Rural
3. Conglomerate

Now all I have to do is wait for the results...

Firstly, like movies, everyone knows a little bit about medicine. We are exposed to it every day. There are blockbuster movies, like (urgh) Titanic. Hence, there are also blockbuster illnesses such as Cancer and Cardiovascular disease each account for a third of mortality in the developed world. In addition to this, the factors comprising any disease (movie), are infinitely complex, and can be studied down to the most minute of aspects. For example, a possible topic for a thesis may involve a tiny fragment of a receptor on an obscure cell. Much in the same way that one might know the birth place and date of the chief sound engineer on the movie My Best Friend's Wedding.

Some people enjoy specific genres. Some do horror, some do action, others art-house, documentaries or even cartoons. Think trauma, emergency, tropical medicine, research and pediatrics. Every now and then, actors try something from another genre, even playing minor roles. De Niro did The Godfather, De Niro also did Shark Tale. Hence, actors/doctors find the what they like and they're good at. Sometimes a doctor may switch into admin or policy making, in the same way that Tom Hanks did My Big Fat Greek Wedding, or as Zac Braff did for Garden State.

The endless journals and magazines about Medicine detail advances in research, information, trends and reviews of current practice, just as Who, Ok! and Hello! Magazines let us know which actor's doing what and with whom. It may be professional, or it may be discussing the finer points of interaction (perhaps like a new drug's mode of action?). All this information is testament to the constantly changing face of the industry. In fact, some experts focus on just one area; they voraciously digest every scene in one movie or of one actor, memerise the finer points of their work and timing, in much the same way we have sub-specialists in medicine. Just as for the illness, often the ones who know the most about a movie are the ones that have watched over and over again. Chronic illness must be like knowing every line to a movie; you can predict where it's going, the finer points of this or that screen angle.

I guess the challenge to someone acting in a movie for the first time is to watch, learn and absorb the experience. I'm looking forward to clinical rotations.