A few nights ago, I had dinner with a dozen people I'd never met before. All were either at university, or completing post-graduate or post-doc work. We hailed from 10 different countries.

In addition to politics, sport and other religions, the conversation wandered to what each person was studying. The young-un's (and myself) could simply state which course we did, but the challenge came for those in research. Particularly, they had to explain their topic, why they chose it and how it was relevant and practical in the real world within a minute.

Additionally, the conversation (and explanation) was in English, the mother-tongue of only two people at dinner. The topics ranged from applying spin theory to neural association networks, to the solar treatment of waste water.

As a pharmacy student, I remember my frustration with a PhD student not being able to explain clearly the principles of Pharmacokinetics. This wasn't because they had savant-like intelligence (which I'm sure happens for some), but because English was not their first language. And seriously, some ideas require a very fine handle on a language, both to explain and to understand.

Unfortunately, I was the sole-monolinguist present at dinner. Whilst this didn't hinder the students' explanation, I was humbled. Clearly, one of my goals whilst en Suisse is to develop a functional level of French.

Long-haul travel is surely one of mankind's oddest examples of selfharm. Nonetheless, after several 8+ hour flights, almost as many hours in stopovers, I'm in Springtime Switzerland.

While "summering in Europe" is usually the stuff of decadence and holiday, I'm here for my Elective. I'm placed at a hospital in South-west Switzerland for eight weeks of Adolescent health.

Before that kicks off, however, the plan is to spend some time with Batman, who's been Medical-globetrotting for the last rotation, aswell as watching some Bicycle Racing in the Dolomites.

So, a few quick observations from the last week;

1. Sure, it's cool to have a soft-toy attached to your stethoscope, but if you only put it on for the exam, then maybe you're missing the point.

2. Exams. If you're in the final year of medicine, then a) you've done more than 100 exams in your life, b) they now closely mimic professional practice, and c) they're only looking to weed out the bad eggs. This means you shouldn't freak out at the word 'exam'.

3. If you can't speak the same language as the person serving you at a cafe, be prepared for the service to take just a touch longer. You'll be madder if the wrong food comes out, right?

4. Cycling Paradise as Europe is, I still can't understand why no-one wears a helmet.

5. Something I already knew, but was yet to see in action from a first person point of view, is the speed at which face-grazes heal vs. ankle-grazes.

6. When airlines lose your bag, they really don't care. Whilst it might turn up eventually, you're still stuck in the same clothes for two six days. Bad luck Batman.

Switzerland is a truly beautiful place in the Spring; wildflowers, waterfalls, azure lakes, snow-capped peaks and the ringing of cowbells. Next week, to the Giro!

About the time the last [Anaemic] post went up, I looked like this. I'd been in a crash at the local cycling club's criterium circuit and been knocked for six.

Keen cricketers and cyclists alike will appreciate that if a red, round ball goes for six, it's good. If, however, it's a red, hairy head getting smashed out of the park, well, that's usually a bad thing.

I took it - literally - on the chin. After unexpectedly slowing from 40kmh to zero in a matter of two meters, I sat dazed and confused on a cold black and white part of the road as cyclists variably whizzed past or stopped and asked are you all okay? I was in outer space. One bloke fractured his collar bone, I'm told.

The next person to ask 'are you okay?' didn't really expect an answer. He wore a green jumpsuit, and had a nice white van with sirens and flashing lights.

I don't remember much of the next part at all, aside from being schlepped up to the Coast Hospital in a C-spine collar and with a 16g cannula providing my sore head and neck (and, as I found out shoulder and leg) with morpheus sensations.

The DEM team poked and prodded me appropriately, fired good amounts of x-rays at my shoulder, ankle and brain and concluded that I was "within normal limits".

With the headaches presently being replaced by memory, thankfully, my noggin hasn't responded too badly to the abrupt 'Hard reset' it received. Touch wood.

This morning I'm sitting my Paediatrics exam, and from Tuesday I'll be reporting from my Elective placement in Sunny Europe. Stay tuned.

It's a week until my paediatrics exam. I've enjoyed the rotation tremendously; it's had the challenge of internal medicine, the wonder of babies and, above all, hope.

Hope is something that tends to be forgotten in hospitals; prognosis boils down to a chance number, a percentage, a fact. Of course that applies to kids too, but the odds seem so much better. A small difference now makes a huge difference down the track. Of course that statement goes both ways, but hey, I'm an optimist.

Paediatrics has been hard. In fact, it's been the most intellectually challenging and rewarding part of medicine I've done. Part of it, I know, is about gaining more experience, thinking systematically and broadly. The other part, I can't explain. The part that gets me out of bed in the morning and to the hospital full of beans (and biscuits). The part that finds me the energy to study late into the night. The part that gets me out cycling for hours at a go, not to avoid study, but to have a clear, sharp, focused mind when the books again fall open in front of me.

I know that, in the wide world of paeds, I have so much to learn. I want to learn it. I'm willing to take my time, soak up the experiences on offer, talk to kids, mums and dads, consultants and junior docs.

Paeds isn't about wolfing down a ginormous meal and digesting it, nor is it about finding a magic key to a hidden lock; it's a long, hard, intellectually and emotionally challenging road. I don't expect to wake up and be the best, nor will I get top of the class in this rotation, but I want to be good at this for a long, long time. I am ready and I am willing.

The last seven weeks has crystallised what I already know;

I want to be a paediatrician.

We can all think of doctors who are less than ideal. They might be rude or arrogant or uncommunicative. Recently, I was unfortunate enough to witness a doctor who is barely safe.

This doctor doesn't understand many disease processes they treat on a daily basis. This doctor doesn't understand the key points of presentations or what they mean or why, if untreated, the patient is in the deep end. This doctor cannot 'hand over' care of a patient to another doctor clearly, accurately or concisely.

The doctor concerned, lets call them Dr F, applies an algorithm to each diagnostic scenario. This approach isn't entirely flawed, in fact, it's often a good way to go, especially if you've got no idea what's happening and you have minimal experience. Importantly, every part of the algorithm needs to be remembered for it to be valuable. And you'd think that with several years of clinical practice under the belt, Dr F would begin to understand what is happening, and why it happens. I'm pretty sure they don't.

Several years ago, I wrote about the Clinical Creep. A jerk of a doctor, to be sure, but a very different beast to Dr F. Essentially, I think that my problem with Dr F is that despite their efforts to be active with their assessments, plans and management, they just seem to miss the point. It's a bit scary.

I appreciate that I'm at the bottom of the clinical tree, and Dr F is several steps above me on the ladder, but I'm just befuddled at how they made it this far. Thankfully, Dr F's superiors are aware of the problem. I wonder what will happen next.

Two teenagers are on the ward, same age. They dress similarly, have similar interests and are the same sex. They don't know each other from a bar of soap.

Both showed up with serious symptoms with potentially life-threatening differentials.

The first knew their symptoms were serious, the other suspected. The first was scared; properly scared. The second was quiet, contemplative. Both kids smiled, just once or twice, in spite of their condition.

The first was investigated and diagnosed with a relatively minor ailment. The second was also investigated and diagnosed with a similar ailment. Both need inpatient treatment.

The next day, the first is surrounded by peers vying for attention; oohing and aahing over the surrounding medical paraphernalia, the patient is cocky, confident, riding the attention. The second sits quietly listening to an iPod, reading.

As they both get better the first's mother says, "Can they go home yet!?". The second's mother asks, "Is my child safe to come home?"

Both go home, safely. The first with fireworks and ceremony. The second calmly picks up the overnight bag, smiles awkwardly at mum as they leave ward.

We all approach mortality with a different style. Our insecurities, however universal, manifest individually.

Mistakes rarely manifest as split second incorrect decisions. Sure, in Pharmacy, dishing out the wrong medication often involves a short, momentary, lapse of concentration where the deed occurs. But many other errors, as such, occur through misreading a situation over a period of time.

We often hear of a patient whose diagnosis was 'missed'. Often these diagnoses are not glaringly obvious. The picture changes over time; it's when there is a level of clinical dissonance the doc needs to rethink their diagnosis. There are many possible outcomes for any given constellation of presenting complaints.

These thoughts wafted into my conscious early this morning, about halfway through a cycling race. In previous cycling races I've been in, when the breakaway jumps off the front of the race, either you see it coming or can react fast enough to go with it. From this piece of information and the fact that my mind was wandering to medical errors, pharmacy and planning a blog post, all whilst racing, you would assume, right then and there, I missed the break.

But today's race was in the hills. Plenty of time to think whilst two young fellows managed to make the weaker riders do all the work, and one by one, we all ran out of puff. Then could they ride away to the victory, we other riders turning the pedals and going nowhere as they launch off to victory.

So, about the time I'm sitting on the front, mind wandering into fairyland and using my energy to maintain a decent pace, something clicks. This is where the mistake happens. For me, it was a cascade of errors; taking a turn at the wrong point, staying on the front too long, burning up energy earlier than necessary, not really concentrating of when to save or burn energy.

And, in fact, the vast majority of medical and pharmacy errors appear to occur the same way. As I discovered during my PharmSchool research project, the literature describes it as a Swiss Cheese model. Only when slices of Swiss Cheese line up, can a certain trajectory of error pass through.

In pharmacy, this is characterised by multiple procedures, checks and double checks for each 'script. In medicine immediate analysis occurs by peer-reviewed diagnostic and management plans; and retrospectively by Morbidity and Mortality(M&M) conferences.

In these meetings, clinicians analyze situations that are considered to be less than ideal, either for the outcome of the process. My previous impression was that M&M was a bit of a witch-hunt; a finger-pointing exercise. They're not.

In the ideal M&M meeting, the scenario is reproduced objectively, and the other clinicians challenged to think;

"What would I do here? What am I concerned about? What information do I need to gather?"

At a particular time point.

Decision making becomes much easier if you already have all of the information, and a 20:20 retrospectoscope. In real life, decisions are made much earlier, borne of necessity with the information available at the time. Often cases in the M&M meetings have a "swing point", where suddenly everything comes together, just like an episode of House MD. In M&M cases, that point is "too late". In near misses, that point is "just in time". In most cases, the ones that are well handled, that point happens well before the critical time. Long before the break has gone and the teenagers have ridden everyone to the ground.

Mistakes happen. The best we can do is to learn from them, analyze them, and try our level best not to repeat ours or others. But they happen. That's medicine and that's life.