Archive for Juli, 2014

Ikea: a place of couples

A large part of the otherwise perfectly lovely and sunny Saturday just gone was spent in Ikea. The new apartment needs a kitchen.

Whilst my husband animatedly discussed and finalised the details of the kitchen, I found my energy levels draining by the minute. Putting together an Ikea kitchen is a long and tedious process, with my interest only lasting to the point of choosing the colour and the surface material.

Aside from my physical presence, my contribution was meagre. My husband, apparently anticipating my uselessness, tried to keep me occupied with small tasks such as choosing handles for the cupboards, looking around the show rooms and searching for refreshment. Each task successfully completed, I arrived back at our work station, where our virtual kitchen was to my dismay, still being pieced together by my husband and the Ikea kitchen advisor.  At one point, I felt we must be close to the end, only to be told firmly that this was far from the case.

Later, as I was stating my growing hunger, my husband leaned over my way and pointed out a few of the other couples at the computer terminals around us. Apparently I was the only woman in the vicinity not taking charge of the kitchen planning.

Hmm.

This off-hand social observation inadvertently resulted in a cascade of further observations. Ikea is a place of couples in all stages of life: young couples holding hands and gleaming with excitement at the prospect of their first home together, more established looking couples, couples expecting their first child, young families, couples with teenage children and couples accompanying their grown-up child probably on the move away from the family home. In fact, the only rarity in Ikea is an elderly couple. And amidst all this coupledom, the interplay between each couple is unique, intriguing and seemingly very telling.

4 hours, a reverie into coupledom and an obligatory Ikea hot dog later though, we thankfully had a kitchen.

The newness of it all

This week I was reminded of what it feels like to be new on the job. After coming to consider my place of work as a sort of second home, it’s something of a shock to be the new one. The one who doesn’t know how everything works. The one who can’t seem to get a simple task done independently. The one who asks three times for directions to the same place and still manages to get lost. The one who doesn’t have any useful telephone numbers in her head. The one who doesn’t have a name badge yet and gets mistaken for the trainee. The one who introduces herself twice to the same person, because with so many new faces it’s hard to remember which ones you’ve already seen.

This past week has brought a lot of newness and uneasiness. But it has also brought a fresh look to things I thought I already knew and a different way of thinking and doing. And that can only be a good thing.

Amidst the newness of it all, the thing that stands out the most are the people who go out of their way to be helpful and who remain patient and cheerful, despite the tediousness of showing someone the ropes. I’m looking forward to paying it forward when I cease to be the newest member of the team.

Being new has some other more positive parts. My new walk to work is probably the nicest one I’ve ever had (quite aside from the fact that the last time I was able to walk to work was 8 years ago).

20140723-194939-71379718.jpgAnd as much as I will miss my old neighbourhood, the new one appears to be a place where fairytales come from (although the building below is sadly not ours).

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Surprising things about being a doctor in Germany

Working as a doctor in another country to the one you trained in is a challenging but overwhelmingly rewarding experience. Those of my colleagues and friends who did a stint in a developing country devoted themselves to the community and its people and made a contribution that I remain in awe of. They came back with stories of exotic tropical diseases and shocking trauma wounds but also of the frustration of having limited resources and not being able to help patients in the way they were trained to do. In got the feeling that they were mostly glad to be back in Britain, and being given the chance to practise medicine to a standard they were used to.

My switch from the national health service to a German hospital was in no way a culture shock. Aside from the initial difficulty of communicating in German, I felt instantly at home on the ward. My doctor-patient encounters were as expected and my management plans didn’t differ greatly from colleagues. There were of course several differences, many small and some big. Here are a few that come to mind:

The majority of German doctors prescribe using brand names rather than generic names: the rather fabulous sounding Belok Zok was actually the beta-blocker Metoprolol and the commonly used Lasix was just the plain old diuretic Furosemide. Even if you decide to prescribe using generic names, you need to be familiar with the brand names too, as nurses and patients are more likely to know just the brand names.

Common laboratory tests are often conducted using a different measuring scale (for example blood sugar is measured in grams rather than moles), which took a while for my head to get around. Simple differences, which all the same made the initial few weeks even more challenging.

The equivalent of the BNF (British National Formulary) for prescribing is the ‚Rote Liste
. The book itself is more the size of an encyclopedia, but the website is great.

White coats are pretty much obsolete in clinical practice in the UK, as they are thought to be nothing but a hygienic hazard. In Germany, you will not be acknowledged as a doctor if you don’t have a white coat on. More embarrassingly, you will often be expected to parade around in an unflattering pair of matching white trousers.

In Germany, graduating from medical school doesn’t automatically entitle you to the use of the title Doctor. For that you have to complete a research project (Doktorarbeit). Until then, you have to settle for being an ‚Arzt‘ but not a doctor.

The specialities are split up differently than in the UK. Psychiatry belongs to the Neurologists and is not a field of its own. Most general medicine specialists deal with the oncological care of the given organ themselves. For example lung specialists take care of lung cancer patients just as much as oncologists do.

You will spend almost as much time dictating detailed discharge letters as you will going on a ward round. The discharge letter is regarded as the visiting card of each hospital. And no German doctor enjoys writing one. There are urban myths of  doctors who successfully stashed away patient files in elevator shafts in order to avoid writing discharge letters, but mostly, it’s an unpleasant job which cannot be escaped.

There are no house officers, senior house officers and registrars in Germany (or foundation doctors and specialist trainees as they are called now).  This means you have to get used to doing pretty much all the jobs yourself, until you reach consultant level.

There are differences in ethical practices too. Recently, the law in the UK changed to make it legally binding for doctors to speak to patients/relative about their resuscitation status. To Germans, this newly enforced law would come as a surprise, seeing as it is common practice to talk openly about resuscitation with patients and relatives, whereas in the UK it is often seen as a purely medical decision.

Many more patients in Germany ask me about alternative medicine and herbal remedies than I was ever asked about in the UK.

In Germany, doctors are legally obliged to conduct a bed-side test of a patient’s blood group prior to transfusion before personally starting the infusion (and therefore assessing for any immediate reactions). This is simply another safety measure to prevent errors occurring blood transfusions, and although safety measures are in place in England too, this one isn’t. In some hospitals, doctors are required to hang up the first dose of an intravenous antibiotic.

Each state has it’s own medical governing body or ‚Ärztekammer‘. They are responsible for everything from licensing, accreditation, exams and learning opportunities. They too seem to follow the ‚Secret German customer service code of conduct‚, but are pivotal for the life of a doctor here.

I spent the first few months, (or if I’m honest years) stopping myself from saying the words „well in England, we did it like this“. I mostly felt that my way was better than the German way, just because it was the way I was brought up in the world of medicine. And change is difficult.

After 5 years of working in Germany (scarily, longer than my time in the NHS), I have come to value the fact that working in a different medical system allows a different perspective of care delivery and challenges the perceived norm. And sometimes we really should look to see what other countries are doing to see if we can learn from their experiences as well as from their mistakes, in order to find the best way.

Moving on

I have a few moves behind me: several times with my family as a child and more than a few times since. It’s taught me that you can make a home anywhere. That happiness can be found within the walls of any city. And that there are good people everywhere.

20140712-163843-59923329.jpgSaying goodbye is still never that easy though. And I think it might be getting harder every time.

On the bright side, a move away invariably means a new beginning. A completely new perspective to life, a chance to discover the corners of another city and the opportunity to meet people who will influence your life in a way you couldn’t have imagined.

A cardboard box of everything and nothing

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I’ve moved home many times in my life, but each move seems to bring more luggage with it. Having moved to Germany with nothing more than a big heart and a suitcase in each hand, retrospectively it was a simple move.  At least on an organisational level. The doubts I had about my ability to live, work and be happy in this country where the only things weighing me down.

This time, there are more than a few boxes, more than a few pieces of furniture and even a kitchen to move. Last night I started packing the things which mean the most to me. And from this big apartment full of so many things, the things that mean the most to me don’t even fill up one cardboard box. Neither are they in any way of any value to anyone except to me. A box full cards, letters, postcards, photos, old trinkets and my journals – bursting at the seams with programs, ticket stubs, little notes and all the un-edited details of my life. In other words: a box full of memories. Funny that.

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