Can i just support the theory of Aeffect threads being swiss cheese. Went out for the first time with a bunch of lads but somehow embarrassingly couldn’t climb at all. I was having to work unbelievably hard to get up the hill despite having completed 100 miles on the road 2 weeks previously.

My right foot felt really loose but they were new pedals so I assumed they had not been adjusted tightly enough and soldiered on. Luckily one keen eyed member of the group noticed that the right pedal looked totally loose. It turned out somehow the pedal spindle had cross-threaded. I have never managed this in 20 years of cycling and they are all of 3 rides old.

I have (maybe stupidly) ordered and installed another pair of Aeffect cranks and was very, very careful when threading the pedals. It is possible it was user error but I have never managed to do this in the past with SRAM or Shimano so will just have to see how it goes. Your story is worrying though..

I have a feeling what you are experiencing is a significant load of endorphins. There most likely is a short-term dopamine boost from this but not sure it will last longer than the feeling one gets when you jump in the sea then go home and have a hot bath. Once the body warms up the stimulation for the endorphins is gone and you are probably neurologically back where you were. Not to say these types of activity don’t awaken the senses though. I still prefer hot showers :)

Thanks for posting this. My sister has MS so very personal to myself. Great idea.

Using a jtek shiftmate with road levers and mtb cassette. Working well so far and much better for a mix of on and off road.

Hi
A very difficult question this. I would ask to speak to a cardiologist. You have a genetic condition that unfortunately puts you at risk of heart attacks much earlier than most. The beta blocker encourages the heart to beat in a rhythmical manner and thus more efficiently. It will limit your max HR though as, well, that’s what it’s supposed to do. I would say that if you are doing exercise then this will encourage a healthier heart although now you know it’s vulnerable I would stay under 130-140 as beyond this the coronary vessel blood flow may get compromised given your underlying atherosclerosis. You need to be able to get a fine medium of health-gaining without going over the top. Best to speak to a cardiologist though.

how does the stack on the new bike compared to the old? I had a bike fit yesterday and was very sensitive to neck pain and we couldn’t go as low as we wanted at the front because of this. If the stack is much lower then bringing the stem up 10mm or even 5mm might fix it.

4 days ago. FFS!!!!

http://singletrackworld.com/forum/topic/psa-garmin-edge-810-180

Doctor here: Get her to her GP’s! If it’s exercise-induced asthma it needs to be treated but could be a multitude of things. Over the internet diagnosing is not a sensible thing!

I don’t want to go back over what I have written before but the main thing I want to say today is that it is the specific jobs that are going to lose out way worse than others that makes the new contract so unfair. Hospital-based jobs are already awful rotas to work. This contract goes out of it’s way to target those same specialties that rely so heavily on out of hours work. These guys should be the ones recompensed the most and given the biggest incentives to be away from their family, life, happiness for essentially their whole career. We were all struggling on until this new contract came along. It now makes it untenable for the manner of work we are asked to do.

10% drop in medical registrar applications means hospitals across the country losing decision-making people through the evenings, nights and weekends. Same goes for surgical registrars, O&G, all specialties that have unpredictable and persistent patient flow. Out hospital are getting into trouble for trying to bully GP trainees into working the medical registrar rota despite them repeatedly saying they do not feel safe doing it and they are not adequately trained. Hospitals are desperate to cover these shifts already. I should say this is in Scotland and not actually affected by the strikes. Think what further discincentive will do to this.

Those arguing against us in this argument cannot understand what it will mean for their own care should they need to go to hospital during these times. You must understand this is personal to each and every one of us, doctor or not. I’m not sure we have got this message across enough..

It’s an XL A11y would you believe it! liking the angled fork holders though. Might work for mine!

…Or clinics…Or GP referrals…Or research…Unless folks actually want a health service without any of these things that Consultant’s tend to do better than junior colleagues!

This article below is the real game being played. I assure you the “physicians assistant can do 85% what a doctor can do” applies to basic tasks a first year post-grad doctor could do but they will never be diagnosticians and thus the argument is so misguided to hurt to see it on paper. I have worked with quite a few PA’s and they are excellent at manual tasks but they receive a fraction of the education we do and will not move on up the decision-making ladder.

This article demonstrates clearly the junior doctor strikes are about the future of the NHS. Maybe it’s time we all paid personal insurance? Hell doctors would benefit. Is that what we want? Doctor’s don’t think so.

How a Government can beat the BMA

We’re not saints or people who live in a vacuum without money. What I want you to understand is this is about making us work MORE weekends, nights and longer hours for LESS money and the government is using statistics that no-one, and I really mean no-one in the medical world believes concerning increased deaths for patient’s admitted on the weekend, which is incredibly complicated and literally **** all to do with staffing.

The beauty of it is the government knows it can exploit enough people’s ignorance about what the strike is really about to impose their plan, which is really about cheapening the NHS whilst making everyone work harder for less.

I’m not going to say anything more than there is a planned mass exodus to other countries to escape this Tory-inspired nonsense. Those who would vote for these very dangerous people will be laughing on the other side of their face when they can’t see doctors in A&E when they need them as there may well not be many left.

These are such grave topics and people like the posters above band about nonsense opinions as if they truly understand the way healthcare works in the UK. You may well get what you want and if you do it is what will be coming to you.

Actually this is about money. Global spending is sky-rocketing because we’re getting very good at keeping sick people alive longer. The patient’s I treat daily tend to have an average of 4-5 illnesses which implies they have very high medication and medical needs but also that they have very high care needs.

Funding of the NHS by itself is only part of the problem as were it purely to look after those with purely medical need then it might actually be ok. The problem is, so many patient’s can’t leave hospital to receive appropriate care as it simply isn’t available. If we get people out of hospital quickly into appropriate rehab or care beds or home with increased care you might reduce the workload of the NHS so much as to reduce most of the funding gaps. The problem is care is very expensive. So instead the nurses do it until beds are available. And we provide GP care in hospital because the patient is not unwell but something has happened to make their previous living arrangements untenable. The system as a whole is what matters.

Paying for these things is very difficult. We have a very negative view of taxation in this country as it’s seen as a way to exploit the common man. Government’s are not willing to have this discussion as people are so convicted that paying higher tax is automatically bad that they will almost guaranteed to lose the next election.

Those who feel the NHS is inefficient should actually visit a hospital. The NHS is hugely efficient relative to other economies because it needs to be (unless you read the Daily Fail which will always tell you otherwise to prevent their owners and buddies paying more tax). The rest of care services are tragically disastrous.

I have an XL meta 5.5 that has everything necessary bar wheels that i’m thinking of selling for £750? 2×10. Fantastic bike for confidence going downhill. Would save you money initially with a view to upgrading once you have done a significant amount of riding.

Well done mate! Viva’s are cack fun. I extolled the virtues of slim-fast in mine! Where are you hoping to go for fy1?

Just 5 minutes? I’d have thought it would take longer than that to read the Telegraph and Daily Mail to get these opinions?! I challenge you, whoever you are (Hunt’s godson?) to come to a BMA meeting and meet these “misled” people. You trust them with your life yet don’t believe they can see through the obfuscation of the lies propogated by this government to suit their ends. Believe me if we felt that more people were dying at weekends due to doctors staffing we would all be at work.

I wanted to reply to some of the more recent comments regarding the impression that this is about pay. What the government are cunningly doing is reducing the amount that out of hours will be paid in a way that will discourage people from entering certain specialties. This is probably not going to make a lot of sense to some people who don’t have previous experience of working in hopsital’s but I will try to make it as clear as I can.

1) It is possible that for many wages will even actually rise. Yes rise! Yet there is a 98% vote in favour of strikes. How could this be? Surely if many people will gain then there is nothing to complain about?

2) The basic rate of pay is to rise. The government has offered 11%. This sounds fantastic! Most people would be delighted with that sort of rise! And if we all worked 9-5 every day (or 7-10pm as David Cameron would have us work) then we would all indeed be 11% better off under the new pay deal.

3) Currently working Saturday and Sunday and nights are regarded as shifts that count towards a “banding” in a job and for many rotas that work 1:3 or 1:4 weekends this banding is 40-50% on top of the basic salary. One of the key things to remember in this is the rotas for jobs are not negotiable and are worked to the absolute limit of 48 hours averaged over 13 weeks with many working rotas of 11-12 days in a row starting on Mondays and finishing the following Friday. Naturally these 11-12 days are all high stress, emotional and by the end make you want to be anywhere but caring for patient’s, although this does not appear to factor into rota planning, probably because it is not done by doctors or even nurses but managers.

So we have a situation currently where doctors will often rotate through long stints followed by weeks with more normal hours although these will often still include the following weekend but you may only say work 40 hours the following week. Again the rota is averaged out to meet the criteria set out in the contracts

4) for overnight registrars, there are 2 types of jobs either 1) basing oneself on site physically or 2) available on the phone at home. Currently there are complicated rules regarding how people are paid for this although currently there is a set amount that is connected to the banding the doctor receives. The government is proposing drastically reducing the amount paid for non-resident on-calls. What’s important to know is that often although these doctors are at home they will be phoned often several times a night for advice, sometimes be required to go in to see seriously unwell patients and will get very little sleep. Then they are expected to work the preceeding and following day as normal. This is a bigger problem than it looks from the outset as these types of jobs are often the ones where highly complex decisions must be made. Reducing the incentive to do these types of jobs will mean complex care will suffer as less people will want to do them! Difficult point to explain but for very tired more senior junior doctors, it’s important!

5) Currently pay progression is automatic year on year. This is because unlike other jobs, every year of clinical experience gained literally means you become entrusted with more seniority and also more independent decision-making. For example, I am currently in my 3rd post-graduate year. I would still go to another junior doctor who may be in say their 6th or 8th postgraduate year as they are both most definitely my senior and will also likely know the answer to my question. Doctors do not become consultants until they literally can be trusted to know the answer to almost any question posed to them and if they don’t will know exactly who to ask to receive a very swift response. So year on year pay progression is particularly important to doctors as it is in line with responsibility and decision-making.increasing. Yet this government wants to remove this. It wants to set specific definitions of what more seniority means and reduce the number of times pay progression occurs. This means in real terms that people will take on greater responsibility, training and all out stress without any real rise in income. What other job does this? Do people stay in these jobs for long?

There are also other interesting aspects including those taking time to do academic training that would lose out in the new contract as this time would now not be considered as part of pay progression despite many working par-time in their old jobs out of necessity plus there research increasing their seniority within a specific specialty. Plus those who take maternity leave in particular are really going to lose out as none of these years will be counted for progression. This has been a matter of hot debate but what’s important to realise is that this may in particular disincentivise potential mothers from entering specialties where they currently make up large numbers of the workforce eg. medical specialties or emergency medicine. Needless to say these are the specialties that are in crisis already over recruitment as they tend to offer the worst rotas out of necessity.

Given all the above information I want to now tell you why what the government is wanting to do is being roundly rejected by all doctors. And I also want to tell you why, even if many might gain from the new contracts, junior doctors and also many other more senior doctors ore now up in arms against their supposed “imposition.”

The first things the government wants to do is do away with the current banding system. Instead of stating that if a doctor works evenings and weekends they will receive a set banding, the government wants to now start paying based on the actual numbers of hours worked varying on the specific hours they do. Of note is the removal of 7am-7pm on a saturday from this and the offer to pay a 30% supplement for work on a saturday night or sunday. They will pay a 50% supplement for nights. This on the face of it sounds ok. Until you come to the actual rotas. As a junior doctor working in the NHS I have become very accustomed to rotas designed by hospitals that are set to maximise the unsocial hours worked whilst minimising the pay given to juniors. The inevitable outcome of these new rotas will be to get us to be paid less overall. In fact the only reason my current cohort of colleagues will not be paid less is that the government have agreed to give those who would be paid less a promise they will receive whatever the extra would be to make up to their current wages. Naturally some will be paid more. Particularly those who work LESS unsocial hours in their jobs. What a great thing, rewarding those who work ordinary hours whilst reducing the amount paid to those who do more unsocial hours. That will clearly increase the desire to work in jobs that provide out of hours care!

Also, what about those who start working after the new contract is signed? Oh they aren’t covered by any pay promise. Under the new system they will simply have a Saturday as a normal day. Plus Sunday is paid at 30% supplement whereas in real terms currently it is more like 50%. And they will be paid the same for nights. This in terms of pay is where the real issue is: for FUTURE generations this is a pay cut. And 6 days in the week are now considered “normal” working hours.

All of a sudden applying to work in a specialty where there are significant amounts of out of hours works becomes even less attractive. Specialties such as say A&E for example. Which already has a recruitment crisis. Do people feel they currently get seen in short enough time already in A&E? Sure if you feel that the time you have spent in a waiting room to see an A&E doctor, anxiously waiting with a loved one or if your child has a severely high temperature and you want them seen immediately, is time you would rather spend there in the waiting room than in the department getting seen quicker. Then sure, go ahead and support these proposals.

Because there will be less doctors there. And also probably less nurses, because we all fear that the government is coming for them next. It turns out many of them have families they like to see too. Particularly at weekends for some reason.

How about becoming a medical registrar? We currently have 4 of 8 medical registrars we are supposed to have. Maybe you didn’t know this but the medical registrar at night is the most senior decision-maker actually in the hospital. Some of ours have been graduated from medical school for a mere 3 years. Yet there they are, at night, being the decision-maker for people with strokes, heart attacks, severe hypoglycaemias, you name it, they are it. Yet the new pay deal seems to want to disincentivise people from doing jobs that require out of ours work. Surely the government must see, as we do as doctors, that those who do out of hours work should be valued above all others? As the system in the NHS depends on these people working high stress jobs right through the night, surely we should be increasing these people’s wages to compensate them for the incredible work they do. Alas no. Instead those who work 9-5, monday to friday will benefit significanty but those who work out of hours will see real-time decreases in their wages whilst being asked to work more weekend days for less money.

I’m hoping I am starting to make some coherent sense now as to why even on this point alone it is worth not accepting the governments offer. I think I have gone on too long to make too many more points but I want you all to know we are doing this so that when you want 24/7 care from the NHS, there are people capable to manage your illness who feel adequately supported and who feel motivated to be at work at the wrong times of the day. I also want you to know that this makes a mockery of the government’s argument that they are doing this to engender more 24/7 cover by doctors. This is the very opposite of what will happen and everyone who cares about the NHS should oppose them too.

I’m a (hospital) doctor and I also have a cervelo! However I paid £900 for mine and it’s an RS which even though being 6 years old was a fundamental improvement on the (second-hand) Foil it replaced. Can recommend for non-doctors.

Possibly reacting to the material in the helmet? Or heat rash? Either way I would consider another helmet. The new Kask Rex (?) I think it’s called looks very well ventilated.

Lots more interesting arguments here. Firstly the job security theme is one that people hold on to as if that means people should always sacrifice adequate pay and working conditions as long as the industry they work in has a stable requirement for their labour across a population. Firstly I can tell you that as a mature student I beat odds of 33-1 to get a place at a medical school in the UK. That’s just amongst the people who actually did apply. I failed to get a place the first year I applied and seriously though about quitting. Not sure why I didn’t but thankfully I persevered.

I then went on to face 6 years of the hardest exams I will ever face, some I scraped through by the skin of my teeth. I was in hospitals 9-5 and then came home and opened the books. Life even as a student would go by for significant periods off time without socialising or having any kind of break from the grind. Some people did not make it through this, some people repeated years, many became disillusioned at the constant examining and testing that we underwent to guarantee we meet the strict criteria set by the GMC to be “good” doctors. Passing finals was one of the best moments of my life so far as it meant after 6 years I now had an actual job! This of course just means we are at the start of our real apprenticeship. Everything up to that point is simply so that you can go onto the ward on the first day and start to learn to be a safe and competent clinical decision-maker. What is important in this is to understand that it takes a minimum of 11-12 years to make a safe, robust independent clinical decision-maker and in many specialties this becomes 16-18 years.

Then there appears to be a perspective that there is a lack of competition within medicine and that everyone simply assimilates in some great gravy train that makes us into fat greedy doctors abusing the tax-payer! Firstly I would go and look at your own GP or consultant if you ever unfortunately have to see one and ask Do they look like the person the media is portraying? Is there a dissonance between the person you meet face to face and that which the great daily newspapers such as The Sun and Daily Telegraph would like to paint of us? What will happen if that person you go to see and trust with your most personal information in the hope they will make you better is replaced by someone so disillusioned that they feel any other career must be better than the one they have? Or alternatively not see anyone for several weeks as the practice can’t hire GP’s as no-one wants to become one any more? Or in hospital be seen by either no registrar or one that doesn’t know the system and is there for one day only as the people who were there formally eventually realised it wasn’t worth the crazy rota’s and volume of hours they were doing and made a different career choice? If you think this is a horror story then you maybe haven’t tried to get a GP appointment recently or been admitted to an acute ward as this is already an every day occurrence.

Competition within medical workforce is high. We compete at everything. Interviews, examinations, every few months we are placed in positions where we are forced to compete against one another. Almost every specialty now has a national competition where everyone from the country comes to a single place for the very aim of competing with one another. Right from the first day of medical school you realise you are competing with your friends, your colleagues and thankfully eventually you become mature enough not to vilify one another for doing well or not doing well and just accept it as a part of life. Many people do not get jobs and end up in places they didn’t foresee. Some people simply don’t make it. This is no different to some competitive professions but to say we all walk into some golden job security is way off the mark and comedic those who have travelled through the system.

We as doctors are saying to the public that we have never tried to make out we are immune from societal problems but we are also saying that relative to other high responsibility jobs we are actually being both paid LESS, pay has diminished significantly in the last few years relative to inflation, we work significant numbers of anti-social hours as a matter of routine in our jobs with the fatigue this brings, with great responsibility and high stakes if we make wrong decisions and are simply asking in this strike for things NOT TO GET WORSE. Because if they do people who are great clinicians and may potentially come and treat you will not be there. Because instead they will have chosen jobs with better hours, less stress and more family time. Because they will also feel devalued by a society turned against them by a government that is seeking once again to beat our morale to beat us down.

If you decide to side with the government on these proposals, are you then going to hold yourself to blame when the NHS system falls apart? What if a Tory government decides that private health insurance is the only way forward for a collapsing NHS? Is that where you want us to go as a country because that would appear to be the result aimed for. Then we will all become like one of the southern English NHS regions that has all its child and adolescent health managed by Virgin health services. Do you want to have Richard Branson’s face plastered all over your local GP surgery? In 10 years from now this is the likely outcome unless something is done to stop it.

Oh and Northshoreniall just write it at the edge :twisted:

That’s an intersting point although I think we are coming from a different semantic perspective and possibly this title has become associated with bureaucracy, of which there is a significant amount (necessary and unneccessary) in the NHS. By public services I mean medical staff, police staff, Fire service staff etc. The provision of the service is what must be fought for and I know our colleagues in the fire service in particular have been placed in very difficult times in recent years. Again I question whether the public’s values have been misappropriated by the government?

Haha yeah I know that particular (unpaid) hour hurt more than some. Thankfully I wasn’t on night’s at that point!

I’m not sure these people ARE idiots matbee. But I think some people want to believe some things about others and some people don’t really know what to believe. It is incredibly easy to convince a non-insider public of some things with the artful use of media crohnies and we have seen that in the Sun and Daily Telegraph in the last few days. What I would ask people is to look at their own jobs and outlook and understand that as workers in public services we all need to fight to sustain and improve these services. Even if these plans are well-meaning by the current government (and many are suspicious they are not) we as doctor’s are very convinced this will not accomplish the ends publicly stated as being sought.

Thanks to the others for their comments. GrahamS you’re putting up a great fight. I now know this is a leap year (!) and I wll most likely be working one extra day this year ;D

What entire rubbish people on this thread have been spouting. I’ve only worked as a doctor for 2 1/2 years but in that time I have seen enough to understand the way the NHS works. Paid for death certificates?! We certainly b**** well do not! It takes me around 3/4 of an hour to do one due to having to scrawl through patient’s notes to find out the exact date the various and often multiple ailments that contributed to their death started. However, I would never dream of asking for extra money for this. It’s one of our responsibilities and is a fundamental part of caring for patient’s, albeit after death. WE DID up until April get money for cremation forms paid to us by the funeral directors, although many people gave theirs to charity. This has now stopped completely as it was felt generally this wasn’t ethically appropriate.

I have just had my first holiday since September. I worked in 5 wards over the christmas period with 1 day off over 17 days. As a junior with my experience I am expected to manage up to 30-40 patient’s by myself, patient’s who are frequently close to death and any decision I make may shorten or lengthen their life if I make the right or wrong judgment. This I did expect when I went to medical school and although often under-prepared for some of the things I see, I know how to manage situations and when to ask for senior help. This help is available 24/7 either in person or on the end of a phone.

The bandings system is in itself very flawed. I get a 50% extra overall if more than 1/3 of my work time is spent outside monday – friday 7am-7pm currently. This meant as an FY1 I took home a gross salary of around £31000 gross in the first year. I did however come out with £72000 of student loan debt, £10000 graduate loan, £6000 of credit card debt plus myself and my partner also owed £3000 to family members. We did work in the first years due to the longer summers but the summer was reduced to 4 weeks in the final 3 years and the study was relentless. We felt we simply couldn’t work part-time and be guaranteed to pass our exams. Some do but they often suffer significantly for it. As our training is 9-5, Mon-Fri with study afterwards it’s not difficult to see why. It’s also not difficult to see why increasing the amount of student loans people have to pay back will make medicine again a purely elitist vocation (which is in nobody’s favour) but I digress. My actual take home pay was less than the above figures as some of the jobs were very carefully rota-d so that you would be at 32% anti-social hours!

Typically in a rota I would work 1 weekend in 3 or 4, sometimes working 80 hour weeks, often working 4 nights in a row. I have gone around a week at times without seeing my fiance just because our hours don’t overlap. All of these hours I am a decision-maker. All of these hours I review patient’s, decide on treatment plans, discuss issues with patient’s families, attempt to implement treatments for incredibly complicated patient’s who often will have several drugs that interact or that they shouldn’t take, or that may have caused some of their medical issues. When the S*** hits the fan it is me the nurses come to for help, me who has to decide what to do next.

I don’t actually have much time to spend money but why is it so difficult for people to believe that for this responsibility and sheer emotional duress I undergo that I should not be rewarded somewhat for what I do. Are these salaries gross, fat-cat salaries that other members of the population can only dream of? Having worked in Aberdeen where the average salary for workers in the oil industry seems to be 80-100k looking at their porsches and bmw’s, why does the fact that senior registrars who often act up as consultants at the end of their training can earn a maximum of £60-70000 seem to be paraded in the press as the definition of greedy doctors that somehow must be stamped out?! What social values does this signify about society and if the argument that the public sector can never expect to earn what the private sector does, I would ask those who post this question to answer me both why and what economic philosophy this is based on. On top of this, can I say that we as doctors are outright REJECTING any notion of private healthcare in the UK DESPITE it offering us greatly inflated salaries as seen in many countries including the US because these systems do not guarantee fairness and free healthcare at the point of use.

The first crazy message the government has spun about the NHS is emergency care needs to become 24/7. What a fantastic, wool-pulling load of old cobblers this is! What the f*** do they want the public to believe we do when we work all these un-social hours?! Do they think people don’t understand that the rota’s we work are made in such a way that this is EXACTLY what is achieved. We are there 24/7, 365 days a year, undertaking PURELY EMERGENCY CARE.

What doesn’t happen at weekends and at night is routine hospital appointments, elective surgery and out-patient scans. TO DO THIS, the amount of money needed would be huge. You can forget your £8 billion pound figure, which is already costed and in line with other close members of the EU. We are talking 20, maybe even 30 billion extra a year to put this in place. The administration costs of this are huge. The costs of an extra day per week for all the consultants, registrars, nurses, ward clerks, radiographers, laboratory scientist’s, cleaners, porters, IT staff and every other part of the essential infrastructure that maintains the NHS on a day to day basis would be incredible. Simply making sure more doctors are in on a Saturday won’t change a thing apart from reducing pay and reducing morale.

As Jeremy ‘unt has stated, this is going to be cost-neutral. The most important part of this is we are not actually asking for MORE money, just NOT FOR LESS. We also reject the notion of a need for us to work more anti-social hours because the way the NHS works now is incredibly efficient at emergency care. So many international comparisons place the NHS as a world leader and there is no health service in THE WORLD that offers non-urgent care 24/7!

The second aspect of all of this that makes all of the junior doctors sad is that the binding penalties that Jeremy ‘unt seems to want to scrap were fought for and won at great cost by a preceding generation of doctors. That generation remembers with horror sometimes doing 4 days on-call with the occasional 3-hour kip. Hospital’s weren’t meant to but as doctors had no method of complaining and it was often career suicide to do so, people either put up or quit. Are the memories of people so short that they don’t remember this? The whole reason this had to change is that doctors were leaving the NHS in droves! Why did that stop? Because these safeguards meant the risk of mental ill-health had reduced to a level that many could cope with and support structures had improved. We are striking as a result of this as much as anything else the government are proposing. We know that guidelines with no teeth are guidelines that won’t be adhered to.

Nobody wants to see those days return. Please understand it is very difficult to see the exact implications from outside the NHS of what this will really mean for the medical work-force but we are all standing up FOR the NHS as we actually believe it’s pretty blooming good!

So I thought I would write about what I, a junior doctor 3 years out of medical school does for a job. I do it simply to enhance understanding and I am not blowing any trumpets about what we do, simply trying to show people who may not understand our role fully some insights into my daily work activities.

Humorously, I am actually locuming currently but before any naysayers out there have a go, I did have a training post in what’s termed core medical training ie. the training you do to become a consultant in, say, cardiology or neurology (or even dermatology, although why they’re in the same training rota is intriguing) although I turned it down as I am not absolutely certain this is what I wish to pursue and have taken a year out of the normal training process to make a decision. Many people take 2 or even 3 years out at this point to work in different specialties although this has been looked down by some although not all a little more in recent years due to training post shortages. Anyway I digress.

So last week I was working in a geriatric orthopaedics role. I am being used in 2 or 3 different medical roles depending on the week but this is what I did last week.

8:30 I attend the handover which is essentially a multi-disciplinary meeting where the information on each patient is discussed, new patient’s are discussed in detail and a general plan is made for each patient so each relevant person including nursing staff, Ot’s, PT’s and discharge officers can all understand where each patient is heading relevant to their role. I tend to take a prominent role in this as I both know the medical information pertaining to each patient in the most depth and possibly (not always!) understand it in the most detailed manner. I therefore am responsible for helping make key decisions pertaining to each patient including the likely outcome of patient’s conditions and when they may look to go home or have investigations completed or need social work input etc.

This is usually over by 9am and everyone goes about their separate tasks and we do our best to action the plan and obviously deal with new information as it arises. Everyday I start doing a ward round by myself as the orthopaedic and geriatric consultants often are busy elsewhere and it is important all the patient’s get seen individually each day. Often this results in my forming a plan for each patient independently, taking into account anything that has happened to them over the preceeding couple of days and any new symptoms they might have developed. I examine some although not all depending on need. I discuss people’s family issues, work issues on top of the routine medical questioning and information exchange that is a part of each interaction. Often this ward round is interrupted by a whole littany of things including phonecalls, other staff wishing to discuss matters with me, people bleeping me, consultants arriving and wanting to do their ward round so they can go to theatre or continue the geriatric ward round that now encompasses the whole hospital. Frequently my ward round can run into the afternoon as some things end up taking significant amounts of time to deal with and I am personally responsible for around 18 patient’s in total. Some days feel as if no progress is being made at all whilst other days things go more smoothly and the team feels adequately functional.

Each day I:
1) order all the blood tests and investigations either I or one of my senior colleagues has felt necessary
2) liaise with up to 6 or 7 consultants during the day depending on who is doing what that day, often doing a ward round with 4 or 5 with their individual patient’s
3) communicate with radiologists, radiographers, microbiologists, psychiatrists or psychiatry liaison nurses plus a continuous and usually comedic communication process with nursing staff
4) Discuss patient’s condition with them and their relatives, being often the sole source for them to ask questions regarding the patient’s condition, outlook, social care issues etc
5) and overall generally often function as the source of much of the information pertaining to individual patient’s for all interested parties.

There are other things I do although I won’t bore you with dealing with all the IT issues, paper filling and many other inane tasks that seem to seek to make my workflow grind to a halt.

At some point between the hours of 12-3pm I will manage to fit my mandatory 30 minute break in. I often feel guilty going as I know there is always more needing done but often there is a point in the day where things are all in motion and there is nothing left practically to do at that point so you opportunistically grab lunch. Frequently this is interrupted by a bleep that you respond to, leaving your lunch whilst you write down whatever you require to deal with the issue at hand.

2-3 days a week I will go at 5pm to work either in the Medical Assessment Unit where we assess acutely unwell patients either in the unit of in A&E, making decisions on whether to admit, when to start treatment etc. We experience the 4-hour targets acutely as A&E relies on us to make decisions within this window, although frequently patient’s just get “punted” straight to wards if they’re too busy, where a junior doctor will fully complete all their basic assessment. This is after an already busy day on a ward doing all of the above. Often you are already quite tired but I find a good source of caffeine goes a long way in the mid-afternoon.

Then eventually I hand over to the night team (whom I will be a key member of tomorrow) so that all the acute patient’s are discussed and the team is informed of outstanding tasks and any more seriously unwell patient’s. I normally get home at 10pm on these nights due to a short commute. Then I go home and fall into bed, then i’m up and ready to go for 8:30 again.

Thankfully under the current rules I am only allowed to work stretches of 12 days straight very infrequently, although I worked a 12-day stint every 4 weeks on my first job in general medicine in my first year of work. To give an example of my rotas I work 4 nights this week then I am off for 2 days then back into a weekend long day working in the medical receiving unit on Sunday then a 9-5 day on MAU again on Monday then off for 2 more days then back in for 3 more nights. We tend to work our nights in the hospital I am based at in quick succession which has it’s advantages and disadvantages but I know I am going to be zombie like for much of the next 2 weeks and will probably get out on my bike only once or twice in those two weeks, which is naturally by far the most negative aspect of this particular pattern of rota.

I am not going to say anything about ethics and the application of learning we implement as there are many other jobs that require a high degree of intellectual input. I more mean to inform those who might wish to feel that somehow as a junior doctor we do not work hard or are not good value for the money invested in us. My personal belief is that we are.

Currently a medic working occasionally in geriatric orthopaedics. 6 weeks seems to be the accepted mantra for all acute fractures although this will be very variable depending on the nature and location of injury. Overall the spine will take a while to be fully back to what you require to go mountain biking and will be vulnerable to refracture if you go out too early. Think like you need to feel you can fall on it to go back outside.

As for indoors as has been said low impact exercise particularly cycling and swimming should be fine after 3 weeks or so but be guided by pain. Any severe pain stop immediately! Hth’s.

I went out in my first proper chaingang and went around 4-5 MPH faster! You’re so protected by the riders in front of you that you get a great rest and can really push on when you get to the front. Great fun!

I have the ones without the DNA switch so can’t comment directly but this obviously sounds wrong. Have you checked the rockshox manual? I have just serviced my forks and it’s possible to really screw them up if you don’t know what you’re doing and aren’t very careful. Try resetting all the pressures and have a ride. Might need to be serviced though. Any way of asking the guy you bought them fro if he noticed anything strange?

I just buy the stock costco stuff. We like the costa-rican stuff as it’s quite a strong roasting although this should mean it’s less caffeinated overall. What I have found is using a metal filter allows more of the oils to come through so produces slightly more body. Taste is incredibly subjective when it comes to coffee so just try different brands.

Just did this very thing a couple of days ago. Both purchased from Halfords. Check your local stock first.

Your leg shouldnt be near straight but around 140 degrees at full extentsion. It’s surprisingly bent actually IMO. Use one of the big bike websites to spit out ball park fit dimensions then vary to suit. You need to start from somewhere. I used competitivecyclist.com. seemed pretty bang on.

Go out the countesswells road. Keep going out then head left to Peterculter then right to banchory. Cross the dee there and head either to Stonehaven or just cycle around those side-roads up there.

Or if you want a challenge do the cairn o mount from Stonehaven and back. One of the top 100 climbs in Britain. Great ride with coffee and cake at the clattering brig if you wish.

Have the same one and I can vouch through many sufferfest sessions that standing up doesn’t change a thing. Mogrim I feel your starting tension is wrong? I can get to well over 400 watts on it but def not sitting down!

Yes it’s supposed to pull off very easily and go back on again. Not sure re the long one on drive side. I remember it being fairly intuitive. Check Hope’s own website, they will have it on there somewhere.

Went to Sofia for a week in May and I am of the opinion it is the best value holiday I have ever been on! Made it to the Rila mountains for hiking (no-one else into mtb :( )but it was tremendously beautiful and the fact you can eat out every night with a 3-course meal and struggle to spend cash just makes the whole experience very memorable. You really can live like kings comparably. Also many people are riding, mainly mountain bikes there, lots about in the streets of Sofia and the trail maps look like you could go for weeks without getting bored. We will most definitely be returning at some point there’s no question.

I have a 20″ 456 Evo titanium frame for sale in Aberdeen but you would need to be at least 6 foot..

Depends. Fear is actually a rational reaction to things that are of danger to us. Most important is how you manage that risk and whether you can cope with the negative outcome should it happen. Often these negative outcomes are not as bad as we feared, even when they occur. Hiding from things simply due to fear when you wish badly to do something is short-changing yourself.