The Alternative F3: Cruise Ship Medicine with Dr Luke Mclennan



This session will discuss the unique opportunity of working as a medical director on a Carnival Cruise ship. It will cover the journey of one doctor's career, from medical school to his current role as well as discussing compliance, lifestyle, and career progression on a cruise ship in medical practice. The talk will provide an in-depth overview of the options available, answering any questions and concerns medical professionals may have on the topic.
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Learning objectives

Learning objectives: 1. Understand the process for applying to become a cruise ship doctor and the compliance requirements. 2. Learn about the differences between cruise ship practice and NHS practice with respect to culture, organization structure, autonomy, study leave and training. 3. Determine the advantages and disadvantages of cruise ship medicine compared to other medical specialties. 4. Explore the lifestyle associated with cruise ship work and evaluate if it could be a suitable career path. 5. Appreciate the importance of portfolio building and administering exams under independent medical practice, while still adhering to the standards of medical practice.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Okay. Well, hello, everyone. Who is out there? Onda anticipating the final upset of the F three Siris. Very excited for this one. Um, we have with us today. Ah, look who, Um, it's ah, raring to tell us all about his experiences working as a, um, into a medical director on, ah, Carnival Cruise, which is something that, um, is not. Ah, I guess not. Something that way, As sort of doctors may pull the understanding fully. Appreciate. Really? I guess it's an extent the route into this sort of pathway, but I think we've We've got a lot Teo, talk about it. A lot to explore, um, in this. So just a Zerit introduction, Um, as we always do. I'm sergeant on one half of the port, but clinic, um, alongside shift, um, on DWI have the final upset of the three series day. I I feel it's a look. Yeah, very good. Thanks for having me on. Really appreciates it. It's guys. That is absolutely later. Yeah. Um, how you say shit is all Yeah, not too bad. I'm excited for this one. I I think this is a really unique opportunity on be had a chat with you. I think you got some really interesting information about the human opportunity. It's I think it's becoming a little bit more commented a little bit more. A little bit more information, being disseminating about weapons, cruise ship, doctor especially. I only heard about it last year or so I can hear about that as well. And I think from the interesting part today, but this show clearly, um, people are really interested in there is an opportunity. Um, so, yeah, I'm excited about that with you today and find out more. Well, well, why don't we don't right into it. I think I think I would make the most. She quickly just, um I'm just going to share the the dynamic notes as well. So I have not clearing. Um, I did that on. Then. I'm gonna just, um Sorry. Benefiber. And then I just want to share crack on while I'm sharing. This is well, perfect. So, um yeah, I think, uh, the the first sort of pointed call or something that that and those who are out there would probably interested Teo. Learn about it. Sort of your, um, your route into medical training and some of your medical background and before obviously you entered be the cruise industry. And what sort of your, um, root post medical school and and, ah, so the direction that your medical career took, um, in the following medical school? Sure. So, um, I had a fairly clear intention when I was at medical school, especially towards the end there, But I wanted to go on a path towards emergency medicine. And so it's a It's a passion that I still have. Um I did my foundation years. I wanted to. I did them in Wales, actually ended up in other give anything if wanted to, um decided I wanted to take in a three year a time I think was still sort of maybe less than a 50 50 split up. That time is the how many people were doing it, but it was definitely more accepted at that point, you know? So I went on and did on a three year, primarily doing emergency medicine. I had, um, applied at that point, or at least looked into the possibility of cruise ship meds, and I had a couple of colleagues who've gone into it and given some pretty good stories about it, but I was too early at that stage and recognize that, you know, even if I was, even if I had the time under my belts, It's obviously a very independent specialty. Yeah, uh, so just persevered. Really? Did. Did a lot off 80 in F three big, long stretches of night shifts in a th doing as much as I could, which is great. Really enjoyed that, uh, and then went into a magistrate in training. So, um, and it was a weird and shift actually from being relatively independent in Wales overnight to then going into ST one in any in a teaching hospital. Big teaching hospital where it was, you know, like very much more. Hands off and think shop around away from recess towards, you know, minor things. And it was it was a good learning experience on then it didn't see my second half of that year in May. You, I think, from going through that process probably what's pertinent two years that you know, maintaining a portfolio as well as doing your definitely a Z. Well, it's doing You're kind of core hours on call or your cats is and doctors and all that kind of stuff. Um, having to beg, stealing, borrow to get my study leave to do a less 80. And I say pee less on any other things. You know, ultrasound basically fell into my spare time and came up my spare funds. Then when I started tractor and exams, uh, you know, my time is just, uh, completely zaps. So towards the end of ST one, I approached the dean, You rinse, asked whether I could get another program experience, and I'm thinking, and in reality, I had to take a program break pause or whatever they call it, So it doesn't count towards your training. Yeah, but I took this roll within cruise ship, so I've done an open day. I went through the through the interview process on that All went really smoothly on the open day that, you know, they used to take on board the ship and show you what Besylate is a like a new She's introduce it to the team. Yeah, I've never done any cruising before or anything like that. I'd sort of table There is a, uh, a Z a. I don't know later in life thing to do, but a zit waas. I went into the thio. And what kind of the UK on? I guess what was good for me at that point was that they were a designated body for the GNC, so I could uphold my registration on all the rest of it. I guess we'll come into the to the weeds. Yeah, okay. For emergency medicine into cruise ship medicine that year turned into two years. I did. Then go back into training on get some anesthetics on. After that, I didn't leave the company formally, but I did take a break, did some anesthetics, got a few more skills and then went off for Didn't few other bits of fun things. And I'm like I said, I think we'll come to some other bits. Yeah, progressions. But yeah, it works on board for for four years on. Now. Find myself having works. Yeah, Short side fall. How long is it now? I can't remember a little while, but now it, like you said on on sort of covering the post, its medical director for their Yeah, it sounds like the sort of the frustration that you had in terms are the restrictions placed on your practice going into sort of pt training, Um, on all those sort of the additional aspects of it, in terms of the portfolio, um, exams, All of these things that you had to do sort of up your own back into your own time was was particularly frustrating. And that sort of the freedom that you have in in the cruise industry sort of attracted you a bit more, would you say, compared to going to say so? Maybe not like a dangerous before. Yeah, I think I think certainly I felt that disparity between working independently in a department that I enjoyed to suddenly being very protected, which is a good thing, I maintain, Yeah, other things that I've been doing wrong that I really shouldn't have been doing before. So I'm not devaluing that experience. But it helped me to identify that. Actually, I really like working well, a tickly independently on, definitely with a smaller team of people that I know going to a big hospital where it's different, nurses, different doctors. Every day you don't get that report. Yeah, it's harder to do your job when you don't know who you can ask or how you have to ask Or, you know, the politics are all the rest of it. So yeah. Uh, that help Help me recognize what I preferred. Um, I actually didn't anticipate enjoying it as much as I did on board. I thought I was just taken a year, like I said. Yeah, but it Christ, it was hard coming back to to the NHS, doing that block of anesthetics. Yeah, not because the work was any harder necessarily, but yeah, it was just a lot of differences and and how The culture of the organization is within the NHS, and it's the same things. You know, the training on your immunities, how they deal with study leave how they have the approach training on. Definitely how how you're looked after and treated as an employee. Not that the NHS is bad, but there's a cultural next cruise industry where you come in a Zarella tiddly senior officer, you're given a great deal of respect. And, uh, if you treat people how you want to be treated, then that comes back straightaway. Yeah, I fell in which I guess, at times, in a very, very busy clinical environment on, especially if doctors are coming I/O. You don't get that camaraderie. And it sounds like the cruise industry really does have that just going back. So you're the path that you took. You did your foundation training. You didn't have three. Um, which is mainly based in any d on, then pulling on from that You actually had the opportunity to work for a short period of time in the cruise industry. Is that so? No, I do best E one and then went to see for two years and then came back to Then it just for a recent on. How did you get in there initially? What? What was it that sort of? So I had a I had a friend who done it, and, um, he he was older than I but was a similar maybe a year or two ahead of me and train. Yeah, and he sort of sat me down and said, Listen, you really want to think about this doing this at some point because you know, the lifestyle you're offered it, I'm sure it would suit you. Is a person you know have to think about this This and this. And like I said, I went on the Web sites. The Carnival UK careers have a look through the kind of jobs back Brecca guys was a little bit further than I need a further away than I should be on then Just just went, went through their kind of performer for what? What we needed to achieve and make sure I was compliant with that. So, um, had an interview was successful. Um, yeah, And then there's just a bit of paperwork to do is get yourself measured for, you know, yeah. On dumb. You mentioned compliance ease and and and being compliant with what? Um, I guess he wanted what? As somebody who wants to go into being a cruise doctor, potentially for a short period of time? Maybe it's a lot for a longer period of time. And what what sort of, um, what you have to be compliant with in in terms of your medical practice in order to get into something like that. So I'm I'll start with kind of non medical side, just a reference point you will need to as a C for I have a medical on that Zeus assessment to make sure they have not got any medical conditions that will conflict with the roll taking. It's hearing sites and any significant, um, past medical history after the time. In terms of medical qualifications toe work on a cruise ship that carries passengers, you need to have a background of some description relating to emergency medicine. It is very preferable to have some intensive historic aesthetics experience on. In our ideal world, you'd have some flavor of general practice is well, although that is not so much the focus from there from the specifications. Um, now alongside that, to be working on board, you need to hold in a less certificate, although we can organize that, you know any company think will help you obtain that. And then once you progress through, if you want to be a senior doctor, you'll need to hold the A TLS course on if the ship is carrying Children and AP lessons, well, it's fairly well structured, but you need to have been qualified for, I think, three years in total. But actually in terms of that's the formalities of what you need. The reality is that you will be responsible for, you know when you join, at least you're you're gonna be the crew doctor and you're responsible for looking after the crew care. Now, I'd say 90 to 95% of that will be mainly General Francis things that the difference from the chest being all of your patients will be relatively young, relatively healthy, relatively happy on relatively came to get better as well. So I don't want to dry the cruise there. They at the end of the well, the critic, the crew in themselves want to be working. You know, they will be primarily looking after, but I'd say that 5% off things that aren't general practice, you will be called two emergencies. You will at times be on call responsible for some of the guests care, and you'll have to have a grasp. You know, if if the worst happens in the on the on the response of that goes off at four in the morning, then then you need to be able to provide that that level of care. So I'd say formalities aside, you would need to be comfortable in a situation where you're a part of an arrest team or dealing with some kind of drawn or you need to have that background or at least on the intention to pick up those those skills before you start taking responsibility for this situation. So yeah, I see. And I guess it is something that, uh, when you're in an environment like that, um, I guess anything could happen at any point. And obviously what you have is is entirely restricted to the cruise ship, I guess, to a certain extent, Um, on how did you feel making that adjustment during your first time that you set out seeing you began working following your ST one year. And it's a good question. I mean, I had the anxiety. You know, what if I'm left and explains that happens. I mean the reality waas okay, in in an e. I don't think I've done an air of a shift. Nevermind a full shift without leaning across to one of the nursing colleagues. And what do you think? Going saw or another doctor or having a conversation and the same applies? You know, you've got potentially 45 nurses around you that might have worked out, see, for one year, five years, 10 years might work and I've been a matron in a medical wards. You know, they got good experience. You've got a senior doctor in charge who will have a least on his, you know, a couple years at sea or a year to see on. Don't know the nuts and bolts of how things worked practically which I think was the biggest Dutchman. The other adjustment that took time was recognized in that it wasn't just your, uh, your clinical problem. But it was also your geographic problems. So you have to kind of correlate the two. So if you've got a you've got someone who's having a heart attack and your important Southampton, you do what you do, you get into hospital and you can use the lab. But if you're four hours away from Barbados, uh, on, uh, you know, on gets rough seas on D, the winds going northeasterly, Then things might change. You might consider your options. So and, you know, you always having to layer on not just what they are, but how long you've got to kind of manage it as gold standard. What comes next? If you can't manage that against, what can we achieve from just perspective, and that's what I really quite enjoyed it. I didn't think I would, but yeah, that's yeah, that's a It's an option to think on your feet, isn't it? Really. But you have to work within the and the restrictions of off the city's that you have around you and also think about the logistics of where you're going to how far you are from sort of what land, I guess to a certain extent at times, yeah, I think on that. You know, I came from my you, which I really didn't enjoy for lots of reasons. But I came from over the main reason. Um, in all honesty, I just think my I'm not well suited to medicine is in your call medicine. You know, I think I've been doing a breath of practice in any on you know, lots of things happening on everyday being very different. And the medicine is different every day. I found the routine of that walk around dragging through the afternoon on. Then you know the other test. You want us. Well, I mean, there's there's a there's a lot off things there that I just didn't feel that engaged with. And that's where I want better suited to being on the ship. And then, like I said, I came on board and certainly day to I'm trying to get somebody off in a Greek island to hospital on on a on a little boat. You know, suddenly I'm in the in the sunshine with the patient, carting them off to a nice Greek that and it all felt all right then. So, yeah, it was It was a good a good change. Yeah, sounds extremely varied. And just something that could really help you develop a Z. A finish in, I think and thinking on your feet. Um, the other thing I want to ask is s O when you sort of first went to see how did you actually come across the opportunity? How did you apply in the first place? Was it online? Was friend Whoa. Actually, um, why did you pick the exact sort of bruise that, um, Polidori within the end? Yeah, so I did. I applied online, had a friend that work for this company, and I had other colleagues that had been successful in applications elsewhere. Now I just kind of the UK for lots of reasons. One because it's kind of British Mark, I suppose. But actually, from a professional perspective, kind of your case. A designated body with respect to the GMC, they have a responsible officer. That's me at the moment. No, but they have a responsible officer on. They are, you know that there are very good organization in terms of professional development. So I was aware that had a good process for training they had. You know, it's not like the NHS where you're sort of assigned a little a little sliver of a budget. And if you don't use it, then too bad you're given, you know, opportunity to spend a period of time for a year and doing whatever courses you think are relevant within reason. But yeah, that primarily it was because I wasn't going to be any risk for metformin from a registration point of you had taken the role. And actually, in hindsight, have been much better off from a professional development spect it as a result of working here. So that is unique to Carnival UK. I think that's not representative of the of the industry that large, but yeah, if you're a British doctor or GMC registered doctor. It's completely translatable. We work within the standards, a good medical practice, and we we you know, we're That's what we expect. So it just makes things easier that if you've you've managed a patient in the NHS, you're gonna do it the same way in principle on board, you're gonna try it anyway. You know the cold. And I just they have a little bit deep into something you just said, which is I mean, you compared the professional development opportunity eat on Many the listeners will already be aware of difficulties with so getting study lied. Actually applying this study budget getting accepted in they're switching off quite challenging road is to get that. Can you give us a little bit more? Information is to why you feel that that fresh compression opportunities with a deterrent professional development, June, you were better. And what? Working and see? Yeah, so I'll give you an example of when I recognize that I've made a a solid choice. So I must have done maybe a one contract by this point, just just for perspective. You you work in a contract system you paid and your least you paid like it would be in any other job. It's a permanent contracting. You paid the same every month, but you work in blocks of generally three months on, maybe three months off. So 200 days a year or 240 days year, depending on what you what you end up doing. But you're you're working in blocks of long since where you work every day and then long distance where you're off on, obviously you're your income is, um, effectively tax free if you're if you're if you're out and firm the UK for for that period of time. So, uh, I must have been on on one of my leave blocks on a happy meal in from the training team saying, Look, we've realized that you're 80 you're 80 or less and you're a less expires in January next year. Your leaves do to be February until April, whenever it waas, for example. So we'd like to put you on the course. We've noticed that you live in Plymouth. There's a course in Plymouth. We'll book you want it. Do you need any help with travel or accommodation on Just to let you know this will be obviously coming out of your working days for the year. So effectively, someone else had realized that my certificates were expired, had taken the time to find the course, book the course, ask if I need any help with accommodation all or travel, and I'd be paid for the privilege of going on. By the way, there, any other courses that you'd like to go on in the next year would really like to get them sorted for you and similarly there at once. I had ultrasound course I wanted to go on on. You know that. You know, the transport, the combination. Of course it was down with forming, and maybe it was not the same as me. But the prospect of booking those things after a 12 hour shift really sent shivers sugars down my spine. So that was a really nice thing for me. And it meant that rather than going through that pain staking process of having to claim it back and wait six months, I was able just to decide what I wanted. I had the block of time to go and do it. I want it on, and that was great on Deacon. Really talk into those things and really get make make the most of it rather than being, you know, doing it on a red eye after after a night shift. So there's a tick marks. Excited. Sounds like you're you're really looked after, Actually, which is something that is it's not usually Oh, is. It's not, um, potentially the majority feeling of those working in in such a pressurized system. Um, you have to book courses and try and sort of find the time that isn't available anyway, you know, to squeeze a lot of these things in on. So was that. Did you feel that that was the turning point for yourself in terms of what I thought because I was still fresh from the intestine. Thought this is perfect, cause I could just get my exam done. I've got a three month gap. I could study as much as I like on dust. Get it sorted. Um, I think it was I learned to ride a motorbike instead, but that doesn't necessarily say I get without a cruise ship. So yeah, you could get these blocks Aleve, and that really just enhanced. My life is Well, just knowing when I was gonna be off knowing how long is going to go for me. How often? You know, chest, you're gonna get two months off. Just, you know, paid Lee just Yeah, have to take some time out in a really without training country. Yeah, exactly. So, yeah, I guess in in my brain at that time, it was taking year. Get your exam done. Get your courses up to speed on. It's great that that's all sorted for May. But then, by the time it came to the end of the year, I started to, you know, enjoy the job. Family that had expected. So and it's kind of stuff been, Yeah. What? I want something that was sort of the the average sort of proceedings or the average day in someone who was working as a cruise doctor. Because obviously, they're gonna be certain similarities to, um, minors. General practice. Sort of the acute care side of things, But there's obviously gonna be some stark differences as well. View what? What was sort of what would be an average day for you working working on the cruise ship. One of the patterns of shifts like and what do you see? So it's really hard to get because there's no average day. I mean, I realize that my biggest question that it totally depends. So, for example, I'll give you my kind of average of my average is I I'd be working on, Let's say, pretend it's it's one of the bigger ships. Yeah, because I think it's probably more representative. There was times when I was on quieter ships and there was a lot less on. But, for example, you a Z, the crew doctor might work a set of on calls alongside being expected to kind of work every day within reason. So, um, the average working day would be you. You get up, you might go for breakfast. You eat in the in, the officers mess. So there's like a spread on and pick and choose kind of, whatever your fancy, a decent coffee machine and, you know, fruit cook, breakfast, cereal, whatever. You really kind of designed trees. All these luxuries. I mean, first very novel, but partly fifth or sixth stone there near maybe have to resolve. So heavy breakfast on your clinic might start at eight o'clock on a on a port day or nine o'clock on. A senior on that clinic will run for around 90 minutes to two hours. It was the crew doctor you're just seeing the crew on. Obviously, they're on board for anything up to 9, 10 months. So you're effectively, They're general practitioners, so you'll see minor injuries, rashes, uh, aches and pains, colds, clues, um, on anything of the like. And I think you get a pattern for for who? Who comes with what and that was That was really important for me having the time to spend with the patient without being pressurized. Uh, I'm actually wanting to spend time with him because there's no it's no motivation for them other than wanting to get better. They're not after a signal that after a prescription, they don't They're not. They're not tracing down referrals for specialists. You just you just doing what you need to do. And if someone does get sick, you know, the flip side of that is your. Then you might be on call one out. Three days in the day is the crew doctor. Someone gets sick in the day. So let's say you finished a clinic a 10 o'clock in the morning. You're on call, and I think happening. Great. You're on course, you have to be on the ship, but you might be in Barbados. See you up to the deck setting the sun for an hour until until you're bothered. Basically on D and sure other doctors mess. Yeah, so, you know, last days where there's other things going on, But on an average day, if there's no calls that I probably would take an hour or two. So either breast or enjoy the sunshine or do something different for a period of time. So they already is something you know happens later. So you might be called over lunch. Someone's falling over a short broken their arm, have to come and see them extra. And then you do the X ray yourself. Any blood tests you do them yourself on. Then you and the nurse on call will pass that up. So if they need a plastic and put a plaster if they if they need a wound, care you, you do. It s so it's a bit like house in that sense way. If you need something, it's You're gonna have to do it now. There are occasions where people have injuries or illnesses that need them to be seen a short one. If they're important, obviously you can send them. Sure. Otherwise, you might have to admit that. So best that you get your afternoon, you do your afternoon clinic from 46. Maybe you've had your lunch in the officers mess again. Yeah, on. Then you got you got your evening. And like I said, if you if you're not being tested with uncle commitments, then generally the expectation, at least once or twice a week will be that you'll join the guest for their cocktail party. So you'll be giving a nice drink your dress up in your nice back tie. You might have to go for drinks we make for dinner with some of these guests, and that's the kind of that's the work aspect. That's that's the obligation, I guess, from from the companies perspective. But it's not really an obligation, you know. It's a nice experience. You talk to people who want to talk to you, and then you might have some social activities with the team. You might have a movie night. You might place a board games, you might have to the group bar that this plenty of opportunities for socializing. So I guess it comes back to that double edge sword where you do get that camera artery. But just recognizing that in that day you woken up and have breakfast with the team, you've done the clinic together at lunch with the team on the claim it together. You've had, you know, your evening potentially together, and that's brilliant where you're all aligned and get along. And I'd say more from the know we did. But sometimes it's quite high pressure. And if some of your tired or crabby or you know a couple, you don't get along them, then there's that flip side. If you're somebody who is very sensitive to how what the people are or how people get along, Um, then that could be tricky. I'd say, Like I said, generally, it was a really good thing for me. I really enjoyed working in this some small team situation, but I think it's fair to say that that's a double edged sword, something. Yeah, that's my average day you might do on a on a perfect day, you'll get four hours of clinic, and the rest of the time it's yours. And if you were not on call, you might be able to go and play on the beach for four hours in the middle of the day. Whatever else you need to do that, that would be a perfect day. Kind of How how often are you on call? So there's two doctors screwed up for a senior doctor up to the senior doctor to kind of work that rotor so it might depend a Xanax. Reject spect a shin. You might be as the crew doctor covering to night on course for everyone that they do on day similarly might be doing to down course for everyone that you do on that just allows them to get there because they've got a lot more abdomen to do and paperwork and things, so that lets then content set to the days, Um, and again, it depends what ship you're honest to help. And you passed it off out of ours. Now I was going to say the worst day then might be that you're woken up three o'clock in the morning for for an arrest or something, and then you still have to go and do the clinic in the morning. And then you got people coming in off all through the day, and then you're covering the second night on call by chance and you get bothered again. So that will be times when when you are really hammered on on, it's on. It's difficult period of time. But if I think as I've said before, if if you're somebody who can roll with the bats to enjoy the goods where the next day you literally might go back perfect day and it's more often than not, you will then get that perfect day. When you wake up the sun shining. You do a couple of hours with some nice crew in clinic. You have a really good conversation. One of the things you're nice slice of cake or something now and then you're off playing in the boat yard of Barbados, and you know that for me, that was that was worth it. And actually from someone that went and did 29 night shifts in in February 1 year, doing a couple of nights and bounce. That really wasn't the end of the world. Yeah, That's the You know, the patients. It's not like, you know, chest where they're wasted for seven hours to be seen. And by the time you get there, they're really angry. That ring ring the number. You're there within a minute, you can have x rays bloods on, you know, a full work up set of ups within your 1st 15 minutes. So you got answers pretty quickly. Um, actually, the clinician that was really, really has really, uh, is really good to see, you know, get someone that comes in with crushing heart failure. Uh, you know, as it comes on within 15 minutes, suddenly they're optional. Comfortable the breathing. And you think, why doesn't this? I've never had this happen in the and it just, you know, it's just taking three hours to get the ambulance And they waited for four hours in a in a waiting room, and I was viral or have had a single spray of GCN, so I mean it. It was really good to see in people do turn around really quickly, and they're really happy, you know, they've got they've got their care, you know that they looked after and and similar you know, if something someone's on well, and you've got three or four nurses standing behind you and what's stopping you, making someone get better? I mean that there's the other difference that I think I noticed from the man. It just where you might have to wonder around the department three or four times, or even, you know, have a video on a medical, warned you want a year in debt. I mean, my days, it's Yeah, yeah, it was a little sample. Those those are the two. That and anything to do with urine, like electrolytes. So osmolality it's It's very drinking. Know so that I really like, You know, you have a question you get an answer on your care is dictated quite quickly. So but you do need to be decided. You know, you do. I guess I need to be decisive. And this some situations where? Yeah, So my knees too unwell to sustain their cruise. And you need to have that different conversation and ruin their holiday. Maybe their families holiday. But, you know, most people understand that that's that's done. Miss it choice to make a whole thing. So yeah, I think I think all things considered this three good outweigh the bad. Quite. Yeah, well, that's that's quite interesting. So, um, moving onto that, we've heard a lot of the positive and and and the good sign of things. Um what, in your opinion, it might be difficult to rack your brain really hard this, but what would you say the, um the negatives of the less less positive aspects. That's a of working in this industry. I think this isn't hard. I mean, this is this is a is a double edged sword with everything we talked about. You're away for three months at a time. Um, which some people is brilliant. You know, if you want to get away, you don't wanna be paying rent on somewhere on you want to live a simpler life, then that's great. If you got family, Children, loved ones that you really take not saying that that's a real problem. And similar working in a small team. I loved it. Some people might really despise waking up and seeing the same people every day or or just find that they're not somebody who gets on, um with with different people or conflicts. So that could be a real burden on if you're on with someone that you know you don't get along with. That could be really challenging. But on the same thing. If you're with someone that you really do like on the May go home after two months and you spend every day together for two months, that's really hard. That's really hard. So those were the worst things for me. Know the small team thing is the best and worst, the time away best and worst. Um, I'm just trying to think of any other kind of really strong, negative things. Um, and I think I have already said that the the variation of what comes in really exciting, not know what's gonna happen next. Really exciting. But if you've got a night would say without sleeping properly on your sort of stressed about whether that page is gonna go off, that's a horrible feeling. Or if you had two nights on the bounce, where on the bounce where the where the medical response alarm's going, you know it's in the back of your mind and that and that's a stress. And I would say after after some of the busier contracts. I did take me a few days to kind of stand down and realized that I'm actually not on call anymore. I can relax. I'm not going to get sleep so around. So you imagine working. You know, you're you're you're nightshift in the NHS and trying to bed down what you're on course. You always aware of that page of waiting to go off if if you if you even manage that and it's the same sensation to an extent. So it did take me a little Also wind down it signs, but, um, no, I think I think that's probably all that could say about the that side. I mean, it's Yeah, I guess that Yeah, they're sort of they're linked, they're not. They just sent extent the positives and negatives. And I think double edged sword is a very good way to describe it. It becomes dancing down to who you are as a person. So yeah, like independent working. If you if you're able to work in stents and enjoy the good and kind of just fend off the bat for a period of time, if you like working independently in a small team, Uh, if if If you uh Yeah, if you're able to improvise a swell, I think that's key. You might run out of you're on amoxicillin one day, and, uh, and you have to decide, You know what you gonna do next? A bad example. But, you know, you learned it using eye drops instead of knows, knows I don't set of ear drops or, you know, there's little things that you'll learn that are useful or little treatments that work for certain conditions. And yeah, you do have what? Flexible. What's the most bizarre experience that you've had? Um, on treating patients on a cruise ship? Uh, it's a tricky one, because, uh, I said, I don't want a kind of over share. It tends what's Yeah. And I mean, there's a few really, um, difficult or strange circumstances being stuck in the middle of the Atlantic, you know, four days away from anything and on the same day, then getting, you know, an appendicitis stroke on a on a nasty sepsis, you know, full blown proper emergencies with things where people say, Well, what if you get you know, an appendicitis what we're going to do? You know, the reality is there's very little you can do, but it's a strange circumstance thinking okay, you know, come, they're going to be able to bounce a helicopter off four separate oil rigs to get to us to get it, but it's just like you're creating really difficult circumstances, but on I'm not sure of any other strange circumstances. Um, it sounds like that experience. On also some of the other example. You said that this quite low of them. A gist ICS and Boca's Well, are you in about a? Presumably you're involved in that as the junior doctor? A swell A. So when you're while you're working off, Shore's off the the medical director How much that management on diskus I'd comes into the, I would say, um, less than I would have worried about. So as a crew doctor always seemed very grown up to be organized in these hello backs and getting blood transfusions, sorts of things sounded really, really scary. But actually, you know, the reality is, you walk up to the bridge, you speak to the captain who's done 50 50 of them this year. Hey, says well, here we hear we are on the map. The local coast Guard is here. What they tend to like to do is to go to get a ship transfer from here. Which is really good because the conditions with C is, you know, slight on a if not, they can get a helicopter from wherever. So you've got a team of people around, you know what the score is, and then you bring the person short side and say, We've got this case and they might say to stand down, it's fine. Or they might say, yet carry on. That sounds like a safer idea on, so it sounds very jazzy. But in reality, you're really what supported you got you got that's what really kind of lead you through the logistics and it's not really you, you know, flying the helicopter. You're not telling the weather land that, you know, the whole ship's drilled on this. The hell you back, you know it takes think about four or 500 man hours. Obviously do it in about half an hour. Clear all of the dex. Take everyone inside. You know that this huge amount of work that goes into it, but it's a great opportunity put in hives and a hard hat, and I'm wondering, and so um yeah, it's It's a good experience. It's a good experience. That sounds like it. Yeah, eso Obviously, you did your initial stint on. Then you came back into the NHS and, um, work done anesthetics. What? What was the reason for that initially? What? What brought you back? I have my number. I had it on hold for a couple years, and I recognize that, uh, you know, my amount of experience in on aesthetics night to you wasn't as good as it could have been, you know, purely for an emergency department perspective, which is fine. But, you know, since it's just really missing a few keep, it's on. At that point, I was a crew doctor, so I came out on. I had been offered on the opportunity for a promotion, but I thought, I need to decide that I'm gonna go back into training. We're going to progress here. I need to have some. I really had some confidence with my ability to manage an airway. And it's not just, you know, doing the airway, because that would be fine, But you got some one for, you know, two or three days I'm on one of these ships and yes, hard. Then when someone's critical for three days and your response before. So I just wanted to be sure that I had that on then, you know, my options were still open. So I came back and did a few months. But as it was, um, I, um I got asked to go and do, um, a contract on soup er instead. Um, and I think it's maybe not the best thing to say, but, um, by that point, I kind of got the skills. I felt that I need it. Um, Andi, just seeing the kind of paycheck coming in every month and recognize that I was probably commuting an hour each way, working most days and falling back into that weird routine of worrying about my assessments. And what about getting stuff signed off and worried about room when my courses and when's my next day off and have a kind of book that you leave or someone else got to take that day off? Um, I thought, Well, Christ, I just I just need to go back. So when did a few months on a super hot, which was fine. Um, it just wasn't very, wasn't. Is engaging as it was on the cruise ships on going back as a senior doctor. It's them kind of the UK And I worked on the flexion piano and thank you dot as well, which is great. So, um yeah, that's my experience with anesthetic was good and they were lovely to him, Really supportive on. I learned plenty, but it was almost worse than when I went to anywhere. I mean, completely independent to certainly being completely supernumerary, which again, right thing to do that for me, it was really hard to just Yeah, I guess you already had a taste of it. All is well, when you talk to your work as on the cruise in the best place Yeah. Oh, yeah, it's tricky, but, um yeah, I think it just reaffirmed that what I already thought I knew, which was actually that this this is ah, a wider picture outside of the NHS that will probably lead me personally to be happier in general. Then I would be if I was in the NHS and I think this really serves a wider issue for me, which was if I had, if I had been more honest with myself area on and said, What do I actually want is an outcome from my career Is a doctor. Well, I want to be financially supported. I want to have access to a lifestyle that makes me happy. I want to have enough breaks so that I can do things that I want to do. I want to travel, um, on. But I'd like to ideally work in a team that I got on with. I'm happy in on day can obviously get that in the in the chest. But I sort of look left and right to my colleagues who are, you know, blinkered, saying it doesn't matter that I you know I hate my job at the moment, and I don't have any friends, hobbies, interests. I've haven't seen my family for a year because if I do this for seven more years, I could be a consultant on. At that point, everything sorted. I fear that I was vulnerable to that notion because everyone else was doing it. But I wasn't confident that at the end of that that I would be in this so place of bliss. And I have colleagues who are, you know, there are genuinely thrilled to have that consultant post and doing really well. But I think I just needed to be honest myself and recognize that, you know, you're gonna get my exit through training to any if you if you ask me a couple of months ago, Um, if there was a way in which I could make you have a career in which I had lots of breaks, it turns of not time to travel on breaks I wanted to I probably would have called you and say so because that the no change my mind 10 instead of, you know, kind of a lot more about this. This role that I didn't think was so impossible to send extent. Yeah, I think it's because we don't really hear enough about these sorts of opportunities. And ah, you know, you I think for yourself obviously had mentioned that you'd seen colleagues who had gone through this system. But if you're somebody who doesn't know anybody this sort of industry whatsoever, you're not really going to come across stuff like this. And I'm sure there's lots of other things out there is. Well, that may make somebody happier than the composition that there in on and the training that they're they're actually working in. And it's all about. So it may be giving that awareness and and, yeah, getting the message. Of course, it's hard because you know, this this point in your life where that might be an okay thing to do is sorry being intruded on by a dog. But it's similar. You know, some people have plans to have families, or they have, like, a close relationship with their friends or want to see people more regularly. But I mean, from my perspective, it was much better than I thought it would be having, you know that they have a really good policy with regards to relatives traveling with you. So, you know, if you got a partner, uh, then you could just dragging on you. Don't they just come along and travel with you so you might be working if they've got a a career where they can get lots of time off, then they contract with you. And I know I had friends, family and left one's travel with me very regularly on that. Made it all. Yeah, yeah. Easier and worthwhile. Actually, I think for those who are concerned about being away from family and friends for such a long period of time and moving on. So obviously we are very passionate about portfolios. That's sort of what we're we're all about during your your time in the cruise industry. And what, what sort of the the method of documenting your career portfolio. Do they provide you with a specific portfolio? And did you yourself haven't interest in, um, keeping a portfolio of all the wonderful, amazing things that you've done? So this implants, that is, when I joined Carnival, I could think of nothing more worthless in keeping a poor fellow there. It was really, really fed up with the process of appraisal, the paperwork on all the rest of it. Now, once I removed the stress and, uh, you know, hassle of of kind of I think I was just over working on not giving myself enough time. I've removed that. And then you read the stress of finding those courses on. Then they give you the platform ltp to to keep everything locked. So once you got enough time and space to actually feel motivated to want to get better and doom or thin. Yeah, I was totally engaged to the process on you. Didn't see. It is just a tick bulk exercise. No, I can't say that now, anyway. But But no, I absolutely don't now. And it's funny because I would have 100% told you it was a tick box exercise use. This is just, you know, covering answers. But at the moment, I really don't see it that way, especially with the more recent changes in the in the process of appraisal on dope oint of it. So certainly how I like it done at the moment. I can't be okay, you know, it's an individualized process. Is there to support people and even the people that I'm appraising now that is saying, Oh, I know it's just a you know, a point. This thing. Well, by the time you got into a conversation about something they actually care about, even if it's lead, even if it's you know, I couldn't get on a course. Even if it's a family issue, there's always something relevant pertinent to their job that they would like to change that they just haven't found time for. So it's just a structure to help build them towards a better existence. So I'm more passionate about it now with more of the personal side, but yeah, I mean, just just assume that a little bit on what I've managed to obtain from this. Yes, I've kept my registration. And yes, I've been up to date with my last April. Unless I've done other courses on the investigation training after my appraisal training of responsible officer training. Um, you know, this is this Heaps, of course, is that I would never have dreamed of being on in my career That I, you know, somehow managed to whittle down into, like, a four year period. Um, just from having the time space toe want to grow, which I think is, I think it's that's pretty significant for me on, I think is representative of the couple of doctors we have. They're generally quite keen to learn a progress, even the ones that just with us for a year, they're here because they want to achieve something here on often like me, they end up staying for longer because they see the rate of growth, Um, and even not professionally dispersing. It's well, yeah, I think that's it. Sounds very, very sort of well rounded in its approach. It's not just sort of about the clerical work, but also there's there's a lot of welfare, um, off, um, conditions On day. It's it seems like there's a very sort of a listing approach to that way. Medicine is practiced in the cruise industry. Um, what, in your opinion would be the your top tip or you're You're biggest sort of advice for those who wish to pursue something similar to what you have. Um, with regards to the cruise industry, I think this may be the wrong answer, but I think the first thing I'd say is if you were in any way interested now it's time to be interested because we just had a huge portion operations. I don't want to comment on it too long, but ultimately way are in need of good. Good physicians were in need of good masses. Um, and you know, we are charges an organization t help those people who are considering it to firm up the ideas. And let's say you've been A. You know, you've been a, um, an emergency medicine doctor for 10 years. When you've been a GP for 30 years on, you've got an interest in some other specialty, but you're just missing. You know, you maybe haven't done enough. You know, I haven't pulled enough limbs or you haven't done quite enough our size or a niece set skills. You just think you might be missing anything. I say it's just get in touch because there's gaps that we can feel. We've got good relationships with hospitals near by on Deacon. Get people in and through pretty rapidly at the moment on get them on to a much, much more even keel with their with their life. So that's the first thing I say is that you know, if you're thinking about it, just just reach out. I speak, you know, I do a shift in any and, you know, half the department. So I was thinking about doing that. It's like, Well, why didn't you just see? It just takes some time. Just just have I think about it. So that's the first thing on. And in terms of was this advice for someone thinking about it. Yes. Yeah, yeah. Um, yeah. I have to say it's just that just do it. I know. I know. Jerry McCabe, one of our senior doctors we didn't open recently, and he said the same thing. Just just do it. You won't regret it. Yeah, Who Who would you say is the is the best of the port of call In terms of getting into contact, is it? Would you online or, you know, the line? So it's the current careers website, and at the moment, yeah, they've got a team of people fielding feeling all the correspondence. We've got a lot of interest, but we are. We are keen to get them as many people interested as we can. So yet the carnival UK careers websites on does any mailbox. What they'll do is if you if you give them a a message to let know your interest. What they tend to do is follow up with that with a performer that just identifies what skills you have, what skills you need, Um, on submit your CV, and then it goes from there. And if the specific areas like I said that are you know that I'm missing I think it could be quite open and say how? How is best for me to approach this on, either? They'll say, You know, you're better off just just doing a block in any or they'll say, You know, we could speak to Lucas and see if there's any opportunities to get things to get things up to speed. So most of the time, we're able to help most now, Perfect. I'm shivering. And if you have any other questions that you wish this No, I think from the, uh, dancing woman. Really, I think you've given us a fantastic reviews to what it's like to execution. Doctor on. I think your personal experience has been really important because I think that's what we're trying to give the these is. It is a basically 1st 1st hand knowledge, what it's like, um, going into and what kind of personality traits more kind of skills on how to dress. It's of the time people that go into the sore throat. So, yeah, I think that's great. And you want to talk about portfolios Well, which is something that's quite good born for us. Uh, the only other thing is just a personal side is probably probably maybe too personal. But, you know, historically, it was someone that was happy as a child, you know, breathe through my exams, have an identity that I associate it with emergency medicine and really felt that entity was really strongly was certain. That so I wanted to do is who I was like, um and I think I let my attachment to that identity delay my decision to make a change in my life. And I think it's the only thing I would critique if, if I have my time again, would be actually recognised earlier that the environment I was in wasn't it wasn't no, not three fault of my own or through anything else was just just not sitting here and making that change was really important. That's that's really interesting, actually, because I think a lot of people do have these preconceptions of what they feel they would be best suited to. People say, you know, since I was 10 years old, I wanted to be an orthopedic surgeon, and you sort of follow down that route because that's all you've ever sort of imagined in visits for. Actually, if you're unhappy um, in what you're doing and you're unhappy in the process, then, um, e think that you have to be open to other avenues and explore their options. And it sounds like, um, you know, your you is dead set on the acute setting an acute medicine, um, or in the D environment. And actually, it was the cruise industry, specifically with the loss of the acute stuff that you felt the most passionate and uncomfortable. Then I think what really took over was that I wanted to be someone that was enjoying their career. I want to be involved in clinical medicine. Uh huh, Yeah. I wanted to be, um, just just happy in my environment in the team that I work in. Uh and that's why I found when I first did emergency medicine was like, Christ, I'm involved in clinical care, even is a student. I'm really in the thick of it. And I like the team, and I'm I'm empowered by being in that environment. And that's I think, what I like to know. If I'd if it actually worked that out sooner, that actually what I like is his team work is having a having a bond with the patients of the people on, um, providing change to people that makes them feel better. And I think that Israel achievable outside of the chest, not it's not the car. Give it within there. But I think if I actually got to the root of what I wanted rather than the identity of it and then I probably would have been better served. So I just tell people to have that for. But then we can, Yeah, I think that's such an important thing to you to mention. I think we can get so wrapped up in where we are over heading that we don't sit and reflect about what we actually want from a roll on were again. We mentioned this before side and we were stuck in a cog of. So the linear progression scheme of your training on. It's very, very difficult for us to actually get off that months where so and mentally glued to it sent on. And you've done that. Um, Ms that's describing a training you take. You take himself. You taking initiative to step off that one year but way to do something different. Naturally, you haven't you haven't really come back once on any pathway. Um, which is Are there any plans to Yeah. I mean, I don't I don't have to see that will be joining any training programs. That's such. I mean, I still still dip into any whenever I can. I don't really enjoy those shifts. Um, knowing that I'm not gonna have to fight that fire for the foreseeable future. Yeah, enjoy the actual work. Um, but I think if you were to tell me that my my career in maritime no longer existed, um, I think I think I would probably move more towards a any kind of career where I can retain my, uh I'm not gonna say personality, but assisted good side of a personality. I'm not gonna compromise again on on on on happiness like I had them before. So yeah, I think I think I take, um, all a back approach and not be so driven by, um, the destination. Actually, that's a That's a good message. Teo, finish this on. So thank you very much, Luke. And I think you've given us ah, wonderful insight into the world of the cruise industry from a conditions point of view and on, but just made it. I think everybody out there really motivated. I'm just following what they're happy with in in life and, uh, pursues the passionate about. So it's been actually wonderful speaking Teo, um, on once again, we'd like to thank medal, obviously providing the platform for us to, um, team this F three Siris and on also, um, to be able Teo, provide the catch up service, which will be available for all of the episodes off the three Siris. Um Onda Also, we want Teo prevent the work that myself and shiver I've been doing with the glasses. The portfolio clinic. Um, poor fellow clinic, um, is a service off here mental ship in which mentees will receive personal practical, um, advice on their aspects of their portfolio in order for them to achieve their desire career path. Um, on. But the moment we were in the phase where we're looking for mentees on also mentors toe, um, start the first pilot off the portfolio clinic eso the website details of there and hop on to the website register. Um and we're also looking for a busted, uh, it's obviously the final left side of the F three Siris. Um, on I think we've had a had a wonderful time exploring all the difference of the ah, wonderful and, um, special Lefteris that people are questions have conducted over over, um, the last couple of years. I'm working. Teo, Um, continue this. I think Teo certain extent to it. We may run another Siris, and what we're looking for the moment is ah, Embassador could help with the sort of ah running's of this of this second Siris s O. That is also the details for that are also available on the for further clinic website as well. Um, so yeah, don't forget to leave your feedback for those who are, um, out there on. But thank you very much for obviously supporting the three Siris and, ah, watching the episodes, they will be available and catch up. Um, and hopefully we'll have another Siris of, um, spectacular clinicians who have conducted some amazing opportunities during their time out of training and any last remark. Shit. No, I think you covered it all. I'm excited to the next installment of the three series. Um Onda? Yeah. Please leave your feedback. We use it. Utilize it to make the next series better. Um, I'm Jeff. Um, Thanks for joining. Thank you, Lucas. Well, thank you. Thanks so much for having me really appreciate it. Yeah. All right. Take, uh