In the fourth and final year of medical school, consultants and registrars never tire of telling you that you are "nearly a doctor". While there are moments where this feels exciting, it is more commonly accompanied by fear as the senior clinician is telling you, "Your really need to know this; you're nearly a doctor, you know."
The most petrifying thing for me at the moment isn't even the idea that I could kill someone (although this certainly is not a comforting thought), it is more the concept that I might be really crap at my job. There is so much to know, and on a day-to-day basis so much to do, that I am mostly worried about struggling with the organisational aspect of getting through things in an efficient and professional manner, and being able to just generally do things well, such as writing up notes and presenting to senior clinicians. Very boring concerns, I'm sure you are thinking, but important none-the-less - the interns who develop less-than-desirable reputations often seem to have their standing tarnished by such seemingly-minor parts of the job.
Bearing this in mind, I am trying to utilise this year as a proper training year to get used to the job I'll be doing in the not-so-distant future, getting lots of practise doing the whole workup of patients - from history, examination and ordering of basic tests, to presenting the case to a senior clinician and developing a management plan, and communicating all of this to the patient. I thought Emergency Medicine, a two-week term which I've just started, would be the perfect place to do this. However, the doctor to which I'm attached seems reluctant to let me out of her sight. As I watch the other students seeing patients alone, and then hear them presenting the cases in the doctors' "fishbowl" area, I am stuck observing. How am I supposed to learn how to actually do all the things I'll need to be able to do if I never get any practice?
I wouldn't be so upset if this was just how all the medical students in the department in general were treated; that would be much easier to accept. It is quite hard to stomach being on such a short leash, though, when I can see all the other students operating relatively independently. It makes me wonder if there is something wrong with me - if I have perhaps somehow given off the impression that I'm not competent to do such a basic and necessary task as take the medical history. I get the impression that my supervising doctor, who trained overseas, has a very different idea of what senior medical students should be capable of. When I did finally see one patient on my own today, she seemed very surprised (and a little concerned) that I had already written it up, which I am used to as being a standard task for us. When I asked if I'd made any mistakes, though, or if she could give me any feedback on improving, she didn't have any corrections for me.
Maybe I need to be a bit more pushy and "train" her as to what are valuable learning experiences for students, and the level we should be expected to operate at? It is beginning to look like a very long couple of days ahead.
Tuesday, April 5
Thursday, June 10
Tut, tut, tut
It truly is a shame to see people blatantly doing the wrong thing in clinical practice. Today I accompanied one of my general practice supervisors to the nursing home she regularly attends, to care for the residents. On the way over there, the GP told me that she has been having difficulty with a new registered nurse there, who has been frequently requesting that patients inappropriately be prescribed sedatives for "behavioural problems".
I don't feel that I should publicise too many of the details, but by the end of our visit today we had discovered that the nurse had been administering a homeopathic "remedy" for these behavioural problems, to at least three-quarters of the residents. The remedy had been written up in the patient's drug charts, along with a sticker stating the treating doctor's name, implying it had been prescribed by the doctor, who in reality had no knowledge of the treatment. Meanwhile, this nurse has apparently been charging the families of the patients for the "treatment".
The mind boggles at how someone involved in healthcare, whose utmost priority should be the welfare of their patients, can think that it is ok to give a potentially harmful substance without any authorisation. Wouldn't you think that an alarm bell would ring in your own mind, that this is NOT the right thing to do, when you have to engage in deceipt by putting the sticker on the drug chart that implies that the doctor ordered the medication?!
As to what happens next, it has been reported via the appropriate channels, and I suppose we shall see.
I don't feel that I should publicise too many of the details, but by the end of our visit today we had discovered that the nurse had been administering a homeopathic "remedy" for these behavioural problems, to at least three-quarters of the residents. The remedy had been written up in the patient's drug charts, along with a sticker stating the treating doctor's name, implying it had been prescribed by the doctor, who in reality had no knowledge of the treatment. Meanwhile, this nurse has apparently been charging the families of the patients for the "treatment".
The mind boggles at how someone involved in healthcare, whose utmost priority should be the welfare of their patients, can think that it is ok to give a potentially harmful substance without any authorisation. Wouldn't you think that an alarm bell would ring in your own mind, that this is NOT the right thing to do, when you have to engage in deceipt by putting the sticker on the drug chart that implies that the doctor ordered the medication?!
As to what happens next, it has been reported via the appropriate channels, and I suppose we shall see.
Monday, March 2
Year 2 So Far
Everyone told us when we started that year 2 would be the hardest of our degree - and that may be true, but so far I'm loving it! Sure, it's a lot of work, with a lot expected of us and more "teach yourself medicine" than ever, but this year is much more clinically-based. One of our major assessment pieces is a portfolio we have to submit, full of long and short cases. A lot of students whinge about it, and then make up their long cases (or copy them from each other), but I really enjoy going to the wards and meeting patients - getting the chance to really talk to them and find out their story, and hopefully hear a cool murmur or something like that along the way. Doing long cases seems to be the closest we get to actually doing medicine at this stage, so I just can't understand why people who want to be doctors would pass up that opportunity!
One of the trickier things with the more academic-based part of year 2 is knowing what to learn. Now that we are focussing a bit more on the clinical aspect of things, there just seems to be so much detail you could potentially go into! I just don't know how much we should know about the 34 different types of lymphoma from last week. To go to one layer of knowledge seems all too easy, while the next seems impossibly difficult - why can't I find the happy medium? This week is a bit the same - our case is malaria, but the broad theme for the week is tropical and travel medicine, which potentially could cover just about anything! We must have covered more than 20 diseases in our lectures this morning alone. A bit of guidance would be great right about now...
One of the trickier things with the more academic-based part of year 2 is knowing what to learn. Now that we are focussing a bit more on the clinical aspect of things, there just seems to be so much detail you could potentially go into! I just don't know how much we should know about the 34 different types of lymphoma from last week. To go to one layer of knowledge seems all too easy, while the next seems impossibly difficult - why can't I find the happy medium? This week is a bit the same - our case is malaria, but the broad theme for the week is tropical and travel medicine, which potentially could cover just about anything! We must have covered more than 20 diseases in our lectures this morning alone. A bit of guidance would be great right about now...
Thursday, February 26
Sore Spot
I don't deal well with patients who've attempted suicide. Even when they're comatose and ventilated in the ICU and I don't have to try to have a conversation with them. I can't really explain what happens to me, and obviously it's something I'll have to get over. I think the idea that anyone can feel that much despair and hopelessness is something that terrifies me. The ICU last week was full of more tragedies than I can bear thinking about.
Wednesday, November 12
A Pleasant Surprise
Despite my initial trepidation, this week on orthopaedics has been a fantastic learning experience. Yes, I'm still completely convinced that I couldn't stand being an orthopaedic surgeon, but it has been great being in a department here the doctors are eager to teach. There have been lots of interesting cases for me to see, as well.
On Wednesday I saw a child with a classic median nerve palsy following a proximal radial fracture. It's fascinating for me to see things that we've learnt about, and examining for the signs that we all read about in the textbooks. The child was displaying the Benedictine sign, and had loss of flexion of his thumb and lateral two fingers, as well as loss of sensation over his lateral two fingers and the lateral half of the ring finger.
I also had the chance of examining a newborn with dislocatable hips. Two weeks ago, on paediatrics, I'd been taught how to do neonate health checks, and one of the routine things we check is the baby's hips, so it was interesting to feel it, and learn about the management. If they're caught as a neonate, management is pretty simple - 8 weeks in a von Rosen splint, which keeps their legs in a flexed, abducted and externally rotated position, enables the acetabulum to develop so that the hip becomes normal. After 8 weeks, they can come out of the splint and be fine!
Yesterday, one of the registrars taught me how to do a proper hand examination, with the patient being an elderly person with severe rheumatoid arthritis. It's so much easier to learn the signs when there's a patient in front of you who actually has them!
The other great thing about the week has been the practice reading x-rays, CTs and MRIs (although there were only a couple of MRIs, as they're not done nearly as often, being much more expensive), and learning to describe fractures properly. Whilst I'm not going to go into orthopaedics, I'm sure this is still an essential skill.
On Wednesday I saw a child with a classic median nerve palsy following a proximal radial fracture. It's fascinating for me to see things that we've learnt about, and examining for the signs that we all read about in the textbooks. The child was displaying the Benedictine sign, and had loss of flexion of his thumb and lateral two fingers, as well as loss of sensation over his lateral two fingers and the lateral half of the ring finger.
I also had the chance of examining a newborn with dislocatable hips. Two weeks ago, on paediatrics, I'd been taught how to do neonate health checks, and one of the routine things we check is the baby's hips, so it was interesting to feel it, and learn about the management. If they're caught as a neonate, management is pretty simple - 8 weeks in a von Rosen splint, which keeps their legs in a flexed, abducted and externally rotated position, enables the acetabulum to develop so that the hip becomes normal. After 8 weeks, they can come out of the splint and be fine!Yesterday, one of the registrars taught me how to do a proper hand examination, with the patient being an elderly person with severe rheumatoid arthritis. It's so much easier to learn the signs when there's a patient in front of you who actually has them!
The other great thing about the week has been the practice reading x-rays, CTs and MRIs (although there were only a couple of MRIs, as they're not done nearly as often, being much more expensive), and learning to describe fractures properly. Whilst I'm not going to go into orthopaedics, I'm sure this is still an essential skill.
Scrub, Scrub, Scrub
I've confirmed that I'm definitely not going to be an orthopaedic surgeon, but I'm still managing to thoroughly enjoy my week in orthopaedics. Funnily enough, the orthopods are the nicest group of doctors I've met in the hospital yet - who'd've thunk it! They are lovely to everyone - nurses, other staff, other doctors, patients, even us mere students - and consistently appear genuinely interested in teaching.
I scrubbed in for the first time yesterday, which was quite an ordeal. The procedure was a total knee replacement, so as well as the standard gown and gloves I also had to put on a visor with a hood to shield myself from the spatter that happens when the surgeons are sawing and drilling - you pretty much end up looking like you're wearing a hazmat suit. When scrubbing in, I felt that I must pretty much be the clumsiest person ever. There's a very particular way of putting on the gown, whereby you have to make sure your hands are still inside the sleeves (so they're not out the cuffs at the end), and then somehow get your gloves on over the cuff and wriggle your hand out into it. Quite tricky! And because I am particularly talented, I managed to get my second layer of gloves on the wrong hands!
The operation was really interesting to watch. One of the surgeons, who is also the director of the department, said that it's pretty much like carpentry, and I certainly saw what he meant. They use so many different tools, and do up lots of jigs to make sure they're getting the angle right.
As well as getting my first experiences in an operating theatre, I'm also getting loads of practice looking at x-rays, CTs and MRIs - which is invaluable to me, considering I'm so bad at interpreting them. It's much more interesting to look at them when it's in a clinical context, and I'm finding that gradually I'm getting better at picking up what isn't quite right about an image. I've certainly still got a long way to go, though!
On another note, I'm missing MBF so much! While I am really enjoying myself here, and learning a lot, I'm also glad to be going home to him soon. We've planned a week away at the beach next month, which we're both really looking forward to. Our apartment has our own private spa, which will be quite a treat, I'm sure!
I scrubbed in for the first time yesterday, which was quite an ordeal. The procedure was a total knee replacement, so as well as the standard gown and gloves I also had to put on a visor with a hood to shield myself from the spatter that happens when the surgeons are sawing and drilling - you pretty much end up looking like you're wearing a hazmat suit. When scrubbing in, I felt that I must pretty much be the clumsiest person ever. There's a very particular way of putting on the gown, whereby you have to make sure your hands are still inside the sleeves (so they're not out the cuffs at the end), and then somehow get your gloves on over the cuff and wriggle your hand out into it. Quite tricky! And because I am particularly talented, I managed to get my second layer of gloves on the wrong hands!
The operation was really interesting to watch. One of the surgeons, who is also the director of the department, said that it's pretty much like carpentry, and I certainly saw what he meant. They use so many different tools, and do up lots of jigs to make sure they're getting the angle right.
As well as getting my first experiences in an operating theatre, I'm also getting loads of practice looking at x-rays, CTs and MRIs - which is invaluable to me, considering I'm so bad at interpreting them. It's much more interesting to look at them when it's in a clinical context, and I'm finding that gradually I'm getting better at picking up what isn't quite right about an image. I've certainly still got a long way to go, though!
On another note, I'm missing MBF so much! While I am really enjoying myself here, and learning a lot, I'm also glad to be going home to him soon. We've planned a week away at the beach next month, which we're both really looking forward to. Our apartment has our own private spa, which will be quite a treat, I'm sure!
Monday, November 3
New Week, New Ward
With a new week started, I'm finished with Paediatrics and off to Medicine. While there was a lot of waiting around on paeds, when we were doing things we had a lot of fun - and learnt a lot, too, of course! I think the highlight of the week was going around the Maternity Ward with the Special Care Baby Unit (SCBU) resident, doing neonate checks on all the newborns before they could be sent home. One thing's for sure - finding the femoral pulses on a newborn is a LOT harder than on an adult! So now I know how to do a newborn check, as well as what to do if some of the results are not quite normal.
We also looked after baby girl who made the national news, after her father poured petrol over her mother and his two children before setting them alight. Thankfully, all patients are fine, but last report I heard the baby had been sent to another city to be looked after by a specialised burns unit, to ensure her burns healed well and there was no significant scar tissue.
Medicine has been very busy - I'm just shadowing the resident and registrar, but it is quite an effort to keep up! I'm on the endocrinology service for the week, which seems like it will be great as a learning experience, as the patients all have multiple co-morbidities and are complex cases. I hope that doesn't make me sound too cold-hearted, saying that patients with many problems are a good thing - it's just the way medical education is, that we need to take the best opportunities to learn that we can.
It was a draining day. The residents have all just rotated into the department, and the endocrine reg for the next couple of days is doing relief cover, so the three of us were completely unfamiliar with the patients. This meant we spent the entire day rounding on patients. The resident said things should settle down, though, once the regular registrar is back mid-week.
The resident I'm with is eager to teach, which I am grateful for. She's suggested I have a think about what I'd like to learn, and I can give her a list tomorrow and she'll try to make the time to teach me later in the week. I've only got a few things on my list so far, so I guess I'll try to add over the next couple of hours! Although, on second thoughts, what I have got should keep me plenty busy, so a few things for one week are probably enough.
We also looked after baby girl who made the national news, after her father poured petrol over her mother and his two children before setting them alight. Thankfully, all patients are fine, but last report I heard the baby had been sent to another city to be looked after by a specialised burns unit, to ensure her burns healed well and there was no significant scar tissue.
Medicine has been very busy - I'm just shadowing the resident and registrar, but it is quite an effort to keep up! I'm on the endocrinology service for the week, which seems like it will be great as a learning experience, as the patients all have multiple co-morbidities and are complex cases. I hope that doesn't make me sound too cold-hearted, saying that patients with many problems are a good thing - it's just the way medical education is, that we need to take the best opportunities to learn that we can.
It was a draining day. The residents have all just rotated into the department, and the endocrine reg for the next couple of days is doing relief cover, so the three of us were completely unfamiliar with the patients. This meant we spent the entire day rounding on patients. The resident said things should settle down, though, once the regular registrar is back mid-week.
The resident I'm with is eager to teach, which I am grateful for. She's suggested I have a think about what I'd like to learn, and I can give her a list tomorrow and she'll try to make the time to teach me later in the week. I've only got a few things on my list so far, so I guess I'll try to add over the next couple of hours! Although, on second thoughts, what I have got should keep me plenty busy, so a few things for one week are probably enough.
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