Saturday, December 29, 2012

A Memorable Year.

1 year ago today, I was thankful and nervous at the same time. Last year's exam was probably the largest hurdle of my degree. I didn't do as well as I had hoped in my exam, but still managed to pass. I was incredibly thankful to be able to pass as many of my friends had failed the exam. Some of which had to repeat the year. I made a promise to myself that the year 2012 will be my comeback year. I was determined to start on the right foot and to never make the same mistakes again.

This year zoomed by. I believe I made leaps and bounds in terms of knowledge and self-confidence whilst on the wards and in clinics. I still got to give lots of credit to my placement in Orthopaedics. I cannot be more thankful to my supervisor. Even my friends have noticed that after my Orthopaedics placement, I was a different medical student. I was no longer afraid to speak up. I was no longer afraid to participate and be proactive. I realized that if you don't ask, you will never know what will happen. The worst answer you can get when asking something is "No". What is there to lose...other than a hurt ego. So one tip for all of you is to be confident. Don't be afraid to ask for help. Again, the worst someone can say is "No". If the answer is "no", just shrug and move on and don't take it personally.

As you move through the degree, Medicine slowly dominates your life and you really got to make an effort to have a social life. As the months pass and you have some free time to reflect, you realize your friends start to drift away and it may get a bit lonely at times. Medicine needs a lot of dedication, but I cannot emphasize enough how important it is to relax and take some time out. Giving yourself a break does not necessarily mean you have to go take a vacation. Taking a break is different for everyone. It may involve going to do something you enjoy or meeting up with friends, or even just spending some time at home to relax and watch TV.  I didn't realize how important it is to take a break until this year when I have finally experienced a whole year of clinical placements, one after another. Work - Life balance. I know many people in my year who are taking a year out to do a BMedSci next year, not because they want to do research, but because they have burnt out.

To top off my memorable year, just earlier today I received confirmation that I have been accepted to present a my research poster at a national conference. Really unexpected as it's quite competitive, so I'm absolutely chuffed. What a way to finish up the year!

In general, I have made many new friends, matured as a person, and gained valuable skills for the future - I think this has probably been one of my most memorable year of my medical degree. Despite the many ups and downs throughout the year, looking back - overall it has been a very good year.

Got to thank those who have made my year so memorable and those who made my experiences so much better. Cheers to 2012, bring on 2013!

Happy New Year!

Thursday, December 27, 2012

Request: Tips for Revising for Exams.

So I had a request to do a post on tips for revising for your year-end medical exam. To be honest, every person will have a different way of revising. The most ideal way to revise for exams is to start from day 1 of the course. After every lecture/day, gather all your notes together and make sure your notes have enough info for you. If not, look at your recommended reading and add info to your notes. Or after end of each day is to consolidate all the things you have learned and to go over it. Some people like to consolidate their knowledge on weekends as most lecture days go from 9-5pm and by the time you finish your day, your brain will be fried. If you stay on top of your notes, when it comes to exam time, you should know your material quite well and just need to commit things to memory and you will not be needing to learn anything "new".

What I just described is the ideal way...but realistically, the chances of that happening is quite slim, unless you're quire organized and on top of everything. For me, that method got tossed out 2 weeks into my course. What actually happens is that you take notes during your lectures/print out your lecture slides. If you're having a good week and have some spare time, your notes will go into a binder so your room stays relatively neat and that you will be able to find your notes. If your university only does 1 year-end exam, like mine, on average, medics begin studying between 4-6 weeks prior to exams. You would think that's ridiculously too far in advance, but the sheer amount of material you learn in one just as ridiculous. I personally need 6 weeks to go through a whole year worth of material, but do keep in mind...I don't really look at my notes again until my 6 week revision period. So here I will list some tips on how to get on top of your revision period:

1) Make a revision schedule. Try and figure out how many days/weeks you will need to go over a topic (eg. 1 week for Paediatrics, 5 days for O&G). How much time to dedicate to each topic will depend on how well you know a topic/how confident you are with the topic. Always leave 1 week prior to exams for leeway/time to go over sample/past papers/revise stuff you don't know very well/last minute cram. I usually start thinking about making my revision schedule well in advance or else if you do one too late, you'll realize you have too little weeks left and too many topics. To avoid that, maybe think about your revision schedule when you come back from your last holiday before exams.

2) Find a study buddy! If you live with other medics, then that's sorted. If you don't, try finding a study buddy who has the same sort of revising method as you. It's a great way to make sure you don't miss out any topics and also a great way to test each  other's knowledge. Make sure this study buddy won't be a distraction though or else you won't accomplish much!

3) Rest! I cannot stress enough how important it is to get enough rest during your revision weeks. No point of pulling all-nighters when your brain can't even function anymore. Nothing will get absorbed. Your body will tell you when it is time to take a break (usually when you find yourself reading the same page over and over again and nothing is going in). Try and get a good nights sleep every day. Pretty basic stuff, but it is so easy to forget to just rest.

4) Use cue cards for memorizing things. Some people don't like cue cards, which is fair enough. In medicine we have to learn a lot of names that aren't even related to the condition such as drug names/some medical syndromes. Once you write it down, you can put it to the side. Also great for the last minute cram a day or two before exams.

5) Start early. At the same time I'm not saying start revising 10 weeks before exams. Obviously this is down to personal preference. I think I started too early for this year's exam, but it's not something I regret. It was extremely tiring and boring though. At the same time, last year I started too late and regretted it and it was extremely stressful. Because I started a bit too early (or maybe even perfect timing), I could sacrifice a day or two to take a break or to spend a few extra days on a topic such as Paediatrics. I originally allocated 10 days for Paediatrics, but actually ended up taking 2 weeks to go through all of Paediatrics, but because I started revising early, I was able to give up a few days and shift my other dates around for my other topics.

6) Use revision books to AID knowledge, not gain knowledge. There are some books called Crash Course or At a Glance, which are really good books which gives you a quick glance at a topic. These are good books to help you look up stuff quickly or to double check info, but these are books you should not base your revision around as it misses out fundamental/basic knowledge that you will get from a proper textbook/lectures.

To be honest, I think the key things for revision is to be organized, good time management, rest lots, and try not to stress out too much. Exams are extremely stressful and your anxiety levels go through the roof. Everyone will be feeling the same so don't think you're the odd one out. On top of revising, you might still have to go into placement as some unis only give you 1 week of revision (where nothing is timetabled), so you'll need to be able to balance going to placement and revising. If you aren't organized, your revision will get quite messy. At the same time, don't start skiving placements so you can revise because at the same time, you can learn/revise while on placement. Sometimes really useful tutorial sessions will be held and you can learn/revise during those sessions. To be honest, this whole revision business sounds a lot harder than it really is. You'll know what to do when it comes to revision.

Hope this helps!

Wednesday, December 19, 2012

I'm baaaaack!

Well it's certainly been awhile since my last post. Apologies. I've been revising for my exams. Finished exams  so I suddenly have a lot of free time. Quite weird. I've technically been studying for over 6 weeks for this exam which felt a lot longer as it just kept dragging on and on. It didn't help that the other years have already taken their exams/have left for winter holiday already. It's gutting when people are away back at home or on vacation and you're stuck in your room/library revising all day, every day.

Today I got my results from my exam and good news: PASSED! Managed to jump over another hurdle. Next hurdle: Finals. Scary! To be honest these exams meant a lot to me. I wasn't very happy with my performance in last year's exams and promised myself that I will never make the same mistake and study harder and work harder. I pretty much declared this year as a "comeback" year. I promised myself to go into placements and actively learn. So today when I went to get my results, I was very nervous. I was confident I had passed, but there's always that little bit of doubt in the back of your mind. The relief when I saw my results. Phew. I think I can officially say that this has been a successful comeback year. I have regained my motivation for Medicine and during the 2nd half of this year, I have regained a lot of confidence. I got to say - it's been a good year (despite the highs and lows).

Along with my results, I have received my schedule and placements for next year. Starting off in A&E, so it will be a very quick and hectic start! Should be very interesting though. Now that exams are over and that I've gotten my results - I can finally relax. Get back to normality. Do what I enjoy and meet up with friends. It was a tough exam period and I cannot wait to go back home. See my school friends. See my parents. Celebrating Christmas and New Year with the family. It will be nice. It will probably be my last proper winter holiday as next year I will be revising for finals as my final exams are after winter holidays. I will definitely have to make use and enjoy this winter holiday as much as I can this year. It's been a very tough road. Scarier thought: after next year's winter holiday, I will be working as a proper doctor in a hospital somewhere during winter holidays! Wow. It's getting close!

One step closer to being a doctor!

Anyways Merry Christmas to everyone and good luck with interviews!

Tuesday, November 20, 2012

Something for you to think about...

To make up for my last short post - I'll give you guys something to think/reflect about.

So you meet a 55 year old male patient on the  neurology ward who was admitted with severe unilateral headaches in the front which radiates to the back of the head with no associated neck stiffness. As you talk to the patient you notice he's fairly relaxed and quite talkative. He tells you how he first presented to his GP 4 weeks ago who didn't explain much and sent him for a CT/MRI scan on his head, then proceeded to send him for Chest X-rays...eventually getting a pelvic MRI scan. The patient says: "I have no idea why I had to go through all these scans. Bit pointless in my opinion. It's just a headache...any ideas doc?" You know all these events had happened over the last 4 weeks and this patient has seen several doctors and you start to wonder why no one has told this man why all these investigations were done. Eventually you find out that the patient is aware that there is a "lump" in the back of his brain and that he's being scheduled to get a biopsy. After saying this, the patient still seems very relaxed and seemingly unaware of what is going on...actually he ends up telling you that he actually doesn't have a clue what's going on.

After the nice conversation you've had with the patient, you go look in his medical notes. You read the report from the scans which clearly says: "Query metastasis to the brain". You know that the GP/other doctors had sent this patient for several different investigations is to locate the primary cancer - which the patient is completely unaware of. Next imaging report: "Primary glioma". All brain tumours are technically malignant. Then you think: does this patient know he's possibly got brain cancer? No one knows how severe it is as a biopsy hasn't been done.

So here's something for you to think about. As a medic or soon to be medic: would you rather know about everything? Know exactly WHY the scans are being done and what are the results. Reasons behind all the investigations. All the plans from the doctors and suspicions/differentials. Then you look at it from another point. If this patient knew about all of the reasons and all the prior suspicions that the doctors had, would he still be as relaxed and calm about his "headache"? So is it actually better to not know that much?

Personally I think there's a fine line between knowing too much and knowing too little. As a patient, I would want as much info as I can as I'm a medic - I want to know things. If I didn't have any medical background, I think I wouldn't want to know anything. Live life in denial and in the unknown I guess? At least I won't be busy stressing myself out. These things can be emotionally difficult and cancer is such a sensitive topic. I would think the general population wouldn't want to know all the reasoning. It's tough. I think every person has a different view on this. Something for you to think about/reflect about.

Saturday, November 17, 2012

Revision Time Again.

So exams are in 3 weeks. Truthfully, I'm not as nervous about these exams as I was last year. Last year was a disaster. It was horrible. Actually those exams last year could be deemed scarring. Worst experience ever. I have been constantly telling myself that nothing can be worse than last year's exam. This year, it is fairly obvious what we need to know for our exams and it has been clearly laid out for us. I think what's making revision difficult is that we still need to go to placements. We only get 1 week of revision. Consultants expect us to be on the wards 9am - 5pm and by the time you get home, you're exhausted. On average, you're looking at around about 3 hours of revision time. I am finding it quite difficult to juggle and obviously have to adapt my revision style to my placement schedule. I am quite used to staying up quite late to revise as I work best at night. On top of that, I am on my Neurology placement, which is an examinable topic for our exams, so I'm trying to learn and revise while on placement. Swear my brain feels like it can explode as I'm trying to do so much all at the same time.

The neurology ward in general has been interesting. We have got various different cases ranging from stroke to epilepsy to multiple sclerosis. If I had this placement at any other time in the year, I would enjoy it a lot as there are so many examination signs to see and the patient histories are really educational. As I've mentioned above, the brain is focused on revising so any time I catch a break, I am heading to the library or a quiet room to revise instead of spending time on the wards. Because we don't have OSCEs this year, I'm not too bothered about seeing signs, but it is certainly affecting the experience I am having on the placement. It is quite annoying as I find neurology quite fascinating...and challenging, but certainly something that does not bore me. It makes you think and it makes you think laterally as well. Anyways I'm going to keep this post short as I have to hit the books. Exam season is tough. I cannot wait for this to be over and bring on the new year.

Work hard. Play harder.

Friday, November 2, 2012

Another Step Forward.

I think a bit back I said I was working on an Orthopaedic project (since May). Today I had the chance to present my project in front of a group of orthopaedic surgeons across the region. It's nice to finally present something that you've been working so hard on, but I would be lying if I said I wasn't nervous. I was fairly confident a week ago when I was preparing my powerpoint though. My run-through with my supervisor went really well, but this was presenting in front of someone who I know. Presenting in front of a group of orthopaedic consultants is a whole other ball game. What I was most worried about were the questions at the end.

One thing about me is that I don't like over-rehearsing/practising my presentations as I like to improvise. I like to give relaxed presentations that can go any direction depending on how I feel as it shows confidence in your presentation/project. I know my project very...very well so this was a route I know I wanted to take, but a risky one as I haven't presented in over 2 years and certainly not in front of a group of consultants. But because I didn't want to make a fool out of myself, I thought it was a good idea to practice a bit more than usual so I rehearsed once a day starting on Monday. The one rule I have for myself is to never use cue cards or notes and this was definitely not going to change for this presentation. When I showed up at the meeting, I think the lead was a bit surprised by the fact all I had was my powerpoint and no notes/cue cards to run through while I wait for my turn. To be fair, I wanted to look like I was confident and at ease about my presentation, but actually I was completely bricking it inside. The night before I was "choking". Was confident until the night before and everything just fell apart. I was stuttering when I was running through and forgetting to talk about certain things as my slides contain very little info as I like to expand on my points.

Anyways it got to my turn and I told myself that one of my strong points are doing presentations and this is not anything different. I introduced my powerpoint and I went through my powerpoint like it was second nature. It was almost like I wasn't even consciously doing it. It felt really good! Then the dreaded part: question time. Surprisingly, the first question wasn't even a question. A consultant took the time to complement me so I was really chuffed about it. It definitely made me feel proud of myself and especially when I was the only medical student presenting amongst a bunch of registrars. At least it was some sort of confirmation that I didn't make myself look like a complete idiot, but the bail out sentence was always ready: "Sorry I am just only a medical student." The questions asked weren't too bad and it actually started a discussion amongst the audience about the thing I studied.

After doing this presentation it gave me an idea to make a post of tips for making presentations:

  • Keep your powerpoint short and simple - maximum 4-5 points per slide - use these as cues for yourself and expand on these points
  • Use images to make your slides/presentation look more interesting 
  • My personal rule is about 30-60 seconds per slide. 10 minute presentations = 10-15 slides. Any more slides, you could potentially end up speaking too quickly
  • Practice your powerpoint without any cue cards or notes from day 1 - if you don't get into the habit of using cue cards...then you'll never need to rely on them
  • If you're really unsure about your presentation, find a friend to practice in front of and ask he/she to give you feedback
  • If you're nervous at the time of your presentation, pause for a second at the end of each slide to allow yourself to gather your thoughts for the next slide. The audience will think you're giving them time to read your slide so use the opportunity to calm yourself and gather yourself.
  • Introduction is key - also an easy way to calm yourself as you'll never forget your own name! 
  • Always end your presentation with a summary slide as it's a nice way to round off the presentation
  • Body language! Be aware of how you stand and what you're doing with your hands. If sitting, don't fidget/swivel in your chair. Standing and don't know what to do with your hands? Clasp them in front of you or try to use your hands to point to relevant images on your slide. Practice makes perfect for this. Avoid closed body positions such as crossing your arms across your chest and leaning against the wall. Don't want to look bored of your own presentation!
  • Look around the room when talking. Don't have to make eye contact, but remember there's more than one person there so involve the room by looking around.
  • And SMILE! Don't want to look grumpy about your own presentation!
So these are my quick few tips about presentations. Everyone has their own unique style so these are tips from my own personal experience. Do what you're most comfortable with. As a medical student, you are BOUND to have to do a presentation...even more likely once you become a doctor so while you can start practising in less serious meetings/conferences so when you do have to go to a proper formal meeting to present - it will be a piece of cake!

Saturday, October 27, 2012

5 Down 1 to Go.

Yesterday was the last day of my Orthogeriatric placement. Was a bit bummed out as I've gotten to know the junior doctors quite well and I enjoyed my placement (despite it being only 2 weeks). By being on the Geriatric ward, you realize all the ethical problems and how cost of care can be so high for these patients. For example - hip fractures cost the NHS 1.7 million pounds per year. The problem is that when these patients turn up, they don't just get an operation and then get discharged after a few days. Older people require a bit more care as they tend to suffer from other medical conditions such as vascular disease (MI, stroke, etc), diabetes, etc. Along with needing to continue treating their co-morbidities, these patients are more susceptible to hospital acquired infections (eg. pneumonia) so essentially it becomes a vicious cycle for these patients. Majority of the patients on the ward stay in hospital for a month which is quite a long time. Care 24/7 for 4+ weeks...the costs do add up.

I was probably most involved with ward rounds in this placement than any other placement I've had so far. I was quite keen to actually help out as I know I do get bored quite easily if I just stand around. I got to write in the patient notes and you just feel a slight bit more responsible while on placement. It sounds a bit sad, but it's quite satisfying signing off on something. I mean as a medical student, we never really get to sign off on anything so it's nice being able to sign off the notes you made in the patient notes during ward round. You also feel a sense of contribution as well, which is a nice bonus. Also good practice for the future as well - will be doing lots of paperwork in the near future...

I think the main problem about being on a geriatric ward is that the turnover rate is quite low so the ward round usually consists of a quick check-up and if there are any new concerns/changes. This made me find this week a slight bit more dull than my first week. The only thing is that now I know the patients, but there isn't anything new to see. Their improvement is also quite slow so I must admit this week's ward round was a bit less interesting.

I mean overall it was nice to be back on a proper medical ward and doing "medical things" as I've spent the whole year in very specific specialties. There was a lot of general medicine and it made me realize how much I have already forgotten (quite scary especially when exams are just around the corner too!). All in all these 2 weeks helped me get my sanity back and I managed to grab some motivation back - well enough to take me through to exams. Now I've got 2 weeks off before my next and final placement - Neurology. Neuro will be tough but I'm quite lucky that I've had an attachment in Stroke medicine last year so I shouldn't be too lost on the ward.

2 weeks to dig my head into my books and do some proper revision. Procrastination mode - on. Need to focus!

Saturday, October 20, 2012

Care of the Elderly.

So I've started yet another placement (5 placements down, 2 more to go) and this placement is "Care of the Elderly". Out of coincidence and sheer luck I've been placed in Orthogeriatrics. Majority of the patients on the ward are patients who broke their hips (neck of femur (NOF) fracture (#)). Because this placement is only 2 weeks, it's a really quick taster and for me it's a bit of time to get my sanity back as I really enjoy orthopaedics so it's nice to just go back to something I'm quite familiar with.

Essentially I've got 10 days to learn and see everything I need to know to care for the elderly...great. Pretty rushed. And on top of that, get to know the staff on the ward which in general takes a bit of time to warm up to. First day - I met my consultant who is really nice so that was good news. The junior doctors are also really nice and chilled out as well and very understanding as they know we've got exams coming up so they aren't too bothered. They are also quite keen to get us involved in terms of helping them do jobs and getting involved in ward rounds (taking notes, looking at obs charts, drug card, etc.). To be honest, I've never been so involved on the ward...ever. It's also a bonus as I can get my clinical skills logbook signed off as I'm getting lots of opportunities to do clinical skills like venepuncture, cannulas, catheters, ABGs, etc. Really enjoying that and it's good practice. On top of that, I've been quizzed on osteoporosis and surgical management of NOF #s, but having done and attachment in orthopaedics (hips), for once I can actually answer questions with ease and confidence. It's actually quite a nice feeling to be able to answer questions...wish my knowledge was that sound with everything else in medicine...

Because I'm on Orthogeriatrics, the team works closely with the orthopods so we have to attend trauma meetings. Actually we don't have to attend trauma meetings (completely up to us as it starts quite early in the morning). I didn't get a chance to attend any trauma meetings during my attachment in orthopaedics, so I was quite keen to check them out as it does have a bit of a reputation. The benefit of having done my attachment in orthopaedics, is that the consultants recognize me so they don't question my presence in the meeting (students tend to avoid trauma meetings). In terms of education value - these meetings aren't great, but you get to hear about some interesting trauma cases that have been admitted...some fairly amusing and crazy stories as well. It's also a bit of a shooting gallery as well as consultants do "fire at will" if a trainee says something wrong or doesn't present a patient well. It's all a bit of a laugh/leg pulling, so it's fairly amusing at the expense of a junior doctor/SHO/registrar. Despite the earlier than usual wake up for placement, I don't mind attending. Again this is something I noticed in my orthopaedics attachment. I didn't struggle to wake up for placement during orthopaedics and was never late. I actually looked forward to going to placement - something to wake up to in the morning. If you follow my blog closely, I struggled quite a bit in GP and waking up was a huge struggle. Now in orthogeriatrics and early morning trauma meetings - I'm finding it easy to wake up again. Just feel like there's something to look forward to in the day. It's a nice breath of fresh air especially after two placements that were mediocre (well poor and mediocre).

I also quite like talking to the elderly as they've always got a great story to tell. One patient that stuck out for me this week was an 80 year old gentleman who was in for a left NOF #. He was a very talkative man and I met him the day before his discharge. He's gotten to know the staff on the wards quite well as he's been in hospital much longer than he should have been due to some complications. When the doctors were speaking to the man, he seemed like a genuinely funny and animated guy. He's obviously fed up with being in hospital and very much looking forward to leaving. He's apparently known to be getting quite critical with the doctors as he is sick of getting prescribed more and more medications as he stays longer and gives the juniors a bit of a tough time (in a joking manner though). After telling the patient he will be leaving the next day, and after quite a bit of joking around, he suddenly turned very thankful and grateful. He shook the doctors' hands and thanked each of them for taking care of him and "putting up" with him. It's quite nice to see as these days some patients don't give doctors enough credit and give doctors quite a tough time. It was a small gesture but it definitely put a smile on my face. It's nice to see the appreciation and I think the staff is happy to see him finally able to leave the hospital.

All in all, this week has been a great week, which is a good change as I've always had slow first weeks/things don't go my way in the first week. It's a good start to a very short placement and I'm getting along with the junior doctors so it's definitely making my placement a lot more enjoyable. It's also nice to see some familiar faces as well in the orthopaedics department. Even the secretaries are recognizing me as I've been popping around. Like one secretary said: "It's almost like you never left!". Funny enough it's actually been almost 4 months since my orthopaedics attachment (seems longer than that though!). It's been a good week and I've been getting some good news as well which I'll talk about at a later time.

Sorry for the long post - it just feels like it's been a long time since I've had a good time at placement and fairly happy. Dreading the fact it's only 2 weeks, but I think it's a good motivation booster - in time for exams. Happy reading!

Wednesday, October 10, 2012

Psychiatry - Final Week

This placement went by QUICK! I think it was the fact that the placement wasn't too bad and that I was quite busy doing my other work - time has just flown by. To be honest, I haven't seen too many exciting things as I had hoped to have seen. There's always a lot of misconceptions about each specialty and I think psychiatry is no different. Before I started the placement I was a bit unsure what to expect. I was a bit scared as on our first day we were each given a personal "alarm" which we would put on our belt loops. In addition to those alarms, when we entered the ward, we got another alarm which has tracking on it as well. You can't help but think that psychiatry might not be the safest specialty. We were also taught a lot about risk assessment when interviewing a patient. I remember we got a tutorial on where to sit and what to look out for in a room. We were told to always look out for objects that can be easily thrown and to sit near the door but not with our backs towards the door so if we need to escape we can just go out without turning around.

Okay yes, there are some "dangerous" patients who are known to be quite aggressive, but I never really felt "in danger" while on the wards or in clinic. I guess the only time I felt a bit "iffy" was today in clinic. The final patient I saw on my psychiatry attachment is known to have a very short temper and when he snaps - he snaps in a big way (throw objects, get violent, etc.). As the consultation went on, I could tell the patient was starting to get agitated and worst bit - I was sat furthest from the door and the patient was sat between the door and I (so much for remembering about risk assessment). To be honest - the clinic room wasn't appropriately arranged so there wasn't much one could do other than hope for the best. The consultation came to an end and for no reason the patient just "lost it". He lashed out but thankfully he didn't throw anything and instead stormed out the door and slammed it with a considerable amount of force. You could actually hear him leave the clinic as he was slamming every door along the way. I expected it to happen but it wasn't a nice situation to be caught in knowing there isn't really anywhere to go other than curling up into a ball.

Other than that incident - all the patients I have seen are all quite "alright". Despite some having a history of violence/aggression, these patients all seemed fairly cooperative. We are told of the ones who we shouldn't go speak to as they aren't cooperative but the "okay" ones are fairly normal. Of my 6 weeks in psychiatry, there hasn't been any major incidences. I'm sure more incidences/violence occur in A&E than in psychiatry. I think the one thing about psychiatry is the need for patience. Some of the patients are great historians...some are terrible and will not admit to anything/are not cooperative. With new patients - the clerking can take up to 1 hour and most of these inpatients don't have the patience to speak to you for an hour. I personally don't even have the patience to ask questions for an hour/listen to their history for an hour. I find it very time consuming. The number of times I have nearly fallen asleep during a consultation has been ridiculous. I drift off not because it is boring, but it's the fact that sitting and listening to a history for an hour is very difficult. Again with this attachment, there wasn't much I could do other than observe, but the good thing I had over GP was that when in the hospital - I can actually wander around and am not constrained to one building/area. Psychiatry is definitely different and I have definitely learned a lot since it is a new topic. I'm fairly certain it isn't something I can do, but it is quite interesting as you see a range of people and personalities.

Unfortunately I don't really get a break between this placement and the next other than a 3 day weekend. My next placement will be in Care of Old People - specifically Orthogeriatrics. Talk about luck. I'm actually really looking forward to it as I'll get to see and deal with something I'm interested in and maybe I can sneak off and see a few surgeries as well. I also know the team in the department - so I don't need to endure the whole awkward introduction/getting used to the ward/staff. It will be a short placement but I think it will be one that will pick my motivation back up and get me going again just in time for exams. Eek!

Sunday, September 30, 2012

Psychiatry - Weeks 3 + 4.

So I'm finally past the halfway point for Psychiatry and to be fair, it isn't that bad. I mean nothing can get any worse than my GP attachment. Anyways...I finally went to the ward and spoke to a bunch of patients. I spent a week in the Substance Misuse Unit and it was really interesting. It was interesting to speak to the patients and to hear about how they have abused drugs/alcohol. It was shocking to hear that most of these patients have started using drugs since the age of 12! I had one patient who told me: "Any drug you can think of, I've tried it."

There was one particular male patient who stuck out for me. He is a 50 year old male (who looked 80 years old) and he was trying to detox off of methadone. He has tried almost every drug you can think of and at the age of 13 had already experimented with LSD. He was actually quite pleasant to talk to and it was interesting to hear about his forensic history. It was crazy to hear that he has been convicted many times and have served several prison sentences. What stuck out for me was his memory. Due to the many many many years of drug abuse, his memory is horrendous. His short-term memory was fairly poor and when doing the Mini Mental State Examination (MMSE), he scored 16 which is very low and abnormal. I'm not kidding - I spoke to him for almost an hour to get his history/why he is in hospital and then left for 20 minutes and came back to do the MMSE. When I came back to do the test, he had already forgotten who I am and thought I was a social worker! It was definitely a bit of a curve ball as I knew his memory wasn't great, but I didn't think he would already forget who I am after speaking to him for an hour and only had left for 20 minutes. Furthermore, because the patient had been injecting for so long, his legs are completely wasted. He has ulcers all over his leg which won't heal as he has poor blood supply to his legs and has suffered with DVTs. When you look at him, he looks unwell, tired, not with it, etc. Apparently on admission he looked like a ghost who was completely out of it. It makes you realize how bad drugs can affect a person. He looks so much older than what he really is and I actually double checked his date of birth with him to confirm that he was only 50! It was incredibly hard to believe.

Also during the 2 weeks I went to the regular ward and spoke to a few inpatients. It wasn't particularly interesting, but I realized that some of the patients don't know why they are in hospital and refuse to accept that they are in hospital for a mental illness. On top of that, I realized that in psychiatry, you have to build good rapport with the patient to get just a decent history as there are a lot of personal questions that you need to ask. In a psychiatric history, you have to ask about their childhood and about their personal life such as relationships and any possible attempts of suicide/self harm. Some of the things you need to ask are quite touchy and personal and I find that quite difficult. At the end of the day I think as a medical student you just need to find a way to word personal questions and be prepared to get an awkward answer or no answer at all.

So at the moment, the placement is starting to pick up, but as usual, once things start getting productive - it means it is coming to the end of my attachment. 2 more weeks left and then onwards to Care of the Elderly (which I'm actually quite excited about as by chance I am placed in Orthogeriatrics).

Sunday, September 16, 2012

That Time of the Year...Again.

So Freshers Week is literally right around the corner. You're sitting in front of your computer/packing/feeling excited and nervous/etc. A million questions race through your mind: What's medical school going to be like? Am I going to make any friends? What is Freshers like? Will I be able to cope? Will I get homesick?

I am probably considered an "oldie" at university now since I am now in 4th year. Most people who started university with me in the UK have all graduated now...most are working as well...and I'm still in school. I've been through 3 fresher weeks now - I think I can safely say that I'm fairly confident about what goes on in Freshers and what students are usually concerned about. Let's crack a few FAQs. 

What is medical school going to be like?

Medical school is going to be challenging, physically and mentally tough, tiring, and most importantly - FUN. At the end of the day - we are medics. We work hard and party hard, BUT it is essential to maintain a good balance between the two. Don't want to work too hard to the point you burn out within first year, but at the same time not party so hard you end up flunking the year. In the first few weeks of school, it will mainly be a lot of introductory lectures. Unfortunately, your first few weeks will probably be a bit of a shock. First 2 weeks - you'll still be either hungover or on cloud 9 as you are still coming to terms that you are in medical school. Then week 3 comes around and so're in lectures from 9am-5pm. You want to be seeing patients and learning clinical things, etc. Here's the truth - everyone has to take baby steps first so you'll probably spend quite a bit of time learning the basics. The science of medicine more than anything. 

How do I make friends?

I cannot stress the importance of getting out there. Don't just stay in your accommodation. Go out and socialize! I do understand drinking/alcohol culture is not everyone's "cup of tea", but not all socials need to be at a pub/bar/club. In your first week (Freshers Week) there will be a lot of fairs. There will be a medical freshers fair, union freshers fair, sports fair, etc. Go to the fairs and join some societies! Remember all the freshers that attend these fairs will also be looking for friends. Thinking back, in the first few weeks of university was quite overwhelming. Every one seems a bit too friendly. You get so many numbers and emails from people you only say "Hi" to. Great place to start is at your first medical lecture. Go meet your classmates! You'll be stuck with them for the next 5-6ish it's not a bad idea to start getting to know them. If you are a shy person, just think about it - everyone is looking to make friends. To be entirely honest - I used to be quite shy and the week before starting medical school - I was pretty nervous. I didn't know if I will be able to make friends. I'm not exactly the best person to initiate conversations. I can actually be quite quiet and can happily stand in the corner and watch the world pass by. Seeing how I'm in a new country, new school, etc - I knew I have to step out of my bubble and really try hard to make the first move and meet as many people as I can. Not sure what to say? Here's a start: "Hi! My name is _______. So where are you from? Liking *the university/city* so far? How are you finding it?" 

Do I have to party every single day to make friends?

No. I did not go party every night. I think I went out twice (?) during Freshers week. BUT a great way to get to know your flatmates is probably to hang out with them, but know your limits. Sometimes you feel really pressured to go out, but if you aren't comfortable going out - then don't go! Just tell your friends you're going to take it easy for the night and need to finish unpacking. It isn't a crime to take it easy and most people should understand. However, I do HIGHLY recommend going to the Medic Freshers Party. I've been to the union party and the medics party 3 years in a row during Freshers week. The Medics' Party is a lot better. Plus it gives you another chance to meet more of your classmates and probably upper years such as people like me who don't want to give up on Fresher parties! I still fondly remember my first year medics freshers party. The people who I met at the party are still my great friends 3 years later. All I can say about these parties is just to enjoy yourself. Let loose. You're a fresher only once - just go for it! You're away from home. You're officially a medical student! I think these are good enough reasons to celebrate!

I got the welcome pack and everything seems really confusing and overwhelming! What to do?!

Just relax. I have always found the welcome packs overwhelming and exciting. Things start to feel real when you read through the welcome pack. I still remember reading mine and going: "wow...I am going to university. I'm going to be a medical student in a few days. There is a lot of stuff to know...crap." Essentially what schools tend to do is try to cram as much info in a welcome pack as they possibly can. It isn't a bad idea to give it a read before you start university, but you don't have to know everything in it. Introductory lectures/induction will probably cover most of it. How I've always seen things is to just "go with the flow". Just remember if you are feeling scared/nervous - there will probably be quite a lot of other people feeling the same thing. You're not the only one on the boat. 

All in all - in a way Freshers week is overhyped. Keep your expectations low, and you won't be disappointed. How much you will enjoy Freshers Week is solely down to you. You control your life so you go out as much as you need to. But like I've said earlier: you're only a Fresher once so enjoy your time. Celebrate your week. You deserve it. You got into medical school - which was certainly not an easy task. Just think how far you have come to get here. It's also a fantastic time to get to know lots of people. Go join societies and get to know people from other courses. You are at university for 5-6 years so it is important to make the first good step. Relax and just go with the flow! Be excited. It will be a very fun 5+ years of university. It will go by quickly so enjoy it. 

Good luck and enjoy your Freshers week. Also congratulations for getting into medical school.  

Friday, September 7, 2012

Psychiatry - Slow Start.

I don't know why, but I'm quite prone to having slow starts on placements. So I've had my first week in psychiatry and to be honest...I've stepped onto the "wards" for about 5 minutes and then left. I don't know if I should be happy about the placement or a bit annoyed. We've got a lot of free time on the placement and seeing how exams are coming up - it gives us a great opportunity to revise. But at the same time...when I did go on the ward and ask if there's anyone I can see or anything I can do - the staff said that there's nothing to do here and told me to go get a cup of coffee. For the rest of the week - I spent my time in half-day clinics with my consultant. Luckily he is very chill and really good at teaching (if asked to teach). The nice bit is that there is a mutual understanding between the two of us. He has established that I do not want to do psychiatry and fairly indifferent about it. He said he will leave me alone BUT will teach if I have any questions or want any teaching. On top of that, he clearly listed out my learning objectives and what he does expect for me to have completed by the end of the attachment - which was pretty easy/fair. I know what my consultant expects and I don't see it being a struggle. He's also extremely nice which is a nice bonus.

I haven't really met any patients with full blown mental illness. All the patients I have seen were follow up patients who have their symptoms under control and doing fairly okay. Somehow due to my luck, I managed to miss the two new patients I was supposed to see in the week so I can see how patients present to the psychiatric team. For the first new patient, I only managed to stay for half the consultation as I had a doctor's appointment. Then in the next clinic, I ended up being 30 minutes late and missed the new patient as I got lost. Was really annoyed with it as apparently that patient was very interesting.

To be honest though, I don't mind this placement! I'm actually enjoying it as it is fairly easy and not very stressful. My schedule is very flexible and essentially to get good at psychiatry is to just speak to a lot of people (which I haven't exactly done as I'm having an extremely slow week). Despite having a slow week, I am learning a lot as everything is new so that's a bonus. So far all the consultants I've met are also very nice and chill, but they claim they should be chilled out as they know stress is a factor for suicide...

Hopefully next week will go a bit better and hopefully I'll be a bit more productive!

Monday, September 3, 2012

Penultimate Year.

"Hi, my name is - and I am a 4th year student doctor."

How time flies. I still remember when I first step foot onto the wards in first year and introduced myself as a first year medical student - it was almost like yesterday! Now, I unwillingly have to introduce myself as a 4th year. I quite liked introducing myself as a 3rd year to patients and to doctors/nurses. I feel like we get a bit more sympathy and leeway. As a 3rd year, we can always pull the: "Sorry it's my first year of clinical.", when we make a mistake. As a 4th year - expectations are higher and mistakes will be looked down on. I feel like 4th year is the "real deal". People expect you to know your place in the hospital and know what you are doing. Questions won't be as well appreciated and you will be much more independent. It's actually quite frightening! As a 4th year - people who know that your course is 5 years will know that as a 4th year, you'll be in your penultimate year and pull the: "You'll be graduating in a year or so - come on, you should know better!"

So I'm starting psychiatry and will on the specialty for 6 weeks. We just had a week of lectures on psychiatry and it seems pretty interesting. It's also nice to learn something completely new as well. The past lectures we've had were more of a refresher and a bit more clinical, but wasn't completely new. We have never learned about psych so it was good.

Had my induction at the psychiatric hospital and it seems promising. It seems really organized and we've got a binder full of info. We've also got schedules for our next 6 weeks. Something so simple is well appreciated as that means I can plan my life. It's a shame other placements can't give our schedules that far in advance. Got a fairly easy week - mainly at clinics. Bit nervous as psych is so unfamiliar and new. Also scared about being quizzed. Yikes. Got to do some reading asap!

Wednesday, August 15, 2012

What to do during summer holiday...

I tend to see a lot of prospective medical students and current medical students wondering what they should be doing during holidays. For most people they see it as a bit of a dilemma...I personally don't...but some people feel the need to be doing something during the summer.

The most common question I see from prospective medical students is what should you read during summer holiday to prepare for medical school. To be completely honest: you don't need to do any pre-reading unless the medical school specifically told you so (which is unlikely).  If you are a gap year student and haven't studied in a long time - then just quickly look over your biology notes. I don't think looking over your notes will really get you ready for medical school. I don't think it is that big of a jump from school to medical school. I guess it varies from university to university, but for me - there was a gradual introduction to medicine. What did I do the summer before I started medical school? I traveled with parents as I know once I get to university, I won't see them as much - so I spent quality time with them. I did a lot of sleeping. Played social basketball and hockey. Chilled with friends before we all split up across the world for university.  Essentially I did a lot of relaxing..I don't think I did anything related to medicine or prepared for medical school. The most preparing I did was probably reading the intro/welcome guide that the university sent.

Another common question from prospective medical students: What books will I need to buy for medical school? I personally won't buy any books until a few months into medical school. Most medical schools will give you a recommended reading list. Go to the library and take a look at all the textbooks and see which one suits you. Textbooks are expensive so choose wisely. I made the mistake of buying books too early and ended up only using a few of them. Some of my textbooks are still sitting on my shelf looking brand new untouched. If I had to recommend ONE textbook - it would probably be Vander's Human Physiology. It is probably the only textbook I have that is quite beat up and well-used. I found it to be the perfect textbook for the first two years. Again, go to the library and check it out before buying! Kumar and Clarke Clinical Medicine is also another great textbook, but I never really used mine. Medical students from other universities say that it's really useful. I've only used it for certain topics that weren't covered well in lectures. The few chapters that I looked at - I really liked the layout and how things were explained. The only problem I had was that I found that there was a lot of assumed knowledge and some descriptions of certain conditions were too brief.  My friends say that it is either a hit or miss. Some students swear by it. Others like me, don't really care for it. Another textbook you should check out in the library before buying.

So you're a medical student and you're sitting around at home feeling that you should be doing something productive and medically related. If you're in 1st or 2nd year and you've still got a long summer holiday - go enjoy your holiday. As the years progress - your summer holiday will get shorter and shorter. This year, my summer holiday is only 3 weeks. Stupidly short. In first year my summer holiday was 3.5 months! Most of the doctors that I have talked to all told me to not work during my summer holiday as I'm currently doing an audit project. I was quite stressed about it before holiday started trying to get it done so I don't have to worry about it, and I'm glad I did get it done before holiday. Now, I can relax and just sleep as much as I want. Actually might be taking the whole sleeping in to a whole other level. Thinking about it, it's nice to sleep in. Before holiday, I was getting about 4-5 hours of sleep per night. Now I'm well rested as I'm getting about 10-12 hours of sleep...doing some major catch-up. Knowing that my holiday is only 3 weeks, I'm glad I didn't bring any work with me as I'm spending as much time as I can relaxing and doing the things I love to do. Hanging out with friends. Eating good food. Sitting around. Just doing absolutely nothing. Need to get the brain rested as exam season is coming up. So my biggest tip to current medics: RELAX when you can! Enjoy your holidays while they last! Take a break as you'll just end up burning out. Medicine is mentally and physically demanding - give yourself the needed break!

Okay so you're not convinced and you HAVE to do something during summer holiday. Try to avoid doing something medically related. Go volunteer for summer camps. Go volunteer for an activity that you enjoy doing. Do the things that you love to do. For medics: I really advise against shadowing a consultant during your holiday at your local hospital. You'll get to spend all the time you want in the hospital in the near future. For some, your next 30+ years will be working in the hospital. You can follow/observe as many consultants you want when you get back to medical school.

Anyways that kind of gives you an idea what I'm usually up to during holidays and what I think is the best way to enjoy your holiday.

Sunday, August 12, 2012

Request: The Future.

There was a request from one of the readers here asking:
"What are you planning to do after medical school? It would be great to get some insight to what Canadian medics plan to do after their studies in the UK."
To be honest, the future can always change directions and I know I will have to be prepared for anything that life throws at me. My first choice is to stay in the UK and do my specialty training here as I know the system,   and I have gotten to know quite a lot of doctors who can give me advice for the future. I will try my hardest to stay in the UK, but laws do change. Hopefully the law won't change to prevent international students who study in a UK medical school from practising in the UK. In my eyes, I have spent 5 years in the UK. Moving isn't easy. The last thing I want to do is moving back and forth between countries. When I set my mind to something, I like to stay on that track and I am a very determined and ambitious person. In a way some people see it as stubborn, but I set goals for a reason - it is something for me to look forward to and to work towards to. I used to be quite a high level athlete and giving up is not an option. I do not like to stray away from the goal and when I do, I do get disappointed. I set high standards for myself and yes I know staying in the UK will not be easy, but I have set my mind to it. I have moved my life over to the UK and I personally don't see much of a future for me in Canada.

Now I may be determined and ambitious, but I'm not going to shoot myself in the foot. Always have a back-up plan. Things can go wrong. Life can throw a curve-ball at you. Rules can change. Who knows. The future is unknown and the most you can do is to be ready. Yes I have my mind set to stay in the UK, but I am still planning to take the Canadian MCCEE so if push comes to shove and I have to go back to Canada, I can. Nothing worse than ending up jobless and stuck in that awkward grey area.

I know quite a few international students wondering about taking the USMLE. (Note: I am not trying to start an argument/debate with this topic - just a personal opinion. Sorry in advance if anyone takes this persona/finds it offensive...) Who doesn't want to live the "American Dream". So why am I not taking it? Because I am not seeking for the "American Dream". To be very blunt - I do not care for working in the US. Some people see it as a great opportunity to make some good money. Some people just like the environment more. How I see it - if you are looking for the "American Dream", I'm sorry to break it to you, but in today's economy - there isn't much of an "American Dream" anymore unless you become a very famous doctor. The US is a very competitive place. Remember not only do you have to take a sickeningly hard exam, but you also have to score well in it. There's no point in just scraping a pass - you have to have a competitive score to get a desirable job in the US. I personally have my mind set on a specialty and it is a very competitive specialty. If I wanted to go the US, I would actually have to ace the USMLE. I don't want to end up working in some small southern town in the states in the middle of nowhere. The UK schools aren't geared to take the USMLE. UK medical students are geared to become practising doctors...not to take a US registry exam. That means students who want to take the USMLE, have to spend a lot of extra time to study for the USMLE alongside with their UK course work/exams. It is a very tough thing to juggle and you really have to be determined to go to the US and be committed to do well. So do your research.

Having said that, those who are determined to go to the US and have their eyes set on the prize - will probably do well in the USMLE. These people would probably take the exam seriously and study hard for it. Some might not really care what specialty they want to go into. These people will probably get a job in a desirable location. I'm sure I wrote a post about priorities before. Personal preferences and priorities - what is important to you, may not be as important to the person sat next to you. To make your priorities work, you will have to make sacrifices. At the moment, my #1 priority is to get into my desired specialty. This will probably require me to make quite a few sacrifices as it is a competitive field. The most likely thing I will have to sacrifice is: location. Someone else who wants to do the same specialty may see location as a huge priority. He or she may rather stay in London than do specialty X or he/she may not mind doing specialty Y in order to stay in London. It is all down to you.

All in all, the future is a personal thing. Everyone has his/her own path. No one path is the same. Know your priorities and stick with them. Don't let someone else alter your priorities or talk you out or into things. It is your life at the end of the day.

Friday, August 3, 2012

Any Requests?

So it is summer holiday and that means I'll have a bit of free time and I'm bound to get bored at some point. If you have any requests for a post you'd like to see - please leave a comment! I'll try my best to write something up for you as soon as I can.

Wednesday, August 1, 2012

End of GP Placement.

Oh how much I looked forward to typing the title to this post. It could have easily been the least brain stimulating placement I have yet to have. Not only that, I couldn't go make myself useful elsewhere unlike being in the hospital. Looking back on the last 6 weeks, it was definitely a struggle and a challenge. It was mentally draining as it was just so much harder to get the motivation to work. After throwing my arms in the air when stepping out the door of the practice...I realized I have another GP placement next year. Joy. BUT, I know it'll be more useful as I'll have my own surgery and get to see my own patients. This placement literally has redefined work experience. It was 20 days, 10 hours/day of work experience.

Also in other news - crisis averted with all the deadlines as you would remember from my "Walls Closing In" post.

1 report - completed and submitted.
1 audit report - completed awaiting for submission.
1 audit poster - 90% complete.
1 audit abstract - completed and awaiting for submission.

Cannot feel any more satisfied and proud of myself managing to get everything done in time. I think it has been a long time since I was really sure I was not going to make the deadlines.  Miracles do happen. Actually it's more like: Efficient...and very late and long nights...

Oddly enough, in my final week of GP placement, I saw the most interesting case. It was a case of a man with an end-stage disease and the GP needed to start the palliative care pathway with him. This man is quite young (40 years old). Initially when I heard about his medical history, I did not know how old is he. In my mind I imagined him to be an elderly man. Surprisingly when I went to go meet the patient, he looked frail and skinny, but young. What really struck me was that he also has two very young children (ages 8 and 3). Unfortunately, the patient has not really told his children what is wrong with him. They are aware that their father is ill, but do not know the extent of his illness. With his condition, no one really knows how many more years he will live. His condition has been progressively getting worse and the GP told the patient and his wife that there would be one day where he does a nose dive and his health severely deteriorates. We discussed the various options for support and care. In my mind I knew the GP was trying to find the right moment to bring up the "Do Not Attempt to Resuscitate" (DNAR). Eventually we had to talk about it and only until you come onto the topic you then come to realize that the patient is still in denial. To be fair, he has a young family and he himself is quite young. Worst bit is that there is no cause for his condition - as what doctors like to call it: "Idiopathic". He was adamant that he wants to be resuscitated when it comes to the end of the line despite the GP fully informing him about the benefits and harm of resuscitation. As we were talking about his palliative care plan, his children were happily running outside - no clue what is going on in the room. It was definitely a very "grim" consultation. Before leaving, the GP advised the patient to find some support for his end-stage disease and to have someone help him to explain his condition to his children as they will have to know at some point. The GP was right that it is better for him to talk to his children while he is still well and still able to versus down the road he might not be well enough to explain - leaving his children a bit puzzled.

In all fairness - my experience in GP has not been the best, but the GPs who I have worked with are all really nice people and some are great at teaching. Guess it just wasn't my "cup of tea". Had a good feedback session with my supervisor though and I suggested giving students a bit more responsibilities and letting us see our own patients. Hopefully they'll take my feedback on board as I really think it'll improve the student's experience. All in all though, 7 weeks...that was painful.

Psychiatry up next...don't really know what to expect...actually I have no clue what to expect. At least it is hospital based (in a more familiar environment). I'm sure it'll be interesting seeing these sort of patients. Hopefully it'll be better than my GP placement and get back to the happy-go-lucky medical student.

Friday, July 27, 2012

Barriers and Professionalism?

I can see the light at the end of the tunnel! To be honest though the placement went by a lot faster than I thought. I can't really complain about the length of it as I'm only in 3 days/week. Obviously knowing that the placement is coming to an end and going back home for holiday is getting near - my mood has definitely been a lot better. Plus the weather is an added bonus. Finally summer is here...hopefully it'll last for more than 1 week.

Had a pretty straight forward short week (in for 2.5 days). Not much really happened, but I was placed with GPs who were more keen to get me involved and doing stuff, which was good. Did ONE (wowwww) consultation on an "unwell" child who was more miserable than anything. It was a fairly straight forward case as the child had a general viral illness and just needed a lot of TLC. I did get to go out with a district nurse which was good as it got me out from the practice. Visited 5 patients and went to their homes. Personally I still find it a bit uncomfortable to be in other peoples' homes. Maybe it's the way I was brought up or culture difference, but I feel very intrusive when going to someone's home and sitting down and making myself comfortable.

The nurse took me to an elderly couple's home who she knew quite well as she visits them almost every week for monitoring. The couple were immigrants and seemed to be quite private and quiet. Obviously noticing that when first meeting them, I instantly felt a bit hesitant entering their home as a complete stranger and at the end of the day - I am just a medical student. Seeing how they are, I obviously waited for them to ask me to sit down before making myself comfortable, but what really surprised me was the nurse's behaviour. I guess since she has known them much longer, she didn't feel the need to be more professional. As I sat down, the nurse was already walking towards the kitchen and asking at the same time to turn on the kettle to make herself a cup of coffee. It was obvious that it was rhetorical question as she was already halfway to the kitchen. She did also ask me if I wanted tea/coffee but I politely refused. I was very confused by this as the nurse was happily making herself at home, using the couple's kitchen and coffee/tea supplies, etc. I personally found it a bit rude, but then again I don't know how well she knows the couple. I would never use a patient's facilities and no matter how well I know them, I would never make myself comfortable in their home. I feel like it's just a professionalism thing more than anything else. At the end of the day, they are my patients and I need to treat them as patients to maintain the professional doctor-patient relationship...or in this case nurse-patient relationship. I guess in general nurses are a lot better with maintaining good relationships with patients and come across much more empathetic and kind. Not only did I feel very uncomfortable in the patient's home, the nurse was taking her sweet time to make herself comfortable and making her coffee, leaving me alone with the couple. It was nice talking to them, but at the end of the day - we were there to go over their blood-sugar diaries and just seeing how they are doing. What could be done very quickly...ended up being a fairly long ordeal (about 30-45 minutes). I don't like to make things take longer than they do. I do understand these are house-bound couples, but I feel like by taking so long to do a job may be interrupting their day. As an outsider - I want to make my visit as quick as possible so they can return to their activities. So again the whole making yourself comfortable in someone else's home was puzzling. Even better, the nurse went to use the couple's bathroom...which again made me raise an eyebrow. If I needed to use the toilet, I would've went before the visit, or hold it and go somewhere else to use the facilities.

If we flipped it around and a nurse/worker or whatever had to come to my home once a week to do some checks...I personally wouldn't want this person to make themselves comfortable in my home. Maybe I'm just a private person or how I have been brought up. I don't mind friends/people who I know well to come over and make themselves at home, but when professionals/workers come...I wouldn't be as comfortable with them making themselves at home. I see them as someone who is here to do a job - not to socialize and I wouldn't expect/want them to break down that barrier of professionalism.

Just found it a bit interesting and wanted to share that experience.

Friday, July 20, 2012

Old Age.

Had quite a weird week...weird as in a week which really made me change my perspective on things.

I got to go visit a nursing home for people with dementia. I had previously volunteered in a nursing home before medical school but I didn't work with patients with dementia. I went to visit a 75 year old man who has vascular dementia and had just moved to this new home. The nursing staff were worried about him as he had spent the entire night pacing up and down the hallways continuously for 15 hours non-stop. I went into his room and sat down in front of him. His room was fairly small. One single bed. One small wardrobe in the corner. 1 night stand. 1 cabinet. This man just sat in his chair, hunched over. He wore a baseball cap so I couldn't see his face. As he sat there I saw him dribbling on to the floor. It was almost like he wasn't even there and was staring at his shadow. I looked over to his night stand and saw 2 pictures of him and his family. In the pictures, he was middle-aged and appeared to be a very proud man. He stood in the pictures full of confidence. He looked very happy. Then I looked back at the patient, still dribbling and staring at the ground. He looked quite frail. I eventually said hello to him and he didn't reply. I moved his hat a bit so I could see his face. He still stared at the ground. I asked him what is his name and he replied me without looking up. I tried to carry out a very basic conversation with him, which proved difficult as midway through he started mumbling. I couldn't quite understand him and he quickly stood up. He walked to his wardrobe and was very unsteady on his feet. He had a very unbalanced waddling gait. I asked him where is he going and he replied: "Home". I kindly told him this is his home and to sit down again. As he came back to his seat I looked into his eyes and he didn't look happy. He didn't really even look like the man in the picture by his bed. As he sat down, he went back to staring at the ground and stopped talking to me. I just sat there looking at him. I thought to myself: Is this how residents here pass their day? I found it pretty sad as they just sit in a fairly tiny room. This particular man, if he isn't pacing up and down the hallway, he is sat in his chair almost lifeless. Really made me think that people need to live their life to the fullest. Appreciate the things and people around them. I felt bad for this man. His life seemed pointless. He was confused. Ageing is a scary thing. Just comparing this man to the man in the pictures - it is almost like night and day.

Then when I went back to the GP practice, I met another lady who desperately needed a total hip replacement. Her x-rays showed severe osteoarthritis (OA) as in it was bone on bone. The patient had a shortened right leg as well due to the OA. On palpation of the greater felt like you were running your hand over a bag of marbles. You could feel the osteophytes! Range of movement was severely decreased and the patient had pain on extension and flexion. Actually any movement made the patient jump. It was fairly remarkable that she doesn't need to use any aids to walk, but you can tell she is struggling. Unfortunately, the surgeons do not want to operate on her due to her health and as well she does not have anyone at home to look after her. She told me that she has outlived her entire family and there was no one left. She explained to me that she tries her best to get through the day, but usually just stays at home to avoid any hassle and because her hip hurts too much. She has tried all sorts of analgesics and even tried topical treatments (which doesn't work, which is no surprise as her hip was bone on bone). I asked her what does she do every day if she doesn't really go out. She told me she just sits there and read and told me that her life has become very boring and that there isn't much meaning to it any more. She talked about how active she was when she was young and gradually as her hip got worse, she couldn't go out for walks in the park or even do her gardening.

If you think about it, when I start reaching the peak of my career, the majority of my patients will be the elderly. In general the population would be quite old as the current generation of "baby boomers" are starting to reach retirement age. I think it is key for medical students to learn how to deal with the elderly. It is frustrating to hear students go: "I don't like old people. I hate talking to them." I sometimes can't help but say back to them: "Well start liking it as the population ain't getting any younger." I'm sure I have said this before,  but I quite enjoy talking to the elderly. They always have a great story to tell or have some pretty wise things to say to you. They are all so strong as they have been through so much. They seriously need a heck load more respect from people of my generation and the younger generations. Ageing is the fact of life and there isn't any way to avoid it (well unless something really tragic happens to you at a young age...). Sometimes it is just hard to see what the future lies for you when you see so many elderly patients.

Tuesday, July 17, 2012

Walls Closing In.

Yes this is another s*** hitting the fan post.

1 report on screening programs.
1 audit report.
1 audit poster.
1 audit abstract.

The beauty of finding out that instead of having 2 full three-day weekends to work on all these actually have 3 full free days to work.

16 days left until deadline.

Calling for lots of coffee. A lot of creative power. And very little sleep. I refuse to let GP be the one placement that becomes the hurdle of my medical degree.

I knew I was going to regret bumming around. Grrrr.


Friday, July 13, 2012

Just Need to Ask.

As you have all realized, I am not enjoying my GP placement as I haven't really gotten to do anything hands-on. Learning is minimal and I essentially just sit the day away. Last week, I requested to sit in with a GP who has a special interest in MSK. Finally got a schedule I could smile about. I was placed in a surgery where majority of the patients came in with MSK complaints. Then my next day was placed in the hospital (oh how much I miss the hospital environment) to shadow a physiotherapist.

Because I am so sick of sitting around, I finally opened my mouth and asked if I could do joint examinations.  The GP was more than happy to allow me to examine and started introducing me as the "Student doctor with a special interest in muscles and bones." Clinic for once actually went by quickly and was fairly enjoyable. Then I decided to ask the physio on my next day if I could participate and get involved. She was also more than happy to allow me. The physio had a special interest in upper limbs while I am interested in lower limbs. It was good for me as I am obviously missing quite a bit of knowledge about upper limbs. I learned loads about the common injuries and presentations you see in upper limbs. I also got to work on my upper limb examination skills which involved a bit of neuro; therefore, it was a really good refresher.  It was also fun to talk to someone who knows the orthopaedic consultants in the hospital and just learn more about the other sub-specialties in orthopaedics.  I got to know about the spinal unit and the shoulder consultants and what they would usually see.

It was also cool to see what would count as an urgent referral as we had one patient who we believe to have cauda equina syndrome. Cauda Equina is essentially where your spinal cord goes further down your spinal column than most people. Most people's spinal cord terminate at L1/L2; therefore, when you do a lumbar puncture, you make sure you go below that to avoid the risk of paralysis. The patient presented with urinary retention symptoms and decreased anal tone.  He also complained of changed sensation in his genitalia region.  It was evident that he also had bi-lateral leg weakness. His symptoms fit cauda equina syndrome so we had to urgently refer him to get an MRI scan. It was also interesting because the patient was claustrophobic and he made it very clear he does not want an MRI scan. We told him that the hospital has a wider scanner so it won't be as tight, but the patient was still adamant that he doesn't want to go through a closed scanner. He allowed us to refer, but he told us that he will refuse to go in on the day. We told him there is medication that he can take before he goes in to keep him calm that he can get from his GP. I don't know why but I felt like he is still adamant that he isn't going to get the scan done and will not go get the medication from his GP. Cauda Equina Syndrome can be quite serious and need to be treated so it was a bit frustrating to see someone refusing a simple scan which can rule out cauda equina.

Then I got a bit of a reality check near the end of physio clinic. I have suffered from a shoulder injury for 5 years now, and never really bothered to take myself to see a doctor. It's a thing about medics: "Medics either go see a doctor too early, or go too late." In my case: I just never go. A shoulder patient came in who obviously needs a shoulder replacement due to OA in the shoulder. The patient had very limited range of movement and you could hear his shoulder grinding as he was abducting his arm. He explained to us that it has completely hindered his lifestyle as he can't even reach up to get things from the cupboard and it is quite painful. He then mentioned that when he was young (my age) he had a few shoulder injuries and reckons that due to those injuries - he now has pretty bad OA of his shoulder. Once the patient left, I told the physio about my shoulder and she sternly told me to go see a GP and get a referral to either physio or orthopaedics as  I am susceptible to early OA if I don't get it sorted out. Even worse, it could hinder my ability to do orthopaedics in the future as it requires a lot of strength and lifting.

To be honest, the physio is right. I've left my shoulder long enough and it is obviously not getting better. Hate being on the other side of the table as the patient.

Sunday, July 8, 2012

A Mask.

This isn't a new revelation, but one that has occurred to me more during my GP placement.

I have come to realize that doctors need to put on a mask most of the time as patients come to doctors for various kinds of problems. No matter how annoyed you are about a patient or how fed up you are with your clinic, you cannot let it show. There are tons of patients out there who visit the GP 2-4x a month and I'm sure as the GP you can get frustrated/annoyed with the patient especially when they are coming in for insignificant things.  It is definitely difficult as patients expect the doctor to be professional and empathetic, but it is extremely difficult to show this when the patient themselves aren't coming in with the right intentions. I have sat in clinics where the patient is very rude and overly demanding. And as a doctor, you can't do anything about their rudeness, other than still treat them respectfully and try your best to listen. Definitely need a high tolerance level when dealing with "troublesome" patients. On the contrary, there are certainly very nice patients (usually tend to be the elderly). They are usually very respectful and always apologizing about wasting your time. These are the patients who are worth treating and you can't help but be a bit more empathetic, despite knowing that you're supposed to treat all patients with empathy and care.

However, masks are not just for GPs. As I have mentioned earlier, I have encountered it in my other placements. You would think surgeons wouldn't need to put on a mask as often, as they have a bit less patient contact. Unfortunately, surgeons have just as much face time with patients; however, the reasons of putting on a mask may be different. After a surgery and you have to break some bad news/complications about the surgery, you have to be able to put on a confident face and an appropriate mask. There isn't as much time for you to gather yourself after the operation. GPs or physicians in general would get results/bad news ahead of time so they will be ready and have time to think about how they will break the news. It is definitely a tough job as you don't want to show that much emotion when talking to patients especially after a tough case/surgery.

With clinics, you could enjoy the company of one of the patients and be laughing about something, but you have to be able to quickly return back to neutral before seeing your next patient. It can work the other way around as for one particular case, we were giving our condolences to a patient as her father had just passed away the day before and she was telling us about his death. Definitely an emotional/sad moment where you have to again put on a mask and empathize and comfort the patient. Easily within 2 minutes between patients, you have to regain your composure and be ready for the next patient as he or she can come in with anything. You certainly can't let things affect you and as well for doctors, you have to be good with moving on. You can't dwell on one particular case.

There has been arguments that doctors should not bring their outside emotions to work. Despite having a horrible morning, people argue that you shouldn't bring that grumpiness into the work place. I personally agree with that point as it isn't fair to your patients and your colleagues. I have met a few GPs who said that it is important to bring your emotions to work as you will seem more genuine. I don't mind bringing in a good mood to work, but I certainly wouldn't want to bring in grumpiness to the work place as you can easily affect your patients and colleagues. No one wants to see a grumpy doctor. In my eyes, I think my emotions should not affect my work, so even in that sense, you will have to put on a mask before coming to work especially when you're having a bad day. People argue as a doctor you should be genuine, but for me it is far more advantageous if I put on a mask for work and sort out my issues/problems when I go home/leave work.

What are your thoughts about putting on a mask for work or bringing your emotions to work?

Post your comments below!

Wednesday, July 4, 2012


One of my biggest pet peeves is when someone wrecks my lunch breaks for no reason. I don't mind missing my lunch because I am in theatre or doing something productive. Actually I don't mind if I'm in clinic and I have to delay my lunch...but what really drives me mental is when someone makes me MISS my lunch when it really didn't need to be missed.

I don't know if I am just being unreasonable or uncooperative, but essentially here's the story:

One week ago I gave notice that I have to attend a compulsory observation session at a clinic which is quite far away. I asked the secretary who does up my schedules if it will be possible for me to leave slightly earlier so I have some travel time and a time for me to eat my lunch. I was told by the secretary that it will be okay and she has left a note for the GP who I will be following in the morning.

Fast forward to today. I made sure I arrived early and kindly asked the GP if I could leave at 11am so I could go to my session at 12:30pm. Clinic usually ends at 11:30am so it wasn't like I'm asking to get off 2 hours early. It was simply just leaving 30 minutes early which is equivalent to seeing 2-3 patients. Despite seeing the note left for the GP about me leaving early, I was then given a fairly rude look and essentially was told why I can't leave after clinic (11:30am ish). Still maintaining my composure, I told the GP that I need to go home and drop off my car and then make my way to the other clinic (which has no parking hence I need to take the bus), and that I would like to have a bit of time to have some lunch as well. The drive home probably takes about 20-30 minutes depending on traffic, then another 30 minutes to travel to the other clinic. That would leave me about 30 minutes lunch break...which isn't unreasonably long. I explained this to the GP and she essentially didn't even listen and proceeded to interrupt me. She went on how I can leave at 11:30am and have my lunch on the go while traveling to the other clinic. I was obviously fuming as I do not understand what is the importance of me staying for an extra 30 minutes. Either way I just sit there and day dream as I don't do anything in clinic. I just sit and listen...and try to stay awake. I think the most annoying bit was the rude attitude the GP gave me first thing when I asked to leave early almost giving me the vibe that she's the "know it all - who are you to leave early" attitude. Hate it when people get all arrogant like that. I asked for permission a week in advance and again I'm only leaving 30 minutes early.

What also drove me mental was in the last 30 minutes of patient needed a sick note/letter and another patient needed a wound to be checked for possible infection. Wow...that was surely useful....I couldn't help but give the GP a look of: "You seriously kept me an extra 30 minutes to see these things?!" Once the clinic was done all you could see behind me was a cloud of dust. Raced home and raced back out to clinic. No lunch. No snack. Didn't even have time to drop off my car keys. By the time I got to the other clinic...I felt like I was going to faint. I was starving and I had a smaller breakfast than usual as I thought I would be having an earlier lunch.

I mean I think the GP was being highly unreasonable and very inflexible especially when I had a valid reason and a reason which was something the medical school required me to attend. I wouldn't even care if I had to miss my lunch because an operation overran and we had to skip lunch so we will stay on time plus the consultant starves with you. I swear this GP did not help me with my experience with this placement so far. To most, if not all of you, you probably think this is such a small thing...why the heck is it bothering me so much. My tolerance for this placement is getting very thin and I am starting to really lose motivation in even putting in effort.

Sunday, July 1, 2012

New Template.

Well I got a bit bored and pretty much re-vamped my blog. If you don't like this template or have any suggestions in terms of colour/font/etc, just leave a comment below. Hopefully you'll like this template more as it is a bit brighter and probably a bit easier on the eyes when reading.

Saturday, June 30, 2012


If I could describe my GP placement with one word I would use the word: "Dull". Dull might even be an understatement. I have caught myself so many times zoning out during consultations. Again my frustrations are growing as I still cannot do anything in clinic. The most I can do is maybe do manual blood pressures. I guess the only thing I can take away so far from GP is the difficulty of immigrants. My practice sees a lot of immigrants and most of these people can't speak English.  You realize that it is very difficult to get a patient history and even more difficult when you have to talk to your patient through an interpreter.

We had one patient who was from Slovakia and could not speak very much English.  It was requested that an interpreter come, but he/she did not show up so the patient attempted to tell us her problem in broken English. Unfortunately, her problem was a mental health related problem so patient history is really important and there was no way we will get what is the problem as her English was not cutting it. We resorted to using the phone interpreter. I swear those things are not user friendly.  The interpreters aren't that great and it is really awkward having a phone in between the patient and you and the phone is on speakerphone so it is quite difficult to hear what the interpreter is saying.  Even weirder is that you lose a lot of rapport with the patient as both of you are trying to talk into a phone. Very confusing stuff.  After 45+ minutes (when it should've been 10 minutes), the GP gave up. It got far too complicated and too difficult to get a proper patient history. I felt like we wasted a lot of time and it obviously makes the clinic run quite behind. We asked the patient to bring an interpreter next time and you just can't help but feel a bit annoyed that you wasted 45 minutes only to get nothing accomplished.  The next few patients weren't too pleased either as clinic got quite delayed. When one patient sees that you spend 30+ minutes with one patient, they think they have the right to have 30 minutes as well and it's hard to cut people short and to keep them on topic about their medical problem/presenting complaint.  When you're running behind, the last thing you want to hear about is what the patient did on the weekend.

I have no problems admitting that GPs are extremely patient people and their job is certainly not easy.  I just feel like I would have a lot of difficulty maintaining my composure during consultations especially when it gets quite frustrating.  I do consider myself quite patient, but I guess not patient enough for GP and probably the main reason why I'm having a difficult time enjoying this placement.  Worst bit is that I still have another 5 weeks to go. Thankfully I am only in 3 days/week so my weeks won't be too long. I'll take it that I have 15 more practice days.  That doesn't sound too bad...I guess....

Friday, June 22, 2012

1 down, 6 More Weeks to Go.

What a shock to the brain. I've tried my best to prepare myself for my next attachment in General Practice....and actually had very little expectations. My main fear prior to starting my attachment was the prospect of just sitting in the corner of a clinic from 9-5pm and not really do anything practical/talk to any patients. I have never had a rotation in GP before so I am obviously out of my element. I have always been in a hospital and there are a lot of advantages of being in a hospital such as if you don't find your attachment particularly interesting/useful - you can always go to another ward/department and there will surely be someone who will be willing to teach. The problem with GP is that you are stuck in the same building and there is no where to run. I am a type of medical student who likes to venture off to find more interesting things if I find myself getting very bored. There is a sense of "freedom" in a hospital as you aren't bound to a single area for the whole day. It is seen to be acceptable for us to roam to other wards to learn about different things while we are in the hospital so no one would really notice you not being on your assigned ward (unless there is scheduled teaching). In terms of GP, it is VERY obvious if I do not turn up as I am the only student in the practice and the GPs who I am attached to can see on their own schedules that they should have me, the student, in clinic with them. Very difficult to escape.

So I had a short week...had 2 days of lecture and 2 days on placement + 1 day off. Despite only being in the GP practice for only 2 still has managed to knock my motivation completely over. My last attachment in orthopaedics probably was the highlight of my degree and my motivation to work was at an all-time high. I could wake up for early morning meetings. I rarely found it boring. Just everything clicked. I was truly happy. I was hoping all the happiness and motivation I managed to build up in my orthopaedics attachment will get me through GP. Wrong. In 1 motivation level is at an all-time low. I am not interested in doing anything. Can't wake up in the morning. Don't feel like doing any work. Do not feel like participating. According to my friends, I am in a horrible mood. I am actually really low at the moment. On my first day I walked in with a very open mind and told myself it will be a good change as I'll get to see various different type of conditions and get to relax a bit more.

I will certainly not dispute that GPs see a lot of different things, and actually props to them for being such patient people. Some of the patients who come through the doors really....erm....there are no words to describe it. GPs are given 10 minutes per patient...but some patients come through the door expecting to get 30 minutes and talk about everything and anything. I can obviously tell in between patients that GPs get frustrated and they have to put on a mask whenever another patient comes through the door. As a student (who is sitting in a corner), it's just painful. If the GP finds it frustrating and boring to constantly have to reassure and listen to life stories...think about the poor student sitting in the corner who can't do anything but sit and watch. There is only so much I can learn by sitting and listening. I learned from my last placement that you won't learn anything until someone pushes you into the deep end of the pool. I was very hesitant in my first week of orthopaedics to go see new patients on my own as I had never done that before...but very quickly I found it very useful and eventually became quite good with taking patient histories. I don't think you can learn communication skills by just observing. It is something you have to learn by experience and I think that by making your student sit in the corner and listen is not very productive/a good way for he/she to learn.

I personally think that medical students can actually be very useful if used correctly. At the moment I feel like an old piece of furniture which isn't being used. I literally just sit there and watch. I don't even get to interact with the patient. I just try my best to not fall asleep and smile. I don't want to look not interested in what GPs do so I have to put on a face. I was so bored in my morning clinic today that I was desperate enough to offer to get things for the GP or make him a cup of coffee/tea, but nope...was told everything is fine and to just sit there. I haven't been so frustrated with a placement in a long time. I mean paediatrics wasn't my most favourite placement....but at least I was in a hospital where I was given the freedom to walk around and go to other wards...go see other things. I feel trapped at the moment. How am I going to survive next week. I don't get how I'll stay sane by the end of this attachment. All I want to do now is just sleep the day away. Props to people who want to be a GP...don't think I have the patience/tolerance to be one. Need to desperately find a way this weekend to pick myself back up or else I won't be able to bring myself in to the practice on Monday.

Tuesday, June 19, 2012

Theatre Etiquette.

As promised I will discuss about surgical theatre etiquette. Theatre is a really good way to see anatomy and learn more about the management of certain conditions.  Again like the wards it's a really daunting place to be in. I actually found theatre a bit of a scary place as there's so much equipment in there, but once you have experienced really isn't that bad. Your consultant finally invites you to go to theatre with him next day so here are some tips: Find the theatre list for the day you'll be going into theatre so you can get an idea what you'll be seeing - best place to go is the consultant's secretary. This will allow you to do a bit of reading up on relevant anatomy for the surgery. Also a great chance to read up on the condition that the surgery is treating. Most consultants like to ask questions during surgery so make sure you're ready. Nothing worse than being the student that seems like he/she didn't do any preparation whatsoever. Also theatre starts at different times so it is something you'll have to find out from the consultant/registrar/theatre staff/secretary. Make sure you turn up for the very beginning as this is when everyone introduces each other and go through a team briefing. So you get to the hospital - what do you do next?

Head on to theatre and sign in. Go get changed into scrubs and put on a theatre cap. Make sure you also change into theatre shoes which are usually clogs/the super fashionable crocs. Hopefully your hospital have some theatre shoes for you to borrow so make sure you ask at reception first. Take off all jewelery. At all times make sure your ID is visible. In general for theatre changing rooms it is best to bring your valuables with you or simply don't bring valuables to a theatre day. I always bring my money and my phone with me and depending on the hospital I also bring my bag with me to theatre as it's just a small messenger bag. Make sure you leave the bag in the prep room or ask theatre staff where you can put your bag.

So you get to the theatre and hopefully you'll know who is the consultant. Go introduce yourself or say "Hi". You'll be surprised how often they don't notice you even though you think they saw you. I guess sometimes they can't recognize you as you are in scrubs and have a theatre cap on. Get in on the team briefing and pay attention to the theatre list for the day. Also find out who is the anaesthetist. Ask the anaesthetist if you can observe the patient being put to sleep. It's quite interesting to watch.

Simple rules of theatre:
  • Don't touch anything green/blue in the operating room especially on tables/trolleys
  • If you're going to faint - don't faint on the patient - so go sit down - it happens to everyone
  • When the surgeons are gowned up - don't make any contact with them as they are now sterile so that means good dodging skills and just stay out of their way until they have gotten to their place at the table
Usually there will be 3 people scrubbed in and working on the patient. It will usually be 1 consultant surgeon, 1 registrar, and 1 scrub nurse. It'll be fairly obvious who is who. Scrub nurse is the one who will be passing all the equipment to the surgeons. If it is open surgery (not laparoscopic) you'll probably need to get a pedestal to see over the shoulders of the surgeons but make sure you ask them first/let them know you're standing behind them so they don't bump into you...but obviously don't be right up behind them - give them some space to breathe and move around. If you wear a lanyard for your ID badge - then this would be a good time to tuck it into your shirt so it doesn't swing around.

If it is a laparoscopic surgery - there will be a tv screen for you to watch so you don't need to be standing as close to the surgeons. Just find a good spot to stand and for me, I never sit down as I think the theatre staff are more deserving of a chair than I am. 

The problem with surgeries is that it can range from 30 minutes to 8 hours. You'll find that your back and feet will be hating you during long surgeries. Also make sure when you're standing for a long time just to keep your legs moving so you don't faint. Sometimes with long procedures I will go take a walk around the operating room just to get my legs moving again and give my back a stretch. No matter how much you love surgery (and take it from me - I really do LOVE surgery) - it will get boring especially when you're not scrubbed in and just observing. If nothing interesting is happening go talk to the anaesthetist. Ask he/she about the machines and what they are doing. The thing with surgeries as well is finding the right time to ask questions. There will be times where the room goes dead quiet as the surgeons are concentrating - obviously horrible time to ask a question. You'll be able to tell when they don't need to focus as much as usually they'll start talking about really random things like plans for the'll be surprised what sort of things surgeons talk about during surgery. Some surgeons even have music playing in the background so don't be shocked when you walk in and there is music playing. I think the best one was when I was waiting outside a day surgery theatre and the doors to the operating room opened and all you can hear was music blasting out...almost seemed like a night club in there!

Hopefully your consultant will be good at teaching and he'll show you the relevant anatomy IF it is easy to see. Not all the time the anatomy is easy to see, but don't be disappointed if you don't really see much. Most surgeries that I have observed - I usually don't see very much so don't think this is your fault. Especially now, surgeons are trying to make incisions smaller to reduce the recovery time...but again as long as your consultant knows he/she has a student around - most are quite good at moving over and letting you do a quick lean in to take a closer look - again make sure you don't touch the patient/surgeons.

When the surgery is done - go make yourself useful and help the theatre staff with moving the patient. Put on a pair of non-sterile gloves and grab hold of one side of the bed sheets (other than the head as the anaesthetist will be there). It'll be made clear which way the patient will be going and usually the clue is probably the empty bed right next to the operating bed with a slide board underneath. The anaesthetist will always count you down to moving so some will say "On 3" or "Ready Steady *Move/Shift*" - either way it'll be obvious.

If the previous surgery was long - you might want to stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Go make yourself a drink or get some water - staying hydrated is key for surgery. Sometimes it is quite frustrating as you could wait for an hour before the next surgery. I always hate coffee room breaks - not because I hate waiting's because sometimes the consultant needs to quickly pop up to the ward and you're left alone in the coffee room. Just keep your eye on someone who is from your theatre as they tend to leave without telling you. Well based on personal experience - I always get left behind so I always got to stay near the registrar/consultant/theatre staff just so I wont miss the next surgery. Another way is before breaking off to the coffee room - ask a theatre staff how long a break do you have or what time does the next surgery start - then at least if you lose everyone - you'll still know what time to get back.

Hopefully this gives you a better idea what to expect when going to theatre for the first time. Hey maybe you'll be lucky and get to scrub in. But don't be disheartened if you don't scrub in as I didn't get to scrub in til this year (3rd year of medical school - been on surgical placements ever since 1st year). So just enjoy your time in theatre and hopefully you'll see lots of cool things. Also a great place to witness some good teamwork and communication skills as well. If you're unsure about anything just ask a theatre staff.