Tuesday, February 28, 2012


I was watching Junior Doctors earlier on and listened to the FY1 doctors saying how they feel more like a real doctor as they have responsibilities and they get to do procedures. I sat on my couch thinking about my last placement on paediatrics. Thinking about it...comparing to my placements just only half a year ago when I first stepped onto the wards as a student doctor, I have seen myself progress. My last placement in paediatrics, I was clerking in patients and presenting the patient history and examination findings to senior doctors. I am probably one of the first "medical" person on the ward to properly sit down and ask them about what has brought them to hospital. I get the honour of seeing these patients prior to the doctors on the ward. While on my placement, I guess I didn't really appreciate this properly as I just took on the responsibility to clerk the patients in, but never realized that I could be one of the first people to see the patient on the ward. I also have to make sure my patient histories are accurate and that my examination is accurate as when I present the history to a senior doctor, it is now expected for me to have a differential diagnosis, possible investigations, and management. Only half a year ago, I was stepping on the consultant's heels going around on ward rounds and just watching. I didn't really get to do very much. If there is something interesting on physical examination that the consultant sees/hears, then he/she would let us take a look/listen. Now...I am the one telling the senior doctor about hearing something and I have to be confident about it. It is actually quite frightening. There were times where I heard crackles at the base of the chest, but I would sometimes doubt myself as they are fairly faint crackles. However, when I present the patient to a senior doctor I have to be sure about these crackles and now I get to write into the patient's notes about any examination findings. It's pretty crazy how much I have progressed from half a year ago.

Also 2 weeks ago the first year medical students got their quick taster of hospital placements and for once I wasn't the most newbie medical student around. There were people more "new"/fresh than me. It was a weird feeling. Then you start noticing that they really don't have a clue how to take patient histories.  And then you think to yourself...about 2 years ago...I was just as clueless. It's weird thinking how much you learn in such a short period of time. Now the structure of patient histories come naturally and you don't really have to think about it. You just ask the questions and go with the flow. I still remember in first year constantly trying to remember what questions to ask...what is important to ask...what the structure is to take a patient history. In first year before I saw a patient, I always wrote on my paper:

PC (presenting complaint)
HPC (history of presenting complaint)
PMH (past medical history)
DH (drug history) - ALLERGIES?
SH (social history)
FMH (family medical history)

This structure is now engraved into my head...and it's only been 2 years! I also taught these freshers how to take a pain history. It's weird that they don't know SOCRATES. SOCRATES is my saving grace. You can never go wrong with it!

Site (where is the pain exactly?)
Onset (when did the pain first come on?)
Character (what does the pain feel like? can you describe it to me?)
Radiation (does this pain go elsewhere?)
Associations (are there any other symptoms that you noticed?)
Timing (does this pain come on at certain times? does it come and go? is it constant?)
Exacerbating/Alleviation (what makes the pain better? what makes it worse?)
Severity (on a scale from 1 to 10 - 1 being not very painful and 10 being the worst pain you have ever felt, what score would you give your pain?)

I found it very confusing to actually see these medical students taking me seriously and genuinely absorbing what I was saying. I'm not much older than them...one of my students was actually older than me! Also when I walked by a few of the first year students and quickly said "Hi!" to them as I walked by, I heard them whispering: "Whoa an older medical student said hi!" I still remembered when an older medical student said "Hi" to me while I was in the hospital...I felt quite happy as I felt like I was noticed and not ignored....more like I actually existed!

Crazy how 2 years make such a big difference, yet thinking about it...it hasn't been too long ago. Speaking of which...this month actually marked the halfway point of my career! Halfway to being a doctor! Scary!

Monday, February 27, 2012

End of Paediatrics.

7 weeks have passed which means I am done with my paediatrics placement! To be honest, it actually went by really fast. I got to admit that the first few weeks went by really slowly...to the point I was dreading the placement. Luckily, the placement started to blow by as I got to know the doctors and nurses on the ward and in general felt more welcomed.  I think 7 weeks was plenty of time for a taster of the specialty so my impression of paediatrics? Not for me. But I won't 100% remove it from my potential list of specialties as I find the surgical side of paediatrics fairly interesting. On my last day of paeds I had a lecture about paediatric orthopaedics, and to be fair...it seems quite interesting. These surgeons see a lot of different conditions ranging from pathological to congenital conditions. Definitely something I wouldn't mind considering in the future.

Also another reason to celebrate about the end of the placement is that I have passed my placement based assessment!!! I was really nervous for it, but it went really well. Did a full patient history on a boy with pneumonia and did a cardiovascular and respiratory examination on him.  I also got a lot of feedback from my supervisor, which was good as I'm constantly trying to improve and do better. I also managed to finish all my essays and reflective writing all in time along with my log book! Really stressful weekend, but everything came together in the end. I was really chuffed with it and after Monday (where everything was due including my assessment), I felt like the world was off my shoulders. I felt so much more at ease and just felt a sense of relaxation. I can finally enjoy the placement again and just take it easy for the last few days on my placement. On top of that, end of paediatrics = end of driving a long way to placement. My next placement is only a 15 minute drive (which is closer than the central hospital from where I live), so I'm excited for that. I no longer have to wake up at a ridiculous time to drive. I've also heard fantastic reviews about the next hospital I will be going to as they like to pride themselves in teaching medical students.

My next placement is Obstetric and Gynaecology. I'm actually really scared for this as I don't really know what to expect as well. Should be interesting as I'll definitely be able to go to theatre (YES!); however, it'll be dealing with quite a sensitive subject so I'll definitely need to change from being playful in Paeds to professional for this specialty. Hopefully I'll be able to compose myself and try to enjoy this specialty as much as I can. First I'll need to go to a week of lectures before commencing my placement. I much rather having lectures first before going to placement as at least I'll have some basic knowledge prior to going to the hospital so I won't look like an idiot in front of the doctors. I also hope I'll have a really nice/easy going/chill supervisor. My last supervisor on paediatrics was very easy-going, which made the placement much more enjoyable. Crossing my fingers that I'll be just as lucky this time with Obs+Gyn. Another 7 weeks of Obs+Gyn and then Easter Holiday! I can't wait for holiday. To be honest...I kinda need one now!

Friday, February 17, 2012

Sh!t Hitting the Fan.

Oh wow...it is quite rare for me to leave work to the last minute. I should be panicking, but I'm not...well not just yet. I have 2 essays and 1 reflective writing to hand in on Monday. One of my essays is a case report, which I have finished...but it is still pretty rough. The other essay is an evidence based medicine essay, which requires me digging through a bunch of literature...haven't started that whatsoever. Reflective writing...I hope it doesn't take long as I haven't done that either, but I usually only take 10-15 minutes to do up reflective pieces. As you can tell...I'm not too shabby at reflecting (which I do believe is a very important part of the degree - can't improve if you can't reflect on your performance/day). It doesn't end there - I've got a summative assessment on Monday where I will be watched by a consultant in taking a full patient history and perform two systems examination (could be either Cardiovascular, Respiratory, GI, Peripheral Nervous System, Cranial Nerves, or Developmental examination). Afterwards I will be asked a few questions about the patient history such as differential diagnosis, management, investigations, pathophysiology, etc. Anything goes as long as it is relevant to the patient's condition. Will also be asked to present my findings on physical examinations. Ack. I mean taking a patient history and doing examinations is just a matter of practising which I think I've done enough of. I'm just worried about the questions my consultant will ask me.

This week has been fairly uneventful. I was only in for 3 days as I had a lot of meetings to attend. Because of all my meetings, I haven't been able to do an "on-call" from 9am-9pm, which means I have to do 2 on-calls in my final week of Paediatrics. Fun. Essentially I spent this week completing my log book in terms of getting my clinical skills signed off and getting a registrar to do my formative assessment for 3 systems examinations in preparation for my summative assessment for next Monday.  I also found this week incredibly hard to wake up. Every morning I was struggling to wake up. Thank goodness 1 more week of Paediatrics and travelling a long way to the peripheral hospital. Next placement is Obs+Gynaecology and the drive there is about 15 minutes so I won't have to wake up as early. PHEW. To be honest I'm quite sick of my placement now. 7 weeks is too long and I haven't really been having a great time either so that doesn't help with my experience. I'm usually bored and I generally feel quite unproductive. To be fair though, I still learned a lot especially on how to interact with children. Still something I'm struggling with, but if I compared myself to the first week of placement, I have definitely grown as a person and have learned some new skills. It'd be unfair for me to write this placement off as it has been very useful. Just not my "cup of tea". Can't love every placement. There will always be up and downs, but medical school is all about exploring specialties and learning about everything. As a medical student, you need to learn how to adapt and essentially "just get on with it". My basketball coach from high school always told me: "If you don't like it, too bad. Make the most of it. If not, just suck it up and keep going."

Sunday, February 12, 2012

Planning Ahead.

I would like to think I am fairly good at planning ahead. I am quite a simple person and fairly straight forward, but few know that I actually think quite a bit about the future. Being an international student, you have to think about the future.  We try our best to not think about the future as anything can happen, but we also have to be ready for anything unexpected. My biggest advice to international students (no matter how confident you are about staying in the UK) is to have a backup plan. What happens if the UK government decide to throw us a curve ball and change the immigration/Visa rules? What happen if you suddenly have to return home due to family issues? And if you're not planning on staying in the UK, you really got to plan when to take the registry exams such as USMLE. It pains me when I see international students not having a single clue what they'll be doing in a few years time. Unfortunately it isn't a straight path for international students, let it be staying in the UK or going back home. Either way it won't be easy and you will have to make sacrifices. Anyways enough with the grim outlook for international students. It isn't all that bad to be honest. It's just that you have to constantly remind yourself you are an international student and it isn't a simple straight path. There will be many obstacles to cross and many walls to climb. It isn't easy, but hopefully it'll be all worth it in the end.

Anyways enough with the weird banter paragraph above. Maybe I should put the beer away. Haha. If you guys read my last post carefully, I did not talk about Friday. No I didn't have lectures...and no I did not go into placement. Then you must assume I was skiving. No I wasn't skiving either...well I wouldn't consider it skiving because I was actually doing something productive. I had a meeting with an Orthopaedic consultant at the central hospital to discuss about my Student Selected Component (SSC) project for this coming May.  The last time I met the consultant, I fell asleep in the chair and he had to wake me up...great first impression. Luckily it didn't really affect him as he was willing to see me again. He was actually quite keen to be my supervisor for my SSC and to mentor me. This time prior to meeting him, I made sure I was not going to fall asleep. I heard him come out from his office so I made sure I didn't look like I was dozing off...to be honest I was zoning out as all I did was stare at the wall. I had to wait for awhile as I was 30 minutes early for the meeting as I messed up on my travel timing so I was quite tired. Went into the office to discuss what I will be doing for my 6 week SSC project. We did a lot of brainstorming and came up with quite a few ideas.  Either this consultant is smart or was prepared to discuss about my SSC as he was rapid firing ideas at me. Unfortunately, I kept zoning out as to be fair...I did not understand half the things he mentioned. He was talking about the different type of implants used in Orthopaedics, and obviously I have never heard of the brands. He talked to me like I knew all the brands so you could imagine I was very lost. When I get lost...I zone out. It's a horrible trait I have. As he went on, he realized he should write down what I will be doing. He set out a bunch of aims and wanted me to expand on it and give it a think. He filled up half a page with notes on the aims of my project (looking at implants). I quickly put the paper away in my bag without looking at the paper.

And then I perked up as the consultant mentioned that during my project he wants to do some clinical things with me. I told him that I got to observe a few trauma surgeries and paeds orthopaedic surgeries over the last few weeks. He ended up throwing a curve-ball at me and told me that it is good that I'm making the effort and be keen to go see these things, BUT the difference is that when I follow him I will be scrubbing in and actually assisting. Oh man, I got so excited it was ridiculous. I immediately sat up straight and couldn't stop smiling. Scrubbing in and assisting = music to my ears. Finally I get the chance to get my hands in and do something that I am interested in. He also went on how I will be able to do some stitching (heart sank a bit as the last time I learned stitching was a year ago). Now, I was very excited about my SSC and the consultant surely knows how to make a student happy.

After the meeting I quickly went home and took out the paper that he wrote on. To my demise, I could not make out half the things he wrote. I regretted zoning out and I should've remembered doctors do not write legibly.  Took me ages to decipher what the consultant wrote. In the end, I figured out most of the things he wrote as I vaguely remembered the stuff he was talking about and managed to crack on with expanding on his notes. Note to self: Do NOT zone out while a consultant is talking to you. You'll regret it as you won't be able to read half the things he wrote down. Imagine if I couldn't decipher what he wrote...the embarrassment I would have to go through as I would have to email him and tell him I can't read what he wrote when I should have been paying attention during the meeting.

Anyways I'm super stoked about my SSC in May! One more meeting and a bit of paperwork before my SSC will be official. Cannot wait.

Friday, February 10, 2012

Lack of Sleep.

5 weeks in! 2 more weeks to go. This has got to me the toughest week in terms of waking up. Every morning I am waking up at 6:30am to get ready, but it doesn't help that there isn't much to motivate me to get up.  I think the only thing that is making me wake up on time is the fact that I have to drive other people to the hospital so they kinda rely on me. I also think that being 5 weeks in, there isn't much else to see. Most of the patients we see have acute illnesses as most of the special illnesses get referred to a bigger hospital. 

I was on-call on Wednesday and the best bit is that the doctors on the ward can tell when I am on-call as I'm never on the ward when I am on-call. I try to go to clinics to try and make the time go by faster. As usual...Wednesday - I escaped the ward. I went to the Children's Orthopaedic Clinic for the entire morning. It was a lot more interesting than I expected it to be. I saw a lot of different cases. I was even able to sympathize with some of the patients. Met a girl who is hypermobile, which was affecting her participation in sports.  The consultant was doing a physical examination on the range of movement of her joints and on doing internal rotation of the hip, the consultant asked me if it was normal. I knew my leg could turn that far so I said: "normal". I have never seen such a confused face. "That is NOT normal. LOOK how far it goes!" Feeling a bit dumb/embarrassed I covered my back side by saying: "Oh sorry didn't notice how far it went *blushes*"

Once the patient left, the consultant questioned why I thought the range of movement was normal as it was apparently fairly abnormal. Then I proceeded to tell him that I am hypermobile as well. Then I found out he isn't very good with hypermobility.  The consultant looked quite uncomfortable and didn't want to see me showing my "flexibility". I was quite surprised about his reaction, but thinking about it....it is fairly gross. Fingers shouldn't bend so far back and such.  Haha. Hypermobility is a great party trick by the way. Just thought I would throw that out there.

Anyways clinic took quite long, but we had a lot of patients. What I enjoyed the most about the clinic is that we did not see two of the same case. Every single patient had a different problem and it really kept me awake and interested. For the first time at a clinic, I did not find myself bored. I was constantly engaged and I found each case interesting.  Probably could be one of the best clinics that I have ever been to. Long, but interesting.

At some point the clinic had to end and I had to return to the ward. On the way back, I stopped for a lunch break.  When I returned to the ward I was told there was another clinic happening in 30 minutes. Obviously I pounced on that opportunity and I disappeared from the ward for another 4 hours. By the time I got back to the ward, I only had 4 more hours left of my on-call to do. Luckily when I got back, the ward started to get busy and I got to clerk in a few patients. Most of them were diarrhoea and vomiting problems, so it wasn't too exciting. It was better than sitting around doing nothing.  But because the ward started to get busy, I didn't get to leave til 9:30pm. I had quite a bit of work to do when I got home and didn't get to sleep early. Worst part, I had to get up at 6:30am the next morning again. Thursday was brutal. For the entire day I was falling asleep whenever I sat down.  We also had lunchtime teaching from the registrar and I accidentally fell asleep. I felt really bad as I didn't mean to fall asleep as it wasn't boring. I was just so tired I couldn't keep my eyes open. Now I think the registrar hates me. She wouldn't talk to me afterwards and it was kinda awkward on the ward. Hopefully she'll forget about it after the weekend. And hopefully I can catch up on my sleep.

Saturday, February 4, 2012

Highlight of my Placement.

It is now the end of week 4 of my placement. 3 more weeks to go. To be honest...these last few weeks have been going by quite quickly. Even the doctors on the ward agree that these last few weeks have blown by. Now 4 weeks in....I'm really feeling a part of the team. We are all starting to get to know each other better so there's a lot more banter going on and joking around, which I really enjoy.  Despite this, there are still a lot of up and downs during this placement. There are days where there's a lot going on, and then there are days where you start asking yourself why did you even come in.

Wednesday could have been easily the highlight day of my entire placement. This day also came at a perfect time as it's halfway into the placement and it really gave me a good boost. Every one noticed that I was in a very good mood on Wednesday and actually had a bit of spark in me. Found out that there was some paediatric surgery going on in the morning and I decided I needed a change of scenery. Heard the consultant surgeon apparently looks fairly stern (cue heart sinking) and no one could pronounce his name. Got changed into greens (oh I missed them soooooo much) and heard that surgery is delayed as the patient hasn't arrived yet. Sat in the coffee room and there was only one doctor in there (who looked kind of stern) and I figured he was the surgeon I will be following in the morning. It was fairly awkward in the room as we just sat in silence and watched a tv show. Few minutes later he got up and I shortly followed behind him and hope it didn't seem like I was stalking him. Saw the surgical list before going in and to my delight I found out he is a Paediatric Orthopaedic Surgeon.  Pretty sure I was smiling like an idiot at the list. Walked into the anaesthetic room and we did introductions and after the consultant introduced himself, I knew immediately he's a really nice guy. He asked me to help him out with setting up equipment and he seemed really keen to get me involved. Slowly my mood was picking up and I was really getting excited. He then allowed me to scrub in for one his surgeries (in grown toe nail). It was a really quick surgery but when a consultant asks you to scrub in, it makes you feel involved and you start to feel more included/less useless. You feel like you're actually helping. It's a hard feeling to describe.  Like during placement, especially early on, you feel unwanted and useless so when a doctor asks you to help even in a tiny little task, you get this good feeling/sense of satisfaction.

Anyways during a break in between surgeries, the consultant and I had a chat and he noticed that I seemed quite keen about surgery. It was cool having a casual chat with the surgeon and I told him I'm interested in orthopaedics. We had a really good talk about the specialty and then he told me to go to the Trauma list in the afternoon. Saw a fracture reduction + internal fixation and it was easily the bloodiest surgery I have ever seen, yet oddly enough, the one I enjoyed the most...ever. Even a few times I questioned myself as I caught myself smiling during surgery. I was really interested and I found the surgery pretty cool. There was a surgical trainee who was observing and he talked me through the surgery. The surgery was fairly complicated, but I was genuinely absorbing everything the trainee was saying. I was following along without difficulty and I just had this good feeling inside me. I think the hardest part about the surgery was wearing the lead aprons for 2.5 hours as there was a mobile xray machine in the room. Xrays were periodically taken to make sure the plate was in the right position and if the screws were placed properly. My back was killing me by the end of surgery (as I've been in surgery all day and almost all the procedures I had to wear a lead apron). But the aching legs and back was totally worth it. I could easily say it has been the best time I've had in surgery. The morning procedures were fairly simple, yet I still really enjoyed my time. It's quite weird.

"Be back by 4pm" said the registrar when I stopped by the ward to grab my bag for lunch. It was now 5:30pm and I was still in surgery watching the surgeon close up. He made stitching seem so effortless and simple, but I guess if you've been doing it for 20 something years, it'll become second nature.  I was in no hurry to leave theatre. To be honest, I didn't want to leave. My bleep went off twice and I knew I should get going. The consultant and I had a chat after surgery and he said throughout the surgery he noticed me looking very interested/keen. I don't think I have ever really heard any doctor tell me I look keen. To be honest, most of the time I probably look like I'm not even there. The consultant also said he was fairly impressed that I didn't get sick as he agreed it was a very bloody/gruesome surgery.  He asked when will I join him again in theatre or pop by his clinic as he said he wouldn't mind me around, especially if I'm interested in the specialty. Again I got this weird feeling of actually being wanted. Usually consultants don't want to deal with students, but this consultant seemed interested/keen to teach me.

Dragged my feet back to the ward and everyone was commenting how I look alive for once and happy. To be fair, I was very happy. I was definitely motivated. I can't wait to go back to theatre next week/hopefully I'll be able to escape to theatre. What a great day. Will never forget the last surgery of the day.