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!

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