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!