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!