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.

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 days...it 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 week....my 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.

O&G Labour Week Part 1.

I'm only 2 days in to my labour week and I'm already struggling. I'm supposed to be in for midwives handover at 7am every day. Day 1 - alarm clock for 5:45am...next thing I knew I woke up again and it was 6:30am. Didn't get to the hospital til 7:10am...by the time I got changed into scrubs for labour ward...it was like 7:20am. Day 2 - alarm clock for 5:45am...actually got up this time. Arrived at the hospital at 6:55am and traffic wasn't bad. I actually tried really hard to make it to handover...ran to get changed. By the time I got out...I had apparently missed handover already and the midwives said I should aim to arrive for 6:50am tomorrow. In my head I was like "6:50am?! Yeaaahhh right." Dreading it already. Also I have been sooo tired. I would sometimes catch myself dozing off in the ward because I start so early in the morning...but still get off at 5ish pm. Brutal. And when I get home...I hardly have the energy to eat and all I want to do is sleep. So unproductive.

Pretty exciting first day though. Saw 2 normal vaginal deliveries. Also assisted as a first assistant on 2 caesarean sections (aka I got to scrub in and actually do proper surgical stuff...not just hang around and watch - just the consultant surgeon, me, and a scrub nurse - what a dream). Also witnessed an emergency caesarean section as the baby was stuck. When the emergency button was pressed it was like a TV show. It was crazy. Loads of people ran in within 5 seconds of the buzzer going off and everyone knew what they were doing. Anaesthetist was already making his way to theatre and some of the theatre staff darted to theatre to prep. About 8 of us were racing the bed down to theatre. It was really surreal. Obviously there was a sense or urgency. The mother had to be put under general anaesthetic (most caesareans is under spinal so the mother stays awake and just can't feel anything down below). Staff was frantically prepping the theatre with the equipment...it was just organized chaos. I was so scared to get in the way so I just crammed myself into a tiny corner of the room. I obviously couldn't scrub in as it was an emergency and the registrar had turned up.  Eventually we managed to get the baby out and I finally got to see the link between the paediatricians and obstetricians. The paeds team was already waiting for us ready for the baby and for any resuscitation as it was a complicated birth. Baby came out floppy and wasn't crying/breathing. It was a very tense moment as we handed the baby over to the paeds team. Unfortunately I'm with the obstetrics team so I couldn't go watch the paeds team work their magic. Finally after a few tense minutes we heard the baby cry and you could see the relief on some of the staffs' faces. I'm sure it was pretty scary for the mother herself as one minute she was just about to give birth but the baby got stuck..the next minute she's asleep. Also the father is left waiting outside of theatre after seeing a bunch of people wheel off his wife. Pretty scary situation for the family in general I would think.  I couldn't say I had as much fun  in the afternoon though. Immensely boring after a frantic morning. But the morning certainly made my day though.

Day 2 - quiet morning. Waited til 9am for elective caesarean sections. Again was really lucky and got asked to scrub in and help out...but not to the certain extent of a first assistant. Still makes a huge difference when you're scrubbed in. I even got to transfer the newborn to the crib after we pulled him out. It was really cool. After the sections...again went quiet again. Saw 1 normal delivery and that was it. Next thing to knock off my list: Instrumental Delivery (eg. using Forceps or Ventouse Suction). Really need to get that signed off tomorrow.

Labour week to be continued.......(if I'm still alive by the end of it)

Paediatrics - Week 1

Wow this week was LONG. First started the week with a whole day of introductory lectures from 9-5. Then on Tuesday it was the start of our placement and the start of long drives early in the morning. Got to the peripheral hospital and the minute I stepped into the Children's Unit, I knew something wasn't right. In first year I had a placement in Paediatrics and you could hear children screaming/crying from outside in the hallway. This time...it was dead quiet. There were no doctors to be seen. We met in the doctor's room and soon all the doctors arrived and did a handover. The reason for the quietness of the ward? We only had 3 patients on the ward and another patient was coming in later in the day. I mean the doctors are all really nice though. All of them are also really keen in teaching as well. They did mention that the lack of patients is common so we do have to be proactive.

We are expected to do 7 on-calls in our entire attachment (7 weeks). So it would make out to be 1 on-call per week. I did my on-call on Friday which meant I was in from 9am-10pm. What a long day. However, I managed to clerk in several patients and I was definitely learning. Also in the middle of the week I got to do baby checks. This is where the doctor would check over a newborn baby making sure he/she is healthy and ready to go home. Some of the babies were so cute; however, after all the baby checks, I feared crying babies. Every time I hear a baby cry, I flinch a bit. Also the funny bit is that almost every baby we checked, the baby decided to leave a present for us in his/her nappy. Lovely. Guess that's what you get in paediatrics. Cute babies and stinky diapers.

Paediatrics is definitely interesting, but the lack of patients in our hospital is really taking a toll on me as I do find myself standing around doing nothing. I also find myself getting bored quite often. Unfortunately there isn't much to talk about for this week. It has been overall quite dull. Not a lot of banter either on the ward. Guess not every placement will be fun. Hopefully next up will pick up. I mean at least I'm starting to get to know the doctors quite well and they are very welcoming. 6 more weeks. Yay....