Having a Bad Day?

Medicine is a constant reminder of how fragile and unfair life can be. Life can throw curve balls and do some pretty unexpected things. I was in clinic and met a lady who is 40 years old and have been getting treatment for cancer. Unfortunately, it has been found that it has metastasised to other parts of her body such as her bowels and her lung. What really struck me was that as I entered the room, having read the notes before seeing her, I was expecting a frail lady who would look quite ill. Instead, I was greeted with a very healthy looking lady. If I had seen her in the hallways, I would not have guessed she had been battling cancer for almost 2 years and now facing another fight against the metastases. While going through her medication list, she was on high doses of analgesics and one can imagine how much pain she is usually in. As we got further into the consultation, what once was a calm looking lady turned into a nervous and worried person. She is supposed to undergo radical surgery in a few days and I really do not blame her for her nerves. I was taken aback by how calm she was at the beginning. It really puts things into perspective. I had a bad week last week with back pain, but after hearing the patient's story, my back pain seemed like nothing. It is nothing compared to what she's going through. And it really amplifies the fact that if you think you're having a bad day, there are people having a much worse day than you. It's easy to forget how fragile life can be. 40 year old woman - most are fit and healthy. Cancer is something still seen as a disease that affects the older population. It was inspiring to hear about her fight and her courage. Pretty sure I didn't whine/complain about anything for the rest of the day.

Life can throw curve balls affecting you physically and your health. But I wanted to talk about mental health. By being in a stressful job, it is important to keep your mind "happy" and not allow work overwhelm you. Your emotions can greatly alter your way of  functioning. Recently, there has been a lot of mental health awareness campaigns going on especially back home in Canada. I personally know quite a few friends affected by mental health issues such as depression. I thought it would be worthwhile for me to write a mini blurb here and raise awareness to those who read my blog. Statistically, about 1 in 4 students are affected by depression and approximately only 1 in 4 people seek help. The main reason for the lack of seeking for help? Stigma. Mental health is still a "taboo" subject and it shouldn't be one! It is a common problem affecting many people. Not many people want to speak up and get help. You can't just "laugh" off depression or mental health illness. I know way too many people suffering with this. What bothered me was how even in the health service, health professionals are almost afraid to ask about psychiatric illness. The number of times where I've seen various professionals very quietly ask if there is any history of psychiatric illness or if he/she suffers from depression. We ask about heart/lung/bowel problems loud and clear, but when it comes to mental health it gets all "hush hush". If there wasn't this "stigma" surrounding mental health, will there be more people seeking for help? I would like to think yes. I've had friends who suffered in silence and I have nothing but praises for those who gathered enough courage to seek help. From what I hear, it can get very dark and lonely. There is so much help out there. People shouldn't be suffering in silence. Stigma is unacceptable. The reason for raising awareness is to eradicate the stigma associated with mental health. 1 in 4 people are affected. That is common. Look at your group of friends. Live in a house with 3 others? Do your part and raise awareness.

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!

Barriers and Professionalism?

I can see the light at the end of the tunnel! To be honest though the placement went by a lot faster than I thought. I can't really complain about the length of it as I'm only in 3 days/week. Obviously knowing that the placement is coming to an end and going back home for holiday is getting near - my mood has definitely been a lot better. Plus the weather is an added bonus. Finally summer is here...hopefully it'll last for more than 1 week.

Had a pretty straight forward short week (in for 2.5 days). Not much really happened, but I was placed with GPs who were more keen to get me involved and doing stuff, which was good. Did ONE (wowwww) consultation on an "unwell" child who was more miserable than anything. It was a fairly straight forward case as the child had a general viral illness and just needed a lot of TLC. I did get to go out with a district nurse which was good as it got me out from the practice. Visited 5 patients and went to their homes. Personally I still find it a bit uncomfortable to be in other peoples' homes. Maybe it's the way I was brought up or culture difference, but I feel very intrusive when going to someone's home and sitting down and making myself comfortable.

The nurse took me to an elderly couple's home who she knew quite well as she visits them almost every week for monitoring. The couple were immigrants and seemed to be quite private and quiet. Obviously noticing that when first meeting them, I instantly felt a bit hesitant entering their home as a complete stranger and at the end of the day - I am just a medical student. Seeing how they are, I obviously waited for them to ask me to sit down before making myself comfortable, but what really surprised me was the nurse's behaviour. I guess since she has known them much longer, she didn't feel the need to be more professional. As I sat down, the nurse was already walking towards the kitchen and asking at the same time to turn on the kettle to make herself a cup of coffee. It was obvious that it was rhetorical question as she was already halfway to the kitchen. She did also ask me if I wanted tea/coffee but I politely refused. I was very confused by this as the nurse was happily making herself at home, using the couple's kitchen and coffee/tea supplies, etc. I personally found it a bit rude, but then again I don't know how well she knows the couple. I would never use a patient's facilities and no matter how well I know them, I would never make myself comfortable in their home. I feel like it's just a professionalism thing more than anything else. At the end of the day, they are my patients and I need to treat them as patients to maintain the professional doctor-patient relationship...or in this case nurse-patient relationship. I guess in general nurses are a lot better with maintaining good relationships with patients and come across much more empathetic and kind. Not only did I feel very uncomfortable in the patient's home, the nurse was taking her sweet time to make herself comfortable and making her coffee, leaving me alone with the couple. It was nice talking to them, but at the end of the day - we were there to go over their blood-sugar diaries and just seeing how they are doing. What could be done very quickly...ended up being a fairly long ordeal (about 30-45 minutes). I don't like to make things take longer than they do. I do understand these are house-bound couples, but I feel like by taking so long to do a job may be interrupting their day. As an outsider - I want to make my visit as quick as possible so they can return to their activities. So again the whole making yourself comfortable in someone else's home was puzzling. Even better, the nurse went to use the couple's bathroom...which again made me raise an eyebrow. If I needed to use the toilet, I would've went before the visit, or hold it and go somewhere else to use the facilities.

If we flipped it around and a nurse/worker or whatever had to come to my home once a week to do some checks...I personally wouldn't want this person to make themselves comfortable in my home. Maybe I'm just a private person or how I have been brought up. I don't mind friends/people who I know well to come over and make themselves at home, but when professionals/workers come...I wouldn't be as comfortable with them making themselves at home. I see them as someone who is here to do a job - not to socialize and I wouldn't expect/want them to break down that barrier of professionalism.

Just found it a bit interesting and wanted to share that experience.

Old Age.

Had quite a weird week...weird as in a week which really made me change my perspective on things.

I got to go visit a nursing home for people with dementia. I had previously volunteered in a nursing home before medical school but I didn't work with patients with dementia. I went to visit a 75 year old man who has vascular dementia and had just moved to this new home. The nursing staff were worried about him as he had spent the entire night pacing up and down the hallways continuously for 15 hours non-stop. I went into his room and sat down in front of him. His room was fairly small. One single bed. One small wardrobe in the corner. 1 night stand. 1 cabinet. This man just sat in his chair, hunched over. He wore a baseball cap so I couldn't see his face. As he sat there I saw him dribbling on to the floor. It was almost like he wasn't even there and was staring at his shadow. I looked over to his night stand and saw 2 pictures of him and his family. In the pictures, he was middle-aged and appeared to be a very proud man. He stood in the pictures full of confidence. He looked very happy. Then I looked back at the patient, still dribbling and staring at the ground. He looked quite frail. I eventually said hello to him and he didn't reply. I moved his hat a bit so I could see his face. He still stared at the ground. I asked him what is his name and he replied me without looking up. I tried to carry out a very basic conversation with him, which proved difficult as midway through he started mumbling. I couldn't quite understand him and he quickly stood up. He walked to his wardrobe and was very unsteady on his feet. He had a very unbalanced waddling gait. I asked him where is he going and he replied: "Home". I kindly told him this is his home and to sit down again. As he came back to his seat I looked into his eyes and he didn't look happy. He didn't really even look like the man in the picture by his bed. As he sat down, he went back to staring at the ground and stopped talking to me. I just sat there looking at him. I thought to myself: Is this how residents here pass their day? I found it pretty sad as they just sit in a fairly tiny room. This particular man, if he isn't pacing up and down the hallway, he is sat in his chair almost lifeless. Really made me think that people need to live their life to the fullest. Appreciate the things and people around them. I felt bad for this man. His life seemed pointless. He was confused. Ageing is a scary thing. Just comparing this man to the man in the pictures - it is almost like night and day.

Then when I went back to the GP practice, I met another lady who desperately needed a total hip replacement. Her x-rays showed severe osteoarthritis (OA) as in it was bone on bone. The patient had a shortened right leg as well due to the OA. On palpation of the greater trochanter...it felt like you were running your hand over a bag of marbles. You could feel the osteophytes! Range of movement was severely decreased and the patient had pain on extension and flexion. Actually any movement made the patient jump. It was fairly remarkable that she doesn't need to use any aids to walk, but you can tell she is struggling. Unfortunately, the surgeons do not want to operate on her due to her health and as well she does not have anyone at home to look after her. She told me that she has outlived her entire family and there was no one left. She explained to me that she tries her best to get through the day, but usually just stays at home to avoid any hassle and because her hip hurts too much. She has tried all sorts of analgesics and even tried topical treatments (which doesn't work, which is no surprise as her hip was bone on bone). I asked her what does she do every day if she doesn't really go out. She told me she just sits there and read and told me that her life has become very boring and that there isn't much meaning to it any more. She talked about how active she was when she was young and gradually as her hip got worse, she couldn't go out for walks in the park or even do her gardening.

If you think about it, when I start reaching the peak of my career, the majority of my patients will be the elderly. In general the population would be quite old as the current generation of "baby boomers" are starting to reach retirement age. I think it is key for medical students to learn how to deal with the elderly. It is frustrating to hear students go: "I don't like old people. I hate talking to them." I sometimes can't help but say back to them: "Well start liking it as the population ain't getting any younger." I'm sure I have said this before,  but I quite enjoy talking to the elderly. They always have a great story to tell or have some pretty wise things to say to you. They are all so strong as they have been through so much. They seriously need a heck load more respect from people of my generation and the younger generations. Ageing is the fact of life and there isn't any way to avoid it (well unless something really tragic happens to you at a young age...). Sometimes it is just hard to see what the future lies for you when you see so many elderly patients.

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.

A Mask.

This isn't a new revelation, but one that has occurred to me more during my GP placement.

I have come to realize that doctors need to put on a mask most of the time as patients come to doctors for various kinds of problems. No matter how annoyed you are about a patient or how fed up you are with your clinic, you cannot let it show. There are tons of patients out there who visit the GP 2-4x a month and I'm sure as the GP you can get frustrated/annoyed with the patient especially when they are coming in for insignificant things.  It is definitely difficult as patients expect the doctor to be professional and empathetic, but it is extremely difficult to show this when the patient themselves aren't coming in with the right intentions. I have sat in clinics where the patient is very rude and overly demanding. And as a doctor, you can't do anything about their rudeness, other than still treat them respectfully and try your best to listen. Definitely need a high tolerance level when dealing with "troublesome" patients. On the contrary, there are certainly very nice patients (usually tend to be the elderly). They are usually very respectful and always apologizing about wasting your time. These are the patients who are worth treating and you can't help but be a bit more empathetic, despite knowing that you're supposed to treat all patients with empathy and care.

However, masks are not just for GPs. As I have mentioned earlier, I have encountered it in my other placements. You would think surgeons wouldn't need to put on a mask as often, as they have a bit less patient contact. Unfortunately, surgeons have just as much face time with patients; however, the reasons of putting on a mask may be different. After a surgery and you have to break some bad news/complications about the surgery, you have to be able to put on a confident face and an appropriate mask. There isn't as much time for you to gather yourself after the operation. GPs or physicians in general would get results/bad news ahead of time so they will be ready and have time to think about how they will break the news. It is definitely a tough job as you don't want to show that much emotion when talking to patients especially after a tough case/surgery.

With clinics, you could enjoy the company of one of the patients and be laughing about something, but you have to be able to quickly return back to neutral before seeing your next patient. It can work the other way around as for one particular case, we were giving our condolences to a patient as her father had just passed away the day before and she was telling us about his death. Definitely an emotional/sad moment where you have to again put on a mask and empathize and comfort the patient. Easily within 2 minutes between patients, you have to regain your composure and be ready for the next patient as he or she can come in with anything. You certainly can't let things affect you and as well for doctors, you have to be good with moving on. You can't dwell on one particular case.

There has been arguments that doctors should not bring their outside emotions to work. Despite having a horrible morning, people argue that you shouldn't bring that grumpiness into the work place. I personally agree with that point as it isn't fair to your patients and your colleagues. I have met a few GPs who said that it is important to bring your emotions to work as you will seem more genuine. I don't mind bringing in a good mood to work, but I certainly wouldn't want to bring in grumpiness to the work place as you can easily affect your patients and colleagues. No one wants to see a grumpy doctor. In my eyes, I think my emotions should not affect my work, so even in that sense, you will have to put on a mask before coming to work especially when you're having a bad day. People argue as a doctor you should be genuine, but for me it is far more advantageous if I put on a mask for work and sort out my issues/problems when I go home/leave work.

What are your thoughts about putting on a mask for work or bringing your emotions to work?

Post your comments below!

Unreasonable.

One of my biggest pet peeves is when someone wrecks my lunch breaks for no reason. I don't mind missing my lunch because I am in theatre or doing something productive. Actually I don't mind if I'm in clinic and I have to delay my lunch...but what really drives me mental is when someone makes me MISS my lunch when it really didn't need to be missed.

I don't know if I am just being unreasonable or uncooperative, but essentially here's the story:

One week ago I gave notice that I have to attend a compulsory observation session at a clinic which is quite far away. I asked the secretary who does up my schedules if it will be possible for me to leave slightly earlier so I have some travel time and a time for me to eat my lunch. I was told by the secretary that it will be okay and she has left a note for the GP who I will be following in the morning.

Fast forward to today. I made sure I arrived early and kindly asked the GP if I could leave at 11am so I could go to my session at 12:30pm. Clinic usually ends at 11:30am so it wasn't like I'm asking to get off 2 hours early. It was simply just leaving 30 minutes early which is equivalent to seeing 2-3 patients. Despite seeing the note left for the GP about me leaving early, I was then given a fairly rude look and essentially was told why I can't leave after clinic (11:30am ish). Still maintaining my composure, I told the GP that I need to go home and drop off my car and then make my way to the other clinic (which has no parking hence I need to take the bus), and that I would like to have a bit of time to have some lunch as well. The drive home probably takes about 20-30 minutes depending on traffic, then another 30 minutes to travel to the other clinic. That would leave me about 30 minutes lunch break...which isn't unreasonably long. I explained this to the GP and she essentially didn't even listen and proceeded to interrupt me. She went on how I can leave at 11:30am and have my lunch on the go while traveling to the other clinic. I was obviously fuming as I do not understand what is the importance of me staying for an extra 30 minutes. Either way I just sit there and day dream as I don't do anything in clinic. I just sit and listen...and try to stay awake. I think the most annoying bit was the rude attitude the GP gave me first thing when I asked to leave early almost giving me the vibe that she's the "know it all - who are you to leave early" attitude. Hate it when people get all arrogant like that. I asked for permission a week in advance and again I'm only leaving 30 minutes early.

What also drove me mental was in the last 30 minutes of clinic....one patient needed a sick note/letter and another patient needed a wound to be checked for possible infection. Wow...that was surely useful....I couldn't help but give the GP a look of: "You seriously kept me an extra 30 minutes to see these things?!" Once the clinic was done all you could see behind me was a cloud of dust. Raced home and raced back out to clinic. No lunch. No snack. Didn't even have time to drop off my car keys. By the time I got to the other clinic...I felt like I was going to faint. I was starving and I had a smaller breakfast than usual as I thought I would be having an earlier lunch.

I mean I think the GP was being highly unreasonable and very inflexible especially when I had a valid reason and a reason which was something the medical school required me to attend. I wouldn't even care if I had to miss my lunch because an operation overran and we had to skip lunch so we will stay on time plus the consultant starves with you. I swear this GP did not help me with my experience with this placement so far. To most, if not all of you, you probably think this is such a small thing...why the heck is it bothering me so much. My tolerance for this placement is getting very thin and I am starting to really lose motivation in even putting in effort.

Dull.

If I could describe my GP placement with one word I would use the word: "Dull". Dull might even be an understatement. I have caught myself so many times zoning out during consultations. Again my frustrations are growing as I still cannot do anything in clinic. The most I can do is maybe do manual blood pressures. I guess the only thing I can take away so far from GP is the difficulty of immigrants. My practice sees a lot of immigrants and most of these people can't speak English.  You realize that it is very difficult to get a patient history and even more difficult when you have to talk to your patient through an interpreter.

We had one patient who was from Slovakia and could not speak very much English.  It was requested that an interpreter come, but he/she did not show up so the patient attempted to tell us her problem in broken English. Unfortunately, her problem was a mental health related problem so patient history is really important and there was no way we will get what is the problem as her English was not cutting it. We resorted to using the phone interpreter. I swear those things are not user friendly.  The interpreters aren't that great and it is really awkward having a phone in between the patient and you and the phone is on speakerphone so it is quite difficult to hear what the interpreter is saying.  Even weirder is that you lose a lot of rapport with the patient as both of you are trying to talk into a phone. Very confusing stuff.  After 45+ minutes (when it should've been 10 minutes), the GP gave up. It got far too complicated and too difficult to get a proper patient history. I felt like we wasted a lot of time and it obviously makes the clinic run quite behind. We asked the patient to bring an interpreter next time and you just can't help but feel a bit annoyed that you wasted 45 minutes only to get nothing accomplished.  The next few patients weren't too pleased either as clinic got quite delayed. When one patient sees that you spend 30+ minutes with one patient, they think they have the right to have 30 minutes as well and it's hard to cut people short and to keep them on topic about their medical problem/presenting complaint.  When you're running behind, the last thing you want to hear about is what the patient did on the weekend.

I have no problems admitting that GPs are extremely patient people and their job is certainly not easy.  I just feel like I would have a lot of difficulty maintaining my composure during consultations especially when it gets quite frustrating.  I do consider myself quite patient, but I guess not patient enough for GP and probably the main reason why I'm having a difficult time enjoying this placement.  Worst bit is that I still have another 5 weeks to go. Thankfully I am only in 3 days/week so my weeks won't be too long. I'll take it that I have 15 more practice days.  That doesn't sound too bad...I guess....

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.

How to Make the Most of Shadowing.

Right so I'm in the mood for a tips post so today I will be discussing how to make the most of a shadowing opportunity. This is mainly aimed to those who aren't in medical school yet.

Let's point out the obvious issues of shadowing doctors when you aren't in medical school yet:

• You can't do any clinical skills
• Don't have much knowledge in medicine 
• Daunting environment - very unfamiliar/disorientating 
• Never really spoken to a patient before

Common problems that you share with medical students:

• You get ignored
• Can't do very much (depends on the placement/consultant)

So with the common problem of getting ignored...there isn't much you can do about it other than finding someone who won't mind having students around/is a good teacher. Not being able to do much is a universal problem. Fair enough some patients don't want to be handled by a student and there has been several times where I have found myself sitting in a corner like an old piece of furniture. It's just something we all have to accept.

Right so as a prospective medical student you want to get some experience and see what it is really like to be a doctor so you ask to shadow a doctor/consultant. So how do you make the most of it? Because you won't have much knowledge about the specialty, the best thing you can do is observe the key skills that a doctor needs. The main skills you'll notice are:

• Communication skills
• Empathy
• Teamwork

Communication is probably the most important skill to have as a doctor. The profession involves a lot of talking to patients, but also the need to listen to the patients as well. Watch how the doctor talks to a patient. Listen to how he/she asks a question. Usually doctors start a consultation with open ended questions to allow a patient to elaborate why they are in clinic. Watch the rapport that the doctor establishes with the patient. The best way to get info from a patient is to get them to trust you so the first few seconds of a consultation is key. Don't dig your head too deep into the medicine. Just focus on the interaction between the doctor and the patient. Some of the consultants who I have been attached to describe it as an art form. Communication is literally needed everywhere. Communication is key in theatre, clinics, and on the wards. If you're fortunate enough to go onto the wards, take some time and talk to the patients. I took my first patient history 1 month into medical school and hardly knew any medicine at that time. Take a social history which involves asking the patient about how his/her medical condition has affected them. Try to find a patient with a chronic disease such as heart conditions. Find out how their condition has changed their lifestyle. This is a good way to practice your communication skills and creating good rapport with the patient. Plus most patients on the wards are really bored so most will welcome a nice lil chat.

Empathy...I've made a post about this not too long ago. Again another important skill and something you'll sometimes see. Talking and listening to a patient is one thing, but watch to see if the consultant shows a bit of empathy. Sometimes patients have a tough time with their medical condition and SOME consultants do take the time to empathize.

Being a doctor involves a lot of teamwork. It is certainly not a one-man job. In clinic, you'll probably have a nurse helping out. Just watch how the doctor and the nurse interact and how they have to be on the same page. Essentially the nurse keeps the clinic running smoothly and on time. You'll probably see more teamwork in the operating theatre. There is always about 6-8 people in an operating theatre so again stressing the importance of communication skills and teamwork skills. Sometimes the consultant may invite you to a MDT meeting (multidisciplinary team meeting). There will be microbiologists, radiologists, surgeons, physicians, nurses, etc all sitting in one meeting to discuss complex cases. Not only do you have to get along with people in your own specialty, but you'll have to get along with people in other specialties. So essentially the care of a patient isn't just in one person's hands...but in many many other people's hands. If you can, take the time to appreciate this as when I first started out in medicine I didn't expect THAT many people to be involved in a patient's care. It was actually surprising and quite amazing how people manage to stay organized and not mix things up (but it does happen from time to time).

Oh and if you really don't know what's going on...best thing to do is just smile and look interested. No one wants a grumpy/tired/not interested student around them. If a doctor sees that you're interested then he/she will be more willing to teach. I've tested this so this is based on first hand experience. Recently in my last orthopaedic attachment...I was falling asleep in clinic (due to jet lag) and my consultant hardly said anything to me or really taught me anything. He just left me alone. Next clinic...got over my jet lag...more keen...leaning forward and looking interested - learned loads. My consultant taught me so much and he seemed to enjoy my company as I was interacting with the patients and with him as well.

Another tip is that if you find yourself on the wards and no one to follow - go find the junior doctors. They know what it is like to be a student as it is still fresh in their minds and they'll probably be able to sympathize and show you some interesting things suited for your level. I've encountered prospective medical students in the hospital before and don't be shy and just ask for help. For me, I'll always be happy to help unless I'm busy. Same goes with junior doctors/doctors of any level. As long as they aren't doing something really important/look really busy, just introduce yourself and ask em if they can show you around/teach. Just make sure they know you're not a medical student and just want to get a taste of what it is like to be a doctor. Some might even get a break and sit down with you and tell you what their day is usually like.

Good luck and I hope this post helped!

Difficulty of Going Backwards.

So I've had a week of lectures...which to be fair weren't too intense. They weren't 9-5 lectures so I can't really complain. Ever since January, I feel like I have made leaps and bounds in terms of progression in clinical experience. In paediatrics, I hardly did any clinical skills and was in a small group for my placement. I had a partner with me for all clinics and was never really on my own. Didn't really even see patients on my own either. Then we get to Obs and Gynae...slowly venturing out a bit and being a bit more independent. Still in a small group on my placement, BUT I didn't have a partner to go with to clinic/theatre. I was actually scared to be on my own as I have never really been to clinic on my own and you get all these thoughts of: "Ahh no one to bail me out when the consultant asks me a question." I actually really enjoyed going to clinics on my own as you get to chat with the consultant more and it isn't as daunting for patients to have two students watching/sitting in. I definitely started becoming more independent on placements and started being more proactive in guiding my learning.

Then my last placement in orthopaedics. It was the first time I ever attended a placement on my own. I have always been in a small group. Funny enough my first concern was: "Who the heck is going to eat lunch with me?!" I am definitely not a fan of eating on my own as it is painfully boring. I like to talk during my lunch as I eat quite quickly so talking helps me slow down. I can easily scoff down lunch in 5-10 minutes and I end up taking extremely short lunch breaks. Luckily, due to my half-days I was able to go home to eat so I didn't have to sit in a cafeteria eating on my own and staring off into space. When I did have to eat lunch at the hospital I was usually with my consultant/registrar so we all ate together. But yeah my independence was really tested in this placement as everything I did was all "me". No one to fall back on. No one to rely on. No one to catch your mistakes...other than the consultant. Went to see new patients on my own and do full examinations on my own..then presented to my supervisor. If you had asked me to do that in my paeds placement...I wouldn't be confident enough to do it. I guess that's one thing with being dropped in the deep end. Got to learn quick and deal with it quickly. To be honest it did help that my supervisor is probably one of the nicest people I have ever met so I knew if I made a mistake I wouldn't get a full blown telling off/humiliation. It was also nice that I actually got to do things during my placement such as see patients, do examinations, assist in surgery, etc.


Now...sitting in lectures on a very hard plastic seat (even the clinic chairs are more comfy) in a small tutorial room...painful. I was talking to my friends and they kept saying it was nice to have a relaxed week of just sitting around and doing nothing but listen. I actually struggled this week. I may not be the hardest working medical student...but I hate sitting around. Especially with my last 2 placements where I was actually being productive and learning loads on placement...I am actually a bit sick of sitting in lectures and listening to one person talk about the same subject for 2-3 hours. Also got my induction pack for my next placement (GP) and the first thing I read: "Patients should not be seen by medical students who are on their own. Medical students will be supervised at ALL times." I'm totally looking forward to GP now...so excited that I'm bouncing off the walls (sarcasm). I really really hope that the package is a bit outdated and my GP will let me go see patients on my own and do some examinations. It's weird getting so much independence and responsibilities...and suddenly being stripped from all of it and back to holding hands. If this is the case...wow this is going to be a shock to the system.

The End of Another Placement.

Seriously cannot believe it has been 6 weeks. It literally blew by. I didn't think it would as I wasn't particularly busy and I had quite a few day offs as well (bank holidays, etc). My friends said that you cannot find a happier medical student on placement than me. I will admit, the placement started off quite slow...but once it got going...I truly truly truly did not want it to end. It's the first specialty where I could see myself work in as a career. Before starting, I was a bit hesitant as ever since I knew I wanted to do medicine, I wanted to do orthopaedics. I had very high hopes for it. Obviously I was very excited to start the placement, but there was a bit of doubt in the back of my mind. These 6 weeks could either make or break this specialty for me. I was actually scared that I will end up not liking orthopaedics...and actually hating it.

Luckily, orthopaedic surgery is just like how I imagined it to be. I was genuinely happy. It's the first placement where I enjoyed everything about the specialty. I enjoyed the surgeries. I enjoyed being on the ward (which was minimal to be fair). And I can't believe I am saying this but I enjoyed clinic. Everything clicked for me. I never struggled waking up to go to this placement. I had 8am meetings to go to (where I had to wake up at 6am) and I never struggled. If this was any other specialty and was told to go to an 8am meeting...I can guarantee you I would struggle and would probably turn up late or maybe even miss it. I was actually motivated to work hard in this placement. I didn't work hard because my supervisor was strict/I was scared of him...I actually worked hard because I enjoyed the specialty. I felt no pressure to work hard...actually my supervisor kept telling me to take it easy and made it very free. It was all down to me. There were times where I wished I was in more.

This was probably the most flexible and easy going placement I have had this year, but this is easily the one placement where I have learned the most. I had lots of fun, but also learned a lot of useful things. I am so lucky to have a supervisor who is really good with teaching and letting me progress. You all probably remember me having great praises for my last O&G placement and that it has set a very high bar. This orthopaedic placement just blew through that bar. I mean I knew it was going to be hard to have more fun and more responsibilities than my last placement, but wow this placement was fantastic. I have nothing but good things to say. I got to scrub in. I assisted in surgery. I learned how to suture and help close up. I saw patients in clinic on my own and got to examine them. I got to start and finish an audit project. I really could not ask for more. I don't even think I could do much more.

Today started out like any other day. Early meeting and then to morning clinic. Usual banter in the meeting...lots of good laughs and teasing. I took up my usual spot at the back of the room against the cabinet. Then off to clinic. Busy clinic as usual. Saw new patients on my own. Did the usual. I'm sure no one knew it was my last day because everything was going like it was just another day of my placement. Patient by patient...the note pile got smaller and smaller. Clinic was coming to an end. Next thing I knew my supervisor was signing my feedback form off. Had a bit of a chat about the placement and then a solid handshake. To be honest it was tough to leave. I wasn't sick of the placement yet. Just wasn't ready for it to end already. Every day when we finish and before I leave, I always crack a: "When am I seeing you next?" It was weird not to say that as I was heading for the door. I didn't even know what to say as I left. I think all I kept saying was "thank you" as I dragged my feet out the door. Even now...I'm absolutely gutted this placement is over. Feels like someone shot me out from cloud 9. Next week is going to be tough. Back to lectures. Back to reality. Then on to GP and being cooped up in a clinic from 9-5. No surgeries. Not in a hospital environment. Going to be out of my element. Hurts just to think about it. Should be a crime to enjoy a placement so much.  Genuinely loved this placement. Entered placement as one of the happiest medical student you can find to probably the most gutted one at the moment. What a contrast. Just shows you how much I enjoyed this placement.

Orthopaedic Clinic.

A bit hard to believe but I've only got 2 more weeks of Orthopaedics left. It definitely flew by despite not being a very "intense" placement. Actually it was extremely slack...but it still went by very quickly as I'm still having fun and having a good time. With this particular specialty at my school, students aren't placed in Orthopaedics for very long. Through the regular rotations through the school we only get about 1 week of Orthopaedics so consultants/registrars don't get to know you very well. With me, because I had self-designed my placement to be in Orthopaedics for 6 weeks...consultants find it weird that I've been around for a lot longer than most people. Every week I attend early morning meetings to discuss about cases and I can tell that the consultants are starting to expect me in meetings and I'm becoming a familiar sight. They are all acknowledging my presence and are talking to me, which is a bit of a surprise as I haven't really followed any of them to clinics/theatre so in general the only time they see me is when I attend their meetings (once a week). 

Essentially I go to clinic twice a week, and we would see quite a lot of patients in a half-day clinic. When I first started out on my first week, I essentially just sat in clinic and observed. The week after, I was allowed to go take full patient histories and then present them to my supervisor in front of the patient, but I would watch my supervisor perform examinations on the joints. Third week: full patient history + joint examination on my own, then present to my supervisor in front of the patient. Fourth week (now): take a full patient history, full joint examination, differential diagnosis + formulate a management plan. I think my supervisor is doing a really good job in terms of allowing me to progress and allow me to do a bit more with every week. Finally getting things to do and a bit of responsibility, which is nice. It also makes the clinic a bit more enjoyable as sitting through a whole clinic and not doing anything gets fairly boring, especially in such a specialized clinic (lower limbs). Patients generally come in with the same complaints so when we get new patients, I get to at least get up and walk around and do a bit of talking/interaction with patients in a side room, while my supervisor sees a follow-up patient. I actually think it helps the clinic move a bit faster as we are seeing two patients at a time at some points and when I present my patient, it obviously takes less time than doing a history on the spot and my supervisor is starting to trust my examination findings so he only needs to quickly check instead of going through all the motions.

I think I'm actually learning a lot as my history taking skills and examination skills can always be improved on so with all this practice, I believe I have improved a lot. Taking a pain history is quite easy now and it is something I don't really need to think about anymore and I hardly miss any questions out as I'm seeing so many patients and getting lots of practice in. This is definitely giving me a bit of a head start compared to other students as other students use their "self-design" placement as a holiday by applying to do a project in "sign language" or something really random. With my placement, it is almost like a regular rotational placement that we get placed in and I'm doing a lot of clinical things which is obviously helping me improve and giving me a lot of opportunities to practice and formulate management plans (which aren't really taught to us...it is something we have to learn on placements).

Overall, really enjoying my time in clinics (can't believe I am enjoying clinics) and they go by fairly quickly as well. My supervisor asks me questions from time to time so he keeps me thinking and he teaches and shows me a lot of x-rays throughout clinic as well. Like I said about my last O&G placement, supervisors definitely matter and they can make a huge difference in your placement. Can't believe only 2 more weeks left...I could do another month of this! Starting to become a routine and I'm starting to feel a bit more comfortable. Best bit is that I'm not in every single day from 9-5, so I get to work on a project/audit at the same time so it keeps my week interesting/varied. Plus I'm getting some free time to enjoy the odd sunny weather here in the UK. Loving it.

O&G Ward Week.

You can hardly call this my "Ward Week" as I probably spent more time in clinics than on the ward. This week also marks my last timetabled week of my placement and I have been seriously trying my best to enjoy every day of it as there is a bit more flexibility with my week.

Spent Monday morning in Gynae clinic. I managed to see a lot of prolapses such as cystoceles (proplapse of the bladder). Luckily the consultant has gotten to know me as I've been in a few of his clinics with him so I got to do a vaginal examination on almost every patient. It was interesting to feel a prolapse as it is definitely very different and then feel the difference when a shelf/pessary is inserted as a temporary treatment for the prolapse. Patients with cystoceles tend to classically present with a "dragging" feeling down below which becomes quite uncomfortable as the day progresses. There is also a "heavy" feeling, which again gets worse as the day progresses especially when stood up for a long time. Some of these patients also present with urinary symptoms such as urinary frequency and hesitancy. I think by coincidence these patients also present with some form of urinary incontinence as well. Usually elderly women would not be offered a surgical repair where stitches will be placed to reinforce the anterior wall of the vagina (where the bladder prolapses through) as these patients are usually unsuitable to go under anaesthesia.  By the looks of it, most of the women are fine with the pessary and it seems to sort out their problems quite well.

Then I wandered onto the wards with one main goal in my mind: Take as many gynae patient histories as possible. Why so keen? This is because my assessment is taking place the following day. Essentially we are required to take a full patient history with an assessor sitting alongside. This assessment either makes or breaks me. If I fail, I would obviously have to resit the assessment which would go down on my records that I had 1 failed attempt. If I fail the second time, then I will have to repeat the entire 7 week placement all over again. I mean I'm having a good time on this placement, but if you asked me to do another 7 weeks, it might be a bit of an overkill. Anyways I took about 4 patient histories in the afternoon and had a good time talking to patients. It's nice to see patients enjoying talking to me as I guess for them it is better than sitting in silence and day dreaming as the hospital is pretty boring in general.

So I had my assessment...and oddly enough...I wasn't too nervous for it. Actually I was so calm it was worrying. I was struggling to take the assessment seriously as before I went in to take the patient history I was chatting away with my colleagues (well I did the talking...they just listened as they all looked very nervous). I kept telling myself to take this assessment seriously but I struggled. I was fairly annoyed with myself, but at the same time - if I'm in a good mood I tend to take better patient histories and form much better rapport with the patients, which is key for the assessment. Luckily, my patient wasn't too complicated (vaginal hysterectomy and anterior wall repair). I finished my history quite quickly and  I thought I did quite well. Didn't have any difficulties whatsoever. Huge contrast from my last placement (paediatrics) assessment. In my last placement I was properly pooping myself prior to my assessment and I was dead scared. I was much more confident for this gynae assessment - night and day in terms of confidence between my last placement assessment and this one. My assessor had no difficulties in passing me and even gave me an "above average" mark which I was quite chuffed about. I was quite proud of myself as I was only expecting a "meets expectation" as my supervisor is known to be quite strict with marking.

Since my next assessment isn't until next week, I knew I can relax for a bit and return to enjoying my placement. Oddly enough I thought I was going to be quite bored on the wards as there isn't much a medical student can do on the wards, but I was actually quite productive on the wards. The doctors were all really welcoming and actually allowed me to write in the medical notes and sign off on them (of course the doctors reviewed and counter-signed my notes). I also got to clerk in a few patients, which is always interesting. It's weird seeing how seriously some of the patients treat me. I mean at the end of the day I'm just a medical student, but these patients really take everything I say seriously and show a lot of respect. It's quite nice to not be treated as a joke and it definitely makes me feel much more responsible.

Because my next assessment is on obstetrics and I haven't had much exposure to it on the wards, I decided to spend my day on the obstetrics ward and practice my obstetrics examination skills. And jeez....I suck at obstetrics examination. I swear I cannot feel a thing. In our assessment I'm supposed to be able to tell the position of the baby, the engagement of the head, the lie, etc. I feel like my hands are dead stubborn as I swear the bum of the baby feels the same as the head! Yes I know one side is flat and the other is round like a ball, but at the same time I'm too scared to palpate deeply in fear of hurting the mother. I definitely need to get more confident in doing this examination or else I will fail my final assessment. Not looking good. I thought I could get away with just a full day of practice, but I definitely need to go back to the obstetrics ward next week to examine more pregnant women. I think I did leave a good impression with the midwives as they seemed keen to have me around and that I am welcomed to come back next week to practice some more.

1 more week until holiday...well not even. Technically only 2.5 more days of placement left as I have a half day next Thursday (and Monday is a bank holiday and I get Friday off).  Can't believe it's already been 7 weeks. I can still remember my very first lecture for O&G like it was just yesterday. This placement seriously went by way too fast...and I'm having such a good time. Argh.

The Grind.

Clinic here. Clinic there. What a brutal week. I don't mind clinics...but I do mind them when I have 2 clinics per day from 9-5pm. I have now grown to fear Antenatal Clinics. It is essentially an overbooked clinic where you talk to high risk pregnant ladies and just following up on their pregnancy. It's nice as you spend about 10-15 minutes with each lady; however, after 5 pregnant women...it gets very boring.

Not only did I have Antenatal Clinics, but I also had to attend Gynae Clinics, which I admit are a bit more exciting/interesting. Gynae Clinic is where patients come in with problems downstairs. This could include menorrhagia, dymenorrhoea, discharge, etc. Because I was with my supervisor, Mr R, I was able to carry out a few examinations and after being taught how to use a Cusco Speculum in theatre, I was finally able to try it out on a patient who is awake. I gotta admit...I was extremely nervous as I obviously don't want to cause any pain and the Cusco can easily cause pain. I managed to find the cervix in the first go and I felt a sense of pride come over me and Mr R was complimenting on my technique. It definitely filled me with confidence and to be honest...inserting the Cusco wasn't that difficult. I don't know why I was pissing my pants about it. I also really appreciate patients being so tolerant with students. I mean if I needed to get my downstairs checked up...the last thing I want in clinic with me is a medical student...and no way the student will be going near my bits. I mean these patients who allow us to practice our skills really need to be more appreciated. It's one thing to practice on a plastic mannequin but being able to practice on a real patient is a whole new ball game and it really helps build confidence. It also helps when your supervisor is keen to allow you to practice skills and perform examinations. Overall I enjoyed my clinic with Mr R as he was also in a good mood and we finished clinic on time (RARE!). Learned loads, got to do examinations + Cusco, and had a lot of good banter and many good laughs.

Unfortunately, I cannot say that I had as much fun with the rest of my clinics. Note to self: READ UP before attending special interest clinics. I literally got wiped all over the floor by another consultant when I went to Colposcopy and Gestational Diabetes Clinic on Tuesday. Because I had an evening meeting, I did not have time to read up on the clinic and I wrongly assumed that the consultant I was going to have wouldn't quiz me like Mr R does. To my demise...this consultant LOVES quizzing and I got my butt kicked. It was so embarrassing. I have never felt so dumb either. I kept blanking out and my heart was racing with every question. Worst bit is that I know the answers to the questions...or more like I SHOULD know the answers but I couldn't spit it out as I had not done any revision. Definitely taught me a good lesson and ever since Tuesday I did some reading prior to clinics especially clinics with consultants I haven't met yet.

On top of all the clinics this week...hands down...I have never worked so hard on placement...ever.  I was putting in so much extra time. Usually we are expected to be in 9-5pm on a standard day.  Monday...technically didn't have to go in until 10:30am for a tutorial. I went in at 9am to take a full patient history for my case study report. Tuesday: 9am clinic...went in at 8am to get a different patient history as the patient history on Monday wasn't good enough for my case study (ended up not seeing any patients as there was a ward round going on). Then had clinic in the afternoon which did not end until 5pm. Went to the ward to see if there are any more interesting patients...didn't leave until 6pm. Wednesday: 9am start for clinic...but stayed until 6pm...when I could've went home at 3:30pm (clinic finished very early) - was chasing after some patient notes I had requested for as I forgot to copy down info. Thursday: 9am start (clinic). Gave up my lunch hour to go read up the patient notes that I had requested for. Then had teaching from 2pm-3pm. Went to clinic...which didn't end until 5:30pm. Friday: FINALLY a normal day - 9pm-5pm.

Worst bit about this case study I was chasing around for a whole week - I ended up writing up on the first patient history I took Monday morning. Most annoying bit: of ALL the patients I could've picked, I picked a patient who was under the care of my supervisor (who is also marking my essay). I didn't want to do up a report on my supervisor's patient as he would know the patient history well so I definitely have to write accurately. This unfortunate coincidence doesn't end there. I thought I could get away with this patient case study as my supervisor had no idea which patient I am writing up, but also this patient presented with a fairly common problem (urinary retention post-op total abdo hysterectomy) so it could easily be anyone. Because the patient was discharged later in the afternoon on Monday and I needed to look at the notes, I requested for the notes to return to the ward so I can read through them. They arrived on Thursday, but were delivered to my supervisor's secretary. No problem right? Wrong...the secretary shares the same office as my supervisor, but luckily my supervisor was called to cover a clinic for another consultant for a few minutes. Perfect - quickly ran to fetch the notes, except the secretary forbid me from leaving the office with the notes. I knew my supervisor had just left his office as his computer was still on (screensaver wasn't up yet), and his chair was still warm. I predicted that my supervisor would be back in 30 minutes so I quickly went through the patient notes.

Unfortunately...my supervisor returned in 10 minutes and found me lounging on his chair and working at his desk and I had moved all his stuff to the side to give myself some room to write. Doh! I quickly stood up and moved over to finish up copying out important info about the patient's operation. My supervisor got curious as why the heck was I in his office, and who's notes was I looking up. He knew I have been working on my case report...and obviously his curiosity took over and he was trying to see the patient name. I kept my hand over the patient label on each page; however, in the 2 seconds I bent over to pick up my pen, which I dropped, my cheeky supervisor took the notes and found out which patient I was writing about. I was obviously a bit annoyed as now my supervisor definitely knows who I am writing about, but now also knows what I will be writing about in my report. He promptly refreshed his memory by flipping through the notes while I stood next to him giving off a dumb face. Guess I really have to do a good job on my essay now that my supervisor knows I'm writing up about his patient and the fact he remembers the patient as well. Great. Bonus bit: my essay is due in 3 days...2 weeks earlier than everyone else. What a tiring week. Hopefully all this hard work will pay off in the end. Next week: Labour Week. Going to be VERY tiring. Long shifts. Lots of waiting around. Yikes.

Obs&Gynae - Initial Thoughts

So I have completed my first week of placement for Obstetrics and Gynaecology. Initial impressions? Fairly interesting. It's nice to see adult patients again. When I took my first patient history on this attachment, it was weird being able to speak directly to the patient and receiving specific information. Also in Obstetrics (pregnant women), you can't really call these people 'patients' as most of them are healthy and essentially are only in hospital to give birth. It's quite a nice change of environment from seeing ill children. In Gynaecology, one has to be quite professional as this specialty deals with quite sensitive things. You have to ask personal questions and you really need to gain the trust of your patients in order to get such personal/sensitive information.  Again a huge contrast from Paediatrics as I have to put on a "fun" attitude when approaching children; however, with gynaecological patients, I have to be composed and essentially act professionally. It is a nice change and I haven't found the transition too difficult...yet. We'll see in the next few weeks.

Again I am in a peripheral hospital, but this hospital isn't actually that far away. For me, it is actually closer than the central hospital so I'm not complaining. It's great to be in a hospital which has a good reputation for teaching. They pride themselves in teaching and on day 1 it was very noticeable. The supervisor and secretary was very organized and were expecting us. We felt very welcomed and we received our schedule for the next 6 weeks! I was not expecting a schedule as in my previous attachment everything was done ad hoc and we received little guidance. Huge difference for this attachment and it was definitely a change I welcomed. It was nice knowing what you will be doing in the next few weeks and I could actually plan my life as I will know when I will be free and I can prepare ahead of time for clinics/teaching.

On top of that, I have come to realize how patient some people are. I went onto the wards to help out and was given the task of clerking in 2 new patients. These 2 patients have not seen anyone yet, so I was excited to go talk to them. The first patient I saw was having severe pain and to my surprise, she had been waiting to be seen for 4.5 hours! Talk about patience! I would've left ages ago and I found it quite ridiculous someone in so much pain has been waiting for so long! After taking the patient history, I realized this patient was in a lot of pain and a doctor had to see her soon. In addition to that, the patient was not impressed with the care so far (not surprised) so I quickly went to go get a senior doctor. It was found that she had surgery a week ago and the stitches were infected and some of it has come away. This patient was promptly admitted to the ward and was finally given stronger pain killers and a surgeon was called to review the case.

Then I went to go talk to my next patient...who actually arrived earlier than the last patient I saw. She had been waiting for 5 hours and I felt really bad for her. She had come to A+E the day before and due to the long wait she left and decided to come to the ward the next day. Because the ward was fairly busy, no one has really seen her and again I was the first person to see her. This could of easily been the longest history I had ever taken. After introducing myself I asked the standard question: "What brings you to hospital today?". This patient went on and on with a very extensive history of her presenting complaint and I was overwhelmed with information. She did not stop talking for a good 10-15 minutes and I was completely lost. I slowly had to work my way back through her history to get a more clear idea what was wrong and this clerking felt like it took ages. It didn't help that this lady's first language was not English so I had to word my questions differently and I had to try and figure out some of her medical conditions as she didn't know the names. It was the few times I actually struggled taking a patient history and this is the first time where there was a bit of a language barrier between the patient and I. It was a good challenge and it was new experience. It definitely taught me to be patient and to take things one by one. Luckily the patient was patient with me as we worked our way through the problem and her history and after 40 minutes I finally got through the history. Mind you...it usually takes me 10-15 minutes to get a full patient history.  After presenting the history to a doctor I  had to leave so unfortunately I could not follow up with the patient.  When I came in the next day she wasn't on the ward list so I assume she didn't need to be admitted to hospital, which I guess is good news.

All in all...interesting week. It was an introductory week so it was quite light and I took things slowly as I found my bearings around the hospital. Next week is my theatre week so lots of surgeries! I can't wait!

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.

Long day - On-call.

So it is week 2 of my paediatric placement. Now I'm getting to know the doctors on the ward much better and they seem more keen to teach us. Even if they see something vaguely interesting, he or she will come and tell us to take a look. I was on-call on Wednesday and what a long day. Got in at 8:45am and didn't get home until 10pm. I was intending to leave at 8pm as I do have to drive back home as I do not stay in the hospital accommodation.  Day started off with a ward round (usual). Saw a few interesting patients, but nothing really out of the ordinary. Managed to see a Stevens-Johnson Syndrome. To be honest...it looks pretty horrible. Essentially Stevens Johnson is where you get really red eyes and blisters all around your mouth and oral mucosa. You can also get blisters elsewhere in your body...including your genitalia........yeah. Anyways it doesn't look pleasant and obviously the patient was in quite a bit of discomfort as he could not really eat any solid food. Then went to clinic after lunch where we saw pretty general stuff. Ear infections, constipation, diarrhoea, etc. Got to play with a few of the kids that came in/working on my "playing with children" skill.

I don't have any younger siblings so I personally am not really used to playing with young children. I am still quite apprehensive about playing with kids as I don't really know what to do with them. I mean I think I'm good at making faces as so far I have been able to make the kids laugh by making faces. In terms of toys....I try and just pick up whatever  I see and hand it to them...which they quickly put to the side/throw it to the side. Had a few quizzical looks from babies...which is quite adorable...and pretty funny. Sometimes they just look so confused even you get confused yourself! So clinic lasted for about 3 hours and I did get my bum grilled to a burnt toast by the consultant. Non-stop questions. I asked my consultant a question and he proceeded to ask my question back to me! I'm sure I gave him several blank looks. I'm alright with being put on the spot to answer questions, but it still gets my heart rate up. Luckily the consultant is very relaxed and nice so I knew he only asked to help me learn instead of trying to make me feel dumb....not like any consultant would have that sort of intention (sarcasm). Nice thing about being quizzed is that you do remember things much better. I did learn quite a few things.

Then the ward went dead. There was nothing to do. I literally was wandering around in circles looking for patients to talk to or something to do, but most of the patients I saw in the morning have been discharged. I sat around at the nurse's/doctor's station and swiveled in my chair. Then my registrar who is on-call with me...started getting several bleeps. Literally 5 patients walked in at the same time right after dinner. So I got to work clerking the patients in and helping the registrar out with some stuff. Did learn how to take blood from a baby. A pretty pain-staking process. You essentially prick the heel of the baby with a device and you let the blood drip out and catch it in the bottle....you can imagine this can take awhile depending on how fast the blood drips out/how cooperative the baby is.

As earlier stated...I was planning to leave at 8pm, but because suddenly all the patients decided to show up at the same time...I ended up getting held back. I didn't want to leave midway through clerking so I told myself I can leave after clerking and presenting the cases to the registrar. At around 9pm I was finally finished and made my way home. Got home...showered...and then passed out on my bed. And up again next day for 9am. As you can guess....I had a lot of difficulty waking up. Plus the prospect of needing to drive for about an hour was not helping. Either way....thankfully this week kind of picked up and I am starting to get much more teaching from the doctors and I'm starting to get along with the doctors. Starting to feel like I'm a part of the team. It's a nice feeling.

The Key is to be Proactive

Have been in placements for about 10 weeks now and I have had many ups and downs as you have read in my previous posts. After looking back at my placements, I've realized that my best experiences had been when I am being proactive. Being active in learning and stepping out from my consultant's shadow. In my first placement in the summer, I put a lot of effort into taking patient histories and doing loads of physical examinations (cardio, resp, and abdo). 2nd placement...did a lot of ward rounds - definitely seen a lot. For comparison sake - first placement I took about 10 patient histories and have done 4 cardiac exams, 3 respiratory exams, and 3 abdo exams. 2nd placement: 1 patient history, 1 shortened peripheral nerve exam. Poor showing in the 2nd placement. Yesterday, I did a group revision session on cardiac, resp, and abdo examinations. I knew how to do those examinations quite well and knew what I was looking for and can easily explain positive findings. The minute we got into neuro and musculoskeletal (MSK) exams...I died a little inside. I didn't know what was going on. Okay well MSK was easy to follow as I'm quite familiar with joints and those tests...but neuro was painful. I obviously didn't know how to do these exams as well as the cardio, resp, and abdo exams and it just felt horrible how lopsided my learning has been. Thinking back - it was because I was really proactive in my first placement. I had put a lot of effort into seeing patients and doing examinations. These last 2 placements - I've been...how should we put it...lazy.

You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.

Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!

Placement 2 - End of Week 2

Holy smokes what a crazy week. To be honest though there isn't much to talk about placement as I only went in 3 out of the 5 days. Well actually more like 2/5. On Monday I had my clinical skills assessment so I spent the whole day pooping myself and practising before my assessment. I was so nervous it was kind of ridiculous. I was nervous because I felt that I haven't had enough practice yet and there's just so much to think about whilst doing a clinical skill.

So it was finally my turn to do the assessment and thank goodness the assessors were REALLY nice. It was really informal and they told me that they don't expect me to be a pro at it and will guide me through each skill. Essentially I was tested on hand washing (easy), vital signs (BP, temperature, pulse, SpO2), venepuncture, cannulation, drug mixing, and finally setting up an IV drug. I didn't mind doing any of those EXCEPT for drug mixing and setting up an IV. I haven't done either of those skills since last year and I didn't get a chance to practice either of those skills prior to my assessment. I nearly started sweating bullets while doing those two skills but thankfully everything came back to me and I managed to pass all my clinical skills. That means I can officially do all of these clinical skills on real patients in the hospital as long as I am supervised.

Tuesday - standard - ward round and clinic. Clinic was really interesting. Saw 2 patients which some interesting case histories. Ward round...was a pain. Dr B was doing ward rounds which meant another grilling session. Also what I have realized is that he is PAINFULLY slow at doing ward rounds. Dr Y takes 3 hours to do a ward round....Dr B takes 4.5 hours and has the same amount of patients to go through. Anyways while Dr B was finishing writing notes in the patient's notes, my partner and I talked about the patient and the physical signs that we saw. Out of no where, Dr B turns around and snaps at us. He told us off for talking and said that if we keep getting distracted/aren't interested we can go to the library and do something else. My partner and I were like "....what?" We were confused because we were talking about the patient and what we saw, so we weren't distracted and obviously we are interested; hence why we were talking about the patient. Obviously Dr B was a bit grumpy today. The way he snapped at us really bugged us as it was uncalled for. So my partner and I had two choices: a) Piss him off more and just leave and go follow Dr Y or b) Bombard Dr B with loads of questions to show him we are interested and obviously to annoy him as much as possible. We chose to go with plan B and cue the waterfall of questions. We literally asked him about EVERYTHING. We looked at a patient's drug chart and asked Dr B about why he would prescribe these medications and why not alternatives. We started asking about the mechanisms of different drugs. I'm pretty sure Dr B got the idea that my partner and I were doing this on purpose and Dr B blazed through the rest of ward round. I guess that's one way of getting things done fast.

Wednesday - I didn't go to placement as I was helping out at the Medic's Fresher's Fair, which was quite tiring. Started setting up quite early and then had to wait for the fair to finish as I also have to help put away stuff. It was really nice meeting the new medics. Then I had an age crisis as some of these freshers look really young. I mean I saw some who barely even look 16 years old! It was crazy. We also got to showcase the Fresher's Video that we made. It turned out quite well and I think (hope) that the freshers enjoyed it.

Thursday was the usual, BUT Thursday night was the night of Medic's Fresher's Fever! I was really excited for it as there was going to be a hot tub and sand at the venue. In the end - I must say this was the best Fresher's Fever I have experienced. It had a really good vibe and for once all the Fresher's stayed til the end! The last two Fresher Fevers I went to, people left 2 hours into the party and essentially used the event as a pre-drink before going to another club. This time - people stayed all the way until the venue closed. I was so glad I got Friday off as there was no way I would've been able to go to placement. I got to get Friday off as there was another freshers event that I had to help out at: Buddy Scheme. That didn't start until 3pm....and I thought I would definitely be able to wake up for that. I ended up waking up at like 2:15pm and was literally running around my flat trying to get ready to get my butt out of the door. But yeah this week has been quite interesting. Highlight of the week must be Fresher's Fever. Yeah yeah I know I'm getting too old for it, but seriously it was amazing. Definitely a memorable night.