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!

Theatre Etiquette.

As promised I will discuss about surgical theatre etiquette. Theatre is a really good way to see anatomy and learn more about the management of certain conditions.  Again like the wards it's a really daunting place to be in. I actually found theatre a bit of a scary place as there's so much equipment in there, but once you have experienced it...it really isn't that bad. Your consultant finally invites you to go to theatre with him next day so here are some tips: Find the theatre list for the day you'll be going into theatre so you can get an idea what you'll be seeing - best place to go is the consultant's secretary. This will allow you to do a bit of reading up on relevant anatomy for the surgery. Also a great chance to read up on the condition that the surgery is treating. Most consultants like to ask questions during surgery so make sure you're ready. Nothing worse than being the student that seems like he/she didn't do any preparation whatsoever. Also theatre starts at different times so it is something you'll have to find out from the consultant/registrar/theatre staff/secretary. Make sure you turn up for the very beginning as this is when everyone introduces each other and go through a team briefing. So you get to the hospital - what do you do next?

Head on to theatre and sign in. Go get changed into scrubs and put on a theatre cap. Make sure you also change into theatre shoes which are usually clogs/the super fashionable crocs. Hopefully your hospital have some theatre shoes for you to borrow so make sure you ask at reception first. Take off all jewelery. At all times make sure your ID is visible. In general for theatre changing rooms it is best to bring your valuables with you or simply don't bring valuables to a theatre day. I always bring my money and my phone with me and depending on the hospital I also bring my bag with me to theatre as it's just a small messenger bag. Make sure you leave the bag in the prep room or ask theatre staff where you can put your bag.

So you get to the theatre and hopefully you'll know who is the consultant. Go introduce yourself or say "Hi". You'll be surprised how often they don't notice you even though you think they saw you. I guess sometimes they can't recognize you as you are in scrubs and have a theatre cap on. Get in on the team briefing and pay attention to the theatre list for the day. Also find out who is the anaesthetist. Ask the anaesthetist if you can observe the patient being put to sleep. It's quite interesting to watch.

Simple rules of theatre:

• Don't touch anything green/blue in the operating room especially on tables/trolleys
• If you're going to faint - don't faint on the patient - so go sit down - it happens to everyone
• When the surgeons are gowned up - don't make any contact with them as they are now sterile so that means good dodging skills and just stay out of their way until they have gotten to their place at the table

Usually there will be 3 people scrubbed in and working on the patient. It will usually be 1 consultant surgeon, 1 registrar, and 1 scrub nurse. It'll be fairly obvious who is who. Scrub nurse is the one who will be passing all the equipment to the surgeons. If it is open surgery (not laparoscopic) you'll probably need to get a pedestal to see over the shoulders of the surgeons but make sure you ask them first/let them know you're standing behind them so they don't bump into you...but obviously don't be right up behind them - give them some space to breathe and move around. If you wear a lanyard for your ID badge - then this would be a good time to tuck it into your shirt so it doesn't swing around.

If it is a laparoscopic surgery - there will be a tv screen for you to watch so you don't need to be standing as close to the surgeons. Just find a good spot to stand and for me, I never sit down as I think the theatre staff are more deserving of a chair than I am. 

The problem with surgeries is that it can range from 30 minutes to 8 hours. You'll find that your back and feet will be hating you during long surgeries. Also make sure when you're standing for a long time just to keep your legs moving so you don't faint. Sometimes with long procedures I will go take a walk around the operating room just to get my legs moving again and give my back a stretch. No matter how much you love surgery (and take it from me - I really do LOVE surgery) - it will get boring especially when you're not scrubbed in and just observing. If nothing interesting is happening go talk to the anaesthetist. Ask he/she about the machines and what they are doing. The thing with surgeries as well is finding the right time to ask questions. There will be times where the room goes dead quiet as the surgeons are concentrating - obviously horrible time to ask a question. You'll be able to tell when they don't need to focus as much as usually they'll start talking about really random things like plans for the weekend...you'll be surprised what sort of things surgeons talk about during surgery. Some surgeons even have music playing in the background so don't be shocked when you walk in and there is music playing. I think the best one was when I was waiting outside a day surgery theatre and the doors to the operating room opened and all you can hear was music blasting out...almost seemed like a night club in there!

Hopefully your consultant will be good at teaching and he'll show you the relevant anatomy IF it is easy to see. Not all the time the anatomy is easy to see, but don't be disappointed if you don't really see much. Most surgeries that I have observed - I usually don't see very much so don't think this is your fault. Especially now, surgeons are trying to make incisions smaller to reduce the recovery time...but again as long as your consultant knows he/she has a student around - most are quite good at moving over and letting you do a quick lean in to take a closer look - again make sure you don't touch the patient/surgeons.

When the surgery is done - go make yourself useful and help the theatre staff with moving the patient. Put on a pair of non-sterile gloves and grab hold of one side of the bed sheets (other than the head as the anaesthetist will be there). It'll be made clear which way the patient will be going and usually the clue is probably the empty bed right next to the operating bed with a slide board underneath. The anaesthetist will always count you down to moving so some will say "On 3" or "Ready Steady *Move/Shift*" - either way it'll be obvious.

If the previous surgery was long - you might want to stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Go make yourself a drink or get some water - staying hydrated is key for surgery. Sometimes it is quite frustrating as you could wait for an hour before the next surgery. I always hate coffee room breaks - not because I hate waiting around...it's because sometimes the consultant needs to quickly pop up to the ward and you're left alone in the coffee room. Just keep your eye on someone who is from your theatre as they tend to leave without telling you. Well based on personal experience - I always get left behind so I always got to stay near the registrar/consultant/theatre staff just so I wont miss the next surgery. Another way is before breaking off to the coffee room - ask a theatre staff how long a break do you have or what time does the next surgery start - then at least if you lose everyone - you'll still know what time to get back.

Hopefully this gives you a better idea what to expect when going to theatre for the first time. Hey maybe you'll be lucky and get to scrub in. But don't be disheartened if you don't scrub in as I didn't get to scrub in til this year (3rd year of medical school - been on surgical placements ever since 1st year). So just enjoy your time in theatre and hopefully you'll see lots of cool things. Also a great place to witness some good teamwork and communication skills as well. If you're unsure about anything just ask a theatre staff.

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!