Shocker - I'm back! Most of you probably thought I fell off the planet or medical school had simply killed me. Actually what had happened is that after my placements in May I had left for my medical elective for 2 months. I went back to Canada to do my medical elective in..........you guessed it: Orthopaedics. It was tough - and that's putting it lightly. I have not worked as hard as I had during my medical elective than any of my last 4 years at medical school. So once I got back I was seriously burnt out while my friends were burnt from their lovely sun filled elective in the beautiful/tropic parts of the world such as: Thailand, Vietnam, Fiji...I am feeling my blood pressure go up again. To put it in even more simple terms - I was miserable during my elective and very jealous of my friends who had a tropical and fun-filled elective to discover themselves.
Why was my elective so tough?
Well North American medical school will always have its stereotype to uphold. My mornings started at 6:30 am and my day didn't end until 6pm and that's me sneaking off early. Despite being a visiting elective student I was expected to still do 24 hour on-calls. Yes there were a few days especially in the first 2 weeks where I wanted to go and hide in a corner and cry. I've never been told off so much in medical school as much as I had during my first 4 week rotation. Apologies I have to leave out details as it will make me very easily identifiable if I start specifying EXACTLY what sub-specialty I was doing. I remember telling my parents several times I would quit. I nearly walked out of clinic many times. I walked out of the operating room once after being unfairly treated. This elective definitely pushed my limits to the max. When I reached my 2nd rotation of 4 weeks - I was back in my comfort zone. Let's say the first 4 weeks was a very steep learning curve and one I hope to never go through again. Looking back at it, I'm glad I got my ass-whipped as not only did I never work so hard before, but I have never learnt so much before in such a short amount of time. I had to gain A LOT of self-confidence and was pushed to the deep end of the pool during my elective and I'm glad the consultant pushed me that hard. I would have never learned...but with that, I sacrificed the enjoyment of the elective. I guess it's a fine balance.
When I returned to the UK I was just so burnt out. I didn't get much of a summer holiday. I was back to placements and well let's just say placement seemed extremely SLOW compared to Canada. I had a hard time adjusting back and consultants thought I was overly too proactive. It's a very different system here in the UK. In Canada I felt like I had to fight for my learning opportunities and I learned by falling flat on my face a million times. In the UK, we are spoon-fed our learning opportunities. There isn't a huge competition atmosphere in the UK. I was with other medical students in Canada and I found myself fighting to get to scrub in and fighting to see patients. As a student in the UK I feel like sometimes we take it for granted the amount of learning opportunities we get. Anyways there isn't much to talk about my elective. If I had to sum it up in one sentence it would go like this: Worked my ass off, but came out more mature and wiser and perhaps a hell lot more worn out. To be honest I still don't know what to think of my elective. Don't get me wrong, I was lucky to have got an elective in Canada in a major city in a very popular specialty, so I don't regret it at all.
Hopefully I'll start updating a bit more, however, final exams are coming up so I am a lot busier than usual now. Currently doing my General Practice rotation so who knows maybe I'll find time. Sorry again for the lack of updates...just had a rough few months.
Showing posts with label consultant. Show all posts
Showing posts with label consultant. Show all posts
Sunday, September 15, 2013
Friday, May 3, 2013
Urology - Week 1
Sorry for the lack of updates. The weird thing with this rotation is that I'm running through all the other specialities: ENT, Ophthalmology, Urology, Haematology, Dermatology, and Oncology. I only get either 1 or 2 weeks in each specialty. You can imagine I only get a quick glimpse of everything and so far nothing interesting has happened.
Because I am now on Urology and have got 2 weeks here, I thought it would be worth doing a bit of an update. So we were inducted into the specialty on the Monday and were pretty much scared stiff. The urology department at our hospital is an academic department as well so they have academic ward rounds and really encourage full participation from students. You will probably wonder: "So what's wrong with that? That's great isn't it?" Well yes, that's great as we get loads of teaching, but that means we got to work twice as hard as we are expected to do presentations. I don't mind working hard, it's just our presentations have to be a case study on an inaptient. With how our schedules are, we don't have much time on the wards as we are timetabled to be in clinics/theatre. We were also told that consultants expect us all to be prepared for clinics/theatre and expect us to do our reading beforehand.
Biggest heart sinker? On theatre days we are expected to go to Theatre Admissions Unit (TAU) at 7:30am to get a brief patient history for all the patients on the list and be prepared to tell the surgeon all about the patient in theatre. Don't get me wrong, I love going to theatre, I just don't enjoy this horrifically early wake-up. I've been quite lucky with not needing to go to TAU in prior placements as the consultants I have been placed with don't require me to go to TAU and talk to the patient ahead of time so I usually get to theatre at around 8:30am. Anyways so Tuesday was my theatre day and I was placed with the academic lead for Urology (perfect...). Being a bit scared, I obviously head to TAU at 7:30am and talked to the 2 patients who were on the theatre list. As I was finishing up the consultant shows up and was actually quite surprised to see me in TAU. I was then promptly quizzed about the 2 patients and about their procedures. Luckily I did a bit of reading before I saw the consultant so everything was fresh in my mind. Think I impressed him as I got the nod of approval and the brief grilling seized.
At theatre, I met with the registrar and was warned I will probably get a full grilling on anatomy and should do some reading while the consultant isn't around. Read up on the prostate and bladder, which wasn't too difficult. I've always remembered the general rule for surgery is to know the blood supply, lymph drainage, and nerve supply for that organ, and you'll be alright. 30 minutes into a cystectomy, the consultant asked me for the blood, lymph, and nerve supply for the bladder. Check. Check. And check. The greatest bit was when he looked over to me in awe and proceeded to go quiet until lunch time. Just going to dust my shoulders off now. Now here comes a curve-ball, I was then shown a muscle and was asked what it was. Thankfully due to my "love" for orthopaedics and hip/knee anatomy, I immediately recognized the muscle as the psoas. Then another dead pan from the consultant who then went quiet again. Then he asked about the path of the Obturator nerve and what it innervates. Easy as I've been quizzed on that before by an orthopaedic consultant for fun not too long ago. As I finished my answer, the consultant put his scissors down and remarked that he'll sign me off for the next 2 weeks. He seemed really impressed and well I obviously felt good for once and not like a complete idiot. I was quite lucky with the questions though as usually it is a hit or miss. Was a fairly good day!
Rest of the week was fairly...dull. Went to a haematuria/cystoscopy clinic and did a bit of ward work, where I found myself being the cannula/bloods monkey again. Was nice being able to put cannulas in again as it has been awhile since I've put one in and I was worried I would lose the skill, but looking at my 100% in one go rate on the ward, think I'm still alright! All in all - okay week. Not very stimulating. Not very interesting. Escaped presentation - think it was partly due to my "good play" in theatre. Hopefully next week will go just as well!
Because I am now on Urology and have got 2 weeks here, I thought it would be worth doing a bit of an update. So we were inducted into the specialty on the Monday and were pretty much scared stiff. The urology department at our hospital is an academic department as well so they have academic ward rounds and really encourage full participation from students. You will probably wonder: "So what's wrong with that? That's great isn't it?" Well yes, that's great as we get loads of teaching, but that means we got to work twice as hard as we are expected to do presentations. I don't mind working hard, it's just our presentations have to be a case study on an inaptient. With how our schedules are, we don't have much time on the wards as we are timetabled to be in clinics/theatre. We were also told that consultants expect us all to be prepared for clinics/theatre and expect us to do our reading beforehand.
Biggest heart sinker? On theatre days we are expected to go to Theatre Admissions Unit (TAU) at 7:30am to get a brief patient history for all the patients on the list and be prepared to tell the surgeon all about the patient in theatre. Don't get me wrong, I love going to theatre, I just don't enjoy this horrifically early wake-up. I've been quite lucky with not needing to go to TAU in prior placements as the consultants I have been placed with don't require me to go to TAU and talk to the patient ahead of time so I usually get to theatre at around 8:30am. Anyways so Tuesday was my theatre day and I was placed with the academic lead for Urology (perfect...). Being a bit scared, I obviously head to TAU at 7:30am and talked to the 2 patients who were on the theatre list. As I was finishing up the consultant shows up and was actually quite surprised to see me in TAU. I was then promptly quizzed about the 2 patients and about their procedures. Luckily I did a bit of reading before I saw the consultant so everything was fresh in my mind. Think I impressed him as I got the nod of approval and the brief grilling seized.
At theatre, I met with the registrar and was warned I will probably get a full grilling on anatomy and should do some reading while the consultant isn't around. Read up on the prostate and bladder, which wasn't too difficult. I've always remembered the general rule for surgery is to know the blood supply, lymph drainage, and nerve supply for that organ, and you'll be alright. 30 minutes into a cystectomy, the consultant asked me for the blood, lymph, and nerve supply for the bladder. Check. Check. And check. The greatest bit was when he looked over to me in awe and proceeded to go quiet until lunch time. Just going to dust my shoulders off now. Now here comes a curve-ball, I was then shown a muscle and was asked what it was. Thankfully due to my "love" for orthopaedics and hip/knee anatomy, I immediately recognized the muscle as the psoas. Then another dead pan from the consultant who then went quiet again. Then he asked about the path of the Obturator nerve and what it innervates. Easy as I've been quizzed on that before by an orthopaedic consultant for fun not too long ago. As I finished my answer, the consultant put his scissors down and remarked that he'll sign me off for the next 2 weeks. He seemed really impressed and well I obviously felt good for once and not like a complete idiot. I was quite lucky with the questions though as usually it is a hit or miss. Was a fairly good day!
Rest of the week was fairly...dull. Went to a haematuria/cystoscopy clinic and did a bit of ward work, where I found myself being the cannula/bloods monkey again. Was nice being able to put cannulas in again as it has been awhile since I've put one in and I was worried I would lose the skill, but looking at my 100% in one go rate on the ward, think I'm still alright! All in all - okay week. Not very stimulating. Not very interesting. Escaped presentation - think it was partly due to my "good play" in theatre. Hopefully next week will go just as well!
Saturday, February 16, 2013
Final Week - Anaesthetics
Wow these last 4 weeks have blown by. Like I've said in my last post, I've seen a great improvement in my practical skills and confidence in doing invasive procedures. It really is true: practice makes perfect!
Because I have made quite an effort to get my logbook signed off early, I took my final week in anaesthetics as a "flexible week". I had a sudden urge to go watch some orthopaedic surgery so I decided to go observe a list. As I walked into the orthopaedics theatre and asked the consultant if I could observe, I was then offered the opportunity to scrub in (which made me very happy). It was so good to be back in orthopaedics and scrubbed in. Geek moment: I was pretty excited while I was scrubbing in. It brought back the good memories I had from last year whilst on my Orthopaedics attachment. Last year, I only helped drape the patient once or twice as there was usually a registrar there, so I would stand back and watch. Let's just say draping a patient for Orthopaedics isn't the "easiest" thing when you're still quite new at it. Because there are plastic walls around the operating area, you really have to be aware of your surroundings to make sure you stay sterile. The draping is also quite the task itself as there are quite a few layers to put on and I will admit that it required a lot of concentration and focus for me to make sure I maintained sterility. When the draping was complete and I didn't screw up, I couldn't help but feel like this:
Anyways, we did an exchange of a total knee replacement. It was fairly straight forward and it was nice being able to assist. Just felt really good. The tasks I were doing were fairly simple, for example, suction, diathermy, etc, but you still feel like you're helping...in a way. At the end I got to do some suturing and close up the wound. Admittedly quite rusty, but after 2 dodgy stitches, I dusted off the cobwebs and got back into it. Of course, being a responsible person, I redid the 2 dodgy stitches (in case you were wondering...). The consultant checked my stitches over and I got the nod of approval and then tidied up. The surgery took about 1.5-2 hours, but it certainly felt much shorter. We took a lunch break and I bumped into my anaesthetic group mates. They noticed that I was looking quite happy and some of them know me quite well could guess immediately that I got to scrub in and assist in surgery. I then bumped into one of my good friends and even he asked why was I oddly happy. When I sat down for my lunch and did a bit of reflection - I really do think surgery is for me. It makes me happy and I really enjoy it. I mean I've seen a few exchange TKRs last year, and it just doesn't get old. Every case is different. We had another operation in the afternoon which was quite straight forward. By the end of the day, I was quite tired and my feet were sore, but I was happy. I felt like I had a productive day. I felt like I learned a lot. I was at the hospital since 8am and got off at 5pm. I would usually be craving to go home, but after the list, I wanted to follow-up with the patients in recovery/post-operative surgical unit. It was a really good day. Probably the happiest I have been on placement this year.
The next day was a huge contrast. I went back to anaesthetics and met up with the consultant anaesthetist at 7:45am. The first thing he told me was that he is too busy and that there won't be any opportunities for me to get any hands-on. He also told me to be prepared to stand to the side for the rest of the day. I couldn't help but get annoyed as I made the effort to come in at 7:45am, ready to learn, and then to be told that I won't get to do anything. I thought the consultant was maybe just over-exaggerating, but I quickly found out that he really did mean it when he said I will be standing to the side. I just stood in the anaesthetic room in one corner and watched everything....and proceeded to zone out. All I could think about was that it was a huge waste of time. Then 2nd case, same thing. I was just stood there. I even asked if I could help out and was promptly ignored. I made the decision that I could be more productive if I went home. By 12pm, I grabbed my bag and told the consultant that I'm going home. He wasn't too impressed that I was leaving early, which surprised me. I was not learning anything and he wasn't teaching. What was the point in me sticking around? I firmly told the consultant that I could be a lot more productive at home and complete some of my assignments. I was fed up and just left. In a way it was rude of me to do that, but at the same time, the consultant knew he was going to have a student around and if he doesn't want a student around, then say something to the administrators so he doesn't get assigned a student. Ridiculous.
Despite the sour ending to my week, at least there was a very high point in this placement, which was unfortunately not anaesthetics related. I'll just treat the orthopaedics day as a treat to myself for getting all my work done early. A few years back, I used to want to do anaesthetics, but this attachment has reaffirmed that it isn't for me. I can see why people would enjoy it, but I really do think I am more suited for surgery. I just enjoy being hands on and fixing things. I enjoy the theatre life, but not sat at the head of the table. My next placement is A&E for 4 weeks. Again, I am quite nervous as I have been placed in the main hospital, which is quite busy. I know what to expect, but I'm not sure if I'm ready for its quick pace. We'll see. I'm excited in a way. Plus more opportunities to work on my clinical skills!
Because I have made quite an effort to get my logbook signed off early, I took my final week in anaesthetics as a "flexible week". I had a sudden urge to go watch some orthopaedic surgery so I decided to go observe a list. As I walked into the orthopaedics theatre and asked the consultant if I could observe, I was then offered the opportunity to scrub in (which made me very happy). It was so good to be back in orthopaedics and scrubbed in. Geek moment: I was pretty excited while I was scrubbing in. It brought back the good memories I had from last year whilst on my Orthopaedics attachment. Last year, I only helped drape the patient once or twice as there was usually a registrar there, so I would stand back and watch. Let's just say draping a patient for Orthopaedics isn't the "easiest" thing when you're still quite new at it. Because there are plastic walls around the operating area, you really have to be aware of your surroundings to make sure you stay sterile. The draping is also quite the task itself as there are quite a few layers to put on and I will admit that it required a lot of concentration and focus for me to make sure I maintained sterility. When the draping was complete and I didn't screw up, I couldn't help but feel like this:
Anyways, we did an exchange of a total knee replacement. It was fairly straight forward and it was nice being able to assist. Just felt really good. The tasks I were doing were fairly simple, for example, suction, diathermy, etc, but you still feel like you're helping...in a way. At the end I got to do some suturing and close up the wound. Admittedly quite rusty, but after 2 dodgy stitches, I dusted off the cobwebs and got back into it. Of course, being a responsible person, I redid the 2 dodgy stitches (in case you were wondering...). The consultant checked my stitches over and I got the nod of approval and then tidied up. The surgery took about 1.5-2 hours, but it certainly felt much shorter. We took a lunch break and I bumped into my anaesthetic group mates. They noticed that I was looking quite happy and some of them know me quite well could guess immediately that I got to scrub in and assist in surgery. I then bumped into one of my good friends and even he asked why was I oddly happy. When I sat down for my lunch and did a bit of reflection - I really do think surgery is for me. It makes me happy and I really enjoy it. I mean I've seen a few exchange TKRs last year, and it just doesn't get old. Every case is different. We had another operation in the afternoon which was quite straight forward. By the end of the day, I was quite tired and my feet were sore, but I was happy. I felt like I had a productive day. I felt like I learned a lot. I was at the hospital since 8am and got off at 5pm. I would usually be craving to go home, but after the list, I wanted to follow-up with the patients in recovery/post-operative surgical unit. It was a really good day. Probably the happiest I have been on placement this year.
The next day was a huge contrast. I went back to anaesthetics and met up with the consultant anaesthetist at 7:45am. The first thing he told me was that he is too busy and that there won't be any opportunities for me to get any hands-on. He also told me to be prepared to stand to the side for the rest of the day. I couldn't help but get annoyed as I made the effort to come in at 7:45am, ready to learn, and then to be told that I won't get to do anything. I thought the consultant was maybe just over-exaggerating, but I quickly found out that he really did mean it when he said I will be standing to the side. I just stood in the anaesthetic room in one corner and watched everything....and proceeded to zone out. All I could think about was that it was a huge waste of time. Then 2nd case, same thing. I was just stood there. I even asked if I could help out and was promptly ignored. I made the decision that I could be more productive if I went home. By 12pm, I grabbed my bag and told the consultant that I'm going home. He wasn't too impressed that I was leaving early, which surprised me. I was not learning anything and he wasn't teaching. What was the point in me sticking around? I firmly told the consultant that I could be a lot more productive at home and complete some of my assignments. I was fed up and just left. In a way it was rude of me to do that, but at the same time, the consultant knew he was going to have a student around and if he doesn't want a student around, then say something to the administrators so he doesn't get assigned a student. Ridiculous.
Despite the sour ending to my week, at least there was a very high point in this placement, which was unfortunately not anaesthetics related. I'll just treat the orthopaedics day as a treat to myself for getting all my work done early. A few years back, I used to want to do anaesthetics, but this attachment has reaffirmed that it isn't for me. I can see why people would enjoy it, but I really do think I am more suited for surgery. I just enjoy being hands on and fixing things. I enjoy the theatre life, but not sat at the head of the table. My next placement is A&E for 4 weeks. Again, I am quite nervous as I have been placed in the main hospital, which is quite busy. I know what to expect, but I'm not sure if I'm ready for its quick pace. We'll see. I'm excited in a way. Plus more opportunities to work on my clinical skills!
Saturday, January 26, 2013
Week 1 - Anaesthetics.
Interesting week here in England. Had a snow storm the day before my first day of placement. A lot of my friends got a snow day, but I haven't heard from my hospital so I ended up leaving later than usual for the central hospital. Because of all the snow - it was actually a very pleasant drive as there were hardly any cars. What is usually a 30-40 minute drive, ended up taking me 10 minutes. I was thinking to myself that I was such a genius to drive as the roads were clear (bit slushy)...until I got to the hospital. The parking lot wasn't cleared and it was packed with snow/ice/slush. Made it a bit daunting to park my car. When I got out of my car, I stepped in about 2" of snow...well there goes my black shoes. Tippy toed my way into the hospital only to overhear people saying that there will be more snowfall in the afternoon. "Shit." was probably the only thing that came into my mind. And then I thought to myself: "How am I going to go home...what an idiot. Shouldn't have driven."
Anyways I made it for my induction and most of us managed to get in. A few people got snowed in as they live on a hill and couldn't make their way. We got our logbooks which has various skills that we need to be signed off on by the end of 4 weeks in anaesthetics/critical care. Such things include putting in cannulas, inserting a laryngeal mask airway (LMA), intubating, drawing up antibiotics, etc. I was quite motivated to get my logbook done as quickly as possible so I walked into the theatre I was assigned to - ready for action. I was then greeted by a consultant anaesthetist, who seemed a bit annoyed. I was quickly told to leave and come back in an hour. Almost felt like I smacked into a brick wall. It kind of threw me off and I got nervous again as the consultant didn't seem too friendly. I went to get some food and returned an hour later and was promptly told to go find a patient in the ward and get a patient history from him. In my head I was getting annoyed as I wanted to work on my logbook, not go and speak to patients. By the time I returned to theatre the consultant had relaxed and apologized to me for being a bit rude earlier. I really appreciated the apology and the consultant gave me a few tasks to do such as mixing and drawing up antibiotics. I was then taught how to insert a LMA and how to hold an oxygen mask to the patient's face. It was really good and exciting. I also got a lot of teaching about regional and local anaesthetics during surgery which was an added bonus. Because of the snowfall, some patients cancelled and we ended up having a short theatre list. I was out of the hospital by 3pm and luckily the snow had just stopped, so I made a run for it before my car gets snowed in. Thankfully made it home with my car (to the surprise of many). Also had the feeling of: "not so dumb after all!"
I would say I had a really good first day as I got a few things signed off and was ready to go for day 2. Unfortunately, it was a bit of a mess as there was teaching going on and the lists were starting later than usual (and I made the effort to go in for 8am when lists weren't starting until 11am). Then I realized that this is something everyone has to accept - as a student and as a doctor. Not everything will go to plan and you just need to adapt and find something productive to do. There were a few theatres running so I decided to go for a wander. Funny enough I ended up scrubbing in for a few procedures and assisting. Yay...but obviously deviating away from my placement goal: to learn anaesthetics! It was a nice bonus and certainly better than sitting in the coffee room for 3 hours. I at least did something productive and I felt like I was helpful. Later in the day I met up with a different anaesthetic consultant and I got a bit of teaching (not as much as I had hoped) and unfortunately did not get a single thing signed off. Great - here's hoping next day will be better. Next day...same thing. I tried to hint to another consultant anaesthetist that I would like to get involved as I had put on my gloves and stood at the top of the bed ready to lend a hand. Instead, I was ignored. I asked if I could insert a few cannulas and was told that it would be too difficult. By now, I had lost a lot of motivation and ended up just standing around for the whole day. I don't think this is really the anaesthetists fault as they are all very nice people and love teaching. I learned loads, it was just a bit more annoying that I couldn't do anything practical. Just another thing as a student you have to accept - sometimes you can't get in on everything. Unlike my group mates, I haven't been kicked out of theatres due to too many students. I've been lucky that I've still been able to stick around and observe and get some teaching. I've also been in orthopaedic theatres so the orthopaedic surgeons were also teaching me about their procedures, which I found really interesting. Essentially other than the first day, this was the story of my week. Just not getting any opportunities to do practical skills.
So I went home and thought what I can do about this as I have a log book that I need to complete. I think next week I will approach with a different mindset and make it clear first thing to the consultant that I am very keen on helping out and trying out some practical skills. Sometimes being subtle and polite doesn't work so I'll just have to be brazen and go for it. Fingers crossed that I will get to do a bit more next week!
Anyways I made it for my induction and most of us managed to get in. A few people got snowed in as they live on a hill and couldn't make their way. We got our logbooks which has various skills that we need to be signed off on by the end of 4 weeks in anaesthetics/critical care. Such things include putting in cannulas, inserting a laryngeal mask airway (LMA), intubating, drawing up antibiotics, etc. I was quite motivated to get my logbook done as quickly as possible so I walked into the theatre I was assigned to - ready for action. I was then greeted by a consultant anaesthetist, who seemed a bit annoyed. I was quickly told to leave and come back in an hour. Almost felt like I smacked into a brick wall. It kind of threw me off and I got nervous again as the consultant didn't seem too friendly. I went to get some food and returned an hour later and was promptly told to go find a patient in the ward and get a patient history from him. In my head I was getting annoyed as I wanted to work on my logbook, not go and speak to patients. By the time I returned to theatre the consultant had relaxed and apologized to me for being a bit rude earlier. I really appreciated the apology and the consultant gave me a few tasks to do such as mixing and drawing up antibiotics. I was then taught how to insert a LMA and how to hold an oxygen mask to the patient's face. It was really good and exciting. I also got a lot of teaching about regional and local anaesthetics during surgery which was an added bonus. Because of the snowfall, some patients cancelled and we ended up having a short theatre list. I was out of the hospital by 3pm and luckily the snow had just stopped, so I made a run for it before my car gets snowed in. Thankfully made it home with my car (to the surprise of many). Also had the feeling of: "not so dumb after all!"
I would say I had a really good first day as I got a few things signed off and was ready to go for day 2. Unfortunately, it was a bit of a mess as there was teaching going on and the lists were starting later than usual (and I made the effort to go in for 8am when lists weren't starting until 11am). Then I realized that this is something everyone has to accept - as a student and as a doctor. Not everything will go to plan and you just need to adapt and find something productive to do. There were a few theatres running so I decided to go for a wander. Funny enough I ended up scrubbing in for a few procedures and assisting. Yay...but obviously deviating away from my placement goal: to learn anaesthetics! It was a nice bonus and certainly better than sitting in the coffee room for 3 hours. I at least did something productive and I felt like I was helpful. Later in the day I met up with a different anaesthetic consultant and I got a bit of teaching (not as much as I had hoped) and unfortunately did not get a single thing signed off. Great - here's hoping next day will be better. Next day...same thing. I tried to hint to another consultant anaesthetist that I would like to get involved as I had put on my gloves and stood at the top of the bed ready to lend a hand. Instead, I was ignored. I asked if I could insert a few cannulas and was told that it would be too difficult. By now, I had lost a lot of motivation and ended up just standing around for the whole day. I don't think this is really the anaesthetists fault as they are all very nice people and love teaching. I learned loads, it was just a bit more annoying that I couldn't do anything practical. Just another thing as a student you have to accept - sometimes you can't get in on everything. Unlike my group mates, I haven't been kicked out of theatres due to too many students. I've been lucky that I've still been able to stick around and observe and get some teaching. I've also been in orthopaedic theatres so the orthopaedic surgeons were also teaching me about their procedures, which I found really interesting. Essentially other than the first day, this was the story of my week. Just not getting any opportunities to do practical skills.
So I went home and thought what I can do about this as I have a log book that I need to complete. I think next week I will approach with a different mindset and make it clear first thing to the consultant that I am very keen on helping out and trying out some practical skills. Sometimes being subtle and polite doesn't work so I'll just have to be brazen and go for it. Fingers crossed that I will get to do a bit more next week!
Saturday, December 29, 2012
A Memorable Year.
1 year ago today, I was thankful and nervous at the same time. Last year's exam was probably the largest hurdle of my degree. I didn't do as well as I had hoped in my exam, but still managed to pass. I was incredibly thankful to be able to pass as many of my friends had failed the exam. Some of which had to repeat the year. I made a promise to myself that the year 2012 will be my comeback year. I was determined to start on the right foot and to never make the same mistakes again.
This year zoomed by. I believe I made leaps and bounds in terms of knowledge and self-confidence whilst on the wards and in clinics. I still got to give lots of credit to my placement in Orthopaedics. I cannot be more thankful to my supervisor. Even my friends have noticed that after my Orthopaedics placement, I was a different medical student. I was no longer afraid to speak up. I was no longer afraid to participate and be proactive. I realized that if you don't ask, you will never know what will happen. The worst answer you can get when asking something is "No". What is there to lose...other than a hurt ego. So one tip for all of you is to be confident. Don't be afraid to ask for help. Again, the worst someone can say is "No". If the answer is "no", just shrug and move on and don't take it personally.
As you move through the degree, Medicine slowly dominates your life and you really got to make an effort to have a social life. As the months pass and you have some free time to reflect, you realize your friends start to drift away and it may get a bit lonely at times. Medicine needs a lot of dedication, but I cannot emphasize enough how important it is to relax and take some time out. Giving yourself a break does not necessarily mean you have to go take a vacation. Taking a break is different for everyone. It may involve going to do something you enjoy or meeting up with friends, or even just spending some time at home to relax and watch TV. I didn't realize how important it is to take a break until this year when I have finally experienced a whole year of clinical placements, one after another. Work - Life balance. I know many people in my year who are taking a year out to do a BMedSci next year, not because they want to do research, but because they have burnt out.
To top off my memorable year, just earlier today I received confirmation that I have been accepted to present a my research poster at a national conference. Really unexpected as it's quite competitive, so I'm absolutely chuffed. What a way to finish up the year!
In general, I have made many new friends, matured as a person, and gained valuable skills for the future - I think this has probably been one of my most memorable year of my medical degree. Despite the many ups and downs throughout the year, looking back - overall it has been a very good year.
Got to thank those who have made my year so memorable and those who made my experiences so much better. Cheers to 2012, bring on 2013!
This year zoomed by. I believe I made leaps and bounds in terms of knowledge and self-confidence whilst on the wards and in clinics. I still got to give lots of credit to my placement in Orthopaedics. I cannot be more thankful to my supervisor. Even my friends have noticed that after my Orthopaedics placement, I was a different medical student. I was no longer afraid to speak up. I was no longer afraid to participate and be proactive. I realized that if you don't ask, you will never know what will happen. The worst answer you can get when asking something is "No". What is there to lose...other than a hurt ego. So one tip for all of you is to be confident. Don't be afraid to ask for help. Again, the worst someone can say is "No". If the answer is "no", just shrug and move on and don't take it personally.
As you move through the degree, Medicine slowly dominates your life and you really got to make an effort to have a social life. As the months pass and you have some free time to reflect, you realize your friends start to drift away and it may get a bit lonely at times. Medicine needs a lot of dedication, but I cannot emphasize enough how important it is to relax and take some time out. Giving yourself a break does not necessarily mean you have to go take a vacation. Taking a break is different for everyone. It may involve going to do something you enjoy or meeting up with friends, or even just spending some time at home to relax and watch TV. I didn't realize how important it is to take a break until this year when I have finally experienced a whole year of clinical placements, one after another. Work - Life balance. I know many people in my year who are taking a year out to do a BMedSci next year, not because they want to do research, but because they have burnt out.
To top off my memorable year, just earlier today I received confirmation that I have been accepted to present a my research poster at a national conference. Really unexpected as it's quite competitive, so I'm absolutely chuffed. What a way to finish up the year!
In general, I have made many new friends, matured as a person, and gained valuable skills for the future - I think this has probably been one of my most memorable year of my medical degree. Despite the many ups and downs throughout the year, looking back - overall it has been a very good year.
Got to thank those who have made my year so memorable and those who made my experiences so much better. Cheers to 2012, bring on 2013!
Happy New Year!
Saturday, November 17, 2012
Revision Time Again.
So exams are in 3 weeks. Truthfully, I'm not as nervous about these exams as I was last year. Last year was a disaster. It was horrible. Actually those exams last year could be deemed scarring. Worst experience ever. I have been constantly telling myself that nothing can be worse than last year's exam. This year, it is fairly obvious what we need to know for our exams and it has been clearly laid out for us. I think what's making revision difficult is that we still need to go to placements. We only get 1 week of revision. Consultants expect us to be on the wards 9am - 5pm and by the time you get home, you're exhausted. On average, you're looking at around about 3 hours of revision time. I am finding it quite difficult to juggle and obviously have to adapt my revision style to my placement schedule. I am quite used to staying up quite late to revise as I work best at night. On top of that, I am on my Neurology placement, which is an examinable topic for our exams, so I'm trying to learn and revise while on placement. Swear my brain feels like it can explode as I'm trying to do so much all at the same time.
The neurology ward in general has been interesting. We have got various different cases ranging from stroke to epilepsy to multiple sclerosis. If I had this placement at any other time in the year, I would enjoy it a lot as there are so many examination signs to see and the patient histories are really educational. As I've mentioned above, the brain is focused on revising so any time I catch a break, I am heading to the library or a quiet room to revise instead of spending time on the wards. Because we don't have OSCEs this year, I'm not too bothered about seeing signs, but it is certainly affecting the experience I am having on the placement. It is quite annoying as I find neurology quite fascinating...and challenging, but certainly something that does not bore me. It makes you think and it makes you think laterally as well. Anyways I'm going to keep this post short as I have to hit the books. Exam season is tough. I cannot wait for this to be over and bring on the new year.
Work hard. Play harder.
The neurology ward in general has been interesting. We have got various different cases ranging from stroke to epilepsy to multiple sclerosis. If I had this placement at any other time in the year, I would enjoy it a lot as there are so many examination signs to see and the patient histories are really educational. As I've mentioned above, the brain is focused on revising so any time I catch a break, I am heading to the library or a quiet room to revise instead of spending time on the wards. Because we don't have OSCEs this year, I'm not too bothered about seeing signs, but it is certainly affecting the experience I am having on the placement. It is quite annoying as I find neurology quite fascinating...and challenging, but certainly something that does not bore me. It makes you think and it makes you think laterally as well. Anyways I'm going to keep this post short as I have to hit the books. Exam season is tough. I cannot wait for this to be over and bring on the new year.
Work hard. Play harder.
Friday, November 2, 2012
Another Step Forward.
I think a bit back I said I was working on an Orthopaedic project (since May). Today I had the chance to present my project in front of a group of orthopaedic surgeons across the region. It's nice to finally present something that you've been working so hard on, but I would be lying if I said I wasn't nervous. I was fairly confident a week ago when I was preparing my powerpoint though. My run-through with my supervisor went really well, but this was presenting in front of someone who I know. Presenting in front of a group of orthopaedic consultants is a whole other ball game. What I was most worried about were the questions at the end.
One thing about me is that I don't like over-rehearsing/practising my presentations as I like to improvise. I like to give relaxed presentations that can go any direction depending on how I feel as it shows confidence in your presentation/project. I know my project very...very well so this was a route I know I wanted to take, but a risky one as I haven't presented in over 2 years and certainly not in front of a group of consultants. But because I didn't want to make a fool out of myself, I thought it was a good idea to practice a bit more than usual so I rehearsed once a day starting on Monday. The one rule I have for myself is to never use cue cards or notes and this was definitely not going to change for this presentation. When I showed up at the meeting, I think the lead was a bit surprised by the fact all I had was my powerpoint and no notes/cue cards to run through while I wait for my turn. To be fair, I wanted to look like I was confident and at ease about my presentation, but actually I was completely bricking it inside. The night before I was "choking". Was confident until the night before and everything just fell apart. I was stuttering when I was running through and forgetting to talk about certain things as my slides contain very little info as I like to expand on my points.
Anyways it got to my turn and I told myself that one of my strong points are doing presentations and this is not anything different. I introduced my powerpoint and I went through my powerpoint like it was second nature. It was almost like I wasn't even consciously doing it. It felt really good! Then the dreaded part: question time. Surprisingly, the first question wasn't even a question. A consultant took the time to complement me so I was really chuffed about it. It definitely made me feel proud of myself and especially when I was the only medical student presenting amongst a bunch of registrars. At least it was some sort of confirmation that I didn't make myself look like a complete idiot, but the bail out sentence was always ready: "Sorry I am just only a medical student." The questions asked weren't too bad and it actually started a discussion amongst the audience about the thing I studied.
After doing this presentation it gave me an idea to make a post of tips for making presentations:
One thing about me is that I don't like over-rehearsing/practising my presentations as I like to improvise. I like to give relaxed presentations that can go any direction depending on how I feel as it shows confidence in your presentation/project. I know my project very...very well so this was a route I know I wanted to take, but a risky one as I haven't presented in over 2 years and certainly not in front of a group of consultants. But because I didn't want to make a fool out of myself, I thought it was a good idea to practice a bit more than usual so I rehearsed once a day starting on Monday. The one rule I have for myself is to never use cue cards or notes and this was definitely not going to change for this presentation. When I showed up at the meeting, I think the lead was a bit surprised by the fact all I had was my powerpoint and no notes/cue cards to run through while I wait for my turn. To be fair, I wanted to look like I was confident and at ease about my presentation, but actually I was completely bricking it inside. The night before I was "choking". Was confident until the night before and everything just fell apart. I was stuttering when I was running through and forgetting to talk about certain things as my slides contain very little info as I like to expand on my points.
Anyways it got to my turn and I told myself that one of my strong points are doing presentations and this is not anything different. I introduced my powerpoint and I went through my powerpoint like it was second nature. It was almost like I wasn't even consciously doing it. It felt really good! Then the dreaded part: question time. Surprisingly, the first question wasn't even a question. A consultant took the time to complement me so I was really chuffed about it. It definitely made me feel proud of myself and especially when I was the only medical student presenting amongst a bunch of registrars. At least it was some sort of confirmation that I didn't make myself look like a complete idiot, but the bail out sentence was always ready: "Sorry I am just only a medical student." The questions asked weren't too bad and it actually started a discussion amongst the audience about the thing I studied.
After doing this presentation it gave me an idea to make a post of tips for making presentations:
- Keep your powerpoint short and simple - maximum 4-5 points per slide - use these as cues for yourself and expand on these points
- Use images to make your slides/presentation look more interesting
- My personal rule is about 30-60 seconds per slide. 10 minute presentations = 10-15 slides. Any more slides, you could potentially end up speaking too quickly
- Practice your powerpoint without any cue cards or notes from day 1 - if you don't get into the habit of using cue cards...then you'll never need to rely on them
- If you're really unsure about your presentation, find a friend to practice in front of and ask he/she to give you feedback
- If you're nervous at the time of your presentation, pause for a second at the end of each slide to allow yourself to gather your thoughts for the next slide. The audience will think you're giving them time to read your slide so use the opportunity to calm yourself and gather yourself.
- Introduction is key - also an easy way to calm yourself as you'll never forget your own name!
- Always end your presentation with a summary slide as it's a nice way to round off the presentation
- Body language! Be aware of how you stand and what you're doing with your hands. If sitting, don't fidget/swivel in your chair. Standing and don't know what to do with your hands? Clasp them in front of you or try to use your hands to point to relevant images on your slide. Practice makes perfect for this. Avoid closed body positions such as crossing your arms across your chest and leaning against the wall. Don't want to look bored of your own presentation!
- Look around the room when talking. Don't have to make eye contact, but remember there's more than one person there so involve the room by looking around.
- And SMILE! Don't want to look grumpy about your own presentation!
Saturday, October 20, 2012
Care of the Elderly.
So I've started yet another placement (5 placements down, 2 more to go) and this placement is "Care of the Elderly". Out of coincidence and sheer luck I've been placed in Orthogeriatrics. Majority of the patients on the ward are patients who broke their hips (neck of femur (NOF) fracture (#)). Because this placement is only 2 weeks, it's a really quick taster and for me it's a bit of time to get my sanity back as I really enjoy orthopaedics so it's nice to just go back to something I'm quite familiar with.
Essentially I've got 10 days to learn and see everything I need to know to care for the elderly...great. Pretty rushed. And on top of that, get to know the staff on the ward which in general takes a bit of time to warm up to. First day - I met my consultant who is really nice so that was good news. The junior doctors are also really nice and chilled out as well and very understanding as they know we've got exams coming up so they aren't too bothered. They are also quite keen to get us involved in terms of helping them do jobs and getting involved in ward rounds (taking notes, looking at obs charts, drug card, etc.). To be honest, I've never been so involved on the ward...ever. It's also a bonus as I can get my clinical skills logbook signed off as I'm getting lots of opportunities to do clinical skills like venepuncture, cannulas, catheters, ABGs, etc. Really enjoying that and it's good practice. On top of that, I've been quizzed on osteoporosis and surgical management of NOF #s, but having done and attachment in orthopaedics (hips), for once I can actually answer questions with ease and confidence. It's actually quite a nice feeling to be able to answer questions...wish my knowledge was that sound with everything else in medicine...
Because I'm on Orthogeriatrics, the team works closely with the orthopods so we have to attend trauma meetings. Actually we don't have to attend trauma meetings (completely up to us as it starts quite early in the morning). I didn't get a chance to attend any trauma meetings during my attachment in orthopaedics, so I was quite keen to check them out as it does have a bit of a reputation. The benefit of having done my attachment in orthopaedics, is that the consultants recognize me so they don't question my presence in the meeting (students tend to avoid trauma meetings). In terms of education value - these meetings aren't great, but you get to hear about some interesting trauma cases that have been admitted...some fairly amusing and crazy stories as well. It's also a bit of a shooting gallery as well as consultants do "fire at will" if a trainee says something wrong or doesn't present a patient well. It's all a bit of a laugh/leg pulling, so it's fairly amusing at the expense of a junior doctor/SHO/registrar. Despite the earlier than usual wake up for placement, I don't mind attending. Again this is something I noticed in my orthopaedics attachment. I didn't struggle to wake up for placement during orthopaedics and was never late. I actually looked forward to going to placement - something to wake up to in the morning. If you follow my blog closely, I struggled quite a bit in GP and waking up was a huge struggle. Now in orthogeriatrics and early morning trauma meetings - I'm finding it easy to wake up again. Just feel like there's something to look forward to in the day. It's a nice breath of fresh air especially after two placements that were mediocre (well poor and mediocre).
I also quite like talking to the elderly as they've always got a great story to tell. One patient that stuck out for me this week was an 80 year old gentleman who was in for a left NOF #. He was a very talkative man and I met him the day before his discharge. He's gotten to know the staff on the wards quite well as he's been in hospital much longer than he should have been due to some complications. When the doctors were speaking to the man, he seemed like a genuinely funny and animated guy. He's obviously fed up with being in hospital and very much looking forward to leaving. He's apparently known to be getting quite critical with the doctors as he is sick of getting prescribed more and more medications as he stays longer and gives the juniors a bit of a tough time (in a joking manner though). After telling the patient he will be leaving the next day, and after quite a bit of joking around, he suddenly turned very thankful and grateful. He shook the doctors' hands and thanked each of them for taking care of him and "putting up" with him. It's quite nice to see as these days some patients don't give doctors enough credit and give doctors quite a tough time. It was a small gesture but it definitely put a smile on my face. It's nice to see the appreciation and I think the staff is happy to see him finally able to leave the hospital.
All in all, this week has been a great week, which is a good change as I've always had slow first weeks/things don't go my way in the first week. It's a good start to a very short placement and I'm getting along with the junior doctors so it's definitely making my placement a lot more enjoyable. It's also nice to see some familiar faces as well in the orthopaedics department. Even the secretaries are recognizing me as I've been popping around. Like one secretary said: "It's almost like you never left!". Funny enough it's actually been almost 4 months since my orthopaedics attachment (seems longer than that though!). It's been a good week and I've been getting some good news as well which I'll talk about at a later time.
Sorry for the long post - it just feels like it's been a long time since I've had a good time at placement and fairly happy. Dreading the fact it's only 2 weeks, but I think it's a good motivation booster - in time for exams. Happy reading!
Essentially I've got 10 days to learn and see everything I need to know to care for the elderly...great. Pretty rushed. And on top of that, get to know the staff on the ward which in general takes a bit of time to warm up to. First day - I met my consultant who is really nice so that was good news. The junior doctors are also really nice and chilled out as well and very understanding as they know we've got exams coming up so they aren't too bothered. They are also quite keen to get us involved in terms of helping them do jobs and getting involved in ward rounds (taking notes, looking at obs charts, drug card, etc.). To be honest, I've never been so involved on the ward...ever. It's also a bonus as I can get my clinical skills logbook signed off as I'm getting lots of opportunities to do clinical skills like venepuncture, cannulas, catheters, ABGs, etc. Really enjoying that and it's good practice. On top of that, I've been quizzed on osteoporosis and surgical management of NOF #s, but having done and attachment in orthopaedics (hips), for once I can actually answer questions with ease and confidence. It's actually quite a nice feeling to be able to answer questions...wish my knowledge was that sound with everything else in medicine...
Because I'm on Orthogeriatrics, the team works closely with the orthopods so we have to attend trauma meetings. Actually we don't have to attend trauma meetings (completely up to us as it starts quite early in the morning). I didn't get a chance to attend any trauma meetings during my attachment in orthopaedics, so I was quite keen to check them out as it does have a bit of a reputation. The benefit of having done my attachment in orthopaedics, is that the consultants recognize me so they don't question my presence in the meeting (students tend to avoid trauma meetings). In terms of education value - these meetings aren't great, but you get to hear about some interesting trauma cases that have been admitted...some fairly amusing and crazy stories as well. It's also a bit of a shooting gallery as well as consultants do "fire at will" if a trainee says something wrong or doesn't present a patient well. It's all a bit of a laugh/leg pulling, so it's fairly amusing at the expense of a junior doctor/SHO/registrar. Despite the earlier than usual wake up for placement, I don't mind attending. Again this is something I noticed in my orthopaedics attachment. I didn't struggle to wake up for placement during orthopaedics and was never late. I actually looked forward to going to placement - something to wake up to in the morning. If you follow my blog closely, I struggled quite a bit in GP and waking up was a huge struggle. Now in orthogeriatrics and early morning trauma meetings - I'm finding it easy to wake up again. Just feel like there's something to look forward to in the day. It's a nice breath of fresh air especially after two placements that were mediocre (well poor and mediocre).
I also quite like talking to the elderly as they've always got a great story to tell. One patient that stuck out for me this week was an 80 year old gentleman who was in for a left NOF #. He was a very talkative man and I met him the day before his discharge. He's gotten to know the staff on the wards quite well as he's been in hospital much longer than he should have been due to some complications. When the doctors were speaking to the man, he seemed like a genuinely funny and animated guy. He's obviously fed up with being in hospital and very much looking forward to leaving. He's apparently known to be getting quite critical with the doctors as he is sick of getting prescribed more and more medications as he stays longer and gives the juniors a bit of a tough time (in a joking manner though). After telling the patient he will be leaving the next day, and after quite a bit of joking around, he suddenly turned very thankful and grateful. He shook the doctors' hands and thanked each of them for taking care of him and "putting up" with him. It's quite nice to see as these days some patients don't give doctors enough credit and give doctors quite a tough time. It was a small gesture but it definitely put a smile on my face. It's nice to see the appreciation and I think the staff is happy to see him finally able to leave the hospital.
All in all, this week has been a great week, which is a good change as I've always had slow first weeks/things don't go my way in the first week. It's a good start to a very short placement and I'm getting along with the junior doctors so it's definitely making my placement a lot more enjoyable. It's also nice to see some familiar faces as well in the orthopaedics department. Even the secretaries are recognizing me as I've been popping around. Like one secretary said: "It's almost like you never left!". Funny enough it's actually been almost 4 months since my orthopaedics attachment (seems longer than that though!). It's been a good week and I've been getting some good news as well which I'll talk about at a later time.
Sorry for the long post - it just feels like it's been a long time since I've had a good time at placement and fairly happy. Dreading the fact it's only 2 weeks, but I think it's a good motivation booster - in time for exams. Happy reading!
Friday, September 7, 2012
Psychiatry - Slow Start.
I don't know why, but I'm quite prone to having slow starts on placements. So I've had my first week in psychiatry and to be honest...I've stepped onto the "wards" for about 5 minutes and then left. I don't know if I should be happy about the placement or a bit annoyed. We've got a lot of free time on the placement and seeing how exams are coming up - it gives us a great opportunity to revise. But at the same time...when I did go on the ward and ask if there's anyone I can see or anything I can do - the staff said that there's nothing to do here and told me to go get a cup of coffee. For the rest of the week - I spent my time in half-day clinics with my consultant. Luckily he is very chill and really good at teaching (if asked to teach). The nice bit is that there is a mutual understanding between the two of us. He has established that I do not want to do psychiatry and fairly indifferent about it. He said he will leave me alone BUT will teach if I have any questions or want any teaching. On top of that, he clearly listed out my learning objectives and what he does expect for me to have completed by the end of the attachment - which was pretty easy/fair. I know what my consultant expects and I don't see it being a struggle. He's also extremely nice which is a nice bonus.
I haven't really met any patients with full blown mental illness. All the patients I have seen were follow up patients who have their symptoms under control and doing fairly okay. Somehow due to my luck, I managed to miss the two new patients I was supposed to see in the week so I can see how patients present to the psychiatric team. For the first new patient, I only managed to stay for half the consultation as I had a doctor's appointment. Then in the next clinic, I ended up being 30 minutes late and missed the new patient as I got lost. Was really annoyed with it as apparently that patient was very interesting.
To be honest though, I don't mind this placement! I'm actually enjoying it as it is fairly easy and not very stressful. My schedule is very flexible and essentially to get good at psychiatry is to just speak to a lot of people (which I haven't exactly done as I'm having an extremely slow week). Despite having a slow week, I am learning a lot as everything is new so that's a bonus. So far all the consultants I've met are also very nice and chill, but they claim they should be chilled out as they know stress is a factor for suicide...
Hopefully next week will go a bit better and hopefully I'll be a bit more productive!
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!
Tuesday, June 19, 2012
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:
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.
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
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.
Monday, June 18, 2012
Ward Etiquette.
My last post was for non-medical students so here is one for medical students. Going onto the wards is quite an exciting thing if it is your first time, but there are a few "unwritten" rules that medical students should know about. Either you learn about em by hearing it from an upper year...or learn by experience (eg. being told off by a nurse). So I'll save some of you from any embarrassment/telling off by doing a quick post on ward etiquette.
Hopefully your medical school will make the hospital aware that you'll be coming to their department for your clinical attachment, BUT there will times where the ward/hospital will not be expecting you. First rule is to turn up to your placement ON TIME - even better: show up a bit earlier. Nothing more frustrating than expecting a student and them either not showing up or showing up late. It is important to leave a good impression. Nurses are quite good at passing on feedback to doctors/consultants. Last thing you want to be known is as a disrespectful student. These nurses can actually make your life very difficult.
Next must-do is to dress appropriately. You guys probably won't believe me but I have had colleagues who show up to placement in a hoodie. Yes it is cold outside, but before showing up on the ward where all the patients are...take off your hoodie and look presentable before you go into the ward/hospital. Some of the staff/patients won't know you have just arrived and no one wants to be seen by a poorly dressed student. I'm pretty sure if you were a patient, you wouldn't want to see a doctor who is in a hoodie/not looking presentable. I've also had friends who have been told to get off the ward because their shirts were not ironed. For girls, heard of female medical students getting kicked off the wards for showing too much cleavage and for short skirts. General rule is that if you bend over you shouldn't be able to see anything in the mirror. Skirts should be below the knees. I save myself from the hassle and wear trousers instead of skirts...plus it isn't very glorious when you're in a skirt and you have to help move a patient or lift things (which I do a lot of as I feel bad watching nurses struggle).
I will always remember this key point: "You will never get kicked out of medical school for not showing up to one day of placement, BUT you can get kicked out for showing up to placement hungover/drunk". If you had a night-out the day before and you're hungover/still drunk...take a sick day. The quote just stated...says it all.
Nothing frustrates me more than seeing my colleagues disrespect the staff. I'm usually quite a modest student, but I like to think I am quite successful with getting along with staff/consultants. My friends always ask me how I become so friendly with consultants/why doctors/staff treat me like a friend. Simple: Respect them first. It is quite annoying to see some students being very arrogant. I was on a placement with another student and he thinks he is the best thing to have graced the hospital. When a consultant asks him to get something...he goes and tells the nurse to get it for him. He treats the nurses like slaves and at the end of the day - you are just a medical student. I have stated it in many many posts that we are probably the LEAST important thing in the entire hospital. I have had a professor talk to us about "knowing our place in the hospital". You cannot go wrong by assuming that you are less important than the janitor. And ever since that day - I go onto the wards and respect every single member of staff. Nurses are your saving grace. If they like you - they will make your life so much easier. Best bit is that they sometimes remind you of things and bail you out if a consultant is being a bit "uncooperative/unfriendly". A way to show your respect to the nurses? Everyone loves a cup of tea. I have lost count the number of teas I have made for the nurses. In my last Obs and Gynae placement...I made 2 pots of tea for all the midwives every 2 hours. They made my life so easy and they passed on very good feedback to my supervisor as well.
When talking to patients - first ask the nurses if the patient is a good patient to talk to. Always introduce yourself before going to talk to the patient. Put yourself on the same level as the patient so go get a visitor chair and sit down. Don't sit on the patient's bed. When asking for the name of the patient always ask them how would they like to be addressed. Some of the more elderly patients usually would like to be addressed as Mr/Mrs, etc. Smile when you talk to the patient and just act professionally. When you leave - make sure you take your chair with you and put things back where you found them. I personally like to ask the patient if there's anything they would like me to get/do for them. It's the little things that makes a difference. Usually their tables are too far away or they need something to drink. If they want something to drink, make sure you ask a nurse first before fetching something just in case.
Finally - the most daunting bit: interacting with the consultant. Some like to make your life very difficult. I like to think it is because the consultant didn't want students and was forced to have them...or he/she is overly bored. My good friend said dealing with consultants is a skill on its own. I like to give myself 2 weeks to get a feel of what the consultant is like. Is he/she friendly? Is he/she talkative? Is he/she interested in teaching? One way to put yourself in the good books of a consultant is obviously the things I have listed above and just smile and be relaxed. Don't be arrogant. And DO NOT correct a consultant...no matter how tempting it is...it is a bad idea to correct a person who has been in the job for 20+ years. It is fairly embarrassing to get corrected by a student. Unless the care of the patient is at risk - I usually keep my mouth shut. If there is really any discrepancy - go look it up on the internet/textbook or ask the registrar/SHO. At the end of the day - the consultant is still a person. It's like dealing with teachers back at school. Yes they teach...but they still have a life. No one wants to talk about medicine 24/7. If you manage to figure out that the consultant is fairly relaxed - chat about regular stuff. People always find it amazing that 90% of my conversations with consultants are random banter. Make yourself enjoyable to be around. Put yourself in their shoes. Be considerate.
Anyways basic ward etiquette. Seems like common sense - but you will be surprised how many students forget about these basic things. Assume you are back in school and the medical staff are your teachers. Address them properly. Address the consultant by their last name unless they make it known that they want to be known by their first name. I have yet to call any of my consultants/supervisor by their first name. I tend to address registrars by their first name as that's how they introduce themselves to me. Can't go wrong by being polite and respectful. It is a pain but I think it is fair.
Hopefully your medical school will make the hospital aware that you'll be coming to their department for your clinical attachment, BUT there will times where the ward/hospital will not be expecting you. First rule is to turn up to your placement ON TIME - even better: show up a bit earlier. Nothing more frustrating than expecting a student and them either not showing up or showing up late. It is important to leave a good impression. Nurses are quite good at passing on feedback to doctors/consultants. Last thing you want to be known is as a disrespectful student. These nurses can actually make your life very difficult.
Next must-do is to dress appropriately. You guys probably won't believe me but I have had colleagues who show up to placement in a hoodie. Yes it is cold outside, but before showing up on the ward where all the patients are...take off your hoodie and look presentable before you go into the ward/hospital. Some of the staff/patients won't know you have just arrived and no one wants to be seen by a poorly dressed student. I'm pretty sure if you were a patient, you wouldn't want to see a doctor who is in a hoodie/not looking presentable. I've also had friends who have been told to get off the ward because their shirts were not ironed. For girls, heard of female medical students getting kicked off the wards for showing too much cleavage and for short skirts. General rule is that if you bend over you shouldn't be able to see anything in the mirror. Skirts should be below the knees. I save myself from the hassle and wear trousers instead of skirts...plus it isn't very glorious when you're in a skirt and you have to help move a patient or lift things (which I do a lot of as I feel bad watching nurses struggle).
I will always remember this key point: "You will never get kicked out of medical school for not showing up to one day of placement, BUT you can get kicked out for showing up to placement hungover/drunk". If you had a night-out the day before and you're hungover/still drunk...take a sick day. The quote just stated...says it all.
Nothing frustrates me more than seeing my colleagues disrespect the staff. I'm usually quite a modest student, but I like to think I am quite successful with getting along with staff/consultants. My friends always ask me how I become so friendly with consultants/why doctors/staff treat me like a friend. Simple: Respect them first. It is quite annoying to see some students being very arrogant. I was on a placement with another student and he thinks he is the best thing to have graced the hospital. When a consultant asks him to get something...he goes and tells the nurse to get it for him. He treats the nurses like slaves and at the end of the day - you are just a medical student. I have stated it in many many posts that we are probably the LEAST important thing in the entire hospital. I have had a professor talk to us about "knowing our place in the hospital". You cannot go wrong by assuming that you are less important than the janitor. And ever since that day - I go onto the wards and respect every single member of staff. Nurses are your saving grace. If they like you - they will make your life so much easier. Best bit is that they sometimes remind you of things and bail you out if a consultant is being a bit "uncooperative/unfriendly". A way to show your respect to the nurses? Everyone loves a cup of tea. I have lost count the number of teas I have made for the nurses. In my last Obs and Gynae placement...I made 2 pots of tea for all the midwives every 2 hours. They made my life so easy and they passed on very good feedback to my supervisor as well.
When talking to patients - first ask the nurses if the patient is a good patient to talk to. Always introduce yourself before going to talk to the patient. Put yourself on the same level as the patient so go get a visitor chair and sit down. Don't sit on the patient's bed. When asking for the name of the patient always ask them how would they like to be addressed. Some of the more elderly patients usually would like to be addressed as Mr/Mrs, etc. Smile when you talk to the patient and just act professionally. When you leave - make sure you take your chair with you and put things back where you found them. I personally like to ask the patient if there's anything they would like me to get/do for them. It's the little things that makes a difference. Usually their tables are too far away or they need something to drink. If they want something to drink, make sure you ask a nurse first before fetching something just in case.
Finally - the most daunting bit: interacting with the consultant. Some like to make your life very difficult. I like to think it is because the consultant didn't want students and was forced to have them...or he/she is overly bored. My good friend said dealing with consultants is a skill on its own. I like to give myself 2 weeks to get a feel of what the consultant is like. Is he/she friendly? Is he/she talkative? Is he/she interested in teaching? One way to put yourself in the good books of a consultant is obviously the things I have listed above and just smile and be relaxed. Don't be arrogant. And DO NOT correct a consultant...no matter how tempting it is...it is a bad idea to correct a person who has been in the job for 20+ years. It is fairly embarrassing to get corrected by a student. Unless the care of the patient is at risk - I usually keep my mouth shut. If there is really any discrepancy - go look it up on the internet/textbook or ask the registrar/SHO. At the end of the day - the consultant is still a person. It's like dealing with teachers back at school. Yes they teach...but they still have a life. No one wants to talk about medicine 24/7. If you manage to figure out that the consultant is fairly relaxed - chat about regular stuff. People always find it amazing that 90% of my conversations with consultants are random banter. Make yourself enjoyable to be around. Put yourself in their shoes. Be considerate.
Anyways basic ward etiquette. Seems like common sense - but you will be surprised how many students forget about these basic things. Assume you are back in school and the medical staff are your teachers. Address them properly. Address the consultant by their last name unless they make it known that they want to be known by their first name. I have yet to call any of my consultants/supervisor by their first name. I tend to address registrars by their first name as that's how they introduce themselves to me. Can't go wrong by being polite and respectful. It is a pain but I think it is fair.
Sunday, June 17, 2012
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:
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:
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!
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
- You get ignored
- Can't do very much (depends on the placement/consultant)
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
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!
Wednesday, May 23, 2012
Empathy.
Empathy is probably one of the most popular answers to medical interview questions such as "skills required to be a doctor." Empathy is essentially the skill to be able to feel another person's feelings. To be entirely honest...it seems like it is a skill that you LOSE, not gain as your career progresses. As a medical student, I treat the patients with a lot of respect and take the time to listen to them and try to empathize and sympathize with them. It is definitely not an easy task. There are countless amount of times where I found myself fake sympathizing/empathizing with patients as I sometimes find it very difficult to place myself in his or her shoes. And some of you may think why you "lose" your empathy skill as you progress through your career. Obviously this is a generalization and there are definitely lots of consultants out there who are really good at empathizing with patients; however, there are some where you start questioning their bedside manners.
I really don't blame the consultants for not empathizing with patients. After doing your job for 30-something years, you might not be as interested in it as you were 30 years ago. Some consultants have extremely busy schedules and it is a shame they don't take the time to empathize with patients. With an aging population, we now see a lot of elderly patients on the wards with chronic conditions. These patients might be in for their 10th surgery on their hip, for example. Sometimes it is unfortunate that surgeons/doctors don't acknowledge these things. Yeah you need to fix a patient's hip, but after having so many surgeries, it is obviously going to affect the patient psychologically and socially. I know there are some doctors who believe in holistic medicine. These doctors would tend to all the needs of the patient: psychological, physical, and social. I feel like the patients who have these sort of doctors feel like they are cared for and sometimes I guess it is pretty frustrating to be tossed between 5 different teams in a hospital as consultants won't know you as well.
Then we start to asking the question: are doctors too specialized? I mean just under orthopaedics, we've got consultants who specialize in only hip replacements, or hand surgery, etc. With such specialized doctors, we start to realize that these doctors start to lose knowledge about other systems in the body. In hospital for hip replacement but have a breathing problem so the orthopod has to refer you to the respiratory team. Are we becoming too one dimensional? It's definitely a tough argument. By having such specialized doctors/surgeons, we get people who are excellent at their field. If we have a bunch of doctors who knows a bit of everything...well we get doctors who are just good at everything and not excellent in anything. It's a tough argument, but to be honest, I would much prefer having a very specialized doctor as I would know for sure that he or she is fantastic at treating a certain condition or performing certain surgical procedures. If my life is at risks...I would obviously want the best and only the best.
Hmm...think I got a bit off topic there. Anyways empathy. It is a shame that some doctors lose this skill and overlook a patient's social/psychological well-being. But like I said earlier...I really don't blame them. I hope I will still be good at empathizing with patients 30 years down the line, but I know it will be something I will have to keep reminding myself to do. What's the point of being rude to patients? You gain nothing. Might as well be nice and listen to them and make their stay at the hospital better. Easy to say...hard to do.
I really don't blame the consultants for not empathizing with patients. After doing your job for 30-something years, you might not be as interested in it as you were 30 years ago. Some consultants have extremely busy schedules and it is a shame they don't take the time to empathize with patients. With an aging population, we now see a lot of elderly patients on the wards with chronic conditions. These patients might be in for their 10th surgery on their hip, for example. Sometimes it is unfortunate that surgeons/doctors don't acknowledge these things. Yeah you need to fix a patient's hip, but after having so many surgeries, it is obviously going to affect the patient psychologically and socially. I know there are some doctors who believe in holistic medicine. These doctors would tend to all the needs of the patient: psychological, physical, and social. I feel like the patients who have these sort of doctors feel like they are cared for and sometimes I guess it is pretty frustrating to be tossed between 5 different teams in a hospital as consultants won't know you as well.
Then we start to asking the question: are doctors too specialized? I mean just under orthopaedics, we've got consultants who specialize in only hip replacements, or hand surgery, etc. With such specialized doctors, we start to realize that these doctors start to lose knowledge about other systems in the body. In hospital for hip replacement but have a breathing problem so the orthopod has to refer you to the respiratory team. Are we becoming too one dimensional? It's definitely a tough argument. By having such specialized doctors/surgeons, we get people who are excellent at their field. If we have a bunch of doctors who knows a bit of everything...well we get doctors who are just good at everything and not excellent in anything. It's a tough argument, but to be honest, I would much prefer having a very specialized doctor as I would know for sure that he or she is fantastic at treating a certain condition or performing certain surgical procedures. If my life is at risks...I would obviously want the best and only the best.
Hmm...think I got a bit off topic there. Anyways empathy. It is a shame that some doctors lose this skill and overlook a patient's social/psychological well-being. But like I said earlier...I really don't blame them. I hope I will still be good at empathizing with patients 30 years down the line, but I know it will be something I will have to keep reminding myself to do. What's the point of being rude to patients? You gain nothing. Might as well be nice and listen to them and make their stay at the hospital better. Easy to say...hard to do.
Tuesday, November 1, 2011
Late Again!
I left my flat really early today to make sure I would show up on time to meet my new consultant. Obviously turning up on time is going to be my new enemy for this placement. Despite leaving my flat much earlier, I still ended up being 5 minutes late and the new consultant started his ward round right at 9am. I can't wait until the roads are reopened so I don't have to deal with the nightmare traffic I had to endure for these 2 days. However, I was quite lucky as this new consultant is really nice. He assumed I was late because I had some teaching earlier and was running a bit late. He greeted me and introduced himself and made sure I felt part of the team. It was definitely a nice thing for him to do and I do admit I felt bad for being late.
Anyways saw a new patient today who was moved from another ward. Found myself sympathizing with this patient as he had a metastatic tumour in his brain. He had undergone chemotherapy and radiotherapy, but is now placed for palliative care as it is an advanced tumour. Met the family today and you see the family trying to be strong and keep their chin up, but in the end the wife broke down. Felt quite useless as a student as no matter what you say - it isn't going to change the situation.
What confuses me the most about this placement is that I am placed in Endocrinology but majority of the patients don't have an endocrine related illness. Most of the patients I've seen have chest infections/pneumonia. It's quite weird. I only saw 1 patient today who had an endocrine related illness (Cushing's). I guess endocrinology is quite flexible? Will definitely have to ask one of the SHOs or FY1/2 doctors about this.
Anyways saw a new patient today who was moved from another ward. Found myself sympathizing with this patient as he had a metastatic tumour in his brain. He had undergone chemotherapy and radiotherapy, but is now placed for palliative care as it is an advanced tumour. Met the family today and you see the family trying to be strong and keep their chin up, but in the end the wife broke down. Felt quite useless as a student as no matter what you say - it isn't going to change the situation.
What confuses me the most about this placement is that I am placed in Endocrinology but majority of the patients don't have an endocrine related illness. Most of the patients I've seen have chest infections/pneumonia. It's quite weird. I only saw 1 patient today who had an endocrine related illness (Cushing's). I guess endocrinology is quite flexible? Will definitely have to ask one of the SHOs or FY1/2 doctors about this.
Saturday, October 29, 2011
End of Placement 3.
What a placement. It actually went by a lot faster than I thought it would as I hated my first week of placements. In the end, it wasn't too bad. Definitely found out colorectal surgery is not for me. I can never seem to orientate myself in theatre especially during laparoscopic procedures. Everything looks the same! Just bowels here and there. Clinics were alright - completely understand why consultants hate it though. It's usually the same old things - over and over again. Only been to 2.5 clinics - and to be fair - it was starting to get repetitive and boring. I must admit, I am a bit embarrassed by the fact that I only turned up to ward rounds ONCE in the entire 4 weeks of placement. Oops. 7:30am ward rounds are too early - Note to self: don't get admitted as a patient to a hospital with 7:30am ward rounds - no wonder most of the patients we saw on ward round were cranky. You're ill/in pain and you're tired - 7:30 am a team of 5+ doctors (have seen teams of 10) crowd around your bed - doctor takes a feel/ask a few questions and then disappear. As a patient, that would really tick me off, but then again I'm not the most cheerful person in the morning.
What else have I learned on this placement? As previously mentioned in an earlier post - common sense takes you a long way. Oh and some consultants are actually human and love to talk about other stuff other than medicine. And again especially at busy hospitals - medical students are probably the least important things in the hospital - be prepared to get ignored/no one caring about you. That's reality and you just have to be proactive and be responsible for your own learning.
Next placement will be in endocrinology. Don't know what to expect; however, I don't even think I will have time to go into placement as exams are around the corner (December). Need to really study and start focusing. Can't tell you how stressed I am - it's mental. Like most students - I hate revising. The only thing that keeps me going is the future. I keep telling myself that once these exams are over I can slack off again and it'll be a year before my next exam. Can't wait as we just had our year-end exams in May - so it's only been 6ish months. The thought of 2nd year exams/revision still scares me - it was tough/a nightmare. At least this year's December exam will be more clinical (what I like) and not as science based. Still a bit lost as to what to study. Just hoping the best and hoping that I'm studying the right material as this year - we've hardly had any guidance. Eep.
What else have I learned on this placement? As previously mentioned in an earlier post - common sense takes you a long way. Oh and some consultants are actually human and love to talk about other stuff other than medicine. And again especially at busy hospitals - medical students are probably the least important things in the hospital - be prepared to get ignored/no one caring about you. That's reality and you just have to be proactive and be responsible for your own learning.
Next placement will be in endocrinology. Don't know what to expect; however, I don't even think I will have time to go into placement as exams are around the corner (December). Need to really study and start focusing. Can't tell you how stressed I am - it's mental. Like most students - I hate revising. The only thing that keeps me going is the future. I keep telling myself that once these exams are over I can slack off again and it'll be a year before my next exam. Can't wait as we just had our year-end exams in May - so it's only been 6ish months. The thought of 2nd year exams/revision still scares me - it was tough/a nightmare. At least this year's December exam will be more clinical (what I like) and not as science based. Still a bit lost as to what to study. Just hoping the best and hoping that I'm studying the right material as this year - we've hardly had any guidance. Eep.
Saturday, October 22, 2011
Common Sense.
On tuesday at clinic my consultant looked me in the eyes and told me: "No matter how smart you are, in order to be a successful doctor, you must have common sense." Since then, I can't stop thinking about what he said.
So I've started revision for my December exams and as I'm studying up on management and treatments of conditions, "common sense" suddenly pops up. I realized I can know nothing about the disease, but if I know the symptoms from a history and use common sense - I can figure out how to manage a patient and treat. What my consultant told me on tuesday was really starting to click.
Clinical years of medicine is all about logic and common sense. A person can study all they want and flip through every textbook and know everything, but without common sense: they won't know how to apply their knowledge. It's all about going back to basics. Picking out key bits in a patient history and focusing on it. Unfortunately, in pre-clinical years of medical school - students tend to forget what is common sense. 2 years of pre-clinical almost trains your brain to just retain information and splurge at exams. Because questions in exams are structured in such a detailed manner such as where cells of something is asked - common sense can't really be used. It's either you know the answer or you don't. It's that straight forward. Now in clinical years, you can work your way through a history and physical examination. It's really difficult to describe but in high pressure situations, you got to stop, relax, and think. Think basic and work through all the clues and start piecing the puzzle. Lots of people have the tendency to just jump to the most ridiculous diagnosis as they panic and don't think how one symptom can lead to a sign.
It sounds easy, but as a medical student it is difficult to remember to just use common sense. 2 years of pre-clinical medical sciences in our brains - we can't help but panic and just dig/try to remember information/answers that we crammed for exams. There were times where I would get put on the spot with a question and I would panic. My consultant had told me off a few times for blanking out as all I need to do is just stop trying to dig for an answer but instead work it out. I guess the closest thing I can relate it to is that in maths we learned 2 + 2 = 4. By now we've all memorized it - don't put any thought into it whatsoever. It's kinda like that in medicine. We see 2 + 2 = 4 (symptom + symptom = disease x) - easy. Sometimes we don't know the answer so when we get 1238 + 236, we will panic. Our brains will go "I haven't memorized this!". Instead break it down and try and link them together to come to your answer.
Anyways I hope that made sense. But only now, after 2.5 years - it has clicked. Medicine is all about common sense. We can't memorize everything. At the end of the day we'll need to use our brain to solve/work out things. It won't all be 2 + 2. But as we encounter more problems, we learn more. The beauty of medicine - never ending knowledge.
So I've started revision for my December exams and as I'm studying up on management and treatments of conditions, "common sense" suddenly pops up. I realized I can know nothing about the disease, but if I know the symptoms from a history and use common sense - I can figure out how to manage a patient and treat. What my consultant told me on tuesday was really starting to click.
Clinical years of medicine is all about logic and common sense. A person can study all they want and flip through every textbook and know everything, but without common sense: they won't know how to apply their knowledge. It's all about going back to basics. Picking out key bits in a patient history and focusing on it. Unfortunately, in pre-clinical years of medical school - students tend to forget what is common sense. 2 years of pre-clinical almost trains your brain to just retain information and splurge at exams. Because questions in exams are structured in such a detailed manner such as where cells of something is asked - common sense can't really be used. It's either you know the answer or you don't. It's that straight forward. Now in clinical years, you can work your way through a history and physical examination. It's really difficult to describe but in high pressure situations, you got to stop, relax, and think. Think basic and work through all the clues and start piecing the puzzle. Lots of people have the tendency to just jump to the most ridiculous diagnosis as they panic and don't think how one symptom can lead to a sign.
It sounds easy, but as a medical student it is difficult to remember to just use common sense. 2 years of pre-clinical medical sciences in our brains - we can't help but panic and just dig/try to remember information/answers that we crammed for exams. There were times where I would get put on the spot with a question and I would panic. My consultant had told me off a few times for blanking out as all I need to do is just stop trying to dig for an answer but instead work it out. I guess the closest thing I can relate it to is that in maths we learned 2 + 2 = 4. By now we've all memorized it - don't put any thought into it whatsoever. It's kinda like that in medicine. We see 2 + 2 = 4 (symptom + symptom = disease x) - easy. Sometimes we don't know the answer so when we get 1238 + 236, we will panic. Our brains will go "I haven't memorized this!". Instead break it down and try and link them together to come to your answer.
Anyways I hope that made sense. But only now, after 2.5 years - it has clicked. Medicine is all about common sense. We can't memorize everything. At the end of the day we'll need to use our brain to solve/work out things. It won't all be 2 + 2. But as we encounter more problems, we learn more. The beauty of medicine - never ending knowledge.
Saturday, October 15, 2011
Placement 3 - Week 2
Pretty straight forward week...well except for Wednesday. I had to wake up early to attend a whole day of theatre. Saw a TEMS procedure to remove an early cancer in the rectum. Also got to do my first PR on a patient...which I was trying to avoid like no tomorrow. It isn't exactly the most pleasant thing to do. I mean I got to feel the cancer which was quite small. But yeah...really didn't enjoy doing the PR. At least the patient was asleep though (as it was right before the start of the operation). Finished the TEMS procedure quite quickly and then we found out that the next patient will be late coming down to theatre. So I had a bit of a dilemma because I had a meeting to go to at 12pm to meet another consultant. Essentially when it was time to do the next operation, I had to leave for my meeting. Grreatt...I was kinda excited for it as it was an APER procedure to remove a late rectal cancer.
If I remember correctly, this involves the removal of the sigmoid colon and the entire rectum. The surgery is done in two parts - first part is to do key hole surgery in the abdomen to separate the sigmoid colon from the rest of the colon. The second part is to turn the patient over into a prone position to remove the sigmoid colon and rectum. Sounds pretty interesting right...so I was pretty bummed out that I had to miss a bit of it.
Anyways rushed to meet another consultant only to find out he was late. I sat outside his office and ended up falling asleep in the chair. Next thing I know, the consultant comes out to meet me and I was snoozing with my phone in one hand. Awkward. He said my name and the first thing that went through my mind was the synonym of crap. Opened my eyes and saw a really confused consultant. Mind you I have never met this consultant before..so great first impression. Had a really great chat though and it was really relaxed. I was pooping myself (before I fell asleep) as I wasn't sure if this consultant was going to be mean or super serious. By the end of the meeting I didn't even know why I was so nervous. It turned out fine and I managed to sort some things out for next year (that's for another blog entry later in the year). I was really happy with how the meeting went and quickly went back to theatre to watch the APER.
Apparently I didn't miss too much of the APER but I did miss the chance to scrub-in. I also realized my consultant has some pretty dodgy camera skills as the abdomen bit of the procedure was laparoscopic. There were times where he would shake the camera so much, everyone would start feeling a bit sick. Oh well. After the first part, we took a 5ish minute break and then went on to the second bit. I must say...this bit was a lot more gruesome than I imagined it to be. Incisions were made around the anus and you would keep cutting in to access the rectum. Because the colon has been separated, all the surgeons had to do was remove the sigmoid colon and rectum and close up the anus. One of the incisions went too deep and there was quite a lot of blood. At one point blood spurted out and luckily I dodged just in time as I was right in its path. My consultant was really on the ball though and quickly stopped the bleed and we continued on with the procedure. Removed the sigmoid colon and rectum (which was quite a large specimen). Unfortunately, I had to leave early from the surgery so I missed the part where they closed everything up. Either way it was a really interesting operation to watch and I enjoyed it quite a bit.
Thursday - day-case surgery. Not going ever again. It was pretty boring as we just did a bunch of procedures to fix anal fissures/fistulas/etc. I didn't really enjoy it and my consultant did pretty much no teaching either. I was pretty excited to just go home and get ready for the epic Medics Fancy Dress Pub Crawl. Obviously that meant I couldn't go into placement on Friday. The registrar told me to go to clinic on Friday morning and I told her "I don't think I'll make it." She gave me a really confused face and I just smiled and laughed nervously. My consultant picked up on my nervous laugh and he was really cool about it and was like "Yeah....clinic will be boring so just sleep in and I'll see you next week *wink*" The registrar was pretty clueless. Pretty sure everyone else got the gist of what I was saying, except for her. I guess she would find out if she ventured out to city centre that night. Haha.
Anyways pretty slack and uneventful week. Wednesday was definitely the highlight of my week though.
If I remember correctly, this involves the removal of the sigmoid colon and the entire rectum. The surgery is done in two parts - first part is to do key hole surgery in the abdomen to separate the sigmoid colon from the rest of the colon. The second part is to turn the patient over into a prone position to remove the sigmoid colon and rectum. Sounds pretty interesting right...so I was pretty bummed out that I had to miss a bit of it.
Anyways rushed to meet another consultant only to find out he was late. I sat outside his office and ended up falling asleep in the chair. Next thing I know, the consultant comes out to meet me and I was snoozing with my phone in one hand. Awkward. He said my name and the first thing that went through my mind was the synonym of crap. Opened my eyes and saw a really confused consultant. Mind you I have never met this consultant before..so great first impression. Had a really great chat though and it was really relaxed. I was pooping myself (before I fell asleep) as I wasn't sure if this consultant was going to be mean or super serious. By the end of the meeting I didn't even know why I was so nervous. It turned out fine and I managed to sort some things out for next year (that's for another blog entry later in the year). I was really happy with how the meeting went and quickly went back to theatre to watch the APER.
Apparently I didn't miss too much of the APER but I did miss the chance to scrub-in. I also realized my consultant has some pretty dodgy camera skills as the abdomen bit of the procedure was laparoscopic. There were times where he would shake the camera so much, everyone would start feeling a bit sick. Oh well. After the first part, we took a 5ish minute break and then went on to the second bit. I must say...this bit was a lot more gruesome than I imagined it to be. Incisions were made around the anus and you would keep cutting in to access the rectum. Because the colon has been separated, all the surgeons had to do was remove the sigmoid colon and rectum and close up the anus. One of the incisions went too deep and there was quite a lot of blood. At one point blood spurted out and luckily I dodged just in time as I was right in its path. My consultant was really on the ball though and quickly stopped the bleed and we continued on with the procedure. Removed the sigmoid colon and rectum (which was quite a large specimen). Unfortunately, I had to leave early from the surgery so I missed the part where they closed everything up. Either way it was a really interesting operation to watch and I enjoyed it quite a bit.
Thursday - day-case surgery. Not going ever again. It was pretty boring as we just did a bunch of procedures to fix anal fissures/fistulas/etc. I didn't really enjoy it and my consultant did pretty much no teaching either. I was pretty excited to just go home and get ready for the epic Medics Fancy Dress Pub Crawl. Obviously that meant I couldn't go into placement on Friday. The registrar told me to go to clinic on Friday morning and I told her "I don't think I'll make it." She gave me a really confused face and I just smiled and laughed nervously. My consultant picked up on my nervous laugh and he was really cool about it and was like "Yeah....clinic will be boring so just sleep in and I'll see you next week *wink*" The registrar was pretty clueless. Pretty sure everyone else got the gist of what I was saying, except for her. I guess she would find out if she ventured out to city centre that night. Haha.
Anyways pretty slack and uneventful week. Wednesday was definitely the highlight of my week though.
Thursday, September 29, 2011
End of Placement 2.
...where did my 3 weeks go?!
Seriously. These last 3 weeks actually blew by. Crazy. Couldn't believe that today was my last day on my placement in the peripheral hospital. Next week I will be back in the local teaching hospitals so I guess YAY no more 45-50 minute drives! Thinking back - I quite enjoyed my placement in the peripheral hospital. There were only 20 medical students at the hospital so the doctors were all really keen to teach and the staff were all very friendly. If only the hospital wasn't so far away. I've been hearing stories how the local teaching hospitals are absolutely packed with students; hence, patients are pretty annoyed with us and the consultants don't have time to teach.
Anyways this week has been really good. Did the standard ward rounds and finished up my first essay assignment that I handed in today. Got loads of teaching from Dr Y so that was really good. Saw some pretty interesting physical signs this week. Saw really marked dyskinesia in a patient with Parkinsons Disease. Today we saw a really interesting case. Patient presented to hospital with left sided weakness as well as facial weakness. This patient had a previous history of stroke. On examination, it was found that the patient had heminiopia and reduced corneal reflex in both eyes. Patient could not show her teeth/smile and could not open her mouth very wide. Arms and legs were not that weak. Both limbs seemed fairly normal and there were no changes in sensation except in the face. So what do you think she has?
Well she was just admitted so investigations have to be done, but it is suspected that she has bilateral facial palsy which is apparently quite difficult to make out. In general her face was emotionless which lead us to think that she may have bilateral facial palsy, and both corneal reflexes were reduced. The team didn't think this is a stroke but probably a pathology in the brain.
I personally thought this case was quite fascinating. It was different and it definitely makes you think. Thought I would share this case with you all.
Found out my next placement will be in General Surgery..........................AGAIN. General Surgery is great, but I have had enough. I'm so sick of it. I've done general surgery in my 2 weeks of placements in first year and then general surgery for my first placement this year. I want to see something else NOT GI related...PLEASE. I'm really interested in surgery and it's just so frustrating to be constantly placed in the same specialty. I really want to see the other surgical specialties and it's annoying how the medical school doesn't take into consideration your previous placements and what specialties you have been on. Pretty sure the school will come up with something like "Life isn't fair." But come on.
But yeah all in all - great placement out in a peripheral hospital. Definitely the complete opposite to my initial impression and have learned not to listen to other students as these students said that the hospital I was just placed in was hostile and unfriendly. Complete opposite and my experience has been fantastic. Really enjoyed it and have learned so much. Hopefully this continues in my next placement.
Seriously. These last 3 weeks actually blew by. Crazy. Couldn't believe that today was my last day on my placement in the peripheral hospital. Next week I will be back in the local teaching hospitals so I guess YAY no more 45-50 minute drives! Thinking back - I quite enjoyed my placement in the peripheral hospital. There were only 20 medical students at the hospital so the doctors were all really keen to teach and the staff were all very friendly. If only the hospital wasn't so far away. I've been hearing stories how the local teaching hospitals are absolutely packed with students; hence, patients are pretty annoyed with us and the consultants don't have time to teach.
Anyways this week has been really good. Did the standard ward rounds and finished up my first essay assignment that I handed in today. Got loads of teaching from Dr Y so that was really good. Saw some pretty interesting physical signs this week. Saw really marked dyskinesia in a patient with Parkinsons Disease. Today we saw a really interesting case. Patient presented to hospital with left sided weakness as well as facial weakness. This patient had a previous history of stroke. On examination, it was found that the patient had heminiopia and reduced corneal reflex in both eyes. Patient could not show her teeth/smile and could not open her mouth very wide. Arms and legs were not that weak. Both limbs seemed fairly normal and there were no changes in sensation except in the face. So what do you think she has?
Well she was just admitted so investigations have to be done, but it is suspected that she has bilateral facial palsy which is apparently quite difficult to make out. In general her face was emotionless which lead us to think that she may have bilateral facial palsy, and both corneal reflexes were reduced. The team didn't think this is a stroke but probably a pathology in the brain.
I personally thought this case was quite fascinating. It was different and it definitely makes you think. Thought I would share this case with you all.
Found out my next placement will be in General Surgery..........................AGAIN. General Surgery is great, but I have had enough. I'm so sick of it. I've done general surgery in my 2 weeks of placements in first year and then general surgery for my first placement this year. I want to see something else NOT GI related...PLEASE. I'm really interested in surgery and it's just so frustrating to be constantly placed in the same specialty. I really want to see the other surgical specialties and it's annoying how the medical school doesn't take into consideration your previous placements and what specialties you have been on. Pretty sure the school will come up with something like "Life isn't fair." But come on.
But yeah all in all - great placement out in a peripheral hospital. Definitely the complete opposite to my initial impression and have learned not to listen to other students as these students said that the hospital I was just placed in was hostile and unfriendly. Complete opposite and my experience has been fantastic. Really enjoyed it and have learned so much. Hopefully this continues in my next placement.
Saturday, September 17, 2011
Placement 2 - End of 1st Week
What a quick change. From sitting in lectures from 9am-5pm to being on my feet from 9am-5pm. Hands down: placement > lectures. There is just so much to learn and see on placements.
For my 2nd placement, I've been placed in the Stroke Unit. On the first day I realized that this is the first time I've been placed on a medical ward. For the last few hospital placements - they have ALL been in surgery. I was definitely preparing myself for the worst as I really do enjoy surgical attachments and I wasn't sure what to expect from a medicine attachment. Also the fact that I was placed in the Stroke Unit was quite intimidating. In my mind Stroke = Neuro = intense. I was scared as heck on the first day and quite nervous, but also excited for the unknown.
The minute I stepped onto the ward, I was greeted by a really friendly receptionist who assured my partner and I that the doctors on this ward are really nice. We asked to see consultant X, but was then told that he no longer works at the hospital. What a great start to the day. We then muttered out another consultant name, Dr Y, and immediately the receptionist became very reassuring as she guaranteed us that we will be just fine with this consultant. Apparently he is very friendly and is a great teacher. I was starting to get excited. Right before going to the Dr Y's office we bumped into another consultant, Dr B. I must admit, I was surprised to learn that he was a consultant as he is quite young. He seemed really friendly...and perhapsa bit quite awkward. Then we met Dr Y. My first impression of him was: "What a boss." I know that sounded a bit weird but Dr Y seems to be a very confident/leader-like person. Very calm, and very approachable. He definitely looks serious, but we came to find out that he is a very patient man. Oddly enough, Dr Y quickly set out a schedule and several goals that he would like us to accomplish and what he aims to do with us. I believe this has been the first time where I've been sat down with a consultant and made goals and aims. I actually quite liked that as we are only 3rd year medics (1st year of clinical), so a little bit of guidance is quite nice as we don't really know what we should be doing in the hospital. He also arranged for some time to teach us about neurology/stroke. I was definitely liking the sound of this.
Anyways we then joined Dr B on ward rounds and pretty much got grilled to death by questions. I guess that's his way of teaching. Not exactly the method I would prefer to learn from as I do get quite nervous when put under pressure with a question, but Dr B is a really nice guy so I'm not too scared about answering a question wrong. He wouldn't put you down or look disappointed, he would simply acknowledge and explain the answer to his question. With this method of teaching, I guess things stick in my head for longer as you remember being grilled on that topic and stuff stands out a bit more.
Impressions of the ward? I'm really surprised at the range of ages on the ward. You would expect the whole ward to be elderly people, but to my surprise - there were quite a lot of middle aged patients. Made me realize that stroke isn't an elderly person's problem, but it can be a risk to anyone of any age. The ward is also extremely friendly and relaxed. You don't feel pressured or watched on the ward. It's also nice that the nurses and junior doctors have welcomed us and do acknowledge our presence. Quite a difference from my last placement where I felt like an ignored object standing in the middle of a corridor looking really awkward and lost. Here, I feel a part of the ward.
I got to admit I have learned loads. I mean LOADS. Information overload. I have learned so much from both Dr B and Dr Y. They are really amazing at teaching. And it's really nice that they show us physical signs and teach us how to classify the signs as we do the ward rounds. I'm definitely looking forward to next week where we will learn more about stroke/neuro. From time to time, I do miss watching surgeries though, but it's good to finally experience a medicine attachment. Not a bad start I guess!
For my 2nd placement, I've been placed in the Stroke Unit. On the first day I realized that this is the first time I've been placed on a medical ward. For the last few hospital placements - they have ALL been in surgery. I was definitely preparing myself for the worst as I really do enjoy surgical attachments and I wasn't sure what to expect from a medicine attachment. Also the fact that I was placed in the Stroke Unit was quite intimidating. In my mind Stroke = Neuro = intense. I was scared as heck on the first day and quite nervous, but also excited for the unknown.
The minute I stepped onto the ward, I was greeted by a really friendly receptionist who assured my partner and I that the doctors on this ward are really nice. We asked to see consultant X, but was then told that he no longer works at the hospital. What a great start to the day. We then muttered out another consultant name, Dr Y, and immediately the receptionist became very reassuring as she guaranteed us that we will be just fine with this consultant. Apparently he is very friendly and is a great teacher. I was starting to get excited. Right before going to the Dr Y's office we bumped into another consultant, Dr B. I must admit, I was surprised to learn that he was a consultant as he is quite young. He seemed really friendly...and perhaps
Anyways we then joined Dr B on ward rounds and pretty much got grilled to death by questions. I guess that's his way of teaching. Not exactly the method I would prefer to learn from as I do get quite nervous when put under pressure with a question, but Dr B is a really nice guy so I'm not too scared about answering a question wrong. He wouldn't put you down or look disappointed, he would simply acknowledge and explain the answer to his question. With this method of teaching, I guess things stick in my head for longer as you remember being grilled on that topic and stuff stands out a bit more.
Impressions of the ward? I'm really surprised at the range of ages on the ward. You would expect the whole ward to be elderly people, but to my surprise - there were quite a lot of middle aged patients. Made me realize that stroke isn't an elderly person's problem, but it can be a risk to anyone of any age. The ward is also extremely friendly and relaxed. You don't feel pressured or watched on the ward. It's also nice that the nurses and junior doctors have welcomed us and do acknowledge our presence. Quite a difference from my last placement where I felt like an ignored object standing in the middle of a corridor looking really awkward and lost. Here, I feel a part of the ward.
I got to admit I have learned loads. I mean LOADS. Information overload. I have learned so much from both Dr B and Dr Y. They are really amazing at teaching. And it's really nice that they show us physical signs and teach us how to classify the signs as we do the ward rounds. I'm definitely looking forward to next week where we will learn more about stroke/neuro. From time to time, I do miss watching surgeries though, but it's good to finally experience a medicine attachment. Not a bad start I guess!
Friday, July 15, 2011
End of the Week.
What a week.
Driving to the peripheral hospital for 40 minutes each way every day does take a toll. Since Monday, I have been going in at about 9 or 10 am, which is considered a late start when compared to others. My consultant is fairly "slack" and told us not to come in too early because we do have to travel a long way and for safety sake not to tire us out too badly. Last few days my partner and I have been going around to different wards to take patient histories and do physical examinations. I swear we have not been that lucky this week. We have been given two patients on our ward who we should definitely speak to as they are quite interesting to talk to and one patient in particular is extremely fun to talk to. Every time we wanted to go speak to this one patient, he is asleep in his chair. We were told by the nurses and junior doctors to not wake him up as he gets tired quite easily (plus he is quite old). Finally, when my partner and I walked by his room he was awake so we went in to ask for permission to speak to him about his condition.
I am not kidding but I think the entire ward (nurses and junior doctors) were playing a mighty good prank on us. Here's the catch: this patient is almost completely deaf. We literally spoke right into his ear and he still could not hear us. My partner and I were absolutely baffled. We could not believe that the staff had been recommending us a patient who is deaf. The main point of patient histories is to ask questions and it does not exactly work if the patient cannot hear you. Now we feel like we are the joke of the ward. However I am VERY determined to get a patient history from this patient as I had a read through his notes and he is definitely an interesting patient. I think I will opt for the writing on a whiteboard to ask my questions.
After being absolutely baffled by this patient, my partner and I decided to abandon our ward and move to other wards to get patient histories. We went to the Cardiology ward and we managed to get a really good patient history. This particular patient was very kind and VERY patient with us. We visited him again today to do a Cardiovascular physical examination on him and again he was very cooperative and seemed really keen on helping us learn.
Today we also went to the respiratory ward and managed to get another patient history and do a respiratory physical examination. Despite being a Friday, I thought today was one of our most productive days. Last few days we were leaving early (e.g. 1:30pm-2:00pm) as we felt redundant. Today, we left feeling like we've done a lot and actually had some fun. Definitely a good way to end the week of placements.
Next week - hopefully we'll start off where we left off and continue to be productive. On Monday we will be doing a theatre list with our consultant so we'll finally see him again and hopefully get some teaching from him as well as he is amazing at teaching and very patient. I was also hoping to ask to be able to scrub in and maybe be a bit more interactive and try and help out as I think that is the best way to learn. Much better than standing in the corner of the room and trying not to be in the way.
Sorry for the long post. Will update hopefully soon. Have a good weekend!
Driving to the peripheral hospital for 40 minutes each way every day does take a toll. Since Monday, I have been going in at about 9 or 10 am, which is considered a late start when compared to others. My consultant is fairly "slack" and told us not to come in too early because we do have to travel a long way and for safety sake not to tire us out too badly. Last few days my partner and I have been going around to different wards to take patient histories and do physical examinations. I swear we have not been that lucky this week. We have been given two patients on our ward who we should definitely speak to as they are quite interesting to talk to and one patient in particular is extremely fun to talk to. Every time we wanted to go speak to this one patient, he is asleep in his chair. We were told by the nurses and junior doctors to not wake him up as he gets tired quite easily (plus he is quite old). Finally, when my partner and I walked by his room he was awake so we went in to ask for permission to speak to him about his condition.
I am not kidding but I think the entire ward (nurses and junior doctors) were playing a mighty good prank on us. Here's the catch: this patient is almost completely deaf. We literally spoke right into his ear and he still could not hear us. My partner and I were absolutely baffled. We could not believe that the staff had been recommending us a patient who is deaf. The main point of patient histories is to ask questions and it does not exactly work if the patient cannot hear you. Now we feel like we are the joke of the ward. However I am VERY determined to get a patient history from this patient as I had a read through his notes and he is definitely an interesting patient. I think I will opt for the writing on a whiteboard to ask my questions.
After being absolutely baffled by this patient, my partner and I decided to abandon our ward and move to other wards to get patient histories. We went to the Cardiology ward and we managed to get a really good patient history. This particular patient was very kind and VERY patient with us. We visited him again today to do a Cardiovascular physical examination on him and again he was very cooperative and seemed really keen on helping us learn.
Today we also went to the respiratory ward and managed to get another patient history and do a respiratory physical examination. Despite being a Friday, I thought today was one of our most productive days. Last few days we were leaving early (e.g. 1:30pm-2:00pm) as we felt redundant. Today, we left feeling like we've done a lot and actually had some fun. Definitely a good way to end the week of placements.
Next week - hopefully we'll start off where we left off and continue to be productive. On Monday we will be doing a theatre list with our consultant so we'll finally see him again and hopefully get some teaching from him as well as he is amazing at teaching and very patient. I was also hoping to ask to be able to scrub in and maybe be a bit more interactive and try and help out as I think that is the best way to learn. Much better than standing in the corner of the room and trying not to be in the way.
Sorry for the long post. Will update hopefully soon. Have a good weekend!
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