End of GP Placement.

Oh how much I looked forward to typing the title to this post. It could have easily been the least brain stimulating placement I have yet to have. Not only that, I couldn't go make myself useful elsewhere unlike being in the hospital. Looking back on the last 6 weeks, it was definitely a struggle and a challenge. It was mentally draining as it was just so much harder to get the motivation to work. After throwing my arms in the air when stepping out the door of the practice...I realized I have another GP placement next year. Joy. BUT, I know it'll be more useful as I'll have my own surgery and get to see my own patients. This placement literally has redefined work experience. It was 20 days, 10 hours/day of work experience.

Also in other news - crisis averted with all the deadlines as you would remember from my "Walls Closing In" post.

1 report - completed and submitted.
1 audit report - completed awaiting for submission.
1 audit poster - 90% complete.
1 audit abstract - completed and awaiting for submission.

Cannot feel any more satisfied and proud of myself managing to get everything done in time. I think it has been a long time since I was really sure I was not going to make the deadlines.  Miracles do happen. Actually it's more like: Efficient...and very late and long nights...

Oddly enough, in my final week of GP placement, I saw the most interesting case. It was a case of a man with an end-stage disease and the GP needed to start the palliative care pathway with him. This man is quite young (40 years old). Initially when I heard about his medical history, I did not know how old is he. In my mind I imagined him to be an elderly man. Surprisingly when I went to go meet the patient, he looked frail and skinny, but young. What really struck me was that he also has two very young children (ages 8 and 3). Unfortunately, the patient has not really told his children what is wrong with him. They are aware that their father is ill, but do not know the extent of his illness. With his condition, no one really knows how many more years he will live. His condition has been progressively getting worse and the GP told the patient and his wife that there would be one day where he does a nose dive and his health severely deteriorates. We discussed the various options for support and care. In my mind I knew the GP was trying to find the right moment to bring up the "Do Not Attempt to Resuscitate" (DNAR). Eventually we had to talk about it and only until you come onto the topic you then come to realize that the patient is still in denial. To be fair, he has a young family and he himself is quite young. Worst bit is that there is no cause for his condition - as what doctors like to call it: "Idiopathic". He was adamant that he wants to be resuscitated when it comes to the end of the line despite the GP fully informing him about the benefits and harm of resuscitation. As we were talking about his palliative care plan, his children were happily running outside - no clue what is going on in the room. It was definitely a very "grim" consultation. Before leaving, the GP advised the patient to find some support for his end-stage disease and to have someone help him to explain his condition to his children as they will have to know at some point. The GP was right that it is better for him to talk to his children while he is still well and still able to versus down the road he might not be well enough to explain - leaving his children a bit puzzled.

In all fairness - my experience in GP has not been the best, but the GPs who I have worked with are all really nice people and some are great at teaching. Guess it just wasn't my "cup of tea". Had a good feedback session with my supervisor though and I suggested giving students a bit more responsibilities and letting us see our own patients. Hopefully they'll take my feedback on board as I really think it'll improve the student's experience. All in all though, 7 weeks...that was painful.

Psychiatry up next...don't really know what to expect...actually I have no clue what to expect. At least it is hospital based (in a more familiar environment). I'm sure it'll be interesting seeing these sort of patients. Hopefully it'll be better than my GP placement and get back to the happy-go-lucky medical student.

Progress.

I was watching Junior Doctors earlier on and listened to the FY1 doctors saying how they feel more like a real doctor as they have responsibilities and they get to do procedures. I sat on my couch thinking about my last placement on paediatrics. Thinking about it...comparing to my placements just only half a year ago when I first stepped onto the wards as a student doctor, I have seen myself progress. My last placement in paediatrics, I was clerking in patients and presenting the patient history and examination findings to senior doctors. I am probably one of the first "medical" person on the ward to properly sit down and ask them about what has brought them to hospital. I get the honour of seeing these patients prior to the doctors on the ward. While on my placement, I guess I didn't really appreciate this properly as I just took on the responsibility to clerk the patients in, but never realized that I could be one of the first people to see the patient on the ward. I also have to make sure my patient histories are accurate and that my examination is accurate as when I present the history to a senior doctor, it is now expected for me to have a differential diagnosis, possible investigations, and management. Only half a year ago, I was stepping on the consultant's heels going around on ward rounds and just watching. I didn't really get to do very much. If there is something interesting on physical examination that the consultant sees/hears, then he/she would let us take a look/listen. Now...I am the one telling the senior doctor about hearing something and I have to be confident about it. It is actually quite frightening. There were times where I heard crackles at the base of the chest, but I would sometimes doubt myself as they are fairly faint crackles. However, when I present the patient to a senior doctor I have to be sure about these crackles and now I get to write into the patient's notes about any examination findings. It's pretty crazy how much I have progressed from half a year ago.

Also 2 weeks ago the first year medical students got their quick taster of hospital placements and for once I wasn't the most newbie medical student around. There were people more "new"/fresh than me. It was a weird feeling. Then you start noticing that they really don't have a clue how to take patient histories.  And then you think to yourself...about 2 years ago...I was just as clueless. It's weird thinking how much you learn in such a short period of time. Now the structure of patient histories come naturally and you don't really have to think about it. You just ask the questions and go with the flow. I still remember in first year constantly trying to remember what questions to ask...what is important to ask...what the structure is to take a patient history. In first year before I saw a patient, I always wrote on my paper:

PC (presenting complaint)

HPC (history of presenting complaint)

PMH (past medical history)

DH (drug history) - ALLERGIES?

SH (social history)

FMH (family medical history)

This structure is now engraved into my head...and it's only been 2 years! I also taught these freshers how to take a pain history. It's weird that they don't know SOCRATES. SOCRATES is my saving grace. You can never go wrong with it!

Site (where is the pain exactly?)

Onset (when did the pain first come on?)

Character (what does the pain feel like? can you describe it to me?)

Radiation (does this pain go elsewhere?)

Associations (are there any other symptoms that you noticed?)

Timing (does this pain come on at certain times? does it come and go? is it constant?)

Exacerbating/Alleviation (what makes the pain better? what makes it worse?)

Severity (on a scale from 1 to 10 - 1 being not very painful and 10 being the worst pain you have ever felt, what score would you give your pain?)

I found it very confusing to actually see these medical students taking me seriously and genuinely absorbing what I was saying. I'm not much older than them...one of my students was actually older than me! Also when I walked by a few of the first year students and quickly said "Hi!" to them as I walked by, I heard them whispering: "Whoa an older medical student said hi!" I still remembered when an older medical student said "Hi" to me while I was in the hospital...I felt quite happy as I felt like I was noticed and not ignored....more like I actually existed!

Crazy how 2 years make such a big difference, yet thinking about it...it hasn't been too long ago. Speaking of which...this month actually marked the halfway point of my career! Halfway to being a doctor! Scary!

End of Paediatrics.

7 weeks have passed which means I am done with my paediatrics placement! To be honest, it actually went by really fast. I got to admit that the first few weeks went by really slowly...to the point I was dreading the placement. Luckily, the placement started to blow by as I got to know the doctors and nurses on the ward and in general felt more welcomed.  I think 7 weeks was plenty of time for a taster of the specialty so my impression of paediatrics? Not for me. But I won't 100% remove it from my potential list of specialties as I find the surgical side of paediatrics fairly interesting. On my last day of paeds I had a lecture about paediatric orthopaedics, and to be fair...it seems quite interesting. These surgeons see a lot of different conditions ranging from pathological to congenital conditions. Definitely something I wouldn't mind considering in the future.

Also another reason to celebrate about the end of the placement is that I have passed my placement based assessment!!! I was really nervous for it, but it went really well. Did a full patient history on a boy with pneumonia and did a cardiovascular and respiratory examination on him.  I also got a lot of feedback from my supervisor, which was good as I'm constantly trying to improve and do better. I also managed to finish all my essays and reflective writing all in time along with my log book! Really stressful weekend, but everything came together in the end. I was really chuffed with it and after Monday (where everything was due including my assessment), I felt like the world was off my shoulders. I felt so much more at ease and just felt a sense of relaxation. I can finally enjoy the placement again and just take it easy for the last few days on my placement. On top of that, end of paediatrics = end of driving a long way to placement. My next placement is only a 15 minute drive (which is closer than the central hospital from where I live), so I'm excited for that. I no longer have to wake up at a ridiculous time to drive. I've also heard fantastic reviews about the next hospital I will be going to as they like to pride themselves in teaching medical students.

My next placement is Obstetric and Gynaecology. I'm actually really scared for this as I don't really know what to expect as well. Should be interesting as I'll definitely be able to go to theatre (YES!); however, it'll be dealing with quite a sensitive subject so I'll definitely need to change from being playful in Paeds to professional for this specialty. Hopefully I'll be able to compose myself and try to enjoy this specialty as much as I can. First I'll need to go to a week of lectures before commencing my placement. I much rather having lectures first before going to placement as at least I'll have some basic knowledge prior to going to the hospital so I won't look like an idiot in front of the doctors. I also hope I'll have a really nice/easy going/chill supervisor. My last supervisor on paediatrics was very easy-going, which made the placement much more enjoyable. Crossing my fingers that I'll be just as lucky this time with Obs+Gyn. Another 7 weeks of Obs+Gyn and then Easter Holiday! I can't wait for holiday. To be honest...I kinda need one now!

Clinical Specialty Placements

So tomorrow I will be starting clinical specialty placements. I will be on Paediatrics for 6 weeks. I am kind of nervous for it as I don't know what to expect. I was placed in Paediatric Surgery in first year (which by the way is still my most memorable and fun time I have had on placement), but  I was only on the attachment for 1 week. I'm pretty sure it'll be a completely different ball game as obviously the consultants will expect much more knowledge. I have been placed in a peripheral hospital so hello to 1 hour drives each way. Should be interesting...hopefully the weather holds up to make my drive less stressful.

To best honest, I am alright with kids. I don't LOVE kids so I'm not uber excited to be surrounded by them. But who knows, in first year I was really inspired by my first attachment and saw some really interesting things. At one point I was thinking about maybe even specializing in Paediatric Surgery. Hopefully this will be a good experience and I will be able to learn loads as the hospital is much smaller so the doctors will have more time to teach.

9 am introductory lectures tomorrow until 4pm, then on Tuesday I'll be going to the peripheral hospital. Really hoping this will be a good attachment. More updates will come in the week!