I can see the light at the end of the tunnel! To be honest though the placement went by a lot faster than I thought. I can't really complain about the length of it as I'm only in 3 days/week. Obviously knowing that the placement is coming to an end and going back home for holiday is getting near - my mood has definitely been a lot better. Plus the weather is an added bonus. Finally summer is here...hopefully it'll last for more than 1 week.
Had a pretty straight forward short week (in for 2.5 days). Not much really happened, but I was placed with GPs who were more keen to get me involved and doing stuff, which was good. Did ONE (wowwww) consultation on an "unwell" child who was more miserable than anything. It was a fairly straight forward case as the child had a general viral illness and just needed a lot of TLC. I did get to go out with a district nurse which was good as it got me out from the practice. Visited 5 patients and went to their homes. Personally I still find it a bit uncomfortable to be in other peoples' homes. Maybe it's the way I was brought up or culture difference, but I feel very intrusive when going to someone's home and sitting down and making myself comfortable.
The nurse took me to an elderly couple's home who she knew quite well as she visits them almost every week for monitoring. The couple were immigrants and seemed to be quite private and quiet. Obviously noticing that when first meeting them, I instantly felt a bit hesitant entering their home as a complete stranger and at the end of the day - I am just a medical student. Seeing how they are, I obviously waited for them to ask me to sit down before making myself comfortable, but what really surprised me was the nurse's behaviour. I guess since she has known them much longer, she didn't feel the need to be more professional. As I sat down, the nurse was already walking towards the kitchen and asking at the same time to turn on the kettle to make herself a cup of coffee. It was obvious that it was rhetorical question as she was already halfway to the kitchen. She did also ask me if I wanted tea/coffee but I politely refused. I was very confused by this as the nurse was happily making herself at home, using the couple's kitchen and coffee/tea supplies, etc. I personally found it a bit rude, but then again I don't know how well she knows the couple. I would never use a patient's facilities and no matter how well I know them, I would never make myself comfortable in their home. I feel like it's just a professionalism thing more than anything else. At the end of the day, they are my patients and I need to treat them as patients to maintain the professional doctor-patient relationship...or in this case nurse-patient relationship. I guess in general nurses are a lot better with maintaining good relationships with patients and come across much more empathetic and kind. Not only did I feel very uncomfortable in the patient's home, the nurse was taking her sweet time to make herself comfortable and making her coffee, leaving me alone with the couple. It was nice talking to them, but at the end of the day - we were there to go over their blood-sugar diaries and just seeing how they are doing. What could be done very quickly...ended up being a fairly long ordeal (about 30-45 minutes). I don't like to make things take longer than they do. I do understand these are house-bound couples, but I feel like by taking so long to do a job may be interrupting their day. As an outsider - I want to make my visit as quick as possible so they can return to their activities. So again the whole making yourself comfortable in someone else's home was puzzling. Even better, the nurse went to use the couple's bathroom...which again made me raise an eyebrow. If I needed to use the toilet, I would've went before the visit, or hold it and go somewhere else to use the facilities.
If we flipped it around and a nurse/worker or whatever had to come to my home once a week to do some checks...I personally wouldn't want this person to make themselves comfortable in my home. Maybe I'm just a private person or how I have been brought up. I don't mind friends/people who I know well to come over and make themselves at home, but when professionals/workers come...I wouldn't be as comfortable with them making themselves at home. I see them as someone who is here to do a job - not to socialize and I wouldn't expect/want them to break down that barrier of professionalism.
Just found it a bit interesting and wanted to share that experience.
Showing posts with label patients. Show all posts
Showing posts with label patients. Show all posts
Friday, July 27, 2012
Sunday, July 8, 2012
A Mask.
This isn't a new revelation, but one that has occurred to me more during my GP placement.
I have come to realize that doctors need to put on a mask most of the time as patients come to doctors for various kinds of problems. No matter how annoyed you are about a patient or how fed up you are with your clinic, you cannot let it show. There are tons of patients out there who visit the GP 2-4x a month and I'm sure as the GP you can get frustrated/annoyed with the patient especially when they are coming in for insignificant things. It is definitely difficult as patients expect the doctor to be professional and empathetic, but it is extremely difficult to show this when the patient themselves aren't coming in with the right intentions. I have sat in clinics where the patient is very rude and overly demanding. And as a doctor, you can't do anything about their rudeness, other than still treat them respectfully and try your best to listen. Definitely need a high tolerance level when dealing with "troublesome" patients. On the contrary, there are certainly very nice patients (usually tend to be the elderly). They are usually very respectful and always apologizing about wasting your time. These are the patients who are worth treating and you can't help but be a bit more empathetic, despite knowing that you're supposed to treat all patients with empathy and care.
However, masks are not just for GPs. As I have mentioned earlier, I have encountered it in my other placements. You would think surgeons wouldn't need to put on a mask as often, as they have a bit less patient contact. Unfortunately, surgeons have just as much face time with patients; however, the reasons of putting on a mask may be different. After a surgery and you have to break some bad news/complications about the surgery, you have to be able to put on a confident face and an appropriate mask. There isn't as much time for you to gather yourself after the operation. GPs or physicians in general would get results/bad news ahead of time so they will be ready and have time to think about how they will break the news. It is definitely a tough job as you don't want to show that much emotion when talking to patients especially after a tough case/surgery.
With clinics, you could enjoy the company of one of the patients and be laughing about something, but you have to be able to quickly return back to neutral before seeing your next patient. It can work the other way around as for one particular case, we were giving our condolences to a patient as her father had just passed away the day before and she was telling us about his death. Definitely an emotional/sad moment where you have to again put on a mask and empathize and comfort the patient. Easily within 2 minutes between patients, you have to regain your composure and be ready for the next patient as he or she can come in with anything. You certainly can't let things affect you and as well for doctors, you have to be good with moving on. You can't dwell on one particular case.
There has been arguments that doctors should not bring their outside emotions to work. Despite having a horrible morning, people argue that you shouldn't bring that grumpiness into the work place. I personally agree with that point as it isn't fair to your patients and your colleagues. I have met a few GPs who said that it is important to bring your emotions to work as you will seem more genuine. I don't mind bringing in a good mood to work, but I certainly wouldn't want to bring in grumpiness to the work place as you can easily affect your patients and colleagues. No one wants to see a grumpy doctor. In my eyes, I think my emotions should not affect my work, so even in that sense, you will have to put on a mask before coming to work especially when you're having a bad day. People argue as a doctor you should be genuine, but for me it is far more advantageous if I put on a mask for work and sort out my issues/problems when I go home/leave work.
What are your thoughts about putting on a mask for work or bringing your emotions to work?
Post your comments below!
I have come to realize that doctors need to put on a mask most of the time as patients come to doctors for various kinds of problems. No matter how annoyed you are about a patient or how fed up you are with your clinic, you cannot let it show. There are tons of patients out there who visit the GP 2-4x a month and I'm sure as the GP you can get frustrated/annoyed with the patient especially when they are coming in for insignificant things. It is definitely difficult as patients expect the doctor to be professional and empathetic, but it is extremely difficult to show this when the patient themselves aren't coming in with the right intentions. I have sat in clinics where the patient is very rude and overly demanding. And as a doctor, you can't do anything about their rudeness, other than still treat them respectfully and try your best to listen. Definitely need a high tolerance level when dealing with "troublesome" patients. On the contrary, there are certainly very nice patients (usually tend to be the elderly). They are usually very respectful and always apologizing about wasting your time. These are the patients who are worth treating and you can't help but be a bit more empathetic, despite knowing that you're supposed to treat all patients with empathy and care.
However, masks are not just for GPs. As I have mentioned earlier, I have encountered it in my other placements. You would think surgeons wouldn't need to put on a mask as often, as they have a bit less patient contact. Unfortunately, surgeons have just as much face time with patients; however, the reasons of putting on a mask may be different. After a surgery and you have to break some bad news/complications about the surgery, you have to be able to put on a confident face and an appropriate mask. There isn't as much time for you to gather yourself after the operation. GPs or physicians in general would get results/bad news ahead of time so they will be ready and have time to think about how they will break the news. It is definitely a tough job as you don't want to show that much emotion when talking to patients especially after a tough case/surgery.
With clinics, you could enjoy the company of one of the patients and be laughing about something, but you have to be able to quickly return back to neutral before seeing your next patient. It can work the other way around as for one particular case, we were giving our condolences to a patient as her father had just passed away the day before and she was telling us about his death. Definitely an emotional/sad moment where you have to again put on a mask and empathize and comfort the patient. Easily within 2 minutes between patients, you have to regain your composure and be ready for the next patient as he or she can come in with anything. You certainly can't let things affect you and as well for doctors, you have to be good with moving on. You can't dwell on one particular case.
There has been arguments that doctors should not bring their outside emotions to work. Despite having a horrible morning, people argue that you shouldn't bring that grumpiness into the work place. I personally agree with that point as it isn't fair to your patients and your colleagues. I have met a few GPs who said that it is important to bring your emotions to work as you will seem more genuine. I don't mind bringing in a good mood to work, but I certainly wouldn't want to bring in grumpiness to the work place as you can easily affect your patients and colleagues. No one wants to see a grumpy doctor. In my eyes, I think my emotions should not affect my work, so even in that sense, you will have to put on a mask before coming to work especially when you're having a bad day. People argue as a doctor you should be genuine, but for me it is far more advantageous if I put on a mask for work and sort out my issues/problems when I go home/leave work.
What are your thoughts about putting on a mask for work or bringing your emotions to work?
Post your comments below!
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.
Friday, June 8, 2012
The End of Another Placement.
Seriously cannot believe it has been 6 weeks. It literally blew by. I didn't think it would as I wasn't particularly busy and I had quite a few day offs as well (bank holidays, etc). My friends said that you cannot find a happier medical student on placement than me. I will admit, the placement started off quite slow...but once it got going...I truly truly truly did not want it to end. It's the first specialty where I could see myself work in as a career. Before starting, I was a bit hesitant as ever since I knew I wanted to do medicine, I wanted to do orthopaedics. I had very high hopes for it. Obviously I was very excited to start the placement, but there was a bit of doubt in the back of my mind. These 6 weeks could either make or break this specialty for me. I was actually scared that I will end up not liking orthopaedics...and actually hating it.
Luckily, orthopaedic surgery is just like how I imagined it to be. I was genuinely happy. It's the first placement where I enjoyed everything about the specialty. I enjoyed the surgeries. I enjoyed being on the ward (which was minimal to be fair). And I can't believe I am saying this but I enjoyed clinic. Everything clicked for me. I never struggled waking up to go to this placement. I had 8am meetings to go to (where I had to wake up at 6am) and I never struggled. If this was any other specialty and was told to go to an 8am meeting...I can guarantee you I would struggle and would probably turn up late or maybe even miss it. I was actually motivated to work hard in this placement. I didn't work hard because my supervisor was strict/I was scared of him...I actually worked hard because I enjoyed the specialty. I felt no pressure to work hard...actually my supervisor kept telling me to take it easy and made it very free. It was all down to me. There were times where I wished I was in more.
This was probably the most flexible and easy going placement I have had this year, but this is easily the one placement where I have learned the most. I had lots of fun, but also learned a lot of useful things. I am so lucky to have a supervisor who is really good with teaching and letting me progress. You all probably remember me having great praises for my last O&G placement and that it has set a very high bar. This orthopaedic placement just blew through that bar. I mean I knew it was going to be hard to have more fun and more responsibilities than my last placement, but wow this placement was fantastic. I have nothing but good things to say. I got to scrub in. I assisted in surgery. I learned how to suture and help close up. I saw patients in clinic on my own and got to examine them. I got to start and finish an audit project. I really could not ask for more. I don't even think I could do much more.
Today started out like any other day. Early meeting and then to morning clinic. Usual banter in the meeting...lots of good laughs and teasing. I took up my usual spot at the back of the room against the cabinet. Then off to clinic. Busy clinic as usual. Saw new patients on my own. Did the usual. I'm sure no one knew it was my last day because everything was going like it was just another day of my placement. Patient by patient...the note pile got smaller and smaller. Clinic was coming to an end. Next thing I knew my supervisor was signing my feedback form off. Had a bit of a chat about the placement and then a solid handshake. To be honest it was tough to leave. I wasn't sick of the placement yet. Just wasn't ready for it to end already. Every day when we finish and before I leave, I always crack a: "When am I seeing you next?" It was weird not to say that as I was heading for the door. I didn't even know what to say as I left. I think all I kept saying was "thank you" as I dragged my feet out the door. Even now...I'm absolutely gutted this placement is over. Feels like someone shot me out from cloud 9. Next week is going to be tough. Back to lectures. Back to reality. Then on to GP and being cooped up in a clinic from 9-5. No surgeries. Not in a hospital environment. Going to be out of my element. Hurts just to think about it. Should be a crime to enjoy a placement so much. Genuinely loved this placement. Entered placement as one of the happiest medical student you can find to probably the most gutted one at the moment. What a contrast. Just shows you how much I enjoyed this placement.
Luckily, orthopaedic surgery is just like how I imagined it to be. I was genuinely happy. It's the first placement where I enjoyed everything about the specialty. I enjoyed the surgeries. I enjoyed being on the ward (which was minimal to be fair). And I can't believe I am saying this but I enjoyed clinic. Everything clicked for me. I never struggled waking up to go to this placement. I had 8am meetings to go to (where I had to wake up at 6am) and I never struggled. If this was any other specialty and was told to go to an 8am meeting...I can guarantee you I would struggle and would probably turn up late or maybe even miss it. I was actually motivated to work hard in this placement. I didn't work hard because my supervisor was strict/I was scared of him...I actually worked hard because I enjoyed the specialty. I felt no pressure to work hard...actually my supervisor kept telling me to take it easy and made it very free. It was all down to me. There were times where I wished I was in more.
This was probably the most flexible and easy going placement I have had this year, but this is easily the one placement where I have learned the most. I had lots of fun, but also learned a lot of useful things. I am so lucky to have a supervisor who is really good with teaching and letting me progress. You all probably remember me having great praises for my last O&G placement and that it has set a very high bar. This orthopaedic placement just blew through that bar. I mean I knew it was going to be hard to have more fun and more responsibilities than my last placement, but wow this placement was fantastic. I have nothing but good things to say. I got to scrub in. I assisted in surgery. I learned how to suture and help close up. I saw patients in clinic on my own and got to examine them. I got to start and finish an audit project. I really could not ask for more. I don't even think I could do much more.
Today started out like any other day. Early meeting and then to morning clinic. Usual banter in the meeting...lots of good laughs and teasing. I took up my usual spot at the back of the room against the cabinet. Then off to clinic. Busy clinic as usual. Saw new patients on my own. Did the usual. I'm sure no one knew it was my last day because everything was going like it was just another day of my placement. Patient by patient...the note pile got smaller and smaller. Clinic was coming to an end. Next thing I knew my supervisor was signing my feedback form off. Had a bit of a chat about the placement and then a solid handshake. To be honest it was tough to leave. I wasn't sick of the placement yet. Just wasn't ready for it to end already. Every day when we finish and before I leave, I always crack a: "When am I seeing you next?" It was weird not to say that as I was heading for the door. I didn't even know what to say as I left. I think all I kept saying was "thank you" as I dragged my feet out the door. Even now...I'm absolutely gutted this placement is over. Feels like someone shot me out from cloud 9. Next week is going to be tough. Back to lectures. Back to reality. Then on to GP and being cooped up in a clinic from 9-5. No surgeries. Not in a hospital environment. Going to be out of my element. Hurts just to think about it. Should be a crime to enjoy a placement so much. Genuinely loved this placement. Entered placement as one of the happiest medical student you can find to probably the most gutted one at the moment. What a contrast. Just shows you how much I enjoyed this placement.
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.
Saturday, March 10, 2012
Obs&Gynae - Initial Thoughts
So I have completed my first week of placement for Obstetrics and Gynaecology. Initial impressions? Fairly interesting. It's nice to see adult patients again. When I took my first patient history on this attachment, it was weird being able to speak directly to the patient and receiving specific information. Also in Obstetrics (pregnant women), you can't really call these people 'patients' as most of them are healthy and essentially are only in hospital to give birth. It's quite a nice change of environment from seeing ill children. In Gynaecology, one has to be quite professional as this specialty deals with quite sensitive things. You have to ask personal questions and you really need to gain the trust of your patients in order to get such personal/sensitive information. Again a huge contrast from Paediatrics as I have to put on a "fun" attitude when approaching children; however, with gynaecological patients, I have to be composed and essentially act professionally. It is a nice change and I haven't found the transition too difficult...yet. We'll see in the next few weeks.
Again I am in a peripheral hospital, but this hospital isn't actually that far away. For me, it is actually closer than the central hospital so I'm not complaining. It's great to be in a hospital which has a good reputation for teaching. They pride themselves in teaching and on day 1 it was very noticeable. The supervisor and secretary was very organized and were expecting us. We felt very welcomed and we received our schedule for the next 6 weeks! I was not expecting a schedule as in my previous attachment everything was done ad hoc and we received little guidance. Huge difference for this attachment and it was definitely a change I welcomed. It was nice knowing what you will be doing in the next few weeks and I could actually plan my life as I will know when I will be free and I can prepare ahead of time for clinics/teaching.
On top of that, I have come to realize how patient some people are. I went onto the wards to help out and was given the task of clerking in 2 new patients. These 2 patients have not seen anyone yet, so I was excited to go talk to them. The first patient I saw was having severe pain and to my surprise, she had been waiting to be seen for 4.5 hours! Talk about patience! I would've left ages ago and I found it quite ridiculous someone in so much pain has been waiting for so long! After taking the patient history, I realized this patient was in a lot of pain and a doctor had to see her soon. In addition to that, the patient was not impressed with the care so far (not surprised) so I quickly went to go get a senior doctor. It was found that she had surgery a week ago and the stitches were infected and some of it has come away. This patient was promptly admitted to the ward and was finally given stronger pain killers and a surgeon was called to review the case.
Then I went to go talk to my next patient...who actually arrived earlier than the last patient I saw. She had been waiting for 5 hours and I felt really bad for her. She had come to A+E the day before and due to the long wait she left and decided to come to the ward the next day. Because the ward was fairly busy, no one has really seen her and again I was the first person to see her. This could of easily been the longest history I had ever taken. After introducing myself I asked the standard question: "What brings you to hospital today?". This patient went on and on with a very extensive history of her presenting complaint and I was overwhelmed with information. She did not stop talking for a good 10-15 minutes and I was completely lost. I slowly had to work my way back through her history to get a more clear idea what was wrong and this clerking felt like it took ages. It didn't help that this lady's first language was not English so I had to word my questions differently and I had to try and figure out some of her medical conditions as she didn't know the names. It was the few times I actually struggled taking a patient history and this is the first time where there was a bit of a language barrier between the patient and I. It was a good challenge and it was new experience. It definitely taught me to be patient and to take things one by one. Luckily the patient was patient with me as we worked our way through the problem and her history and after 40 minutes I finally got through the history. Mind you...it usually takes me 10-15 minutes to get a full patient history. After presenting the history to a doctor I had to leave so unfortunately I could not follow up with the patient. When I came in the next day she wasn't on the ward list so I assume she didn't need to be admitted to hospital, which I guess is good news.
All in all...interesting week. It was an introductory week so it was quite light and I took things slowly as I found my bearings around the hospital. Next week is my theatre week so lots of surgeries! I can't wait!
Again I am in a peripheral hospital, but this hospital isn't actually that far away. For me, it is actually closer than the central hospital so I'm not complaining. It's great to be in a hospital which has a good reputation for teaching. They pride themselves in teaching and on day 1 it was very noticeable. The supervisor and secretary was very organized and were expecting us. We felt very welcomed and we received our schedule for the next 6 weeks! I was not expecting a schedule as in my previous attachment everything was done ad hoc and we received little guidance. Huge difference for this attachment and it was definitely a change I welcomed. It was nice knowing what you will be doing in the next few weeks and I could actually plan my life as I will know when I will be free and I can prepare ahead of time for clinics/teaching.
On top of that, I have come to realize how patient some people are. I went onto the wards to help out and was given the task of clerking in 2 new patients. These 2 patients have not seen anyone yet, so I was excited to go talk to them. The first patient I saw was having severe pain and to my surprise, she had been waiting to be seen for 4.5 hours! Talk about patience! I would've left ages ago and I found it quite ridiculous someone in so much pain has been waiting for so long! After taking the patient history, I realized this patient was in a lot of pain and a doctor had to see her soon. In addition to that, the patient was not impressed with the care so far (not surprised) so I quickly went to go get a senior doctor. It was found that she had surgery a week ago and the stitches were infected and some of it has come away. This patient was promptly admitted to the ward and was finally given stronger pain killers and a surgeon was called to review the case.
Then I went to go talk to my next patient...who actually arrived earlier than the last patient I saw. She had been waiting for 5 hours and I felt really bad for her. She had come to A+E the day before and due to the long wait she left and decided to come to the ward the next day. Because the ward was fairly busy, no one has really seen her and again I was the first person to see her. This could of easily been the longest history I had ever taken. After introducing myself I asked the standard question: "What brings you to hospital today?". This patient went on and on with a very extensive history of her presenting complaint and I was overwhelmed with information. She did not stop talking for a good 10-15 minutes and I was completely lost. I slowly had to work my way back through her history to get a more clear idea what was wrong and this clerking felt like it took ages. It didn't help that this lady's first language was not English so I had to word my questions differently and I had to try and figure out some of her medical conditions as she didn't know the names. It was the few times I actually struggled taking a patient history and this is the first time where there was a bit of a language barrier between the patient and I. It was a good challenge and it was new experience. It definitely taught me to be patient and to take things one by one. Luckily the patient was patient with me as we worked our way through the problem and her history and after 40 minutes I finally got through the history. Mind you...it usually takes me 10-15 minutes to get a full patient history. After presenting the history to a doctor I had to leave so unfortunately I could not follow up with the patient. When I came in the next day she wasn't on the ward list so I assume she didn't need to be admitted to hospital, which I guess is good news.
All in all...interesting week. It was an introductory week so it was quite light and I took things slowly as I found my bearings around the hospital. Next week is my theatre week so lots of surgeries! I can't wait!
Tuesday, February 28, 2012
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:
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!
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!
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!
Friday, February 10, 2012
Lack of Sleep.
5 weeks in! 2 more weeks to go. This has got to me the toughest week in terms of waking up. Every morning I am waking up at 6:30am to get ready, but it doesn't help that there isn't much to motivate me to get up. I think the only thing that is making me wake up on time is the fact that I have to drive other people to the hospital so they kinda rely on me. I also think that being 5 weeks in, there isn't much else to see. Most of the patients we see have acute illnesses as most of the special illnesses get referred to a bigger hospital.
I was on-call on Wednesday and the best bit is that the doctors on the ward can tell when I am on-call as I'm never on the ward when I am on-call. I try to go to clinics to try and make the time go by faster. As usual...Wednesday - I escaped the ward. I went to the Children's Orthopaedic Clinic for the entire morning. It was a lot more interesting than I expected it to be. I saw a lot of different cases. I was even able to sympathize with some of the patients. Met a girl who is hypermobile, which was affecting her participation in sports. The consultant was doing a physical examination on the range of movement of her joints and on doing internal rotation of the hip, the consultant asked me if it was normal. I knew my leg could turn that far so I said: "normal". I have never seen such a confused face. "That is NOT normal. LOOK how far it goes!" Feeling a bit dumb/embarrassed I covered my back side by saying: "Oh sorry didn't notice how far it went *blushes*"
Once the patient left, the consultant questioned why I thought the range of movement was normal as it was apparently fairly abnormal. Then I proceeded to tell him that I am hypermobile as well. Then I found out he isn't very good with hypermobility. The consultant looked quite uncomfortable and didn't want to see me showing my "flexibility". I was quite surprised about his reaction, but thinking about it....it is fairly gross. Fingers shouldn't bend so far back and such. Haha. Hypermobility is a great party trick by the way. Just thought I would throw that out there.
Anyways clinic took quite long, but we had a lot of patients. What I enjoyed the most about the clinic is that we did not see two of the same case. Every single patient had a different problem and it really kept me awake and interested. For the first time at a clinic, I did not find myself bored. I was constantly engaged and I found each case interesting. Probably could be one of the best clinics that I have ever been to. Long, but interesting.
At some point the clinic had to end and I had to return to the ward. On the way back, I stopped for a lunch break. When I returned to the ward I was told there was another clinic happening in 30 minutes. Obviously I pounced on that opportunity and I disappeared from the ward for another 4 hours. By the time I got back to the ward, I only had 4 more hours left of my on-call to do. Luckily when I got back, the ward started to get busy and I got to clerk in a few patients. Most of them were diarrhoea and vomiting problems, so it wasn't too exciting. It was better than sitting around doing nothing. But because the ward started to get busy, I didn't get to leave til 9:30pm. I had quite a bit of work to do when I got home and didn't get to sleep early. Worst part, I had to get up at 6:30am the next morning again. Thursday was brutal. For the entire day I was falling asleep whenever I sat down. We also had lunchtime teaching from the registrar and I accidentally fell asleep. I felt really bad as I didn't mean to fall asleep as it wasn't boring. I was just so tired I couldn't keep my eyes open. Now I think the registrar hates me. She wouldn't talk to me afterwards and it was kinda awkward on the ward. Hopefully she'll forget about it after the weekend. And hopefully I can catch up on my sleep.
I was on-call on Wednesday and the best bit is that the doctors on the ward can tell when I am on-call as I'm never on the ward when I am on-call. I try to go to clinics to try and make the time go by faster. As usual...Wednesday - I escaped the ward. I went to the Children's Orthopaedic Clinic for the entire morning. It was a lot more interesting than I expected it to be. I saw a lot of different cases. I was even able to sympathize with some of the patients. Met a girl who is hypermobile, which was affecting her participation in sports. The consultant was doing a physical examination on the range of movement of her joints and on doing internal rotation of the hip, the consultant asked me if it was normal. I knew my leg could turn that far so I said: "normal". I have never seen such a confused face. "That is NOT normal. LOOK how far it goes!" Feeling a bit dumb/embarrassed I covered my back side by saying: "Oh sorry didn't notice how far it went *blushes*"
Once the patient left, the consultant questioned why I thought the range of movement was normal as it was apparently fairly abnormal. Then I proceeded to tell him that I am hypermobile as well. Then I found out he isn't very good with hypermobility. The consultant looked quite uncomfortable and didn't want to see me showing my "flexibility". I was quite surprised about his reaction, but thinking about it....it is fairly gross. Fingers shouldn't bend so far back and such. Haha. Hypermobility is a great party trick by the way. Just thought I would throw that out there.
Anyways clinic took quite long, but we had a lot of patients. What I enjoyed the most about the clinic is that we did not see two of the same case. Every single patient had a different problem and it really kept me awake and interested. For the first time at a clinic, I did not find myself bored. I was constantly engaged and I found each case interesting. Probably could be one of the best clinics that I have ever been to. Long, but interesting.
At some point the clinic had to end and I had to return to the ward. On the way back, I stopped for a lunch break. When I returned to the ward I was told there was another clinic happening in 30 minutes. Obviously I pounced on that opportunity and I disappeared from the ward for another 4 hours. By the time I got back to the ward, I only had 4 more hours left of my on-call to do. Luckily when I got back, the ward started to get busy and I got to clerk in a few patients. Most of them were diarrhoea and vomiting problems, so it wasn't too exciting. It was better than sitting around doing nothing. But because the ward started to get busy, I didn't get to leave til 9:30pm. I had quite a bit of work to do when I got home and didn't get to sleep early. Worst part, I had to get up at 6:30am the next morning again. Thursday was brutal. For the entire day I was falling asleep whenever I sat down. We also had lunchtime teaching from the registrar and I accidentally fell asleep. I felt really bad as I didn't mean to fall asleep as it wasn't boring. I was just so tired I couldn't keep my eyes open. Now I think the registrar hates me. She wouldn't talk to me afterwards and it was kinda awkward on the ward. Hopefully she'll forget about it after the weekend. And hopefully I can catch up on my sleep.
Friday, January 20, 2012
Long day - On-call.
So it is week 2 of my paediatric placement. Now I'm getting to know the doctors on the ward much better and they seem more keen to teach us. Even if they see something vaguely interesting, he or she will come and tell us to take a look. I was on-call on Wednesday and what a long day. Got in at 8:45am and didn't get home until 10pm. I was intending to leave at 8pm as I do have to drive back home as I do not stay in the hospital accommodation. Day started off with a ward round (usual). Saw a few interesting patients, but nothing really out of the ordinary. Managed to see a Stevens-Johnson Syndrome. To be honest...it looks pretty horrible. Essentially Stevens Johnson is where you get really red eyes and blisters all around your mouth and oral mucosa. You can also get blisters elsewhere in your body...including your genitalia........yeah. Anyways it doesn't look pleasant and obviously the patient was in quite a bit of discomfort as he could not really eat any solid food. Then went to clinic after lunch where we saw pretty general stuff. Ear infections, constipation, diarrhoea, etc. Got to play with a few of the kids that came in/working on my "playing with children" skill.
I don't have any younger siblings so I personally am not really used to playing with young children. I am still quite apprehensive about playing with kids as I don't really know what to do with them. I mean I think I'm good at making faces as so far I have been able to make the kids laugh by making faces. In terms of toys....I try and just pick up whatever I see and hand it to them...which they quickly put to the side/throw it to the side. Had a few quizzical looks from babies...which is quite adorable...and pretty funny. Sometimes they just look so confused even you get confused yourself! So clinic lasted for about 3 hours and I did get my bum grilled to a burnt toast by the consultant. Non-stop questions. I asked my consultant a question and he proceeded to ask my question back to me! I'm sure I gave him several blank looks. I'm alright with being put on the spot to answer questions, but it still gets my heart rate up. Luckily the consultant is very relaxed and nice so I knew he only asked to help me learn instead of trying to make me feel dumb....not like any consultant would have that sort of intention (sarcasm). Nice thing about being quizzed is that you do remember things much better. I did learn quite a few things.
Then the ward went dead. There was nothing to do. I literally was wandering around in circles looking for patients to talk to or something to do, but most of the patients I saw in the morning have been discharged. I sat around at the nurse's/doctor's station and swiveled in my chair. Then my registrar who is on-call with me...started getting several bleeps. Literally 5 patients walked in at the same time right after dinner. So I got to work clerking the patients in and helping the registrar out with some stuff. Did learn how to take blood from a baby. A pretty pain-staking process. You essentially prick the heel of the baby with a device and you let the blood drip out and catch it in the bottle....you can imagine this can take awhile depending on how fast the blood drips out/how cooperative the baby is.
As earlier stated...I was planning to leave at 8pm, but because suddenly all the patients decided to show up at the same time...I ended up getting held back. I didn't want to leave midway through clerking so I told myself I can leave after clerking and presenting the cases to the registrar. At around 9pm I was finally finished and made my way home. Got home...showered...and then passed out on my bed. And up again next day for 9am. As you can guess....I had a lot of difficulty waking up. Plus the prospect of needing to drive for about an hour was not helping. Either way....thankfully this week kind of picked up and I am starting to get much more teaching from the doctors and I'm starting to get along with the doctors. Starting to feel like I'm a part of the team. It's a nice feeling.
I don't have any younger siblings so I personally am not really used to playing with young children. I am still quite apprehensive about playing with kids as I don't really know what to do with them. I mean I think I'm good at making faces as so far I have been able to make the kids laugh by making faces. In terms of toys....I try and just pick up whatever I see and hand it to them...which they quickly put to the side/throw it to the side. Had a few quizzical looks from babies...which is quite adorable...and pretty funny. Sometimes they just look so confused even you get confused yourself! So clinic lasted for about 3 hours and I did get my bum grilled to a burnt toast by the consultant. Non-stop questions. I asked my consultant a question and he proceeded to ask my question back to me! I'm sure I gave him several blank looks. I'm alright with being put on the spot to answer questions, but it still gets my heart rate up. Luckily the consultant is very relaxed and nice so I knew he only asked to help me learn instead of trying to make me feel dumb....not like any consultant would have that sort of intention (sarcasm). Nice thing about being quizzed is that you do remember things much better. I did learn quite a few things.
Then the ward went dead. There was nothing to do. I literally was wandering around in circles looking for patients to talk to or something to do, but most of the patients I saw in the morning have been discharged. I sat around at the nurse's/doctor's station and swiveled in my chair. Then my registrar who is on-call with me...started getting several bleeps. Literally 5 patients walked in at the same time right after dinner. So I got to work clerking the patients in and helping the registrar out with some stuff. Did learn how to take blood from a baby. A pretty pain-staking process. You essentially prick the heel of the baby with a device and you let the blood drip out and catch it in the bottle....you can imagine this can take awhile depending on how fast the blood drips out/how cooperative the baby is.
As earlier stated...I was planning to leave at 8pm, but because suddenly all the patients decided to show up at the same time...I ended up getting held back. I didn't want to leave midway through clerking so I told myself I can leave after clerking and presenting the cases to the registrar. At around 9pm I was finally finished and made my way home. Got home...showered...and then passed out on my bed. And up again next day for 9am. As you can guess....I had a lot of difficulty waking up. Plus the prospect of needing to drive for about an hour was not helping. Either way....thankfully this week kind of picked up and I am starting to get much more teaching from the doctors and I'm starting to get along with the doctors. Starting to feel like I'm a part of the team. It's a nice feeling.
Monday, October 31, 2011
Final Placement of the Year!
So today was Day 1 of my final placement of 2011. I'm only on this placement for 3 weeks so yay, but that also means...EXAMS are coming up. Been revising for the last 2 weeks and it's bringing good ol' memories of how much I hate revising. It's tedious, tiring, and stressful. Oh and I have to juggle it with placements as well. Luckily I've been placed in a fairly slack placement (Endocrinology) so hopefully I won't have to be too committed.
Met my consultant today and I always believe in first impressions. If you want to impress:
Saw quite a lot of patients - all seemed pretty ill. I also noticed a trend that most of the patients are quite confused. We had one patient who told us that her husband had passed away 30 minutes earlier, and seemed quite depressed. However, when asked what date it is she thought it was the 10th of October, 2009! She didn't know where she was either and didn't know what our consultant was (expected answer = doctor, she had no clue!). She is a new patient and the consultant wasn't sure whether the news of her husband's passing was whether she was confused or it really did happen. At this point my partner and I left the patient and stepped to one side as our consultant talked to a nurse about the patient's story. Unfortunately it was quite noisy and we couldn't hear what the nurse had told our consultant. I guess it is now just a mystery to us. Anyways our ward round lasted 2.5 hours (which isn't too bad as I've been on 4 hour ward rounds). At the end we were told that today was our consultant's last day and another consultant will be taking over for the month. But because our consultant isn't actually leaving the hospital he now has more time to teach so he offered to teach us this week on anything we would like. It was great news as endocrinology is quite complex and it would be great revision for exams. However, that also means I will have to go in tomorrow morning to meet the new consultant as he will be the one to sign us off for the placement. I wasn't planning to go in so I could stay home to revise - guess that won't be happening. Who knows, this consultant might be really nice and good at teaching, so I guess there is something to look forward to! Cross my fingers that this new consultant won't be stern/serious/intimidating. Some of the doctors on the ward knows of this consultant and they say he is quite nice. Hopefully they were being honest. Bring on tomorrow!
Met my consultant today and I always believe in first impressions. If you want to impress:
- Dress well
- Show up early
- Be keen
- Read up on the specialty
Saw quite a lot of patients - all seemed pretty ill. I also noticed a trend that most of the patients are quite confused. We had one patient who told us that her husband had passed away 30 minutes earlier, and seemed quite depressed. However, when asked what date it is she thought it was the 10th of October, 2009! She didn't know where she was either and didn't know what our consultant was (expected answer = doctor, she had no clue!). She is a new patient and the consultant wasn't sure whether the news of her husband's passing was whether she was confused or it really did happen. At this point my partner and I left the patient and stepped to one side as our consultant talked to a nurse about the patient's story. Unfortunately it was quite noisy and we couldn't hear what the nurse had told our consultant. I guess it is now just a mystery to us. Anyways our ward round lasted 2.5 hours (which isn't too bad as I've been on 4 hour ward rounds). At the end we were told that today was our consultant's last day and another consultant will be taking over for the month. But because our consultant isn't actually leaving the hospital he now has more time to teach so he offered to teach us this week on anything we would like. It was great news as endocrinology is quite complex and it would be great revision for exams. However, that also means I will have to go in tomorrow morning to meet the new consultant as he will be the one to sign us off for the placement. I wasn't planning to go in so I could stay home to revise - guess that won't be happening. Who knows, this consultant might be really nice and good at teaching, so I guess there is something to look forward to! Cross my fingers that this new consultant won't be stern/serious/intimidating. Some of the doctors on the ward knows of this consultant and they say he is quite nice. Hopefully they were being honest. Bring on tomorrow!
Thursday, October 20, 2011
The Key is to be Proactive
Have been in placements for about 10 weeks now and I have had many ups and downs as you have read in my previous posts. After looking back at my placements, I've realized that my best experiences had been when I am being proactive. Being active in learning and stepping out from my consultant's shadow. In my first placement in the summer, I put a lot of effort into taking patient histories and doing loads of physical examinations (cardio, resp, and abdo). 2nd placement...did a lot of ward rounds - definitely seen a lot. For comparison sake - first placement I took about 10 patient histories and have done 4 cardiac exams, 3 respiratory exams, and 3 abdo exams. 2nd placement: 1 patient history, 1 shortened peripheral nerve exam. Poor showing in the 2nd placement. Yesterday, I did a group revision session on cardiac, resp, and abdo examinations. I knew how to do those examinations quite well and knew what I was looking for and can easily explain positive findings. The minute we got into neuro and musculoskeletal (MSK) exams...I died a little inside. I didn't know what was going on. Okay well MSK was easy to follow as I'm quite familiar with joints and those tests...but neuro was painful. I obviously didn't know how to do these exams as well as the cardio, resp, and abdo exams and it just felt horrible how lopsided my learning has been. Thinking back - it was because I was really proactive in my first placement. I had put a lot of effort into seeing patients and doing examinations. These last 2 placements - I've been...how should we put it...lazy.
You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.
Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!
You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.
Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!
Wednesday, August 10, 2011
End of Week 3.
Sorry for the late update. Literally left for Canada the day after the end of my first placement, so I haven't had time to update.
Anyways. This was my final week on my first placement. I realized that the patient I was originally going to use for my SSC project/essay does not fit the criteria for the essay. Therefore, I was out hunting for another SSC patient. Decided to take a stroll to the Coronary Care Unit to see if there are any straight forward patients. We met a patient who was quite talkative and in general well enough to talk to us. He had an MI and was waiting for a bypass surgery. This time I made sure we got every single bit of info we need for this essay and all in all it was a really straight forward patient history. Did cardio, respiratory, and abdominal physical examinations. The patient was really friendly and actually didn't want us to leave because he was so bored. Kinda feel bad for some of the patients as they really do look like they are bored out of their mind. Some of them don't even get patients so you really do sympathize.
Actually before we went SSC patient hunting (on Monday) we went to theatre to look for our consultant. We literally stood there for 1.5 hour as our consultant was late and we didn't want to risk missing him so we turned up quite early. Finally caught our consultant racing through the corridor and asked to meet him on Wednesday so we could get our proformas signed off. I swear those 1.5 hours were horrendous as nurses kept asking if we were alright and if we needed anything. Swear we nearly blended into the background.
So come Wednesday, our consultant had clinic so we went to meet him at his clinic...only to find out he isn't there yet and will be an hour late. Great. I decided to talk to the SHO and nurses about bariatric surgery as I was thinking of writing up about it for my 2nd SSC essay on ethics and law. Had a really really good conversation going and I learned quite a lot. It's all down to personal opinion and it is definitely an interesting topic. So an hour later, consultant turns up...only to be in a bad-ish mood and completely ignored my partner and I. We waited til the end of his clinic to talk to him. So we gave him our proformas for him to assess how we did in placement. He took our sheets, quickly glimpse and it, and just circled "Satisfactory" for each section. My partner and I were panicking and our consultant returned the sheets to us without leaving feedback. In general it is expected for us to get an overall mark of "Good" in placement or else the medical school may think we didn't show up to placement. So out of desperation we asked if we can show him what we have been doing on placement as he hasn't watched us therefore couldn't really mark us properly. We were hoping after showing him our work he would raise our grade. He told us to meet him in between surgery on Thursday at 12:30pm.
We get there at 12pm...he apparently finished his first surgery early and had an early lunch break so he could get on with his second surgery. So we stood in for one of his surgeries which was expected to be only 2 hours. Not bad right? Wrong...midway through surgery we had a complication and the surgery ended up taking 4.5 hours. My legs were not happy with me. I think at one point I lost feeling in my quads. After surgery, our consultant was obviously annoyed, but still managed to meet us. We gave him a new proforma and he was like "Didn't I sign something like this yesterday?". We pretty much told him it's a different sheet and it requires written feedback. Somehow he fell for it and before marking us we showed him all our patient histories we took over the 3 weeks. Despite all the effort...he still gave us "Satisfactory" but in the feedback he put down that it was difficult to mark us and was sure we were "good/excellent" students but he didn't get the opportunity to watch us in the wards. At least we got some sort of reason. But to be honest, we now understand why he gave us a "Satisfactory".
So on Friday, we actually had nothing to do and it was our last day. Went in at like 10pm and my partner and I decided to get assessed on our history and examination skills. I think I did alright in it, but was told that my smiling was unprofessional. Still confused about it because if I was a patient I wouldn't want to be greeted by a doctor looking like he/she doesn't give a crap and is in a bad mood. Anyways everyone has their own opinions but it was one feedback point that I will keep in the back of my mind but definitely won't change the way I greet patients. It's not like I excessively smile and laugh/be inappropriate with my facial expression. Just want to treat the patients like a person. It was a weird one to get my head around, and still kinda bothers me. Oh well. After the assessment, we managed to leave at like 12pm and returned our lockers and bleeps. Only if I could relax the minute I got home. It was more like "need to pack. need to pack. need to pack." I don't think I sat down at all for the rest of the day as I was running all over the place trying to get things done and running some final errands before I left.
All in all my first placement as a student doctor has been enjoyable and I definitely learned loads. When I return to placements at the end of September, I will be able to take bloods and do injections/perform invasive procedures, so I'm really looking forward to that. Shame I have 2 weeks of 9-5 lectures prior to my 2nd placements. Yuck.
But finally a week into holiday I've had my chance to sleep in and relax. Now getting to writing up my first SSC essay. The brain hardly wants to work though.
Anyways sorry again for the late update. Hope everyone is enjoying their holiday! Freshers week is getting closer! :D
Anyways. This was my final week on my first placement. I realized that the patient I was originally going to use for my SSC project/essay does not fit the criteria for the essay. Therefore, I was out hunting for another SSC patient. Decided to take a stroll to the Coronary Care Unit to see if there are any straight forward patients. We met a patient who was quite talkative and in general well enough to talk to us. He had an MI and was waiting for a bypass surgery. This time I made sure we got every single bit of info we need for this essay and all in all it was a really straight forward patient history. Did cardio, respiratory, and abdominal physical examinations. The patient was really friendly and actually didn't want us to leave because he was so bored. Kinda feel bad for some of the patients as they really do look like they are bored out of their mind. Some of them don't even get patients so you really do sympathize.
Actually before we went SSC patient hunting (on Monday) we went to theatre to look for our consultant. We literally stood there for 1.5 hour as our consultant was late and we didn't want to risk missing him so we turned up quite early. Finally caught our consultant racing through the corridor and asked to meet him on Wednesday so we could get our proformas signed off. I swear those 1.5 hours were horrendous as nurses kept asking if we were alright and if we needed anything. Swear we nearly blended into the background.
So come Wednesday, our consultant had clinic so we went to meet him at his clinic...only to find out he isn't there yet and will be an hour late. Great. I decided to talk to the SHO and nurses about bariatric surgery as I was thinking of writing up about it for my 2nd SSC essay on ethics and law. Had a really really good conversation going and I learned quite a lot. It's all down to personal opinion and it is definitely an interesting topic. So an hour later, consultant turns up...only to be in a bad-ish mood and completely ignored my partner and I. We waited til the end of his clinic to talk to him. So we gave him our proformas for him to assess how we did in placement. He took our sheets, quickly glimpse and it, and just circled "Satisfactory" for each section. My partner and I were panicking and our consultant returned the sheets to us without leaving feedback. In general it is expected for us to get an overall mark of "Good" in placement or else the medical school may think we didn't show up to placement. So out of desperation we asked if we can show him what we have been doing on placement as he hasn't watched us therefore couldn't really mark us properly. We were hoping after showing him our work he would raise our grade. He told us to meet him in between surgery on Thursday at 12:30pm.
We get there at 12pm...he apparently finished his first surgery early and had an early lunch break so he could get on with his second surgery. So we stood in for one of his surgeries which was expected to be only 2 hours. Not bad right? Wrong...midway through surgery we had a complication and the surgery ended up taking 4.5 hours. My legs were not happy with me. I think at one point I lost feeling in my quads. After surgery, our consultant was obviously annoyed, but still managed to meet us. We gave him a new proforma and he was like "Didn't I sign something like this yesterday?". We pretty much told him it's a different sheet and it requires written feedback. Somehow he fell for it and before marking us we showed him all our patient histories we took over the 3 weeks. Despite all the effort...he still gave us "Satisfactory" but in the feedback he put down that it was difficult to mark us and was sure we were "good/excellent" students but he didn't get the opportunity to watch us in the wards. At least we got some sort of reason. But to be honest, we now understand why he gave us a "Satisfactory".
So on Friday, we actually had nothing to do and it was our last day. Went in at like 10pm and my partner and I decided to get assessed on our history and examination skills. I think I did alright in it, but was told that my smiling was unprofessional. Still confused about it because if I was a patient I wouldn't want to be greeted by a doctor looking like he/she doesn't give a crap and is in a bad mood. Anyways everyone has their own opinions but it was one feedback point that I will keep in the back of my mind but definitely won't change the way I greet patients. It's not like I excessively smile and laugh/be inappropriate with my facial expression. Just want to treat the patients like a person. It was a weird one to get my head around, and still kinda bothers me. Oh well. After the assessment, we managed to leave at like 12pm and returned our lockers and bleeps. Only if I could relax the minute I got home. It was more like "need to pack. need to pack. need to pack." I don't think I sat down at all for the rest of the day as I was running all over the place trying to get things done and running some final errands before I left.
All in all my first placement as a student doctor has been enjoyable and I definitely learned loads. When I return to placements at the end of September, I will be able to take bloods and do injections/perform invasive procedures, so I'm really looking forward to that. Shame I have 2 weeks of 9-5 lectures prior to my 2nd placements. Yuck.
But finally a week into holiday I've had my chance to sleep in and relax. Now getting to writing up my first SSC essay. The brain hardly wants to work though.
Anyways sorry again for the late update. Hope everyone is enjoying their holiday! Freshers week is getting closer! :D
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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