To make up for my last short post - I'll give you guys something to think/reflect about.
So you meet a 55 year old male patient on the neurology ward who was admitted with severe unilateral headaches in the front which radiates to the back of the head with no associated neck stiffness. As you talk to the patient you notice he's fairly relaxed and quite talkative. He tells you how he first presented to his GP 4 weeks ago who didn't explain much and sent him for a CT/MRI scan on his head, then proceeded to send him for Chest X-rays...eventually getting a pelvic MRI scan. The patient says: "I have no idea why I had to go through all these scans. Bit pointless in my opinion. It's just a headache...any ideas doc?" You know all these events had happened over the last 4 weeks and this patient has seen several doctors and you start to wonder why no one has told this man why all these investigations were done. Eventually you find out that the patient is aware that there is a "lump" in the back of his brain and that he's being scheduled to get a biopsy. After saying this, the patient still seems very relaxed and seemingly unaware of what is going on...actually he ends up telling you that he actually doesn't have a clue what's going on.
After the nice conversation you've had with the patient, you go look in his medical notes. You read the report from the scans which clearly says: "Query metastasis to the brain". You know that the GP/other doctors had sent this patient for several different investigations is to locate the primary cancer - which the patient is completely unaware of. Next imaging report: "Primary glioma". All brain tumours are technically malignant. Then you think: does this patient know he's possibly got brain cancer? No one knows how severe it is as a biopsy hasn't been done.
So here's something for you to think about. As a medic or soon to be medic: would you rather know about everything? Know exactly WHY the scans are being done and what are the results. Reasons behind all the investigations. All the plans from the doctors and suspicions/differentials. Then you look at it from another point. If this patient knew about all of the reasons and all the prior suspicions that the doctors had, would he still be as relaxed and calm about his "headache"? So is it actually better to not know that much?
Personally I think there's a fine line between knowing too much and knowing too little. As a patient, I would want as much info as I can as I'm a medic - I want to know things. If I didn't have any medical background, I think I wouldn't want to know anything. Live life in denial and in the unknown I guess? At least I won't be busy stressing myself out. These things can be emotionally difficult and cancer is such a sensitive topic. I would think the general population wouldn't want to know all the reasoning. It's tough. I think every person has a different view on this. Something for you to think about/reflect about.
Showing posts with label case study. Show all posts
Showing posts with label case study. Show all posts
Tuesday, November 20, 2012
Saturday, March 24, 2012
The Grind.
Clinic here. Clinic there. What a brutal week. I don't mind clinics...but I do mind them when I have 2 clinics per day from 9-5pm. I have now grown to fear Antenatal Clinics. It is essentially an overbooked clinic where you talk to high risk pregnant ladies and just following up on their pregnancy. It's nice as you spend about 10-15 minutes with each lady; however, after 5 pregnant women...it gets very boring.
Not only did I have Antenatal Clinics, but I also had to attend Gynae Clinics, which I admit are a bit more exciting/interesting. Gynae Clinic is where patients come in with problems downstairs. This could include menorrhagia, dymenorrhoea, discharge, etc. Because I was with my supervisor, Mr R, I was able to carry out a few examinations and after being taught how to use a Cusco Speculum in theatre, I was finally able to try it out on a patient who is awake. I gotta admit...I was extremely nervous as I obviously don't want to cause any pain and the Cusco can easily cause pain. I managed to find the cervix in the first go and I felt a sense of pride come over me and Mr R was complimenting on my technique. It definitely filled me with confidence and to be honest...inserting the Cusco wasn't that difficult. I don't know why I was pissing my pants about it. I also really appreciate patients being so tolerant with students. I mean if I needed to get my downstairs checked up...the last thing I want in clinic with me is a medical student...and no way the student will be going near my bits. I mean these patients who allow us to practice our skills really need to be more appreciated. It's one thing to practice on a plastic mannequin but being able to practice on a real patient is a whole new ball game and it really helps build confidence. It also helps when your supervisor is keen to allow you to practice skills and perform examinations. Overall I enjoyed my clinic with Mr R as he was also in a good mood and we finished clinic on time (RARE!). Learned loads, got to do examinations + Cusco, and had a lot of good banter and many good laughs.
Unfortunately, I cannot say that I had as much fun with the rest of my clinics. Note to self: READ UP before attending special interest clinics. I literally got wiped all over the floor by another consultant when I went to Colposcopy and Gestational Diabetes Clinic on Tuesday. Because I had an evening meeting, I did not have time to read up on the clinic and I wrongly assumed that the consultant I was going to have wouldn't quiz me like Mr R does. To my demise...this consultant LOVES quizzing and I got my butt kicked. It was so embarrassing. I have never felt so dumb either. I kept blanking out and my heart was racing with every question. Worst bit is that I know the answers to the questions...or more like I SHOULD know the answers but I couldn't spit it out as I had not done any revision. Definitely taught me a good lesson and ever since Tuesday I did some reading prior to clinics especially clinics with consultants I haven't met yet.
On top of all the clinics this week...hands down...I have never worked so hard on placement...ever. I was putting in so much extra time. Usually we are expected to be in 9-5pm on a standard day. Monday...technically didn't have to go in until 10:30am for a tutorial. I went in at 9am to take a full patient history for my case study report. Tuesday: 9am clinic...went in at 8am to get a different patient history as the patient history on Monday wasn't good enough for my case study (ended up not seeing any patients as there was a ward round going on). Then had clinic in the afternoon which did not end until 5pm. Went to the ward to see if there are any more interesting patients...didn't leave until 6pm. Wednesday: 9am start for clinic...but stayed until 6pm...when I could've went home at 3:30pm (clinic finished very early) - was chasing after some patient notes I had requested for as I forgot to copy down info. Thursday: 9am start (clinic). Gave up my lunch hour to go read up the patient notes that I had requested for. Then had teaching from 2pm-3pm. Went to clinic...which didn't end until 5:30pm. Friday: FINALLY a normal day - 9pm-5pm.
Worst bit about this case study I was chasing around for a whole week - I ended up writing up on the first patient history I took Monday morning. Most annoying bit: of ALL the patients I could've picked, I picked a patient who was under the care of my supervisor (who is also marking my essay). I didn't want to do up a report on my supervisor's patient as he would know the patient history well so I definitely have to write accurately. This unfortunate coincidence doesn't end there. I thought I could get away with this patient case study as my supervisor had no idea which patient I am writing up, but also this patient presented with a fairly common problem (urinary retention post-op total abdo hysterectomy) so it could easily be anyone. Because the patient was discharged later in the afternoon on Monday and I needed to look at the notes, I requested for the notes to return to the ward so I can read through them. They arrived on Thursday, but were delivered to my supervisor's secretary. No problem right? Wrong...the secretary shares the same office as my supervisor, but luckily my supervisor was called to cover a clinic for another consultant for a few minutes. Perfect - quickly ran to fetch the notes, except the secretary forbid me from leaving the office with the notes. I knew my supervisor had just left his office as his computer was still on (screensaver wasn't up yet), and his chair was still warm. I predicted that my supervisor would be back in 30 minutes so I quickly went through the patient notes.
Unfortunately...my supervisor returned in 10 minutes and found me lounging on his chair and working at his desk and I had moved all his stuff to the side to give myself some room to write. Doh! I quickly stood up and moved over to finish up copying out important info about the patient's operation. My supervisor got curious as why the heck was I in his office, and who's notes was I looking up. He knew I have been working on my case report...and obviously his curiosity took over and he was trying to see the patient name. I kept my hand over the patient label on each page; however, in the 2 seconds I bent over to pick up my pen, which I dropped, my cheeky supervisor took the notes and found out which patient I was writing about. I was obviously a bit annoyed as now my supervisor definitely knows who I am writing about, but now also knows what I will be writing about in my report. He promptly refreshed his memory by flipping through the notes while I stood next to him giving off a dumb face. Guess I really have to do a good job on my essay now that my supervisor knows I'm writing up about his patient and the fact he remembers the patient as well. Great. Bonus bit: my essay is due in 3 days...2 weeks earlier than everyone else. What a tiring week. Hopefully all this hard work will pay off in the end. Next week: Labour Week. Going to be VERY tiring. Long shifts. Lots of waiting around. Yikes.
Not only did I have Antenatal Clinics, but I also had to attend Gynae Clinics, which I admit are a bit more exciting/interesting. Gynae Clinic is where patients come in with problems downstairs. This could include menorrhagia, dymenorrhoea, discharge, etc. Because I was with my supervisor, Mr R, I was able to carry out a few examinations and after being taught how to use a Cusco Speculum in theatre, I was finally able to try it out on a patient who is awake. I gotta admit...I was extremely nervous as I obviously don't want to cause any pain and the Cusco can easily cause pain. I managed to find the cervix in the first go and I felt a sense of pride come over me and Mr R was complimenting on my technique. It definitely filled me with confidence and to be honest...inserting the Cusco wasn't that difficult. I don't know why I was pissing my pants about it. I also really appreciate patients being so tolerant with students. I mean if I needed to get my downstairs checked up...the last thing I want in clinic with me is a medical student...and no way the student will be going near my bits. I mean these patients who allow us to practice our skills really need to be more appreciated. It's one thing to practice on a plastic mannequin but being able to practice on a real patient is a whole new ball game and it really helps build confidence. It also helps when your supervisor is keen to allow you to practice skills and perform examinations. Overall I enjoyed my clinic with Mr R as he was also in a good mood and we finished clinic on time (RARE!). Learned loads, got to do examinations + Cusco, and had a lot of good banter and many good laughs.
Unfortunately, I cannot say that I had as much fun with the rest of my clinics. Note to self: READ UP before attending special interest clinics. I literally got wiped all over the floor by another consultant when I went to Colposcopy and Gestational Diabetes Clinic on Tuesday. Because I had an evening meeting, I did not have time to read up on the clinic and I wrongly assumed that the consultant I was going to have wouldn't quiz me like Mr R does. To my demise...this consultant LOVES quizzing and I got my butt kicked. It was so embarrassing. I have never felt so dumb either. I kept blanking out and my heart was racing with every question. Worst bit is that I know the answers to the questions...or more like I SHOULD know the answers but I couldn't spit it out as I had not done any revision. Definitely taught me a good lesson and ever since Tuesday I did some reading prior to clinics especially clinics with consultants I haven't met yet.
On top of all the clinics this week...hands down...I have never worked so hard on placement...ever. I was putting in so much extra time. Usually we are expected to be in 9-5pm on a standard day. Monday...technically didn't have to go in until 10:30am for a tutorial. I went in at 9am to take a full patient history for my case study report. Tuesday: 9am clinic...went in at 8am to get a different patient history as the patient history on Monday wasn't good enough for my case study (ended up not seeing any patients as there was a ward round going on). Then had clinic in the afternoon which did not end until 5pm. Went to the ward to see if there are any more interesting patients...didn't leave until 6pm. Wednesday: 9am start for clinic...but stayed until 6pm...when I could've went home at 3:30pm (clinic finished very early) - was chasing after some patient notes I had requested for as I forgot to copy down info. Thursday: 9am start (clinic). Gave up my lunch hour to go read up the patient notes that I had requested for. Then had teaching from 2pm-3pm. Went to clinic...which didn't end until 5:30pm. Friday: FINALLY a normal day - 9pm-5pm.
Worst bit about this case study I was chasing around for a whole week - I ended up writing up on the first patient history I took Monday morning. Most annoying bit: of ALL the patients I could've picked, I picked a patient who was under the care of my supervisor (who is also marking my essay). I didn't want to do up a report on my supervisor's patient as he would know the patient history well so I definitely have to write accurately. This unfortunate coincidence doesn't end there. I thought I could get away with this patient case study as my supervisor had no idea which patient I am writing up, but also this patient presented with a fairly common problem (urinary retention post-op total abdo hysterectomy) so it could easily be anyone. Because the patient was discharged later in the afternoon on Monday and I needed to look at the notes, I requested for the notes to return to the ward so I can read through them. They arrived on Thursday, but were delivered to my supervisor's secretary. No problem right? Wrong...the secretary shares the same office as my supervisor, but luckily my supervisor was called to cover a clinic for another consultant for a few minutes. Perfect - quickly ran to fetch the notes, except the secretary forbid me from leaving the office with the notes. I knew my supervisor had just left his office as his computer was still on (screensaver wasn't up yet), and his chair was still warm. I predicted that my supervisor would be back in 30 minutes so I quickly went through the patient notes.
Unfortunately...my supervisor returned in 10 minutes and found me lounging on his chair and working at his desk and I had moved all his stuff to the side to give myself some room to write. Doh! I quickly stood up and moved over to finish up copying out important info about the patient's operation. My supervisor got curious as why the heck was I in his office, and who's notes was I looking up. He knew I have been working on my case report...and obviously his curiosity took over and he was trying to see the patient name. I kept my hand over the patient label on each page; however, in the 2 seconds I bent over to pick up my pen, which I dropped, my cheeky supervisor took the notes and found out which patient I was writing about. I was obviously a bit annoyed as now my supervisor definitely knows who I am writing about, but now also knows what I will be writing about in my report. He promptly refreshed his memory by flipping through the notes while I stood next to him giving off a dumb face. Guess I really have to do a good job on my essay now that my supervisor knows I'm writing up about his patient and the fact he remembers the patient as well. Great. Bonus bit: my essay is due in 3 days...2 weeks earlier than everyone else. What a tiring week. Hopefully all this hard work will pay off in the end. Next week: Labour Week. Going to be VERY tiring. Long shifts. Lots of waiting around. Yikes.
Monday, October 12, 2009
FRESHERS WEEK - SEPT 25, 2009
Luckily our first lecture of the day was at 1pm so most of us could get over/recover slightly from any hangovers. When I got to the lecture theater, half the class was holding a water bottle which I found pretty hilarious. Schedule for the day was just:
1:00pm - 2:00pm : Summing Up Introductory Activity
Pretty easy day to be honest. Anyways by 1:15pm our lecturer still hasn't showed up and people started to get bored. People started throwing paper planes and paper balls around the room. It was quite the scene. Things flying from side to side, from back to front. By 1:40pm a MedSoc rep. noticed that our lecturer was still not here and contacted the med school that there are 250 students are impatiently waiting for their lecture. So at around 1:50pm our lecturer shows up and everyone was really bummed out for obvious reasons. The lecturer was pretty considerate and just rushed through the conclusion of our task and went over the answer. The diagnosis for our case study ended up being H1N1/Swine flu and the differential diagnosis was just the common flu. Lecture ended at like 2:10pm which was REALLY fast. We all ran off pretty fast back to our flats.
After the lecture I quickly went over the student union to check our the Sports Activity Fair. There was SO MANY PEOPLE! By the time I finished my late lunch (after lecture) and got INTO the sports fair, the stands were starting to pack up. I didn't get to see much and was interested in signing up for some stuff but sadly they were all done for the day and took away their sign-up sheets.
Oh forgot to mention: I could hear the beginning of freshers flu flying around the class (oh no!). Nice short post as I didn't do anything interesting and just went home and took a nap.
Tip of the day: Load up on vitamin C during freshers week if you want to avoid freshers flu. No guarantees though. Oh and party really hard during freshers week because you won't be able to party as hard during actual uni time...too much work. Oh and if you really want to go sign up for stuff at a fair and you know you'll be in a rush after your lecture to go to the fair...just go before. It makes life much easier.
Side note: Hopefully most of you have already submitted your UCAS application for medical school by now or putting in the final touches to your personal statement. Good luck!
1:00pm - 2:00pm : Summing Up Introductory Activity
Pretty easy day to be honest. Anyways by 1:15pm our lecturer still hasn't showed up and people started to get bored. People started throwing paper planes and paper balls around the room. It was quite the scene. Things flying from side to side, from back to front. By 1:40pm a MedSoc rep. noticed that our lecturer was still not here and contacted the med school that there are 250 students are impatiently waiting for their lecture. So at around 1:50pm our lecturer shows up and everyone was really bummed out for obvious reasons. The lecturer was pretty considerate and just rushed through the conclusion of our task and went over the answer. The diagnosis for our case study ended up being H1N1/Swine flu and the differential diagnosis was just the common flu. Lecture ended at like 2:10pm which was REALLY fast. We all ran off pretty fast back to our flats.
After the lecture I quickly went over the student union to check our the Sports Activity Fair. There was SO MANY PEOPLE! By the time I finished my late lunch (after lecture) and got INTO the sports fair, the stands were starting to pack up. I didn't get to see much and was interested in signing up for some stuff but sadly they were all done for the day and took away their sign-up sheets.
Oh forgot to mention: I could hear the beginning of freshers flu flying around the class (oh no!). Nice short post as I didn't do anything interesting and just went home and took a nap.
Tip of the day: Load up on vitamin C during freshers week if you want to avoid freshers flu. No guarantees though. Oh and party really hard during freshers week because you won't be able to party as hard during actual uni time...too much work. Oh and if you really want to go sign up for stuff at a fair and you know you'll be in a rush after your lecture to go to the fair...just go before. It makes life much easier.
Side note: Hopefully most of you have already submitted your UCAS application for medical school by now or putting in the final touches to your personal statement. Good luck!
Friday, October 9, 2009
FRESHERS WEEK - SEPT 24, 2009
Right so today again was pretty hectic and I have been super super excited for the entire day as tonight is the medics FRESHERS FEVER FOAM PARTY!!!! Anyways I had to get through two lectures for the day which isn't too bad. Here's my schedule for today:
11:00 pm: Dissection Lecture
2:00 pm: Small Group Work
So first lecture I had was at the dissection room in another building (not med school). Today's lecture was mainly based around the dissection activities that we will have pretty frequently throughout the year. However, the dissection room is the hardest place to find. I was with a group of people and it took us 30 mins to find the room. Apparently they made the room to be super hard to find so people of the public will not accidentally walk into the room as we do full body dissections (hence many cadavers). When we got there none of us were really prepared to see anything. We thought it was going to just be a quick introduction, set some rules, and ask some questions......NOPE. When we walked in there were two gurneys in the middle of the room with a cloth covering each one. None of us really thought much about it. Let's just say when it was unveiled many people weren't exactly "ready" and didn't exactly feel too well. We'll leave it at that.
However I am very glad that I managed to get into a university which does full body dissections as the amount of things you learn from dissections are priceless. Being able to see where things are in a real human body and how things are connected just makes the learning process so much more interesting and in depth. I am truly excited for dissections and I am really looking forward to it.
After the dissection lecture we had a two hour lunch break. Had some lunch at the student union with some peeps. Lunch was okay....nothing special. Kinda disappointed because people kept hyping up the cafe. Anyways after lunch there was the official university Activities Fair. Went to go check it out and joined a few societies. It wasn't that great...again had to fight the crowd and got bounced around.
At 2pm I went over to my lecture and it was so DULL! All we did was discuss in small groups about the case study that we got on Monday....yup did that for an entire hour. The discussing itself within the group probably took 10 minutes MAX. Was so glad when the lecture was over. Made some plans with my friends to meet up before going to the party tonight. Then I went home to get ready and chill.
The medic's freshers party was SO AMAZING that I have to give it its own post. Please see the next post for details about the party. If you don't give a crap about it...don't read it. :) Again here's another tip for freshers: TRY to look ahead of time which societies you want to join at the university. It makes signing up so much easier and faster as you don't have to wander around looking for stuff to catch your eye...plus less pushing around. Pretty much you go in sign up and leave. Simple.
11:00 pm: Dissection Lecture
2:00 pm: Small Group Work
So first lecture I had was at the dissection room in another building (not med school). Today's lecture was mainly based around the dissection activities that we will have pretty frequently throughout the year. However, the dissection room is the hardest place to find. I was with a group of people and it took us 30 mins to find the room. Apparently they made the room to be super hard to find so people of the public will not accidentally walk into the room as we do full body dissections (hence many cadavers). When we got there none of us were really prepared to see anything. We thought it was going to just be a quick introduction, set some rules, and ask some questions......NOPE. When we walked in there were two gurneys in the middle of the room with a cloth covering each one. None of us really thought much about it. Let's just say when it was unveiled many people weren't exactly "ready" and didn't exactly feel too well. We'll leave it at that.
However I am very glad that I managed to get into a university which does full body dissections as the amount of things you learn from dissections are priceless. Being able to see where things are in a real human body and how things are connected just makes the learning process so much more interesting and in depth. I am truly excited for dissections and I am really looking forward to it.
After the dissection lecture we had a two hour lunch break. Had some lunch at the student union with some peeps. Lunch was okay....nothing special. Kinda disappointed because people kept hyping up the cafe. Anyways after lunch there was the official university Activities Fair. Went to go check it out and joined a few societies. It wasn't that great...again had to fight the crowd and got bounced around.
At 2pm I went over to my lecture and it was so DULL! All we did was discuss in small groups about the case study that we got on Monday....yup did that for an entire hour. The discussing itself within the group probably took 10 minutes MAX. Was so glad when the lecture was over. Made some plans with my friends to meet up before going to the party tonight. Then I went home to get ready and chill.
The medic's freshers party was SO AMAZING that I have to give it its own post. Please see the next post for details about the party. If you don't give a crap about it...don't read it. :) Again here's another tip for freshers: TRY to look ahead of time which societies you want to join at the university. It makes signing up so much easier and faster as you don't have to wander around looking for stuff to catch your eye...plus less pushing around. Pretty much you go in sign up and leave. Simple.
Sunday, October 4, 2009
FRESHERS WEEK - SEPT 22, 2009
Today I gotta sleep in which was nice as I didn't have anything to do until 1:00pm. The schedule was:
1:00 pm - Collect Welcome Packs
2:00-4:30pm - Welcome Talks from School of Medicine
Anyways I decided to take my sweet time to go get my welcome pack as I totally thought I was done with lining up. To my surprise when I got to the Medical School, the line up was all the way OUT of the school and along the street! I thought to myself: "You can't be serious...". I was pretty annoyed as that meant more waiting/more standing around doing NOTHING. I decided to say "Hi" to the people around me and started having a few conversations. It was nice to talk to someone as it made the time pass by faster. Finally got my welcome pack and went into the lecture theater. Had to prepare myself for a long haul as it 2.5 hours of lectures. It actually went by pretty fast as it was just a bunch of introductions. It was neat meeting the rest of the medical department. There wasn't anything special at these lecturers so I will keep you guys away from boring details. After the lectures I decided to start on the right foot and head to the library to work on my assignment (details of it below).
I forgot to mention something cool that we did yesterday. At the medical lecture we also jumped right into a case study about a woman who returned from Mexico City and was ill. We got a list of symptoms and we got to ask the patient some additional questions. We were supposed to answer a few questions by Friday which were:
1) What is your diagnosis?
2) What are your differential diagnosis?
3) What treatment will you give?
4) What other actions would you take?
5) Why do you think you are right?
So I did a bit of research today and found my answers and took down some notes. It really wasn't hard at all as it is pretty obvious. But wow what a way to start med school. Just dumping us into a case study. I can see that it will be an interesting/fun/exciting/stressful year.
Just a quick tip: Do your assignment the day or the day after it is assigned! If you let it drag you will eventually forget about it and you will be rushing last minute to finish it off. Plus if you get it down early you don't have to think about it at all and you can go off and party as much as you want! Makes sense right? Too bad it is easier to say than to do. Hmph.
1:00 pm - Collect Welcome Packs
2:00-4:30pm - Welcome Talks from School of Medicine
Anyways I decided to take my sweet time to go get my welcome pack as I totally thought I was done with lining up. To my surprise when I got to the Medical School, the line up was all the way OUT of the school and along the street! I thought to myself: "You can't be serious...". I was pretty annoyed as that meant more waiting/more standing around doing NOTHING. I decided to say "Hi" to the people around me and started having a few conversations. It was nice to talk to someone as it made the time pass by faster. Finally got my welcome pack and went into the lecture theater. Had to prepare myself for a long haul as it 2.5 hours of lectures. It actually went by pretty fast as it was just a bunch of introductions. It was neat meeting the rest of the medical department. There wasn't anything special at these lecturers so I will keep you guys away from boring details. After the lectures I decided to start on the right foot and head to the library to work on my assignment (details of it below).
I forgot to mention something cool that we did yesterday. At the medical lecture we also jumped right into a case study about a woman who returned from Mexico City and was ill. We got a list of symptoms and we got to ask the patient some additional questions. We were supposed to answer a few questions by Friday which were:
1) What is your diagnosis?
2) What are your differential diagnosis?
3) What treatment will you give?
4) What other actions would you take?
5) Why do you think you are right?
So I did a bit of research today and found my answers and took down some notes. It really wasn't hard at all as it is pretty obvious. But wow what a way to start med school. Just dumping us into a case study. I can see that it will be an interesting/fun/exciting/stressful year.
Just a quick tip: Do your assignment the day or the day after it is assigned! If you let it drag you will eventually forget about it and you will be rushing last minute to finish it off. Plus if you get it down early you don't have to think about it at all and you can go off and party as much as you want! Makes sense right? Too bad it is easier to say than to do. Hmph.
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