Something for you to think about...

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.

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!