End of GP Placement.

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

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

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

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

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

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

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

Walls Closing In.

Yes this is another s*** hitting the fan post.

1 report on screening programs.
1 audit report.
1 audit poster.
1 audit abstract.

The beauty of finding out that instead of having 2 full three-day weekends to work on all these things....you actually have 3 full free days to work.

16 days left until deadline.

Calling for lots of coffee. A lot of creative power. And very little sleep. I refuse to let GP be the one placement that becomes the hurdle of my medical degree.

I knew I was going to regret bumming around. Grrrr.

Help!

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.