Psychiatry - Slow Start.

I don't know why, but I'm quite prone to having slow starts on placements. So I've had my first week in psychiatry and to be honest...I've stepped onto the "wards" for about 5 minutes and then left. I don't know if I should be happy about the placement or a bit annoyed. We've got a lot of free time on the placement and seeing how exams are coming up - it gives us a great opportunity to revise. But at the same time...when I did go on the ward and ask if there's anyone I can see or anything I can do - the staff said that there's nothing to do here and told me to go get a cup of coffee. For the rest of the week - I spent my time in half-day clinics with my consultant. Luckily he is very chill and really good at teaching (if asked to teach). The nice bit is that there is a mutual understanding between the two of us. He has established that I do not want to do psychiatry and fairly indifferent about it. He said he will leave me alone BUT will teach if I have any questions or want any teaching. On top of that, he clearly listed out my learning objectives and what he does expect for me to have completed by the end of the attachment - which was pretty easy/fair. I know what my consultant expects and I don't see it being a struggle. He's also extremely nice which is a nice bonus.

I haven't really met any patients with full blown mental illness. All the patients I have seen were follow up patients who have their symptoms under control and doing fairly okay. Somehow due to my luck, I managed to miss the two new patients I was supposed to see in the week so I can see how patients present to the psychiatric team. For the first new patient, I only managed to stay for half the consultation as I had a doctor's appointment. Then in the next clinic, I ended up being 30 minutes late and missed the new patient as I got lost. Was really annoyed with it as apparently that patient was very interesting.

To be honest though, I don't mind this placement! I'm actually enjoying it as it is fairly easy and not very stressful. My schedule is very flexible and essentially to get good at psychiatry is to just speak to a lot of people (which I haven't exactly done as I'm having an extremely slow week). Despite having a slow week, I am learning a lot as everything is new so that's a bonus. So far all the consultants I've met are also very nice and chill, but they claim they should be chilled out as they know stress is a factor for suicide...

Hopefully next week will go a bit better and hopefully I'll be a bit more productive!

End of Placement 2.

...where did my 3 weeks go?!

Seriously. These last 3 weeks actually blew by. Crazy. Couldn't believe that today was my last day on my placement in the peripheral hospital. Next week I will be back in the local teaching hospitals so I guess YAY no more 45-50 minute drives! Thinking back - I quite enjoyed my placement in the peripheral hospital. There were only 20 medical students at the hospital so the doctors were all really keen to teach and the staff were all very friendly. If only the hospital wasn't so far away. I've been hearing stories how the local teaching hospitals are absolutely packed with students; hence, patients are pretty annoyed with us and the consultants don't have time to teach.

Anyways this week has been really good. Did the standard ward rounds and finished up my first essay assignment that I handed in today. Got loads of teaching from Dr Y so that was really good. Saw some pretty interesting physical signs this week. Saw really marked dyskinesia in a patient with Parkinsons Disease. Today we saw a really interesting case. Patient presented to hospital with left sided weakness as well as facial weakness. This patient had a previous history of stroke. On examination, it was found that the patient had heminiopia and reduced corneal reflex in both eyes. Patient could not show her teeth/smile and could not open her mouth very wide. Arms and legs were not that weak. Both limbs seemed fairly normal and there were no changes in sensation except in the face. So what do you think she has?

Well she was just admitted so investigations have to be done, but it is suspected that she has bilateral facial palsy which is apparently quite difficult to make out. In general her face was emotionless which lead us to think that she may have bilateral facial palsy, and both corneal reflexes were reduced. The team didn't think this is a stroke but probably a pathology in the brain.

I personally thought this case was quite fascinating. It was different and it definitely makes you think. Thought I would share this case with you all.

Found out my next placement will be in General Surgery..........................AGAIN. General Surgery is great, but I have had enough. I'm so sick of it. I've done general surgery in my 2 weeks of placements in first year and then general surgery for my first placement this year. I want to see something else NOT GI related...PLEASE. I'm really interested in surgery and it's just so frustrating to be constantly placed in the same specialty. I really want to see the other surgical specialties and it's annoying how the medical school doesn't take into consideration your previous placements and what specialties you have been on. Pretty sure the school will come up with something like "Life isn't fair." But come on.

But yeah all in all - great placement out in a peripheral hospital. Definitely the complete opposite to my initial impression and have learned not to listen to other students as these students said that the hospital I was just placed in was hostile and unfriendly. Complete opposite and my experience has been fantastic. Really enjoyed it and have learned so much. Hopefully this continues in my next placement.

Placement 2 - End of 1st Week

What a quick change. From sitting in lectures from 9am-5pm to being on my feet from 9am-5pm. Hands down: placement > lectures. There is just so much to learn and see on placements.

For my 2nd placement, I've been placed in the Stroke Unit. On the first day I realized that this is the first time I've been placed on a medical ward. For the last few hospital placements - they have ALL been in surgery. I was definitely preparing myself for the worst as I really do enjoy surgical attachments and I wasn't sure what to expect from a medicine attachment.  Also the fact that I was placed in the Stroke Unit was quite intimidating. In my mind Stroke = Neuro = intense. I was scared as heck on the first day and quite nervous, but also excited for the unknown.

The minute I stepped onto the ward, I was greeted by a really friendly receptionist who assured my partner and I that the doctors on this ward are really nice. We asked to see consultant X, but was then told that he no longer works at the hospital. What a great start to the day. We then muttered out another consultant name, Dr Y, and immediately the receptionist became very reassuring as she guaranteed us that we will be just fine with this consultant. Apparently he is very friendly and is a great teacher. I was starting to get excited. Right before going to the Dr Y's office we bumped into another consultant, Dr B. I must admit, I was surprised to learn that he was a consultant as he is quite young. He seemed really friendly...and perhaps a bit quite awkward. Then we met Dr Y. My first impression of him was: "What a boss." I know that sounded a bit weird but Dr Y seems to be a very confident/leader-like person. Very calm, and very approachable. He definitely looks serious, but we came to find out that he is a very patient man. Oddly enough, Dr Y quickly set out a schedule and several goals that he would like us to accomplish and what he aims to do with us. I believe this has been the first time where I've been sat down with a consultant and made goals and aims. I actually quite liked that as we are only 3rd year medics (1st year of clinical), so a little bit of guidance is quite nice as we don't really know what we should be doing in the hospital. He also arranged for some time to teach us about neurology/stroke. I was definitely liking the sound of this.

Anyways we then joined Dr B on ward rounds and pretty much got grilled to death by questions. I guess that's his way of teaching. Not exactly the method I would prefer to learn from as I do get quite nervous when put under pressure with a question, but Dr B is a really nice guy so I'm not too scared about answering a question wrong. He wouldn't put you down or look disappointed, he would simply acknowledge and explain the answer to his question. With this method of teaching, I guess things stick in my head for longer as you remember being grilled on that topic and stuff stands out a bit more.

Impressions of the ward? I'm really surprised at the range of ages on the ward. You would expect the whole ward to be elderly people, but to my surprise - there were quite a lot of middle aged patients. Made me realize that stroke isn't an elderly person's problem, but it can be a risk to anyone of any age.  The ward is also extremely friendly and relaxed. You don't feel pressured or watched on the ward. It's also nice that the nurses and junior doctors have welcomed us and do acknowledge our presence. Quite a difference from my last placement where I felt like an ignored object standing in the middle of a corridor looking really awkward and lost. Here, I feel a part of the ward.

I got to admit I have learned loads. I mean LOADS. Information overload. I have learned so much from both Dr B and Dr Y. They are really amazing at teaching. And it's really nice that they show us physical signs and teach us how to classify the signs as we do the ward rounds. I'm definitely looking forward to next week where we will learn more about stroke/neuro. From time to time, I do miss watching surgeries though, but it's good to finally experience a medicine attachment. Not a bad start I guess!

End of Week 2.

Wow this week went by really quickly. One more week and then summer holiday!

So last week wasn't the most productive, so this week I wanted to make sure I get lots of patient histories and examinations done, as well as find a patient for my SSC project. This week I have managed to do about five patient histories and managed to do at least two physical examinations on 3 of the 5 patients. Again today (Friday), was my most productive day. Started bright and early and went to go see a patient my partner and I had taken a history from yesterday. The patient was going to be discharged today so we quickly did all the physical examinations we needed to do for our SSC project. Our SSC project requires us to find a patient where we do a full case history and all physical examinations (Cardio, Respiratory, GI, GALS, and CNS). This patient was extremely nice. I mean he was not feeling well and was quite frail. My partner and I expected him to say "no" when we asked for permission to take a history and examine him, but to our surprise he quickly said "yes" with a big smile on his face!

We first asked why he was admitted into hospital and listening to his history made me feel quite sad. This patient lives on his own and is almost at the grand age of 90 and he had collapsed on his floor at night. Because no one lived with him, no one knew he had collapsed and unfortunately he could not get up off the floor. He spent the entire night on the cold floor and because he had not answered his phone, his son had gotten worried about him and went to see if he was alright. The way the patient described his ordeal made it sound painful and you just feel really bad for the patient. He looked very upset and distressed about collapsing and told us that the pain he had from falling was immense. Whilst talking to the patient, we realized he was quite short of breath and had a constant and productive cough; therefore, we thought we should give the patient a break and would come back and examine him the next day (Friday).

So today we went to see the patient and the nurses told us not to bother the patient because they had just finished ward rounds and had prodded him quite a bit. He also looked quite tired as well and did not look very comfortable. We were then told he was going to be discharged later in the afternoon, so after popping to another ward to join a ward round we went back to the patient and asked if it was alright to do a quick full examination on him. Again, we were expecting to hear a "no" and a "leave me alone!" as he did look quite annoyed; however, he looked at us and promptly smiled and told us that he'll be more than happy to let us examine him. Because the patient looked quite tired, we tried to do our examination as quick as possible to minimize the amount of "prodding" we had to do. At the end we thanked our patient again and he gave us a firm handshake and wished us good luck with our career. He said it with so much sincerity and kindness it definitely brightened up my day. If I was in the patient's position I definitely would not let two medical students poke around and bother me if I was not feeling well. What a kind man and I got to say, my partner and I had learned a lot from this patient as he had an extensive history and was an immense pleasure to talk to.

Also now being my 2nd week of venturing the hospital, I realized that the staff in the ward I am placed in are starting to recognize me and it was nice to see them saying "Hi" to me. Makes me feel like I am not invisible and that the staff do remember there's a medical student wandering around. I even had a lovely chat with one of the nurses as well and finally felt welcomed. Worst part is that next week is my last week and I feel like I am starting to get the hang of being in my ward and getting to know people. The turnover is so quick as each placement only lasts 3 weeks for us (total of 4 placements). Can't believe that next week is my last week! I feel like I've still got lots of stuff to do. I still have to be assessed on doing a patient history and a physical examination by a doctor. As well, I need to find another patient for my second SSC project with some sort of ethics and law background to it, such as discussing patient confidentiality, DNR forms, etc. Not only do we have to do that, but also we need to find our consultant. We haven't seen him since Monday in theatre as he is away for the rest of this week. He said he'll be back next Monday and my partner and I will have to chain him down (as he can vanish into thin air in a blink of an eye) and hopefully arrange a meeting with him on Wednesday morning as he will be free. I will definitely make the most of my final week and I still haven't been in clinic so I'm going to try really hard to go to one next week. It should be good. And then...I'll be HOME! Haven't been back since winter holiday and I'm starting to get really homesick.

Anyways sorry for the long post. Will update next week if I have time!

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!

First Year Medicine - OFFICIALLY DONE.

Great news - I PASSED! Yay! I managed to pull a 4 as well so I was quite pleased when I saw my mark. Sadly my celebration with my other friends kind of abruptly stopped an hour later when we got a phone call from one of our good friends that he has failed and need to do resits. We were quite shocked as this guy worked and studied quite hard and it was shocking to see someone who worked so hard has failed. It was definitely a sobering thought and snapped us out of our "cloud 9" and really showed us that it could have been easily any of us who fails. I really felt bad for him as he does not deserve to fail due to all his work (he started studying PRIOR to Easter break). We all wish him the best of luck and pass his resits!!!

On a more happier note, I just got home from a massive party - Drink Medsoc Dry. It was amazing. Who can complain about 50p drinks?! Started drinking at about 7:45pm and decided to leave at 10:30pm. We decided to head to a club to have some real fun and went to a great club. Great music and it was PACKED. There were so many people there! Eventually more medics showed up at the same club and it was a lot of fun. Definitely had a great night with friends and it was a good "goodbye" as I am leaving tomorrow so I won't see my friends again until September.

All in all, what an amazing first year of medicine. It is a great subject and one I definitely enjoy. Medicine has a reputation that it is hard/difficult and I have generally thought it was quite okay. After exams I realized how tough the subject can get and definitely do NOT underestimate the exams. They can literally ask ANYTHING. Learned loads this year - especially on how to study and work throughout the year so next year when it comes to exam time I won't be pulling super late nights and almost to the point of cramming.

2nd year of Medicine - Bring it on.