Barriers and Professionalism?

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.

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