A Memorable Year.

1 year ago today, I was thankful and nervous at the same time. Last year's exam was probably the largest hurdle of my degree. I didn't do as well as I had hoped in my exam, but still managed to pass. I was incredibly thankful to be able to pass as many of my friends had failed the exam. Some of which had to repeat the year. I made a promise to myself that the year 2012 will be my comeback year. I was determined to start on the right foot and to never make the same mistakes again.

This year zoomed by. I believe I made leaps and bounds in terms of knowledge and self-confidence whilst on the wards and in clinics. I still got to give lots of credit to my placement in Orthopaedics. I cannot be more thankful to my supervisor. Even my friends have noticed that after my Orthopaedics placement, I was a different medical student. I was no longer afraid to speak up. I was no longer afraid to participate and be proactive. I realized that if you don't ask, you will never know what will happen. The worst answer you can get when asking something is "No". What is there to lose...other than a hurt ego. So one tip for all of you is to be confident. Don't be afraid to ask for help. Again, the worst someone can say is "No". If the answer is "no", just shrug and move on and don't take it personally.

As you move through the degree, Medicine slowly dominates your life and you really got to make an effort to have a social life. As the months pass and you have some free time to reflect, you realize your friends start to drift away and it may get a bit lonely at times. Medicine needs a lot of dedication, but I cannot emphasize enough how important it is to relax and take some time out. Giving yourself a break does not necessarily mean you have to go take a vacation. Taking a break is different for everyone. It may involve going to do something you enjoy or meeting up with friends, or even just spending some time at home to relax and watch TV.  I didn't realize how important it is to take a break until this year when I have finally experienced a whole year of clinical placements, one after another. Work - Life balance. I know many people in my year who are taking a year out to do a BMedSci next year, not because they want to do research, but because they have burnt out.

To top off my memorable year, just earlier today I received confirmation that I have been accepted to present a my research poster at a national conference. Really unexpected as it's quite competitive, so I'm absolutely chuffed. What a way to finish up the year!

In general, I have made many new friends, matured as a person, and gained valuable skills for the future - I think this has probably been one of my most memorable year of my medical degree. Despite the many ups and downs throughout the year, looking back - overall it has been a very good year.

Got to thank those who have made my year so memorable and those who made my experiences so much better. Cheers to 2012, bring on 2013!

Happy New Year!

Psychiatry - Final Week

This placement went by QUICK! I think it was the fact that the placement wasn't too bad and that I was quite busy doing my other work - time has just flown by. To be honest, I haven't seen too many exciting things as I had hoped to have seen. There's always a lot of misconceptions about each specialty and I think psychiatry is no different. Before I started the placement I was a bit unsure what to expect. I was a bit scared as on our first day we were each given a personal "alarm" which we would put on our belt loops. In addition to those alarms, when we entered the ward, we got another alarm which has tracking on it as well. You can't help but think that psychiatry might not be the safest specialty. We were also taught a lot about risk assessment when interviewing a patient. I remember we got a tutorial on where to sit and what to look out for in a room. We were told to always look out for objects that can be easily thrown and to sit near the door but not with our backs towards the door so if we need to escape we can just go out without turning around.

Okay yes, there are some "dangerous" patients who are known to be quite aggressive, but I never really felt "in danger" while on the wards or in clinic. I guess the only time I felt a bit "iffy" was today in clinic. The final patient I saw on my psychiatry attachment is known to have a very short temper and when he snaps - he snaps in a big way (throw objects, get violent, etc.). As the consultation went on, I could tell the patient was starting to get agitated and worst bit - I was sat furthest from the door and the patient was sat between the door and I (so much for remembering about risk assessment). To be honest - the clinic room wasn't appropriately arranged so there wasn't much one could do other than hope for the best. The consultation came to an end and for no reason the patient just "lost it". He lashed out but thankfully he didn't throw anything and instead stormed out the door and slammed it with a considerable amount of force. You could actually hear him leave the clinic as he was slamming every door along the way. I expected it to happen but it wasn't a nice situation to be caught in knowing there isn't really anywhere to go other than curling up into a ball.

Other than that incident - all the patients I have seen are all quite "alright". Despite some having a history of violence/aggression, these patients all seemed fairly cooperative. We are told of the ones who we shouldn't go speak to as they aren't cooperative but the "okay" ones are fairly normal. Of my 6 weeks in psychiatry, there hasn't been any major incidences. I'm sure more incidences/violence occur in A&E than in psychiatry. I think the one thing about psychiatry is the need for patience. Some of the patients are great historians...some are terrible and will not admit to anything/are not cooperative. With new patients - the clerking can take up to 1 hour and most of these inpatients don't have the patience to speak to you for an hour. I personally don't even have the patience to ask questions for an hour/listen to their history for an hour. I find it very time consuming. The number of times I have nearly fallen asleep during a consultation has been ridiculous. I drift off not because it is boring, but it's the fact that sitting and listening to a history for an hour is very difficult. Again with this attachment, there wasn't much I could do other than observe, but the good thing I had over GP was that when in the hospital - I can actually wander around and am not constrained to one building/area. Psychiatry is definitely different and I have definitely learned a lot since it is a new topic. I'm fairly certain it isn't something I can do, but it is quite interesting as you see a range of people and personalities.

Unfortunately I don't really get a break between this placement and the next other than a 3 day weekend. My next placement will be in Care of Old People - specifically Orthogeriatrics. Talk about luck. I'm actually really looking forward to it as I'll get to see and deal with something I'm interested in and maybe I can sneak off and see a few surgeries as well. I also know the team in the department - so I don't need to endure the whole awkward introduction/getting used to the ward/staff. It will be a short placement but I think it will be one that will pick my motivation back up and get me going again just in time for exams. Eek!

Psychiatry - Weeks 3 + 4.

So I'm finally past the halfway point for Psychiatry and to be fair, it isn't that bad. I mean nothing can get any worse than my GP attachment. Anyways...I finally went to the ward and spoke to a bunch of patients. I spent a week in the Substance Misuse Unit and it was really interesting. It was interesting to speak to the patients and to hear about how they have abused drugs/alcohol. It was shocking to hear that most of these patients have started using drugs since the age of 12! I had one patient who told me: "Any drug you can think of, I've tried it."

There was one particular male patient who stuck out for me. He is a 50 year old male (who looked 80 years old) and he was trying to detox off of methadone. He has tried almost every drug you can think of and at the age of 13 had already experimented with LSD. He was actually quite pleasant to talk to and it was interesting to hear about his forensic history. It was crazy to hear that he has been convicted many times and have served several prison sentences. What stuck out for me was his memory. Due to the many many many years of drug abuse, his memory is horrendous. His short-term memory was fairly poor and when doing the Mini Mental State Examination (MMSE), he scored 16 which is very low and abnormal. I'm not kidding - I spoke to him for almost an hour to get his history/why he is in hospital and then left for 20 minutes and came back to do the MMSE. When I came back to do the test, he had already forgotten who I am and thought I was a social worker! It was definitely a bit of a curve ball as I knew his memory wasn't great, but I didn't think he would already forget who I am after speaking to him for an hour and only had left for 20 minutes. Furthermore, because the patient had been injecting for so long, his legs are completely wasted. He has ulcers all over his leg which won't heal as he has poor blood supply to his legs and has suffered with DVTs. When you look at him, he looks unwell, tired, not with it, etc. Apparently on admission he looked like a ghost who was completely out of it. It makes you realize how bad drugs can affect a person. He looks so much older than what he really is and I actually double checked his date of birth with him to confirm that he was only 50! It was incredibly hard to believe.

Also during the 2 weeks I went to the regular ward and spoke to a few inpatients. It wasn't particularly interesting, but I realized that some of the patients don't know why they are in hospital and refuse to accept that they are in hospital for a mental illness. On top of that, I realized that in psychiatry, you have to build good rapport with the patient to get just a decent history as there are a lot of personal questions that you need to ask. In a psychiatric history, you have to ask about their childhood and about their personal life such as relationships and any possible attempts of suicide/self harm. Some of the things you need to ask are quite touchy and personal and I find that quite difficult. At the end of the day I think as a medical student you just need to find a way to word personal questions and be prepared to get an awkward answer or no answer at all.

So at the moment, the placement is starting to pick up, but as usual, once things start getting productive - it means it is coming to the end of my attachment. 2 more weeks left and then onwards to Care of the Elderly (which I'm actually quite excited about as by chance I am placed in Orthogeriatrics).

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!

Penultimate Year.

"Hi, my name is - and I am a 4th year student doctor."

How time flies. I still remember when I first step foot onto the wards in first year and introduced myself as a first year medical student - it was almost like yesterday! Now, I unwillingly have to introduce myself as a 4th year. I quite liked introducing myself as a 3rd year to patients and to doctors/nurses. I feel like we get a bit more sympathy and leeway. As a 3rd year, we can always pull the: "Sorry it's my first year of clinical.", when we make a mistake. As a 4th year - expectations are higher and mistakes will be looked down on. I feel like 4th year is the "real deal". People expect you to know your place in the hospital and know what you are doing. Questions won't be as well appreciated and you will be much more independent. It's actually quite frightening! As a 4th year - people who know that your course is 5 years will know that as a 4th year, you'll be in your penultimate year and pull the: "You'll be graduating in a year or so - come on, you should know better!"

So I'm starting psychiatry and will on the specialty for 6 weeks. We just had a week of lectures on psychiatry and it seems pretty interesting. It's also nice to learn something completely new as well. The past lectures we've had were more of a refresher and a bit more clinical, but wasn't completely new. We have never learned about psych so it was good.

Had my induction at the psychiatric hospital and it seems promising. It seems really organized and we've got a binder full of info. We've also got schedules for our next 6 weeks. Something so simple is well appreciated as that means I can plan my life. It's a shame other placements can't give our schedules that far in advance. Got a fairly easy week - mainly at clinics. Bit nervous as psych is so unfamiliar and new. Also scared about being quizzed. Yikes. Got to do some reading asap!