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.
Showing posts with label reflection. Show all posts
Showing posts with label reflection. Show all posts
Tuesday, November 20, 2012
Friday, July 20, 2012
Old Age.
Had quite a weird week...weird as in a week which really made me change my perspective on things.
I got to go visit a nursing home for people with dementia. I had previously volunteered in a nursing home before medical school but I didn't work with patients with dementia. I went to visit a 75 year old man who has vascular dementia and had just moved to this new home. The nursing staff were worried about him as he had spent the entire night pacing up and down the hallways continuously for 15 hours non-stop. I went into his room and sat down in front of him. His room was fairly small. One single bed. One small wardrobe in the corner. 1 night stand. 1 cabinet. This man just sat in his chair, hunched over. He wore a baseball cap so I couldn't see his face. As he sat there I saw him dribbling on to the floor. It was almost like he wasn't even there and was staring at his shadow. I looked over to his night stand and saw 2 pictures of him and his family. In the pictures, he was middle-aged and appeared to be a very proud man. He stood in the pictures full of confidence. He looked very happy. Then I looked back at the patient, still dribbling and staring at the ground. He looked quite frail. I eventually said hello to him and he didn't reply. I moved his hat a bit so I could see his face. He still stared at the ground. I asked him what is his name and he replied me without looking up. I tried to carry out a very basic conversation with him, which proved difficult as midway through he started mumbling. I couldn't quite understand him and he quickly stood up. He walked to his wardrobe and was very unsteady on his feet. He had a very unbalanced waddling gait. I asked him where is he going and he replied: "Home". I kindly told him this is his home and to sit down again. As he came back to his seat I looked into his eyes and he didn't look happy. He didn't really even look like the man in the picture by his bed. As he sat down, he went back to staring at the ground and stopped talking to me. I just sat there looking at him. I thought to myself: Is this how residents here pass their day? I found it pretty sad as they just sit in a fairly tiny room. This particular man, if he isn't pacing up and down the hallway, he is sat in his chair almost lifeless. Really made me think that people need to live their life to the fullest. Appreciate the things and people around them. I felt bad for this man. His life seemed pointless. He was confused. Ageing is a scary thing. Just comparing this man to the man in the pictures - it is almost like night and day.
Then when I went back to the GP practice, I met another lady who desperately needed a total hip replacement. Her x-rays showed severe osteoarthritis (OA) as in it was bone on bone. The patient had a shortened right leg as well due to the OA. On palpation of the greater trochanter...it felt like you were running your hand over a bag of marbles. You could feel the osteophytes! Range of movement was severely decreased and the patient had pain on extension and flexion. Actually any movement made the patient jump. It was fairly remarkable that she doesn't need to use any aids to walk, but you can tell she is struggling. Unfortunately, the surgeons do not want to operate on her due to her health and as well she does not have anyone at home to look after her. She told me that she has outlived her entire family and there was no one left. She explained to me that she tries her best to get through the day, but usually just stays at home to avoid any hassle and because her hip hurts too much. She has tried all sorts of analgesics and even tried topical treatments (which doesn't work, which is no surprise as her hip was bone on bone). I asked her what does she do every day if she doesn't really go out. She told me she just sits there and read and told me that her life has become very boring and that there isn't much meaning to it any more. She talked about how active she was when she was young and gradually as her hip got worse, she couldn't go out for walks in the park or even do her gardening.
If you think about it, when I start reaching the peak of my career, the majority of my patients will be the elderly. In general the population would be quite old as the current generation of "baby boomers" are starting to reach retirement age. I think it is key for medical students to learn how to deal with the elderly. It is frustrating to hear students go: "I don't like old people. I hate talking to them." I sometimes can't help but say back to them: "Well start liking it as the population ain't getting any younger." I'm sure I have said this before, but I quite enjoy talking to the elderly. They always have a great story to tell or have some pretty wise things to say to you. They are all so strong as they have been through so much. They seriously need a heck load more respect from people of my generation and the younger generations. Ageing is the fact of life and there isn't any way to avoid it (well unless something really tragic happens to you at a young age...). Sometimes it is just hard to see what the future lies for you when you see so many elderly patients.
I got to go visit a nursing home for people with dementia. I had previously volunteered in a nursing home before medical school but I didn't work with patients with dementia. I went to visit a 75 year old man who has vascular dementia and had just moved to this new home. The nursing staff were worried about him as he had spent the entire night pacing up and down the hallways continuously for 15 hours non-stop. I went into his room and sat down in front of him. His room was fairly small. One single bed. One small wardrobe in the corner. 1 night stand. 1 cabinet. This man just sat in his chair, hunched over. He wore a baseball cap so I couldn't see his face. As he sat there I saw him dribbling on to the floor. It was almost like he wasn't even there and was staring at his shadow. I looked over to his night stand and saw 2 pictures of him and his family. In the pictures, he was middle-aged and appeared to be a very proud man. He stood in the pictures full of confidence. He looked very happy. Then I looked back at the patient, still dribbling and staring at the ground. He looked quite frail. I eventually said hello to him and he didn't reply. I moved his hat a bit so I could see his face. He still stared at the ground. I asked him what is his name and he replied me without looking up. I tried to carry out a very basic conversation with him, which proved difficult as midway through he started mumbling. I couldn't quite understand him and he quickly stood up. He walked to his wardrobe and was very unsteady on his feet. He had a very unbalanced waddling gait. I asked him where is he going and he replied: "Home". I kindly told him this is his home and to sit down again. As he came back to his seat I looked into his eyes and he didn't look happy. He didn't really even look like the man in the picture by his bed. As he sat down, he went back to staring at the ground and stopped talking to me. I just sat there looking at him. I thought to myself: Is this how residents here pass their day? I found it pretty sad as they just sit in a fairly tiny room. This particular man, if he isn't pacing up and down the hallway, he is sat in his chair almost lifeless. Really made me think that people need to live their life to the fullest. Appreciate the things and people around them. I felt bad for this man. His life seemed pointless. He was confused. Ageing is a scary thing. Just comparing this man to the man in the pictures - it is almost like night and day.
Then when I went back to the GP practice, I met another lady who desperately needed a total hip replacement. Her x-rays showed severe osteoarthritis (OA) as in it was bone on bone. The patient had a shortened right leg as well due to the OA. On palpation of the greater trochanter...it felt like you were running your hand over a bag of marbles. You could feel the osteophytes! Range of movement was severely decreased and the patient had pain on extension and flexion. Actually any movement made the patient jump. It was fairly remarkable that she doesn't need to use any aids to walk, but you can tell she is struggling. Unfortunately, the surgeons do not want to operate on her due to her health and as well she does not have anyone at home to look after her. She told me that she has outlived her entire family and there was no one left. She explained to me that she tries her best to get through the day, but usually just stays at home to avoid any hassle and because her hip hurts too much. She has tried all sorts of analgesics and even tried topical treatments (which doesn't work, which is no surprise as her hip was bone on bone). I asked her what does she do every day if she doesn't really go out. She told me she just sits there and read and told me that her life has become very boring and that there isn't much meaning to it any more. She talked about how active she was when she was young and gradually as her hip got worse, she couldn't go out for walks in the park or even do her gardening.
If you think about it, when I start reaching the peak of my career, the majority of my patients will be the elderly. In general the population would be quite old as the current generation of "baby boomers" are starting to reach retirement age. I think it is key for medical students to learn how to deal with the elderly. It is frustrating to hear students go: "I don't like old people. I hate talking to them." I sometimes can't help but say back to them: "Well start liking it as the population ain't getting any younger." I'm sure I have said this before, but I quite enjoy talking to the elderly. They always have a great story to tell or have some pretty wise things to say to you. They are all so strong as they have been through so much. They seriously need a heck load more respect from people of my generation and the younger generations. Ageing is the fact of life and there isn't any way to avoid it (well unless something really tragic happens to you at a young age...). Sometimes it is just hard to see what the future lies for you when you see so many elderly patients.
Thursday, April 12, 2012
Expectations.
Everyone has his or her own expectations for certain things. In my case: I had my own expectations for this placement (Obs & Gynae). Before I even started this new year and embarked on my specialty placements, I had already made up my mind about some of the specialties. And I have once again been proven wrong and again shouldn't be making judgments before even starting a specialty. You would think I would learn by now not to judge so early. Before I started O&G I constantly told myself that it is going to be my worst placement ever and I will truly hate it. I was not looking forward to it. I even marked it on my calendar as: "Ugh." To make things short, I had extremely low expectations for O&G. And you know what, sometimes I like being proven wrong. Don't get me wrong I have respect for the specialty, it just never clicked with me. You get this whole: "Awkwardddd women's health...it's going to be weeeirdddd!". I think in general anything that deals with bits downstairs is a whole taboo subject.
So I went back to my archives and read up on my blog post that I typed up before starting the specialty:
And I can't really call it luck anymore with getting a nice/easy going/chill supervisor. I've said it before, but at the end of the day, a consultant/supervisor is a person as well. Yes they too have expectations for me and I try to meet their expectations, but because they are also people, you can certainly have some good banter with them. I got to know my supervisor and probably saw my supervisor the most out of the rest of my group so I guess he got to know me better than the others. Definitely made the attachment more enjoyable as I could feel that my supervisor genuinely cared about my learning and it's also nice to get to know your supervisor as it'll keep my blood pressure and heart rate from shooting through the roof whenever I see him. In some placements I would purposely avoid my supervisor just to avoid getting told off/being quizzed. For this placement, I didn't mind bumping into my supervisor on the ward or even in the corridors. I think we also had a "mutual understanding". He knew what my personality is like and what sort of student I am so he didn't form unrealistic expectations for me so that put me at ease and allowed me to feel comfortable in the hospital. Again it is a two-way process. I know when my supervisor didn't want to see me and I guess I'm fairly good at telling when I can be cracking jokes. I guess it is a skill I definitely cherish as like I said I'm a "happy-go-lucky" and a bit of a prankster/joker who is quite cheeky as well...so I definitely need to know where to draw my line with each person.
All in all, I think this attachment has worked out really well and essentially exceeded my expectations. I have definitely gained a heck lot more respect for the specialty and it has definitely changed my view on the specialty. It really ain't that bad at the end of the day. The doctors are also pretty cool people as well so it was good. The hospital was great as well and was really good at making sure medical students are learning and interacting. Following a doctor around is one thing, but being able to assist and do things is a whole other ball game that makes your attachment so much better. This could be the very last time I'll be doing O&G for the rest of my career, but hey if I do get a rotation in it in the future, I won't mind doing it again. Hate to say this, but this is easily the best placement I have ever had so far. Who would've thought I would be saying this 7 weeks later. I wish all my placements can be this good. Now I'm scared about my future attachments as this placement has set the bar so high. How can I go back to just following a doctor around? How can I go back to standing in theatre not scrubbed in and peering over the surgeon's shoulder? Will I get along with my next supervisor how I got along with my supervisor now? What are my expectations for my next placements now?
Thank you for proving me wrong and giving me the best 7 weeks of my medical degree. What a placement. Damn. Can't believe it is over. The one time I am dreading for the end of a placement. I guess one good thing about this is that I finally get a much needed 3 week holiday.
Side note: Will be on holiday for the next 3 weeks and I, most likely, will not be posting as I really need a break. Sorry!
So I went back to my archives and read up on my blog post that I typed up before starting the specialty:
"My next placement is Obstetric and Gynaecology. I'm actually really scared for this as I don't really know what to expect as well. Should be interesting as I'll definitely be able to go to theatre (YES!); however, it'll be dealing with quite a sensitive subject so I'll definitely need to change from being playful in Paeds to professional for this specialty. Hopefully I'll be able to compose myself and try to enjoy this specialty as much as I can. First I'll need to go to a week of lectures before commencing my placement. I much rather having lectures first before going to placement as at least I'll have some basic knowledge prior to going to the hospital so I won't look like an idiot in front of the doctors. I also hope I'll have a really nice/easy going/chill supervisor. My last supervisor on paediatrics was very easy-going, which made the placement much more enjoyable. Crossing my fingers that I'll be just as lucky this time with Obs+Gyn. Another 7 weeks of Obs+Gyn and then Easter Holiday! I can't wait for holiday. To be honest...I kinda need one now!"I really can't blame myself for being scared as it is a sensitive subject, but in terms of changing my behaviour from playful to professional was something I was a bit unsure about as I'm naturally a "happy-go-lucky" so I was a bit nervous for that change. Thinking back through the last few weeks, I haven't had so much fun on placement. Even more fun than my paediatric placement. Yes I have to be professional and build a good rapport with patients to talk about more sensitive things, but I realized that if I'm having a good time, the rapport comes naturally and you as a person become a bit more easier to approach and get along with. In paeds I was told that it was "written all over me" that I was not enjoying my placement. For this placement, yes I went in knowing I'll hate it, but I really wanted to make sure that I didn't make it obvious that I'm not enjoying the attachment. Because I went in with such low expectations I was open for anything and had little expectations. This actually helped me be a bit more welcome to anything and I think a lot of the staff and my supervisor could see that. I was even told by the nurses that some of the patients thought I was a "breath of fresh air" as I was always smiling on the wards and just enjoying my time. A patient told me that most of the staff look bored, but I look interested and just trying to have fun. Because in my last placement in paeds I looked super bored, it was probably the main reason it took me a bit longer to get to know the staff and interact with the patients.
And I can't really call it luck anymore with getting a nice/easy going/chill supervisor. I've said it before, but at the end of the day, a consultant/supervisor is a person as well. Yes they too have expectations for me and I try to meet their expectations, but because they are also people, you can certainly have some good banter with them. I got to know my supervisor and probably saw my supervisor the most out of the rest of my group so I guess he got to know me better than the others. Definitely made the attachment more enjoyable as I could feel that my supervisor genuinely cared about my learning and it's also nice to get to know your supervisor as it'll keep my blood pressure and heart rate from shooting through the roof whenever I see him. In some placements I would purposely avoid my supervisor just to avoid getting told off/being quizzed. For this placement, I didn't mind bumping into my supervisor on the ward or even in the corridors. I think we also had a "mutual understanding". He knew what my personality is like and what sort of student I am so he didn't form unrealistic expectations for me so that put me at ease and allowed me to feel comfortable in the hospital. Again it is a two-way process. I know when my supervisor didn't want to see me and I guess I'm fairly good at telling when I can be cracking jokes. I guess it is a skill I definitely cherish as like I said I'm a "happy-go-lucky" and a bit of a prankster/joker who is quite cheeky as well...so I definitely need to know where to draw my line with each person.
All in all, I think this attachment has worked out really well and essentially exceeded my expectations. I have definitely gained a heck lot more respect for the specialty and it has definitely changed my view on the specialty. It really ain't that bad at the end of the day. The doctors are also pretty cool people as well so it was good. The hospital was great as well and was really good at making sure medical students are learning and interacting. Following a doctor around is one thing, but being able to assist and do things is a whole other ball game that makes your attachment so much better. This could be the very last time I'll be doing O&G for the rest of my career, but hey if I do get a rotation in it in the future, I won't mind doing it again. Hate to say this, but this is easily the best placement I have ever had so far. Who would've thought I would be saying this 7 weeks later. I wish all my placements can be this good. Now I'm scared about my future attachments as this placement has set the bar so high. How can I go back to just following a doctor around? How can I go back to standing in theatre not scrubbed in and peering over the surgeon's shoulder? Will I get along with my next supervisor how I got along with my supervisor now? What are my expectations for my next placements now?
Thank you for proving me wrong and giving me the best 7 weeks of my medical degree. What a placement. Damn. Can't believe it is over. The one time I am dreading for the end of a placement. I guess one good thing about this is that I finally get a much needed 3 week holiday.
Side note: Will be on holiday for the next 3 weeks and I, most likely, will not be posting as I really need a break. Sorry!
O&G - Done!
One of the most stressful days ever. Let's just say this placement never really got my heart rate and blood pressure up until today (my last day). Waited to do my final assessment with my supervisor and I was really stressed out. Hate waiting around. You see if this was one day earlier, I would not be as stressed out. I was a bit of a smart ass and booked to leave for home 1 day before official holiday. Seriously talk about luck. Supervisor couldn't do my assessment until my final day...5 hours before the departure of my train to go to the airport. Essentially, we are allowed to resit our assessment if our supervisor believe we are incompetent. You would usually resit the assessment immediately or the week after, BUT because we are doing our assessment in the final week on my last day of placement, I don't really get another go. So that means I have ONE shot at this assessment. I pass...I pass. I fail...let's just say that is NOT an option. I essentially needed a bit of skill (to pass the assessment) and a heck lot of luck to not only pass my assessment, but to also catch my train. Doing an assessment is already stressful enough especially when you've got only 1 shot at it. Travelling is also another very stressful thing. Put the two together (assessment AND travelling) is the formula for a heart attack. Yes why should I be worrying about my assessment? I worked hard. I came in every day. Didn't skive. Studied...a bit. Practiced my examination skills quite a bit. So why am I not confident? Simple. Anything can happen eg. bad luck such as getting a difficult patient, blanking out aka brain fart, nerves, etc. I think I'm pretty chill with my supervisor and I don't really "fear" him that much, BUT at the end of the day yes he is a person...but he is also my SUPERVISOR, which I cannot forget. He essentially is the one who determines whether I pass or fail this placement. Kind of hard not to be a bit scared/nervous/stressed/intimidated.
Anyways luckily I passed my assessment and it all went very well. Got all my forms signed off, handed in my locker keys, and next thing I knew, I was saying my goodbyes to the staff and shaking hands with my supervisor: "I guess that's it. 7 weeks. Done. I really enjoyed the placement. Thank you. Maybe we will meet again in the future, maybe not. It was a pleasure to meet you and your team. Thanks again." It was probably the first genuine "thank you" I have said to a supervisor at the end of a placement. These last 7 weeks have opened my eyes and taught me not to judge. I have never done so much active learning in one placement. Best bit: I wanted to learn. I wasn't forced. What a great overall placement. I guess the only way to show your gratitude towards a placement is to work hard and show that you have learned. Actions certainly do speak louder than words. Even my good friend said that if only my supervisor saw what type of student I was on placements and how much I have changed in terms of motivation and work ethic - only then it is obvious how much I enjoyed this placement.
What a placement. Who would've thought.
Anyways luckily I passed my assessment and it all went very well. Got all my forms signed off, handed in my locker keys, and next thing I knew, I was saying my goodbyes to the staff and shaking hands with my supervisor: "I guess that's it. 7 weeks. Done. I really enjoyed the placement. Thank you. Maybe we will meet again in the future, maybe not. It was a pleasure to meet you and your team. Thanks again." It was probably the first genuine "thank you" I have said to a supervisor at the end of a placement. These last 7 weeks have opened my eyes and taught me not to judge. I have never done so much active learning in one placement. Best bit: I wanted to learn. I wasn't forced. What a great overall placement. I guess the only way to show your gratitude towards a placement is to work hard and show that you have learned. Actions certainly do speak louder than words. Even my good friend said that if only my supervisor saw what type of student I was on placements and how much I have changed in terms of motivation and work ethic - only then it is obvious how much I enjoyed this placement.
What a placement. Who would've thought.
Monday, February 27, 2012
End of Paediatrics.
7 weeks have passed which means I am done with my paediatrics placement! To be honest, it actually went by really fast. I got to admit that the first few weeks went by really slowly...to the point I was dreading the placement. Luckily, the placement started to blow by as I got to know the doctors and nurses on the ward and in general felt more welcomed. I think 7 weeks was plenty of time for a taster of the specialty so my impression of paediatrics? Not for me. But I won't 100% remove it from my potential list of specialties as I find the surgical side of paediatrics fairly interesting. On my last day of paeds I had a lecture about paediatric orthopaedics, and to be fair...it seems quite interesting. These surgeons see a lot of different conditions ranging from pathological to congenital conditions. Definitely something I wouldn't mind considering in the future.
Also another reason to celebrate about the end of the placement is that I have passed my placement based assessment!!! I was really nervous for it, but it went really well. Did a full patient history on a boy with pneumonia and did a cardiovascular and respiratory examination on him. I also got a lot of feedback from my supervisor, which was good as I'm constantly trying to improve and do better. I also managed to finish all my essays and reflective writing all in time along with my log book! Really stressful weekend, but everything came together in the end. I was really chuffed with it and after Monday (where everything was due including my assessment), I felt like the world was off my shoulders. I felt so much more at ease and just felt a sense of relaxation. I can finally enjoy the placement again and just take it easy for the last few days on my placement. On top of that, end of paediatrics = end of driving a long way to placement. My next placement is only a 15 minute drive (which is closer than the central hospital from where I live), so I'm excited for that. I no longer have to wake up at a ridiculous time to drive. I've also heard fantastic reviews about the next hospital I will be going to as they like to pride themselves in teaching medical students.
My next placement is Obstetric and Gynaecology. I'm actually really scared for this as I don't really know what to expect as well. Should be interesting as I'll definitely be able to go to theatre (YES!); however, it'll be dealing with quite a sensitive subject so I'll definitely need to change from being playful in Paeds to professional for this specialty. Hopefully I'll be able to compose myself and try to enjoy this specialty as much as I can. First I'll need to go to a week of lectures before commencing my placement. I much rather having lectures first before going to placement as at least I'll have some basic knowledge prior to going to the hospital so I won't look like an idiot in front of the doctors. I also hope I'll have a really nice/easy going/chill supervisor. My last supervisor on paediatrics was very easy-going, which made the placement much more enjoyable. Crossing my fingers that I'll be just as lucky this time with Obs+Gyn. Another 7 weeks of Obs+Gyn and then Easter Holiday! I can't wait for holiday. To be honest...I kinda need one now!
Also another reason to celebrate about the end of the placement is that I have passed my placement based assessment!!! I was really nervous for it, but it went really well. Did a full patient history on a boy with pneumonia and did a cardiovascular and respiratory examination on him. I also got a lot of feedback from my supervisor, which was good as I'm constantly trying to improve and do better. I also managed to finish all my essays and reflective writing all in time along with my log book! Really stressful weekend, but everything came together in the end. I was really chuffed with it and after Monday (where everything was due including my assessment), I felt like the world was off my shoulders. I felt so much more at ease and just felt a sense of relaxation. I can finally enjoy the placement again and just take it easy for the last few days on my placement. On top of that, end of paediatrics = end of driving a long way to placement. My next placement is only a 15 minute drive (which is closer than the central hospital from where I live), so I'm excited for that. I no longer have to wake up at a ridiculous time to drive. I've also heard fantastic reviews about the next hospital I will be going to as they like to pride themselves in teaching medical students.
My next placement is Obstetric and Gynaecology. I'm actually really scared for this as I don't really know what to expect as well. Should be interesting as I'll definitely be able to go to theatre (YES!); however, it'll be dealing with quite a sensitive subject so I'll definitely need to change from being playful in Paeds to professional for this specialty. Hopefully I'll be able to compose myself and try to enjoy this specialty as much as I can. First I'll need to go to a week of lectures before commencing my placement. I much rather having lectures first before going to placement as at least I'll have some basic knowledge prior to going to the hospital so I won't look like an idiot in front of the doctors. I also hope I'll have a really nice/easy going/chill supervisor. My last supervisor on paediatrics was very easy-going, which made the placement much more enjoyable. Crossing my fingers that I'll be just as lucky this time with Obs+Gyn. Another 7 weeks of Obs+Gyn and then Easter Holiday! I can't wait for holiday. To be honest...I kinda need one now!
Thursday, October 20, 2011
The Key is to be Proactive
Have been in placements for about 10 weeks now and I have had many ups and downs as you have read in my previous posts. After looking back at my placements, I've realized that my best experiences had been when I am being proactive. Being active in learning and stepping out from my consultant's shadow. In my first placement in the summer, I put a lot of effort into taking patient histories and doing loads of physical examinations (cardio, resp, and abdo). 2nd placement...did a lot of ward rounds - definitely seen a lot. For comparison sake - first placement I took about 10 patient histories and have done 4 cardiac exams, 3 respiratory exams, and 3 abdo exams. 2nd placement: 1 patient history, 1 shortened peripheral nerve exam. Poor showing in the 2nd placement. Yesterday, I did a group revision session on cardiac, resp, and abdo examinations. I knew how to do those examinations quite well and knew what I was looking for and can easily explain positive findings. The minute we got into neuro and musculoskeletal (MSK) exams...I died a little inside. I didn't know what was going on. Okay well MSK was easy to follow as I'm quite familiar with joints and those tests...but neuro was painful. I obviously didn't know how to do these exams as well as the cardio, resp, and abdo exams and it just felt horrible how lopsided my learning has been. Thinking back - it was because I was really proactive in my first placement. I had put a lot of effort into seeing patients and doing examinations. These last 2 placements - I've been...how should we put it...lazy.
You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.
Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!
You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.
Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!
Thursday, March 3, 2011
Agitated Patient.
As some of you know - I am currently on my 6 week SSC Research Attachment. Today I was lucky enough to go to clinic with my supervisor to get some clinical experience. It was quite a straight forward day. 6 patients - all mainly with osteoporosis. However, one patient does stick out. She is fairly young to be having osteoporosis and the minute she walked in there was a sense of tension. I quickly noticed that she seemed fairly annoyed/agitated. It seemed like she was forced to come and was absolutely not interested about going to clinic.
I have followed/gone to clinics several times and have seen some patients and I luckily have not come across an "agitated" patient before. All the ones I have met are quite nice and did not fuss much about going to clinic.
First question asked to the patient: "Do you know why you're here today?"
Patient: "NO."
Immediately there was a bit of an awkward silence and in your head you're already saying: "This is going to be an interesting one..." Throughout the consultation it almost seemed like the patient was not listening at all and just did not care. At one point I thought she was going to get aggressive and thump my supervisor with her bag! It was such an uncomfortable environment. Throughout the consultation there were no bad news and everything was good - my supervisor and I were smiling and thinking that the patient would be glad to hear the good news and would smile...well she still looked "pissed". My supervisor tried to inform the patient about her treatment options and that everything will be fine and that it is essentially up to her if she wants to follow with the treatment. At no point was he rude or confronting. He was actually REALLY nice and patient. He took his time to explain to her about things and the treatment.
Anyways after a bit, the consultation was done and the patient left - obviously still agitated and annoyed. She was apparently moaning to the nurses about the treatment and all that and was being a bit uncooperative. No joke I had a sigh of relief when she left as it was really uncomfortable. It didn't help that the office was TINY.
Definitely a neat experience and I will definitely encounter some patients who do not want to be in the hospital or at the clinic and will be a bit uncooperative. It was a good learning experience and it is something I will keep in mind. I felt that my supervisor handled it very well and calmly. Thought I'd mention this as I thought it was something different and made clinic a bit more interesting.
I have followed/gone to clinics several times and have seen some patients and I luckily have not come across an "agitated" patient before. All the ones I have met are quite nice and did not fuss much about going to clinic.
First question asked to the patient: "Do you know why you're here today?"
Patient: "NO."
Immediately there was a bit of an awkward silence and in your head you're already saying: "This is going to be an interesting one..." Throughout the consultation it almost seemed like the patient was not listening at all and just did not care. At one point I thought she was going to get aggressive and thump my supervisor with her bag! It was such an uncomfortable environment. Throughout the consultation there were no bad news and everything was good - my supervisor and I were smiling and thinking that the patient would be glad to hear the good news and would smile...well she still looked "pissed". My supervisor tried to inform the patient about her treatment options and that everything will be fine and that it is essentially up to her if she wants to follow with the treatment. At no point was he rude or confronting. He was actually REALLY nice and patient. He took his time to explain to her about things and the treatment.
Anyways after a bit, the consultation was done and the patient left - obviously still agitated and annoyed. She was apparently moaning to the nurses about the treatment and all that and was being a bit uncooperative. No joke I had a sigh of relief when she left as it was really uncomfortable. It didn't help that the office was TINY.
Definitely a neat experience and I will definitely encounter some patients who do not want to be in the hospital or at the clinic and will be a bit uncooperative. It was a good learning experience and it is something I will keep in mind. I felt that my supervisor handled it very well and calmly. Thought I'd mention this as I thought it was something different and made clinic a bit more interesting.
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