Ward Etiquette.

My last post was for non-medical students so here is one for medical students. Going onto the wards is quite an exciting thing if it is your first time, but there are a few "unwritten" rules that medical students should know about. Either you learn about em by hearing it from an upper year...or learn by experience (eg. being told off by a nurse). So I'll save some of you from any embarrassment/telling off by doing a quick post on ward etiquette.

Hopefully your medical school will make the hospital aware that you'll be coming to their department for your clinical attachment, BUT there will times where the ward/hospital will not be expecting you. First rule is to turn up to your placement ON TIME - even better: show up a bit earlier. Nothing more frustrating than expecting a student and them either not showing up or showing up late. It is important to leave a good impression. Nurses are quite good at passing on feedback to doctors/consultants. Last thing you want to be known is as a disrespectful student. These nurses can actually make your life very difficult.

Next must-do is to dress appropriately. You guys probably won't believe me but I have had colleagues who show up to placement in a hoodie. Yes it is cold outside, but before showing up on the ward where all the patients are...take off your hoodie and look presentable before you go into the ward/hospital. Some of the staff/patients won't know you have just arrived and no one wants to be seen by a poorly dressed student. I'm pretty sure if you were a patient, you wouldn't want to see a doctor who is in a hoodie/not looking presentable. I've also had friends who have been told to get off the ward because their shirts were not ironed. For girls, heard of female medical students getting kicked off the wards for showing too much cleavage and for short skirts. General rule is that if you bend over you shouldn't be able to see anything in the mirror. Skirts should be below the knees. I save myself from the hassle and wear trousers instead of skirts...plus it isn't very glorious when you're in a skirt and you have to help move a patient or lift things (which I do a lot of as I feel bad watching nurses struggle).

I will always remember this key point: "You will never get kicked out of medical school for not showing up to one day of placement, BUT you can get kicked out for showing up to placement hungover/drunk". If you had a night-out the day before and you're hungover/still drunk...take a sick day. The quote just stated...says it all.

Nothing frustrates me more than seeing my colleagues disrespect the staff. I'm usually quite a modest student, but I like to think I am quite successful with getting along with staff/consultants. My friends always ask me how I become so friendly with consultants/why doctors/staff treat me like a friend. Simple: Respect them first. It is quite annoying to see some students being very arrogant. I was on a placement with another student and he thinks he is the best thing to have graced the hospital. When a consultant asks him to get something...he goes and tells the nurse to get it for him. He treats the nurses like slaves and at the end of the day - you are just a medical student. I have stated it in many many posts that we are probably the LEAST important thing in the entire hospital. I have had a professor talk to us about "knowing our place in the hospital". You cannot go wrong by assuming that you are less important than the janitor. And ever since that day - I go onto the wards and respect every single member of staff. Nurses are your saving grace. If they like you - they will make your life so much easier. Best bit is that they sometimes remind you of things and bail you out if a consultant is being a bit "uncooperative/unfriendly". A way to show your respect to the nurses? Everyone loves a cup of tea. I have lost count the number of teas I have made for the nurses. In my last Obs and Gynae placement...I made 2 pots of tea for all the midwives every 2 hours. They made my life so easy and they passed on very good feedback to my supervisor as well.

When talking to patients - first ask the nurses if the patient is a good patient to talk to. Always introduce yourself before going to talk to the patient. Put yourself on the same level as the patient so go get a visitor chair and sit down. Don't sit on the patient's bed. When asking for the name of the patient always ask them how would they like to be addressed. Some of the more elderly patients usually would like to be addressed as Mr/Mrs, etc. Smile when you talk to the patient and just act professionally. When you leave - make sure you take your chair with you and put things back where you found them. I personally like to ask the patient if there's anything they would like me to get/do for them. It's the little things that makes a difference. Usually their tables are too far away or they need something to drink. If they want something to drink, make sure you ask a nurse first before fetching something just in case.

Finally - the most daunting bit: interacting with the consultant. Some like to make your life very difficult. I like to think it is because the consultant didn't want students and was forced to have them...or he/she is overly bored. My good friend said dealing with consultants is a skill on its own. I like to give myself 2 weeks to get a feel of what the consultant is like. Is he/she friendly? Is he/she talkative? Is he/she interested in teaching? One way to put yourself in the good books of a consultant is obviously the things I have listed above and just smile and be relaxed. Don't be arrogant. And DO NOT correct a consultant...no matter how tempting it is...it is a bad idea to correct a person who has been in the job for 20+ years. It is fairly embarrassing to get corrected by a student. Unless the care of the patient is at risk - I usually keep my mouth shut. If there is really any discrepancy - go look it up on the internet/textbook or ask the registrar/SHO. At the end of the day - the consultant is still a person. It's like dealing with teachers back at school. Yes they teach...but they still have a life. No one wants to talk about medicine 24/7. If you manage to figure out that the consultant is fairly relaxed - chat about regular stuff. People always find it amazing that 90% of my conversations with consultants are random banter. Make yourself enjoyable to be around. Put yourself in their shoes. Be considerate.

Anyways basic ward etiquette. Seems like common sense - but you will be surprised how many students forget about these basic things. Assume you are back in school and the medical staff are your teachers. Address them properly. Address the consultant by their last name unless they make it known that they want to be known by their first name. I have yet to call any of my consultants/supervisor by their first name. I tend to address registrars by their first name as that's how they introduce themselves to me. Can't go wrong by being polite and respectful. It is a pain but I think it is fair.

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.

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!