5 Down 1 to Go.

Yesterday was the last day of my Orthogeriatric placement. Was a bit bummed out as I've gotten to know the junior doctors quite well and I enjoyed my placement (despite it being only 2 weeks). By being on the Geriatric ward, you realize all the ethical problems and how cost of care can be so high for these patients. For example - hip fractures cost the NHS 1.7 million pounds per year. The problem is that when these patients turn up, they don't just get an operation and then get discharged after a few days. Older people require a bit more care as they tend to suffer from other medical conditions such as vascular disease (MI, stroke, etc), diabetes, etc. Along with needing to continue treating their co-morbidities, these patients are more susceptible to hospital acquired infections (eg. pneumonia) so essentially it becomes a vicious cycle for these patients. Majority of the patients on the ward stay in hospital for a month which is quite a long time. Care 24/7 for 4+ weeks...the costs do add up.

I was probably most involved with ward rounds in this placement than any other placement I've had so far. I was quite keen to actually help out as I know I do get bored quite easily if I just stand around. I got to write in the patient notes and you just feel a slight bit more responsible while on placement. It sounds a bit sad, but it's quite satisfying signing off on something. I mean as a medical student, we never really get to sign off on anything so it's nice being able to sign off the notes you made in the patient notes during ward round. You also feel a sense of contribution as well, which is a nice bonus. Also good practice for the future as well - will be doing lots of paperwork in the near future...

I think the main problem about being on a geriatric ward is that the turnover rate is quite low so the ward round usually consists of a quick check-up and if there are any new concerns/changes. This made me find this week a slight bit more dull than my first week. The only thing is that now I know the patients, but there isn't anything new to see. Their improvement is also quite slow so I must admit this week's ward round was a bit less interesting.

I mean overall it was nice to be back on a proper medical ward and doing "medical things" as I've spent the whole year in very specific specialties. There was a lot of general medicine and it made me realize how much I have already forgotten (quite scary especially when exams are just around the corner too!). All in all these 2 weeks helped me get my sanity back and I managed to grab some motivation back - well enough to take me through to exams. Now I've got 2 weeks off before my next and final placement - Neurology. Neuro will be tough but I'm quite lucky that I've had an attachment in Stroke medicine last year so I shouldn't be too lost on the ward.

2 weeks to dig my head into my books and do some proper revision. Procrastination mode - on. Need to focus!

Care of the Elderly.

So I've started yet another placement (5 placements down, 2 more to go) and this placement is "Care of the Elderly". Out of coincidence and sheer luck I've been placed in Orthogeriatrics. Majority of the patients on the ward are patients who broke their hips (neck of femur (NOF) fracture (#)). Because this placement is only 2 weeks, it's a really quick taster and for me it's a bit of time to get my sanity back as I really enjoy orthopaedics so it's nice to just go back to something I'm quite familiar with.

Essentially I've got 10 days to learn and see everything I need to know to care for the elderly...great. Pretty rushed. And on top of that, get to know the staff on the ward which in general takes a bit of time to warm up to. First day - I met my consultant who is really nice so that was good news. The junior doctors are also really nice and chilled out as well and very understanding as they know we've got exams coming up so they aren't too bothered. They are also quite keen to get us involved in terms of helping them do jobs and getting involved in ward rounds (taking notes, looking at obs charts, drug card, etc.). To be honest, I've never been so involved on the ward...ever. It's also a bonus as I can get my clinical skills logbook signed off as I'm getting lots of opportunities to do clinical skills like venepuncture, cannulas, catheters, ABGs, etc. Really enjoying that and it's good practice. On top of that, I've been quizzed on osteoporosis and surgical management of NOF #s, but having done and attachment in orthopaedics (hips), for once I can actually answer questions with ease and confidence. It's actually quite a nice feeling to be able to answer questions...wish my knowledge was that sound with everything else in medicine...

Because I'm on Orthogeriatrics, the team works closely with the orthopods so we have to attend trauma meetings. Actually we don't have to attend trauma meetings (completely up to us as it starts quite early in the morning). I didn't get a chance to attend any trauma meetings during my attachment in orthopaedics, so I was quite keen to check them out as it does have a bit of a reputation. The benefit of having done my attachment in orthopaedics, is that the consultants recognize me so they don't question my presence in the meeting (students tend to avoid trauma meetings). In terms of education value - these meetings aren't great, but you get to hear about some interesting trauma cases that have been admitted...some fairly amusing and crazy stories as well. It's also a bit of a shooting gallery as well as consultants do "fire at will" if a trainee says something wrong or doesn't present a patient well. It's all a bit of a laugh/leg pulling, so it's fairly amusing at the expense of a junior doctor/SHO/registrar. Despite the earlier than usual wake up for placement, I don't mind attending. Again this is something I noticed in my orthopaedics attachment. I didn't struggle to wake up for placement during orthopaedics and was never late. I actually looked forward to going to placement - something to wake up to in the morning. If you follow my blog closely, I struggled quite a bit in GP and waking up was a huge struggle. Now in orthogeriatrics and early morning trauma meetings - I'm finding it easy to wake up again. Just feel like there's something to look forward to in the day. It's a nice breath of fresh air especially after two placements that were mediocre (well poor and mediocre).

I also quite like talking to the elderly as they've always got a great story to tell. One patient that stuck out for me this week was an 80 year old gentleman who was in for a left NOF #. He was a very talkative man and I met him the day before his discharge. He's gotten to know the staff on the wards quite well as he's been in hospital much longer than he should have been due to some complications. When the doctors were speaking to the man, he seemed like a genuinely funny and animated guy. He's obviously fed up with being in hospital and very much looking forward to leaving. He's apparently known to be getting quite critical with the doctors as he is sick of getting prescribed more and more medications as he stays longer and gives the juniors a bit of a tough time (in a joking manner though). After telling the patient he will be leaving the next day, and after quite a bit of joking around, he suddenly turned very thankful and grateful. He shook the doctors' hands and thanked each of them for taking care of him and "putting up" with him. It's quite nice to see as these days some patients don't give doctors enough credit and give doctors quite a tough time. It was a small gesture but it definitely put a smile on my face. It's nice to see the appreciation and I think the staff is happy to see him finally able to leave the hospital.

All in all, this week has been a great week, which is a good change as I've always had slow first weeks/things don't go my way in the first week. It's a good start to a very short placement and I'm getting along with the junior doctors so it's definitely making my placement a lot more enjoyable. It's also nice to see some familiar faces as well in the orthopaedics department. Even the secretaries are recognizing me as I've been popping around. Like one secretary said: "It's almost like you never left!". Funny enough it's actually been almost 4 months since my orthopaedics attachment (seems longer than that though!). It's been a good week and I've been getting some good news as well which I'll talk about at a later time.

Sorry for the long post - it just feels like it's been a long time since I've had a good time at placement and fairly happy. Dreading the fact it's only 2 weeks, but I think it's a good motivation booster - in time for exams. Happy reading!

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).

That Time of the Year...Again.

So Freshers Week is literally right around the corner. You're sitting in front of your computer/packing/feeling excited and nervous/etc. A million questions race through your mind: What's medical school going to be like? Am I going to make any friends? What is Freshers like? Will I be able to cope? Will I get homesick?

I am probably considered an "oldie" at university now since I am now in 4th year. Most people who started university with me in the UK have all graduated now...most are working as well...and I'm still in school. I've been through 3 fresher weeks now - I think I can safely say that I'm fairly confident about what goes on in Freshers and what students are usually concerned about. Let's crack a few FAQs. 

What is medical school going to be like?

Medical school is going to be challenging, physically and mentally tough, tiring, and most importantly - FUN. At the end of the day - we are medics. We work hard and party hard, BUT it is essential to maintain a good balance between the two. Don't want to work too hard to the point you burn out within first year, but at the same time not party so hard you end up flunking the year. In the first few weeks of school, it will mainly be a lot of introductory lectures. Unfortunately, your first few weeks will probably be a bit of a shock. First 2 weeks - you'll still be either hungover or on cloud 9 as you are still coming to terms that you are in medical school. Then week 3 comes around and so on...you're in lectures from 9am-5pm. You want to be seeing patients and learning clinical things, etc. Here's the truth - everyone has to take baby steps first so you'll probably spend quite a bit of time learning the basics. The science of medicine more than anything. 

How do I make friends?

I cannot stress the importance of getting out there. Don't just stay in your accommodation. Go out and socialize! I do understand drinking/alcohol culture is not everyone's "cup of tea", but not all socials need to be at a pub/bar/club. In your first week (Freshers Week) there will be a lot of fairs. There will be a medical freshers fair, union freshers fair, sports fair, etc. Go to the fairs and join some societies! Remember all the freshers that attend these fairs will also be looking for friends. Thinking back, in the first few weeks of university was quite overwhelming. Every one seems a bit too friendly. You get so many numbers and emails from people you only say "Hi" to. Great place to start is at your first medical lecture. Go meet your classmates! You'll be stuck with them for the next 5-6ish years...so it's not a bad idea to start getting to know them. If you are a shy person, just think about it - everyone is looking to make friends. To be entirely honest - I used to be quite shy and the week before starting medical school - I was pretty nervous. I didn't know if I will be able to make friends. I'm not exactly the best person to initiate conversations. I can actually be quite quiet and can happily stand in the corner and watch the world pass by. Seeing how I'm in a new country, new school, etc - I knew I have to step out of my bubble and really try hard to make the first move and meet as many people as I can. Not sure what to say? Here's a start: "Hi! My name is _______. So where are you from? Liking *the university/city* so far? How are you finding it?" 

Do I have to party every single day to make friends?

No. I did not go party every night. I think I went out twice (?) during Freshers week. BUT a great way to get to know your flatmates is probably to hang out with them, but know your limits. Sometimes you feel really pressured to go out, but if you aren't comfortable going out - then don't go! Just tell your friends you're going to take it easy for the night and need to finish unpacking. It isn't a crime to take it easy and most people should understand. However, I do HIGHLY recommend going to the Medic Freshers Party. I've been to the union party and the medics party 3 years in a row during Freshers week. The Medics' Party is a lot better. Plus it gives you another chance to meet more of your classmates and probably upper years such as people like me who don't want to give up on Fresher parties! I still fondly remember my first year medics freshers party. The people who I met at the party are still my great friends 3 years later. All I can say about these parties is just to enjoy yourself. Let loose. You're a fresher only once - just go for it! You're away from home. You're officially a medical student! I think these are good enough reasons to celebrate!

I got the welcome pack and everything seems really confusing and overwhelming! What to do?!

Just relax. I have always found the welcome packs overwhelming and exciting. Things start to feel real when you read through the welcome pack. I still remember reading mine and going: "wow...I am going to university. I'm going to be a medical student in a few days. There is a lot of stuff to know...crap." Essentially what schools tend to do is try to cram as much info in a welcome pack as they possibly can. It isn't a bad idea to give it a read before you start university, but you don't have to know everything in it. Introductory lectures/induction will probably cover most of it. How I've always seen things is to just "go with the flow". Just remember if you are feeling scared/nervous - there will probably be quite a lot of other people feeling the same thing. You're not the only one on the boat. 

All in all - in a way Freshers week is overhyped. Keep your expectations low, and you won't be disappointed. How much you will enjoy Freshers Week is solely down to you. You control your life so you go out as much as you need to. But like I've said earlier: you're only a Fresher once so enjoy your time. Celebrate your week. You deserve it. You got into medical school - which was certainly not an easy task. Just think how far you have come to get here. It's also a fantastic time to get to know lots of people. Go join societies and get to know people from other courses. You are at university for 5-6 years so it is important to make the first good step. Relax and just go with the flow! Be excited. It will be a very fun 5+ years of university. It will go by quickly so enjoy it. 

Good luck and enjoy your Freshers week. Also congratulations for getting into medical school.  

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!