April 25, 2017

Paediatrics and Prescribing

We’ve had a few nice weeks so far on the paediatrics ward as part of our Child Health rotation. It’s been a really interesting experience and our timetable has given us a nice distribution between clinics, ward rounds and teaching. The hospital we’re based at has a substantial paediatrics ward, and patients come there for all sorts of reasons. We’ve seen patients with serious infections, patients with severe asthma episodes, patients with mental-health problems and lots of other issues that cause them to be hospitalised. Some are routine, and others are a lot less common – which is of course really cool for us students!

Most hospital wards have the reputation of being functional places without much emphasis on décor or surroundings. The paediatrics ward at our hospital is nothing like that, though. The designers have given a lot of thought to making it a friendly, welcoming and non-intimidating place for children. It has a jungle theme, and there are pictures of wild animals and even palm trees throughout. The floor has a long snake and lots of lily pads for frogs to jump off of! The nurses’ uniforms have a little bit of extra colour around the collars and sleeves to make them seem less severe and more playful. As a child, I definitely would have thought it really cool to spend time in such a nice ward and it’s great to see that so much effort has gone into helping the patients and their families feel comfortable.

We don’t just spend time on the paediatrics ward, of course. We also have spent a lot of time on the Special Care Baby Unit (SCBU), in which newborns with specific problems will spend some time after birth. A lot of the issues relate to either congenital abnormalities, infections or complications brought about by prematurity. We’ve seen some pretty strong babies, and the care that they get from the nurses and doctors is absolutely stellar. It’s also a great opportunity for us to see conditions in real life that we’ve only read about – including some very interesting heart malformations and manifestations of infections.

We have bi-weekly academic days as well, at which we address general topics applicable to all students in all rotations (not just paediatrics). Most of the time, this covers prescribing for core medical systems – as this will be a large part of our jobs as junior and senior doctors. I remember as a first-year student (and even before I enrolled), I honestly thought I would never be able to keep all of the drug names straight. But with time and exposure, it gets much, much easier to remember them all and their indications (I’m still working on contraindications, and interactions, and side-effects, and doses, and everything else). But the instruction that we get on academic days is very useful, and I expect it will serve us well into the future.


John


April 10, 2017

Starting on the Paediatrics Ward

We’ve just started our third specialist clinical rotation and it’s focused on Child Health. This is actually a really diverse block. The medical school in combination with our base hospital puts a lot of effort into making sure that our timetables show expose us to various different aspects of paediatrics, so I’ve been to allergy clinics, development clinics and a few others so far – and it’s only been two weeks. We’ve got a lot more of this coming up over the following month. I wasn’t quite sure what I was expecting, but the care and the patients’ needs seem much more varied than I realised. I guess that’s what medical education is for.

In addition to clinics, we are also expected to spend time on the paediatrics ward and on the special-care baby ward (known affectionately as SCBU), among other places. I’m really looking forward to SCBU and to seeing some of the neonatal presentations. We will get to learn how to perform baby checks and see lots of the presentations that affect babies who are born unwell. Although it’s not an always-pleasant thing to confront, it’s part of someone’s health journey. I know that they’re in the best hands possible when admitted in the SCBU and each patient’s best shot at a happy and healthy life comes from being looked after by the staff there. I cannot wait to see it in action.

Taking patient histories (a mainstay of clinical contact, and something we learn from the first week of the first year) can introduce a different challenge with paediatrics patients: I’m rarely talking to one patient, I’m talking to a patient plus a parent and sometimes two! Sometimes the child is non-verbal, sometimes a grandparent comes along, sometimes the parents don’t speak English as a first language, and so on. These are all real-life factors that can make clear communication a more vital and significant part of the history. Furthermore, it can be really intimidating for a child to have lots of adults paying looking at them and asking questions about their health. We really have to ensure that we make it as non-threatening an environment as possible for the best interests of the patient, and all of the doctors on this ward are experts in this and teach us well.

Additionally, there are lots of components to a paediatric history that don’t have so much relevance in adult histories. For instance, we gather information where possible from parents about the child’s pregnancy and delivery, immunisations, developmental milestones and other social factors such as family life, schooling and siblings. These all contribute to a complete health picture for the patient and help us understand their background better than we otherwise would. It’s really good that the med school give us this practice; we need to have it down to an art by the time finals roll round!


John


April 03, 2017

The End of the GP Block

My clinical partner and I have come to the end of our GP block and it’s been a lot more enjoyable than I ever expected. The doctors at our surgery have all been lovely and extremely keen to teach us, and we’ve seen all sorts of different things come through the door. It’s been extremely eye-opening and educational in equal measure.

It seems that everyone expects GP surgeries to see coughs and colds and little else, and whilst we have seen our fair share of upper-respiratory-tract infections (URTIs, as we know them), we have been involved with a whole lot more. I think the less-than-entirely-complimentary way in which the profession can be viewed by other doctors is not always entirely justified. We have seen extremely vulnerable people who depend on their carers and doctors to help maintain their quality of life. We have seen difficult situations with depressed or anxious patients managed expertly by excellent and empathetic doctors. We have dealt with gynaecological problems, with issues involving sexual health and problems caused by deprivation – and all this in just one day.

The beauty of the GP role is that many times you just don’t know what’s going to come through the door. Just because a patient has a history of ovarian cancer doesn’t mean that she’s going to come in about that; she very well may have just stubbed her toe the night before (more than likely she has an URTI…). It really does require a nimble and agile doctor who is able to think on his or her toes. I liken it to having a massive flowchart in your head, which starts to be followed from the moment you lay eyes on the patient. Of course, every consultation starts with a “Please tell us why you’ve come in today…”, but ideally assessment of the patient comes about from the moment you lay eyes on them. We’re taught this from our first week at med school: does the patient look weak, ill or frail? Do they walk with a frame, stick or cane?, and so on. It really is a huge, complex and multifaceted profession – and one that I have perhaps a little begrudgingly come to love.

I remember one survey which we conducted not long after we started at med school; of the 170-odd people in the cohort, no more than five or six said (or would admit?) that they were interested in becoming GPs. And going into med school, I never thought I’d find the profession attractive. I still am not very, very interested in it, but even I cannot deny that this role is a lot more attractive than I once thought. I guess that’s one point of the block: we have spent several weeks seeing how the career of a GP operates and the myriad things that go on behind closed doors – not just the ten-minute consultations, of course! – and it has been an integral part of our education. I hope that every student who is lucky enough to take part in a GP block at some point in their WMS career gets as much out of theirs as I have out of mine.


John


March 27, 2017

2 blocks down, just 6 more to go!

I can’t believe I’ve reached the end of my second specialist clinical placement, 2 down, just 6 more to go! I enjoyed my time on the paediatric ward. Paediatric history and examination is obviously very different to adult medicine, the differential diagnosis can also be completely different which takes some getting used to! I’m also not used to being around babies or young children so I was quite nervous around them at first but over the 6 weeks after taking lots of histories and examining lots of children of all ages I’m pleased with how much I improved. I can make a neurological exam a fun game and can see the tonsils of the iratest of toddlers and even get nods to yes or no questions from a stubbornly silent child.

I’m now leaving the relative safety of the children’s ward and moving back into the world of adult medicine, starting with the Obstetrics and Gynaecology block. Last year in Core Clinical Education we spent several shifts on the labour ward and with the community midwives, I got to see lots of babies been born and attended antenatal and postnatal check-ups with the midwives. In the O&G speciality block in Phase 3 we will spend some time on the labour ward but will also be in the clinics seeing women with problems during and after their pregnancy. On the gynaecology side, we will be in theatre and clinics seeing a variety of conditions that affect women of all ages.

As well as being in hospital I’ve been busy in my role as president of the Psychiatry society. We’ve had two events in the last few weeks that we organised with the GP society. Both events were on topics that we don’t receive much teaching on in medical school, sexual abuse and eating disorders, both taboo subjects that we as future healthcare professionals need to know about. Our Sexual Abuse Awareness evening had a talk from a Paediatrician who specialised in safeguarding children as well as a talk from a representative from a local charity CRASAC that supports victims of sexual abuse Hearing practical advice about how victims of abuse are assessed and supported by the health service and powerful stories from survivors who receive ongoing support from CRASAC was really powerful and generated a lot of discussion. Hearing personal stories helps us as medical students to understand these sensitive issues so we can be better prepared to help our patients in the future who may have experienced these issues first hand. The same was true of our Eating disorder awareness evening, where we had a talk from a Psychiatry trainee who has worked at an eating disorder treatment centre and a talk from a BEAT (an eating disorder charity) Young ambassador. Hearing from the young ambassador about their own personal experience of suffering from an eating disorder put the medical information from our other speaker in context and was incredibly moving.  The turnout for both these events was great and everyone had lots of questions. It’s great to be involved in organising these events and inspiring other students to be passionate about often neglected subjects.

I think I’ve said before that one of the best things about medical school is that there is always a society or club that you can get involved in no matter what your interests or passions. Getting involved extracurricular activities does help your CV, but for me it keeps me motivated and stops me getting bogged down in medicine too much. Sometimes you can get to wrapped up in the seemingly never ending cycle of placements, sign offs and exams and having something else to focus on helps me keep some perspective. So here’s to block 3 of 8-bring on Obstetrics and Gynaecology!


Joanne


March 13, 2017

Vulnerability

We’re just over halfway through our six-week GP block, the second of eight Specialist Clinical Placements. Our surgery is a lovely, pleasant place in an area which draws on a very diverse population. We get to see a variety of problems and presenting complaints – although as it is wintertime, we are definitely seeing more than our fair share of coughs and colds. I am slightly relieved, however, as we have been told that hayfever season is just round the corner- it’s such a shame, but unfortunately we are going to miss it!

A lot of GP work involves what we typically think of a GP as doing: there are consultations in surgeries in the famous ten-minute slots (or fifteen minutes, if you’re a medical student). Some surgeries have also started introducing telephone consultations, where they assess patients over the phone (where appropriate, obviously) or home visits, for patients who are very infirm. Our surgery does all of this, and more, and it’s been really interesting watch the different ways in which they engage in the community and serve the members.

It’s probably less well known that many GPs also see patients who are at care homes or nursing homes as part of their daily or weekly routine. We accompany the GPs along on some of these visits for several reasons. We go to get a good feel of how care homes are run and patients’ problems present there. We go to see different ways in which GPs’ knowledge is put to use. We also go to gain an understanding of other patients’ experiences and to see how they live and are cared for.

Recently, we visited a care home which houses patients who have suffered brain injuries. It was very interesting and – I can’t lie – it made a profound impression on me. It made me think of many things at once. I am so happy and we are all so lucky to live in a society where people who are vulnerable (or in some cases completely unable to look after themselves) are still treated with dignity and care. It made me proud that they are still able to get care from the NHS. (I come from a country in which such a thing absolutely does not exist.) Finally, it made me realise that being a good doctor, a good GP, is not just caring for those people with coughs and colds and allergies; it is looking after everybody in society. We are trusted to help and care for those who are vulnerable and it is a massive responsibility. I will never forget visiting that care home, and I will never forget the dignity those patients are given, day in and day out. It made me proud to continue doing what I am doing.


John


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Our Med Life blogs are all written by current WMS MB ChB students. Although these students are paid to blog, we don’t tell our bloggers what to say. All these posts are their thoughts, opinions and insights. We hope these posts help you discover a little more about what life as a med student at Warwick is really like.

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