All entries for Wednesday 05 July 2017

Fly on the wall

As a medical student, I spend a lot of my time hovering awkwardly behind consultants and other doctors as they see patients on the ward. In clinics, myself and my clinical partner are also squeezed into the room, often sat across from the patient, it feels like a follow up appointment in the form of a panel interview! I am always so grateful to patients and their relatives who are happy to put up with a committee of people on ward rounds and very crowded clinic rooms all so we can learn. I have been even more grateful over the last few weeks during my care of the medical patient block to patients and their families who have allowed me to sit in on clinics where doctors are regularly breaking bad news: the oncology clinics.

Cancer biology was not my strongest subject during my biomedical science undergraduate degree but in medicine it’s not just the underlying cellular and molecular biology that’s important, we need to know all the clinical manifestations so we can diagnose cancer, when to refer and what investigations are needed. So, in this block I decided to make a concerted effort to try and improve my clinical knowledge of both the diagnosis and investigation of cancer and of oncology as a speciality.

One of the clinics I attended was a fast track clinic for suspected lung cancer. GP’s can refer patients with symptoms or signs indicative of lung cancer and they will be seen in hospital within 2 weeks. Patients attending this clinic have often had a chest X ray and in some cases a CT scan before they attend so the consultant can in either reassure the patient or show the patient where the problem is that they need additional information from, perhaps in the form of a biopsy or a different scan. What struck me most in this clinic was the number of patients who were told that they had a suspicious mass in their lung but decided not to have further investigations, many were elderly and were quite clear that they didn’t want to undergo any further procedures. Having these conversations requires a very sensitive and perceptive type of doctor and is a very different type of medicine to what medical students probably envisioned before medical school.

Attending the oncology clinics, patients already knew they had a diagnosis of cancer but often didn’t know what treatment if any was available. These appointments lasted up to an hour and the doctors were clear that the appointment lasted until the patient wanted to leave, they encouraged questions from the patient and their family, and took the time to explain things multiple times. They comforted patients and relatives as they cried at the prognosis and then did it all again for the next patient.

All the time I’m sat in the room, a fly on the wall, observing how the doctor handles the different consultations, learning how they manage these complex patients, but all the while I’m trying my best to not get emotional too and reminding myself that it is a real privilege to be invited into people’s lives to experience their best and their worst times.

Joanne

Luke Pemberton : 05 Jul 2017 11:47 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem