All entries for Friday 21 July 2017
July 21, 2017
Scrubbed up…
It’s now Specialist placement 5, the last block of year 3, and for me it’s my care of the surgical patient block. Despite all those years watching Grey’s Anatomy I’m not particularly interested in surgery and have spent most of my time in theatres so far thinking about lunch or how much my feet hurt! At the start of the surgical block I was definitely less than enthused and thinking more about my upcoming holiday in august than the anatomy of the abdominal wall, but I must say I have been pleasantly surprised!
I’m based at George Elliot, which is a small district hospital. Over the 6 weeks we rotate round 3 different surgical specialities: Urology, Colorectal and Breast Surgery. I’ve been with urology for my first 2 weeks, learning about different types of disease that can affect the prostate, bladder or kidneys that may require surgical intervention rather than medical intervention from the nephrologists. Clinics in urology are really varied; there is some overlap with gynaecology in women suffering from incontinence due to pelvic floor damage and there are lots of patients referred through the fast track system for worrying symptoms such as blood in the urine. Learning about the different investigations for these patients was something we covered last year but this year there is more focus on learning about the surgical management options, and how you decide which is best. Being able to get scrubbed up in surgeries means you can get much closer to the action and see the anatomical structures, and really appreciate the complexity of some of the operations. One operation to remove a patients kidney that had a tumour, lasted 6 hours, watching the surgeons avoid major blood vessels and control bleeding as they dissected the large tumour was fascinating. In contrast, another operation I observed was to remove a bladder tumour, which took less than half an hour-but to the patient these are both major, life saving operations.
As well as spending time in clinic and in theatres with the surgeons and anaesthetists we have also spent time with the junior members of the team while they are on call. The surgical senior house officer (not an FY1 but not a registrar yet) carries a bleep and sees all new patients that come into A&E or are referred by GP’s who may need to see a surgeon. This was a great opportunity for my clinical partner and I to take the history, examine the patient, come up with our differential diagnosis and decide what investigations we would want. The SHO was brilliant and gave us really useful feedback and helped us understand things we might have missed and importantly asked us to justify our investigations, something we have to do in our exams!
So 2 weeks in and I fairly sure I still won’t ever be a surgeon but so far I’ve learnt lots, which is always good with the prospect of 4th year approaching, and as an added bonus I haven’t fainted in theatres (yet)-win win!
Joanne
Luke Pemberton
21 Jul 2017 12:24
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The Broad Church of the CMP Block
It’s hard to believe, but we have passed the halfway point in our Specialist Clinical Placement (SCP) blocks, although I wouldn’t yet say that the end is in sight yet! Our fifth, and current, block is called “Care of the Medical Patient” (CMP) and is the block with the broadest focus yet. The purpose of this block seems to be to cover the general-medicine topics that we don’t see in a lot of our other blocks. For instance, we’ve already had blocks covering musculoskeletal health, paediatrics and obstetrics & gynaecology, all of which are very focused in nature. This block is much broader in approach, and the hospital where we are working has done a very good job of distributing us very widely across multiple disciplines.
What I’m really liking about this block is that we are exposed to a lot of topics in more detail than we ever were in Core Clinical Education (the latter two-thirds of Phase II). It’s great, and I’m really glad that (finally) so much of my work in Phase II seems to be bearing fruit. For instance, we are getting focused haematology teaching for the first time – so we are learning about lymphomas and leukaemias, factor deficiencies and all sorts of stuff that we briefly skimmed over last year. And the best part is that now we get to go to clinics and see patients in the flesh who live with these conditions. I learn best when there is an actual human being with whom I can associate a particular condition. It just helps tremendously when I can picture a patient in my mind to recall presentation, examination and treatment. As a case in point, I feel much more comfortable with lymphomas and leukaemias than I did before starting this block.
For my first placement in the first CCE block of Phase II, I spent about ten weeks on a respiratory ward at a local hospital. At this point, I had been a medical student for about fifteen months. It seems so very long ago now! This was probably my favourite placement, and I really felt at home in this learning environment. I was lucky enough to spend another day in a respiratory ward again just this past week, and it reminded me of how much I liked it. The presentations were fairly common (exacerbations of COPD, advanced pneumonia, bronchial carcinoma, etc.) but it was great to come back to a respiratory setting with a lot more experience under my belt. I felt much more comfortable working with the doctors and nurses and also felt much more comfortable understanding which investigations were being done and way. I hope to see more respiratory medicine in the future.
I have also spent some time observing neurology clinics for the first time; this was another area in which I had read a great deal but had seen hardly any patients. Now I can confidently say that I have seen and can hopefully recognise cases of myasthenia gravis, epilepsy, early-stage Parkinson’s disease, multiple sclerosis and many other common neurological conditions. Attending neurology clinics definitely brought more than one flashback to Block 3 of Year 1 (Brain and Behaviour), especially the direct and indirect pathways for movement regulation and how they can become inhibited. Thankfully I didn’t have to worry much about the various tracts that go up and down the spinal cord – that’s a headache for another day!
John
Luke Pemberton
21 Jul 2017 12:10
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