All entries for Friday 22 December 2017
December 22, 2017
Buzzwords…
In my last blog I spoke about the change of pace when I started the Psychiatry block. There is certainly less urgency about the psychiatry block but the days are no less intense and most days at the end of placement I’m just as exhausted as any of the shifts I worked in A&E.
My clinical partner and I are currently assigned to a male adult inpatient psychiatric ward. Like any other ward most days there is a ward round, however instead of a group of people peering at a patient from the end of the bed, there is a ward round room where patients come to speak to the team about their care. Sometimes the doctors or nurses may request to see someone, other times there are prescheduled appointments. Some of these meetings can be brief, patients who have improved a lot who are discussing spending more time at home and are nearly ready for discharge. In contrast, some of the patients may be seen for over an hour, taking a complex history from a newly admitted patient, as well as a collateral history from family, followed by time to discuss the plan among the clinical team. In other areas of medicine while patient centred care and involvement of family and friends is preached, it isn’t always practiced. However, in psychiatry every consultation starts with the same, important question: how are you feeling? Often patients don’t know how to answer this, but their response is key. Key to knowing if they are ready for discharge, if their home leave was a success, or if their new medication is having side effects or if their symptoms have improved. The involvement of family and friends is strongly encouraged and where these are lacking other means of social support are utilised in the form of community psychiatric teams and social services as well as other members of the MDT or multidisciplinary team (a key buzzword for exam purposes!).
One of the things I really like about Psychiatry is that it takes a truly holistic approach to patient care. While a patient’s main reason for being in hospital may be their psychiatric condition the doctors know that treatment of this alone won’t solve the issue. Another key buzzword for medical school exams is treating patients using the “bio-psych-social model”. You need all three to treat any condition effectively, this applies to any medical condition but it is particularly pertinent in psychiatry. A psychiatric illness may require medication or even ECT treatment (the biological approach), but a patient may also benefit enormously from psychological support. The social approach can be very complex in psychiatric patients, patients may need help with housing if they are homeless or may not know how to claim all the benefits they are entitled too. They may need help finding a job or gaining work experience. These are things the doctors and nurses discuss at ward round with the patients, finding out what their hopes and ambitions are for when they are discharged.
Mental health services may be severely under pressure and underfunded, but it’s great to see the psychiatric team help a patient with every aspect of their lives to achieve the best management of their psychiatric illness. Perhaps psychiatry is where all the MDT and Bio-psycho-social magic really does happen!
Joshua Galvin
22 Dec 2017 10:14
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Tags: Joanne Mbchb Warwick Wms
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The Acute Block… the Pressure Mounts
We’ve recently started our acute-medicine block, which is a very descriptive title. This block has us students at the very thin end of the wedge as far as treatment and patient management goes, and the block also has the reputation for being one of the most enjoyable of all specialist clinical placements. I can see why – it’s fast-paced, exciting and the timetable is laid out really, really well. Our opportunities are wide and varied and all of the doctors whom we work with are willing to help and get us involved. It’s a very collegial and inclusive atmosphere, at least from what I’ve seen so far. This is a branch of medicine that I could really see myself liking a lot.
The people designing the timetables have worked hard to give us exposure to a huge variety of disciplines at both a large hospital and a smaller one. We have rotations in the Intensive Treatment Unit (ITU), in the ‘majors’ and ‘minors’ departments of both large and small hospitals, a couple of shifts on the resuscitation wards, and a whole lot of other things as well. It’s really interesting. I feel like we are also being taken very seriously as medical students finally – perhaps when you reach the final year, doctors know that you’re more experienced and are happy to supervise you in your role but give you less guidance – which is exactly what we’ll need as F1s. On several shifts, I have been given the opportunity to clerk patients (conduct an initial history and examination) and present my summary along with differential diagnoses and a management plan to the doctor in charge, and I have always got useful and worthwhile feedback afterward.
I recently spent some time on the resuscitation ward within the larger of our two hospitals, and loved every minute of it. It was an evening shift – this is so that we can see patients at the busiest time of the day – and there were loads of interesting presentations. The purpose of resus is to stabilise each patient and make sure that all life-threatening conditions are neutralised before they are transferred to more appropriate care – which usually means another ward within the hospital. On my most recent resus shift, we saw several people with complicated fractures – treating these involved taking x-rays, putting on emergency plaster casts and sometimes re-applying the cast if the subsequent x-rays weren’t showing what the doctors wanted to see. I got to hold lots of legs in place for stability whilst wet slabs of plaster were slapped on and wrapped up. All I can say is: thank goodness for aprons!
Our time on the ITU was a little more sedate, although still very interesting. We saw patients who had usually come from A&E (although not always) and had usually suffered severe injury, several of which were to the brain. Several patients were in induced comas whilst their serious medical issues were treated. It took a little bit of getting used to, but once we were stuck in, it was really very exciting. We still have four weeks left of the acute block, and I’m really excited for what we have yet to see – watch this space!
Joshua Galvin
22 Dec 2017 10:10
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Getting Stuck into the Acute Block
We’re in the middle of the acute block and it is really living up to its vaunted reputation. I am having a great time and learning a lot, and it seems like everyone in my rotation is having similar experiences. My clinical partner and I are lucky because most of our teaching and shadowing sessions are at a very large regional hospital; this appears to mean that we see lots of injuries and presentations that wouldn’t normally go to a regional hospital. There is a lot of trauma and some fairly serious acute medical presentations, and we get to see a lot of very interesting and cool things.
I’ve found that we are really encouraged to get involved once we tell the A&E staff that we are students, and this is a huge advantage of the acute block and being so far advanced in our careers as students. When we’ve been observing/helping out in A&E, most of our time is split between A&E minors (where people present with not-very-acute conditions) A&E majors (where people come for acute and serious but not life-threatening presentations) and A&E resus, which is geared toward stabilising patients, saving their lives and initiating immediate management before passing them along to more appropriate parts of the hospital.
Each area has its positives: the minors area is the least hectic and stressful of the three, which means that when we see patients here, we can spend more time focusing on their presenting complaint without the added pressure of it becoming urgent very quickly. In the majors area, the energy level is really high, and there are loads of doctors around, so as students we get support as soon as we need it and clinical contact all the time. And the resus area gives us the opportunity to see the bare face of medicine, where people’s lives need to be saved immediately. Both my clinical partner and I have seen some really eye-opening trauma in resus – let’s just say that I am absolutely never, ever getting on a motorbike in my life.
I feel that we’re lucky because our acute block is coming rather late in Phase III (much luckier than had it been our first rotation, for instance). It being so late has equipped us to consolidate a lot of the medical knowledge that we’ve built over the phase and indeed over the preceding years, and we also have a lot more confidence speaking to patients and getting straight to the point about what information needs to be uncovered. Unlike lots of other degrees, basically everything that we’ve learned throughout our time in medical school (especially a lot of the anatomy and physiology from Phase I) is relevant at all parts. The vocational nature of the degree means that everything is applicable at all times – we were quizzed the other day on the mechanism of action of bronchodilators, which we learned in November of our first year! In any event, the acute block has exceeded my expectations, and I am seriously considering a career in emergency medicine because of it
Joshua Galvin
22 Dec 2017 10:09
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