All entries for Monday 27 January 2020
January 27, 2020
Term didn’t exactly start out how I wanted it to. I pictured jumping into clinical life, getting to know my consultant and getting to grips with managing hospital life with solo learning. My immune system, however, had different ideas. So, instead of getting sign offs done and (more importantly) enjoying paediatric week, I was at home with a mammoth ear infection (think IV morphine) thoroughly researching the patient journey. However, I eventually got back, managed to set off my hall’s fire alarm cooking biscuits (and suffered the mocking of 90X 18 year olds) and started my clinical life in care of the elderly.
I hadn’t thought much about this speciality to be honest. I was so driven on surgery and neuro that the idea of being on the ward caring for elderly hadn’t taken any of my interest but,now I’m drifting away from the idea of surgery, I found that I loved being on the ward and getting to know the patients there. We arrived at 9am on Monday morning and I felt immediately included into the team which was amazing. You always hear of these horror stories of being left out in the cold as such but it was like we were important to the doctors there. We sat in on the board round which involved a lot of medical abbreviations but thankfully I was able to keep up as I’ve decided to use a tablet to take notes, which means I can quickly google things I don’t understand. The team even stopped at one point to explain lasting power of attorney and what they can do if they feel the appointed person isn’t acting in the patients best interests. We were also alerted to a flu diagnosis on the ward meaning everyone was told to get their flu jab (my clinical partner was virtually dragged by a nurse to get his!). I had mine earlier as I wanted the free pen and sticker to go with it. Even at 23 years old I can’t resist a sticker…..
We were assigned to a consultant and as a group of three took a history, general and focused exam on a patient who had been admitted with shortness of breath. She was lovely and had so much to say so we were struggling to steer the conversation in the direction we needed to. I think it’s being British, we never want to be rude! My history taking has definitely taken a turn for the worse since OSCE’s last year (sorry, Prof Patel!) so I need to review my structure. We were then taken aside and given some tips on OSCE skills and common mistakes to avoid. I had some slight tachycardia during this point as I’m 60% sure the consultant was examining me in my exam last year when I completely forgot to ask patient details!
The rest of the week flew by and I got two sign off’s done. There was a potential third sign off but if I have learnt anything this week, it’s that elderly veins are hard to draw blood from. You can hit the vein and they will not bleed, yet when you remove the needle they bleed everywhere and you panic inside to stop the bleed and not look completely incompetent (totally didn’t happen to me this week).
We have also been in the presence of an amazing F1 who was chasing us around the ward telling us to go and see patients, recommending certain exams to do on them and offering us procedures at every stage. He was lovely and a Warwick grad! It does make you feel like there is a light at the end of this tunnel when you see someone who was once in your boat out there and doing well. He was also teaching us at every stage he could (even getting dragged away by the consultant because they had to get work done). I hope to be like that as an F1 one day. I know I am going home for F1 now just to save costs and be near family so, I will have Kings College and the new Kent and Medway Medical School students to teach so, I am hoping to pass down Warwick Wisdom. If I get there!
I love being able to teach myself the topics we need to know and I am finding it easier to retain information. I just have to get used to being tired after hospital as at the moment all I want to do is go to sleep! I'm looking forward to the rest of the block as I am on O&G, finally going to GP placement and going back into theatre with anaesthetics, a speciality of which is now growing on me. I guess that’s it for me now, good luck to all our amazing final years with their finals! You will all SMASH it!
How is my Psychiatry block treating me? Well, I’m enjoying it more than I thought I would! I mentioned in my last blog about the clinical skills lab; well now I can report back as to what it was like. The skills lab is basically a simulated practice of how we would manage a psychiatric patient. The Medical School get professional actors to act out a “character” and we get a chance to practice taking a history from them as if they were a real patient. The “character” I got to talk to was a patient who had MUS (Medically unexplained symptoms). This is an interesting condition as the character was convinced they had stomach cancer and were experiencing symptoms. However, they had been investigated by specialists and there was no sign of cancer, so the symptoms were suspected to be psychiatric in nature. This doesn’t mean that the patient is making it up at all – in this condition, the patient experiences these symptoms as if they were real. However, they were not due to cancer, and could be eased by psychological talking therapies and psychiatric treatment. It was a difficult one to do as you have to be very careful to listen carefully and acknowledge that the patient IS experiencing these symptoms but also have in the back of your mind that the patient doesn’t have cancer. I wasn’t sure how to do this, but went for something reassuring such as “I can see that the symptoms you are experiencing are distressing for you”. Overall it was a very useful learning experience as psychiatric histories can be difficult.
This week I also had some stressful news – I’ve been hacked! Someone was trying to log into my personal email addresses and social media accounts. Luckily, they didn’t access anything, but it still scared me into changing all my passwords and wiping my laptop and phone etc in case they were bugged. I always think you can’t be too paranoid about these things so I changed everything. I think my paranoia about being hacked in that week probably met the diagnostic criteria for Paranoid Personality Disorder, but hopefully everything is okay now I’ve changed my passwords!
Every Tuesday we have small group teaching on psychiatric topics to help pad out and support the clinical experiences we are getting. This week it was on the topic of psychopharmacology (drugs used in mental health). It was exciting as a lot of the teaching was on how to use these drugs and side effects, considerations etc, which makes it very clear that we need to be stepping up our knowledge into actually managing patients ourselves. It is slightly scary that in a year’s time exactly we will be sitting our final exams and soon after be qualified doctors…yikes! The safety blanket of being a student, where it is perfectly acceptable to say “I don’t know” will be replaced by actually having to look after patients (albeit with support).
On Wednesday of this week we also had a CAMHS clinic (Child and Adolescent Mental Health), where we sat in with a consultant who was seeing children and teenagers. I enjoyed this as the child side of mental health focuses around development and family issues which means that you are not only dealing with the patient, but often parents, school, social services. I really enjoyed this clinic and our consultant was fantastic and very good at explaining what was going on. I think we must have done okay as the consultant then contacted the Psychiatry coordinator and gave some lovely positive feedback about us. Often a lot of feedback in medicine is negative or neutral and rarely given at all, so it really does mean a lot to get some positive feedback. It reassures us that we are doing everything right and gives us a morale boost. At a time of generally low morale in the NHS, positive feedback can be a very powerful tool to tell us when something goes right. One consultant who I worked with in my gap year between my first degree and medicine pioneered “Learning from Excellence” which formalises positive feedback in the same way that incident reporting is formalised. Positivity can be a powerful tool against burn-out and understaffing. Google “Learning from Excellence” to learn more about the philosophy – it may change your perspective and encourage you to offer positive feedback for a good experience. That’s all for this week – remember to say so if you have a good experience!