Introduction to Prescribing
It has been another busy week for my clinical partner and I. Up until now most of our experiences with psychiatry have been in an outpatient and community settings, so we were both looking forward to seeing how acute psychiatric issues are dealt with. This week, we have been placed on an acute psychiatric ward this week, in a Psychiatric hospital. It was interesting being able to sit in on the ward rounds and see the various conditions the team must deal with on a day to day basis. These conditions are amongst some of the hardest to treat medical conditions and include; severe depression, anxiety, mania and personality disorders.
Our consultant was keen that we get involved and gave us the opportunity to practice our history taking with patients where we could get consent, although admittedly it was a whole new experience when compared to your standard history taking scenario. Some of the conversations we had and listened to this week were very emotionally difficult for all involved, and I have huge admiration for the staff and indeed the patients who have to work to improve often difficult situations.
This week we also had an academic day where we were given an introduction to prescribing. I had been looking forward to this for some time, as prior to starting medical school I worked in Pharmacy as a dispenser, so I was waiting for an opportunity for my pharmacy knowledge to become useful! We had lectures which focused on the basics of pharmacology relevant to prescribing, a lot of which was revision from our first-year studies (which feels like a long time ago!) We also had a lecture on some of the pitfalls of prescribing, for example, making sure that you write units in full to avoid confusion and also about some of the common errors junior doctors make. It turns out that junior doctors make 90% of prescribing errors, which I suppose demonstrates both how junior they are and also the fact that most hospital prescribing is done by the juniors. It was all slightly terrifying to think about how much responsibility we will have in just over a year’s time. I know first-hand from my previous work experience how crucial it is to get things right and minimise mistakes to make sure the patient gets the correct treatment.
We also had a lecture on the UK foundation programme, the two-year programme that all UK graduates must complete immediately after graduation. Up until this lecture I had happily forgotten how soon this process kicks off – by the end of this year we will have applied for our first jobs as doctors and ranked the areas we would like to work. Currently I want to stay in the West Midlands after graduation as I have had experience of many of the hospitals in the area, and I feel this will make the transition from student to junior doctor smoother. Allocation is completely points based, with 50% of your mark coming from your achievements at medical school and the other 50% coming from a test called the Situational Judgement Test. This test is sort of a test of reasoning. For example, the questions will be something along the lines of “This thing has happened. What is the most appropriate thing to do?”. We get lots of practice questions and cases in CBL, lectures and other aspects of the teaching so I hope that I will pick up the knack to it.
Next week is last week of our psychiatry placement, which means that we have to finish our sign-offs and say goodbye to our faculty team before moving on to our Acute placement block. Looking ahead at our timetable for Acute it looks to be a busy block, with lots of long days and night shifts. Some of these are in A+E, and others on acute medical wards. After Psychiatry, which is a very separate field to “physical” medicine, I have to admit that I am excited to get stuck in and have some exciting experiences on the very front-line of Medicine. However, it will be stressful – here’s hoping that my knowledge from exams comes rushing back….