All entries for April 2017
April 25, 2017
Paediatrics and Prescribing
We’ve had a few nice weeks so far on the paediatrics ward as part of our Child Health rotation. It’s been a really interesting experience and our timetable has given us a nice distribution between clinics, ward rounds and teaching. The hospital we’re based at has a substantial paediatrics ward, and patients come there for all sorts of reasons. We’ve seen patients with serious infections, patients with severe asthma episodes, patients with mental-health problems and lots of other issues that cause them to be hospitalised. Some are routine, and others are a lot less common – which is of course really cool for us students!
Most hospital wards have the reputation of being functional places without much emphasis on décor or surroundings. The paediatrics ward at our hospital is nothing like that, though. The designers have given a lot of thought to making it a friendly, welcoming and non-intimidating place for children. It has a jungle theme, and there are pictures of wild animals and even palm trees throughout. The floor has a long snake and lots of lily pads for frogs to jump off of! The nurses’ uniforms have a little bit of extra colour around the collars and sleeves to make them seem less severe and more playful. As a child, I definitely would have thought it really cool to spend time in such a nice ward and it’s great to see that so much effort has gone into helping the patients and their families feel comfortable.
We don’t just spend time on the paediatrics ward, of course. We also have spent a lot of time on the Special Care Baby Unit (SCBU), in which newborns with specific problems will spend some time after birth. A lot of the issues relate to either congenital abnormalities, infections or complications brought about by prematurity. We’ve seen some pretty strong babies, and the care that they get from the nurses and doctors is absolutely stellar. It’s also a great opportunity for us to see conditions in real life that we’ve only read about – including some very interesting heart malformations and manifestations of infections.
We have bi-weekly academic days as well, at which we address general topics applicable to all students in all rotations (not just paediatrics). Most of the time, this covers prescribing for core medical systems – as this will be a large part of our jobs as junior and senior doctors. I remember as a first-year student (and even before I enrolled), I honestly thought I would never be able to keep all of the drug names straight. But with time and exposure, it gets much, much easier to remember them all and their indications (I’m still working on contraindications, and interactions, and side-effects, and doses, and everything else). But the instruction that we get on academic days is very useful, and I expect it will serve us well into the future.
John
Luke Pemberton
25 Apr 2017 15:58
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April 10, 2017
Starting on the Paediatrics Ward
We’ve just started our third specialist clinical rotation and it’s focused on Child Health. This is actually a really diverse block. The medical school in combination with our base hospital puts a lot of effort into making sure that our timetables show expose us to various different aspects of paediatrics, so I’ve been to allergy clinics, development clinics and a few others so far – and it’s only been two weeks. We’ve got a lot more of this coming up over the following month. I wasn’t quite sure what I was expecting, but the care and the patients’ needs seem much more varied than I realised. I guess that’s what medical education is for.
In addition to clinics, we are also expected to spend time on the paediatrics ward and on the special-care baby ward (known affectionately as SCBU), among other places. I’m really looking forward to SCBU and to seeing some of the neonatal presentations. We will get to learn how to perform baby checks and see lots of the presentations that affect babies who are born unwell. Although it’s not an always-pleasant thing to confront, it’s part of someone’s health journey. I know that they’re in the best hands possible when admitted in the SCBU and each patient’s best shot at a happy and healthy life comes from being looked after by the staff there. I cannot wait to see it in action.
Taking patient histories (a mainstay of clinical contact, and something we learn from the first week of the first year) can introduce a different challenge with paediatrics patients: I’m rarely talking to one patient, I’m talking to a patient plus a parent and sometimes two! Sometimes the child is non-verbal, sometimes a grandparent comes along, sometimes the parents don’t speak English as a first language, and so on. These are all real-life factors that can make clear communication a more vital and significant part of the history. Furthermore, it can be really intimidating for a child to have lots of adults paying looking at them and asking questions about their health. We really have to ensure that we make it as non-threatening an environment as possible for the best interests of the patient, and all of the doctors on this ward are experts in this and teach us well.
Additionally, there are lots of components to a paediatric history that don’t have so much relevance in adult histories. For instance, we gather information where possible from parents about the child’s pregnancy and delivery, immunisations, developmental milestones and other social factors such as family life, schooling and siblings. These all contribute to a complete health picture for the patient and help us understand their background better than we otherwise would. It’s really good that the med school give us this practice; we need to have it down to an art by the time finals roll round!
John
Luke Pemberton
10 Apr 2017 14:36
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April 03, 2017
The End of the GP Block
My clinical partner and I have come to the end of our GP block and it’s been a lot more enjoyable than I ever expected. The doctors at our surgery have all been lovely and extremely keen to teach us, and we’ve seen all sorts of different things come through the door. It’s been extremely eye-opening and educational in equal measure.
It seems that everyone expects GP surgeries to see coughs and colds and little else, and whilst we have seen our fair share of upper-respiratory-tract infections (URTIs, as we know them), we have been involved with a whole lot more. I think the less-than-entirely-complimentary way in which the profession can be viewed by other doctors is not always entirely justified. We have seen extremely vulnerable people who depend on their carers and doctors to help maintain their quality of life. We have seen difficult situations with depressed or anxious patients managed expertly by excellent and empathetic doctors. We have dealt with gynaecological problems, with issues involving sexual health and problems caused by deprivation – and all this in just one day.
The beauty of the GP role is that many times you just don’t know what’s going to come through the door. Just because a patient has a history of ovarian cancer doesn’t mean that she’s going to come in about that; she very well may have just stubbed her toe the night before (more than likely she has an URTI…). It really does require a nimble and agile doctor who is able to think on his or her toes. I liken it to having a massive flowchart in your head, which starts to be followed from the moment you lay eyes on the patient. Of course, every consultation starts with a “Please tell us why you’ve come in today…”, but ideally assessment of the patient comes about from the moment you lay eyes on them. We’re taught this from our first week at med school: does the patient look weak, ill or frail? Do they walk with a frame, stick or cane?, and so on. It really is a huge, complex and multifaceted profession – and one that I have perhaps a little begrudgingly come to love.
I remember one survey which we conducted not long after we started at med school; of the 170-odd people in the cohort, no more than five or six said (or would admit?) that they were interested in becoming GPs. And going into med school, I never thought I’d find the profession attractive. I still am not very, very interested in it, but even I cannot deny that this role is a lot more attractive than I once thought. I guess that’s one point of the block: we have spent several weeks seeing how the career of a GP operates and the myriad things that go on behind closed doors – not just the ten-minute consultations, of course! – and it has been an integral part of our education. I hope that every student who is lucky enough to take part in a GP block at some point in their WMS career gets as much out of theirs as I have out of mine.
John
Luke Pemberton
03 Apr 2017 09:26
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