All entries for May 2016

I am training to be a doctor, right?

For many people becoming a Doctor is the fulfillment of a lifelong dream. For myself I remember as a 7 year old in school being asked to draw what I want to be when I grow up and I drew a Doctor complete with white coat and stethoscope. Staring Warwick Medical School was one of the best days of my life, however the relentless lectures and seemingly endless amounts of information soon brought me down to earth with a bump. The one thing that kept me going was the promise of all the clinical, practical medicine in 2^nd year. Now that I’m over halfway through core clinical education I’m starting to ask myself where did all the practical medicine go?

In our GP placements, in particular, I’m struck by the number of medical problems that turn out to be social issues. When taking a history from a stressed out single mother who is having panic attacks due to the pressures of looking after her children alone, one of whom is autistic, I’m left thinking: how can the GP help her? Sure we could think about medication or a referral for counselling but what she really needs is some help at home and some time to herself and unfortunately that doesn’t come in a pill. We also see a lot of cases of anaemia, most of which are caused by a lack of dietary intake of iron. In the area we are in many people have poor diets, some through a lack of education, some through a lack of equipment: one lady didn’t have a working oven as her landlord had still not fixed hers after 3 months! Some people just don’t have enough money to feed themselves properly. Are iron supplements really going to solve that problem?

You may be thinking that social issues are a big part of medicine in primary care but social issues have been causing problems in hospital for a long time. I am currently assigned to a Geriatric (Elderly care) ward at UHCW. Speaking to older patients is extremely satisfying, you get to hear wonderful stories and they often enjoy testing your knowledge by throwing in a few left field answers, especially if they have spoken to medical students before! While the Geriatric ward can be very fulfilling it can also be heartbreaking. Some of the patients are only in hospital because they haven’t been looking after themselves and sadly no one else has either. Patients come in dehydrated and malnourished and with poor levels of self-care. The paramedics who brought them into hospital might have been the first people they have spoken to in weeks. Social issues bring people into hospital but they can also prevent them from leaving. If people aren’t coping at home they need to remain in hospital while packages of care are organized, every extra day that goes by is another chance to acquire a hospital acquired infection. As a medical student I am starting to understand just how complex the healthcare system is and just how many people are involved. All the cogs have to turn together to make the machine work and sadly it is often social care issues that this all come unstuck! As medical students we need to know to navigate this minefield so we can help our patients in the future and stop social inequalities impacting on the health of our patients. I’m training to be a doctor, not a social worker, but I don’t think you can be a good doctor without all the other cogs!

Joanne

Catrin Davies : 27 May 2016 11:56 |  Tags: Joanne Mbchb Patients Social Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Orthopaedics

At the beginning of each CCE block we are assigned to a new consultant, whose job it is to teach us about their speciality and assess our competence in particular areas. The theme for CCE1 was “history and examination”, and the theme for CCE2 is “investigations and diagnosis”. My trust has assigned me to an orthopaedic surgeon for this block, so I’m seeing lots of bone and joint conditions – a lot more than I ever expected to!

Block 4 in the first year was called “Locomotion”, and it was a very anatomy-heavy block. We learned all about the muscles and bones that help humans move, the blood vessels that supply and drain them, and the nerves that control them. It was a very intense five weeks, but since I love anatomy, it was by far my favourite block. Being with an orthopaedic surgeon (or orthopod, as they are commonly known) has brought all of that knowledge back to the fore. My consultant loves to quiz me on random musculature and arteries. Lumbricals? The posterior interosseous nerve? The attachment point of fibularis brevis? It’s all fair game, and my powers of recall have been put under serious stress – but I suppose I had better get used to it.

We see patients in many different scenarios, depending on the nature of their visit. Some patients turn up in the fracture clinic (which actually has little to do with fractures, and apparently more to do with either re-assessment of injuries after surgery or ongoing assessment of chronic conditions). These fracture clinics have themes as well: some are focused on foot-and-ankle injuries, some appear to be more focused on hip-and-knee complaints, and so on. It’s been a really good way to practice hands-on the musculoskeletal examinations that we learned during the first year on real live patients.

Of course, since my consultant is a surgeon, he spends a fair amount of his time in operating theatre as well. I have also been lucky enough to accompany him on a few occasions. He does all sorts of things, from joint replacement to bone revisions to trauma and accident repair. I have seen a few different procedures (mainly joint replacements) and it is amazing – it’s like an anatomy lesson come to life! The knee in real life actually looks like how it does in the diagrams and flashcards. I don’t know why this surprises me, but it’s been fascinating all the same. My consultant also seems to do a lot of x-ray-guided joint injection of steroids – this is because the synovial space for some large joints can be difficult to reach with a needle in the absence of some guidance, hence the x-ray to help show the way.

It’s been a very interesting rotation and I’ve been enjoying myself. I’m not sure I’m cut out to be an orthopaedic surgeon – it seems to take a very specific skillset – but I’m still willing to remain open-minded. In any event, I’m glad to have the chance to see something entirely new.

Megan Earle : 16 May 2016 10:03 |  Tags: John Mbchb Orthopaedics Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Visiting a Hospice

Warwick Medical School put a lot of effort into ensuring that we students spend a significant amount of time out in the community, so that we are exposed to methods of providing health care other than just what goes on in the hospital ward or the GP surgery. One of the very useful exercises we recently completed was visiting a hospice and chatting with one of the patients in its care.

Like most people, the word ‘hospice’ to me has always conjured up images of a slightly macabre place where patients come to live out their days, perhaps somewhat morose but doubtless very serious and sombre. The hospice we visited, however, was entirely different from what I expected. It was an extremely comforting, welcoming and supportive environment. There were inpatients who were looked after by the staff, but there were also groups who attended the ‘day hospice’ (including the patient whom we interviewed). The day hospice is a programme which hosts individuals from the community who are facing terminal diagnoses, and helps them participate in workshops, games, crafts and other therapeutic and palliative activities one day per week. It gives individuals far more support than they would have on their own, and helps them manage their end-of-life care with dignity and compassion.

This hospice also put a lot of emphasis on patient wellbeing and peace of mind – and for that of family members, too. There was a wellness room, several alternative-therapy practitioners generously volunteered their time to assisting patients (there were Reiki healers, acupuncturists and many others), and there was even a handful of occupational and physiotherapists to provide help and assistance to patients in need. For the handful of inpatients, the hospice also provides separate relatives’ accommodation so that they can focus their thoughts elsewhere. The most humbling thing about this hospice was not even the fact that it depended on donations for 80% of its operating budget – it was that across its network, it relied on the kindness of over 2,000 volunteers to help with the day-to-day running (in addition to the paid staff, of course).

Visits like these help me to get a huge amount from the community-day exercises and are helping me to become a much more well-rounded doctor. It was really important and valuable to see care managed outside of a hospital setting; it became very clear to my clinical partner and me that having a hospice environment which people attend voluntarily enabled them to manage their life course in the way best suitable for them – which is really the essence of patient-centred care. Hospital wards are great places in many ways, but I wouldn’t think that most are very relaxing or stress-free, and thus appreciating the hospice as a useful recourse to patients who are in need of them is a key component of our medical-school education.

Megan Earle : 06 May 2016 07:52 |  Tags: Hospice John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem