All 47 entries tagged Joanne

High security….

With just one 6 week block to go before my last Christmas holiday of medical school its all getting a bit scary. My fellow final year students are all getting a bit jittery at the mere mention of exams and some of us are still in denial that exams are happening at all. Helping at my final societies fayre a few weeks ago it felt strange to be asked what my plans were after graduation, how I had found the course and if I had any tips from eager first years when it doesn’t seem that long ago that I was in their shoes! It was great fun welcoming new students and handing over to the new president of the Psychiatry Society, a society that I’ve enjoyed been part of since I started medical school. I’ve been involved in organising some great events, increasing the size of the society and getting the chance to promote a speciality I feel passionate about. I’ve also met lots of people that will hopefully help in future job applications-perhaps I’m getting a little ahead of myself but its preferable to thinking about exams!

Overall, I’ve really enjoyed my psychiatry block, I’m even more keen to pursue it as a future career and being interested in the subject makes it that bit easier to study! For the last two weeks we have been assigned to a community psychiatrist who specialises in psychosis. It was interesting to be in these clinics where the focus wasn’t on treating every single symptom but on improving their level of functioning so they could remain in the community. To my surprise this often meant that patients had untreated delusions or hallucinations but as the consultant pointed out if the patient is safe and is not distressed by these symptoms then is it worth the risk of unpleasant side effects? On one occasion, a patient presented to clinic acutely unwell and was very agitated, I must admit I was quite nervous and unsure if I should pull my personal alarm (to call for help) but the consultant was able to calm the patient down an arranged to follow them up at home with the rest of his team. I was glad I hadn’t called for help unnecessarily in contrast to the previous week when I accidently set my alarm off and only realised when several people burst into the room!

Dealing with difficult patients is a vital skill in all branches of medicine but especially important in psychiatry, and particularly in forensic facilities. A great thing about the psychiatry block is that we can organise additional placements within different subspecialties, I organised time with the eating disorders team, the perinatal psychiatry team and also arranged a 1 day placement at a local Medium secure hospital. Secure units aren’t just for people who have committed crimes that require psychiatric treatment, some have challenging behaviour that is difficult to manage in normal inpatient settings and there may be a high risk of criminal behaviours. Apart from additional security within the building the ward environment wasn’t very different. Forensic services are different in that patients tend to remain in hospital for longer periods of time and continuity of care is highly valued with the same consultant responsible for their care when they leave hospital as an outpatient. Following up patients over the course of their illness and see someone literally get their life back on track must be very rewarding and wasn’t something I expected to think after visiting a secure unit!

I’m sad to see my 6 weeks of psychiatry come to an end but time marches on-so off I go to my final block, musculoskeletal medicine here I come!

Joshua Galvin : 10 Nov 2017 09:15 |  Tags: Joanne Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Lesson’s to be learnt…

Open any newspaper and you will be greeted with headlines telling of a “social care crisis”, of “bed blockers” and a “dementia time-bomb”. While many of the headlines are misleading and not helpful, the issue of an increasingly aging population and the increasing rates dementia are very real. As a medical student, we witness the problems increasing rates of dementia causes in the NHS on all our placements. On the Care of the elderly wards many patients were “medical fit for discharge” but remained in hospital due to social care issues, many patients with dementia can become aggressive and upset when they are confused and can be difficult for staff to manage and also upsetting for other patients. Observing the challenges dementia places on the healthcare system is no different in the psychiatry block. We spend some of our time in Old age psychiatry where most of the work focuses on dementia but also other mental illnesses that have presented in old age.

Spending time in the community memory clinics I saw patients presenting with a variety of memory problems. The memory clinic is designed to help improve detection rates of dementia and ensure patients receives the best medical treatment and social support. For example, if a patient is diagnosed early with vascular dementia, there is an opportunity to ensure they are on the best treatment for their high blood pressure and diabetes which could help reduce the decline in their memory. Slowing the memory decline can allow people to live independently for much longer and have a higher quality of life. Alongside the medical interventions, psychological interventions in the form of support groups for patients and carers can help maintain good mental health and help families cope in these difficult situations. Providing the right social support can also help patients stay at home longer with their families. Observing how the medical and nursing team all worked together to help these patients was interesting and it was great to see the positive impact the team had.

Treatment of dementia is focused on community care but sometimes it isn’t safe for patients to be at home or even in care homes if they have complex behavioural needs. As part of our placement we also spent time on the inpatient dementia wards. In contrast to any other ward I’ve been on, every patient had a completely individualised care plan that had been formulated through careful observation. Even though many of the patients had severe dementia, staff had spent time with them to find out what their interests were, what music did they like, what activities or food were there favourites? Spending the time getting to know the patient meant that staff could engage the patients in activities that they actually enjoyed and find out what was possibly upsetting them or causing anxiety. One patient that had previously been violent and aggressive was now calm and ready for discharge, no medication had been given, just time.

While I’m panicking about my prescribing exam it’s good to know that the answer isn’t always medication and that getting to know all of our patients, no matter what their condition, can make a huge difference. That’s certainly a lesson that will stick with me and I hope will make me a better doctor.

Joshua Galvin : 24 Oct 2017 15:59 |  Tags: Clinics Joanne NHS Patient Student Warwick |  Comments (0) |  Close comments |  Report a problem

In Demand…

Having started my acute block on the acute medical wards, clerking relatively stable patients, I have spent the last two weeks on the Intensive care unit (ITU) and in A&E where stable is not a word used to describe many of the patients!

The ward round in ITU was one of most fascinating ward rounds I’ve been on as a medical student, many of the conditions you read about as a medical student thinking you will never actually see were there, as well as patients recovering from major traumas with multiple injuries. On ITU patients conditions aren’t just identified and treated, patients are only on ITU if one or more of their organ systems need support. That might be blood pressure supporting drugs in the case of a patient with life threatening sepsis or in more severe cases patients may require multi-organ support, for example, dialysis for kidney failure as well as mechanical ventilation to allow them to breathe. Patients in ITU have 1:1 nursing and are constantly monitored, as such a stay on ITU is very expensive and there are only so many beds, dictated by the number of staff available. ITU beds are in high demand; deteriorating patients around the hospital are referred to the ITU registrar who can then discuss potential new admissions with the consultant. In addition as UHCW is a major trauma centre there is also the possibility of a major trauma arriving that may require admission. Deciding who to admit to ITU is a murky area with no strict rules; does the patient need organ support right now, are they likely to survive even with ITU support? Unfortunately using a crystal ball isn’t an option.

Patients often get referred to ITU from A&E and while it’s much easier for patients to get through the doors of A&E, demand is so high that getting a cubicle to actually assess a patient is not so easy. In just a handful of A&E shifts I’ve seen queues of patients on ambulance trolleys, paramedics waiting to handover their patients to the nurse in charge while the nurse is frantically trying to find a space. Reading about this in the newspapers is disheartening but actually seeing it is shocking. Demand is so high and while some A&E attendances are inappropriate the vast majority aren’t and need to be seen. It was nice to feel useful as a medical student in A&E by helping the doctors clerk patients, take bloods and insert cannulas (my success rate has now improved to 50:50-good for me, maybe not so good for the poor patients!). Seeing a wide variety of presenting complaints was really interesting and used lots of different skills. In Minors I saw lively children injured in various trampolining /climbing incidents, a few sports injuries ranging from badly sprained ankles to fractured bones and even a builder with a chemical injury to the eye. In majors I saw first-hand what happens when social care fails our elderly patients, patients discharged from hospital one day and then back again the next. I was able to observe the treatment of an acute asthma attack, something which can be quite scary but didn’t seem to fluster the experienced A&E consultant. I was also excited to be asked to see a patient had been referred urgently by their GP for a possible stroke, which I correctly identified as Bell’s palsy-a relatively benign condition that will improve in time on its own.

I don’t think there is ever a dull shift in A&E and despite some of the problems with the system it was inspiring to see the Nurses and Doctors in A&E working as a team-and actually feeling like I was a contributing member of that team! I have more A&E shifts over the final two weeks of this block, here’s hoping my cannula success rate improves!

Joshua Galvin : 12 Sep 2017 14:10 |  Tags: Joanne |  Comments (0) |  Close comments |  Report a problem

Finals countdown…

After a relaxing two week break I have emerged from my chrysalis as a fully-fledged final year medical student. Do I feel any different? Do I look any different? People certainly seem to be treating me differently, all the focus is now on job applications in October and final exams in February next year. Doctors teaching us in hospitals have high expectations and seeing students from the year above us now working as FY1 Doctors is inspiring fear rather than confidence! I don’t think I have felt this nervous since freshers week, nervous feelings about the task ahead have resurfaced now that my ambition to become a Doctor is almost a reality, with a few final hurdles to overcome.

I embark on my final year by starting on my Acute Medicine block. This block is split between UHCW in Coventry and Warwick hospital. We spend time in the emergency department and the acute medical wards, doing a variety of shifts so we can see as many patients as possible. I’ve spent the first two weeks of the block on the acute medical wards at UHCW. These are interesting places to be as a student as you get to see lots of patients presenting with common medical problems that will come up in finals. Patients are clerked in A&E and once its decided that they are stable and need medical treatment as an inpatient or are waiting the results of investigations they come to the Acute medical ward (AMU) at UHCW. The doctors on AMU then clerk the patient and then arrange or follow up investigations and start treatment. There is a huge variety of patients on AMU at any one time. Patients may have come in with chest pain and shortness of breath so things like heart attack or pulmonary embolism need to be ruled out even if you suspect a chest infection. Some patients may need to be admitted under a particular medical specialty and will move once a bed becomes available and for others they can stay on AMU and leave after a few days of treatment. As a student you can clerk patients, help take bloods, insert cannulas and attend ward rounds and because its AMU, every day there are new patients to figure out.

Another area we have been assigned to is the Medical decisions unit (MDU), where patients are referred in by their GP for tests or treatment only available in hospital. These patients are usually not acutely unwell or unstable but they have presented with a problem that could be serious. For example if a patient presents to their GP with central chest pain that came on after eating a large meal, the GP simply doesn’t have the tests available in the community to rule in or rule out a heart attack even if it sounds like heartburn, that patient needs to come to hospital for further tests but they don’t necessarily need to come in an ambulance and wait for several hours in A&E. In MDU the tests can be done quickly and so patients can either be reassured confidently or brought in for further treatment. MDU is one of my favourite places to be as a medical student and it is great practice for finals. You can take a fresh history and examine the new patients and decide what your differential diagnosis is and what tests you want to do and then present it to one of the junior doctors who will agree (or disagree!) with you and who can organise the appropriate tests. Over the course of your shift you can chase up the results and actually find out if you were right and can decide on the management with the juniors and consultants. It’s a great chance to present cases to seniors and get feedback on your clinical reasoning skills and management.

Aside from getting to grips with the acute block I have also made a revision planner for finals, having the next 20 weeks before my first exam planned out and stuck to my study wall is terrifying! Hopefully when I start my A&E shifts next week that will provide a welcome distraction from my revision planner and the countdown to finals!

Luke Pemberton : 01 Sep 2017 12:29 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

End of third year…

If I close my eyes I can still picture the second year exam pass list, seeing my name there and relief flooding over me, it feels like only yesterday. Since then I’ve started and completed a research project (student selected component 2), had a refresher course of hospital life (advanced cases 2) and had five of my speciality clinical placements. So far I’ve completed 6 week blocks in General practice, Child health, Obstetrics and Gynaecology, Care of the Medical patient and Care of the Surgical patient. There are no exams in third year (phew!) so the main thing to worry about is making sure you have submitted all the correct forms and assessments for every block on your e-portfolio.

It’s been a busy year since we started our speciality placements in January and I’m really looking forward to a break, every block has had its good and bad points, but all have been enjoyable and interesting in different ways. In General practice it was a great confidence boost to be able to conduct entire consultations on our own for the first time. In both child health and O&G we were exposed to a lot of intense emotions from both the patients and staff, helping care for sick children is about reassuring and supporting parents as well as providing medical care for their child and in O&G caring for the same patient over the course of a long labour is stressful for everyone involved. Care of the medical patient wasn’t just about the theory, our consultant always made us think about the person behind the disease and the effect on their life. Care of the surgical patient has been about when not to operate just as much as any of the surgical procedures, something which surprised me!

Learning when to intervene or not is a huge part of medicine but I suppose in surgery it is vital to ensure that if an operation is performed it is for the right reasons. The last two weeks of my surgery block at George Elliot hospital have been with a Breast Surgeon. The breast clinic is a one-stop clinic, patients are examined and can also have a mammogram and ultrasound of the breast and get the results on the same day. This means lots of patients can be reassured and others can be referred quickly for further investigations. A lot of the results are then discussed at the breast surgery multidisciplinary team meeting where histo-pathologists, oncologists and surgeons, radiologists and nurses all decide together the best course of treatment for patients. In some cases it could be a simple benign lump that needs no further treatment, or in others it could involve deciding what type of surgery or systemic treatment is required for a cancer. It’s great to see how these complex decisions are made as a medical student, I’ve certainly learnt not to believe everything I watch in Greys Anatomy!

Following our break I come back to the acute medicine block. I’ll be working evenings and nights in A&E as part of the team. This will be followed by the Psychiatry and Musculoskeletal blocks. During this time I will also apply for my foundation doctor jobs (i.e. decide where I want to live!) and sit the situational judgement test, which plays a huge part in what job I will get. It’s going to be a busy autumn for me but what’s important now is that I have 2 weeks off, time to relax, ready to come back as a final year medical student.

Joanne

Luke Pemberton : 10 Aug 2017 15:27 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem