All 14 entries tagged John

4 Weeks later…

I’m coming to the end of a four-week stay at a large regional hospital in The Gambia. I came down here to do research for the SSC2 (Student-Selected Component) part of our curriculum. Every Warwick MB ChB student does a self-directed research project during the autumn of our third year, and it’s proven to a really interesting and thought-provoking experience for me for many reasons.

Although I’ve got experience working within several NHS hospitals, I’ve never spent much time in a healthcare setting outside of the United Kingdom. Seeing how a different system operates is absolutely fascinating to me. There are many things that I would change, and there are many things that I think are done quite well. I am still surprised and quite taken aback by the lack of primary care in The Gambia. All of the clinical staff in this hospital are consummate professionals, and they make the very best of what they’ve got, but resources are limited, and patients do tend to present to clinic or onto wards with more advanced stages of illness. That is something I never expected.

There is also a lack of trained specialist doctors. For instance, I don’t know if The Gambia has any endocrinologists within its borders; I’ve heard there are none.. This has caused me to reflect: the people here are just as human as anyone in the UK, and in an ideal world, they would be just as entitled to healthcare as the rest of us. Being at the thin end of the wedge here has made me think much more about global health and the importance of providing a basic service to those most in need.

Since my project was to conduct an audit of tuberculosis diagnostic-technique requests, I spent a LOT of time trawling though patient notes and trying to figure out what investigations and diagnoses were requested, and when. It was a very painstaking, manual process. I have definitely learned that writing clearly and concisely in patients’ notes is essential – even if you think nobody is ever going to read them again, you might be very wrong! Although I *generally* got used to the handwriting styles of the different doctors, sometimes it was a bit of a struggle.

The most different thing about being here is definitely the weather. I checked the climate forecasts on Wikipedia before I came down here, but I must have misread something as I brought a hoodie “just in case”. It’s been over 30 every single day, and I haven’t seen a drop of rain since leaving England in September. Since I’m Fitzpatrick skin type 1 (thank you, Phase II dermatology book!), I have been slathering on the sunblock. I’m kind of looking forward to returning to England if, for nothing else, some respite from the sun overhead. I suspect I’ll regret this within forty-eight hours of returning though!

John

Luke Pemberton : 26 Oct 2016 13:51 |  Tags: John Mbchb Student Warwick |  Comments (0) |  Close comments |  Report a problem

Self–Directed Research Project (Gambia)

At the beginning of our third years, all students are required to participate in the second Student-Selected Component of our curriculum (with the first being in the winter and spring of our first year). SSC2, as this one is known, is a self-directed research project that we are expected to undertake and conduct on our own, under the guidance of at least one supervisor whose profession and speciality depend on the nature of the project. For my project, I am conducting an audit to investigate the requests for tuberculosis diagnostic tests at a large, charity-run hospital in The Gambia and compare what actually happens in clinical practice to the country’s recognised standard. I will be here for the month of October.

Last week was, needless to say, a bit of a blur! We got our exam results on Monday, started with our SSC2 seminars on Tuesday, carried on throughout the week, and then on Saturday I woke up at an inhuman hour and flew from Birmingham to Banjul. I still couldn’t quite believe it, even when the plane took off. My first impression: it is hot! It was 8 degrees out when I left Coventry last Saturday and it was 31 when we landed in The Gambia. I know we’re in the tropics, but I was not expecting this. Mind you, I’m not complaining. My other impressions: it is really lush and green, and the people are all so friendly with such a vibrant look. So many people have such decorative and colourful clothing and are really striking – it’s a welcome change from what can often be monotonous dark and grey so commonplace in England this time of year (or any time of year, let’s face it).

Although my project involves inspecting patient notes and monitoring requests for laboratory tests, I have had the opportunity to observe some clinical activities as well. I have sat in with several one-on-one, doctor-run clinics (similar to GP consultations in the UK in structure and function) and have also watched a few ward rounds. But I think that this is where the similarity ends. Since primary care doesn’t really exist for most people here, many of the patients present with advanced stages of diseases that aren’t normally seen in the UK – at least I’ve certainly never seen them. For instance, conditions such as extra-pulmonary tuberculosis and Tetralogy of Fallot are common enough that I’ve seen a few of each in the week that I’ve been here. You certainly don’t see many of those in Warwickshire!

I know that I keep coming back to the same point, but seeing healthcare outside of England always makes me that much more appreciative of the NHS, and that we are lucky enough to live in a rich and developed country. I could not imagine having to make a life-or-death decision based on how much money my family has or how easy it is to go to a city several hours away in a neighbouring country for treatment on an ongoing basis. These are decisions that people here are confronted with quite frequently, and it breaks my heart to see this happen even once. Confronting such dilemmas must be such a difficult thing to do, and spending this time at the coal face has impressed on me even more the importance of a strong and dedicated health service.

John

Luke Pemberton : 18 Oct 2016 10:33 |  Tags: John Student Warwick |  Comments (0) |  Close comments |  Report a problem

Coming to the End of Core Clinical Education

It’s hard to believe that we’re now more than halfway through the final block of Core Clinical Education. Time has just flown by – although sometimes I have to remind myself that it seems every other university student is done for the year, and we’re still going even though it’s mid-July! Ah well, that’s what we signed up for. Anyway, it’s not much longer to go now until revision and then exams.

I’m really getting a lot out of CCE, and looking back on the past seven months, I can see how lucky we are to have got exposure to so many different basic disciplines – respiratory, orthopaedic and cardiac medicine, just to name a few. Most recently, my clinical partner and I were lucky enough to spend the past month or so on a ward dedicated to cardiology patients. So many of the cases were fascinating and very eye-opening, and in many cases it was (I know this sounds like a cliché) a lecture series come to life. We got to hear lots of heart murmurs, some artificial valves, uncommon heartbeats and we got to investigate some pathologies that we’d only heard about but never seen. We got drilled by the (very nice but scarily knowledgeable) consultant on the different drugs given to cardiac patients, their mechanisms of actions and side effects, indications and contraindications.

And it was extremely inspiring when we actually realised how our skills changed and grew over the course of the placement. I have sat through several lectures on electrocardiograms, have read countless websites and books and other resources, but until I actually saw some “hot off the presses”, as it were, it was difficult to know where to start. But standing in the middle of a ward and being asked what’s wrong with a patient’s ECG (warning: sometimes there’s nothing wrong with it, and you have to have the confidence to say so!) made me think on my toes. By the end of the rotation, and with some helpful encouragement from the doctors and other staff around us, my clinical partner and I felt much more comfortable with things that had terrified us barely a month before. I wouldn’t say I’m the world’s expert at interpreting ECGs, but I feel far less intimidated than I ever have.

So far, Core Clinical Education has been a very useful and worthwhile experience. We have been exposed to opportunities and disciplines that we’ve never seen before, and might not get to see again for a very long time. We’ve learned how to conduct clinical skills and then have been given the chance to practice them. We’ve got stuck into clinical teams by very welcoming and informative staff. And we’ve been able to put our pre-clinical teaching to work in a supportive and educational environment. I will miss the CCE experience when it’s over, so for now I plan on enjoying everything more that it has to offer.

John

Catrin Davies : 18 Jul 2016 10:00 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Communication

We had the last of our community-day exercises for the second year last week. These are non-hospital days, where my clinical partner and I meet with a patient to discuss how they are managing in the community with a specific condition, diagnosis, or care package (or all three). Usually our discussions are very focused – for instance, we once met with a patient who was making use of hospice services. We also once met the parents of a child who was living with Down Syndrome and discussed with them all of the services that they are provided and how they make use of them.

These sessions are really useful, as they open our eyes to the services that our government and communities provide and show us all of the support that families can use. As someone who has led a relatively health-filled life, I’ve never had to make much use of these services – apart from the odd visit to the GP – and thus it’s always very useful and educational to see what else is out there. Health Visitors, District Nurses, physiotherapists, occupational therapists – just to name a few – all play a very important role in managing patient health, especially out in the community. And it’s so important for us to talk with these professionals as well to get an idea on how they can help our patients.

On our “recap” day, we get together with a few other clinical-partner pairs to present our cases and discuss any common themes that might come up across some or all of them. It’s interesting for several reasons. First, the different patients’ conditions are, of course, interesting by themselves. After spending so long in lectures and discussing people on paper, it’s really interesting to see them in real life. But more importantly (and fulfilling the purpose of our exercise), we are there to see how their packages of care fit together. Sometimes this works really well, and other times it doesn’t fit quite so nicely.

Communication (or lack thereof) was the one common theme that came up across all clinical-partner groups in our most recent meeting. Most patients and their families could not fault the quality of service nor the professionalism they received from each of their caregivers. And none had a bad word to say about the facilities. But what came up time and time again was the fact that, at least for these people, it simply didn’t seem joined up. Every time some of them saw a new doctor, they had to start from the beginning and explain their cases again. It seemed that either the letters were getting lost (or never sent) or, somehow, the communication train was breaking down a little too often for them.

This gave me a lot to think about – whilst, even as a practicing doctor, I expect to be little more than one cog in an enormous wheel most of the time, at least I am better equipped to understand where my patients are coming from should they be frustrated at the “system”. This portion of our education is very valuable. It cannot be taught from PowerPoint, nor even told from a hospital bed. Seeing these first-hand encounters really brings home for me what the entire patient experience is all about.

John

Catrin Davies : 29 Jun 2016 15:11 |  Tags: Communication John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

A New Block and a New Hospital

We’ve just started the final block of our Core Clinical Education module. It’s hard to believe that the second year is almost over – this officially marks the halfway point in our journey through med school. As with most students in our cohort, my clinical partner and I are at a new hospital for the final ten weeks of the year. With this comes an entirely new set of corridors to memorise, IT systems to navigate and ward-round schedules to memories. I think this is what it’s going to be like for a very long time if we continue pursuing our careers in the NHS! The rotations throughout the rest of med school and beyond – into the foundation programme and even specialist training – will see us rotated about like this as well.

As the first core-clinical education block focused on history-taking and examination, and the second block focused on investigations and diagnosis, this final block will focus on management of conditions, diseases and illnesses. And of course “management” is more than just giving someone some pills or scheduling a date for them to turn up to operating theatre. We are highly encouraged to take a wide approach to condition management, considering all aspects of a patient’s health. We adhere to the bio-psycho-social model, examining the biological component of condition management alongside any impact that a patient’s condition may have upon the psychological and social aspects of their lives. It’s fascinating to see how this plays out in practice.

My assigned consultant for the first section of this block is a gastroenterologist, and my clinical partner has been given a cardiologist. Since our assigned consultants are employed in this aspect to support, teach and evaluate us, this means that we will spend a lot of time focusing on real core medicine with these doctors – the stuff we learned in the first term of the first year, and among my favourite part of the curriculum. It’s time to brush up on interpreting ECG tracings, hepatic metabolism of drugs and the mechanism of action for lots of different diuretics (among many other things)! This makes a major change from the previous block, where we were both linked with orthopaedic surgeons, and brings us back to some of the stuff we learned about quite early on.

Earlier this week we were lucky enough to see a few minor operations pertaining to cardiac abnormalities. First, we saw the placement of a pacemaker. The consultant cardiologist who performed the procedure was actually the same gentleman who lectured us about it back in Advanced Cases 1. Like most of these experiences, it was like an anatomy lesson come to life – in this case, he pointed out to us the patient’s cephalic vein, which he was going to use to access the heart (how he was able to find that vein and know that it was the right one, I will never know). The patient was conscious the entire time, and the entire procedure was conducted under local anaesthetic! We also saw the insertion of a few devices into other patients that function very similar to memory sticks – they collect information about a patient’s heart function over the course of months and even years. They are indicated in many situations, including strokes and various forms of arrhythmia. I look forward to seeing many more sorts of these procedures and many more over the coming weeks and months.

John

Catrin Davies : 09 Jun 2016 09:15 |  Tags: Cardiology Gastroenterology John Mbchb Medicine Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem