All 19 entries tagged Patients

Spending time in clinics!

Well, the pace of the fourth year hasn’t slackened at all, and things have picked right back up after our summer break. I’m still really enjoying the Care of the Surgical Patient block and am learning loads at the same time. I’m not only spending time in the theatres and on ward rounds, but also attend my fair share of clinics. A clinic is (usually) a half-day session where the doctor has appointments to meet patients alone in a treatment room and discuss their condition. Clinic appointments can be either new referrals or follow-ups; the nature of the follow-up appointments varies depending on the discipline. Some people with lifelong chronic conditions will check in with their doctor every six months or every year or something. But others, for instance after surgery or a broken bone, will come in for a meeting just to make sure that everything is OK before being discharged.

I like the nature of clinics and find them very useful to attend. It’s much easier for me to remember details of a condition when I can attach a person’s name and face to it. I can almost walk through the consultation in my head after the fact, which helps me remember investigations and management. You’re not guaranteed to see everything in a clinic, but you’ll definitely see more by attending than if you don’t go at all, and that’s what I like about them. In this block, we have the opportunity to attend a great deal of post-surgery clinics and some pre-surgery clinics as well – including vascular clinics (lots of foot ulcers and artery blockage), colorectal clinics, ENT (ear, nose and throat) clinics, breast clinics, urology clinics and more. It’s great that the organisers of the block are giving us so much of an opportunity to take advantage of what our huge hospital has to offer.

In addition to a main surgical consultant, we are also assigned to an anaesthetist (or two…) for the block and are given a lot of anaesthetics training and tutorials. I have had the privilege of spending some time in theatre with my assigned anaesthetist and have learned a great deal about the science of anaesthetics and how a lot of our physiology needs to be taken into account when anaesthetists do their jobs. It’s not all about making people unconscious and then waking them back up – so many things need to be monitored and kept within safe ranges whilst a patient is being operated on. The list of things to monitor and that can go wrong is really endless.

I recently saw an operation on a patient who was having an adrenal tumour removed; an excess level of adrenaline and related hormones were being released by the adrenal gland directly into the patient’s bloodstream. So before the gland was removed, the anaesthetist had to administer drugs to counteract the effects of the adrenaline: the patient’s heart rate and blood pressure had to be brought down and kept within safe ranges to avoid the effects of high blood pressure. But – and this is where teamwork with the surgeons comes in – as soon as the gland was removed (and ideally a few minutes before), supplementary adrenaline had to be given for a while to counteract for the sudden deficit that the patient’s body was now experiencing. Watching the physiology literally in action was absolutely fascinating and an extremely worthwhile use of my time. I cannot wait to see more!

Joshua Galvin : 21 Sep 2017 12:12 |  Tags: John Patients Student Warwick |  Comments (0) |  Close comments |  Report a problem

Care of the Surgical Patient – and the Beginning of Year Four

When I first became a medical student, being a fourth-year student seemed such a distant place to be. Before getting there, we had lectures to sit through, ward rounds to attend, and – who can forget? – exams to pass. I used to look in awe at the fourth-years I knew and think, “Wow – they must know so much. I wonder how I’ll ever learn enough to make it into the fourth year.” Well, odd as it may seem, last week we started our fourth year – it’s a bit anti-climactic, however, as it’s really a continuation of what we’ve been doing in the third year. Nevertheless, it’s hard to believe that I’m in that position now. I certainly don’t feel as confident and knowledgeable as those fourth-years seemed to me, way back when. But maybe I just don’t realise how much I’ve actually learned in the intervening three years. I’ll have to wait and see how I do on finals!

Along with our fourth year of medical school, we have also just started our sixth Specialist Clinical Placement block – this one is the CSP block (Care of the Surgical Patient). I’m thrilled about it for a couple of reasons. First, my clinical partner and I are at the largest of our teaching hospitals. I am taking full advantage of the huge variety of cases and the opportunities for teaching that are sometimes present at smaller hospitals but are definitely routinely present at ours. There’s just so much going on here. Second, I’m teamed up with a vascular-surgery team for most of this block. In previous blocks, I’ve spent time in orthopaedic surgery, colorectal surgery, urological surgery, gynaelogical surgery and loads of other disciplines, but I’ve never actually spent time watching operations on blood vessels, so this is an area entirely new to me.

So far, it’s been really interesting. I thought a lot of vascular surgery was occupied with conducting bypass operations, but there’s so much more to it than that! A lot of the patients we’re treating are elderly people who have diabetes and/or a smoking history, as these are two of the many risk factors for peripheral vascular disease. The issues that the surgery team deal with are much more varied than I expected: there are lots of bypass operations, some toe/limb amputations, a lot of wound debridement (removing dead tissue from wounds that have not healed fully) and lots of other things that you probably wouldn’t discuss over the dinner table with your mother – unless she is a vascular surgeon. Let’s just say there’s more gangrene than I expected.

And of course, although we’ve had our fair share of shadowing operations (I even got to make a stitch the other day!), there’s much more to the CSP block than just time spent in theatre. We have post-take ward rounds, clinics and lots and lots of teaching around surgery-related topics. We’ve had anaesthetics sessions, suturing workshops, teaching on wound dressing and care, and many other topics. I wasn’t too keen on a career in surgery before coming into this block, but who knows? There’s still time to change my mind!

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Luke Pemberton : 31 Aug 2017 15:44 |  Tags: John Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Coming to the End of Year Three

Starting the Care of the Medical Patient block felt like staring into the great unknown – how could we possibly cover all of this information in just six weeks?! – but it’s actually been great, if hard work. I’ve seen so much – it feels like all of medicine compressed into one six-week period and it’s hard to believe it’s almost over. It feels like a whirlwind tour!

Despite the time constraints of the block, however, our tutors have put a lot of thought into our timetable and, whilst it’s very broad in its focus, sometimes it feels like we’re jumping around a lot. I guess this is what being an F1 on A&E feels like! For instance, it’s not rare at all to spend the morning on an endocrine ward, have haematology teaching at lunchtime and then spend the afternoon in a neurology clinic! But thankfully we have developed a very strong base on core medicine in the second year – our hard work in Core Clinical Education is paying off – and so this block is allowing us to build on that.

I spent some time last week in an oncology clinic. I’d somehow never been to one before and it was really interesting. All of the patients were follow-up patients, so I was not present for any new diagnosis or any situations in which bad news was broken – but of course that’s not all that medicine is about. We spoke a lot about follow-ups and ongoing treatment and how different upper-GI cancers can present. I got to hear about a really uncommon presentation over the phone (as my consultant was also on call) and we saw the patient’s scans on the internal imaging system. The patient’s superior vena cava had been almost completely occluded by an undetected growth just under the sternum, which was detected incidentally after imaging for a different problem – this is apparently very rare and everyone got very excited by this. How interesting to see!

One of the other timetabled sessions last week gave us the opportunity to follow the Diabetes Specialist Nurses around the hospital. As med students and future junior doctors we don’t interact much with Specialist Nurses on a day-to-day basis (at least at the hospital where I am, they tend to move between wards), so this was a great opportunity to see healthcare from the shoes of people whose roles were slightly different to ours. We went on a massive, great ward round around the entire hospital, seeing diabetic patients and making sure that they were all supported in their needs. Some were newly diagnosed and some had lived with the condition for years, but the Specialist Nurses gave them excellent support; I was really amazed how well-versed they were and the strength of the rapport they had built up with their patients across the entire hospital.

We’ve not got much time left but I feel like we’ve got loads out of this block. And even though we had CCE in the second half of year two, all of the knowledge from that 30-week chunk has created a very strong base for this block. I’m really glad we did it as we did. And when this block ends, so will our third year! I just cannot believe that we’re almost fourth-years. This sounds so terrifyingly old. In the meantime, I’ll just concentrate on enjoying my summer vacation.

John

Luke Pemberton : 27 Jul 2017 16:49 |  Tags: John Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Obstetrics and Gynaecology continued…

We’re about halfway through our fourth specialist rotation of the year and the pace is still, shall we say, energetic. Things are going well but it takes a lot of effort to keep our noses to the grindstone at times! We look on with envy at the students in the year below us who had the last week off, bringing back fond memories of 2016! (We haven’t had a break yet.) Anyway, we are still on our Obstetrics and Gynaecology rotation right now and it’s been really interesting to see all of the issues that clinicians in this speciality confront on a regular basis.

So far, the block has been going well. Although the focus is heavily on female anatomy for obvious reasons, I’m also liking the fact that the Genito-Urinary Medicine clinics are for both sexes and cover lots of different presentations. Aside from a week with midwives and on a labour ward in our second year, we aren’t provided much exposure to the O&G side of medicine from a practical and real-life perspective until this clinical rotation. We have loads of lectures, but it’s all been very conceptual and didactic – and not very hands-on. But this all changes once we are in Phase III. At our hospital, the education coordinators have been doing a great job of giving us extremely varied exposure to different clinics and theatre opportunities, and it’s been a good form of revision.

Most of the procedures we have seen have been relatively routine, including hysteroscopies (inspection of the uterus with a little camera at the end of a tube – very similar in concept to a colonoscopy), excisions of suspicious cervical tissue and even caesarean sections. It’s been like Block 5 (Reproduction and Child Health from year 1) come to life!

Theoretically, a woman can progress through an entire pregnancy in the UK and never need to see a doctor, provided that the pregnancy is low risk and that everything progresses normally and without issue. As I’ve learnt, normally patients are referred to specialists only if there are concerns about the mother’s or the baby’s health during the pregnancy, the delivery or the post-partum period. These are the cases that we tend to see these days – and this has taken a lot of getting used to for me, since midwives don’t really exist in my country of origin, in which almost all babies are delivered by doctors. Anyway, when women are referred to neonatal clinics staffed by registrars or consultants, they usually have a condition that requires additional monitoring and support (although sometimes it’s the baby who requires attention). I’ve seen lots of endocrine issues, some obstetric cholestasis, some social-care issues and even saw a baby with a very high chance of being born with Down Syndrome who required some extra monitoring. All in all, it’s been a fascinating glimpse into the variety of humanity and I’ve loved what I’ve seen so far.

John

Luke Pemberton : 30 May 2017 15:37 |  Tags: John Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

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 |  Tags: John Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem