All 14 entries tagged Patients

Vulnerability

We’re just over halfway through our six-week GP block, the second of eight Specialist Clinical Placements. Our surgery is a lovely, pleasant place in an area which draws on a very diverse population. We get to see a variety of problems and presenting complaints – although as it is wintertime, we are definitely seeing more than our fair share of coughs and colds. I am slightly relieved, however, as we have been told that hayfever season is just round the corner- it’s such a shame, but unfortunately we are going to miss it!

A lot of GP work involves what we typically think of a GP as doing: there are consultations in surgeries in the famous ten-minute slots (or fifteen minutes, if you’re a medical student). Some surgeries have also started introducing telephone consultations, where they assess patients over the phone (where appropriate, obviously) or home visits, for patients who are very infirm. Our surgery does all of this, and more, and it’s been really interesting watch the different ways in which they engage in the community and serve the members.

It’s probably less well known that many GPs also see patients who are at care homes or nursing homes as part of their daily or weekly routine. We accompany the GPs along on some of these visits for several reasons. We go to get a good feel of how care homes are run and patients’ problems present there. We go to see different ways in which GPs’ knowledge is put to use. We also go to gain an understanding of other patients’ experiences and to see how they live and are cared for.

Recently, we visited a care home which houses patients who have suffered brain injuries. It was very interesting and – I can’t lie – it made a profound impression on me. It made me think of many things at once. I am so happy and we are all so lucky to live in a society where people who are vulnerable (or in some cases completely unable to look after themselves) are still treated with dignity and care. It made me proud that they are still able to get care from the NHS. (I come from a country in which such a thing absolutely does not exist.) Finally, it made me realise that being a good doctor, a good GP, is not just caring for those people with coughs and colds and allergies; it is looking after everybody in society. We are trusted to help and care for those who are vulnerable and it is a massive responsibility. I will never forget visiting that care home, and I will never forget the dignity those patients are given, day in and day out. It made me proud to continue doing what I am doing.

John

Luke Pemberton : 13 Mar 2017 09:15 |  Tags: John Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

General Practice Rotation

We Phase-III students are now well into our second Specialist Clinical Placement (SCP) of eight in 2017. After six weeks learning all about Musculoskeletal Health, my clinical partner and I are now on the General Practice (GP) block through the end of March. It’s been an overall wonderful experience so far, and we both hope it continues to be. Every clinical-partner pair in this block is assigned to a local GP surgery, most of which are local to the medical school and South Warwickshire. Our practice is a very diverse one, and we have worked with five or six different GPs so far – and we’re only two weeks in! We of course had GP placements during our second year (Phase II) as well, and we rotated through three different practices over the course of our 30-week Core Clinical Education block.

There are some similarities to our consultations in Phase II but it’s also different in many ways. First of all, our time slots are a lot shorter. We’ve generally only got fifteen minutes per consultation (much shorter than 20 minutes – or sometimes 30 – during CCE). Secondly, we know so much more this time round! It’s amazing to think of how much we’ve learned in such a short time period. And finally, and most importantly, we are much more actively involved in the entire consultation – from history to management and safety-netting (ensuring that more-serious conditions are accounted for when discharging a patient). I feel like we are taken very seriously by our supervising doctors these days; this gradual increase in responsibility (and accountability) will help us well when we qualify.

We also spend time observing the consulting styles of different GPs at the practice, which is extremely valuable for our development from students into doctors. It’s really important to see how different people handle different situations with patients, and it’s also a vital part of our medical education to learn how to be flexible and adaptable. I cannot count the number of times that a consultation has come to an end and I’ve been amazed by the way a GP has dealt with a tricky topic or adapted a message to a specific situation; I know that this can come with years (and sometimes decades) of practice, but it really useful for us to observe these skills so that we can develop them for ourselves.

And of course, the GP block isn’t just sitting in on consultations with live patients. We have a lot of skill-building exercises and off-site teaching as well. Our block gives us two days per week at the medical school. Once per week we have teaching in very small groups, where we spend the day talking to simulated patients who present with a specific set of problems. For instance, the theme this week was “difficult consultations”, where we had to deal with very sensitive diagnoses and figure out the best way to discuss them with the (simulated) patient. My session had an actor playing a woman who had just tested positive for an STI, and I had to discuss the diagnosis and possible causes with her. It was a little awkward to discuss these issues for the first time, but I’d much rather it be awkward with an actor than with a real-life patient. Broaching sensitive subjects with patients, and bringing up topics that they might not want to hear, is of course a skill which is not used only in general practice; these are skills that are useful to doctors of all disciplines.

John

Luke Pemberton : 24 Feb 2017 15:16 |  Tags: John Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Musculoskeletal Health Care…

Our cohort is a few weeks into the first of our eight Specialist Clinical Placements (SCPs) and 2017 is stretching out before us. Although it seems long, the time is actually going by quite quickly. I wouldn't say it's exactly fun, but I'm enjoying myself tremendously on this block and am learning a great deal.

My first rotation is the MSK block (musculoskeletal health), which is pretty self-explanatory. In this block, we become more familiar with problems of joints, muscles and bones (and nerves and connective tissue and some skin and so many other things as well...). Many people run a mile when they think of anatomy and memorising lists of muscles and bones, but block 4 in the first year (Locomotion) was actually my favourite block and I'm loving the MSK placement. We've seen so many things that I wasn't expecting and we're only just over three weeks in.

As is probably fairly obvious, a lot of the work revolves around bones and joints - so we see fractures and their treatment, joint replacements, and that sort of thing. But of course they don't exist in a bubble - for instance, fractures are often accompanied by soft-tissue injuries and we have to know all of the repairs that come along with them. Getting a new knee or a new hip is a major operation and can take weeks or months to recover from fully. A lot of the learning we've done in earlier years around the biological, psychological and social impact of health conditions has come in very handy in understanding the lives that our patients live and how injuries might change them. It's proven incredibly applicable now that we are seeing more patients in a clinical setting than we did in the first years of the course.

I was not expecting that we'd be taught rheumatology as much in this block as we have been. It's a very diverse field and there's so much going on! The more I see of it and the more I learn about the speciality, the more interested I become. The patients are very interesting and diverse, and being an effective rheumatologist requires extensive knowledge of many branches of medicine and the ability to pull them all together very quickly. Since rheumatological diseases can affect multiple body systems, specialists in this field need to be quite broad in their knowledge and approach. We have seen patients with rheumatoid arthritis (of course) but also psoriasis (and the multiple effects that it has), polymyalgia rheumatica, systemic lupus erythematosus and several other conditions that we've only seen in textbooks before now.

I'm enjoying the block so much, I'm really gutted that it is coming to an end so soon. But of course new adventures await in the next placement, too.

John

Luke Pemberton : 26 Jan 2017 14:46 |  Tags: John Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

It’s as simple as ABCDE

As a medical student we are usually quite far from an emergency situation, but that doesn’t mean it will stay like that forever, we need to know how to manage an emergency situation in case it does happen while we are students. Even as students we may find ourselves able to do some practical procedures that some nurses on the ward cannot do that are needed in an emergency, such as inserting cannulas or managing an airway. Staying calm under pressure and been able to fully assess a situation are vital skills as a doctor especially when you are the one called to an emergency.

To help us prepare for this all second year medical students are sent on a course designed to teach you how to recognise a deteriorating patient and how to systematically approach and manage an emergency situation. Students at Warwick and UHCW do the AIM course, where as I did the ALERT course at George Eliot. They all teach you the ABCDE approach. A for airway, B for breathing, C for circulation, D for disability and E for exposure/everything else! You work through each part systematically, never moving on until you have secured each part. If your airway isn’t secure you won’t be able to get oxygen to your tissues and organs so this must be assessed first. In Breathing you have to conduct a mini respiratory exam, you might hear some crackles on their chest and start thinking about an infection and sepsis or you might hear a wheeze and think asthma attack. The ABCDE approach isn’t just designed to manage an emergency, it also gives us the framework to find a reason for the deterioration and a diagnosis quickly so we can start the right treatment. In C for circulation you check pulses and blood pressure, you may discover they are hypotensive and need fluids, so then you need IV access. In Disability you check blood sugars, consciousness and pupil responses. Exposure ensures you don’t miss anything, like a rash or a source of bleeding.

As part of the course we had a series of lectures taught around clinical scenarios. What is your approach to the acutely hypotensive patient? ABCDE of course! What is your approach to the unconscious patient? You guessed it ABCDE! In the afternoon we had several practice stations where we all got a chance to manage a situation and receive some feedback on our performance. One of the students was the patient and others in the group could act as helpers as they were needed. In my scenario my patient was unconscious and their airway was compromised so I placed an oropharyngeal airway in, I then made my way through to D and found that they were hypoglycaemic (low blood sugar), I gave them some glucose and they became more responsive, so much so that they started to gag on the oropharyngeal airway. Back to A it was! I removed the airway adjunct and they could breathe on their own. I went back through B, C, D and then onto E. I thought the end was in sight but then they vomited and were making gurgling sounds, back to A again! After some suction everything was ok and the crisis was averted! Although these practice scenarios are obviously very different from the real thing the facilitators try to make it as realistic as possible, if you don’t do something then the patient will deteriorate. In my station if I had forgotten to take to blood sugar levels my patient would have started to have a seizure, so I’m glad I averted that!

I really enjoyed the ALERT course and I think it helped me a lot that I have been volunteering as a helper for the Advanced Life support course run at UHCW. The ALS course is for doctors and nurses working in emergency areas and also uses an ABCDE approach but for more advanced and life threatening scenarios. It is run in a very similar way with actors playing patients and helpers who the candidate can call on to help them as they manage the scenario. Through the Warwick Emergency Medicine and Trauma Society I have been able to volunteer for this which has meant I have acted as a helper to the candidates on the ALS course, which certainly helped me in my own practice situation! Hopefully when I’m getting ready to start my first job as an FY1 in 2 years’ time I won’t find the ALS course too scary and will be ready when I’m that doctor on call!

Joanne

Catrin Davies : 18 Jul 2016 10:04 |  Tags: Joanne Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Clinical Skills and T–DOCS

As medical students, we obviously spend a great deal of time learning how to be competent and effective clinicians. A lot of this involves learning about the human body, what can go wrong with it and how to treat that. We learn this, initially, through lectures and case-based learning, and then later during placements on the wards. But the development of another essential skillset, the hands-on, practical techniques that we actually use with patients – comes from more tactile and interactive forms of instruction.

In the first year, we were drilled on our “clinical skills”; this is the battery of basic examinations that every doctor knows by heart. They could be major-system based (abdominal, cardiac, respiratory), neurological or musculoskeletal – we had to know them all, and testing us on them formed a major part of our end-of-year-one summative OSCE exams. And a large part of our clinical days in the first year (and beyond) involved practicing our exams on very patient and willing patients, most of whom were resident on wards and had provided consent to letting us try our skills on them. These people, the uncountable thousands across the country, are absolutely invaluable resources to the NHS.

In the second year, our clinical skills (now renamed TDOCs) have taken on a very focused, very clinical approach. We have focused much more on basic tasks that doctors, especially junior doctors, are expected to carry out on a daily basis. We learn in great detail procedures such as cannulation, venepuncture (drawing blood from veins for laboratory tests, etc.), drawing arterial blood, inserting nasogastric tubes and so on. The list is long, and the instruction is very complete – we don’t just learn the basics of how to insert needles into veins, for instance. We also learn about the indications, contraindications, complications and risks of each of these procedures – all of these are extremely important, and I’m glad that the medical school goes to great lengths to ensure patient safety. For instance, I wouldn’t want someone to poke my arm or a relative's arm with a needle unless they’ve had this training, and I’m glad that we go through this process.

Once we have been assessed as competent by our clinical-skills instructor, then we are given permission to put our skills to use on our assigned wards – under supervision by qualified doctors, of course. And it is with practice that our competence and confidence grows. Not every encounter is perfect of course, because human bodies are complex, but this is the reality of medicine. Gaining experience is the best part of our education. By the time we qualify, we will have had a great deal of practice with all of our TDOC skills, and hopefully, at least in this aspect, transitioning to being junior doctors should not be so challenging. I’m sure it will be challenging in many other ways, though!

John

Catrin Davies : 02 Jun 2016 09:27 |  Tags: John Mbchb Patients Skills Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem