Back in civilisation

My DGH placement finished today, which means that I am living back in Manchester and, more importantly, have internet access. This means that I no longer have an excuse not to post more frequently.

I want to start by talking about the placement I have just finished. It was a complex care (geriatrics) placement in a district general hospital. I didn't have the most auspicious of starts, that's for certain. My consultant hadn't emailed me back when I asked her which ward I was supposed to be on and who to report to on the first day, and so I spent most of my first morning running round the hospital looking for her. Eventually I found out that the reason I couldn't find her was because she was on a community geriatrics rotation currently and therefore wasn't actually in the hospital. Classic University of Manchester cock-up: send a student on a hospital attachment with a doctor who wasn't actually based at the hospital. I busied myself as much as possible over the first couple of days and eventually found my consultant when she popped into her hospital office late on the afternoon of my second day of placement. She was lovely and told me which ward I was supposed to be on, gave me the contact details of the other doctors and outlined what was expected of me. So my placement really started on the Wednesday of that first week.

I spent most of my time shadowing the foundation doctors and learning how to do their job, since it will hopefully be my job next year. Shadowing is a vital part of 5th year and you can potentially learn a lot from it. However you need to be attached to a doctor who is willing to at least have you following them around, even if they don't actually teach you. There were 3 junior doctors and 2 consultants on the ward and all of them were really good to me. I actually felt useful and part of the medical team - a rare thing indeed for a student.

Another fantastic thing about the placement was that I saw the same patients each day. For example, it was great to see whether the drug that I'd written up the day before (under supervision obviously) had helped the patient with their symptoms or not. It gave proper meaning to the whole idea of "caring for patients" rather than just making an intervention and leaving them to it.

Dealing with elderly patients with lots of pathology also taught me that more often than not, their acute illness is the least of their problems. The aim with our patients was to get them back to "baseline" - in other words to make them as medically fit as they were before this current illness. Once this has been reached (or as close to as possible), it is necessary to assess whether they have the home support necessary for a safe discharge. More often than not the answer to this question is no. This is where the "therapists" come in. We had a MDT (multi-disciplinary team) meeting each day, where every patient was discussed and plans for discharge were made. This meant that everyone knew exactly what the plans were for each patient and unnecessary delays were kept to a minimum. This was by no means my first exposure to an MDT but I have never seen one work so efficiently as this one did.

I could say a lot more about what I have learnt about on this placement but I will spare you. This has become more of a portfolio piece and less of a blogpost and for that I apologise. Rest assured I have a list of more interesting things to write about than this, and now that I'm in GP land for the next 4 weeks, I should hopefully find time to write about them. Finally, I would like to say thanks to those who commented on my last post. It was really interesting to hear other opinions on the subject, as it had been something on my mind recently.

A scenario

I have a scenario for you:

You are a member of medical staff in A&E. A patient comes in who is severely unwell and they go into cardiac arrest. You open their shirt to find a tattoo with the words "Do not resuscitate" on their chest. You cannot find any paperwork for a DNR order or advanced directive.

1. Would you carry on with the resuscitation attempt or not?
2. Would it make a difference if the tattoo was obviously recent?
3. Would it make a difference if your patient was 16 or 85?

I also have another question i would like your opinion on.


4. If your doctor had visible piercings and/or tattoos, would your attitude towards them change?
5. What if the tattoos and/or piercings were on your doctor's face?
6. Should medical students be made to remove piercings and cover up tattoos whilst on clinical placements?

Let me know what you think! Would love to hear your opinions.

Placement

Just thought I should let people know that I haven't fallen off the face of the earth. I am very much still alive. I am on a DGH placement at the moment and am living in the hospital accommodation. Internet access is very restricted. I can use my phone to update Twitter, but blogging is out of the question.

I will be back soon I promise. I have an idea for a post planned out as well. A proper "reflective" portfolio-style post as well. Which will make a change from me moaning. Hopefully it will be up in the next week or so.

Suddenly very popular

I checked my reader numbers this morning and was very surprised to see that they had more than doubled in the space of a day. Presuming that someone "big" must have linked to me, I set off on a hunt to find out who this may be.

I was wrong though. It appears that this increase in traffic is due to 5th years panicking and googling the foundation application questions which have to be answered by tomorrow, and finding this post.

Sorry guys, no help here I'm afraid. Good luck though, I feel your pain!

Happy news

As I alluded to in my last post, although I have been very busy recently, not all of my busyness has been due to bad things. In fact, there is one very good thing which has been (gladly) occupying much of my time recently, and I have decided that it is only right that I share this news with any readers of this blog.

A couple of months ago, I wrote about meeting a fellow medical student blogger in person and what a great time I had. Some readers may remember her as Samantha Alex, she used to have a blog herself until relatively recently. I ended that post by saying that I hoped to see her again in the future. Well, since then we have indeed met up a couple of times since as well as talking a lot online and on the phone, and we have got to know each other very well indeed. The bonds that we have formed are stronger than anything I thought I would ever find with another human being. And because of this I am really really pleased to announce to the world that we are now in a proper relationship, and I couldn't be happier. Since meeting her, everything in life has seemed a million times better and this happiness has spread into my work as well. Revision seems easier and I am enjoying my medical student life so much more. Things are great. :-)

I started this blog as a place to rant about stuff, and I can't believe my luck that something so fantastic has come out of it. I feel like the luckiest guy in the world right now. I just hope she knows how much she means to me and how happy she's made me.

Still here

Hello everyone,

Just a quick post to let you know that I've not died or anything. I'm still here. I have just become uber busy all of a sudden. I have about a million things going on in my life at the moment (not all bad, one very good in fact but more about that at a later date...) and blogging has been right down on my list of priorities. Luckily I am on a placement at the moment which the UoM calls the "special study module". I call it the "stuff we forgot to teach you properly module". So, apart from the occasional session on oncology, ophthalmology, clinical skills revisions and some communication skills sessions, I have been relatively free from hospital work.

Right now my major concern isn't actually revision but the application form for my first jobs as a doctor, the two year Foundation Programme. As I have mentioned before, I have my heart set on where I want to go and I will be devastated if I don't get my first choice. This gives me extra incentive to put together a good application so that I get my wish.

The application is scored out of 100 points. 40 points are determined by our academic performance in medical school. Basically, there is nothing that can be done about my score there, it is decided upon which quartile of the year I am in when it comes to exam results. I am also powerless to affect my score in the next 10 points either, as they are awarded based upon any previous degrees I have, as well as whether I have published any research or presented at conferences. I get a few marks here for my BSc (thank you St. Andrews!) but I have no publications to date (two in the pipeline however).

The final 50 points are based upon my answers to five "white space"questions. Each question has a word limit of 200 words and is scored out of 10. This is effectively the bit that determines whether I get my first choice or not, as it is the only bit where I can influence my mark at this stage. The questions are an absolute nightmare and I am really struggling to answer them. What's worse I only have a week left to get them sorted and I haven't even made a start of two of them yet.

Just in case you didn't believe me about how hard the questions are, I am going to include them below:

• Describe a case from your clinical experience that you have observed in the first 24 hours from hospital admission. How did members of different professional teams interact and how did this contribute to effective patient care? What did you learn from this that will influence your future practice as a new doctor?
• Describe a memorable experience of being taught and how this has shaped your thinking about teaching. Identify a particular situation in which you might be teaching as a doctor in the future. Describe how you might apply what you have learned to maximise the effectiveness of your teaching?
• You are one of two foundation doctors on a ward round. The registrar identifies a minor error made by your colleague and makes inappropriate critical comments in front of the patient and the healthcare team. Your colleague is visibly distressed. What actions would you take and how would you prioritise these? What actions do you believe your colleague should take in relation to these comments? How might you address a minor error made by a more junior colleague in the future?
• Describe one example from your medical training when you received feedback on an aspect of your performance. Explain how that feedback altered your subsequent practice. How will you use this experience to develop a specific aspect of your foundation training?
• At times, the patient and the medical team have different ideas on the management of the patient’s illness, because of personal, social or cultural views held by the patient. Describe a clinical case where you have observed this. Identify the factors that contributed to these differing views. Why is it important to understand these differences in your practice as a foundation doctor?

To me, this seems to be just a creative writing exercise. How is it that this part of the form is worth more than my actual performance at medical school? It just seems so stupid to me...

Medical school: Things they don't include in the prospectus - Part 2

Here is the second and concluding part to my mega-length post aimed at new medical students and A level students contemplating medical school. If you haven't already done so, I would advise reading part one first.

4. Be a nurse
If you find yourself short of cash (let's face it, this is highly likely) then you may consider getting yourself a part time job. But before you go and hand in your CV at the local bar, why not consider doing some nursing work? It is highly likely that you will be able to get some shifts working as a healthcare assistant (auxiliary nurse) in your local hospital. It pays as well as most bar jobs (if not better) and you will get opportunity to develop your clinical skills as well as learning about patient care from a nursing perspective. This is something that I wish I had thought about a couple of years ago as it would have done me a lot of good. Unfortunately I don't really have the time this year to take my own advice, but others could learn from my mistakes. You can find out more at https://www.jobs.nhs.uk/, or alternatively contact the local hospital's staff bank/human resources department.

5) The patients
Eventually the time will come that you set foot on the ward for the first time as a clinical medical student and will be expected to deal with patients. They may seem scary at first but most of them are lovely people and are only too happy to spend time with a medical student. Listen to their stories and remember that you will probably spend more time with them in one sitting than any doctor or nurse. So let them tell their story and chat to you - they are probably bored and appreciate the company. By this point you will almost definitely have learnt about history taking in communication skills workshops and will quite probably have been introduced to the Calgarry-Cambridge guide. However, don't be afraid to stray from this framework when talking to real patients. Very quickly you will find that you develop your own style to communicating with patients, and you will learn what approaches do and don't work well with you. Before long, the communication skills sessions will fade into your distant memory.

I have a second point to make regarding patients. Occasionally patients will prefer that medical students are not present for their consultation. When this happens, be polite and understanding and make a hasty exit from the room. It can be embarrassing for you as a student, but it's a lot worse for the patient. Try to see things from their perspective. They've obviously got something really worrying to share with the doctor and are probably very scared. It is rare for a patient to refuse a student's presence - the exception being male students in O+G placements. My advice to male students in this situation is to make the most of every examination opportunity that you get, because you won't get many. Also, don't worry about it too much, O+G is a disgusting specialty and you're really not missing out. Go and practice bimanual exams on the models in the clinical skills lab instead!

6) When things go well
Whether you've just successfully sited a particularly difficult cannula, or received some rare words of praise from your consultant, there will be days in your medical student career where you feel like king/queen of the world. For a few glorious hours everything will seem fantastic and you will stride the corridors of the hospital enforced with a new found confidence in your ability. My advice is to make the most of this time because it won't last for long, trust me. Enjoy it - this is why you spent all that time/effort/money coming to medical school in the first place. At the same time, don't get cocky around other people because when you do come back down to earth they will be more likely to laugh at your woes.

7) Friends and relatives
It is a scientifically recognised fact that, the second you step into medical school on the first day of your first year, your friends and relatives will immediately assume that you have knowledge to rival that of Dr House. You will never again be able to attend a family get-together without an aunt wanting to discuss her HRT regimen with you or something else equally unpleasant. The best way to deal with this is to take a deep breath, count to ten slowly in your head and then explain that as a first year medical student you don't feel that it is appropriate for you to comment on the management decisions of a consultant who has been working as a doctor for over 20 years. This may make them shut up. Probably not though.

In summary, medical school is great fun, extremely rewarding and a very unique experience. You will get to do and see things that almost no other profession in the world allows you the freedom to do. It is also incredibly hard work and at times you will just want to give it all up. Fight through the bad times and you'll come out the other side a stronger person. There are many highs and lows of being a medical student. However if you are truly committed to the subject then the good times will by far outweigh the bad and, five or six years down the line, you will come out as a newly qualified and confident young doctor, eager to get out there and try out your new skills and care for patients in the process.